Komodo Dragon, Monitor Lizard, ne Alligator Snapping Turtle Bites: Anticoagulant Venom, Tendon Avulsion, and Aeromonas Prophylaxis¶

Disuma dia nyunyi minene (Varanidae, kusangisha ne Komodo dragon [Varanus komodoensis], Asian water monitor [Varanus salvator], Nile monitor [Varanus niloticus], ne lace monitor [Varanus varius]) ne nyunyi minene ya mu mayi (**Alligator turtleysMachelys temminckii] ne Common snapping turtle [Chelydra serpentina]) bidi bileja ntatu ya bungi ya dipanda ne ya buanga pamutu pa disuma dia nyama dia patupu. Nsengu idi ne meno makuate ku luseke, mapingaja, adi ne meno (ziphodont dentition) adi afuanangana ne meno a requin anyi a dinosaure wa theropod mu mushindu wa kukosa, misangisha ne glande ya poison ya mu tshiadi idi ipatula bukole bua anticoagulant phospholipase A2 (PLA2) bu mudi toxine, ne enzymes natriuretic/CRISP peptides. Padi mbua wa tshiamu tshia nzembu uluma ne ukoka panyima mu tshitupa tshia dikosa, meno ende adi ne mishiku adi akosa bipese bia muinshi mua buloba bidi bipita mu mishipa ya flexor ne ya extensor eku manga adi akanda dikola dia plakete ne alama mishipa mikosa bua kupatuka mashi a bungi. Kadi, Alligator ne Common snapping turtles kabena ne meno to, kadi badi ne razor-edged keratinous rhamphotheca (mukana) udi ulombodibua kudi hyper-hypertrophied jaw adductor muscles udi mua kukosa bimpe kupitshila ku minu ya muntu, mifuba ya phalangeal, ne neurovascular bundle, kulonda kudi dibuela dia mayi a virus bactérie (Aeromonas hydrophila, Edwardsiella tarda, Pasteurella, ne Salmonella). Shi muntu mushimibua kudi mpuku, dragon wa Komodo, nansha nkunda wa snapping, ubikile muaba uudi musombele nomba ya tshimpitshimpi diakamue. Tangila kabidi mikanda yetu ya bana betu pa dipatuka dia mashi dikole ne dilama dia tourniquet, disuma dia nyama, ne sepsis ne septic shock.

Tshiudi ne bua kuenza tshia kumpala ntshia kulekela nyama wa nsongo mu bukubi kakuyi dikosa tshianza tshiebe (teka nyama wa nsongo panshi anyi umuele mu mayi bitekete bitekete bua ikale unzulula mukana wende ku budisuile, ne kuyi muanji kubandisha nsongo wa nsongo ku mukila wende), kuimanyika dienza dia anticoagulant anyi dia artériel ** ne bukole bua gazeutique kuela bintu mu tshibombi, anyi tshiamu tshia windlass arterial tourniquet**, kulama minu yonso mikosa mu tshibombi tshiume tshiteka pa mayi a mashika, ne kuya ne mubedi bua kumupandabu mishipa ne kumupeshabu manga a antibiotique adi ne Aeromonas hydrophila.

Enza nunku mpindieu¶

1. Bikila nimero ya lukasa ya muaba uudi musombele diakamue pikala mashi a bungi apatuka, mifuba mityumuke, mifuba mityumuke, anyi mbua munene. Ela 911 mu États-Unis ne mu Canada, 112/119 mu Indonésie, 000 mu Australie, 112 mu Union européenne mujima, 999 mu Royaume-Uni anyi mu tshilaminu tshietu tshia buloba bujima nomba ya tshimpitshimpi. Disuma dia nyama minene ya varanid ne ya snapping turtle itu misangu ya bungi ikosa mishipa ya digitale anyi ya radial/tibial ne idi ilomba dipanda dia lukasa dia tshianza anyi dia mifuba.
2. Bikala mbua udi unyunguluka anyi mbua wa tshiamu tshia nzembu utshidi mukuatshike ku tshianza tshiebe anyi ku dikasa diebe, KUKOKA dikasa diebe panyima nansha dimue ne KUANGUDI NYUKU udi unyanguka ku mukila wende nansha kakese. Kukoka tshianza tshiebe mukana mua mbuji wa tshiamu tshia kutangila natshi malu kudi kukoka mijilu yebe mu milongo ya meno adi malengeja panyima, adi ne mishiku bu tshiamu tshia nyama. Shi mbua udi unyunguluka udi mukuatshike, teka mbua panshi anyi ela mbua ne tshianza tshiebe mu tshina tshia mâyi anyi mu mayi adi kaayi makole: mbua idi ikuata panshi bua buôwa bua dikuba dia buloba ne misangu yonso itu ilekela mu tusunsa tukese padiyi yumvua mâyi anyi buloba bukole muinshi mua plastron (tshitupa tshia difu).
3. Lekela mashi adi kaayi ajika diakamue ne dikuma dia bianza bibidi, dibuikila dia mputa idi kayiyi ijika mashi, anyi tshiamu tshia windlass tshia mu tshisalu. Bu mudi bintu bidi bipatuka mu tshiadi bia Komodo dragon ne monitor lizard bikale ne anticoagulant phospholipase A2, mputa ya varanid idi ipatuka ne ipatuka mashi misangu ya bungi mu mêba a bungi. Fina tshilongo tshinene tshia tshiamu tshia sterile (anyi kaolin/chitosan hemostatic gauze) bikole mu tshina tshia mputa ne ikala anu utshikuma munkatshi mua minite 10 anyi 15 mijima kuyi utangila to. Bua mashi adi afumina ku dikasa anyi ku diboko adi apueka ku diambuluisha dia bilamba bia pression, ela CoTCCC-approved windlass tourniquet 5 to 8 centimètres (2 to 3 inches) pa mutu pa tshilonda ne utshikuate too ne padi mashi ajika.
4. Upingaje ne ulengeje bimpe munu wonso mukosa, dikasa, anyi tshitupa tshinene tshia mubidi tshidi tshikosa. Bikala mukana wa Alligator anyi wa Common snapping turtle mukose dikasa, udi mua kubuikila tshitupa tshidibu bakose mu tshilamba tshia sterile tshidibu balengeje kakese ne mâyi a mukele anyi malenga, utshikanga munda mua tshibombi tshia plastique tshidi katshiyi ne mâyi, ne utshiteke mu tshibombi tshiuwule tente ne mâyi** mashika ne mayi. Kuteka tshitupa tshia mubidi wa muntu tshidibu bakose buludiludi pa mabue a mashika anyi kutshibueja mu mayi, bualu ebu budi mua kuenza mashika anyi kunyangakaja mishipa ya tshiamu tshia mashinyi ne kunyangakaja dipingaja dia mishipa mikese.
5. Ela mputa mâyi a bungi ne mayi malenga a bungi anyi mâyi a mukele adi kaayi ne disama, ne umbusha bipese bionso, ma-watch, ne bisabata bikole. Umbusha bitotshi bia mu tshina, algue, ne mate a nyama idi yenda mu mâyi ne litre 1 anyi 2 (1 anyi 2 quarts) ya mâyi malenga, pashishe ufuke mputa ne tshilamba tshidi katshiyi tshiendakana anyi uleke tshianza tshiende dikasa pa tshilamba tshilengeja.
6. Kulomba bua kuenza mudimu ne manga a antibiotique adi atangila Aeromonas hydrophila ne mionji ya Gram-negative ya mu mayi mu lupitadi, ne kubenga bua kusuika mputa mikole ya kumpala idi ne bukoya. Maluvu a antibiotique a pa tshibidilu bu mudi cephalexin (Keflex) anyi dicloxacillin Aeromonas hydrophila adi kayi mua kuluisha eromonas hydrhilaudi upatula chromosome beta-ltamases). Disuma dia mbua ya mu mayi ne dia mbua ya tshisuku bidi bikengela fluoroquinolone (ciprofloxacin), trimethoprim-sulfamethoxazole, anyi cephalosporin wa tshipungu tshisatu pamue ne tshibuikidiji tshia anaerobic.

Mutshi wa dipangadika: Varanid lizard vs Snapping turtle bite rescue ne surgical triage¶

flowchart TD
    A["Tangila mbua, Dragon wa Komodo, anyi Nzolo wa Snapping Bite"] --> B{"Tshintu tshidi tshienda tshinyunguluka tshitshidi tshilamakaja ku tshianza anyi?"}
    B -->|Yes: Snapping Turtle clamped| C["KUENA tshitupa tshia mubidi anyi kubandisha ku mukila to; Teka mbua panshi anyi ela mbua mu mayi bua kumulekela"]
    B -->|Yes: Monitor Lizard clamped| D["Kukuatshisha bujitu bua mubidi wa mbua; kukangula mishiku ne mutshi mukole anyi tshiamu tshipepele kunyima kua meno a kumpala"]
    B -->|No: Reptile detached| E{"Kudiku dipatuka dia mashi mu mishipa anyi dia anticoagulant didi mua kunyanga muoyo anyi?"}
    C --> E
    D --> E
    E -->|Yes: Pulsatile arterial bleed or deep extremity hemorrhage| F["Ela tourniquet wa windlass 5 too ne ku 8 cm pa mutu pa mputa + uteke tshina tshikole ne tshilamba tshia mashi; bikila 911 / nomba wa tshimpitshimpi"]
    E -->|Moderate but continuous oozing (Varanid PLA2 anticoagulant)| G["Ikala ne tshisumi tshikole ne gaze munene munkatshi mua minite 15 kuyi ubandisha; ela tshilamba tshia bukole"]
    F --> H{"Kudi tshianza tshikosa, ditshibuka dia munu, anyi dijimija dia dikoseka dia munu anyi?"}
    G --> H
    H -->|Yes: Amputated digit or severed tendon/bone| I["Bungila tshitupa tshikosa mu tshiamu tshia gaze munda mua tshibombi tshia plastique tshikanga pa mayi a mashika; Dipanda dia lukasa dia tshianza/mishipa mikese"]
    H -->|No amputation: Deep serrated lacerations or beak crush| J["Dikumbaja dia mâyi a mukele a bungi; Rayon X bua meno a ziphodont adi mashale anyi matshibuka; kushiya mputa idi ne bukoya mikanguke anyi kayiyi pabuipi"]
    I --> K["Dikuba dia antibiotique: Ciprofloxacin anyi TMP-SMX + Metronidazole/Amoxicillin-Clavulanate bua Aeromonas & Edwardsiella"]
    J --> K

Difuanyikija dia mutu ne mutu: Komodo Dragon & Monitor Lizards vs Alligator Snapping Turtle vs Common Snapping Turtle¶

Kujingulula bingoma bishilangane bia mubidi, biochimie wa mate, ne bikunyibua bia mu bisumbu bisatu bia nyama bidi biendakana bidi bilombola diakamue diambuluisha dia kumpala ne dipanda:

Biomechanics ne toxicology ya Komodo Dragon ne Monitor Lizard (Varanus) bites¶

1. Ziphodont serrated teeth ne "pull-and-slice" tendon avulsion mechanism¶

Nzolo yonso munene (Mushindu wa Varanus) udi ne meno a pleurodont, a ziphodont: miele mishindame ku luseke, mikoseka idi ne mishiku (meno) ku muelelu wayi wa dikosa, mikoleshibue ku nsongo ne tshiamu tshia mitaku tshidi ne tshiamu tshia mitaku. - Bua tshinyi dikoka dia mishipa didi ditshibula: Padi dragon wa Komodo (Varanus komodoensis), tshintu tshia kutangila natshi mâyi tshia mu Azia (Varanus salvator), anyi tshintu tshia kutangila natshi mâyi tshia mu Nile (Varanus niloticus) tshisuma tshianza tshia muntu, diboko dia kumpala anyi muana wa ngombe, meno adi abuela buludiludi mu tshitupa tshia mubidi tshia munda mua mishipa ne afua. Bishilangane na mbua udi utshibula mifuba ne dikuma dia mpala muimane, mbua udi wenza mudimu ne misunya yende ya bukole ya mu nshingu (mu nshingu) ne ya kumpala bua kukoka panyima ne kunyunguluka mutu wende ku luseke ne ku luseke bilondeshile dikoseka dia mpala wende. - Tshipeta tshia dipanda: Shi mbua upingana panyima, anyi shi muntu udi ne buôwa mupatule tshianza tshiende mukana mua mbua wa tshiamu tshia kutangila natshi, menu au adi ne mishiku mikoseka kunyima adi enza mudimu bu tshiamu tshia kupanda natshi mifuba, atshibula bimpe mu flexor digitorum profundus, flexor digitorum superficial, tensordons,/ulgitorum, nerves, ne ulgitorum raditals mishipa ya radial/ulnar/tibial. Bu mudi menu a varanid milamakaja anu kakese ku tshimanu tshia munda tshia tshiadi ne adi ne nsongo mitekete, bifulu bia meno bitu bipatuka misangu ya bungi munda mua mionji anyi periosteum, bilomba bua kuenza rayons X ya filme mupepele mu disuma dionso dia varanid.

2. Varanid mandibular venom vs the historical "bacteria-only" myth¶

Munkatshi mua makumi a bidimu, mikanda mimanyike ivua yamba ne: nyama ya mu Komodo ivua ishipa nyama anu bualu mishiku yayi ivua ya bukoya "miaba ya tuishi tua septic." Bimfuanyi bia matuku etu aa bia nzembu (MRI), histology, ne proteomic analysis (Fry et al., PNAS 2009; Dobson et al.) bivua biumvuija pathophysiologie mulelela wa Varanus bites:

1. Mandibular Protein-Secreting Glands: Komodo dragons, lace monitors (Varanus varius), perenties (Varanus giganteus), and water monitors are complex, compartimentated mandibular glands running along the lower jaw, with ducts opening directly between the lower the serrated the lower teure (pa mutu pa tshitupa tshimue meno a munda mutupu).
2. Profound Anticoagulant Phospholipase A2 (\(PLA_2\)): Tshintu tshidi ne mushinga wa bungi mu malu a luondapu mu bite bia varanid bia bantu ntshia Group III phospholipase A2, tshidi tshipangisha bikole arachidonic acid- ne collagen-induced platelet aggregation ne tshinyanga tshitupa tshia phospholipide-dependent cascade. Mu lupitadi, babedi badibu basuma kudi ntambue ya Komodo, biamu bia lace, anyi biamu bia kutangila nabi mâyi batu bapeta mashi adi apatuka mu mishipa ne mu mishipa adi kaayi ajika, a bungi, adi atungunuka munkatshi mua mêba 1 too ne ku 4 panyima pa dikosa dia tshiamu tshia bunene bua muomumue divua mua kuikala dimane kujika.
3. Vasoactive and Shock-Inducing Peptides (Kallikreins, Natriuretic Peptides, and AVIT Toxins): Varanid oral secretions also contain kallikrein-like serine proteases (generating bradykinin), B-type natriuretic peptides (activating vascular guanyly clasterial cyclase to mocles mucles), helodermin-like VIP peptides, ne AVIT family proteins (homologs of black mamba MIT1 / prokineticin that cause painful hyperalgesia and smooth muscle contraction). Mu dibunda dikole dia ntambue wa Komodo anyi disuma dia mutantshi mule kudi bantu badibu bakuate, bintu ebi bidi bipatuka mu mashi bidi bipetangana ne dijimija dia mashi bua kuenza bua tension, tachycardie, disama dia tshiadi, ne edema wa lukasa wa bianza.
4. Bua tshinyi bactérie idi anu ne mushinga mu malu a luondapu: Kuleja ne: mbua ya monitor idi ne bintu bidi bipangisha mashi bua kuela mu mishiku kakuena kumvuija ne: mishiku yayi kayena ne disama to. Nzolo ya mu mpata ya Komodo itu idia nyama mifue ne nyama ya mbuji ya mu mayi, ne mate yayi idi ilama Pasteurella multocida, Streptococcus, Staphylococcus, Pseudomonas aeruginosa, ne Enterobacter, eku semi-aquatic Asian water monitors (V.) ne salvator Nilotic ****. tshitudilu tshikole tshia Aeromonas hydrophila. Nunku, disuma dia mbua yonso didi dilomba dilongolola dia lukasa dia mashi bua kupangisha mashi bua kupatuka ne dikuba dia manga a antibiotique a spectre mualabale.

================================================================================
   SAFE RELEASE OF CLAMPED SNAPPING TURTLES & MONITOR LIZARDS
================================================================================

  [1. SNAPPING TURTLE CLAMPED ON HAND]
  ------------------------------------------------------------------------------
  * NEVER yank your hand back (keratin beak shears tendons and skin like shears)
  * NEVER lift the turtle by its tail (fractures turtle spine + long neck whips
    back to bite your other hand)

  --> ACTION A (Best): Submerge the turtle (and your hand) into a bucket, tub,
      or shallow pond edge. Turtles release almost instantly underwater to swim.
  --> ACTION B (On dry land): Place the turtle's flat belly shell (plastron)
      firmly on the ground, keep completely still so it feels supported, and
      wedge a smooth wooden dowel or pry bar into the side of the beak.

  [2. MONITOR LIZARD (VARANUS) CLAMPED ON HAND]
  ------------------------------------------------------------------------------
  * NEVER pull your hand backward against the recurved serrated teeth

  --> ACTION: Support the lizard's heavy body flat on the ground/table, grip
      firmly behind the head so it cannot shake sideways, wedge a flat stick
      or spoon handle behind the front teeth, lever jaws open, and lift out.
================================================================================

Biomekanike ne dipatuka dia bukubi dia Alligator ne Common Snapping Turtle bites¶

Bua tshinyi mbua ya snapping itu isuma ne mudi mishiku yayi mishilangane¶

1. Chelydra serpentina):* Pambelu pa mayi (tshilejilu, padibu basabuka njila anyi padibu bakuate ku muonji wa diloba), Chelydra serpentina udi ne plastron mukese wa nkuruse (muinshi mua tshibombi) udi ushiya maulu ende a mubidi ne mukila wende patoke. Bu mudiye kayi mua kukoka mubidi wende munda mua tshibombi tshiende bu mudi mbua wa mu kazubu, udi udikuba bikole pa buloba pa kuenda kumpala anyi panyima ne lubilu lua mupenyi, ulombodibua kudi nshingu mule mubumbakane udi mua kufika ku tshitupa tshia bule bua tshilamba tshiende. Padiye usuma tshianza anyi dikasa, misangu ya bungi udi ukanga mukana wende ne ukoka mutu wende panyima mutangile ku tshibombi eku wenda ututa diboko dia muntu udibu bashipe ne maboko ende a kumpala adi ne buôwa.
2. Alligator Snapping Turtle (Macrochelys temminckii): Nzubu munene wa mu mayi mimpe mu Amerike wa ku Nord (ufika ku kilo 90 too ne ku 200) udi ne mutu munene wa nseke isatu, nsongo isatu ya nsongo, ne mukana wa kuulu udi ne nsongo udi bu wa nyunyi wa nkutshi. Bishilangane na mushipa wa snapper, Macrochelys udi na nshingu muipi ne udi mulobi udi usomba ne windila udi ulala kayi unyema muinshi mua musulu ne mukana muende mubulula, wenda unyunguluka tshintu tshidi tshimueneka bu tshia nsese (vermiform lure)** pa ludimi luende. Padi mushipa wa wader ubuela mukana muende mubulula anyi mulobi uteta bua kumupatula anyi kumubandisha ku muelelu wa kumpala kua tshibombi, mishiku idi ikanga bu diteyi dia tshiamu tshia hydraulique, bipepele itshibula mifuba ya phalangeal ne itshibula minu anyi minu diakamue.

Kupatula ku kakese ku kakese dia nkutshi udi utapa¶

Shi mbua wa Common nansha wa Alligator udi utapa ku munu, ku tshianza, anyi ku makasa ebe:

1. KUKOKA panyima, kunyunguluka, anyi kunyungulula mbua mu lupepele: Kukoka munu webe ku muelelu wa keratine wa rhamphotheca kudi kukudimuna mputa wa dikuma mu dikosa dia guillotine dijima.
2. Wenza mudimu ne tshienzedi tshia dibuela mu mayi (dipatuka dia lukasa didi kadiyi ne kanyinganyinga):
3. Nyunyi wa nkutshi utu anu ulama bianza bia muntu bua buôwa bua kudikuba padiye pambelu pa mayi.
4. Kuambuluisha tshibombi tshia nkutshi ne tshianza tshiebe tshia tshianana (anyi lomba muntu udi ukuambuluisha akuate ku nseke/kunyima kua tshilamba) ne puekesha nkutshi ne tshianza tshiebe tshidibu bakusume buludiludi mu musulu, mu tshina tshia mâyi, mu tshibombi tshinene, mu tshiamu tshia mashika, anyi mu tshibombi tshia mâyi.
5. Diakamue padi mishiku ne tshibombi tshia nkutshi bibuela mu mayi, lungenyi luende ludi lushintuluka kumbukila ku dikuba dia kuowa mâyi: pabuipi ne nkutshi yonso idi ituta mishiku idi ibulula mukana wayi ne ipatuka mu tusunsa 2 anyi 10 muinshi mua mayi.
6. Bikalaku kakuyi mayi pabuipi apu (tshiambuluisha tshia buloba butekete + tshiamu tshia ku mukana tshia ku luseke):
7. Teka mbua panshi bua maulu ende onso anayi ne plastron wende bikale bimane pa buloba, ne ukuate tshianza tshiebe tshidibu basume tshishindame (kuimana kua mbua kutu misangu ya bungi kuenza bua mbua apatuke mu tusunsa 30 anyi 60 bua yeye kunyema).
8. Bikalabi bishala bikanga, lomba muntu muibidi bua kukuata nyima kua mutu/tshiamu paudi wela tshiamu tshia mutshi tshilengeja, mutshi munene, anyi tshiamu tshia tshiamu tshia mashinyi/tshiamu tshia tournevis tshibuikila mu ditumba dia ku luseke lua mukana (kule ne munu webe) ne utshinyungulula bitekete bitekete bua kubandisha dikasa panshi anu bua kubandisha munu webe.
9. Kuena ne bua kuela maluvu, tshintu tshia kulengeja natshi anyi kapia pa mutu wa mbuji to, bualu ebu budi buenza bua mbuji au apingaje nshingu wende munda menemene mu tshibombi tshiende eku muikale anu mukuate ku munu webe, ukoka tshianza tshiebe mu muelelu wa kumpala wa tshilamba.

Microbiologie ya mu mayi ne ya nyama idi yenda mu mâyi: Bua tshinyi Aeromonas hydrophila ne Edwardsiella tarda badi dijinga ne manga adi anyanga bimpe¶

Tshilumbu tshinene tshia luondapu lua lukasa lukasa ntshia kuondopa disama dia nkutshi anyi dia tshintu tshia kutangila natshi mâyi tshia mu Azia (Varanus salvator) ne manga a tshilele tshia mbwa/mpushi nkayawu anyi ne cephalosporins (cephalexin) anyi anti-staphylococcal penicillins (dicloxacillin/fluxacillin).

Tshilumbu tshia tshipupu tshia mu mayi¶

Bitotshi bia mu mayi matalale, mayi a mu tshina, ne bikunyibua bia ku mishiku bia mbua ya nsongo ne ya nsese ya mu mayi bidi ne mishindu isatu ya njiwu ya Gram-negative rods pamue ne anaerobes:

1. Aeromonas hydrophila ne Aeromonas veronii: Biamu bia anaerobique, oxidase-positive, fermentative Gram-negative bidi miaba yonso mu misulu ya mayi mimpe, majiba, ne misulu ya mâyi a mukele.
2. Tshilejilu tshia disama: Aeromonas disama dia mputa didi dienda dikola ne lukasa lua dikema, misangu ya bungi mu mêba 8 to ne ku 24 a disuma (anu bu Vibrio vulnificus mu mayi a mukele). Mputa udi upeta kanyinganyinga kakole kakole, katambakana ne lukasa, bullae hemorrhagic (bipumbishi bia mashi), subcutaneous crepitus (gaz mu bitupa bia mubidi bidi bifuanangana ne clostridial gas gangrene), necrotising myositis, tenosynovitis, ne fullminant granetive shock.
3. Bua tshinyi beta-lactams ya pa tshibidilu itu ipanga: Aeromonas hydrophila udi ne chromosome beta-lactamases (mudi cephalosporinases ne metallo-beta-lactamases) idi ifila ditantamana dia munda dia penicillin, ampicillin, amoxicillin-clavulanate (mu mishindu ya bungi ne cephalosporen wa kumpala ne muibidi), (cephalexin, cefazolin, cefuroxime).
4. Edwardsiella tarda: Mutshi wa Enterobacterales Gram-negative udi upetangana bikole ne mbua ya mu mayi mimpe, mushipa wa mbuji, ne nyama ya mu mayi udi ukebesha mputa mikole, necrotizing fasciitis, osteomyelitis, ne bacteremia (nangananga kudi babedi badi ne disama dia tshiadi anyi dia tshiamu tshia mitaku).
5. Pasteurella, Salmonella, Pseudomonas aeruginosa, ne Bacteroides: Bidi mu Varanus lizards ya pa buloba ne ya mu mayi (kusangisha ne Komodo dragons ne savannah/lace monitors), idi ikebesha flexor tenosynovitis ya lukasa ne septic arritis ne tenosynovitis 24 mêba 2 kubuela mu tshitupa tshia mubidi anyi mu tshitupa tshia mishipa.

Mukenji wa disama dia mu lupitadi ne dipanda dia bianza¶

1. Dikonkonona dia mashi ne dikola dia mashi (Nangananga mu Varanus Bites):
2. Bua mputa mikole idi ifumina ku ntambue ya mu Komodo anyi ku mputa minene idi itungunuka ne kupatuka ku bukole bua anticoagulant \(PLA_2\) ya mu tshiadi, ela mputa ne tranexamic acid (TXA)-soaked gauze anyi kaolin hemostatic gauze, wela tshilamba tshia elastique tshidi tshikuma, ne kukonkonona aPTT, fibrinogen, ne nomba ya plakete**.
3. Paudi mu nzubu wa dipanda anyi mu tshibambalu tshia malu a mpukapuka muinshi mua dikanga dia mijilu ya mu tshitupa anyi anesthésie générale, enza dikebulula dia dipanda ne dikanga dia mijilu buludiludi anyi dikosolola dia bipolar electrocautery dia mijilu ya pa mutu mikosa ne matamba a digitale/radial.
4. Dikonkonona dia mishipa ne mishipa ya mu mikolo (kumpala kua dienza dia anesthesie wa muaba):
5. Kumpala kua kuela lidocaine anyi bupivacaine bua kupangisha mijilu, teta disungula dia bitupa bibidi (mijilu ya radial, ya pankatshi ne ya ulnar), diuja dia mijilu, ne mudimu wa mijilu udi pa nkayende bua kuluisha:
   • Flexor Digitorum Profundus (FDP): Kuata tshiadi tshia pankatshi tshilulame ne lomba mubedi bua kuinama tshitupa tshia munu tshia kule (DIP).
   • Flexor Digitorum Superficialis (FDS): Kuata minu idi pabuipi (kukanga FDP) ne kulomba mubedi bua kuinama tshitupa tshia munu wa pankatshi (PIP).
   • Extensor Tendons: Teta dikola dia MCP, PIP, ne DIP joints ku ditantamana.
6. Umanye ne: dinyanguka dia tshitupa tshia muonji (nansha 70% dikosolola kudi dinu dia tshiamu tshia ziphodont) didi mua kuenza mudimu ne munu bimpe; mputa yonso udi upitshila mu tshitupa tshia muonji udi ne tshia kuikala mukonkonona ku mêsu ku diambuluisha dia tshitupa tshidi katshiyi ne mashi.
7. Bimfuanyi bia tshiamu tshia nzembu (X-Rays) mu bilumbu bionso:
8. Lomba bimfuanyi bia patupu bia tshianza, tshianza, dikasa anyi dikasa bisuma bua kumanya:
   • Bitupa bia meno a ziphodont adi kaayi amueneka bimpe bia Varanus mbua.
   • Ditapuluka dia mu tshiadi, dia mu tshiadi, anyi dia mu tshiadi didi difumina ku mishiku ya nkutshi.
   • Luya lua muinshi mua dikoba lua ku ntuadijilu kua Aeromonas anyi disama dia clostridial.
9. Mikenji ya dilengeja dia mputa ne dikanga dia mputa:
10. Ela tshilonda ne 1 too ne ku 3 litre ya mâyi a mukele a sterile ku diambuluisha dia angiocatheter wa 18-gauge pa tshiamu tshia 35-mL (tshidi tshipatula bukole bua mâyi bua 7 too ne ku 8 psi) bua kupatula mate a nyama udi unyunguluka, buloba bua mu tshina tshia mâyi ne mafuta adi afua; epuka kuela povidone-iodine anyi peroxyde d'hydrogène munda mua tshilonda tshidi katshiyi tshilongolola, tshidi tshishipa fibroblastes ya bantu ne tshinyanga phagocytose wa globules blancs.
11. Mukenji wa dikanga dia mputa: Mputa mikole, mputa ya nkutshi mitshibule, ne mputa mipite pa mêba 6 to ne ku 8 kayena ne bua kuikala misuika bikole nansha kakese**, bualu kukanga tshina tshidi ne Aeromonas kudi kuenza tshipupu tshikole tshia lufu mu mêba 24. Pamutu pa nanku, udi mua kuela tshintu tshidi tshilengeja ne mâyi a mukele bua dijika dia kumpala dia panyima pa mêba 72 too ne ku 96, anyi teka bipese bia pa mutu bia pa mutu pa tshina tshia dipanda anu panyima pa diondopangana dia mu nzubu wa dipanda ne manga a antibiotique.
12. Dikuba dia disama dia tetanus: Ufila Tdap anyi Td booster pikala mubedi kayi muanji kupeta booster mu bidimu 5, ne Human Tetanus Immune Globulin (TIG, 250 IU IM) pikala mubedi ne dose ya tetanus mitue ku 3 ya matuku ende onso a muoyo anyi kayi mumanye nsombelu wa dikuba dia mubidi.

Nomba ya tshimpitshimpi ya mu tshijengu ne mikenji ya bibambalu¶

• États-Unis ne Canada: Ela 911 bua mashi makole, dikosa dia bianza, anyi dibunda dia nyama minene. Tuilangana ne US Poison Control ku nimero eyi: 1-800-222-1222 bua kupeta lungenyi lua mumanyi wa malu a buanga pa bidi bitangila disuma dia nyama wa varanid.
• Indonésie (Komodo National Park, Flores, Rinca, and Nusantara): Ela 112 anyi 119 bua malu a luondapu. Pa bidiila bia Komodo ne Rinca, manyisha Komodo National Park Rangers diakamue bua buatu bua lubilu lukole anyi bua ndeke ya mvita idi mua kuya ku Siloam Hospitals Labuan Bajo (Flores) anyi ku nzubu ya luondapu mu Denpasar (Bali) anyi Jakarta.
• Australie ne Nouvelle-Zélande: Ela 000 mu Australie anyi 111 mu Nouvelle-Zélande. Disuma dia goannas minene ya mu Australie (Varanus giganteus, Varanus varius, Varanus gouldii) didi difikisha ku dipatuka dia anticoagulant mutantshi mule ne ku ditapa dia ziphodont; muinshi mua ANZCOR Guideline 9.4.1, Pressure Immobilization Bandage (PIB) udi bua nyoka, KI mbua goanna/monitor lizard bites to (enza mudimu ne tshiamu tshia direct strong wound pressure ne splint immobilization pamutu patshi). Bikila Tshibambalu tshia malu a buanga tshia mu Australie ku 13 11 26.
• Royaume-Uni ne Union européenne: Ela 999 mu UK anyi 112 mu UE mujima bua kupeta dipanda dia lukasa kunyima kua dikuma dia mbua anyi dia nkutshi, ne tangila NPIS / TOXBASE.
• Asia wa ku Sud-Est ne Afrike: Ela 1669 mu Thailande, 999 mu Malezia, 911 mu Philippines, 112 mu Inde, anyi 10177 / 112 mu Afrike wa ku Sud bua kupeta tshiamu tshia kubandila natshi mâyi tshia mu Azia anyi tshia mu bimenga (Varanus salvator) ne tshiamu tshia kubandila natshi Nile (*Varanus nilotic). Kufila diakamue dikuba dia disama dia tetanus ne dikuba dia ciprofloxacin + amoxicillin-clavulanate.

Nkonko itubu bela misangu ya bungi¶

Ba-dragon ba Komodo ne ba-monitor badi bushuwa ne buanga anyi, anyi badi anu ne mishiku ya bukoya?¶

Malongesha a matuku etu aa a mubidi ne a biochimie adi aleja ne: ntambue ya Komodo (Varanus komodoensis) ne ntambue mikuabu (bu mudi ntambue ya lace ne ntambue ya mâyi ya mu Azia) idi ne tuishi tua mu mishiku tukole tudi ku mishiku yabu ya kuinshi, pa kumbusha tuishi tua mukana tua njiwu. Padi meno abu a ziphodont apanda mputa mikole, bitupa biabu bia mu tshiadi bidi bipatula enzyme ya phospholipase A2 idi ikandika dikola dia mashi ne disangisha dia plakete, pamue ne kallikrein ne natriuretic peptides idi ivula mijilu ya mashi ne ipuekesha tension. Nunku bantu badibu bakengesha badi dijinga ne tshiamu tshikole tshia dikuba dia mashi bua dipatuka dia mashi mutantshi mule ne manga a antibiotique a bungi bua bactérie ya mukana.

Mmunyi muudi mua kuenza bua mbua wa tshisuku alekele munu webe kuyi ujimija munu?¶

Kukoki tshianza tshiebe tshianyima mu mukana wa nkutshi udi unyunguluka, ne kuangatshi nkutshi ku mukila wende nansha kakese. Pamutu pa nanku, diakamue upuekesha nkutshi ne tshianza tshiebe tshidibu bakusume mu tshibombi tshia mâyi, mu tshina tshia kuowa mâyi, anyi ku muelelu wa tshina tshia mâyi anyi wa musulu; mbua ya nsongo idi ikuata panshi bua buôwa bua kudikuba pa buloba buume ne misangu yonso itu ibulula mukana wayi ne ilekela mu tusunsa tukese padiyi mibuele mu mayi bua ikale mua kuowa mâyi. Shi kakuena mayi pabuipi apu, teka mbua panshi bua maulu ende onso anayi ne tshifu tshiende biumvuike bikuatshisha, kuata tshianza tshiebe tshishindame, ne bikalabi bikengela, ukangula luseke lua mukana bitekete bitekete ne mutshi mulenga.

Bua tshinyi kuena ne bua kukuata nkutshi udi wenda unyunguluka ku mukila wende?¶

Kubandisha mbua wa Common anyi wa Alligator ku mukila wende kudi ne njiwu kudi muntu ne kudi nyama udi wenda unyunguluka. Mukolo wa nkutshi udi ulamakaja buludiludi ne tshibombi tshiende tshikole tshia mifuba, nunku kuela nkutshi wa kilo 10 too ne ku 50 ku mukila wende kudi kunyanga mikolo yende ne kunyanga muonji wende wa mukolo. Kabidi, mbua wa Common snapping turtle (Chelydra serpentina) udi ne nshingu mule wa dikema udi ne misunya idi mua kuela tshianza panyima pa mutu pa tshibombi tshiende mu tshitupa tshia sekonde bua kukosa minu ya muntu udi mukuate mukila wende.

Bua tshinyi manga a antibiotique bu mudi cephalexin (Keflex) kaena akumbana kunyima kua nyunyi wa nkutshi anyi tshiamu tshia kutangila natshi mâyi?¶

Nyunyi ya nsongo ne nyunyi ya semi-aquatic monitor lizards idi mu mayi mimpe ne idi ne tshipupu tshia Gram-negative tshidibu babikila ne: Aeromonas hydrophila (pamue ne Edwardsiella tarda). Aeromonas hydrophila udi wenza beta-lactamase enzymes idi ibutula manga a dikoba bu mudi penicillin, ampicillin, ne cephalosporins ya tshipungu tshia kumpala bu mudi cephalexin (Keflex), bienza bua se disama dilue lukasa mu bipupu bia mashi ne fasciitis mu mêba 24. Baminganga badi ne tshia kufunda manga adi ashipa Aeromonas, bu mudi ciprofloxacin (anyi trimethoprim-sulfamethoxazole) musangisha ne amoxicillin-clavulanate anyi metronidazole.

Mmunyi muudi mua kuambula munu uvuabu bashipe kudi mbua wa Alligator?¶

Tshia kumpala, ikala ukanda mashi adi apatuka ku tshianza tshidi tshitapike ne dikuma dia gaze dikole ne dibandisha. Pashishe, sukula bitekete bitekete bukoya bua munu udibu bakose ne mâyi a mukele anyi mâyi malenga kuyi uwusukula, udi mua kuela tshianza mu tshitupa tshia gaze tshidi katshiyi tshinyanguka tshidibu balengeje ne mâyi a mukele, utshisuike mu tshibombi tshiume tshidi katshiyi tshibuela mâyi, ne uteke tshibombi atshi mu tshintu tshia pambelu tshiuwule tente ne mabue a mashika ne mâyi. Kuteke munu mukosa buludiludi pa mabue a mashika anyi kuwuteka mu mayi to, bualu mashika anyi dibuela dia mayi bidi binyanga mishipa ya mashi mikese idi ikengedibua bua kuyilamakaja.

Bua tshinyi disuma dia mbua didi ditungunuka ne kupatuka mashi munkatshi mua mêba a bungi nansha mudi tshitupa tshimueneka tshikese?¶

Nzolo ya kulonda idi ipatula manga a Groupe III phospholipase A2 (PLA2) adi afumina ku mishiku yabu ya muinshi mua tshiadi buludiludi mu bitupa bia menu. Ma enzyme aa adi abuikila mishipa ya mashi idi mitapa ne adi akanda plakete ya muntu bua kudisangisha pamue bua kuenza tshintu tshidi tshipangisha mashi bua kupatuka. Udi ne tshia kuikala ne tshianza tshikole, kakuyi lutatu pa tshilamba tshinene tshia gaze (anyi gaze wa hemostatic) munkatshi mua minite 15 mijima kuyi ubandisha tshilamba bua kutangila, ne kuela tshilamba tshia kukanga natshi padi mashi apatuka bitekete bitekete.

Miaba ne buludiki bua mbulamatadi¶

• Miyuki ya tshilongelu tshia ditunga tshia malu a sianse (PNAS) ne tshilongelu tshinene tshia Queensland (Australia): Mudimu munene wa buanga mu didia dia Varanus komodoensis (Komodo Dragon) ne Toxicofera Mandibular Glands (Fry et al., PNAS 2009; Dobson et al., Toxins).
• Infectious Diseases Society of America (IDSA, United States): Mibelu ya kuenza bua masama a kikoba ne a mubidi: Disuma dia nyama ya mu mayi, Aeromonas hydrophila, Edwardsiella tarda, ne dikuba dia nyama idi itambula.
• Société américaine pour la chirurgie de la main (ASSH) & ACS (États-Unis): Dilama dia dipanda dia nyama idi yenda ikola, dipanda dia mishipa, ne dilama dia dipanda dia tshianza.
• Wilderness Medical Society (WMS): Practice Guidelines for Reptiles Envenomations and Aquatic Traumas.
• Tshipangu tshia dilengeja dia bantu tshia mu Australie (ANZCOR): Dilombola dia malu adi atangila disuma dia mbua wa mu Australie (Goanna / Varanus) ne mikenji ya disuma dia nyoka.

Malu adi apetangana¶

• Dipatuka dia mashi dikole, dibuikila dia mputa, ne dienza dia tourniquet
• Disuma dia nyama ne dikuba dia mputa mikole
• Disama dia sepsis, tshipupu tshia septic, ne disama dia lukasa lukasa
• Ditangalaka dia disama dia selulite, milonda ya lymphangite mikunze, ne dikola dia tshipupu
• Nomba ya njiwu bilondeshile ditunga