Update manajemen

snakebite
Dr.dr.Tri Maharani Msi SpEm

BIODIVERSITY OF INDONESIAN
SNAKE
Wallacea

Papua New
Guinea
Sundaland
 ➢
Snakebites data
Data : 135.000/year incidence
➢ mortality over 10% people per year
➢ Cases report in ITS : 500-1000 cases,kematian
50-100 dari data ITS

Indonesia memiliki biodiversitas yang tinggi untuk ular berbisa

Namun kasus gigitan ular yang dilaporkan* masih jauh dari angka yang seharusnya

6 spesies (Australian
elapidae)

*periode 2015 - 2021

 Snake families and general venom effects

Venomous Snake families

Elapidae Hydrophiidae Viperidae Colubridae

Neurotoxin Cytotoxic
Neurotoxic
Myotoxic Myotoxic Coagulopathic
(bungarus sp),calliophis
Renal toxicity Coagulopathic
+cytotoxic in cobra & king
cobra
+ coagulopathy in
Australasian elapids

Indonesia
Total snake species : 350
Venomous snake species:
•Elapidae: 55
•Viperidae: 21
•Colubridae: 1
Pictures of venomous snakes found in Irian
Jaya

Micropechis ikaheka Acanthophis laevis Pseudoechis papuanus

Pseudoechis rossignolii

Pseudonaja textilis Oxyuranus scutellatus

Sea krait and sea snakes

Sea krait Beaked sea snakes Spine-bellied sea snake

Laticauda colubrina Hydrophis schistosa Hydrophis curtus
 Berbisa

Tidak Berbisa

Non venomous
 Hasil bekas gigitan pada
ular tidak berbisa
berbentuk V.appertum
dan V .abrasio

venomous
Bekas
gigitan ular
berbisa
yaitu
tusukan
atau
V.ictum
First aid
Step terapi (1)
Terapi kegawatdaruratan
• 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
• Circulation
• Make iv access, give Normal Saline 0.9% (don’t forget
to take some blood for laboratory checking)
• Blood pressure
• Pulse
Step terapi (2)
Fase Lokal dan sistemik
Jika fase local :
-First aid:
• Imobilisasi :
• A.imobilisasi
• B.PBI
• C.Pads Pressure imobilisasi
• Simptomatis (analegesik dan antivomit dsb)
-Sistemik:
• Antivenom :
• BiosaveG OF CHOICE
• 2 vials SABU + 500mml Normal saline 0.9% dripped

Snake antivenom in Indonesia

Snake Antivenom
Monovalent Polyvalent

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Step terapi(3)

• Anticholinesterase drugs
• Especially for neurotoxin envenoming
• Should give atropine before giving the drugs to prevent physostigmine
intoxication.
• Physostigmine dose
• Adult (>12 yo) : 0,5-2,5 mgevery 1-3 hours up to 10 mg/24hours
• Children ≤ 12 yo : 0.01 mg-0,04/kg
• Should be given slowly 3-5 minutes by IV /IV/SC repeat 2-4 hours
• Atropin inj bradikardia

Neurotoksin(julian
whie,2016)
Haemotoxin system

Venom oftalmia
Mitos ,mistis

20 wbct dan RPP alat penunjaang diagnose gigitan ular

wound care snakebite
dan rehabilitasi
gigitan ular
Death adder cases