Case Snake Bite

7/23/2019 Case Snake Bite

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SNAKE BITE

Oleh:

MUHAMMAD JAUHARIL WAFINarasumber:

dr. Saleh

RSUD ADJIDARMO LEBAK


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IDENTITAS

Nama : Tn. S

Usia : 45 tahun

Jenis kelamin : Laki-lakiAlamat : Kp. Pasir eurih

Agama : Islam

Suku bangsa : Suna

Peker!aan : Petani"kebun


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ANAMNESIS

# Keluhan Utama$S atang ke I%& engan keluhan igigit ular paa

tangan kanan kira-kira ' !am sebelum masukrumah sakit (S)*S+

# Keluhan tambahan

$S !uga mengeluhkan setelah igigit ular merasalemas, pusing, neri paa bekas gigitan an mual

serta terapat luka melepuh paa sekitar bekasgigitan ular tersebut


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R!a"a# $e%"a Se&ara%'

OS me%'a#a&a% bah!a d''# ular saa#seda%' be&er(a mem)#)%' rum*u#d&ebu%+ ular #ersebu# me%'''##a%'a% &a%a%%"a *ada ba'a% (ar

#e%'ah da% (ar ma%s.Be&as ''#a% #erasa %"er+ mele*uh*ada sear%"a da% )s me%'eluh&a%lemas+ *us%' da% mual.

Lu&a d#u#u* de%'a% &a% da% d#e&a%u%#u& me%'ura%' &eluar%"a darah&emuda% )s dba!a &e I,D rumah

sa da% me%da*a#&a% *era!a#a%


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- Saa# d*er&sa d rua%'a% #am*aa%'a% &a%a% #er#u#u* &asa+ se#elahdbu&a #a%'a% &a%a% se#%'' s&u

be%'&a& ber!ar%a &emeraha% da%dser#a bebera*a lu&a mele*uhdsear%"a

- $ase% me%"a%'&al ada%"a mmsa%+mu%#ah darah+ sesa&+ &elemaha%&a&+ &e(a%'

- BAB da% BAK dalam ba#as %)rmal


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- Os me%'a#a&a% ular "a%'me%'''#%"a meru*a&a% ular #a%a%

ber!ar%a )&la# de%'a% bela%'&e&u%%'a%+ ular #ersebu# lar se#elahme%'''#.


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R!a"a# $e%"a Dahulu

- ,'#a% sera%''a a#au ularselum%"a dsa%'&al

- R!a"a# HT /01 *e%')ba#a%#da& #era#ur

- DM+ aler'+ as#ma dsa%'&al


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$EMERIKSAAN FISIK

Status %eneralis

-Keaaan umum : Tampak sakit seang

-Kesaaran : /mp/s )entis

-Tana 0ital2Tekanan &arah : 123"3mmg

2Nai : 2 6 " menit

- Pernapasan : '3 kali " menit

2Suhu : 78.' 3


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La%(u#a%...# Kepala

n/rm/9ephali

# )ata

k/n!ungtia pu9at (-"-+, sklera ikterik (-"-+, pupil is/k/r,

re;leks 9ahaa langsung an tiak langsung (


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La%(u#a%...Paru

I%s*e&s : *er'era&a% dada sme#rs saa# s#a#s da%d%ams

$al*as: 3)&al 4rem#us #eraba sama d &edua la*a%' *aru

$er&us: s)%)r d &edua la*a%' *aru

Aus&ul#as: suara %a*as 3es&uler d &edua la*a%' *aru+rhonki 252+ wheezing252

Jantung

I%s*e&s : us &)rds #da& #am*a&

$al*as: us &)rds #eraba d I6S 7 l%ea md&la3&ula

s%s#ra$er&us :

Ba#as &a%a% : I6S I7 l%ea *aras#er%als de&s#ra

Ba#as &r : I6S 7 l%ea md&la3&ulars s%s#ra

$%''a%' : I6S III l%ea *aras#er%als s%s#raAus&ul#as: BJ I da% II re'ular+ murmur /21+ gallop/21


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La%(u#a%...

AbdomenI%s*e&s : Da#ar+ su*el+ &ela%a% &ul#/21

be%()la% /21

Aus&ul#as : Bs%' usus /01 N

$er&us : Sh4#%' dull%ess /21$al*as : N"er #e&a% /21


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E&s#rem#as

S#a#us l)&als+ e# re') d'# III2I7 ma%usde8#ra:

-Look :

#am*a& lu&a ''#a% /fang marks1+edema /01+ *erdaraha% a /21+ bullae /01+*e#e&e /21

-Feel:

$erabaa% ha%'a#+ %"er #e&a% /01+ a.radals/01

-Movement:

Range of Movement#erba#as &are%a %"er


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S#a#us l)&als


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LABORATORIUMPemeriksaan Hasil Satuan Nilai

Rujukan

Hematologi

Hemoglobin 11,2 gr/dl 10,7 14,7

Hematokrit 34 % 31 43

Leukosit 13 ribu/ul 5,5 15,5

Trombosit 25 ribu/ul 150 440

!ritrosit 5,57 "uta/ul 3,70 5,70

Hemostasis

#$TT 55,3 et 33,& ' 43,(

)ontrol #$TT 25'42,1 et '

$T 1&,2 et 12,1 14,5

)ontrol $T ,'11,( et '

*+ 1,4& '


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DIA,NOSIS KERJA

S%a&e B#e ,rade III


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$ENATALAKSANAAN

I7FD : RL 9 5 ;< (am I7.SABU ; 3al dalam Nal ;5= (am

Am*l% >89 m' /31

Te#a'am$arae#am)l ?8


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Prognosis

@u) ad 3#am :b)%am

@u) ad 4u%'s)%am :

b)%am@u) ad sa%a#)%am: b)%am


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TINJAUAN PUSTAKA


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,'#a% Ular

Terapat lebih ari 7333 spesies ulari seluruh unia an 785 iantaranaaalah ular berbisa ;amili =lapiae,5-r/piiae, atau 0iperiae.

)isal : ular tanah (.all/selasmarh//st/ma+, ular sen/k (Na!a sumatrana+,an ular king k/bra ($phi/phagus hannah+.

-H. uidelines or te linial anagemento 6nake bite in te 6out'!ast #sia egion 2005

Jur&)3h+,re')r" J+ ,e%#lell)+Larr" M. E%3e%)ma#)% a%d E%3r)me%#al I%(ures % ,ree%elds Sur'er": Se%# $r%*les a%d$ra#e.ed :Mulh)lla%d e# all.>#hed#)%. L**%)## Wllams C Wl&%s.ha*#er ??.


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SNAKE BITE


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$a#)'e%ess da% *a#)s)l)'


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Ta%da da% ,e(ala

Ta%da ''#a% #ar%' /fangmarks1+

,e(ala l)&al : edema+ %"er#e&a% *ada lu&a ''#a%+e&m)ss /dalam ? me%# (am1

,e(ala ss#em& : h*)#e%s+

&elemaha% )#)#+ ber&er%'a#+me%''l+ mual+ h*ersal3as+mu%#ah+ %"er &e*ala+ da%*a%da%'a% &abur


urko8i,regor9 , entilello,Larr9 !n8enomation and !n8iromental *n"uries in reenield:s 6urger9; 6ientii $rini


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,EJALA KLINIS

Dera(a# 7e%eras Lu&a

''#

N"er Udem5 Er#em Ta%da ss#em&

0 052 ?m5;


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$e%a#ala&sa%aa%

La%'&ah2la%'&ah *e%a#ala&sa%aa% ''#a%ular mel*u# /WHO+ .$e%laa% &l%& le%'&a* da% da'%)ss

9.$emer&saa% lab)ra#)rum=.Obser3as res*)% #erhada* a%#3e%)m/ me%e%#u&a% a*a&ah d*erlu&a%

*e%ambaha% d)ss a%#3e%)m1.Tera* su*)r#4.$e%a#ala&sa%aa% *ada ba'a% lu&a''#a%

.Rehabl#as-H. uidelines or te linial anagemento 6nake bite in te 6out'!ast #sia egion 2005


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$er#)l)%'a% *er#ama

Tu(ua% *er#)l)%'a% *er#ama :Me%'ura%' abs)rbs bsa ularseara ss#em&

Me%"elama#&a% &ehdu*a% da%me%e'ah &)m*l&as sebelum *ae%me%erma *e%')ba#a% seara meds/ d rumah sa a#au &l%&1

Mere%a%a&a% #ra%s*)r#as *ase%&e #em*a# dma%a *ase% da*a#mem*er)leh *e%a#ala&sa%aa%meds.



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$er#)l)%'a% *er#ama

Hal2hal "a%' #da& da%(ur&a%/WHO+


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$er#)l)%'a% $er#ama

Te%a%'&a% *ase%

me#)depressure immobilisation

h%dar berba'a #%da&a%%#er3e%s *ada lu&a ''#a%&are%a a&a% me%%'&a#&a%

%4e&s+ me%%'&a#&a% abs)rbsbsa ular da% *erdaraha% l)&al.



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Tra%s*)r#as &e Rumah

Sa- Ba!a *ase% &e rumah sa

/#em*a# dma%a *ase%da*a# me%da*a#&a%*e%a#ala&sa%aa% meds1

- Im)blsas+ &ura%'*er'era&a%


$ l & d


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$e%a#ala&sa%aa% dRumah sa

$rmar" sur3e"

2 Ar!a"

2 Brea#h%'

2 6rula#)%

2 Dsabl#"Se)%dar" Sur3e"



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$emer&saa% $e%u%(a%'


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$embera% serum A%# Bsa

UlarSABU mmu%)'l)bul%"a%' dmur%&a% dar serum

a#au *lasma &uda a#au&amb%' "a%' #elahdmu%sas de%'a% bsa ularsa#u a#au lebh s*eses ular

SABU :2 M)%)3ale%2 $)l3ale%


Jur&)3h+,re')r" J+ ,e%#lell)+Larr" M. E%3e%)ma#)% a%d E%3r)me%#al I%(ures % ,ree%elds Sur'er": Se%# $r%*lesa%d $ra#e.ed :Mulh)lla%d e# all.>#hed#)%. L**%)## Wllams C Wl&%s.ha*#er ??.


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$embera% serum A%# BsaUlar

I%d&as :2,e(ala ss#em&

2 ,e(ala hema#)&s&

2 'e(ala %eur)#)&s&2 ,e(ala &ard)#)&s&2 'e(ala 'a%''ua% 4u%'s '%(al2 hem)'l)b%ura

2,e(ala l)&al :

2 *embe%'&a&a% l)&al2 *embe%'&a&a% "a%' meluas

de%'a% e*a#

2 &e#erlba#a% *embuluh lm4e-H. uidelines or te linial anagemento 6nake bite in te 6out'!ast #sia egion 2005


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$embera% Serum A%#Bsa Ular

$ed)ma% #era* SABU+ me%'au *ada Sh!ar#G da%Wa" /De*&es+


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$e%a#ala&sa%aa% Su*)r#4

- $e%')ba#a% su*)r#4 #erdrdar %4us Na6l+ *lasmaa#au darah da% *embera%3as)*res)r u%#u&me%a%''ula%' s")&

- Kelum*uha% *er%a*asa% %#ubas

- S%dr)m &)m*ar#eme% 4as)#)m



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$e%a#ala&sa%aa% $ada lu&a''#a%

- I%4e&s baer

- S%dr)m &)m*ar#eme%



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DAFTAR $USTAKAS(amsuhda(a# R+ De J)%' Wm Buku-Ajar Ilmu Beah. Ed.


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TERIMA KASIH

Case Snake Bite

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