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Article
September 27, 1958

RECENT EVALUATION OF THE TREATMENT OF TETANUS

Author Affiliations

Indianapolis

From the Indiana University Medical Center. Dr. Miller is now at Creighton University and Creighton Memorial St. Joseph's Hospital, Omaha.

JAMA. 1958;168(4):393-394. doi:10.1001/jama.1958.03000040029006
Abstract

The plan for managing patients with tetanus has three features: immunization, diagnosis, and sedation. Their effectiveness is shown by experience with 17 patients over a period of 7 years. The mortality was 17%, which is lower than the national average of 40 %. As soon as tetanus is suspected, an anesthesiologist is requested to begin sedation by large doses of short-acting barbiturates injected intramuscularly at six-hour intervals. Promethazine hydrochloride is given intramuscularly midway between the barbiturate injections to reduce the anxiety of the patient. A prophylactic tracheotomy is performed under local anesthesia, and a supportive program is then started. The sedation is maintained in order to prevent convulsions with apnea; while it continues, the patient must be turned every two hours to prevent decubitus ulcers and hypostatic pneumonia. After the initial critical period of 7 to 10 days, oral medication generally becomes possible.

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