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Charles L. Miller, M.D.; V. K. Stoelting, M.D.
JAMA. 1958;168(4):393-394. doi:10.1001/jama.1958.03000040029006.
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The plan for managing patients with tetanus has three features: immunization, diagnosis, and sedation. Their effectiveness is shown by experience with 17 patients over a period of 7 years. The mortality was 17%, which is lower than the national average of 40 %. As soon as tetanus is suspected, an anesthesiologist is requested to begin sedation by large doses of short-acting barbiturates injected intramuscularly at six-hour intervals. Promethazine hydrochloride is given intramuscularly midway between the barbiturate injections to reduce the anxiety of the patient. A prophylactic tracheotomy is performed under local anesthesia, and a supportive program is then started. The sedation is maintained in order to prevent convulsions with apnea; while it continues, the patient must be turned every two hours to prevent decubitus ulcers and hypostatic pneumonia. After the initial critical period of 7 to 10 days, oral medication generally becomes possible.


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