2. DIFFERENTIAL DIAGNOSIS

3. Strychnine poisoning • usually appear within 15 to 60 minutes INITIAL Symptoms: • agitation • apprehension • restlessness • LATER Symptoms: • heightened perception • painful muscle spasm • arching of the back & neck • rigid arms & legs • jaw tightness • difficulty breathing • PATIENT: • 60y/o, gardener • Hx of punctured wound (erythematous and swollen R. Index finger) • lockjaw • muscle strength 5/5 • Low grade Fever (38.5’C) • Hypertensive (170/90) • RR: 23/min, PR: 110/min

4. Tetanus • Median time of onset after injury is 7 days(3-21days) • Fever (38.5 degrees C) • ↑BP (170/90) • ↑ RR (23/min) • Lockjaw / trismus • Risussardonicus (sardonic grin) • Dysphagia / stiffness / pain – neck, shoulder, back muscles • Opisthotonos • Rigid abdomen and proximal limb muscles • Muscle spasms • Autonomic dysfunction