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Basically someone has not received tetanus prophylaxis (Step 2 knowledge) and has impaled her hand on barbed wire outside.
What is relatively contraindicated?
PENICILLIN
But.. but.. first aid says give penicillin!
Well, UpToDate also says penicillin is acceptable.
There were a couple of studies done comparing metronidazole vs penicillin.
Although mortality did not differ significantly, there was less muscle relaxant use in the group with metronidazole.
They surmise that this is due to the fact that penicillin and 3G cephalosporins have CNS excitability effects (GABA antagonistic effects.
Bottom line: Metronidazole is first line treatment for tetanus
Source: UpToDate
Though IIRC, my Step 1 merely tested the fact taht GABA and GLYCINE were the main NTs utilized with tetanus
What is relatively contraindicated?
PENICILLIN
But.. but.. first aid says give penicillin!
Well, UpToDate also says penicillin is acceptable.
There were a couple of studies done comparing metronidazole vs penicillin.
Although mortality did not differ significantly, there was less muscle relaxant use in the group with metronidazole.
They surmise that this is due to the fact that penicillin and 3G cephalosporins have CNS excitability effects (GABA antagonistic effects.
Bottom line: Metronidazole is first line treatment for tetanus
Source: UpToDate
Though IIRC, my Step 1 merely tested the fact taht GABA and GLYCINE were the main NTs utilized with tetanus