Barcode

RSUP. Dr. Moh. Hoesin Palembang Nama :

Tgl Lahir :
CATATAN RESUSITASI JANTUNG PARU No. RM :

Dokter yang hadir:

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TEMUAN PENTING DAN TINDAKAN

Waktu kejadian Pukul : ____:____ Lokasi : _____________________________________

Aktivitas pasien saat terjadi serangan : _____________________________________________________

PENGKAJIAN

Denyut Jantung : Ada / Tidak

Pernafasan : Ada / Tidak
Pasien sedang dimonitor dengan EKG saat serangan: Ya / Tidak
Ritme EKG : _____________________________________________________________________
Waktu RJP dimulai : _____________________________________________________________________
Tindakan Awal : _____________________________________________________________________
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Waktu Intubasi Pukul : ____:____ Oleh : ______________________ Ukuran ETT : __________

DEFIBRILASI / KARDIOVERSI

Waktu Ritme EKG Joule Ritme EKG

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OBAT

Waktu Nama Obat Dosis Ritme EKG

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KETERANGAN

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Waktu selesai RJP Pukul : ____ : ____

Outcome : ICU / Bangsal Umum / Meninggal / _______________
Waktu pemberitahuan kepada keluarga pasien Pukul : ____ : ____

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Tanda Tangan & Nama Lengkap Dokter Tanggal : .................
Jam : .................