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Indonesia : No Data
Coral Snake
Rattle Snake
Indonesia :
Of 247 species of snakes ; only 5 - 10 are venomous
ELAPIDAE HYDROPIIDAE VAPERIDAE
✓Elapidae : 55 species
✓Viperidae : 21 species
✓Colubridae : 1 species
Elapidae - Naja sputatrix
Elapidae – Ophiophagus hannah
Elapidae Family
Ular Viper Pohon
Ular Tanah – Calloselasma rhodostoma Ular Viper Pohon – Trimeresurus insularis
Bungarus candidus - Ular Weling
Bungarus fasciatus - Ular Welang
PERKIRAAN JUMLAH KASUS GIGITAN ULAR PER BULAN DI BEBERAPA LOKASI
BERDASARKAN LAPORAN DOKTER TAHUN 2016
PROPINSI LOKASI JUMLAH KASUS PER BULAN
BANTEN Serang 10-15
YOGYAKARTA Yogyakarta 5-6
Neurotoxic
Cardiotoxic
Hemotoxic
Anticoagulant - Antifibrin
SNAKE VENOM
Cholinesterase Neurotoxin
Proteinase Necrotizing effect in tissue, Anticoagulant
Adenosine Triphosphates Central Neurotoxin
Phosphodiesterase Cardiotoxic
Amino Acid Oxidase Enhancing other Toxin
Hyaluronidase Accelerating other Toxin Penetration
GENERAL CLINICAL SIGNS & SYMPTOMPS AFTER SNAKE BITE
PANIC
SYSTEMIC SIGNS & SYMPTOMPS :
▪ Sweating, Hypersalivation
▪ Hypotension, Shock
▪ Arrhythmia
▪ Lung Edema
▪ Conjunctival Edema and Chemotic
▪ Spontaneous Bleeding (Petechiae, Epistaxis,
Hemoptysis)
COAGULOPATHY :
Bleedings from snake bite site or vein puncture.
Spontaneous Bleeding : Petechiae, Epistaxis, Hemoptysis, Hematuria,
Hematemesis, Melena.
NEUROTOXICITY :
Paralysis in Cranial Nerves : Ptosis, Progressive Ophthalmoplegia
Flaccid Paralysis in Extremity Muscles
Paralysis in Respiratory Muscles
MYOTOXICITY :
Especially after SEA SNAKE bite.
Muscle pain, Tenderness, Myoglobinuria
Acute Renal Failure, Hyperkalemia, Cardiotoxicity
HOW TO MANAGE SNAKE BITE CASE OUT OF HOSPITAL ?
Do Not PANIC
Do Not put Tourniquet, Sucking the Venom or Other Traditional Treatment
1-3:
Apply a broad elastic bandage from
below upwards and over the bite site as
soon as possible.
4 – remove
Do not 6 : trousers, as the
movement doing so will assist venom to
spreadainsplint
Apply the blood
to the stream.
leg, immobilizing
joints either side of the bite.
Extend the bandage as high as
possible,
Bind ideallyfirmly,
the splint up towalking
the groin.
should be
restricted.
LABORATORY EXAMINATION :
Hemoglobin
White Blood Cells
Platelet Count
Liver Function Test
Renal Function Test
Prothrombin Time (PT) : external coagulation pathway
aPTT (Activated Partial Thromboplastin Time) : internal coagulation pathway
INR (International Normalized Ratio) based on PT, in patient with anticoagulant therapy (Warfarin)
20 Minutes WHOLE BLOOD CLOTTING TEST (20’WBCT)
AIM : to identify the presence of Hemotoxin
▪ Take a GLASS BOTTLE, do not use Plastic Bottle
▪ Draw 2 ml of vein blood
▪ Put the blood into the Glass Bottle
▪ Wait 20 Minutes
▪ Repeat the test TWICE if needed
RESULT :
CLOTTING (+) : NO COAGULATION DISORDER – NO HEMOTOXIN
▪ Take a tape as the marker to measure the edema, and put it on the proximal part of the edematous limb
▪ Write down the date and time at measurement
▪ Repeat the evaluation of the edema every 2 hours and measure by measurement tape
▪ Result : increase of the in cm per hour
BREATHING :
Evaluate the Respiratory Rate
CIRCULATION :
IV Access for Maintenance Fluid and Drugs
Blood Pressure and Heart Rate Monitoring
Oxygen Saturation
Transfusion of PRC or FFF as indicated
TREATMENT (2) :
Immobilize the Bitten Area by using
Pressure Bandage Immobilization Technique
PHYSOSTIGMINE dose :
▪ ADULT ( > 12 y.o ) : 1-2 mg
▪ CHILDREN ( < 12 y.o ) : 0.02 mg/kg/dose
(Max Single Dose 0.5 mg)
rabies.
DEFINITIVE TREATMENT
Based on the findings, treatment should be addressed to the
need for rabies and tetanus prophylaxis, the prevention or
therapy of wound infection and the elimination of any
possible functional and cosmetic sequelae.
✓ Wound Toilette
✓ Antiseptics
✓ Human Rabies Ig
✓ Anti Tetanus
✓ Antibiotics
1. Wound Toilette 2. Emergency Department
2. Drooling :
4. Muscle contraction :