Tétano Acidental no Departamento de Emergência: relato de caso

Abstract

Tetanus is an acute infectious disease, which in Brazil has a similar incidence between the sexes, although it is more frequently associated with males, due to greater exposure to trauma. This disease occurs due to the action of neurotoxins produced by Clostridium tetani, which have tropism for the cells of the Central Nervous System and act by blocking the neurotransmission and excitability of this system. This study aims to report a case from the Emergency Department of a hospital in Recife/PE. This is a 66-year-old patient, black, married, resident of a rural area, farmer, who comes to the service complaining of low back pain for 1 day, refractory to simple analgesics, anti-inflammatories and opioids. During medical evaluation, sialorrhea, intense sweating and generalized spastic movements begin. It then progresses to respiratory failure and cardiorespiratory arrest. Return to spontaneous circulation after 2 cycles and is medicated with IV Diazepam, due to the persistence of spastic movements and standard infections in wheezing. This is followed by orotracheal intubation and connection to a mechanical ventilator. After leaving the acute condition, family members told a story of perforating lesions on the knee 10 days before the symptoms appeared. The diagnosis of severe accidental tetanus is confirmed and anti-tetanus serum (SAT) or gamma globulin (IGAT) and dT vaccine are administered. Metronidazole, IV diazepam, continuous neuromuscular blockade and pump fentanyl are administered. Continue mechanical ventilation with a PEEP of 10 and transfer to the ICU. As this is a disease with a clinical diagnosis, but which has several differential diagnoses, early identification in the emergency room is a fundamental measure for this disease, as well as an appropriate treatment institution as soon as possible.