157.2 📚 國考版

157.2.0.1 必背 — 細菌 + 毒素

• C. tetani: drumstick spore, anaerobic, soil
• Tetanospasmin: cleaves synaptobrevin → 阻 GABA/glycine release → spastic paralysis

157.2.0.2 必背 — 臨床

• Trismus + risus sardonicus + opisthotonos
• Spastic (vs botulism flaccid)
• 4 forms: generalized, localized, cephalic, neonatal

157.2.0.3 必背 — 治療

1. TIG (Tetanus Immune Globulin) IM 大劑量
2. Wound debridement
3. Metronidazole (或 PCN G — 但理論 antagonize GABA)
4. BZD (diazepam) 大劑量 控痙
5. ICU airway + autonomic management

157.2.0.4 必背 — Wound Prophylaxis

• Dirty wound + ≥ 3 doses > 5y → Td booster
• Dirty wound + < 3 / unknown → Td + TIG

157.2.0.5 必背 — 主動疫苗 in recovery

• 自然感染 NOT confer immunity → 復原後仍要 vaccine

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