Inggris Snake Bite

8/15/2019 Inggris Snake Bite

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Morning Report Snake Bite

ICD X : T.630

GIZKA YOLANDA PUTRI1408465718

SKDI 4


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HISTORY TAKING

Patie t I!e tit"

1. Name : Mrs. H2. Age : 42 yo3. Gender : female4. Occupation : house ife

!. "eligion : #slam$. Admitted to the hospital : %& No'em(er 2%1!). Address : *l. Hangtuah

+,ung- enayan"aya /e0an(aru


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Ai#$a" a ! Ce#%i&a' C( t#('• /atient tal0 spontaneously.• Assessment: Airway clear

)#eat*i +• #nspection: (reathing spontaneously- fre uency 2% minute- simetrical

(oth of chest mo'ement.• /alpation : crepitations 56• /ercussion : resonant• Auscultation: 'esicular sound 7 76• Assessment: Breathing clear

• Action : 2 8 of O2 ith nasal cannula

PRIMARY SURVEY


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Ci#&,'ati( • 9arm e tremity- oedema 5 56•

" ; 2 seconds-• Heart rate )2 minutes- regular- feel strong•


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Di-a i'it"• G > 1!• #socoric pupil (oth sides• /upil reflects direct and indirect 7 76• Assessment: mini neurologist e amination as good

/ (-,#e• emperature: 3$-=

• Action: o'er the patient


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SECONDARY SURVEY

Bitten by a snake on left foot, 30minutes before admitted to the

hospital

CHIEF COMPLAINT


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? 3% minutes (efore admission- patientcomplaint her left foot as (itten (y aco(ra hen she or0ed on her yard./atient@s leg as (eing tied up ithropes a(o'e the sna0e (ites right afterthe incident./atient then immediately (rought to the

hospital.

RECENT ILLNESS

HISTORY

TRAUMA MECHANISM


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/atient complaint her foot felt thro(- s ollen-

eritema and sore on the (itten mar0.

Nausea 76- 'omiting 76. /atient pu0ed fora(out $ times- mingled ith meal- (lood 56-

ith amount ? glass- diBBiness 76.

here@s no (lood fle out from the (ittenmar0- dyspnoe 56- loss of conciousness 56-

ptechiae 56- (lurred 'ision 56


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•

here@s no history of (eing (itten (efore• here@s no illness relati'e to patient@s

illness

Pa-t I'' e-- 2i-t(#"

a i'" I'' e-- 2i-t(#"

here@s no relati'ity


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1. General condition : loo0s ill2. A areness : composmentis3. Cital >ign


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Head and nec0 : normallyhora : normally

A(domen: normally

Genitourinarius: normallyE tremity: locally state

Status Generalis :


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"egio : orsum pedis sinistra#nspection : hematoma 76- (itten mar0 76- s0inaround the (itten mar0 seems in (lac05purple colour./alpation : tenderness 76- oedema 76- " ;2seconds and arm e tremity

Localized state :


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>na0e (ite

Working diagno !

omplete (lood count

S"gg! #i$! !%a&ina#ion


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C( 'ete '((! &(, tH( : 13-3 8H : 3!-3 I9< : 1).=%% H 8

/8 : 4%2.%%% 8"< : 4-3= 1% $ 8

WORKUP


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a e iteDIAGNOSIS


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#CJ "8>a(u in,ection 1 'ial in 1%% cc Na 8A > 1!%% i+

eftria on in,ection 2 1 gr

ramadol in,ection 2 3% mg

TREATMENT


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THEORY

Snak! 'i#!


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1. rangle head- there@s ca'ity (et een eyesand nose

2. Ha'e 2 caninus

3. Ha'e o'al pupil4. here@s t o (ars of sla( (elo its tail

SNAKE


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/oisonous sna0e di'ided (y its to in: #. Neuroto ic: o(ra- ular Kraits L ular

Karang- ular 9elang##. Hemolitic : "attlesna0e- comperhead.###. Neuroto ic dan Hemolitic : sea sna0e.


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i i


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D!gr!!

V!n!rai

(i##!n&ark

Pain O!d!&a)Eri#!&a

S* #!&i+*&,#o&,

0 0 + +/- < 3cm/12hour

0

I +/- + + 3 12 cm/ 12hour

0

II + + +++ 12 2! cm/12 hour

+ ,neuroto"icnausea,di##iness,

shockIII ++ + +++ $ 2! cm/ 12

hour++%hock,ptechi,echimosis

I& +++ + +++ $ e"tremity ++

+-a i.+a#ion


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o holes mar0: oedema- petechiae- (ullae-eritema- echimosis- and tissue necrosissymptomps

>prayed on the eye → (lindness

>ign and symptomps of neuroto in : tingling-

limp- sali'ation- 'omiting- ptosis- a(normalreflects- dyspnoe- respiratory arrest → paraliBed on respiratory muscles.


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DIAGNOSE

• History ta0ing• /hysical e amination• 8a(oratory findings: < - electrolyte

count- / A/ - fi(rinogen- +reumcreatinin

• Electrocardiography


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o slo do n the to in entering (loodstream-to neutraliBed and get rid of the to in andmaintaning (lood 'olume.#mmo(iliBation of the affected areaApply cross ise cutlet on the (itten mar0

ooling the ound soa0 in the cold ater >A 1!%% + supporti'etheraphy6

TREATMENT


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T/ank Yo"

Inggris Snake Bite

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