RUMAH SAKIT GRAHA HERMINE

Komplek Ruko Asih Raya No 6-15 Batu Aji, Batam

Tlpn : (0778)363318, 363127 Fax (0778) 363164 Email : graha_hermine@yahoo.com

Standar Isi Emergency Trolly Ruang UGD

Bulan :
Apoteker supervisor :
URAIAN KELOMPOK OBAT / JUMLAH STOK TERPAKAI SUPERVISI KET
ALAT KESEHATAN DAN TANGGAL APOTEKER

l.LACI I :
1. Sulfas Atropin ( SA ) inj 10 ampul
2. Amiodarone inj 1 ampul
3. Deksametason inj 10 ampul
4. Dopamin inj 5 ampul
5. Diazepam inj 5 ampul
6. Furosemid inj 5 ampul
7. Ephedrin inj 10 ampul
8. Fargoxin inj 5 ampul
9. Catapres inj 5 ampul
10. Lidocain 2 % 10 ampul
11. Aminophylin 5 ampul
12. Aquabidest 25 ml 2 fls
13. Alkohol Swab 10 pcs
14. D40% 2 fls
15. KCL 7,46% 2 fls
16. Manitol 40% 2 fls
2.LACI II :
1. Disposable syringe 3 ml 5 pcs
2. Disposable syringe 5 ml 5 pcs
3. Disposable syringe 10 ml 5 pcs
4. Disposable syringe 20 ml 2 pcs
5. Disposable syringe 50 ml 2 pcs
6. IV cath dewasa 18,20,22 @ 2 pcs
7. Skin elektroda 6 pcs
8. Hypapix 1 box
9. leukoplast 1 pcs
10. Lubricant Jelly 1 pcs
3.LACI III :
1. Chest tube 1 pcs
2. Blood set 2 pcs
3. Infus set 2 pcs
4. Laringoskop 1 set
5. Sarung tangan steril @ 1 pcs
no.6,5 ,7,7,5
6. Sarung tangan non steril 5 pasang
7. Endotracheal Tube/ ETT @ 1 pcs
no.3,4 ,5;5,5;7 dan 8
8. Suction cateter 12 1 pcs
9. Guadel- 80 mm, 70 mm, 2, 2
10. NGT 8, 12,16, 18 1,1,1,1 pcs
 RUMAH SAKIT GRAHA HERMINE
Komplek Ruko Asih Raya No 6-15 Batu Aji, Batam
Tlpn : (0778)363318, 363127 Fax (0778) 363164 Email : graha_hermine@yahoo.com

Standar Isi KIT Emergency

Bulan :
Apoteker supervisor :
URAIAN KELOMPOK OBAT / JUMLAH STOK TERPAKAI SUPERVISI KET
ALAT KESEHATAN DAN TANGGAL APOTEKER

1. Sulfas Atropin ( SA ) inj 5 ampul

2. Amiodarone inj 1 ampul
3. Deksametason inj 3 ampul
4. Diazepam inj 2 ampul
5. Furosemid inj 5 ampul
6. Ephedrin inj 5 ampul
7. Fargoxin inj 1 ampul
8. Lidocain 2 % 5 ampul
9. Aquabidest 25 ml 2 fls
10. Alkohol Swab 5 pcs
11. D40% 2 fls
12. KCL 7,46% 2 fls
13. Manitol 40% 2 fls
11. Disposable syringe 3 ml 2 pcs
12. Disposable syringe 5 ml 2 pcs
13. Disposable syringe 10 ml 2 pcs
14. Disposable syringe 20 ml 2 pcs
15. Disposable syringe 50 ml 1 pcs
16. IV cath dewasa 18,20,22 @ 1 pcs
17. Hypapix 1 pcs
14. Leucoplast 1 pcs
11. Blood set 2 pcs
12. Infus set 2 pcs
13. Sungkup O2 anak, dewasa @ 1 pcs
14. Sarung tangan steril @ 1 pcs
no.6,5 ,7,7,5
15. Sarung tangan non steril 2 pasang
15. Endotracheal Tube/ ETT @ 1 pcs
no.3,4 ,5;5,5;dan 7
 RUMAH SAKIT GRAHA HERMINE
Komplek Ruko Asih Raya No 6-15 Batu Aji, Batam
Tlpn : (0778)363318, 363127 Fax (0778) 363164 Email : graha_hermine@yahoo.com

Standar Isi Emergency Trolly Ruang NICU

Bulan :
Apoteker supervisor :
URAIAN KELOMPOK OBAT / JUMLAH STOK TERPAKAI SUPERVISI KET
ALAT KESEHATAN DAN TANGGAL APOTEKER

l.LACI I :
1. Amiodarone inj 1 ampul
2. Deksametason inj 5 ampul
3. Furosemid inj 5 ampul
4. Lidocain 2 % 2 ampul
5. Aquabidest 25 ml 2 fls
6. Alkohol Swab 10 pcs
7. D40% 2 fls
8. KCL 7,46% 2 fls
2.LACI II :
1. Disposable syringe 1 ml 5 pcs
2. Disposable syringe 3 ml 5 pcs
3. Disposable syringe 5 ml 5 pcs
4. Disposable syringe 10 ml 2 pcs
5. Disposable syringe 20 ml 1 pcs
6. Disposable syringe 50 ml 1 pcs
7. IV cath dewasa 18,20,22 @ 2 pcs
8. Skin elektroda 6 pcs
9. Hypapix 1 box
10. leukoplast 1 pcs
11. Lubricant Jelly 1 pcs
3.LACI III :
16. Chest tube 1 pcs
17. Blood set 2 pcs
18. Infus set 2 pcs
19. Laringoskop 1 set
20. Sarung tangan steril @ 1 pcs
no.6,5 ,7,7,5
21. Sarung tangan non steril 5 pasang
22. Endotracheal Tube/ ETT @ 1 pcs
no.3,4 ,5;5,5;7 dan 8
23. Suction cateter 12 1 pcs
24. Guadel- 80 mm, 70 mm, 2, 2
25. NGT 8, 12,16, 18 1,1,1,1 pcs
 RUMAH SAKIT GRAHA HERMINE
Komplek Ruko Asih Raya No 6-15 Batu Aji, Batam
Tlpn : (0778)363318, 363127 Fax (0778) 363164 Email : graha_hermine@yahoo.com

Standar Isi KIT Emergency

Bulan :
Apoteker supervisor :
URAIAN KELOMPOK OBAT / JUMLAH STOK TERPAKAI SUPERVISI KET
ALAT KESEHATAN DAN TANGGAL APOTEKER

1. Sulfas Atropin ( SA ) inj 2 ampul

2. Aminophylin inj 2 ampul
3. Deksametason inj 2 ampul
4. Asam tranexamat inj 2 ampul
5. Furosemid inj 2 ampul
6. Ephedrin inj 3 ampul
7. Dobutamin inj 2 ampul
8. Lidocain 2 % 5 ampul
9. Vit K inj 2 ampul
10. Aquabidest 25 ml 2 fls
11. Alkohol Swab 5 pcs
12. D40% 2 fls
13. KCL 7,46% 2 fls
14. MgSO4 2 fls
18. Disposable syringe 3 ml 2 pcs
19. Disposable syringe 5 ml 2 pcs
20. Disposable syringe 10 ml 2 pcs
21. IV cath dewasa 18,20,22 @ 1 pcs
26. Sungkup O2 anak, dewasa @ 1 pcs
27. Sarung tangan steril @ 1 pcs
28. Guedel 4/5 @1 pcs
29. Endotracheal Tube/ ETT @ 1 pcs
no.2,5,;5,5;
 RUMAH SAKIT GRAHA HERMINE
Komplek Ruko Asih Raya No 6-15 Batu Aji, Batam
Tlpn : (0778)363318, 363127 Fax (0778) 363164 Email : graha_hermine@yahoo.com

Standar Isi Tas KIT Emergency

Bulan :
Apoteker supervisor :
URAIAN KELOMPOK OBAT / JUMLAH STOK TERPAKAI SUPERVISI KET
ALAT KESEHATAN DAN TANGGAL APOTEKER

1. Sulfas Atropin ( SA ) inj 3 ampul

2. Amiodaron inj 1 ampul
3. Aminophylin inj 2 ampul
4. Deksametason inj 3 ampul
5. Fargoxin inj 1 ampul
6. Furosemid inj 3 ampul
7. Ephedrin inj 2 ampul
8. Dobutamin inj 2 ampul
9. Lidocain 2 % 2 ampul
10. Aquabidest 25 ml 2 fls
11. Alkohol Swab 2 pcs
12. D40% 2 fls
13. KCL 7,46% 2 fls
14. MgSO4 1 fls
22. Disposable syringe 3 ml 1 pcs
23. Disposable syringe 5 ml 1 pcs
24. Disposable syringe 10 ml 1 pcs
25. Disposable syringe 20 ml 1 pcs
26. IV cath dewasa 18,20,22 @ 1 pcs
29. Elektroda 4 pcs
30. Sarung tangan steril @ 1 pcs
31. Guedel 4/5 @1 pcs
29. Endotracheal Tube/ ETT @ 1 pcs
no.7 dan 7,5;
30. NRM dewasa 1 pcs
31. Slang amubag 1 pcs
32. Infuset makro, mikro @ 1 pcs
33. Bloodset 1 pcs
34. Polipropylen 3.0 1 pcs
35. Polipropylen 4.0 1 pcs
36. Suct. Cath 12,16,20 @1 pcs
37.Gelang identitas 3 pcs
38.Hypafix 1 pcs
39. Toerniqwet 1 pcs
40. Kasa gulung 1 pcs
41. Nald 23 2 pcs
42. Threeway 2 pcs
 RUMAH SAKIT GRAHA HERMINE
Komplek Ruko Asih Raya No 6-15 Batu Aji, Batam
Tlpn : (0778)363318, 363127 Fax (0778) 363164 Email : graha_hermine@yahoo.com

Standar Isi Emergency Trolly Ruang NICU

Bulan :
Apoteker supervisor :
URAIAN KELOMPOK OBAT / JUMLAH STOK TERPAKAI SUPERVISI KET
ALAT KESEHATAN DAN TANGGAL APOTEKER

l.LACI I :

1. Pytometadion injeksi 3 ampul

2. Furosemed injeksi 5 ampul
3. Dexamethasone injeksi 5 ampul
4. Lidocain injeksi 3 ampul
5. Dobutamine injeksi 1 ampul
6. Natrium Phenytoin injeksi 1 ampul
7. Noreepinefrin injeksi 1 ampul
8. Dopamin injeksi 1 ampul
9. Calcium gluconat injek 1 ampul
10. Proanes injeksi 1 ampul
11. Ketamin injeksi 1 ampul

2.LACI II :
1. Venflon No. 26 2 pcs
2. Three way 2 pcs
3. Blood transfusion set 2 pcs
4. Suction catheter no 8 2 pcs
5. Suction catheter no 6 2 pcs
6. Infus set pediatric 2 pcs
7. ETT No. 3.0 2 pcs
8. ETT No. 2.5 2 pcs
9. Extension Tube 4 box
10. NGT No. 3.5 1 pcs
11. NGT No. 8 2 pcs
12. Handscoon steril No. 6 ½ 2 pasang
13. Handscoon steril No. 7 2 pasang
14. Handscoon steril No. 7 ½ 2 pasang
15. Disposable syringe 1 ml 7 pcs
16. Disposable syringe 3 ml 9 pcs
17. Disposable syringe 5 ml 3 pcs
18. Disposable syringe 10 ml 7 pcs
19. Disposable syringe 20 ml 1 pcs
20. Disposable syringe 50 ml 1 pcs
21. Leukomed 2 pcs

3.LACI III :
Neopuff 1
4.LACI IV :
1. Infus RL 2 fls
2. Otsu Salin 3 % 1 fls
3. Dextrose 10 3 fls
4. Infuse NS 500 ml 2 fls
5. Infuse D5 100 ml 2 fls
6. Infuse NS 100 ml 2 fls
7. Infuse D5 ½ NS 1 fls
9. D 40% 2 fls
8. KCL 7,46% 2 fls
9. Steril water injeksi 7 fls
10. Meylon 1fls