UMEM Educational Pearls

Category: Airway Management

Title: Tetanus

Posted: 12/5/2012 by Walid Hammad, MD, MBChB (Updated: 12/2/2023)
Click here to contact Walid Hammad, MD, MBChB


40 yo previously healthy male in China who presents with prolonged “seizure” after receiving a cut on his foot while fishing 5 days ago.

Dx: Tetanus

Clinical features:

·      Incubation period 4-14 days

·      3 clinical forms:

1.     Local spasm

2.     Cephalic (rare) -  cranial nerve involvement

3.     Generalized (most common) - Descending spasm: facial sneer (risus sardonicus),   “locked jaw” trismus, neck stiffness, laryngeal spasm, abdominal muscle spasm.

·      Spasms continue to 3-4 weeks and can take months to fully recover

Complications: apnea, rhabodymyolysis, fracture/dislocations

Treatment: supportive, benzodiazepines, RSI, Tetanus IG (3000-5000 units IM), wound debridement



University of Maryland Section for Global Emergency Health

Author: Veronica Pei, MD