The most important objectives in the management of tetanus are: (1) neutralization of free toxin with tetanus antitoxin; (2) elimination of the source of toxin by débridement of all accessible portals of entry or by administration of antibiotics; (3) prevention of convulsions and severe muscle spasms by use of sedatives, anesthetics, or such muscle relaxants as curare preparations and, preferably, mephenesin; (4) maintenance of efficient hydration and of electrolyte balance; (5) maintenance of proper nutrition, and (6) prevention and treatment of pulmonary complications through maintenance of unobstructed air passages by mechanical means and by administration of antibiotics.
Most observers1 agree that 50,000 units of tetanus antitoxin given intravenously is a dose large enough to neutralize all the unfixed or free toxin in any patient with a chance of recovery. Since it is impossible to ascertain whether fixation of the toxin by the cells of the central nervous system is
Díaz-Rivera RS, Ramirez E, Pons ER, Torregrosa MV. MANAGEMENT OF TETANUS: EFFECT OF PENICILLIN ON CLOSTRIDIUM TETANI IN VIVO. JAMA. 1951;147(17):1635–1641. doi:10.1001/jama.1951.03670340025006
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