Penatalaksanaan Gigitan Ular BerbisaFull description
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penyuluhan luka akibat gigitan ularFull description
Sop Gigitan Ular
Gigitan Ular SOPFull description
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ASKEPFull description
keracuanan gigitan seranggaDeskripsi lengkap
BAB II PEMBAHASAN
A. Peng Penger erti tian an Menurut Smetlzer and Bare Luka gigitan atau vulnus biasanya ditimbulkan akibat binatang seperti kucing an!ing ular dan lain" lain. #e$ini #e$inisi si lainnya lainnya luka gigita gigitan n adala% adala% cedera yang yang disebabk disebabkan an &le% mulut dan gigi %e'an.. He'an %e'an He'an mung mungki kin n meng menggi gigi gitt untu untuk k memp mempert erta% a%an anka kan n diri diriny nya a dan dan pada pada kesempatan k%usus untuk mencari makanan (igitan (igitan dan sengata sengatan n serangg seranggaa adala% adala% gigita gigitan n yang yang diakib diakibatka atkan n karena karena serangga atau binatang yang menyengat atau menggigit sese&rang. #ari #ari beberap beberapaa de$ini de$inisi si diatas diatas dapat dapat disimp disimpula ulakan kan gigita gigitan n dan sengat sengatan an serangg seranggaa adala% gigitan atau sengatan dari binatang atau serangga yang dapat menyebabkan luka gigitan atau vulnus vulnus dimana dimana binatang binatang ataupun serangga yang menggigit menggigit tersebut menggigit untuk memperta%ankan dirinya. B. Macam"m Macam"macan acan gigita gigitan n dan panang panangana anan n ). (igi (igita tan n bin binat atan ang g dara daratt a. (igitan (igitan an!ing an!ing kuci kucing ng kera kera dan dan kelela' kelela'ar ar.. *asus (igitan an!ing merupakan kasus tertinggi yang paling sering ter!adi. #imana #imana an!ing an!ing merupa merupakan kan sala% sala% satu satu penyebab penyebab atau vekt&r vekt&r dari dari penyaki penyakitt rabies. rabies. +abies atau dikenal !uga dengan istila% penyakit an!ing gila adala% penyakit in$eksi yang bersi$at akut pada susunan sara$ pusat yang disebabkan &le% virus rabies. Penyebab Rabies: Adap Adapun un vekt vekt&r &r dala dalam m penu penular laran an peny penyak akit it ini ini adal adala% a% an!in an!ing g kuci kucing ng dan dan binatang"binatang liar seperti kera kelela'ar rakun serta ruba%. Cara Penularan Rabies: ,iru ,iruss rabie rabiess ditem ditemuk ukan an dalam dalam !uml !umla% a% bany banyak ak pada pada air air liur liur %e'a %e'an n yang menderita rabies. ,irus ini akan ditularkan ke %e'an lain atau ke manusia terutama melalui " " "
1
Luka gi gigitan ilat ilatan an pada pada luka luka / kul kulit it yang yang tidak tidak utu% utu% ilat ilatan an pada pada selap selaput ut muk& muk&sa sa yang yang utu% utu%
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"
Meng% Meng%iru irup p udara udara yang yang tercem tercemar ar virus virus rabies rabies 0 meskip meskipun un sanga sangatt !arang !arang ter!adi ter!adi namun tela% dilap&rkan 1 kasus yang menimpa pen!ela!a% yang meng%irup udara di dalam g&a yang terdapat banyak kelela'ar 2
Masa Inkubasi: Inkubasi adala% 'aktu antara penggigitan sampai timbulnya ge!ala penyakit . Masa inkubasi penyakit rabies pada an!ing dan kucing kurang lebi% 1 minggu 0)3 %ari 4 )5 %ari2. Pada manusia 1"6 minggu dan paling lama ) ta%un. Masa inkubasi tergantung dari "
L&ka L&kasi si gigi gigita tan n bias biasan any ya pali paling ng pend pendek ek pada pada &ran &rang g yang yang digi digigi gitt di daer daera% a%
" "
kepala tempat yang tertutup celana pendek Bila Bila gigi gigitan tan terda terdapa patt di di bany banyak ak temp tempat at ,irul ,irulens ensii 0banyak 0banyakny nyaa virus virus yang yang masu masuk k melalu melaluii gigitan gigitan / !ilatan !ilatan22
Gejala Rabies: Penyak Penyakit it rabies rabies dibeda dibedakan kan dalam dalam 1 bentuk bentuk yaitu yaitu bentuk bentuk diam diam 0#umb 0#umb +abies2 dan bentuk ganas 07uri&us +abies2. 8anda 8anda 4 tanda +abies Bentuk #iam 0#umb +abies2 "
Air Air liur liur menete menetess berl berlebi ebi%a %an n ra%an ra%ang g ba'a ba'a% % tida tidak k dapa dapatt dika dikatu tupk pkan an dan %e'an %e'an
" " "
tidak dapat mengunya% dan menelan makanan. 8idak 8idak ada ada keing keingina inan n pada pada %e'an %e'an untuk untuk meny menyeran erang g atau atau menggi menggigit git Selu Seluru ru% % bagi bagian an tub tubu% u% meng mengala alami mi kelu kelump mpu% u%an an He'a He'an n aka akan n mat matii dal dalam am bebe bebera rapa pa !am !am
He'an He'an men!a men!adi di agre agresi$ si$ dan dan tida tidak k lagi lagi meng mengena enall pemili pemilikny knyaa Menyeran Menyerang g &rang &rang %e'an %e'an dan dan benda benda"be "benda nda yang yang berg bergerak erak.. Bila Bila berdiri berdiri sikapny sikapnyaa kaku kaku ek&r ek&r dilipat dilipat dianta diantara ra kedua kedua pa%a pa%a belakan belakangny gnya. a. Pada Pada anak anak an!i an!ing ng akan akan men!a en!adi di lebi% lebi% linca linca% % dan dan suka suka berma bermain in teta tetapi pi akan akan menggigit bila dipegang dan akan men!adi ganas dalam beberapa !am
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"
#ia'al #ia'alii dengan dengan demam demam ringan ringan atau atau sedan sedang g sakit sakit kepala kepala na$su na$su maka makan n menurun menurun badan terasa lema% mual munta% dan perasaan yang abn&rmal pada daera%
" " " " "
sekitar gigitan 0rasa panas nyeri berdenyut2 +asa +asa takut takut yang yang sangat sangat pada pada air dan peka peka ter%a ter%adap dap ca%ay ca%aya a udara udara dan dan suara suara Air Air liu liurr dan dan air air mata mata kelu keluar ar berl berleb ebi% i%an an Pupil mata ata membesa esar Bicara Bicara tida tidak k karua karuan n selal selalu u ingin ingin berg bergerak erak dan nampak nampak kesakit kesakitan an Selan!utny Selan!utnyaa ditandai ditandai dengan dengan ke!ang" ke!ang"ke!ang ke!ang lalu lumpu% lumpu% dan ak%irnya ak%irnya meninggal meninggal dunia
Penatalaksaan • • •
• • • •
Amankan diri dari lingkungan sekitar Nilai keadaan dari status AB9 pasien 9uci luka pada air mengalir dan sabun atau larutan deter!en selama )3 4 ): menit Im&bilisasi bagian yang digigit Berikan serum anti rabies Bila dapat lakukan penangkapan binatang yang menggigit untuk identi$ika si Segera ru!uk penderita untuk mendapatkan pert&l&ngan lebi% lan!ut.
b. (igitan linta% Luda% linta% mengandung zat anti pembekuan dara%. #ara% akan terus mengalir ke luar dan masuk ke perut linta%. Pada &rang yang peka ter%adap zat tersebut gigitan linta% akan menyebabkan reaksi yang berupa pembengkakan gatal dan kemera%an.
Penatalaksaan 8indakan pert&l&ngan yang dapat dilakukan adala% dengan %ati 4 %ati lepaskanla% dari tempat ia menggigit. Menyiram minyak atau air tembakau ke tubu% tubu% linta% linta% akan akan memban membantu tu memperc mempercepa epatt usa%a usa%a melepas melepaskan kan gigita gigitan n liinta% liinta%.. Apabila ada tanda 4 tanda reaksi seperti yang disebutkan di atas cukup dig&s&k dengan &bat atau salep anti%istamin atau anti gatal. (i i
l
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sangat akti$ yaitu pada sen!a %ari atau $a!ar.ebagai akibat dari ) !enis t&ksin sa!a. Bisa ular 0 ven&m 2 terduiri dari 13 atau lebi% k&mp&nen se%ingga pengaru%nya tidak dapat diinterpretasikan. ;ntuk menduga !enis ular yang menggigit adala% ular yang berbisa atau tidak dapat dipakai rambu 4 rambu bert&lak dari bentuk kepala dan luka bekas gigitan sebagai berikut "
9iri 9iri 4 ciri ular ular berbisa berbisa < bent bentuk uk kepal kepalaa segi empat empat pan! pan!ang ang gigi gigi taring taring kecil kecil
bekas gigitan ular %alus berbentuk lengkungan " 9iri 9iri 4 ciri ular ular tidak tidak berbi berbisa sa < kepala kepala segit segitiga iga terdapa terdapatt tt 1 gigi gigi taring taring besar besar di atas ra%ang 1 luka gigitan utama akibat gigi taring 8etapi untuk identi$ikasi yang lebi% pasti lebi% baik apabila ularnya dapat dibu dibunu nu%. %. Iden Identi ti$i $ikas kasii ini ini pent pentin ing g untu untuk k meng mengena enali li !eni !eniss bisa bisa yang yang tela% tela% dima dimasu sukk kkan anny nyaa bersa bersama ma bisa. bisa. Bisa Bisa ular ular ada ada yang yang dapa dapatt meru merusak sak dind dindin ing g pembulu% dara% dan ada yang yang bersi$at merusak !aringan sara$. (e!ala atau gambaran klinis yang dapat ter!adi antara lain ). (e!ala l&kal l&kal - edema edema nyeri nyeri tekan pada luka luka gigitan gigitan ekim&sis ekim&sis 0 dalam 63 63 menit menit 4 15 !am 2 1. (e!ala (e!ala sistemi sistemik k - %ip&te %ip&tensi nsi kelema% kelema%an an &t&t berkerin berkeringat gat menggi menggigil gil mual mual %ipersalivasi munta% nyeri kepala dan pandangan kabur. 6. (e!ala (e!ala k%usu k%ususs gigitan gigitan ular ular berbi berbisa sa antara antara lain lain •
Hema Hemat& t&t& t&ks ksik ik - pend pendar ara% a%an an di temp tempat at gigi gigita tan n paru paru !ant !antun ung g gin! gin!al al perit&nium &tak gusi %ematemesis dan melena pendara%an kulit 0 petekie dan ekim&sis 2 %ematuria.
re$lek re$lek abn&rm abn&rmal al ke!ang ke!ang dan k&ma k&ma
0 akibatnya pada sara$ tepi dan sara$ pusat 2
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•
9yt&t&ksin - gangguan pada !antung dan pembulu% dara%
•
9yt&lytik - peradangan serta kematian !aringan
•
Sindr&m k&mpartment - edema tungkai dengan tanda 4 tanda : P 0 Pain pall&r parest%esia paralysis pulselesness 2
Menurut Sc%'artz 0 #epkes 133) 2 gigitan ular dapat diklasi$ikasikan sebagai berikut #era!at ,anerasi
Luka Nyeri Edema /eritema Sistemik
3
=
3
I
=/"
=
=/" 4
>6 cm / )1 !am 3
6")1 cm / )1 !am
3 =
II
=
=
===
?)1"1:cm/ )1 !am
Neur&t&ksik mual pusing sy&k sy&k ==
II I
=
=
===
?1: cm / )1 !am
Ptek%ieae sy&k ekim&sis ==
I,
== =
=
===
?ekstremitas
(agal gin!al akut pendara%an k&ma
*epada setiap kasus gigitan ular perlu dilakukan •
Anamnase lengkap - identitas 'aktu dan tempat ke!adian !enis dan ukuran ular
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•
Pemeriksaan $isik - status umum dan l&kal serta perkembangannya setiap )1 !am. Penatalaksaan 8u!uan penatalaksaan pada kasus gigitan ular berbisa adala% -
•
Meng%alangi atau memperlambat abs&rpsi bisa ular
•
Menetralkan bisa ular yang suda% masuk ke dalam sirkulasi dara%
•
Mengatasi e$ek l&kal dan sistemik
8indakan penatalaksanaan ). Sebelum Sebelum penderita penderita di ba'a ba'a ke pusat peng&b peng&batan atan beberapa beberapa %al yang yang perlu diper% diper%atikan atikan antara lain•
Penderita diistira%atkan pada p&sisi %iriz&ntal ter%adap luka gigitan
•
angan memanipulasi daera% gigitan
•
Penderita dilarang ber!alan atau minum minuman yang berak&%&l
•
Apabila ge!ala timbul secara cepat sementara belum tersedia antibisa ikat daera% pr&ksimal dan distal dari gigitan. 8idakan mengikat ini tidak akan e$ekti$ !ika dilakukan lebi% dari 63 menit pasca gigitan. 8u!uan ikatan adala% mena%an aliran lim$e bukan mena%an aliran vena atau arteri.
1. Setela% penderita penderita tiba di di pusat peng& peng&batan batan diberika diberikan n terapi supp& supp&rti$ rti$ seperti seperti •
Penatalaksaan !alan na$as
•
Penatalaksaan $ungsi perna$asan
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Beri pert&l&ngan pertama pada luka gigitan seperti balut ketat pada dan luas di atas
•
luka lakukan im&bilisasi dengan bidai. Ambil : 4 )3 ml dara% untuk pemeriksaan seperti pr&tr&mbin $ibrin&gen dan Hb
•
leuk&sit dll. •
Apus tempat gigitan dengan ven&m detecti&n
•
Beri SAB; 0 serum anti bisa ular 2 yaitu serum kuda yang dikebalkan. Indikasi SAB; adala% ge!ala venerasi sistemik dan edema %ebat pada bagian luka. Ped&man terapi SAB; mengacu pada Sc%'artz dan @ay @ay yaitu
#era #era!a !att ")
3 tida tidak k dipe diperl rluk ukan an SAB; SAB;.. #ilak #ilakuk ukan an eval evalua uasi si dalam dalam )1 !am !am !ika !ika dera dera!at !at meningkat maka diberika SAB;
#era #era!a !att II II 6 4 5 via viall SAB SAB; ; #era!at #era!at III : 4 ): vial vial SAB; SAB; #era!at I, berikan berikan penamba%a penamba%an n 4 C vial SAB; SAB; Sedangkan menurut Luck ped&man ped&man terapi SAB; yaitu Beratnya
8aring 8aring atau ;kuran
even&vasi
gigi
eriremat& kulit 0 cm 2
sistemik
ven&m
3
8idak ada
=
>1
4
3
I
Minimal
=
1 4 ):
4
:
II
Sedang
=
): 4 63
=
)3
II I
Berat
=
?63
==
):
#era!at
z&na
edema
/ (e!ala
uml umla% a%
vial vial
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). ika ika k&ag k&agul ulas asii tidak tidak membai membaik k 0 $ibri $ibrin& n&ge gen n tdk tdk meni mening ngka katt dan dan 'akt 'aktu u pemb pembek ekua uan n dara% meman!ang 2 ulangi pemberian SAB;. ;langi pemeriksaan dara% pada ) dan 6 !am berikutnya. 1. ika ika k&agul k&agulasi asi membaikma membaikmaka ka m&nit& m&nit&rin ring g ketat ketat diteru diteruska skan n dan ulangi ulangi pemerik pemeriksaan saan dara% untuk m&nit&ring perbaikannya. M&nit&ring dilan!utkan sampai 1 D 15 !am untuk mendeteksi kemungkinan !&agulasi berulang. 8erapi 8erapi supp&rti$ lainnya pada keadaan ). Pendara%an %an 1. Hip&tensi 6. (ang (anggu guan an neur neur&t &t&k &ksi sik k •
8erapi erapi pr&k$i pr&k$ilak laksis sis seperti seperti pember pemberian ian antibi antibi&ti &tik k spektr spektrum um luas luas berika berikan n t&ks&id t&ks&id tetanus. 1. (igitan Binatang Air ). (igi (igitan tan trig trig&i &id d 0 dur durii babi babi 2 8rig&id atau bulu babi biasanya terdapat diperairan laut dangkal. Biasanya penderita terkena sengatan trig&id disebabkan karena tidak senga!a mengin!ak atau bersentu%an dengan bagian tubu% binatang tersebut. 8anda dan ge!ala -
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8enangkan penderita 9abut duri babi yang menusuk +endam bagian yang tergigit dengan air %angat Bersi%kan luka dengan antiseptik dan im&bilisasi daera% yang luka
• • • •
1. (igi (igita tan n ikan ikan pari pari *el&mp&k %e'an 4 %e'an laut ini menyuntikkan racunnya dengan menusukkan duri atau !arumnya 8anda dan ge!ala • • •
Amankan diri dan lingkungan sekitar Nilai keadaan AB9 AB9 Bersi%kan luka dengan sabun dalam air %angat sela ma 63 4 3 menit. 9ara
ini e$ekti$ untuk me"n&n"akti$kan racun yang tidak ta%an panas Ba'a segera ke ruma% sakit • 6. (ig (igitan itan guri gurita ta (urita tidak akan menggigit kecuali terin!akatau diganggu. (igitannya sangat beracun dan sering kali menimbulkan kematian 8anda dan ge!ala •
*egagalan na$as secara pr&gresi$ter!adi dalam )3 "): menit
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•
*esulitan berna$as
•
(angguan pengli%atan
•
Ink&&rdinasi
•
*elumpu%an &t&t
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Perna$asan ber%enti
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#enyut nadi ter%enti
•
#apat diikuti kematian
Penatalaksaan • • • • • • • •
9.
Amankan diri dan lingkungan Nilai status AB9 klien 8enangkan penderita Bersi%kan / cuci luka bekas gigitan dengan air %angat Lakukan pressure im&bilisasi pada bagian yang cedera M&nit&t tanda 4 tanda vital Lakukan +P !ika diperlukan Segera ba'a ke pelayanan kese%atan terdekat.
Macam 4 macam sengatan sengatan serangga serangga dan penatalaksaan penatalaksaannya nya a. Seng Sengata atan n seran serangg ggaa / %e'a %e'an n darat darat Sengatan laba 4 laba Sengatan laba 4 laba dapat menimbulkan rasa sakit ba%kan dapat meninbulkan
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diameternya bisa mencapai 1: cm dan kadang 4 kadang membuat !aringan cekung. Pr&ses penyembu%an bisa 6 4 bulan. Bila mengenai !aringan lemak penyembu%an dapat mencapai 6 ta%un. *&mplikasi l&kal dapat berupa in$eksi sekunder melukai !aringan sara$ demam nyeri lema% mual munta%. 8anda 8anda dan ge!ala •
Bengkak dan kemera%an di daera% gigitan
•
(atal 4 gatal
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Nyeri dan terasa panas
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#emam menggigil kadang disertai sulit tidur
•
#apat ter!adi sy&k
Penatalaksaan •
•
Amankan lingkungan Nilai keadaan air'ay breat%ing circulati&n
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8enangkan 8enangkan penderita
•
Bersi%kan gigitan dengan menggunakan menggunakan air sabun atau alk&%&l F3 G atau antiseptik lainnya balut dengan balutan dan diusa%akan balutan steril dan
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Sengatan kelabang dapat meninggalkan bekas luka berupa sepang luka dan menyebabkan pembengkakan rasa sakit dan kemera%andi sekitar tempat luka. +asa terbakar pegal dan sakit biasanya akan %ilang dengan sendirnya setela% 5": !am kemudi kemudian. an. (igitan (igitan kelaba kelabang ng 'alaup 'alaupun un tidak tidak selalu selalu memba% memba%aya ayakan kan !i'a !i'a dapat dapat menimbulkan reaksi alergi yang ga'at dan kadang 4 kadang dapat berakibat $atal 8anda 8anda dan ge!ala •
Bengkak dan kemera%an di daera% gigitan
•
(atal 4 gatal Nyeri dan terasa panas
•
•
#emam menggigil kadang disertai sulit tidur
•
#apat ter!adi sy&k
Penatalaksaan •
Amankan diri dari lingkungan
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•
Bengkak dan kemera%an di daera% gigitan
•
(atal 4 gatal
•
Nyeri dan terasa panas
•
#emam menggigil kadang disertai sulit tidur
•
#apat ter!adi sy&k
Penatalaksaan o o o o
o o o o o
Amankan diri dari lingkungan Nilai status air'ay breat%ing breat%ing dan circulati&n 8enangkan 8enangkan penderita Ambil Ambil sengat sengatny nyaa kalau kalau nampak nampak 0 %ati %ati 4 %ati saat mencab mencabut. ut. angan sampai menekan kantng bisa atau kalen!ar bisa 2 9uci daera% gigitan dengan air sabun atau alk&%&l F3 G atau antiseptik lainnya. *&mpres daera% sekitar luka dengan air dingin. Im&bilisasikan daera% yang tergigit Bisa dik&mbinasikan dengan &bat peng%ilang rasa nyeri dan ant%istamin. ru!uk ika ge!ala semakin para% segera ruuk ke pelayanan kese%atan terdekat.
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u!ung u!ung ek&rny ek&rnya. a. Sengata Sengatan n tersebu tersebutt dapat dapat menimb menimbulk ulkan an rasa rasa panas panas dan nyeri nyeri yang yang p&tensial menimbulkan keracunan yang mematikan. (ambara (ambaran n klinis klinis pada pada l&kasi l&kasi sengat sengatan an kadang kadang 4 kadang kadang terli% terli%at at minima minimall dengan secara umum racun kala!engking menun!ukan si$at %em&litik dan neur&t&ksik yang dapat meng%asilkan keracunan yang berat. (e!ala l&kal yang dapat ditimbulkan antara lain Nyeri seperti terbakar (e!ala peradangan disertai parestesi l&al
• •
(e!ala sistemik yang dapat ditimbulkan antara lain •
;munya ditemukan pada anak 4 anak yang berusia kurang dari )3 ta%un. (e!ala yang timbul antara lain gelisa% keluar keringat berlebi%an dipl&pia nistagmus $asikuli &pist&t&nus salivasi %ipertensi takikardi dan kadang 4 kadang ke!ang
•
paralisis &t&t perna$asan (e!a (e!ala la 4 ge!a ge!ala la ters terseb ebut ut dapa dapatt pula pula dise disert rtai ai deng dengan an edem edemaa paru paru sy&k sy&k k&agul&pati pankreatitis gangguan $ungsi gin!al ikterus %ipertermia.
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•
Pemantauan Pemantauan selama peng&batan peng&batan dapat diberi dan sedati$ atau nark&tik !ika perlu terutama pasien yang mengalami ge!ala 4 ge!ala neur&muskular untuk mencega% ter!adinya %enti na$as.
Secara umum penatalaksaan dapat dibagi men!adi 6 terapi yaitu ). 8erapi 8erapi supp&rti$ a. Stabili ilisasi " Penat enatal alak aksa saan an !ala !alan n na$ na$as as " Penatal Penatalaks aksaan aan $ungsi $ungsi na$as na$as - venti ventilasi lasi dan &ksige &ksigenas nasii " Penatal Penatalaks aksaan aan sirkula sirkulasi si - pasang pasang in$us in$us kristal kristal&id &id b. #ek&ntaminasi " 9uci 9uci luka luka dan dan berik berikan an teta tetanus nus pr&$ila pr&$ilaksi ksiss !ika !ika diper diperluk lukan an " angan angan melak melakuka ukan n pengi pengisapa sapan n dan dan insisi insisi l&kal l&kal pada pada area area senga sengatan tan 1. 8erapi rapi spes spesi$ i$ik ik 8erapi 8erapi antivenim dengan pemberian serum ser um sk&rpi&n 0 p&livalen 2 6. 8erapi rapi ting tingka katt lan lan!ut !ut 8erapi ini dilakukan untuk mengatasi ge!ala sistemik akibat keracunan sengatan kala!engking seperti %ipertensi edema paru bradiritmia gelisa% dan sy&k
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8anda 8anda dan ge!ala •
+asa panas dan terbakar serta sedikit pendara%an
•
;rtikaria
•
Mual munta%
•
*e!ang &t&t
•
Sy&k
•
*esulitan berna$as
Penatalaksaan o o o
o o
Amankan diri dari lingkungan Nilai status air'ay breat%ing breat%ing dan circulati&n Bebaskan angg&ta badan yang cedera dari tentakel 4 tentakel dengan %anduk basa% 9uci luka dengan larutan alk&%&l F3 G Berikan )3 ml larutan Na (luk&nat
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). Neur&t&ksik 1. Hem&litik 6. Neur&t&ksik dan %em&litik Bisa adala% suatu zat atau substansi yang ber$ungsi untuk melumpu%kan mangsa dan sekaligus !uga berperan pada sistem perta%anan diri. Bisa tersebut merupakan luda% yang term&di$ikasi yang di%asilkan &le% kelen!ar k%usus. *elen!ar yang mengeluarkan bisa merupakan suatu m&di$ikasi kelen!ar luda% par&tid yang terletak di setiap bagian ba'a% sisi kepala di belakang mata. Bisa ular tidak %anya terdiri atas satu substansi tungga tunggal l tetapi tetapi merupa merupakan kan campur campuran an k&mple k&mpleks ks terutam terutamaa pr&tein pr&tein yang yang memili memiliki ki aktivitas enzimatik.
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;lar !enis %em&litik %em&litik termasuk termasuk dalam keluarga keluarga *r&taluidae *r&taluidae sering disebut disebut !uga keluarga pit viper yaitu +attelesnaker +attel esnaker 0cr&talus2 ular 9&pper%ead 0Angkis"8r&d&n2 0Angkis"8r&d&n2 (e!ala yang ditimbulkan ). #aera% yang digigit dalam 'aktu 6": menit akan membengkak %ebat dan ter!adi ganggr ganggren. en.
Hal ini diseba disebabka bkan n ular ular itu selalu selalu mengel mengeluar uarkan kan racun racun dan dan enzim enzim
pr&te&litik. 1. sakit yang %ebat di daera% gigitan 6. daera% yang di%ancurkan menembus dinding pembulu% lalu berkumpul di !aringan sekitarnya 5. Sakit kepala %ebat dan %aus
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C. Etiologi
Secara garis besar ular berbisa dapat dikel&mp&kkan dalam 6 kel&mp&kJ 9&lubridae 0Mangr&ce cat snake B&iga dendr&p%ilia dan lain"lain2 J Elapidae 0*ing c&bra Blue c&ral snake Sumatran spitting c&bra dll2 J ,iperidae ,iperidae 0B&rne& green pit viper Sumatran pit viper dan lain"lain2. lain"la in2. Bisa Bisa ular ular dapat dapat menye menyebab babkan kan peruba peruba%an %an l&cal l&cal seperti seperti edema edema dan pendar pendara%a a%an. n. Banyak bisa yang menimbulkan peruba%an l&cal tetapi tetap dil&kasi pada angg&ta badan yang tergigit. Sedangkan beberapa bisa Elapidae tidak terdapat lagi dil&kasi gigitan dalam 'aktu C !am . #aya t&ksik bisa ular yang tela% diketa%ui ada 1 macam a. Bisa ular yang bersi$at racun ter%adap dara% dara% 0%emat&Dic2
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J
Neur&t Neur&t&ks &ksinin- berakiba berakibatt pada pada sara$ sara$ peri$er peri$er atau sentral. sentral. Berakibat Berakibat $atal karena karena
paralise &t&t"&t&t lurik. Mani$estasi Mani$es tasi klinis- kelumpu%an &t&t perna$asan kardi&vaskuler yang terganggu dera!at kesadaran menurun sampai sa mpai dengan k&ma. J Haem&t&ksin- bersi$at %em&litik dengan zat antara $&s$&lipase dan enzim lainnya atau menyebabkan k&agulasi dengan mengakti$kan pr&tr&mbin. Perdara%an itu sendiri sebagai akibat lisisnya sel dara% mera% karena t&ksin. Mani$estasi klinis- luka bekas gigitan yang terus berdara% %aemat&m pada tiap suntikan IM %ematuria %em&ptisis %ematemesis gagal gin!al. J My&t&k My&t&ksin sin-- mengak mengakiba ibatka tkan n r%abd& r%abd&mi& mi&lisi lisiss yang yang sering sering ber%ub ber%ubung ungan an dengan dengan m%aem&t&ksin. My&gl&bulinuria yang menyebabkan kerusakan gin!al dan %iperkalemia akibat kerusakan sel"sel &t&t.
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K +asa sakit pada pada &t&t"&t&t dinding perut perut K #emam K *eringat dingin •
Luka bekas patukan yang yang terus berdara% berdara%
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seperti ini sebagai tanda ba%aya bagi petugas kese%atan untuk memberi pet&l&ngan segera. 6. E$ek sistemik spesi$ik E$ek sistemik spesi$ik dapat dibagi berdasarkanJ *&agul&pati
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))
= ==
==
)1 4 1: cm/)1 !am
Neur&t&ksik pusing mual sy&k
)))
= ==
===
?1: cm/ )1 !am
Pendara%an kulit sy&k
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