Penatalaksanaan Gigitan Ular Berbisa

7/26/2019 Penatalaksanaan Gigitan Ular Berbisa

1/19

PENATALAKSANAAN

GIGITAN ULAR BERBISAOleh :

Purwo Suwignjo, SKp.


2/19

PENDAULUAN

In!i"en!i : USA : #$$$ %&!u!'(&hun

)# * "igigi( "i e%!(re+i(&!

E(iologi : $ * : R&((le!n&%e


3/19

SI-AT BISA ULAR

Bi!& ul&r +erup&%&n !u&(u polipep(i"& &ng/er!i0&( en1i+&(i% : -o!0olip&!e

-o!0o+enoe!(er&!e ATP2&!e

RNA2&!e

DNA2&!e

3 Nu%leo(i"&!e

Koline!(er&!e

Pro(e&!e

i&luroni"&!e


4/19

E-EK BISA ULAR

Neuro(o%!i%

e+or&rgi%

Tro+/igeni%

e+oli(i%

Si(o(o%!i%

An(i0i/rin

An(i%o&gul&n

K&r"io(o%!i%

G&nggu&n 4&!%uler 5+eru!&% (uni%& in(i+&6

7engh&!il%&n 1&(21&(!eper(i %inin, hi!(&+in"&n !lowre&8(ing !u/!(&n8e


5/19

9eni! ul&r /er/i!& /er"&!&r%&n

-&+ilin& -&+ili El&pi"&e : ul&r welung, wel&ng,

!en"o%, ul&r &n&ng, ul&r 8&/&i

-&+ili ro(&li"&e : ul&r (&n&h, ul&r hij&u,

ul&r /&n"o(&n pu!po

-&+ili "ropi"&e : ul&r l&u(

-&+ili olu/ri"&e : ul&r pohon


6/19

ULAR BERBISA ;ANG BAN;AK DI

INDONESIA E7ATOTOKSIK:

Tri+ere!uru! &l/ol&ri! 5ul&r hij&u6

An%ri!(ro"on rho"o!(o+& 5ul&r (&n&h6

NEUROTOKSIK : Bung&ru! -&!8i&(u! 5ul&r wel&ng6

N&& !pu(&ri< 5 ul&r !en"o%6

Ul&r %o/r&

Ul&r l&u(


7/19

IRI2IRI ULAR BERBISA

Ben(u% %ep&l& !egi (ig&

Du& gigi (&ring /e!&r "ir&h&ng &(&!

Du& lu%& gigi(&n u(&+& &%i/&( gigi (&ring


8/19

GE9ALA KILINIS

LOKAL : e"e+&, neri, neri (e%&n,

e%hi+o!i! 5"&l&+ =$ +eni( > ?@ j&+6

SISTE7IK : hipo(en!i, %ele+&h&n,

/er%ering&(, +enggigil, +u&l, +un(&h, "&n

neri %ep&l&


9/19


10/19

KALIS-IKASI 5+enuru( S8hw&r(16

DERA9AT $ : lu%& , neri '2, e"e+&' eri(e+& =8+'C? j&+

DERA9AT I : Lu%& , neri , e"e+&'eri(e+& = >C? 8+'C? j&+

DERA9AT II : Lu%& , neri , e"e+&'eri(e+&C? > ?3 8+'C? j&+, neuro(o%!i%, pu!ing, +u&l!o%

DERA9AT III : Lu%& , nrei , e"e+& eri(e+&

?3 8+'C? j&+, Per"&r&h&n %uli(, !o% DERA9AT I : Lu%& , neri , e"e+&'eri(e+&

e%!(re+i(&! GGA, %o+&, per"&r&h&n


11/19

GA7BARAN KLINIS

GIGITAN ELAPIDAE E-EK LOKAL : !&%i( ring&n, !e"i%i( &(&u (&np& pe+/eng%&%&n

&(&u %eru!&%&n %uli( "e%&( gigi(&n. P&"& /e/er&p& ul&r "&ri&0ri%& "&n /e/er&p& %o/r& &!i& : !&%i( /er&(, +elepuh, %uli(ru!&% "e%&( gigi(&n

SE7BURAN KOBRA PADA 7ATA : S&%i( /er"enu(, %&%u p&"&%elop&% +&(&, /eng%&% "i!e%i(&r +ulu(, %eru!&%&n p&"& l&pi!&nlu&r +&(&

GE9ALA SISTE7IK : +un8ul C3 +eni(2C$ j&+ !e(el&h gigi(&n :p&r&li!i ur&(2ur&( w&j&h, /i/ir, li"&h "&n (enggoro%&n, %elop&%

+&(& +enurun, !u!&h +enel&n, le+&!, !&%i( %ep&l&, %uli( "ingin,+un(&h p&n"&ng&n %&/ur, +&(i r&!& "i!e%i(&r +ulu( !el&nju(n&"&p&( (erj&"i p&r&li!i! o(o( pern&0&!&n, TD (urun, n&"i l&+/&(,%e!&"&rn +enurun


12/19

GIGITAN IPERIDS

E-EK LOKAL : C3 +eni( > /e/er&p& j&+:

/eng%&% "&n !&%i( "e%&( gigi(&n "&n 8ep&(

+ene/&r

E-EK SISTE7IK : 3 +eni( > /e/er&p& j&+:+un(&h, /er%e(ring&(, %oli%, "i&re, per"&r&h&n

p&"& gigi(&n, lu/&ng "&n lu%& &ng "i/u&( (&ring,

+un(&h&n, urin, 0e!e!. Be/er&p h&ri %e+u"i&n

(i+/ul, +elepuh "&n %eru!&%&n j&ring&n,%eru!&%&n ginj&l, oe"e+& p&ru


13/19

GIGITAN ;DROPIDS

GE9ALA EPAT : !&%i( %ep&l&, li"&h

(er&!& (e/&l, /er%ering&( "&n +un(&h

SETELA =$ +eni( > /e/er&p& j&+: %&%u

"&n neri +eneluruh, !p&!+ o(o( r&h&ng,

p&r&li!i! o(o(, urine w&rn& 8o%l&( gel&p,

ginj&l ru!&%, hen(i j&n(ung


14/19

PE7ERIKSAAN PENUN9ANG

LAB :/, (, T, Kr, Ure& N, ele%(roli(,

BT'T, PT'APTT, D2"i+er, (e! 0&&l hep&r,

8ro!! +&(8h

EKG

TORAF -OTO


15/19

PENATALAKSANAAN

TU9UAN 7engh&l&ngi'+e+perl&+/&( &/!or/!i /i!&

7ene(r&l%&n /i!& &ng !u"&h +&!u%

%e!ir%ul&!i

7eng&(&!i e0e% lo%&l "&n !i!(e+i%


16/19

PENATALAKSANAAN

Pen&(&%!&n&&n j&l&n n&0&!

Pen&(&l&%!&n&&n 0ung!i pern&0&!&n

Pen&(&l&%!&n&&n !ir%ul&!i

Per(olong&n p&"& lu%& gigi(&n

Pe+eri%!&&n l&/

Apu! (e+p&( gigi(&n "eng&n Venom Detection

SABU :gej&l&4ener&!i !i!(e+i%, &"&n& e"e+&he/&( p&"& /&gi&n lu%&


17/19

PEDO7AN PE7BERIAN SABU

5S8hw&r(1, &6 DERA9AT $ > I : /elu+ "i/eri%&n, nil&i

"&l&+ C? j&+, /il& "er&j&( +ening%&(

"i/eri%&n

DERA9AT II : = > @ 4i&l

DERA9AT III : 3 > C3 4i&l

DERA9AT I : /eri%&n pen&+/&h&n H #

4i&l


18/19

PENATALAKSANAAN

7oni(or %e!ei+/&ng&n 8&ir&n "&nele%(roli(

7oni(or l&/ !e(el&h pe+/eri&n SABU, ji%&

%o&gulop&(i +e+/&i% +oni(or %e(&(. 9i%&%o&gulop&(i (i"&% +e+/&i% ul&ngipe+/eri&n SABU, ul&ngi l&/ !e(el&h C > =

j&+ Ter&pi pro0il&%!i! : ATS, TT, AB !pe%(ru+lu&!


19/19

PENATALAKSANAAN

G&nggu&n %o&gul&!i /er&( : --P 5-re!h2-ro1en

Pl&!+&6

Per"&r&h&n : (r&n!0u!i "&r&h !eg&r &(&u

%o+ponen "&r&h, 0irinogen, i( K ipo(en!i : in0u! "eng&n %ri!(&loi"

7oni(or p&+/eng%&%&n lo%&l

Seger& lep&! 8in8in &(&u &ng +engi%&( Sin"ro+& %o+p&r(e+en : 0&!8io(o+i

G&nggu&n neuro(o%!i% : &!e(il%oline!(er&!e, SA

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Penatalaksanaan Gigitan Ular Berbisa