GIGITAN ULAR (SNAKE BITE)

ARIS NUGROHO S.Kep,Ners

EPIDEMIOLOGI

INCIDENCE :
AMERIKA : - 45000/tahun, 8000 ular berbisa - adanya antivenom menekan <0,5% (5-10/tahun) dari 25% kematian. - terbanyak gigitan ulardesis/pit vipers/rattle snake( species cortalus) dan Elapidae family/ coral snake(species micrurus/ular belang dan cobra) AUSTRALIA: - 3000/tahun dengan kematian 3,7orang dan biasanya oleh gigitan brwon snake(pseudanaja). - Banyak jenis ular berbisa.5-6 jenis ular pembunuh.

ASIA

- Terbanyak di India dan Srilangka - Indonesia ?.

JENIS ULAR PALING BERBISA

no:1 fierce snake/inland taipan

2.king brwon snake/pseudaochis Australis

3.taipa/oxyuranusscutellatus

4&5 tiger snake/mainland

6 Sea Krait/laticauda colubrina

7 Tiger snake/notechis stutatus

8 Black tiger snake/notechis acther

9 Death adder/achantopis antarcticus

10 Westren brown snake/pseudonaja nuchalis

Ular berbisa

Venomous snakes can also be recognized by their triangular-shaped heads, elliptical pupils, fangs, and the presence of a pit between the eye and nostril

VENOM APPARATUS
Venom Apparatus Fang

For more presentations www.medicalppt.blogspot.com

Ular yang tidak berbisa

Biokimia bisa / venom

-DIKELUARKAN OLEH GLANDULA SALIVA
BINATANG TERTENTU MIS. ULAR , SPIDER, DSB. -TERDIRI BAHAN :

-PROTEIN.(PEPTIDA BRADYKININ & GLYCOPROTEIN)

-ENZIM : - PROTEOLITYC - PSOSPHOLIPASE. -HYALURONIDASE. - COMPLEX .

CARA KERJA VENOM:

SESUAI DENGAN BIOKIMIA PROTEIN MASING-MASING -LOKAL & SISTEMIK -MEMECAH SEL DAN JARINGAN, VASODILATASI -TROMBOLITIC,ANTICLOTHING, STIMULUS DST. NERVE, CARDITOXIC

Neurotoxic Hematotoxic

Musculotoxic
Cardiotoxic

GEJALA : ( VENOMOUS ) ( ELAPIDAE, VIPER ) DINI : ( 1 JAM) LOKAL : -PAIN/ NUMBNESS -COMPARTEMENT SYND

SISTEMIK
-PALPEBRA DROP SULIT MENELAN BICARA TAK JELAS
SEVERE THRIST VERTIGO KESULITAN BERNAPAS. -SHOCK !!! LANJUT : - TENSI DROP DAN CARDIAC ARREST.

Mild envenomation is characterized by local pain, edema, no signs of systemic toxicity, and normal lab values. Moderate envenomation is characterized by severe local pain; edema larger than 12 inches surrounding the wound; and systemic toxicity including nausea, vomiting, and alterations in lab values (eg, fallen hematocrit or platelet values). Severe envenomation is characterized by generalized petechiae, ecchymosis, blood-tinged sputum, hypotension, hypoperfusion, renal dysfunction, changes in prothrombin time and activated partial thromboplastin time, and other abnormal tests defining consumptive coagulopathy.

Field care The phrase "first, do no harm, including making an incision over the bite, mouth suctioning, tourniquets, ice packs, or electric shock. Emergency life support. ABCs Restrict activity and immobilize the affected area (commonly an extremity); keep walking to a minimum. Negative-pressure suctioning devices offer some benefit if used within several minutes of envenomation. Again, do not make an incision in the field. Immediately transfer to definitive care. Do not give antivenin in the field.

Hospital Give antivenin for coral snake bites as a standard of care if the patient presents within 12 hours of the bite, regardless of local or systemic signs. Neurotoxicity may develop without warning and lead to respiratory failure. Surgical assessment follows the injury site and assess for the development of compartment syndrome.

Protap negara Australia

Quickly tie a light restricting band both above and below the bite area a few inches away from the puncture/bite marks.

1. Apply a broad pressure bandage over the bite site as soon as possible.

2. Keep the limb still. The bandage should be as tight as you would bind a sprained ankle.
3. Extend the bandage down to the fingers or toes then up the leg as high as possible. (For a bite on the hand or forearm bind up to the elbow). 4. Apply a splint if possible, to immobilise the limb. 5. Bind it firmly to as much of the limb as possible. (Use a sling for an arm injury).

-ADVISKAN SUPAYA PX TIDAK BANYAK GERAK. -IMOBILISASI DAERAH YANG TERLUKA DAN POSISIKAN DIBAWAH BATAS JANTUNG. -HINDARI CARA KUNO SPT ; TORNIQUET, KOMPRESS ES,DIISAP DGN MULUT, ALKOHOL &ASPIRIN , BAKAR -BILA MEMUNGKINKAN ULAR YANG BERTANGGUNG JAWAB DIBAWA KE RS/ TEAM .TIDAK DIPERKENANKAN UNTUK MENCARI/MENANGKAP ULAR TSB BUANG WAKTU. -WASPADAI TANDA-TANDA SHOCK ( TERSERING).

TINDAKAN :
TKP : DI FOKUSKAN AGAR MELARIKAN SECEPATNYA KE RS ,UPAYAKAN PX. INAKTIF UNTK MEMBATASI PENYEBARAN VENOM. HOPITAL : - OBSERVASI 8 JAM (VITAL SIGN, PERNAPASAN,EKG).

- CUCI LUKA, CROSS INCISI ( ADA CONTROVESI).

- ANTI TETANUS , ANTIBIOTIKA , SABU.

SEMOGA BERMANFAAT