Animal Poisoning
Animal Poisoning
Scorpion
Neurotoxin
Asetilkolinesterase, hialuronidase, serotonin, fosfolipase A2
Acts on neuronal synapse and neuro-muscular junction
Increased neuron sodium permeabilityNeurotransmitter release at synapses
Increased acetylcholine release at neuromuscular junction
(Centuroides sculpturatus)
Gejala : nyeri lokal, rasa terbakar
Sistemik : diplopia, nistagmus, hipereksitabilitas,opistotonus, hipersalivasi, takikardi, kejang
Dekontaminasi
Antidotum : serum scorpion (polivalen)
SnakeNeurotoxins: have the ability to damage and or destroy nerve tissues
Cobra & Coral snake
Haematoxins: affects the blood and causes Haemolysis and Hemorrhage
Vipers
slower and more painful than the neurotoxin
• Myotoxins: these cause muscle pain and turn urine brown to black because of the protein Myoglobin that is present
• Sea snake
• There are no symptoms really.
• Just severe upper body pain and urine changes to brown black color
Coral snake copperhead
Western Diamondback Rattlesnake
Sea Snake
Black Spitting Cobra
Ptosis in victim of Coral Snake bite
Bite from a Western Diamondback Rattlesnake
TINGKAT
KERACUNANGEJALA / TANDA
KLINIK
TERAPI
0. Tidak keracunan Abrasi, lobang gigitan,
nyeri, bengkak ringan
Perawatan luka lokal,
tidak perlu ABU
I. RINGAN Nyeri, bengkak, parestesi
perioral bisa muncul
Jika perlu ABU dapat
diberikan 5 vial
II. SEDANG Nyeri, bengkak, eritema,
gejala sistemik kadang
muncul, koagulopati ringan
ABU 5 – 15 vial
III.BERAT Nyeri berat, bengkak seluruh
ekstrimitas, gejala sistemik
berat, koagulopati
ABU minimal 15 –
20 vial
IV.MENGANCAM
HIDUP
Gejala dan tanda yang
sangat berat, koagulopati
berat
ABU minimal 25 vial
KERACUNAN SISTEMIK
Kelainan Hemostatik perdarahan spontan sistemik, koagulopati, trombositopeni
Neurotoksik ptosis, eksternal opthalmoplegi, paralysis
Kelainan Kardiovaskuler hipotensi, shock, aritmia, EKG abnormal
Gagal ginjal akut oliguri, anuri, peningkatan ureum, kreatinin
Hemoglobin/mioglobinuria urin warna coklat gelap, dipstick
Kelainan laboratorium 20 WBCT > 20 menit, peningkatan atau penurunan hematokrit
KERACUNAN LOKAL
Pembengkakan > ½ bagian tanpa torniket
Pembengkakan jari setelah digigit jari kaki atau tangan
Pembengkakan yang cepat dalam beberapa jam bengkak sudah sampai pergelangan tangan atau kaki sesuai
tempat gigitan
Pembengkakan limfonodi
Tindakan pada gigitan ular
menjauhkan dari tempat kejadianmenjaga agar tetap hangatmeletakkan bagian tubuh yang tergigit lebih rendah dari jantungimobilisasiPasien gigitan ular harus dikirim ke unit gawat darurat untuk :
pembersihan luka pemberian toksoid tetanus pemberian cairan intravena pemeriksaan laboratorium
(Jucket & Hancock ,2002)
Pertolongan pertama
transport ke rumah sakit
pemeriksaan klinik secara cepat dan resusitasi
pemeriksaan klinik teliti dan menyeluruh serta diagnosis jenis ular
pemeriksaan laboratorium
pemberian anti bisa ular (ABU)
observasi efek pemberian ABU dan penentuan perlu tidaknya pemberian ABU ulangan
terapi suportif, terapi untuk bagian yang tergigit
rehabilitasi
terapi komplikasi kronik(Jucket & Hancock ,2002)
Pemeriksaan laboratorium
pemeriksaan darah rutin
angka trombosit
prothrombin time (PT)
activated partial-thromboplastin time(APTT)
fibrinogen
fibrin degradation products (FDP)
elektrolit
blood urea nitrogen (BUN)
kreatinin serum
urinalisis
Test mudah:
Test 20 WBCT : teteskan beberapa mililiter darah penderita kedalam tabung dan dibiarkan 20 menit.
Jika dalam waktu 20 menit masih cair berarti terdapat hipofibrinogenemi akibat racun ular.
SABU (Serum Anti Bisa Ular) polivalen 1 ml berisi:1. 10-50 LD50 bisa Ankystrodon2. 25-50 LD50 bisa Bungarus3. 25-50 LD50 bisa Naya sputarix4. Fenol 0,25% v/v.
Teknik Pemberian:2 vial @ 5 ml dalam 500 ml NaCl 0,9 % atau Dextrose 5%, 40-80 tetes per menit. Maksimal 100 ml (20 vial).
Venom Extraction (Milking)
How to Make AntiveninMilk the snake (make sure it has venom in it)
Inoculate a horse and let it build up antibodies to the it, this neutralizes the venom
Collect your horse serum with antibodies against toxins
Make sure your batch of antivenin is injected into infected blood stream within an hour, if not, you could be to late
WARNING: Antivenin only blocks further damage, it can’t undo whats already been done
SIDE EFFECTS: Could cause an allergic reaction ( i.e. serum sickness from the horse proteins)
Medicinal Value of Snake Venom
In the olden days, rattlesnake venom was administered by mouth and lotions to humans with leprosy. It was thought that the toxin that made the snakes wounds heal when it shed would also help humans. This was unsuccessful.
In 1994, it was found that certain proteins found in Copperhead venom helped to inhibit cancer cells from metastasizing
Copperhead venom has also been found to contain anticoagulants that are able to dissolve blood clots that cause strokes and heart attacks.
Two drugs that have been made from snake venom are Aggrastat, given to heart attack victims, and Ancrod, being tested for stroke victims.
Black widow
Neurotoxic venom
More potent than pit viper venom
Binds to nerve-ending calcium channelsTriggers neurotransmitter release
Blocks neurotransmitter re-uptake
Inhibits normal nerve impulse transmission
Produces low serum calcium
TreatmentAntivenin indicated for:
Hypertensive reactions
Acute respiratory distress
Jellyfish
Stinging cells (nematocysts) in tentacles
Intense, burning pain
Red, hemorrhagic lesions
Nausea, vomiting
Fever, chills
Respiratory distress, wheezing, stridor
Hypotension, shock
Cardiovascular collapse
Venomous FishSting ray
Scorpionfish (Lion fish, Stonefish)
Sea UrchinsImmerse injured area in hot water
Use acetic acid to dissolve embedded spines
Larger spines may require surgical removal
Hymenoptera
Bees, wasps, hornets, yellowjackets, ants
ProblemsAllergic reactions
Anaphylaxis
Toxic venom effects (rare)
Local reactionSharp, burning pain
Itching
Edema
Extensive reactions may involve entire extremity
Stings to tongue/throat may cause loss of airway
Systemic reactionsImmediate
Mild: Diffuse itching, urticaria, swelling distant from sting site, flushingSevere: Laryngeal edema, severe bronchospasms, profound hypotension
Delayed1 to 48 hours after stingMay be life threatening
TreatmentImmediate
Remove stinger (scrape)Manage airwayOxygenSupport BP with fluidEpinephrineAntihistaminesSteroid