Morning Report

Snake Bite

GIZKA YOLANDA PUTRI

1408465718

SKDI 4

ICD X : T.630

HISTORY TAKING
Patient Identity
1.
2.
3.
4.
5.
6.
7.

Name
: Mrs. H
Age
: 42 yo
Gender
: female
Occupation
: housewife
Religion
: Islam
Admitted to the hospital : 09 November 2015
Address
: Jl. Hangtuah
Ujung, Tenayan
Raya Pekanbaru

PRIMARY SURVEY
Airway and Cervical Control
Patient talk spontaneously.
Assessment: Airway clear

Breathing
Inspection: breathing spontaneously, frequency 20 x/minute, simetrical
both of chest movement.
Palpation : crepitations (-)
Percussion : resonant
Auscultation: vesicular sound (+/+)
Assessment: Breathing clear
Action : 2 L of O2 with nasal cannula

Circulation

Warm extremity, oedema (-/-)

CRT < 2 seconds,
Heart rate 72x/minutes, regular, feel strong
Blood pressure120/70 mmHg

Assessment: Circulation clear

Action: Intra vein NaCl 18 drip per minute was
given

Disability

GCS 15
Isocoric pupil both sides
Pupil reflects direct and indirect (+/+)
Assessment: mini neurologist examination was good

Exposure
Temperature: 36,8 C
Action: Cover the patient

SECONDARY SURVEY

CHIEF COMPLAINT
Bitten by a snake on left foot, 30
minutes before admitted to the
hospital

RECENT ILLNESS
HISTORY

TRAUMA MECHANISM

30 minutes before admission, patient

complaint her left foot was bitten by a
cobra when she worked on her yard.
Patients leg was being tied up with
ropes above the snake bites right after
the incident.
Patient then immediately brought to the
hospital.

 Patient complaint her foot felt throb, swollen,

eritema and sore on the bitten mark.
Nausea (+), vomiting (+). Patient puked for
about 6 times, mingled with meal, blood (-),
with amount glass, dizziness (+).
Theres no blood flew out from the bitten
mark, dyspnoe (-), loss of conciousness (-),
ptechiae (-), blurred vision (-)

Past Illness History

Theres no history of being bitten before
Theres no illness relative to patients
illness
Family Illness History
Theres no relativity

PHISICAL
EXAMINATION
1. General condition : looks ill
2. Awareness
: composmentis
3. Vital Sign
Blood pressure: 110/60 mmHg
Heart rate
: 96/minute
Temperature : 36,8C
Respiration rate : 22/minute

Status Generalis :

Head and neck : normally

Thorax : normally
Abdomen: normally
Genitourinarius: normally
Extremity: locally state

Localized state:
Regio : Dorsum pedis sinistra
Inspection : hematoma (+), bitten mark (+), skin
around the bitten mark seems in black-purple colour.
Palpation : tenderness (+), oedema (+), CRT <2
seconds and warm extremity

Working diagnose
Snake bite

Suggestive examination
Complete blood count

WORKUP
Complete blood count
Hb : 13,3 /L
HT : 35,3 %
WBC : 17.800 H /L
PLT : 402.000 /L
RBC : 4,38 x106/L

DIAGNOSIS
Snake bite

TREATMENT

IVFD RL
Sabu injection 1 vial in 100 cc NaCL
ATS 1500 iU
Ceftriaxon injection 2x1 gr
Tramadol injection 2 x 30 mg

THEORY

Snake bite

POISONOUS
SNAKE
1. Trangle head, theres cavity between eyes
and nose
2. Have 2 caninus
3. Have oval pupil
4. Theres two bars of slab below its tail

Poisonous snake divided by its toxin:

I. Neurotoxic: Cobra, ular Kraits & ular
Karang, ular Welang
II. Hemolitic : Rattlesnake, comperhead.
III. Neurotoxic dan Hemolitic : sea snake.

classification

Degre Venera Bitten

e
si
mark

Pain

+/-

+/-

II

+++

III

++

+++

IV

+++

+++

Oedema/Erit Systemic
ema
symptomp
s
<3
0
cm/12hour
3 12 cm/ 12 0
hour
12 25 cm/
+,
12 hour
neurotoxic
nausea,
dizziness,
shock
> 25 cm/ 12 ++
hour
Shock,
ptechi,
echimosis
> extremity
++

 Two holes mark: oedema, petechiae, bullae,

eritema, echimosis, and tissue necrosis
symptomps
Sprayed on the eye blindness
Sign and symptomps of neurotoxin : tingling,
limp, salivation, vomiting, ptosis, abnormal
reflects, dyspnoe, respiratory arrest
paralized on respiratory muscles.

 History taking
Physical examination
Laboratory findings: CBC, electrolyte
count, PT/APTT, fibrinogen, Ureum/
creatinin
Electrocardiography

DIAGNOSE

TREATMENT
To slow down the toxin entering bloodstream,
to neutralized and get rid of the toxin and
maintaning blood volume.
Immobilization of the affected area
Apply crosswise cutlet on the bitten mark
Cooling the wound soak in the cold water
SABU : 5 ml around the bite, 15 ml im
PP 1,2 million U, ATS 1500 U (supportive
theraphy)

Thank You