Treatment of established tetanus

1. Tetanus immune globulin (TIG)
   • Give 500 IU intramuscularly as soon as possible to neutralize toxin that has not yet bound to nerves.
   • It cannot reverse toxin already attached to nerve endings. CDC clinical care guidance
2. Airway and supportive critical care
   • Quiet, low-stimulation environment.
   • Sedation and muscle-relaxing medicines for spasms.
   • Intubation, ventilation, or tracheostomy may be needed when spasms threaten the airway.
   • Treat autonomic instability, such as marked swings in blood pressure or heart rate.
3. Wound management
   • Find the source wound if possible.
   • Clean it thoroughly, remove foreign material, and debride dead tissue.
4. Antibiotics
   • Used to eradicate Clostridium tetani at the wound site, commonly metronidazole. Penicillin is an alternative in some settings.
   • Choice and course should be determined by the treating clinician.
5. Tetanus vaccination
   • Infection itself does not produce reliable immunity.
   • Start or complete a tetanus toxoid-containing vaccine series once the patient is clinically stable. CDC guidance

If you mean prevention after an injury

• Clean, minor wound: booster if the primary series is complete but the last dose was 10 or more years ago.
• Dirty, deep, puncture, bite, burn, crush, or contaminated wound: booster if the last dose was 5 or more years ago.
• If vaccination history is unknown or fewer than 3 doses were received, give vaccine for any wound. For a dirty or major wound, also give TIG 250 IU IM.
• TIG is not indicated for a clean, minor wound. CDC wound guidance

Go to an emergency department now if there is:

• Severe or rapidly increasing pain, a rigid or swollen abdomen
• Fever, repeated vomiting, fainting, confusion, sweating, or low blood pressure
• Blood in vomit or stool, black stools, or inability to pass stool/gas
• Pain with pregnancy or possible pregnancy
• Pain after trauma, in an older adult, or with significant heart/vascular disease
• Chest pain, shortness of breath, or pain spreading to back/shoulder

Initial treatment in hospital

1. ABC stabilization
   • Check airway, breathing, circulation, vital signs, oxygen saturation.
   • IV access, monitoring, and IV fluids if dehydrated, septic, bleeding, or hypotensive.
2. Nothing by mouth (NPO)
   • Often required until a surgical cause is excluded or a procedure is planned.
3. Pain and nausea control
   • Early analgesia, including IV opioids when appropriate, is safe and does not prevent accurate diagnosis.
   • Antiemetics for vomiting.
4. Tests to identify the cause
   • Blood tests often include CBC, electrolytes/renal function, liver tests, lipase, glucose, inflammatory markers, urinalysis, and pregnancy test where applicable.
   • Imaging depends on location and suspected cause: ultrasound for biliary or pelvic disease; CT abdomen/pelvis is often used for non-localized or concerning pain. AAFP review
5. Antibiotics when infection or perforation is suspected
   • For example, suspected appendicitis, cholecystitis/cholangitis, diverticulitis with complications, bowel perforation, or intra-abdominal sepsis.
   • They are not routinely needed for every abdominal pain.
6. Urgent surgical or specialist treatment when indicated
   • Examples: appendicitis, perforated ulcer/bowel, bowel obstruction with ischemia, strangulated hernia, ectopic pregnancy, ovarian/testicular torsion, ruptured aneurysm, or mesenteric ischemia.
   • Acute abdomen care requires prompt diagnosis alongside resuscitation, rather than waiting for all pain to resolve first.

Cause-specific examples

• Appendicitis: IV fluids, analgesia, antibiotics, usually appendectomy.
• Acute cholecystitis: fluids, pain control, antibiotics when indicated, early surgical review.
• Pancreatitis: IV fluids, analgesia, antiemetics, treat cause.
• Kidney stone: analgesia, antiemetic, hydration as appropriate; urgent drainage if infection plus obstruction.
• Bowel obstruction/perforation: NPO, IV fluids, nasogastric decompression in selected cases, antibiotics if ischemia/perforation suspected, urgent surgical review.
• Ectopic pregnancy: immediate gynecology assessment, medical or surgical treatment depending on stability and findings.