KEMENTERIAN KESEHATAN REPUBLIK INDONESIA

19 mei 2022

PROGRAM PENANGGULANGAN GIGITAN

SENGATAN HEWAN BERBISA DAN TANAMAN
BERACUN

Kementrian kesehatan Republik Indonesia

2
Indonesia memiliki biodiversitas yang tinggi untuk ular berbisa
Namun kasus gigitan ular yang dilaporkan* masih jauh dari angka yang seharusnya
Viperidae 5
Elapidae 6
Viperidae 2
Hydrophidae 11
Elapidae 2
50 kasus Hydrophidae 8
24 kasus 6 spesies
(Australian elapidae)
51 kasus Genus Toxicity

Viperidae Haematotoxic
Myotoxin
cytotoxin
Elapidae Neurotoxic,
cardiotoxin,cytoto
xin
Hydrophidae Neurotoxic,
Viperidae 14
Elapidae 7 Nephrotoxic,
Hydrophidae 6 Myotoxic
124 kasus

Viperidae 5
Elapidae 7 Viperidae 2
Hydrophidae 14 Elapidae 3
1.141 kasus Hydrophidae 4
195 kasus

*periode 2015 - 2021 3

 Snakebites data
 Data : 135.000/year incidence
 mortality over 50 -100 people per year
 Cases report in ITS : 500-1000 cases
Kasus gigitan ular yang terekam selama 2015 – 2021
Data kasus diperoleh dari dokumentasi pribadi sehingga angka gigitan ular belum merefleksikan angka yang
sebenarnya
No Provinsi 2015 2016 2017 2018 2019 2020 2021 Total Catatan:
1 Aceh - - - - - 50 10 60 Di tahun 2020-2021, dilakukan
2 Sumatera Utara - - - - - 35 6 41 kajian kasus gigitan ular di
3 Riau - - - - - 5 8 13 Litbangkes Kemenkes sehingga
4 Jambi 1 - - - 2 2 3 8 didapati laporan jumlah kasus
5 Lampung 1 - - - - 1 - 2 yang lebih tinggi dari tahun-tahun
6 DKI Jakarta - - - - - 5 2 7
sebelumnya
7 Jawa Barat - 2 - - - 46 72 120
8 Jawa Tengah - 2 7 3 22 26 152 212
9 Jawa Timur 98 77 70 51 58 156 292 802
10 Bali - - - - 2 19 4 25
11 NTB - - - - - 10 45 55
12 NTT - - - - - 44 71 115
13 Kalimantan Barat - - - - - 8 12 20
Kalimantan
14 - - - - - 4 - 4
Selatan
Kalimantan
15 - - - - - 13 3 16
Tengah
16 Kalimantan Utara - - - - - 6 4 10
17 Sulawesi Barat - - - - - 3 3 6
18 Sulawesi Selatan - - - - - 5 3 8
19 Sulawesi Tengah - - - - - 2 8 10
20 Maluku - - - - - 2 3 5
21 Papua - 1 1 - 1 23 10 36
22 Papua Barat - - 1 - - 7 2 10
Total 100 82 79 54 85 472 713 1.585 5
Sumber: Dokumentasi pribadi dr. Maha dan RSUD Bondowoso
6
Blue bottle jellyfish

Box jellyfish
8
9
10
 LESSER SUNDA ISLANDS

Trimeresurus insularis Laticauda colubrina

Daboia russellii

Ophiophagus hannah

Naja sputatrix
• Viperidae 2
• Elapidae 3 Bungarus candidus
• Hydrophidae 4
Papua maluku
Snake families and general venom effects

Venomous
Snake
families

Elapidae Hydrophiidae Viperidae Colubridae

Neurotoxin Cytotoxic
Neurotoxic Myotoxic Myotoxic
Renal toxicity Coagulopathic
(bungarus sp),calliophis Coagulopathic
+cytotoxic in cobra &
king cobra
+ coagulopathy in
Australasian elapids
Indonesia
Total snake species :
370
Venomous snake
species:
• Elapidae: 55
• Viperidae: 21
• Colubridae: 1
Pictures of venomous snakes found in Irian
Jaya

Micropechis ikaheka Acanthophis laevis Pseudoechis

papuanus

Pseudonaja textilis Oxyuranus scutellatus Pseudoechis rossignolii

Sea krait and sea snakes

Sea krait Beaked sea snakes Spine-bellied sea snake

Laticauda colubrina Hydrophis schistosa Hydrophis curtus
 Berbisa

Tidak Berbisa
Non venomous
Luka gigitan ular tidak berbisa :
V.appertum dan V.abrasio

19
venomous
 Bekas gigitan ular berbisa : bentuk
bekas givitan seperti luka
tusuk/V.ictum jumlah bervariasi dari
jam 1 sampai tak terhimgga

21
First aid
TREATMENT (1)
Keep the Airway Breathing and Circulation stable
• Airway
• 02 Non Re-Breathing Mask 12 lpm
• Laryngeal Mask Airway and Endotracheal Tube (if needed)
• Suction if gargling (+), Head tilt and chin lift if snoring (+)
• Breathing
• Evaluate the respiratory rate
• Circulation
• Make iv access, give Normal Saline 0.9% (don’t forget to
take some blood for laboratory checking)
• Blood pressure
• Pulse
• Oxygen saturation by using pulse oxymetri
• Blood or Fresh Frozen Plasma as indicated
TREATMENT (2)
• Immobilize bitten area by using Pressure Bandaging
Immobilization
• Antivenom : DRUG OF CHOICE
• If the snake that bite the patient include in 3 snakes which
are covered by the SABU, we can give SABU quickly
• 2 vials SABU + 500mml Normal saline 0.9% dripped 0-80
drop permminute hemotoxin bites
• Repeated every 6 hours. BE AWARE TO RE-
ENVENOMATION SIGN!!!
• Symptomatic
• Analgesia : morphine (PS≥7) and paracetamol infusion or
oral (PS<7)
• Antibiotic
• When indicated, example : leucocytosis
Snake antivenom in Indonesia
Snake Antivenom
Monovalent Polyvalent
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TREATMENT (3)

• Anticholinesterase drugs
• Especially for neurotoxin envenoming
• Should give atropine before giving the drugs to prevent physostigmine
intoxication.
• Physostigmine dose
• Adult (>12 yo) : 0,5-2,5 mgevery 1-3 hours up to 10 mg/24hours
• Children ≤ 12 yo : 0.01 mg-0,04/kg
• Should be given slowly 3-5 minutes by IV /IV/SC repeat 2-4 hours
• Atropin inj bradikardia
Neurotoksin(julian
whie,2016)
Haemotoxin system
Venom oftalmia
Mitos ,mistis
20 wbct dan RPP alat penunjaang diagnose gigitan ular
wound care snakebite
dan rehabilitasi
gigitan ular
Death adder cases
Borang gigitan dan sengatan hewan berbisa dan
tanaman beracun
 ALUR SPGDT 119

CALL CENTER 119 SPGDT

Ruang lingkup tugas call center NCC 119:

NCC
• Menerima panggilan masuk
• Memilah panggilan emergency/no emergency
Data Base • Meneruskan panggilan ke PSC NCC-119

Ruang lingkup tugas call center PSC 119:

• Menerima panggilan masuk/dispatch
dari NCC 119
• Mengirimkan Tim Medis ke Lokasi
Kejadian
• Bila diperlukan melakukan evakuasi ke
fasyankes • Panggilan gawat
darurat dari
Data Informasi masyarakat ke no 119
Rumah Sakit No
PSC PSC-119
Jejaring RS

RUMAH
SAKIT

Tracking
Tracking Tracking
Rescue
PSC
Rescue
Evacuation Caller
SEBARAN PSC DI INDONESIA

Jumlah
Kabupaten/Kota 514
Jumlah
Kabupaten/Kota
yang memiliki PSC
279
Yang registrasi 220
Jumlah
Kabupaten/Kota
yang belum
235
memiliki PSC
Jumlah
Kabupaten/Kota
yang terintegrasi
120
dengan NCC 119