PEMERINTAH PROVINSI LAMPUNG

RSUD BANDAR NEGARA HUSADA

Komplek Pemprov Lampung, Kota Baru Jati Agung Lampung Selatan 35365
HP: 0811-724-5333
e-mail : rsbnh.lampung@gmail.com, website : rsudbnh.lampungprov.go.id

FORM CHECKLIST TROLY EMERGENSI

TROLY : RANAP

No. Nama Obat/BHP Sat Jumlah Exp

A OBAT EMERGENSI

1 Epinephrine 1mg/mL inj Amp 5

2 Norepinephrine 1 mg/ml inj Amp 5 (3)
3 Dopamin 40 mg/mL inj Amp 2 (0)
4 Dobutamin 50 mg/mL inj Amp 2
5 Aminofilin inj Amp 2 (0)
6 Amiodaron HCl 50 mg/ mL Amp 5 (3)
7 Diazepam 5 mg/mL inj Amp 4
8 Atropin Sulfas 0,25 mg/mL inj Amp 10
9 Dexamethason 5 mg/mL inj Amp 5
10 Dextrose 40% Fls 4
11 Ca Gluconas 100 mg/mL Amp 2
12 Diltiazem 50 mg inj Vial 2
13 Lidocain inj Amp 2
14 Dextrose 5% Fls 1
15 MgSo4 20% Fls 1
16 MgSo4 40% Fls 1
17 Furosemid inj Amp 4
18 Vit.K Amp 2
19 Asam Tranexamat inj Amp 2
20 Nicardipine Amp 2 (0)
B ALKES/BHP
1 Ambu bag Pcs 1
Gudel Merah, Pink, Hijau, Hitam,
2 Putih, Kuning, Biru Pcs 1/1/1/1/1/1/1
3 Urine bag Pcs 3
4 Spuit 1/3/5/10/20/50 Pcs 2/2/2/2/2/2
5 Makroset / Mikroset Pcs 1/1
6 ETT (No. 3/3,5/4/4,5/5/7/7,5) Pcs 1/1/1/1/1/1/1
7 Nasal Canul Dewasa/Anak/Bayi Pcs 1
8 HI-Oxy Mask Dewasa/Anak Pcs 1
9 Nebulizer Dewasa/Anak Pcs 1
10 NGT 12/16/18 Pcs 1/1/1
11 IV cath ukuran : 18/20/22/24/26 Pcs 2/2/2/2/2
12 Suction Catheter 8/10/12/14 Pcs 1/1/1/1
13 Three way stop cock Psc 3
14 Alkohol Swab Pcs 5
15 Fulse Oxymeter Pcs 1