Materi KePPo #2, Penanganan Gigitan Ular PDF
Materi KePPo #2, Penanganan Gigitan Ular PDF
Materi KePPo #2, Penanganan Gigitan Ular PDF
SNAKE HANDLER
Relawan SIOUX = Muscle SIOUX
• Area Jawa Barat = 70 muscles
• Area Jakarta = 40 muscles
• Area Banten = 13 muscles
• Area Jawa Tengah = 27 muscles
• Area DIY = 78 muscles
• Area Jawa Timur = 38 muscles
• Area Bali NTB NTT = 20 muscles
• Area Kaltim = 9 muscles
• Area campur = 18 muscles
Profil Trainer Utama
1. Komisaris PT Satu Benih Organik
2. Direktur Utama CV LareAngon Indonesia
3. SIOUX
1. Salah satu Pendiri SIOUX
2. Ketua Yayasan SIOUX Ular Indonesia
3. Sertifikasi Trainer Utama, Yayasan SIOUX Ular
Indonesia, Pemateri ular sejak tahun 1998 dengan
lebih dari 1000 jam Sebagai Trainer
4. Sertifikasi BNSP AJI RACHMAT P, ST
1. “Fasilitator Experiential Learning level Utama (Programmer)”
2. Sertifikasi BNSP “Pemandu Wisata Gunung level Madya” 08176800446
3. Sertifikasi BNSP “Tour Guide” @aji_rachmat
4. Sertifikasi BNSP “Asesor Kompetensi”
5. Instruktur Kegiatan Alam Terbuka &Pembina Pramuka
6. Pendamping Host Petualangan Liar TV7, Jejak Petualang
Trans7, Host Sang Pawang Lativi
Mengapa Ular ada di
sekitar Pemukiman ?
Mengapa ular ?
Mencari makanan
Highly-venomous Snakes
Tropidolaemus wagleri
Highly-venomous Snakes
Rhabdophis subminiatus
Highly-venomous Snakes
Caliophis bivirgata
Highly-venomous Snakes
Caliophis intestinalis
Highly-venomous Snakes
Penanganan
Gigitan Ular
Update WHO 2016
NEW SITUATION OF SNAKEBITES
MANAGEMENT IN INDONESIA
DR. dr. Tri maharani Msi,
SpEM
Medically important snakes in
Indonesia
Australasian
snake species
South East
Asian snake
species
Ophiophagus hannah
Naja sputatrix
• Viperidae 2
• Elapidae 3 Bungarus candidus
• Hydrophidae 4
Indonesia
Total snake species :
348.
Venomous snake
species:
• Elapidae: 55
• Viperidae: 21
• Colubridae: 1
Snake families and general venom
effects
Venomous
Snake families
• Data
• First Aids
• Transportation
• Doctors and nurses skills (A,B,C)
• Antivenom availability
Snakebites cases in Indonesia
from 2012-2018
200
180
160
140
120 disease
100
80
60
40
20
0
HIV snakebites cancer
In hospital mortality
20
18
16
14
12
10 2016
8
6 2017
4 2018
2
0
HUMAN LYMPHATIC DRAINAGE
PBI
First aid
FIRST AID
100%
90%
80%
70%
60%
CASES 2012
50%
CASES 2016
40%
30%
20%
10%
0%
WHO TRADDISIONAL
CLINICAL MANIFESTATION
LOCAL SYSTEMIC
• Swelling > half bitten • Haemostatic abnormality
limb/48 hours • Neurotoxic signs
• Toes especially fingers • Cardiovascular
• Rapid extension within a abnormalities
few hours • Acute kidney injury
• Enlarged tender lymphnode • Myoglobinuria/generalised
draining the affected area rhabdomyolysis/haemolysis
• Supporting lab evidence of
systemic envenoming
RESULT
A. MILD : 1-2 mm
B. MODERATE : 3 mm
C. SEVERE : 4 mm
MONITORING
• Vital sign (BP, RR, Pulse, temp)
• Complain
• Pain score
• RPP test
• Bitten area evaluation
TREATMENT (1)
Keep the Airway Breathing and Circulation
stable
• Airway
• 02 Non Re-Breathing Mask 12 lpm
• Laryngeal Mask Airway and Endotracheal Tube (if
needed)
• Suction if gargling (+), Head tilt and chin lift if
snoring (+)
• Breathing
• Evaluate the respiratory rate
TREATMENT (2)
• Immobilize bitten area by using Pressure
Bandaging Immobilization
• Antivenom : DRUG OF CHOICE
• If the snake that bite the patient include in 3
snakes which are covered by the SABU, we can give
SABU quickly
• 2 vials SABU + 500mml Normal saline 0.9% dripped
0-80 drop permminute hemotoxin bites
• Repeated every 6 hours. BE AWARE TO RE-
ENVENOMATION SIGN!!!
• Symptomatic
TREATMENT (3)
• Anticholinesterase drugs
– Especially for neurotoxin envenoming
– Should give atropine before giving the drugs to
prevent physostigmine intoxication.
– Physostigmine dose
• Adult (>12 yo) : 1.0-2.0 mg
• Children ≤ 12 yo : 0.02 mg/kg/dose (max single
dose 0.5 mg)
– Should be given slowly 3-5 minutes by IV
push,repeat every 4 hour
Neurotoksin(julian
whie,2016)
Haemotoxin system
In hospital length of stay
30
25
20
no AV
15
AV
10
0
neuro hemato necro nefro
Cost for in hospital patients given AV
versus not given AV
300
250
200
non AV
150 AV
Column1
100
50
0
neuro hemato necro nefro
Sequele of snakebite cases
100%
80%
60%
40% sequele
20%
0%
hemato
neuro
nefro
necro
20 MINUTES WBCT
• Aim : to make sure hemotoxin or not by
knowing from the coagulation.
• How to do?
– Take a glass bottle, DO NOT USE PLASTIC BOTTLE
– Take 2 ml of blood
– Then take that blood into the glass bottle
– Wait for about 20 minutes
– Repeat that test 2 times minimal
– Result :
• After waiting about 20 minutes:
Rate Proximal Progression Test
• Aim : to evaluate the edema progression to make a
best next medical treatment.
• How to do?
– Take a tape as a mark to measure the edema
– Make sure the proximal margin of the edema, then take
the distal margin of the tape into the proximal margin of
the edema.
– Note the time when the tape was given (date and time)
– Repeat the evaluation of the edema every 2 hours
– Result : cm/hour
– Example : 10/10/15 ; 09.00 – 11.00 = 4 cm. So we have
evaluated that the edema increase about 2 cm per hour.
How to do RPP Test?
5 cm / 2 hours, so
5 cm RPP = 2.5 cm/hour
HOW TO MANAGE SNAKE BITE CASE
OUT OF HOSPITAL?
• HOME
– DO NOT PANIC
– DO NOT GIVE CONSTRICTING BAND (TORNIQUET),
SUCKING, or OTHER TRADITIONAL TREATMENT
– IMMOBILIZE BITTEN AREA (will be discussed)
– SEND TO PRIMARY HEALTH CARE OR EMERGENCY
DEPARTMENT
– BRING DEAD OR ALIVE SPECIMENT OR SNAKE
PHOTO INTO EMERGENCY TO BE IDENTIFIED TO
GIVE A SUITABLE ANTIVENOM
• PRIMARY HEALTH CARE
– DO GENERAL EXAMINATION, MAKE IT STABLE !
What next???
• Net working
• Standard guideline
• Education & Training
• Drug & management ABC
•Antivenom
MoU MST and TSI
• Education, training, research
• During AMSEM Jogjakarta 2018
WHO Guideline 2016 and Guideline of
Poisoning Management 2017
RECS Indonesia consultations
800
700
600 2014
500 2015
2016
400
2017
300
2018
200
100
0
snakebite
Donation of BioCSL Australia neuropolyvalent antivenom to Sorong Hospital and training of
snakebites management 100 doctor in Sorong, West Papua.
Snake antivenom in Indonesia
SNAKE ANTIVENOM
MONOVALENT POLYVALENT
Cobra bite
Trimeresurus bite (local phase)
Trimeresurus bite
(hemotoxin, systemic phase)
Calloselasma
bites
NeurotoXin SNAKEbite
Klinik Heroku
Venom oftalmia
0817-6800-446
@ular_indonesia
siouxindonesia.org