Severe tetanus

• Intubate and ventilate since asphyxia may occur due to prolonged respiratory muscle spasm.

• Sedation may be achieved with diazepam (20 mg 4-6-hrly NG and 5 mg IV as necessary).

• Muscle rigidity is best treated with magnesium sulphate 20 mmol/h IV ± chlorpromazine 25-75 mg 4-hrly IV or NG, with muscle relaxants if necessary.

• Autonomic hyper-reactivity is a feature (arrhythmias, hypotension, hypertension and myocardial ischaemia). It is minimised by sedation, anaesthesia and treated by atropine 1-20 mg/h IV, propranolol 10 mg 8-hrly IV or NG, and magnesium sulphate 20 mmol/h IV.

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