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Cara Tradisional
Venom composition
More than 90% of snake venom (dry weight) is
protein.
Each venom contains more than a hundred
different proteins:
enzymes (constituting 80-90% of viperid and 2570% of elapid venoms),
non-enzymatic polypeptide toxins,
and non-toxic proteins such as nerve growth
factor.
Venom enzym
Phospholipase A (lecithinase):
The most widespread and extensively studied of all
venom enzymes. It damages mitochondria, red blood
cells,leucocytes, platelets, peripheral nerve endings,
skeletal muscle, vascular endothelium, and other
membranes, produces presynaptic neurotoxic activity,
opiate-like sedative effects, leads to the
autopharmacological release of histamine and anticoagulation.
Acetylcholinesterase: Although found in most elapid
venoms, it does not contribute to their neurotoxicity.
Hyaluronidase: Promotes the spread of venom through
tissues.Proteolytic enzymes (metalloproteinases,
endopeptidases or hydrolases) and polypetide
cytotoxins (cardiotoxins): Increase vascular
permeability causing oedema, blistering, bruising and
necrosis at the site of the bite.
2
First aid
kasus
Kasus
O Laki-laki 16 tahun datang ke IGD RSU Dr. H. Koesnadi
Pendahuluan
DISKUSI
DISKUSI
DISKUSI
Time
10.30 am
1.00 pm
10.00 pm
4.00 am
7.00 am
10.00 am
Complaints
Dyspneu,
No dyspneu,
Blurred vision,
dyspneu, pain
all of the body
Blurred vision,
pain all of the
body
Pain score
9/10
6/10
8/10
6/10
6/10
4/10
110/70
120/75
116/71
115/71
117/78
21
29
20
24
24
88
144
120
79
80
36.9
36.6
36.8
36.8
36.4
Airway Breathing
BloodPress.
100/60 and
Circulation must be
Resp. Ratekeep stable30
Repeat : 100 cc NaCl
0.9% + 2 vial
Heart Rate
130 SABU
Atropine 1 mg iv and
o
Temp. ( C)
36.8 2 mg iv
Physostigmin
Morphine 1 mg iv
Ptosis (mm)
2/2
2/2
2/2
2/2
2/2
2/2
SpO2 (%)
94
100
95
98
98
99
Hb (g/dL)
12.8
WBC (/mm)
6.100
Repeat :- 100 cc
Platelet(/mm)
337.000
NaCl 0.9% + 2
vial SABU
PCV (%)
35
Repeat : Atropine
1 mg iv and
Physostigmin
- 2 mg
iv
-
Time
10.00 pm
76
7.00 pm
Repeat :
100Pain
cc NaCl
Pain all of the body
all of the body
decreased, only in bite0.9%
decreased,
+ 2 vialonly in bite
site
site
SABU
Atropine
2/10
2/10 1
mg iv and
113/72
111/71
Physostigmin
2 mg iv
18
18
Ketorolac 30
mg 81
iv
110
Temp. ( C)
36.8
36.6
36.5
36.8
Ptosis (mm)
2/2
2/2
2/2
2/2
SpO2 (%)
100
99
100
100
Hb (g/dL)
WBC (/mm)
Platelet(/mm)
PCV (%)
Repeat :
100 cc NaCl
Complaints
0.9% + 2 vial
SABU
Atropine
Pain
score 1
mg iv and
Blood
Press.
Physostigmin
2 mg iv
Resp. Rate
Ketorolac 30
mgRate
iv
Heart
o
1.00 pm
Pain all of the body
decreased, only in bite
site
2/10
103/68
17
4.00 pm
Repeat : Atropine
- 1 mg iv
and Physostigmin 2 mg iv
-
2/10
118/78
19
90
Time
4.00 am
12.00 pm
18.00 pm
04.00
Complaints
No complaint
Pain score
2/10
1/10
1/10
1/10
Blood Press.
100/60
114/70
111/72
113/70
Resp. Rate
18
22
19
19
Heart Rate
88
78
81
88
Temp. ( C)
36.8
36.6
36.3
36.8
Ptosis (mm)
1/2
-/-
-/-
-/-
SpO2 (%)
100
100
99
100
HbRepeat
(g/dL):
100 cc
WBC NaCl
(/mm)
0.9%
+ 2 vial
Platelet(/mm)
SABU
(%)
Ketorolac
PCV
30 mg iv
Ketorolac 30 mg iv
-
DISKUSI
DISKUSI
DISKUSI
KESIMPULAN
O Penanganan
awal
yang
benar
dikombinasikan dengan antibisa ular
spesifik
serta
terapi
suportif
dan
simptomatis yang benar, dapat menurunkan
angka kesakitan dan kematian pasien.
Hemotoxin bite
antivenom
BULLAE
HEMOTOKSIN
VENOM OPHTHALMIA:
DISCUSSION
Venom Ophthalmia
Snake venom composition is
protein (more than 90%)
Wide variety of post synaptic
three finger fold
neurotoxins,
cytotoxins,cardiotoxins and
enzymes (PLA2).
Each venom contains more
than a hundred different
proteins:
1.
2.
3.
enzymes (25-70% of
elapid venoms)
non-enzymatic
polypeptide toxins
(cobrotoxin)
non-toxic proteins (nerve
growth factor)
VENOM OPHTHALMIA:
WHAT CAUSES OCULAR
TOXICITY?
1.Cardiotoxin
In large,responsible for ocular toxicity
Direct lytic factor and membrane damaging
properties accounts for chemosis and corneal
abrasions
Works synergystically with Phospholipase A2
Varying toxin and protein fractions of the
venom in different cobra species determine the
different magnitudes of topical ophthalmologic
toxicity they displace ( Fung HT et al, Hong
Kong j.emerg.med. 2009;16:26-28)
VENOM
OPHTHALMIA:WHAT
CAUSES OCULAR
TOXICITY?
2. Corneal collagenase
calcium dependent zinc metalloenzyme
mediates the development of corneal liquefaction and
opacification
Enhanced by topical steriods causing corneal melting
VENOM OPHTHALMIA:
Drug
Purpose
Pain relieve
Topical anaesthetic
(tetracaine)
Pain relieve
topical antimicrobials
(tetracycline or
chloramphenicol)
to prevent endophthalmitis or
blinding corneal opacities
prevention of posterior
synechiae, ciliary spasm and
discomfort
antihistamines
2010
2. TOPICAL ANALGESIA
Vasoconstrictors with weak mydriatic
activity, 0.5% topical adrenaline
Limited use of topical anaesthetic drops
( oxybuprocaine 0.4% or tetracaine)
Overcomes acute blepharospasm,
facilitates irrigation.
Prolonged use of topical anaesthetics
not recommended as adverse effects
include stromal keratocyte, corneal
epithelium toxicity.
Risk of bacterial superinfection in
anaesthesized damaged cornea
3. TOPICAL CYCLOPEGICS
Recommended for anterior segment inflammation
atropine, scopolamine
Reduces risk of posterior synechiae formation and ciliary spasm
Reduces patient discomfort
Complication: acute glaucoma in anterior chamber
4. TOPICAL ANTIBIOTICS
Recommended if corneal erosion cannot be excluded by
flourescein stain and slit lamp examination
Prevents secondary bacterial infection
Tetracycline, cmc, penicillin-streptomycin ointment and
polymixin B sulfate
59
Do and dont
CENTER
SUB
Non medical
Pemetaan lokasi ular
Pengetahuan penanganan awal gigitan ular
Provokasi masyarakat untuk ke tenaga
kesehatan bila digigit ular
Pengetahuan akan pusat rujukan
penanganan gigitan ular dan ketersediaan
serum antibisa ular
Image gallery jenis jenis ular
Pre hospital
In Hospital
Post hospital
Pre hospital
BORANG
SNAKE BITE
step by step
1.Sosialisasi cara penanganan yang benar dan
kebutuhan antibisa ular
2..Membuat image gallery tenaga medik dan awam
bisa tahu tentang identifikasi ular
3.Kampenye untk memfoto atau membawa ular yang
mengigit
Provokasi langsung
Pemerintah
Masyarakat
Tenaga kesehatan
share ilmu ke beberapa negara tetangga
Tidak langsung
Provokasi ke masyarakat
Pembuatan film
E.N.S.
Kompas 14 juli
2015
Kasus snake
bite dari bulan
maret sampai
juli 2015
41 kasus
35 kasus ular
hijau
(trimesurus
albolabris),2
kasus gigitan
,kobra 2 kasus
1 venom
aftalmia,2
bungarus,2
kaus uar kopi
Bungarus 2
kasus
Gigitan
kobra 2
kasus
TERIMAKASIH