LEARNING OBJECTIVE

AGROMEDICINE
SK2

ELINA RAHMA
1418011069
1. Sign & symptoms, diagnosis, and treatment
for insect bites and poisoning snake?
2. Pathogenesis insects bites and poisoning
snake?
 1. Sign & symptoms, diagnosis, and treatment
for insect bites and poisoning snake?

Characteristics of
venomous snake bites: Characteristics of not
venomous snake bites:
Has a 2 point bite scar,
smooth wound
Pain and discoloration at leaving a U-shaped bite
the site of the bite within mark with many
a few moments after wounds.
being bitten.
 Hemotoksik

Venomous
bite snake

Sitotoksik Neurotoksik
Local : edema, nyeri, ecchymosis ( 30 minute until 24
hours).
Systemic symptoms: Hypotension, weakness, sweating,
nausea, vomiting, headache.
Spesific signs:
Hematotoxic : bleeding at the wound site, lungs,
kidney, heart, peritoneum, gum, brain, skin
(petechiae, ecchymosis), melena, hematemesis,
hemoptoe, hematuria.

Neurotoxic : hipertonic, fasciculation, pareses,

respiratory paralysis, ptosis, opthalmoplegia,
laryngeal muscles paralysis, abnormal reflex,
convulsion, coma.

Cardiotoxic : hypotension, cardiac arrest, coma

Derajat keparahan gigitan ular
Derajat Venerasi Luka Nyeri Edema/eryt systemic
hema
O - + +/- <3cm/12 hrs -
I +/- + + 3-12cm/12 -
hrs
II + + +++ >12- +,
25cm/12hrs neurotoxic,n
ausea,
dizziness
III ++ + +++ >25cm/12hr ++,
s ptechiae,
shock,
ecchymosis
IV +++ + +++ > extremity ++, ARF,
coma
,bleeding
 Pemeriksaan Penunjang
Laboratorium Examination:
Darah : rutin, urea-N, creatinine, electrolyte,
BT, CT, PT, APTT, thrombocyte , D-dimer, Liver
Function Tests, blood typing & cross match.
Urinalysis : hematuria, glycosuria &
proteinuria.
ECG
Radiology : Chest - X-ray
Theraphy of snake bite
Clean the injured area with a sterile
water.
For local effects, immobilization is
recommended using elastic cotton
bandages of 10 cm wide, 45 m long,
wrapped firmly around the bitten part
of the body, from the tip of the toe to
the nearest part of the bite
Provision of supporting measures in the
form of stabilization which includes the
management of the airway;
management of respiratory function;
 Giving antitetanus injection, or if the patient
has toxoid then given a dose of tetanus toxoid
Giving 2 million intramuscular crystalline
penicillin injections
Giving sedation or analgesics to relieve fear
quickly die / panic
Provision of antibody serum
 Immunotherapy : Antivenin (SABU)

Indication : the presence of systemic venational

symptoms and severe edema in the wound.
Guidelines for SABU therapy refer to Schwartz and
Way (MOH, 2001):
Degrees 0 and I are not required SABU, evaluated
in 12 hours, if degree increases then given SABU
Degree II: 3-4 vial SABU
Degree III: 5-15 vial SABU
Degree IV: add 6-8 vial SABU
 INSECT BITES
SPIDER
Symptoms that can arise due to anaphylactic reactions:
Shock
Coughing, shortness of breath, feeling pain in the
mouth or throat / throat
Swelling of the lips, tongue, ears, eyelids, palms, soles
of feet, and mucous membranes (angioedema)
Dizzy
Nausea, diarrhea, and abdominal pain
Itching with red and swollen spots
SCORPION

Local Symptoms: burning pain, inflammatory symptoms

such as local paresthesia, itching, may improve within a
few hours

Systemic symptoms:
Restlessness, excessive sweating, diplopia, nigtagmus,
fasciculation, seizures, salivation, tachycardia
occasionally spasm and respiratory muscle paralysis
(commonly in children <10 years), nausea vomiting.
 HYMENOPTERA
Including bees, wasps and ants
Local symptoms: pain, redness, localized
edema, itching.
If multiple bites / heavy reactions are life-
threatening:
Nausea, diarrhea, edema anasarka, dyspnea,
hypotension, swelling of the throat and
tongue, weak and rapid pulse, dizziness or
fainting.
 Support examination
Rarely do investigations.
From the histopathologic in the acute phase there is
an edema between epidermal cells, spongiosis,
parakeratosis and polymorphonuclear cells. The
infiltrates may be eosinophils, neutrophils,
lymphocytes and histiocytes. In the dermis was
found dilation of blood vessel tip and the presence
of acute inflammatory cells.
Laboratory examination where there is an
increase of eosinophil count in blood test.
 Treatment
Treatment is usually used to avoid itching and to
control the occurrence of secondary infection of
the skin.Itching is usually a major complaint,
topical medications can reduce itching, can be
given oral antihistamines such as CTM, Loratadin,
Cetirizine to relieve itching.
In case of severe reaction with systemic
symptoms, a 1: 1000 epinephrine dilution with a
dose of 0.3-0.5 mg / kgBW is administered
subcutaneously.
 PATOGENESIS insect bite
Enzim
Hyaluronidas Spingomyelina
menyebabkan e se D (toksin)
kerusakan kecil
pada kulit

Reaksi immediate Reaksi delayed

akan melepaskan
histamin,
serotonin, asam
formic atau kinin

dan ditandai dengan

reaksi lokal atau reaksi
sistemik
Snake bite
 Daftar pustaka
Guidelines for the Clinical Management of
Snakes bites in the South-East Asia Region,
World Health Organization, 2005.
Pedoman Pertolongan Keracunan untuk
Puskesmas, Badan Pengawas Obat dan
Makanan Republik Indonesia, 2002.
Snake Venom: The Pain and Potential of
Poison, The Cold Blooded News Vol. 28,
Number 3, March, 2001.