Tetanus physical examination: Difference between revisions
Usama Talib (talk | contribs) |
Usama Talib (talk | contribs) |
||
Line 48: | Line 48: | ||
**[[Contractions]] may last for weeks before subsiding gradually | **[[Contractions]] may last for weeks before subsiding gradually | ||
**Generalized tetanus may follow localized tetanus | **Generalized tetanus may follow localized tetanus | ||
*'''Cephalic Tetanus''' | *'''Cephalic Tetanus''' |
Revision as of 21:49, 2 June 2017
Tetanus Microchapters |
Diagnosis |
---|
Treatment |
Case Studies |
Tetanus physical examination On the Web |
American Roentgen Ray Society Images of Tetanus physical examination |
Risk calculators and risk factors for Tetanus physical examination |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Michael Maddaleni, B.S.
Overview
The diagnosis of tetanus is completed through a physical examination. Tetanus infection produces some very clear symptoms that will be used for a clinical diagnosis.
Physical Examination
Tetanus may initially present with stiffness of muscles. Jaw muscles i.e the maseters are most commonly involved initially along with headaches. Neck stiffness, difficulty swallowing, spasms involving various muscles groups including the abdominal muscles and sweating may be seen later in the disease. Physical examination of tetanus may also lead to the following:[1][2]
- Fever
- Autonomic dysfunction
- Intervals of bradycardia and hypotension accompanied by of hypertension and tachycardia may be seen later in the disease.
- Severe cases of tetanus may show:
- Opisthotonos
- Extension of the legs, flexion of the arms
- Spasms of the diaphragm and intercostals leading to episodes of apnea
- Rgid abdominal wall
The physical examination can reveal a few different forms of the infection. These include:
- Local Tetanus
- Uncommon
- Anatomic area is similar to the injured area
- Contraction of the muscles localized initially
- Contraction is usually painful and swelling
- Contractions may last for weeks before subsiding gradually
- Generalized tetanus may follow localized tetanus
- Cephalic Tetanus
- Rare form
- May occur with ear infections
- May occur following head injury
- There is involvement of cranial nerves, especially the ones in the facial area
- Generalized Tetanus
- Approximately 80% of reported cases.
- Presents with a descending pattern
- First sign is trismus
- Followed by stiffness of the neck
- Difficulty in swallowing
- Rigidity of abdominal muscles
- Other symptoms include
- Elevated temperature
- Sweating
- Elevated blood pressure
- Episodic rapid heart rate
- Spasms may occur frequently and last for several minutes
- Spasms continue for 3-4 weeks
- Complete recovery may take months
- Neonatal Tetanus
- Occurs in infants without protective passive immunity because the mother is not immune
- Usually occurs through infection of the unhealed umbilical stump
- This especially occurs when the stump is not cut with a sterile instrument
- More common in developing countries (estimated to be around 257,000 annual deaths worldwide in 2000-2003)
- Very rare in the USA
The Spatula Test
The "spatula test" is a clinical test for tetanus that involves touching the posterior pharyngeal wall with a sterile, soft-tipped instrument, and observing the effect. A positive test result is the contraction of the jaw (biting down on the "spatula"), and a negative test result would normally be a gag reflex attempting to expel the foreign object.
References
- ↑ Mohamed Amirali Gulamhussein, Yueyang Li & Abhijit Guha (2016). "Localized Tetanus in an Adult Patient: Case Report". Journal of orthopaedic case reports. 6 (4): 100–102. doi:10.13107/jocr.2250-0685.592. PMID 28164065. Unknown parameter
|month=
ignored (help) - ↑ Yuki Kotani, Kenji Kubo, Satoko Otsu & Toshihide Tsujimoto (2017). "Cephalic tetanus as a differential diagnosis of facial nerve palsy". BMJ case reports. 2017. doi:10.1136/bcr-2016-216440. PMID 28108438. Unknown parameter
|month=
ignored (help)