penatalaksanaan gigitan ular berbisa
TRANSCRIPT
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PENATALAKSANAAN
GIGITAN ULAR BERBISAOleh :
Purwo Suwignjo, SKp.
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PENDAULUAN
In!i"en!i : USA : #$$$ %&!u!'(&hun
)# * "igigi( "i e%!(re+i(&!
E(iologi : $ * : R&((le!n&%e
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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
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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
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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
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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(
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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
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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&
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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
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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
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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
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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
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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
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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%
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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%&
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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
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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&!
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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