PERTOLONGAN PERTAMA DAN PENILAIAN KEPARAHAN ENVENOMASI PADA PASIEN GIGITAN ULAR

Distribusi keracunan dan kematian akibat gigitan ular di dunia bevariasi. Dalam kasus berat, akan luka gigitan akan berkembang menjadi bula dan jaringan nekrotik, serta muncul gejala sistemik berupa mual, muntah dan kelemahan otot atau kejang. Tingginya angka kejadian snake bite di Indonesia belum diimbangi dengan penanganan yang optimal di prehospital. Fenomena yang muncul, Masyarakat cenderung melakukan pertolongan pertama menggunakan cara-cara tradisional, sedangkan WHO sejak tahun 2016 tidak lagi merekomendasikan bentuk pertolongan tersebut.Metode penelitian ini yaitu deskriptif kuantitatif. Penelitian ini menggunakan teknik total sampling dengan jumlah 35 responden, waktu pengambilan data Januari – September 2019 (9 bulan) dengan kriteria eksklusi: Pasien dengan gigitan ular yang meninggal saat datang ke IGD RSUD Gemolong. Teknik pengumpulan data dengan kuesioner meliputi pertolongan pertama prehospital dan tanda dan gejala klinis yang muncul pada pasien saat tiba di rumah sakit utnuk menentukan derajat keparahan envenomasi. Analisa data univariat digunakan untuk menggambarkan deskriptif masing-masing variabel.Gambaran Pertolongan pertama prehospital yang dilakukan yaitu: 40,3% mengikat luka gigitan ular dengan tali, 31% responden menghisap ara luka, 14,3% responden merobek luka dengan pisau, 8,5% responden mencuci luka dengan sabun, 2,9% responden membakar luka dan memberikan jahe bakar pada area luka. Gambaran tingkat keparahan envenomasi responden yaitu: 57,2% responden menglami envenomasi derajat 2, sejumlah 22,8% responden mengalami envenomasi derajat 3, dan 20% responden mengalami envenomasi derajat 1. Tidak ada responden yang mengalami envenomasi derajat 4.Tindakan tradisional yang dilakukan dapat meningkatkan keparahan luka dan juga mempercepat penyebaran bisa. Prinsipn utama yang direkomendasikan untuk penanganan pertama gigitan ular adalah mecegah kecemasan yang berlebihan, melakukan imobilisasi area dengan balut tekan (pressure immobilitation tehnik) dan segera rujuk ke rumah sakit. The distribution of poisoning and mortality caused by snake bites in the world is increasing. In severe cases, the bite wound will develop into bullae and necrotic tissue, as well as systemic symptoms such as nausea, vomiting and muscle weakness or spasms. The high incidence of snake bite in Indonesia has not been matched by optimal handling at prehospital. The phenomenon that arises, the community tends to do first aid using traditional methods, WHO since 2016 no longer recommends this form of help. Design of this study is quantitative descriptive with cross sectional approach. This study used a total sampling technique with a total of 35 respondents, data collection time was January - September 2019 (9 months) with exclusion criteria: Patients with snake bites who died when they came to the Emergency Room. Data collection techniques using questionnaires included prehospital first aid and clinical signs and symptoms that appeared in patients when they arrived at the hospital to determine the severity of envenomation. Univariate data analysis is used to describe the descriptive of each variable. Result of this study showed the Prehospital First Aid overview: 40.3% respondent used a tourniquet technique, 31% of respondents sucking wound, 14.3% of respondents give an incission of the bite wound, 8.5% of respondents washed wounds with soap, 2.9% of respondents burn wounds and give burnt ginger to the injured area. The description of the severity of envenomation is: 57.2% of respondents in grade 2, 22.8% of respondents in grade 3, and 20% of respondents in grade 1. No one respondents experienced grade 4 envenomation.The traditional actions taken by the lay persone can increase the severity of the wound and also accelerate the spread of bacteria. The main principles recommended for the first treatment of snake bites are preventing excessive anxiety, immobilizing the area with pressure immobilization technique and immediately referring to the hospital.

An Unexpected Case of Black Mamba (Dendroaspis polylepis) Bite in Switzerland

Mambas (genusDendroaspis) are among the most feared venomous African snakes. Without medical treatment, mamba bites are frequently fatal. First-aid treatment includes lymphatic retardation with the pressure immobilization technique. Medical management comprises continuous monitoring, securing patency of the airway, ensuring adequate ventilation, symptomatic measures, and administration of specific antivenin. We report an unusual case of a snake breeder bitten by a black mamba in Switzerland, report the clinical course, and review the lifesaving emergency management of mamba bites. This case highlights the importance of early antivenin administration and suggests that emergency and critical care physicians as well as first responders all around the world should be familiar with clinical toxinology of exotic snake bites as well as with the logistics to most rapidly make the specific antivenin available.