|
2 . ‘ Avoid routine sunscreen if you have dark skin ’: New sun safety advice
Page views : 2500
3 . Spot Dx : What is behind this dyspnoea ?
Page views : 1600
4 . How to Treat : Mammalian bite injuries
Page views : 1400
5 . How to Treat : Marine stings and poisonings
Page views : 1000
Source : AusDoc website ; 1 Feb to 28 Feb .
|
Dr Ashraf Saleh GP in Toowoomba , Queensland .
EAMON , a 51-year-old gardener , presents to his GP with an acutely painful jaw , which feels tight and difficult to open . This is causing him distress and he is apprehensive to talk , since opening his jaw causes severe pain . Swallowing is also uncomfortable and he is having difficulty eating and drinking . This has been progressing over the previous two hours . There was no obvious trigger and no injury or trauma preceding his symptoms and Eamon has no history of bruxism or temporomandibular joint dysfunction . Eamon generally does not like seeing doctors , and since he is usually well , has not seen one for many years . He takes no regular medications and has no known allergies . He drinks alcohol most nights ( 2-3 standard drinks ) and does not smoke . In his line of work , he sustains frequent bumps and
|
scratches which he self-manages . He cannot recall when he last had a tetanus immunisation , but was vaccinated as a child .
On examination , Eamon is visibly uncomfortable and grimacing with trismus . He has tachycardia at 100 beats per minute , regular rhythm , with otherwise normal vital signs . Cardiorespiratory examination is unremarkable . He has no evidence of other muscular spasm at the time of assessment . There are multiple small cuts and abrasions on his feet and hands with no associated evidence of cellulitis or joint involvement .
Diagnosis
The GP suspects tetanus , so refers Eamon urgently to the ED , where blood tests are requested while awaiting the arrival of tetanus antitoxin immunoglobulin . FBC shows only a mild neutrophilia and EUC shows mildly elevated creatinine and urea consistent with dehydration .
Management
Eamon is rehydrated with normal saline and given 4000 IU of tetanus immunoglobulin via slow IV , which settles the trismus within an hour of administration . He is then treated with cefazolin 2g IV three
|
times a day and given a tetanus booster vaccination . He is admitted and makes a complete recovery , having not experienced any further muscle spasm , and is discharged home 72 hours later on oral cefalexin .
Discussion
This case , presenting with the highly
|