Form Follow Up Anestesi.docx
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FORM FOLLOW UP ANESTESI
Nama
:
Usia
:
Ruangan
:
TTL
:
Diagnosa
:
Tindakan
:
S:
A: M: P: L: E:
O:
K U: .............................
Kes U:................................
GCS: E .......V .......M.......
TTV: TD: ............mmHg Nadi:...............x/menit
Resp: ..............x/menit
Suhu: ................oC
Head To Toe: o o
Mata: Leher:
CA L:
/SI
E: M: Mallampati O: N: o
Thorax: P: VBS , Rh C: BJ I, II:
o o o
, Whz ,M ( ), G( )
Abdomen: BU ( ), Nyeri Tekan ( ) Ekstremitas: Akral .................., CRT .......................... Status Lokalis: *kalau bedah look, feel, move *kalau ada luka diinspeksi, palpasi
Pemeriksaan Penunjang :
Nama
:
Usia
:
Ruangan
:
TTL
:
Diagnosa
:
Tindakan
:
S:
A: M: P: L: E:
O:
K U: .............................
Kes U:................................
GCS: E .......V .......M.......
TTV: TD: ............mmHg Nadi:...............x/menit
Resp: ..............x/menit
Suhu: ................oC
Head To Toe: o o
Mata: Leher:
CA L:
/SI
E: M: Mallampati O: N: o
Thorax: P: VBS , Rh C: BJ I, II:
o o o
, Whz ,M ( ), G( )
Abdomen: BU ( ), Nyeri Tekan ( ) Ekstremitas: Akral .................., CRT .......................... Status Lokalis: *kalau bedah look, feel, move *kalau ada luka diinspeksi, palpasi
Pemeriksaan Penunjang :
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