UPDATE MANAJEMEN

SNAKEBITE
Dr.dr.Tri Maharani Msi SpEM (K) toxino
BIODIVERSITY OF INDONESIAN SNAKE

Wallacea

Papua New
Guinea
Sundaland
Snakebites data
 Data : 135.000/year incidence
 mortality over 10%incidence (50-100 ITS data )
 Cases report in ITS : 500-1000 cases
 INDONESIA MEMILIKI BIODIVERSITAS YANG TINGGI UNTUK ULAR BERBISA
Namun kasus gigitan ular yang dilaporkan* masih jauh dari angka yang seharusnya

6 spesies (Australian elapidae)

4
*periode 2015 - 2021
SNAKE FAMILIES AND GENERAL VENOM EFFECTS

Venomous Snake families

Elapidae Viperidae
Colubridae
Hydrophiidae

Neurotoxin Cytotoxic
Neurotoxic
Myotoxic Myotoxic
(bungarus sp),calliophis Coagulopathic
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 PAPUA

Micropechis ikaheka Acanthophis laevis Pseudoechis papuanus

Pseudonaja textilis Oxyuranus scutellatus Pseudoechis rossignolii

WEST PAPUA
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
V APERTUM DAN
VULNUS ABRASIO
VENOMOUS
VULNUS ICTUM
First aid
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
• Circulation
• Make iv access, give Normal Saline 0.9% (don’t forget to take some blood for laboratory checking)
• Blood pressure
• Pulse
• Oxygen saturation by using pulse oxymetri
• Blood or Fresh Frozen Plasma as indicated
TREATMENT (2)

• fase local and sistemik

• Lokal:
• 1.imobilisasi: dengan spalk saja (ular tidak diketahui jenisnya atau selain neurotoxin dan daboia
sp

• Jika neurotoxin efek venomnya maka PBI (pressure bandage immobilisation)

• Jika jenis daboia :pads pressure immobilization

JIKA FASE SISTEMIK ATAU FASE LOKAL PROGRESIF

 1.menentukan species
 2.menentukan antibisa (sabu) sesuai species

20
Snake Antivenom
Monovalent Polyvalent
EXAMPLES OF AVAILABLE ANTIVENOMS FOR
PAPUAN-AUSTRALIAN VENOMOUS SNAKES
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 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

TREATMENT (3)
Neurotoksin(julian
whie,2016)
Haemotoxin system
Venom oftalmia
MITOS ,MISTIS
 TN G/28TH DEATH ADDER
/ACANTHOPIS CASE
DEATH ADDER CASE
HARI KE 2
HASIL LAB HR KE 3
 Analisa gigitan ular
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