Patients with tetanus should be managed in an intensive care unit. Respiratory compromise may require immediate neuromuscular blockade and orotracheal intubation, but tracheostomy provides the best method of prolonged ventilatory control. Environmental stimuli must be minimized to prevent the precipitation of reflex convulsive spasms.
Identification and debridement of the wound through which the clostridial spores were introduced are necessary to minimize further toxin production and to improve the oxidation-reduction potential of the infected tissue. A wound may not be identified in up to 10 percent of patients with tetanus.
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