• Tetanus is caused by an exotoxin, tetanospasmin, produced by Clostridium tetani, an anaerobic gram-positive bacillus. • Tetanospasmin prevents the release of inhibitory neurotransmitter gamma-aminobutyric acid (GABA) in the spinal cord, brainstem motor nuclei, and the brain, producing muscle rigidity and tonic spasms. • Trismus (lockjaw), dysphagia, laryngeal spasms, rigidity of limbs and paraspinal muscles, and opisthotonic posture are common. • Frequent severe spasms triggered by touch, pain, bright light, or sounds may produce apnea and rhabdomyolysis. • Autonomic overactivity occurs in severe tetanus causing labile hypertension, tachycardia, increased secretions, sweating, and urinary retention. Dysautonomia is difficult to manage and is a common cause of mortality; magnesium sulfate infusion is often used. • Antibiotics (penicillin or metronidazole) and wound care reduce toxin production and human tetanus immune globulin neutralizes the circulating toxin. • Nasogastric tube placement for feeding and medications is needed. • Early elective tracheostomy is performed in moderate or severe tetanus to prevent aspiration and laryngeal stridor. • Benzodiazepines help reduce rigidity, spasms, and autonomic dysfunction. Large doses of diazepam (0.2–1 mg/kg/h) are administered via nasogastric tube. • Neuromuscular blocking agents and mechanical ventilation are used for refractory spasms. • Mortality ranges from 5% to 50%.