Approach to the Critical Patient

Immediate priorities

Airway and generalisation threats

Monitoring and targets

Monitoring bundle

Escalation triggers

PEARLS

Key clinical pearls

History

Presentation pattern

Core syndrome

Alarm features

Features suggesting generalisation

Vaccination and wound history

Vaccination history

Wound characteristics

Risk factors

Host risk factors

Review of systems

Systems review

Physical Exam

Vital signs

Vital sign assessment

Wound and local findings

Wound inspection

Generalisation screen

Signs of generalised disease

Neurological exam

Neurological findings

PITFALLS

Examination pitfalls

Differential Diagnosis

Life-threatening mimics

Strychnine poisoning

Neuroleptic malignant syndrome

Neuromuscular mimics

Drug-induced dystonia

Hypocalcaemic tetany

Stiff-person syndrome or PERM

Local wound differentials

Local wound infection or abscess

Compartment syndrome

Cephalic tetanus differentials

Laboratory Tests

Diagnostic approach

Tetanus is a clinical diagnosis

Core labs

Infection and metabolic assessment

Muscle injury markers

Rhabdomyolysis workup

Inflammatory and immune markers

Supporting investigations

Diagnostic Tests

Scoring Systems

Ablett classification of tetanus severity

Phillips score

MRI

MRI role in tetanus

CT

CT role in evaluation

Ultrasound

Ultrasound applications

Disposition

Admission criteria

All suspected tetanus cases admitted

Level of care

Step-down versus ICU decision

Consultations

Specialist consultations

Discharge criteria

Readiness for discharge

Treatment

Immediate stabilisation

Environmental measures

Antitoxin

Human tetanus immunoglobulin (HTIG)

Antibiotic therapy

Metronidazole (first-line)

Alternative: Benzylpenicillin IV

Avoided agents

Spasm control

Benzodiazepines (first-line)

Neuromuscular blockade for refractory spasms

Autonomic dysfunction management

Magnesium sulfate

Labetalol for hypertension and tachycardia

Morphine sulfate for refractory autonomic instability

Active immunisation

Tetanus toxoid (Td or Tdap)

Wound care

Wound debridement

Supportive care

Nutritional support

DVT prophylaxis

Pressure injury prevention

Special Populations

Pregnancy

Tetanus in pregnancy

Geriatric

Tetanus in older adults

Pediatrics

Tetanus in children

Background

Epidemiology

Global burden

Pathophysiology

Toxin production and spread

Therapeutic Considerations

Evidence base for treatment

Patient Discharge Instructions

copy discharge instructions

Discharge instructions for Tetanus (Local)

References

Guidelines and key sources

Sudarshan R, Sayo AR, Renner DR, et al. Tetanus: Recognition and Management. Lancet Infect Dis. 2025. PMID: 40543524

Ergönül O, Kolsuz S, Figueroa JP. Tetanus. Lancet. 2026. PMID: 41544646

Yen LM, Thwaites CL. Tetanus. Lancet. 2019. PMID: 30935736

Liang JL, Tiwari T, Moro P, et al. Prevention of Pertussis, Tetanus, and Diphtheria — ACIP Recommendations. MMWR Recomm Rep. 2018. PMC5919600

Zhou S, Malani P. What Is Tetanus? JAMA. 2026.

Additional references

An Y, Guo Y, Li L, et al. Management and Outcome of Adult Generalised Tetanus. Front Public Health. 2023. PMID: 38425467

Pham OKN, Tran BN, Duong MC, et al. Cardiovascular Events in Tetanus — Cohort Study of 572 Patients. Open Forum Infect Dis. 2023. PMID: 37795506

Thwaites CL, Beeching NJ, Newton CR. Maternal and Neonatal Tetanus. Lancet. 2015. PMID: 25149223

SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.