Microsoft PowerPoint - Dipacok Oray.ppt
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Transcript of Microsoft PowerPoint - Dipacok Oray.ppt
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Snakes
Bite
SnakesSnakes
BiteBite
Snakes BiteSnakes Bite
Dr. Lili K. Djoewaeny SpB
SMF Bedah RSUD Cianjur
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In North America approximatelly 8000 person areIn North America approximatelly 8000 person are
bitten each year by poissonous snakesbitten each year by poissonous snakes
Over 98 percent of bite occuring on theOver 98 percent of bite occuring on the
extremitiesextremities
Rattle snakes are responsible for approximatellyRattle snakes are responsible for approximatelly
70 percent of deaths from snakes bites70 percent of deaths from snakes bites
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The venoms of poisonous snakes consist ofThe venoms of poisonous snakes consist of
enzymatic complex proteins that affect allenzymatic complex proteins that affect all
soft tissuesoft tissue
Venoms have been shown to haveVenoms have been shown to have
neurotxic, antifibrinolytic, hemolytic,neurotxic, antifibrinolytic, hemolytic,
thrombogenic, hemorrhagic, cytotoxic, andthrombogenic, hemorrhagic, cytotoxic, and
anticoagulant effectsanticoagulant effects
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Most of venoms contain hyaluronidase,Most of venoms contain hyaluronidase,which enhances the rapid spread of venomswhich enhances the rapid spread of venoms
by way of th superficial lymphaticby way of th superficial lymphatic
Variation of the venoms effectsVariation of the venoms effects
Neurotoxic such as muscle cramping,Neurotoxic such as muscle cramping,
fasciculation, weakness, and respiratoryfasciculation, weakness, and respiratoryparalysis or hemolytic characteristic mayparalysis or hemolytic characteristic may
predominate, depending on the snakepredominate, depending on the snake
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Fang marks produce characteristically bysnakes
Local signs and symptoms can includeswelling, tenderness, pain, and echymosisand may appear within minutes at the site
of venom injection
If no pain or edema is present within 30minutes after injury, the snake probablydidnot inject any venom
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Swelling may continue to increase for 24
hours
Hemorrhage vesiculation, bullae, andpetechiae may appear between 8 and 36hours, with thrombosis superficial vesselsand eventual sloughing of tissues
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Systemic symptom include such ashypotension, weakness, sweating and
chills, dizziness, nausea and vomiting,parestesias, and muscle fasciculating
Muscle fasciculation are most common
after a ratlesnake bite, often in the perioralregion and face muscle area, neck andback
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Some times the venomsproduce deleterious changes
in the blood cells, defect inblood coagulations, injuries into the intimal linings ofvessels, damage to the heartmuscles, alterations in
respiration, and to lesserextent, changes inneuromuscular conduction
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In severe poisoning: pulmonary
edema, hemorrhage into the lungs,kidney, heart, and peritoneum can
occurs
Hematemesis, melena, changes insalivation, and muscle fascuculation
may be seen
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Urinalysis may reveal hematuria,glycosuria, and proteinuria
Red blood cells and platelets are can
decrease, bleeding and clotting timeusually are prolonged
Total afibrinogrenemia are hallmark of
severe envenomation
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Management of Snake BitesManagement of Snake Bites
Application of tourniquet, incission, and
suction are appropriate if used within 1hour of the time of bite
The tourniquet should be applied toobstruct only venous and lymphatic flow
The tourniquet is not released once
applied and may be left in place during the30 minutes that suction is applied.
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The tourniquet may be removed afterdefinitive treatment has been instituted
and patient is not in shock
Incision and suction for 30 minutes may be
beneficial if accomplished within 30minutes after snakebite
The incision should be longitudinal notcruciate
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When two fang marks are seen, the depthof the venom injection is generally
considered to be one-third of the distancebetween the fang marks
Incision made proximal to the bite arecontraindicated
Most important treatment for snakebite isantivenin
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Because antivenin contains horse serum,
before its administration skin testing isrequired
Epinephrine 1/1000 in a syringe should beavaliable before antivenin is given
The indication of antivenin is governed by
the degree of envenomation (see table)
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Always presentPresentMay extend beyond
the involve
extremityinto the ipsilateral
trunk
Severe+IV
Very Severe
Envenomation
Petechie and
ecchymosis
Present> 12 inchSevere+III
Severe
Envenomation
Possible12 hours after
bite
6 12 inchSevere+II
Moderate
Envenomation
No12 hours after
bite
1 5 inchModerate
To
Severe
+I
Minimal
Envenomation
NoAt 12 hours< 1 inchMinimal+0
No
Envenomat
ion
systemicerythemaedemapainfang markgrade
Table of grading envenomatinTable of grading envenomatin
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Grade 0 I usually not required
Grade II may required 3 4 ampules
Grade III usually required 5 15 ampules
If systemic manisfetation are severe,antivenin should be given rapidly, byintravenous drip, in large dose
The injection antivenin locally around the
bite is not advised
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If antivenin is indicated, 3 to 5 ampules are
given by intravenous drip in 500 mLnormal saline solution or 5% glucosesolution
If severe systemic symptom are alreadypresent 6 to 8 ampules are given inaddition
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The dose of antivenin more easily titrated
with respond to treatment, based onimprovement sign and symptoms not onthe weight of the patient
Antivenin is administered until severe localor systemic symptoms improve
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If too much time has elapsed for excisionto be effective or the patient is allergic to
horse serum, a slow infusion 1 ampule ofantivenin in 250 mL of 5% glucose solutionmay given in 90 minutes period constant
monitoring of blood pressure andelectrocardiogram
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If an immediate reaction occurs, the
antivenin is stopped, and vasopressor andepinephrine may be required
Vitamin K also may also be required
Tetanus toxoid is administered
Antibiotic is recomended to preventsecondary infection
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