Simbol : 260
40o C 240 Besar Pupil :
Sistole = ^ 220 2
Diastole = v 3
39o C 200
Nadi = ●
Temp. = ▲ 180
38o C 160 4
140 5
37o C 120
100 6
36o C 80
60
7
40
20
10
0o C 0
G
BREATHIN
Jenis Ventilasi
PEEP/CPAP
Resp Rate
Tidal Volume
FiO2
Sensitivity
N
LATIO
SaO2
CIRCU
Gb EKG
CVP
Kesadaran
DISABILITY
Besar Pupil
Reaksi Pupil
Glasgow E
coma V
Scale M
Reflek Path +/-
1.
2.
3.
Kekuatan Otot
7 8 9 1 1 1 1 1 1 1 1 1 1 2 2 2 2 2 1 2 3 4 5 6
0 1 2 3 4 5 6 7 8 9 0 1 2 3 4
Makan/Minum
NGT
Infus : Sisa Sisa Sisa
INTAKE
1.
2.
3.
4.
5.
Jumlah
24 Jam
Total
Urine
NGT
OUT PUT
BAB
Drain/Darah :
1.
2.
Muntah
IWL Jumlah
24 Jam
Total
PaO2/PaCO2 Balance
pH/HCO3 -
Hb/Ht
Leucocyt
DATA LABORATORIUM
LED
Thrombocyt
Deff. Count
GD Puasa
GD 2 J PP
GD Sewaktu
Na/ K
Cl/Ca
Mg
Ureum/BUN
Creatinin
LDH
Cholesterol
Trigliserida
CKMB
Troponin
SGOT/SGPT
Albumin
Globulin