Skenario 2

Skenario 2
Seorang pria asal Korea berusia 28 tahun dievakuasi menggunakan helikopter darurat
dari Gili Trawangan setelah diduga disengat oleh ubur-ubur. Dia disengat di lengan
kanan bawah, dengan bekas sengatan tentakel terlihat di sekitar sendi siku. Pasien
merasa sangat kesakitan, sehingga sebelum diangkut dengan helikopter, pria tersebut
diberikan Morfin 10 mg dan Metoclopramid 10 mg secara intravena di Klinik Gili,
namun saat tiba di unit gawat darurat, pasien masih merasa sangat kesakitan. Gejala
yang muncul saat tiba meliputi gelisah, piloereksi lokal di lokasi sengatan, menggigil
tetapi berkeringat deras, pernapasan berat dan cepat, serta tampak gelisah dilihat dari
kaki yang terus bergerak. Tanda vital saat masuk adalah sebagai berikut: denyut
jantung 100 x/menit; pernapasan 35 x/menit; tekanan darahnya tinggi, yaitu 160/90
mmHg dan saturasi oksigen 99% di udara ruangan. Pada pasien dilakukan
pemeriksaan EKG dan rontgen dada. Hasil EKG menunjukkan inversi gelombang T
inferior yang hilang pada pemeriksaan selanjutnya. Rontgen dada menunjukkan tanda
interstisial paru yang konsisten dengan edema paru. Hasil pemeriksaan darah, leukosit
21,3 109 /L.
Kata kunci: ubur-ubur, tekanan darah tinggi, piloereksi
1. Apa saja hewan laut yg menyebabkan trauma dan apa traumanya

2. ⁠tanda dan gejala trauma hewan laut
3. ⁠tanda dan gejala kondisi yg mengancam nyawa pada trauma hewan laut
4. ⁠tatalaksana awal dan rujukan
5. ⁠talak awal trauma hewan laut jenis gigitan dan tusukan
Jawab:
1. Phylum Porifera (marine and freshwater sponge) → Eczematous plaque
Lesi localized yang di akibatkan oleh sponge laut (Neofibularia sp.,
Tedania ignis & Microciona prolifera). Kontak dengan sponge laut dapat
menyebabkan erupsi dengan pola eksem. selain itu lesi lainnya yaitu
dermatitis akibat kontak dengan duri sponge yang tersebar di perairan.
2. Phylum Cnidaria (Ubur-Ubur dan Portuguese Man-of-war) → Anthozoa,
Hydrozoa, Scyphozoa, dan Cubozoa.
Envenomasi paling parah disebabkan oleh Cubomedusae terutama
Chironex fleckeri. Ubur-ubur Portugis juga dapat menyebabkan envenomasi
berat. Ratusan kematian dilaporkan disebabkan kontak dengan Cubomedusae.
Meskipun struktur tubuh sederhana, cnidaria memiliki struktur beracun

kompleks berupa nematocyst yang menyuntikkan racun ke kulit. Beberapa
spesies hydrozoa dan scyphozoan juga dapat menyebabkan cedera.
Gejala cedera ditandai rasa sakit intens, garis linier edema dan eritema.
Komplikasi sistemik seperti kegagalan jantung dan paru-paru dapat terjadi
pada kasus berat. Reaksi alergi juga mungkin terjadi. Pengobatan meliputi
pendinginan dan penghilangan nematocyst tersisa. Kasus berat perlu dirawat
di rumah sakit.
Trauma injuries:
Bites account for the majority of marine life associated trauma. Fortunately,
serious encounters are extremely rare. Traumatic injuries are usually the result
of an animal’s defensive reaction to a perceived threat or misidentification of a
diver’s body part as a food source. Most puncture wounds do not contain
venom and are, therefore, a traumatic injury. Bleeding is the most common
acute complication to trauma, while infections are the most common
secondary complication.
● stingrays: Stingrays are not aggressive by any means, and injuries are
rarely fatal. The stingray’s defense mechanism consists of a serrated
barb at the end of its tail with venom glands located at the base of the
barb. The barb can easily tear wetsuits and penetrate skin, and may
cause deep, painful lacerations.
● sea urchin: Sea urchins are covered in spines, which can easily
penetrate divers’ boots and wetsuits, puncture the skin and break off.
These spines are made of calcium carbonate, the same substance that
comprises eggshells. Sea urchin spines are usually hollow and can be
fragile, particularly when it comes to extracting broken spines from the
skin. Injuries usually happen when people step on them on while
walking across shallow rocky bottoms or tide pools. Divers and
snorkelers are often injured while swimming on the surface in shallow
waters as well as when entering or exiting the water from shore dives.
1. should utilize seawater and not fresh water, as the difference in osmotic gradient can
cause nematocysts to discharge
contain heat labile proteins that can be denatured quickly with inexpensive treatment,
usually with hot water (2). Supporting this, other evidence suggests that the lethal
toxins of Chironex are proteins that can be denatured with heat (42). Carrette et al.
demonstrated in an animal model that higher temperatures and longer exposure time
of C. fleckeri venom to heat had a significant decrease in lethality (p 0.0001 and p
0.0001, respectively) (43). Venom exposure for 20 min at 48°C, or 2 min at 53°C, was
enough to avoid death. Conversely, when exposures were between 4°C and 39°C, no
change in venom toxicity was achieved, even with exposures 20 min (43). Although
this may seem an impractical treatment due to potential skin damage, as immersion in
water at 48°C for 5 min may be enough to produce a severe burn, according to the
American Burn Association, hot water showers as tolerated for 10 –20 min could be
helpful in denaturing the venom and relieving the pain. This practice has been proven
useful for treating Irukandji and other jellyfish; but still there is little evidence for
using hot water for C. fleckeri envenomations in humans, and vinegar irrigation still
remains as the most widely accepted first-aid therapy for deactivation of the
nematocysts (44).

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Skenario 2

1. Apa saja hewan laut yg menyebabkan trauma dan apa traumanya

Meskipun struktur tubuh sederhana, cnidaria memiliki struktur beracun

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