Skip to main content Accessibility help
×
Home

Tetanus and its complications: intensive care and management experience in 150 Indian patients

  • F. E. Udwadia (a1), A. Lall (a1), Z. F. Udwadia (a1), M. Sekhar (a1) and A. Vora (a1)...

Summary

A total of 150 patients were treated for tetanus in the tetanus ward of the J. J. Hospital, Bombay, between October 1983 and January 1986. The complications of tetanus and the mode of management in the presence of restricted resources are outlined. Intensive care, proper nutrition, early tracheostomy and ventilator support in severe tetanus were chiefly responsible for an overall reduction in mortality from 30 to 12%. The mortality in severe tetanus was reduced from 70 to 23%.

Sudden death due to unexpected cardiac arrest was an important complication in severe tetanus. We observed that an abrupt marked rise in rectal temperature ( > 107 °F, 41·7 °C), if undetected, could lead to sudden circulatory collapse and death. Well-marked hypoxaemia was observed in all patients with severe tetanus, and was related to ventilation perfusion inequalities and to an increase in the true venous admixture (increased Qs/Qt)in the lungs. Bronchopulmonary infections and the adult respiratory distress syndrome added significantly to morbidity and mortality. Autonomic cardiovascular disturbances included bradycardia alternating with tachycardia, and hypertension which was either labile, paroxysmal or sustained. Persistent hypotension was of ominous significance. Amongst numerous complications involving other systems, sepsis and septic shock were associated with a high mortality.

    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Tetanus and its complications: intensive care and management experience in 150 Indian patients
      Available formats
      ×

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Tetanus and its complications: intensive care and management experience in 150 Indian patients
      Available formats
      ×

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Tetanus and its complications: intensive care and management experience in 150 Indian patients
      Available formats
      ×

Copyright

References

Hide All
Ablett, J. J. L. (1967). In Symposium on Tetanus in Great Britain, Leeds United Hospitals, (ed. Ellis, M.).
Benedict, C. R. & Kerr, J. H. (1977). Assessment of sympathetic overactivity in tetanus. British Medical Journal ii, 806.
Clifton, B. (1964). Hypotension associated with tetanus. Lancet i, 785788.
Corbett, J. L. (1969). Cardiovascular disturbances in severe tetanus due to overactivity of the sympathetic nervous system. Anaesthesia 24, 198203.
Edmondson, R. S.& Flowers, M. W. (1979). Intensive care in tetanus management. Complications and mortality in 100 patients. British Medical Journal i, 14011404.
Hollow, V. M.& Clarke, G. M. (1975). Autonomic manifestations of tetanus. Anaesthesia and Intensive Care 3, 142146.
Kanarek, D. J. (1973). Severe sympathetic hyperactivity associated with tetanus. Archives of Internal Medicine 132, 602604.
Kerr, J. H., Corbett, J. L., Prys-Roberts, C., Crampton Smith, A.Spaldino, J. M. K. (1968). Involvement of the sympathetic nervous system in tetanus. Studies on 82 cases. Lancet ii, 236241.
Kerr, J. H., Corbett, J. L.& Spaldino, J. M. K. (1969). Sympathetic overactivity in severe tetanus. Proceedings of the Royal Society of Medicine 62, 659662.
Kokal, K. C., Dastur, F. D., Mahashur, A. A.& Kolhatkar, U. P. (1984). Disordered pulmonary function in tetanus. Journal of the Association of Physicians of India 32, 691695.
Lavesquel, P. R.& Rosenberg, H. (1975). Rapid bedside estimation of wasted ventilation. Anesthesiology 42, 98100.
Nicholson, D. (1976). Tetanus – still a therapeutic challenge. Heart Lung 5, 226229.
Trujillo, M. M., Castillo, M. D., Espana, J. V., Guevara, M. D.& Eoanez, M. D. (1980). Tetanus in the adult: intensive care and management experience with 233 cases. Critical Care Medicine 7, 419423.
Tsueda, K., Oliver, P. B.& Riciiffer, R. W. (1974). Cardiovascular manifestations of tetanus. Anesthesiology 40, 588592.

Tetanus and its complications: intensive care and management experience in 150 Indian patients

  • F. E. Udwadia (a1), A. Lall (a1), Z. F. Udwadia (a1), M. Sekhar (a1) and A. Vora (a1)...

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed