Daftar Obat Emergency.xls
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DAFAR OBAT EMERGENCY RSUD AL-MULK NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
NAMA OBAT AMINOFILIN INJ 24 MG/ML 10 ML
SATUAN AMPUL
AMIODARONE HCL TAB 200 MG ( KENDARON )
tablet
AMIODARONE INJ HCL 50 MG / ML
ampul
AMLODIPINE BESILATE TAB 10 MG
TABLET
AMLODIPINE BESILATE TAB 5 MG
TABLET
AQUA PRO INJEKSI STERIL BEBAS PIROGEN 20 ML ASAM TRANEKSAMAT INJ 5 %
VIAL ampul
ASETOSAL TAB 80 MG (MINIASPI)
TABLET
ATROPIN SULFAT INJ 0,25 MG/ML 1 ML
AMPUL
DEKSAMETASON INJ 5 MG/ML 1 ML
ampul
DIAZEPAM INJ 2 MG / 5 ML
ampul
DIAZEPAM RECTAL 10 MG
TUBE
DIAZEPAM RECTAL 5 MG
TUBE
DIFENHIDRAMIN INJ 10 MG/ML
AMPUL
DOBUTAMIN INJ 50 MG / ML
ampul
DOPAMIN HCL INJ 40 MG / ML
ampul
EPINEPHRINE HCL BITARTAT INJ 1 MG / ML (ADRENALIN)
AMPUL
FENITOIN NATRIUM INJ 50 MG/ML
ampul
FITOMENADION (VIT K) INJ 10 MG/ML 1 ML
AMPUL
FUROSEMIDE 10 MG/ML INJEKESI
AMPUL
GLUCONAS KALSIUM INJ 10%
AMPUL
GLUKOSA LAR INFUS 40% STERIL 25 ML
BOTOL
ISOSORBID DINITRAT TAB SUBLINGUAL 5 MG
TABLET
KAPTOPRIL TAB 25 MG KLOPIDOGREL KAP 75 MG
tablet TABLET
LIDOCAIN COMPOSITUM INJ 2 ML
ampul
LIDOCAIN HCL INJ 2%
ampul
MAGNESIUM SULFAT INJ (IV) 20% 25 ML
VIAL
NOREPINEPHRINE BITARTAT INJ 4 MG / 4 ML
ampul
WIDA BESS LARUTAN INFUS STERIL
KOLF
WIDA KN 1 LARUTAN INFUS STERIL
KOLF
DAFTAR BMHP EMERGENCY RSUD AL-MULK NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27
NAMA OBAT
SATUAN
ALAT SUNTIK 3 ML
PCS
ALAT SUNTIK 5 ML
PCS
ALAT SUNTIK 10 ML
PCS
ALAT SUNTIK SEKALI PAKAI 50 ML
PCS
ENDOTRACHEAL TUBE SIZE 6.5
BUAH
ENDOTRACHEAL TUBE SIZE 7
BUAH
ENDOTRACHEAL TUBE SIZE 7.5
BUAH
FOLY CATETHER 16 FOLY CATETHER 18
PCS PCS
GUEDEL 100 MM
BUAH
GUEDEL 70 MM
BUAH
GUEDEL 90 MM
BUAH
INFUSION SET DEWASA
SET
IV CATHETHER 18
PCS
IV CATHETHER 20
PCS
IV CATHETHER 22
PCS
IV CATHETHER 24
PCS
KASA STERIL 16X16 CM
BOX
NASAL OXYGEN CANUL - ADULT NASAL OXYGEN CANUL - CHILD
BUAH
NASAL OXYGEN CANUL 02 SIZE XS
PCS
OXYGEN MASK - NON REBREATHING CHILD
PCS
OXYGEN MASK - NON REBREATHING ADULT
PCS
PCS
STOMACH TUBE 85 CM NO. 16
BUAH
STOMACH TUBE 85 CM NO. 18
BUAH
TRANFUSION SET
BUAH
URINE BAG
PCS
DAFTAR OBAT DAN BMHP EMERGENCY PERAWATAN ANAK NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
NAMA OBAT AQUA PRO INJEKSI STERIL BEBAS PIROGEN 20 ML
SATUAN VIAL
ATROPIN SULFAT INJ 0,25 MG/ML 1 ML
AMPUL
DEKSAMETASON INJ 5 MG/ML 1 ML
ampul
DIAZEPAM INJ 2 MG / 5 ML
ampul
DIAZEPAM RECTAL 5MG
SUPP
DIFENHIDRAMIN INJ 10 MG/ML
AMPUL
DOBUTAMIN INJ 50 MG / ML
ampul
DOPAMIN HCL INJ 40 MG / ML
ampul
EPINEPHRINE HCL BITARTAT INJ 1 MG / ML (ADRENALIN)
AMPUL
FITOMENADION (VIT K) INJ 10 MG/ML 1 ML
AMPUL
NATRIUM KLORIDA LAR INFUS 0,9% STERIL 100 ml
BOTOL
WIDA BESS LARUTAN INFUS STERIL
KOLF
WIDA KN 1 LARUTAN INFUS STERIL
KOLF
NASAL OXYGEN CANUL - CHILD
PCS
NASAL OXYGEN CANUL 02 SIZE XS
PCS
OXYGEN MASK - NON REBREATHING CHILD
PCS
JUMLAH 10 5 2 2 2 2 2 2 5 2 1 1 1 2 2 2
DAFTAR OBAT EMERGENCY PERAWATAN DEWASA NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
NAMA OBAT AMINOFILIN INJ 24 MG/ML 10 ML
SATUAN AMPUL
AMIODARONE HCL TAB 200 MG ( KENDARON )
tablet
AMIODARONE INJ HCL 50 MG / ML
ampul
AQUA PRO INJEKSI STERIL BEBAS PIROGEN 20 ML
VIAL
ATROPIN SULFAT INJ 0,25 MG/ML 1 ML
AMPUL
DEKSAMETASON INJ 5 MG/ML 1 ML
ampul
DIAZEPAM INJ 2 MG / 5 ML
ampul
DOBUTAMIN INJ 50 MG / ML
ampul
DOPAMIN HCL INJ 40 MG / ML
ampul
EPINEPHRINE HCL BITARTAT INJ 1 MG / ML (ADRENALIN)
AMPUL
FENITOIN NATRIUM INJ 50 MG/ML
ampul
FITOMENADION (VIT K) INJ 10 MG/ML 1 ML
AMPUL
FUROSEMIDE 10 MG/ML INJEKESI
AMPUL
GLUCONAS KALSIUM INJ 10%
AMPUL
GLUKOSA LAR INFUS 40% STERIL 25 ML
BOTOL
ISOSORBID DINITRAT TAB SUBLINGUAL 5 MG
TABLET
KLOPIDOGREL KAP 75 MG
TABLET
LIDOCAIN HCL INJ 2%
ampul
NOREPINEPHRINE BITARTAT INJ 4 MG / 4 ML
ampul
JUMLAH 2 10 2 2 5 2 1 2 3 5 1 2 2 2 3 10 12 3 3
NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24
DAFTAR BMHP EMERGENCY PERAWATAN DEWASA NAMA OBAT
SATUAN
ALAT SUNTIK 3 ML
PCS
ALAT SUNTIK 5 ML
PCS
ALAT SUNTIK 10 ML
PCS
ALAT SUNTIK SEKALI PAKAI 50 ML
PCS
ENDOTRACHEAL TUBE SIZE 6.5
BUAH
ENDOTRACHEAL TUBE SIZE 7
BUAH
ENDOTRACHEAL TUBE SIZE 7.5
BUAH
FOLY CATETHER 16 FOLY CATETHER 18
PCS PCS
GUEDEL 100 MM
BUAH
GUEDEL 70 MM
BUAH
GUEDEL 90 MM
BUAH
INFUSION SET DEWASA
SET
IV CATHETHER 18
PCS
IV CATHETHER 20
PCS
IV CATHETHER 22
PCS
IV CATHETHER 24
PCS
KASA STERIL 16X16 CM
BOX
NASAL OXYGEN CANUL - ADULT OXYGEN MASK - NON REBREATHING ADULT
BUAH PCS
STOMACH TUBE 85 CM NO. 16
BUAH
STOMACH TUBE 85 CM NO. 18
BUAH
TRANFUSION SET
BUAH
URINE BAG
PCS
JUMLAH 3 5 5 3 1 1 1 2 2 1 1 1 2 3 3 3 3 2 2 2 2 2 2 2
DAFTAR OBAT ENERGENCY UNIT UGD NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
NAMA OBAT
SATUAN
AMIODARONE INJ HCL 50 MG / ML
ampul
AMLODIPINE BESILATE TAB 10 MG
TABLET
AMLODIPINE BESILATE TAB 5 MG
TABLET
ASAM TRANEKSAMAT INJ 5 % ASETOSAL TAB 80 MG (MINIASPI)
ampul TABLET
DIAZEPAM INJ 2 MG / 5 ML
ampul
DIAZEPAM RECTAL 10 MG
TUBE
DIAZEPAM RECTAL 5 MG
TUBE
DIFENHIDRAMIN INJ 10 MG/ML
AMPUL
DOBUTAMIN INJ 50 MG / ML
ampul
DOPAMIN HCL INJ 40 MG / ML
ampul
EPINEPHRINE HCL BITARTAT INJ 1 MG / ML (ADRENALIN)
AMPUL
FUROSEMIDE 10 MG/ML INJEKESI
AMPUL
GLUKOSA LAR INFUS 40% STERIL 25 ML
BOTOL
ISOSORBID DINITRAT TAB SUBLINGUAL 5 MG
TABLET
KAPTOPRIL TAB 25 MG
tablet
LIDOCAIN COMPOSITUM INJ 2 ML
ampul
MAGNESIUM SULFAT INJ (IV) 20% 25 ML NOREPINEPHRINE BITARTAT INJ 4 MG / 4 ML
VIAL ampul
JUMLAH 3 15 20 5 15 2 2 2 3 4 4 3 3 2 15 15 30 2 3
Formulir Pemakaian Obat Emergensi TROLLEY EMERGENCY RUANGAN : PEMAKAIAN : Tanggal / Jam : NAMA OBAT/ALKES
JUMLAH
PETUGAS DOKTER
PERAWAT
Note : - Kunci lama diserahkan ke bagian farmasi - Form ini sebagai pengganti resep pemakaian obat dan alkes Trolley Emergency Serah
Terima
(.........................) Perawat
(.........................) Farmasi
Formulir Penggantian Obat Emergensi TROLLEY EMERGENCY Tanggal :
Jam : Nama Obat / Alkes
No. Kunci Baru : Jumlah
Nama Obat / Alkes
Jumlah
Serah
Terima
(........................) Farmasi
(.......................) Perawat
FORMULIR STOK OPNAME PERBEKALAN EMERGENCY Nama Pasien : Tanggal / Waktu Ganti : No Seal Lama No Seal Baru No
Tanggal / Waktu Buka
Perbekalan Emergency
Qty LACI 1
Fisik
ED
No
NO
Perbekalan Emergency
Qty LACI 2
Fisik
ED
No
NAMA OBAT AMINOFILIN INJ 24 MG/ML 10 ML
SATUAN AMPUL
AMIODARONE HCL TAB 200 MG ( KENDARON )
tablet
AMIODARONE INJ HCL 50 MG / ML
ampul
AMLODIPINE BESILATE TAB 10 MG
TABLET
AMLODIPINE BESILATE TAB 5 MG
TABLET
AQUA PRO INJEKSI STERIL BEBAS PIROGEN 20 ML ASAM TRANEKSAMAT INJ 5 %
VIAL ampul
ASETOSAL TAB 80 MG (MINIASPI)
TABLET
ATROPIN SULFAT INJ 0,25 MG/ML 1 ML
AMPUL
DEKSAMETASON INJ 5 MG/ML 1 ML
ampul
DIAZEPAM INJ 2 MG / 5 ML
ampul
DIAZEPAM RECTAL 10 MG
TUBE
DIAZEPAM RECTAL 5 MG
TUBE
DIFENHIDRAMIN INJ 10 MG/ML
AMPUL
DOBUTAMIN INJ 50 MG / ML
ampul
DOPAMIN HCL INJ 40 MG / ML
ampul
EPINEPHRINE HCL BITARTAT INJ 1 MG / ML (ADRENALIN)
AMPUL
FENITOIN NATRIUM INJ 50 MG/ML
ampul
FITOMENADION (VIT K) INJ 10 MG/ML 1 ML
AMPUL
FUROSEMIDE 10 MG/ML INJEKESI
AMPUL
GLUCONAS KALSIUM INJ 10%
AMPUL
GLUKOSA LAR INFUS 40% STERIL 25 ML
BOTOL
ISOSORBID DINITRAT TAB SUBLINGUAL 5 MG
TABLET
KAPTOPRIL TAB 25 MG KLOPIDOGREL KAP 75 MG
tablet TABLET
LIDOCAIN COMPOSITUM INJ 2 ML
ampul
LIDOCAIN HCL INJ 2%
ampul
MAGNESIUM SULFAT INJ (IV) 20% 25 ML
VIAL
NOREPINEPHRINE BITARTAT INJ 4 MG / 4 ML
ampul
WIDA BESS LARUTAN INFUS STERIL
KOLF
WIDA KN 1 LARUTAN INFUS STERIL
KOLF
DAFTAR BMHP EMERGENCY RSUD AL-MULK NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27
NAMA OBAT
SATUAN
ALAT SUNTIK 3 ML
PCS
ALAT SUNTIK 5 ML
PCS
ALAT SUNTIK 10 ML
PCS
ALAT SUNTIK SEKALI PAKAI 50 ML
PCS
ENDOTRACHEAL TUBE SIZE 6.5
BUAH
ENDOTRACHEAL TUBE SIZE 7
BUAH
ENDOTRACHEAL TUBE SIZE 7.5
BUAH
FOLY CATETHER 16 FOLY CATETHER 18
PCS PCS
GUEDEL 100 MM
BUAH
GUEDEL 70 MM
BUAH
GUEDEL 90 MM
BUAH
INFUSION SET DEWASA
SET
IV CATHETHER 18
PCS
IV CATHETHER 20
PCS
IV CATHETHER 22
PCS
IV CATHETHER 24
PCS
KASA STERIL 16X16 CM
BOX
NASAL OXYGEN CANUL - ADULT NASAL OXYGEN CANUL - CHILD
BUAH
NASAL OXYGEN CANUL 02 SIZE XS
PCS
OXYGEN MASK - NON REBREATHING CHILD
PCS
OXYGEN MASK - NON REBREATHING ADULT
PCS
PCS
STOMACH TUBE 85 CM NO. 16
BUAH
STOMACH TUBE 85 CM NO. 18
BUAH
TRANFUSION SET
BUAH
URINE BAG
PCS
DAFTAR OBAT DAN BMHP EMERGENCY PERAWATAN ANAK NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
NAMA OBAT AQUA PRO INJEKSI STERIL BEBAS PIROGEN 20 ML
SATUAN VIAL
ATROPIN SULFAT INJ 0,25 MG/ML 1 ML
AMPUL
DEKSAMETASON INJ 5 MG/ML 1 ML
ampul
DIAZEPAM INJ 2 MG / 5 ML
ampul
DIAZEPAM RECTAL 5MG
SUPP
DIFENHIDRAMIN INJ 10 MG/ML
AMPUL
DOBUTAMIN INJ 50 MG / ML
ampul
DOPAMIN HCL INJ 40 MG / ML
ampul
EPINEPHRINE HCL BITARTAT INJ 1 MG / ML (ADRENALIN)
AMPUL
FITOMENADION (VIT K) INJ 10 MG/ML 1 ML
AMPUL
NATRIUM KLORIDA LAR INFUS 0,9% STERIL 100 ml
BOTOL
WIDA BESS LARUTAN INFUS STERIL
KOLF
WIDA KN 1 LARUTAN INFUS STERIL
KOLF
NASAL OXYGEN CANUL - CHILD
PCS
NASAL OXYGEN CANUL 02 SIZE XS
PCS
OXYGEN MASK - NON REBREATHING CHILD
PCS
JUMLAH 10 5 2 2 2 2 2 2 5 2 1 1 1 2 2 2
DAFTAR OBAT EMERGENCY PERAWATAN DEWASA NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
NAMA OBAT AMINOFILIN INJ 24 MG/ML 10 ML
SATUAN AMPUL
AMIODARONE HCL TAB 200 MG ( KENDARON )
tablet
AMIODARONE INJ HCL 50 MG / ML
ampul
AQUA PRO INJEKSI STERIL BEBAS PIROGEN 20 ML
VIAL
ATROPIN SULFAT INJ 0,25 MG/ML 1 ML
AMPUL
DEKSAMETASON INJ 5 MG/ML 1 ML
ampul
DIAZEPAM INJ 2 MG / 5 ML
ampul
DOBUTAMIN INJ 50 MG / ML
ampul
DOPAMIN HCL INJ 40 MG / ML
ampul
EPINEPHRINE HCL BITARTAT INJ 1 MG / ML (ADRENALIN)
AMPUL
FENITOIN NATRIUM INJ 50 MG/ML
ampul
FITOMENADION (VIT K) INJ 10 MG/ML 1 ML
AMPUL
FUROSEMIDE 10 MG/ML INJEKESI
AMPUL
GLUCONAS KALSIUM INJ 10%
AMPUL
GLUKOSA LAR INFUS 40% STERIL 25 ML
BOTOL
ISOSORBID DINITRAT TAB SUBLINGUAL 5 MG
TABLET
KLOPIDOGREL KAP 75 MG
TABLET
LIDOCAIN HCL INJ 2%
ampul
NOREPINEPHRINE BITARTAT INJ 4 MG / 4 ML
ampul
JUMLAH 2 10 2 2 5 2 1 2 3 5 1 2 2 2 3 10 12 3 3
NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24
DAFTAR BMHP EMERGENCY PERAWATAN DEWASA NAMA OBAT
SATUAN
ALAT SUNTIK 3 ML
PCS
ALAT SUNTIK 5 ML
PCS
ALAT SUNTIK 10 ML
PCS
ALAT SUNTIK SEKALI PAKAI 50 ML
PCS
ENDOTRACHEAL TUBE SIZE 6.5
BUAH
ENDOTRACHEAL TUBE SIZE 7
BUAH
ENDOTRACHEAL TUBE SIZE 7.5
BUAH
FOLY CATETHER 16 FOLY CATETHER 18
PCS PCS
GUEDEL 100 MM
BUAH
GUEDEL 70 MM
BUAH
GUEDEL 90 MM
BUAH
INFUSION SET DEWASA
SET
IV CATHETHER 18
PCS
IV CATHETHER 20
PCS
IV CATHETHER 22
PCS
IV CATHETHER 24
PCS
KASA STERIL 16X16 CM
BOX
NASAL OXYGEN CANUL - ADULT OXYGEN MASK - NON REBREATHING ADULT
BUAH PCS
STOMACH TUBE 85 CM NO. 16
BUAH
STOMACH TUBE 85 CM NO. 18
BUAH
TRANFUSION SET
BUAH
URINE BAG
PCS
JUMLAH 3 5 5 3 1 1 1 2 2 1 1 1 2 3 3 3 3 2 2 2 2 2 2 2
DAFTAR OBAT ENERGENCY UNIT UGD NO 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
NAMA OBAT
SATUAN
AMIODARONE INJ HCL 50 MG / ML
ampul
AMLODIPINE BESILATE TAB 10 MG
TABLET
AMLODIPINE BESILATE TAB 5 MG
TABLET
ASAM TRANEKSAMAT INJ 5 % ASETOSAL TAB 80 MG (MINIASPI)
ampul TABLET
DIAZEPAM INJ 2 MG / 5 ML
ampul
DIAZEPAM RECTAL 10 MG
TUBE
DIAZEPAM RECTAL 5 MG
TUBE
DIFENHIDRAMIN INJ 10 MG/ML
AMPUL
DOBUTAMIN INJ 50 MG / ML
ampul
DOPAMIN HCL INJ 40 MG / ML
ampul
EPINEPHRINE HCL BITARTAT INJ 1 MG / ML (ADRENALIN)
AMPUL
FUROSEMIDE 10 MG/ML INJEKESI
AMPUL
GLUKOSA LAR INFUS 40% STERIL 25 ML
BOTOL
ISOSORBID DINITRAT TAB SUBLINGUAL 5 MG
TABLET
KAPTOPRIL TAB 25 MG
tablet
LIDOCAIN COMPOSITUM INJ 2 ML
ampul
MAGNESIUM SULFAT INJ (IV) 20% 25 ML NOREPINEPHRINE BITARTAT INJ 4 MG / 4 ML
VIAL ampul
JUMLAH 3 15 20 5 15 2 2 2 3 4 4 3 3 2 15 15 30 2 3
Formulir Pemakaian Obat Emergensi TROLLEY EMERGENCY RUANGAN : PEMAKAIAN : Tanggal / Jam : NAMA OBAT/ALKES
JUMLAH
PETUGAS DOKTER
PERAWAT
Note : - Kunci lama diserahkan ke bagian farmasi - Form ini sebagai pengganti resep pemakaian obat dan alkes Trolley Emergency Serah
Terima
(.........................) Perawat
(.........................) Farmasi
Formulir Penggantian Obat Emergensi TROLLEY EMERGENCY Tanggal :
Jam : Nama Obat / Alkes
No. Kunci Baru : Jumlah
Nama Obat / Alkes
Jumlah
Serah
Terima
(........................) Farmasi
(.......................) Perawat
FORMULIR STOK OPNAME PERBEKALAN EMERGENCY Nama Pasien : Tanggal / Waktu Ganti : No Seal Lama No Seal Baru No
Tanggal / Waktu Buka
Perbekalan Emergency
Qty LACI 1
Fisik
ED
No
NO
Perbekalan Emergency
Qty LACI 2
Fisik
ED
No
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