RM 82h

CATATAN PEMANTAUAN ANASTESI LOKAL

No. Rekam Medik : …………………………………………… Tanggal Operasi : ................................................................

Nama Pasien : …………………………………………… Dokter Operator : ................................................................
Tanggal Lahir : ……………………………………………
NIK : ……………………………………………
CATATAN PEMANTAUAN

Konversi : Tidak Ya ,........................................................

Pernafasan : Spontan Asisted Kontrol
Posisi Operasi : Supine Prone Lateral Litothomi

Tanda-tanda vital sebelum Medikasi di Ruang TIndakan

tindakan
Tensi : 1 ...................................................... 6 ...................................................... 11 .....................................................
Nadi : 2 ...................................................... 7 ...................................................... 12 .....................................................
3 ...................................................... 8 ...................................................... 13 .....................................................
RR 4 ...................................................... 9 ...................................................... 14 .....................................................
SpO2 5 ...................................................... 10..................................................... 15 .....................................................

Tensi :
Nadi :
RR :
SpO2 :
Kondisi kulit setelah Tindakan anastesi lokal :

Kondisi Selama dan Alergi : Ya/Tidak

setelah dilakukan Keterangan :
anastesi lokal

Perdarahan : Ya/Tidak
Keterangan :

Perawat Asisten Operator Dokter Operator

................................................. .................................................
(Tanda tangan & nama terang) (Tanda tangan & nama terang)