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Tetanus is an acute, toxin mediated disease caused by Clostridium tetani infection. Under favourable anaerobic conditions, such as in dirty, necrotic wounds, this ubiquitous bacillus may produce tetanospasmin, an extremely potent neurotoxin. A 38 year-old man was admitted to emergency room, at Zainoel Abidin General Hospital, with a main complaint of back-muscle stiffness. Based on physical examination, he was fully allert with a slightly rapid breathing, trismus with the maximum oral cavity opening was only about 1 finger width, but rhisus sardonicus was not evident. Ten days before admission, while gardening, his left foot accidentally stabbed by wooden tree stake. We immediately started a single dose of tetanus immunoglobulin followed by intravenous metronidazole, penicillin G and intravenous diazepam. Tetanus diagnosed by physical clinical finding. There are several grading system, the scale proposed by Ablett which the most widely used. The management of tetanus patients including use of immunoglobulin and antibiotic therapy, analgesia, sedation and neuromuscular blockade management and mechanical ventilation, the care was delivered outside the Intensive care unit.