Penatalaksanaan Gigitan Ular Berbisa

PENATALAKSANAAN GIGITAN ULAR BERBISA Oleh : Purwo Suwignjo, SKp.

PENDAULUAN   

In!i"en!i : USA : #$$$ %&!u!'(&hun )# * "igigi( "i e%!(re+i(&! E(iologi : $ * : R&((le!n&%e

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

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 !low re&8(ing !u/!(&n8e

9eni! ul&r /er/i!& /er"&!&r%&n -&+ilin& 

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-&+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

ULAR BERBISA ;ANG BAN;AK DI INDONESIA 

E7ATOTOKSIK: 

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Tri+ere!uru! &l/ol&ri! 5ul&r hij&u6  An%ri!(ro"on rho"o!(o+& 5ul&r (&n&h6

NEUROTOKSIK : 

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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(

IRI2IRI ULAR BERBISA   

Ben(u% %ep&l& !egi (ig& Du& gigi (&ring /e!&r "ir&h&ng &(&! Du& lu%& gigi(&n u(&+& &%i/&( gigi (&ring

GE9ALA KILINIS 

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LOKAL : e"e+&, neri, neri (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 neri %ep&l&

GE9ALA KUSUS 

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E7ATOTOKSIK :per"&r&h&n "i(e+p&( gigi(&n, pul+o, j&n(ung, ginj&l, peri(oniu+, o(&%, gu!i, he+&(he+e!i!, +elen&, %uli(, he+op(oe, he+&(uri&, DI (Diasseminated Intravascular Coagulation) NEUROTOKSIK : iper(oni%, 0&!o%ul&!i, p&re!i!, p&r&li!i! pern&0&!&n, p(o!i!, P&r&li!i! o(o( l&ring, re0le% &/nor+&l, %ej&ng "&n %o+& KARDIOTOKSIK : ipo(en!i, hen(i j&n(ung SINDRO7A KO7PARTE7EN

KALIS-IKASI 5+enuru( S8hw&r(16 

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DERA9AT $ : lu%& , neri '2, e"e+&' eri(e+&  =8+'C? j&+ DERA9AT I : Lu%& , neri , e"e+&'eri(e+& = > C? 8+'C? j&+ DERA9AT II : Lu%& , neri , e"e+&'eri(e+& C? > ?3 8+'C? j&+, neuro(o%!i%, pu!ing, +u&l !o% DERA9AT III : Lu%& , nrei , e"e+& eri(e+&  ?3 8+'C? j&+, Per"&r&h&n %uli(, !o% DERA9AT I : Lu%& , neri , e"e+&'eri(e+&  e%!(re+i(&! GGA, %o+&, per"&r&h&n

GA7BARAN KLINIS 

GIGITAN ELAPIDAE 

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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"enu(, %&%u p&"& %elop&% +&(&, /eng%&% "i!e%i(&r +ulu(, %eru!&%&n p&"& l&pi!&n lu&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

GIGITAN IPERIDS 

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E-EK LOKAL : C3 +eni( > /e/er&p& j&+: /eng%&% "&n !&%i( "e%&( gigi(&n "&n 8ep&( +ene/&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

GIGITAN ;DROPIDS 

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GE9ALA EPAT : !&%i( %ep&l&, li"&h (er&!& (e/&l, /er%ering&( "&n +un(&h SETELA =$ +eni( > /e/er&p& j&+: %&%u "&n neri +eneluruh, !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

PE7ERIKSAAN PENUN9ANG 

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LAB :/, (, T, Kr, Ure& N, ele%(roli(, BT'T, PT'APTT, D2"i+er, (e! 0&&l hep&r, 8ro!! +&(8h EKG TORAF -OTO

PENATALAKSANAAN 

TU9UAN 

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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%

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%&

PEDO7AN PE7BERIAN SABU 5S8hw&r(1, &6 

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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

PENATALAKSANAAN 

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7oni(or %e!ei+/&ng&n 8&ir&n "&n ele%(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&ngi pe+/eri&n SABU, ul&ngi l&/ !e(el&h C > =  j&+ Ter&pi pro0il&%!i! : ATS, TT, AB !pe%(ru+ lu&!

PENATALAKSANAAN 

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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