A Young Boy's Triumph Over Adversity and Medical Challenges

Tetanus, a disease often associated with rusty nails and old wounds, rarely makes headlines in today's medical world. However, a recent case of severe tetanus involving a 12-year-old boy has captured our attention, presenting unique challenges and insights into its management. This blog delves deep into the intriguing journey of this young patient, highlighting the complexities of tetanus diagnosis, treatment, and recovery.

A 12-year-old boy, presented to the rural private hospital with symptoms of severe abdominal pain & rigidity; USG s/o transient intussusception & the patient was being managed conservatively .He started having  intermittent locked jaw & tightening of limbs but normal sensorium so thought of hypocalcemia  Tetany & was given calcium but sooner this patient started having intermittent opisthotonos posturing & was referred to us in the middle of night .

Physical examination revealed trismus, risus  sardonicus (facial features of tetanus), opisthotonos posturing  & stimulus induced muscle rigidity consistent with a diagnosis of tetanus.

He had history of penetrating wound on right foot by rusty nail a week prior to the onset of symptoms.

Most challenging thing is the intubation of tetanus patient as lock jaw gets aggravated by laryngoscope manipulation . you need to use muscle relaxant for it & you can land up in " can't intubate , can't ventilate situation"

He was intubated with rapid sequence intubation (RSI) with midazolam + ketamine+ vecuronium & was given

ventilator support.  .Right subclavian  Central line was put , catheterization was done & he was started on  metronidazole , Diazepam + fentanyl+ vecuronium drip ,IVF .He started on a comprehensive treatment plan. The wound was cleaned thoroughly, and a tetanus vaccine was administered. Tetanus immunoglobulin was not available; we got it from Pune & given on day 2 of admission. IV Diazepam dose was titrated to control  spasms .After spasms were controlled , we shifted to oral diazepam .

He was ventilated for 24 days . tracheostomy was done on day 9 by Dr.Visapure sir &

Dr. Chougule sir .Due attention was given to

nutrition  during his stay . The tracheostomy tube was also removed after 3/4 days .

The beauty of this case is  in spite of almost 40 days ICU stay , he was only given

Metronidazole for 10 days(for tetanus) &

Piperacillin tazobactam for 7 days i/v/ o suspected central line infection.

Minimal antibiotics abuse .

No ventilated associated pneumonia/urinary Catheter related infection /CRBSI

No bed sore .

His voice was well preserved .

Went home walking .

This case serves as a testament to the importance of timely diagnosis, comprehensive treatment planning, and holistic care in managing severe tetanus. It also underscores the invaluable role of a dedicated medical team, who worked tirelessly to ensure the best possible outcome for their patient. As we reflect on this rare case, we are reminded of the unpredictable nature of medical conditions and the incredible strength of the human spirit in overcoming challenges.