snake bite rssm pub

8/20/2019 Snake Bite RSSM Pub

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SNAKE BITE

CASE PRESENTATIONDr. Dion Faisal

SMF Bedah RSUD Dr. Soedono Madiun


2/27

Case

• Nama: Tn. ES

• Umur : ! Tahun

• Alama" : Dsn. Se#ulun# RT $% R& '( Ke).

Da#an#an( Madiun• MRS : $* +anuari $,'-

• No. DMK : --!%'

• +K : '-.,, &IB

• +D : $$.,! &IB


3/27

Anamnesis

• KU: Ben#/a/ di /a/i /iri

• RPS: Dialami se"elah di#i#i" ular - 0am se1elum MRS. Ka/i/iri 1en#/a/ dan n2eri. Memar /e1iruan di "an#an /anandan /iri. Ke3ala 3usin# 456( mual 7 mun"ah 486( demam 486.

• Ri9a2a" di#i#i" ular di 3er0alanan 3ulan# dari /e1un.e"eroanamnesis /eluar#a 3asien ular 0enis 1ando"anma)an "elah di1unuh di "em3a" /e0adian.

• Ri9a2a" 1ero1a" di IRD RSUD Dolo3o dila/u/an )ross in)isi(3asien menola/ MRS /arena alasan 1ia2a. Tera3i 2an# "elah

di1eri/an: SABU ' ;ial( de


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Pemeri/saan Fisi/

STATUS =ENERA>

• KU >emah( =CS !-( BP '',?@, mm#( R %,13m( RR '*


5/27

STATUS >OKA> 4Re#io CrurisSinis"ra6

• I: . Morsum $ 1uah "elah dila/u/an )ross in)isi( edema456( hi3eremis 456( 3e"e)hiae 486( e)h2mosis 486( 1ulae486

• P: "era1a din#in( n2eri "e/an 456


6/27

>a1

• 1 ''(*

• )" (*

• >eu/osi" .',,

• Trom1osi" $$.,,,

• =DA ,%

• Ur?Cr '(!?'('$

• Na?K?Cl '@?(-?',@


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Asses"men"

• Dia#nosis Primer: Sna/e Bi"e =rade

• Dia#nosis Se/under: 8

• Dia#nosis Kom3li/asi: "rom1o)i"o3enia(

leu)o3enia( hi3er#li/emia


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Plannin#

• MRS in"ensi;e )are

• Na)l ,(% '!,,))?$ 0am

• Dri3 SABU $ ;ial dalam Na)l ,(% !,,))

• Ce"ria

• Immo1ilisasi d#n s3lin"

• O1ser;asi /e"a" S( s3on"an 1leedin#


9/27

Klinis 18 jam paska gigitan

E))h2mosis

Pe"e)hiae


10/27

SNAKE ENVENOMATION

Tin"inalli +E( Kelen =D( S"a3)2ns/i +S( eds. Sna/e 1i"es.Emer en) Medi)ine: A Com rehensi;e S"ud =uide. -"h ed.

• EMATOTOGIC

• NEUROTOGIC

• SITOTOGIC


11/27

Klasifkasi ParrishDerajat Vener

asiLka gigit N!eri O"ema#

eritemaTan"a sistemik

$ , 5 5?8 H)m?'$ 0am ,

I 5?8 5 5 H)m?'$ 0am ,

II 5 5 555 '$)m8$!)m?'$0am

5. Neuro"o/si/(mual( 3usin#( s2o/

III 55 5 555 $!)m?'$0am

55( s2o/( 3e"e/ie(e/imosis

IV 555

5 555 Pada sa"ue/s"remi"as

se)aramen2eluruh

55( #an##uan aal#in0al( /oma(

3erdarahan

Schwartz dan Way (Depkes, 2001):

• Derajat 0 dan I tidak diperlukan SA!, dilakukan e"aluasi dala# 12 ja#, jika derajat #enin$kat #aka di%erikan SA!

• Derajat II: &' "ial SA!

• Derajat III: '1 "ial SA!

• Dera0a" I: 1eri/an 3enam1ahan -8* ;ial SABU


12/27

Ven%m%s snakes& Medi)all2 im3or"an"s3e)ies in Sou"h8Eas" Asia Re#ion)oun"ries 4&O $,',6

• Elapi"ae& )o1ras( /in# )o1ra( /rai"s( )oral sna/es(Aus"ralasian sna/es

• 'i"r%ph!"ae& sea sna/es.

• Viperi"ae& "23i)al ;i3ers 4i3erinae6 7 3i" ;i3ers

4Cro"alinae6.• (%l)ri"ae& "he red8ne)/ed /eel1a)/ Rhabdophissubminiatus( >ar#e 32"hons 4Boidae6( no"a1l2 "he re"i)ula"ed32"hon Python reticularis

&arren DA( $,'!


13/27

Elapi"aeRelatively long, thin, uniformly-coloured snakes with large smoothsymmetrical scales (plates) on the top (dorsum) of the head. There is noloreal scale between the preocular and nasal scales


14/27

'i"r%ph!"ae

Flattened paddle-like tails and their ventral scales are greatly

reduced in sie or lost.


15/27

Viperi"ae

Rela"i;el2 lon# an#s 4soleno#l23h69hi)h are normall2 olded Ja" a#ains""he u33er 0a9 1u"( 9hen "he sna/es"ri/es( "he2 are ere)"ed. S3e)ial senseor#an( "he loreal 3i" or#an( "o de"e)"

"heir 9arm81looded 3re2. This issi"ua"ed 1e"9een "henos"ril and "he e2e.


16/27

(%l)ri"ae

!arge pythons ("oidae), notablythe reticulated python Pythonreticularis in #ndonesia, havebeen reported to attack and eveningest humans, usually

inebriated farmers


17/27


18/27

Management

1* Assest#ent: airway, %reathin$,

circulat+ry status, and

c+nsci+usness*

2* !r$ent resuscitati+n sh+ck

(cardi+"ascular t+icity),

respirat+ry -ailure (neur+t+in),

and cardiac arrest (due t+ hyp+ia,

cardiac t+icity, +r hyperkale#ia

-r+# rha%d+#y+lysis)*

. Se;eri"2 o "he 1i"e 7iden"i)a"ion o "he s3e)ies

* .as" "e"anus immunia"ion(use o an2 medi)a"ion(

3resen)e o an2 s2s"emi)disease( and his"or2 oaller#2

* S/II 345A/6: An"iLsna/e ;enom 4AS6immuno#lo1ulins

7* Supp+rti- 8* 3rans-usi+n: /, 3, -resh W


19/27

Management %* P%is%n%sSnake)ites


20/27

Se+ere Snake En+en%mati%n

• Sna/e iden"ied is a ;er2 ;enomous one

• Ra3id earl2 e


21/27

SA,- 4serum an"i 1isa ular6

• Poli;alen( 3lasma /uda 2an# di/e1al/an "erhada3 1isa ular:neuro"o/si/ 4Na0a s3u"a"ri< 7 Bun#arus as)ia"us6 7hemo"o/si/ 4An/2s"rodon rhodos"oma6

•

Kom3osisi: "ia3 ml mene"ralisasi ', 8 '! >D!, 1isa ular"anah 4An/2s"rodon rhodos"oma6( $! 8 !, >D!, 1isa ular1elan# 4Bun#arus as)ia"us6( $! 8 !, >D!, 1isa ular /o1ra4Na0a s3u"a"rioadin# dose $ ;ial ! ml laru"an $ dalam #aram aali(

inus ,8*, "3m( diulan# se"elah - 0am.

• A3a1ila di3erlu/an: "erus di1eri/an "ia3 $ 0am ma/simum*,8',, ml.

• Dosis un"u/ ana/8ana/ sama a"au le1ih 1esar dari3ada dosisde9asa.


22/27

Indicati+ns -+r anti'snake "en+#

S2s"em Clini)al ea"ures

S3on"aneous s2s"emi) 1leedin#

&hole 1lood )lo""in# "ime $, min

Throm1o)2"o3enia 43la"ele"sH',,(,,,?mm6

Sho)/

Arrh2"hmia

A1normal ele)"ro)ardio#ram

Neurolo#i)al P"osis and 3aral2sis

Renal A)u"e renal ailure

=eneralied rha1dom2ol2sis andmus)ular 3ains

23er/alemia

>o)al s9ellin# in;ol;in# more "han hal

o "he 1i""en lim1Ra3id e


23/27

Pressre imm%)ili.ati%n

• Ideall2: elas"i)a"ed 1anda#e( a33ro


24/27

Pre+enti%n 4=ENERA>6

• A;oid sna/es as ar as 3ossi1le( in)ludin# "hose dis3la2ed12 sna/e )harmers 9ho are reuen"l2 1i""en.

• Ne;er handle( "hrea"en or a""a)/ a sna/e and ne;erin"en"ionall2 "ra3 or )orner a sna/e in an en)losed s3a)e.

• Kee3 2oun# )hildren a9a2 rom areas /no9n "o 1e sna/e8ines"ed.

• In o))u3a"ions "ha" )arr2 a ris/ o sna/e81i"e( su)h as ri)earmin# and sh armin#( em3lo2ers mi#h" 1e heldres3onsi1le or 3ro;idin# 3ro"e)"i;e )lo"hin# 41oo"s6.

• Sna/es sear)h o ood 4ra"s6 3es" )on"rol

• In M2anmar( armers )an "a/e ou" s3e)ial lo98)os"insuran)e "o )o;er "hem s3e)i)all2 a#ains" sna/e81i"e.

($happuis et al., %&&')


25/27

Pre+enti%n 4FARM ARD(COMPOUND( =ARDEN6

• Tr2 no" "o 3ro;ide hidin# 3la)es or sna/es. Clear"ermi"e mounds( hea3s o ru11ish( 1uildin#ma"erials e"). rom near "he house.

•

Kee3 #rass shor" or )lear "he #round around2our house and )lear lo9 1ushes in "he ;i)ini"2so "ha" sna/es )anno" hide )lose "o "he house.

• Kee3 2our #ranar2 a9a2 rom "he house( i" ma2a""ra)" roden"s "ha" sna/es 9ill hun".

• &a"er sour)es( reser;oirs and 3onds ma2 alsoa""ra)" 3re2 animals su)h as ro#s and "oads.

• Use a li#h" 9hen 2ou 9al/ ou"side "he house or;isi" "he la"rine a" ni#h".

($happuis et al., %&&')


26/27

Calloselasma rhodostoma

41ando"an 1erde/i/( Bando"an 1edor( ora2lemah( ora2 #i1u#( ular edor( Mala2an 3i" ;i3er6


27/27

/E0E/ENSI

• Dale2.B.+.( $,,-. Sna/e1i"e. De3ar"men" o Sur#er2( Di;ision o Traumaand Cri"i)al Care( Uni;ersi"2 o Tennessee S)hool o Medi)ine.99.eMedi)ine.)om.

• De +on# &.( '%%*. Bu/u A0ar Ilmu Bedah. E=C: +a/ar"a

• De3/es. $,,'. Pena"ala/sanaan #i#i"an ular 1er1isa. Dalam SIKer(

Dir0en• POM De3/es RI. Pedoman 3ela/sanaan /era)unan un"u/ rumah sa/i".

• Sudo2o( A.&.( $,,-. Bu/u A0ar Ilmu Pen2a/i" Dalam. Pusa" Pener1i"an

• De3ar"emen Ilmu Pen2a/i" Dalam. Fa/ul"as Kedo/"eran Uni;ersi"asIndonesia.

• &arrell( D.A.( '%%%. =uidelines or "he Clini)al Mana#emen" o Sna/eBi"e in "he Sou"h8Eas" Asia Re#ion. &orld eal"h Or#ania"ion. Re#ionalCen"re or Tro3i)al Medi)ine( Fa)ul"2 o Tro3i)al Medi)ine( MahidolUni;ersi"2( Thailand.

• &arrell(D.A.( $,,!. Trea"men" o 1i"es 12 adders and e

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