4. Elapidae ra (Naja naja): (a) and (b) Sri Lanka,
(d) Nepal (Copyright Mark O’Shea)
b
Common spectacled Indian cobra N. naja (Fig. 3) (Theakston et al., 199
Figure 4: North Indian or Oxus cobra (Naja oxiana)
(Copyright DA Warrell)
North Indian or Oxus cobra N. oxiana (Fig. 4) (Warrell, 1995).
Figure 12: Greater black krait (Bungarus niger) Nepal
(Copyright F. Tillack)
Greater black krait B. niger (Fig. 12) (Faiz et al., 2010)
Figure 13: Banded krait (Bungarus fasciatus) Thai specimens
(Copyright DA Warrell)
(a) Showing black and yellow bands
(b) Showing circumferential black bands and blunt-tipped tail (scale in cms).
a b
18 GUIDELINES FOR THE MANAGEMENT OF SNAKE-BITES
Figure 15: Spotted coral snake (Calliophis maculiceps) Thai
specimen (Copyright DA Warrell)
Banded krait B. fasciatus (Fig. 13) (Tun-Pe et al., 19
Figure 14: Red-headed krait (Bungarus flavicep
(Copyright DA Warrell)
Red-headed krait B. flaviceps (Fig. 14), Wall’s krait B
5. Ular Laut Figure 21a: Blue spotted sea snake (Hydrophis cyanocinctus)
(Copyright DA Warrell)
21GUIDELINES FOR THE MANAGEMENT OF SNAKE-BITES
Figure 21b: Banded sea snake (Hydrophis fasciatus atriceps)
(Copyright DA Warrell)
Figure 21c: Flattened paddle-like tail of sea snakes: Hydrophis
cyanocinctus (above); Lapemis curtus (below) (Copyright DA Warrell)
Figure 21c: Flattened paddle-like tail of sea snakes: Hydrophis
cyanocinctus (above); Lapemis curtus (below) (Copyright DA Warrell
Figure 22: Hardwick’s sea snake (Lapemis curtus) showing tiny fang
(arrow) (Copyright DA Warrell)
Figure 24: Sea krait (Laticauda colub
Madang, Papua Ne
(a) Showing blue and banded pattern
(b) Showing fa
a
6. Viperidae
Figure 26: Western Russell’s viper (Daboia russelii)
(Copyright DA Warrell)
(a) Specimen from southern India
(b) Specimen from Sri Lanka
Russell’s vipers, Western, Daboia russelii (Fig. 26) (Phillips et al., 1988;
Warrell 1989; Gawarammana et al., 2009); and Eastern, D. siamensis (Fig.
27) (Myint-Lwin et al., 1985; Tun-Pe et al., 1987; Than-Than et al., 1987;
Than-Than et al., 1988; Warrell 1989; Than-Than et al., 1989; Thein-Than
et al., 1991; Tin-Nu-Swe et al., 1993; Belt et al., 1997)
a b
Levantine or blunt-nosed viper Macrovipera lebetina (Fig. 28b)
(Sharma et al., 2008)
Pit vipers (sub-family Crotalinae):
Figure 29: Malayan pit viper (Calloselasma rhodostoma) Thai specimen
(Copyright DA Warrell)
(a) Showing characteristic posture and triangular dorsal markings (scale
in cms) (b) Showing supralabial markings
Malayan pit viper Calloselasma rhodostoma (Fig. 29) (Reid et al., 1963a;
a b
Figure 31: White-lipped green pit viper (Cryptelytrops albolabris) Thai
specimen (Copyright DA Warrell)
(a) Showing colouring and distinctive brown-topped tail
(b) Showing details of the head: note smooth temporal scales
White-lipped green pit viper Cryptelytrops albolabris (Fig. 31) (Hutton et al.,
1990; Rojnuckarin et al., 2006)
a b
Figure 32: Spot-tailed green pit
Specimen from near Yangon, M
(a) Showing colouring
(b) Showing details of head;
Spot-tailed green pit viper Cryptelytro
a b
15. First Aid
Figure 69: Pressure immobilisation method. Recommended first-
aid for bites by neurotoxic elapid snakes (by courtesy of the
Australian Venom Research Unit, University of Melbourne)
19. Pemeriksaan Lab
• Darah Ru2n
• Diffcount
• PT/APTT
• Fibrinogen
• Fibrin deg products
• Golongan darah cross
match
• Elektrolit serum
• Glukosa
• SGOT/SGPT
• Bilirubin
• CK
• Uerum/Crea2nine
• Urinalisis
• EKG
• BGA
20. Grading
Derajat
Gigitan Ular
Klinis Penatalaksanaan
Derajat 0 Bekas taring, abrasi, nyeri lokal Perawatan Luka, ABU (-)
D 1. Ringan Nyeri, nyeri tekan, edema, parestesia
perioral
5 Vial ABU
D 2. Sedang Nyeri, nyeri tekan, eritema, edema
melebihi area gigitan, koagulopa2
ringan
15 Vial ABU
D 3. Berat Nyeri meningkat, pembengkakan
seluruh ekstremitas, tanda sistemik,
koagulopa2
15-20 Vial ABU
D 4.
Mengancam
Nyawa
Koagulopa2 Berat Min 25 Vial ABU
