LEMBAR TRIASE
DATA IDENTITAS SOSIAL PASIEN
No. Rekam Medis : Tanggal / Jam
Nama Lengkap : Pendidikan :
PEMERIKSAAN DEAT OF
EMERGENT URGENT NON URGENT
(Examination) ARRIVAL
Jalan Napas Sumbatan Bebas Bebas Sumbatan
(Airway) (Obstruction) (Patent) (Patent) (Obstruction)
Pernapasan Henti Napas Frek. Nafas (RR) Frek. Nafas (RR) Henti Napas
(Breathing) (Breathing Arrest) > 32 x/mnt 24 - 32 x/mnt (Breathing Arrest)
Sirkulasi Henti jantung Nadi teraba lemah Frek. Nadi (HR) Henti jantung
(Circulation) (Cardiac Arrest) (Weakness pulse) 120-150 x/mnt (Cardiac Arrest)
Nadi tidak teraba Frek. Nadi (HR) TD Sistolik Nadi tidak teraba
(Pulsene) < 50 x/mnt > 160 mmHg (Pulsene)
Pucat (Pale) Frek. Nadi (HR) TD Sistolik Pucat (Pale)
Akral dingin > 150 x/mnt > 100 mmHg Akral dingin
(Clammy) Pucat (Pale) (Clammy)
Akral Dingin
CRT < 2 detik
Kesadaran GCS < 9 GCS 9-12 GCS > 13 Pupil = Midriasis
(Disability) Reflex cahaya
Resusitasi/Bedah/Interna/Obgyn/Anak/THT/Neuro
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