Nombre: _______________________________________________________________________________
Domicilio: ______________________________________________________________________________
Presión arterial
Frecuencia cardiaca
Frecuencia respiratoria
Temperatura
Decisión
Pasa a observación
Pasa a hospitalización
Candidato a traslado
Observaciones:
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
Nombre: _______________________________________________________________________________
Domicilio: ______________________________________________________________________________
SIGNOS VITALES 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 01 02 03 04 05 06 07
390 180
FC 0
380 140
T0 X
370 100
360 60
TA
08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 01 02 03 04 05 06 07
PRESION ARTERIAL.
FRECUENCIA
RESPIRATORIA
INGRESOS 08 09 10 11 12 13 14 T 15 16 17 18 19 20 21 T 22 23 24 01 02 03 04 05 06 07 T
VSO
Soluciones
IV
Alimentos
EGRESOS 08 09 10 11 12 13 14 T 15 16 17 18 19 20 21 T 22 23 24 01 02 03 04 05 06 07 T
DIARREA
(ml)
VOMITO
(ml)
DIURESIS*
*ml/kg / hr
Oliguria <0.5 ml/kg/hr
Indicaciones médicas
Observaciones:___________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________