ceck list trolley emergency.xlsx

EMERGENCY TROLLEY (ADULT & PAED)CHECK LISTDiperiksa sebulan sekali/setelah dipakai

UGD,Kamar Operasi,

NO Nama obat/barang Jumlah

TOP SHELF / IV POLE1 Oxygen Supply tubing 12 Aquasonic Jelly 3 pcs3 Electrode infant dan adult 1 pc4 oropharyngeal airway no 0,1,2,3,4,5 1 pc5 Resusitator face mask adult,infant,neonate 1 pc 6 Handle Laringoscope infant & adult 1 pc7 Blade laringoscope No, 0,1,2,3,4,5 1 pc8 Back up blade laringoscope/disposible No. 3,4 1 pc9 Baterai AA dan Medium 2 pc

10 Resusitator bag : infant,paed,adult 1 pc11 o2 tabung 112 unit Defibrilator 113 ECG paper 1

Drawer I (Drugs)14 Amiodarone 150 mg/3 ml 515 Epinephrine 0,1 % - 1 mg/ml 1516 NaCl 0,9 % - 25 ml 517 Sulfas Atropin 1518 Ca Gluconas 100 mg/ml 219 Dextrose 40 % -25 ml 220 Dobutamin 250 mg/ 10 ml 121 Dopamin 200 mg/ 10 ml 122 Midazolam 5 mg 223 Herbesser 50 mg inj 124 Meylon 8,4 % - 25 ml 425 Dexametasone 5 mg/ml 226 D5% 100 ml 127 Lidocain 2 % ,2 ml 528 MgSo4 20 % 2

DRAWER II29 KY Jelly 130 ETT No. 2,5 131 ETT No. 3,0 132 ETT No. 3,5 133 ETT No. 4,0 134 ETT NO. 4,5 135 ETT NO. 5,0 1

Keterangan/ (Exp Date)

36 ETT NO. 5,5 137 ETT NO. 6,0 138 ETT NO. 6,5 139 ETT NO. 7,0 140 ETT NO. 7,5 141 ETT NO. 8,0 142 Intubating Stylet Portex S / M / L 143 Magil forceps child/Adult 144 Syringe Terumo 20 ml 145 Suction Cath N0 : 6,14 146 Penlight 147 Lidocain 2% Spray 1

DRAWER III


48 Dispo syringe 20 ml 549 Dispo syringe 50 ml 250 Infution set Dewasa 151 Surflo 18 ; 20 ; 22 ;24 252 Abbocath No. 26 253 Gunting 154 Hypafix 155 Tourniquit 156 Alas plastik 157 Needle No. 18 G 258 Needle No. 23 G 359 Extention Tube ET-1 160 Tegaderm 1610 ; 1633 261 3 way stopcock 162 Alkohol Swab 10

DRAWER IV


63 Mask Rebreating child ; adult 164 Mask Non Rebraething child ; Adult 165 Nasal Oxygen Child ; Adult 166 Suction Conecting Funnel 167 NaCl 0,9 % - 500 ml 268 Suction Bottle 169 Regulator Suction 170 Oxygen Flowmeter 1

SIDE DRAWER


71 Feeding Tube ;6 ;8; 10 1




72 Stomach Tube 12 ; 14 ; 16 173 Urine Bag 174 Syringe 50 ml Cath Tip 175 Glove Non Steril 176 Aquasonic 177 Maskerearlop 1

NAMA PASIENNO.RMALASAN DIBUKANo.KunciDiperiksa Oleh : Nursing

(Paraf dan nama jelas)Farmasi


UGD,Kamar Operasi,

tgl tgl tgl tgl tgl tgl tgl tgl


Tanggal dan No.Kuncitgl tgl tgl tgl tgl tgl tgl tgl



UGD,Kamar Operasi,

tgl

tgl

Tanggal dan No.Kuncitgl

tgl


UGD,Kamar Operasi,

NO Nama obat/barang Jumlahtgl tgl tgl

Drawer I (Drugs)1 Amiodarone 150 mg/3 ml 52 Epinephrine 0,1 % - 1 mg/ml 153 NaCl 0,9 % - 25 ml 54 Sulfas Atropin 155 Ca Gluconas 100 mg/ml 26 Dextrose 40 % -25 ml 27 Dobutamin 250 mg/ 10 ml 18 Dopamin 200 mg/ 10 ml 19 Midazolam 5 mg 2

10 Herbesser 50 mg inj 111 Meylon 8,4 % - 25 ml 412 Dexametasone 5 mg/ml 213 D5% 100 ml 114 Lidocain 2 % ,2 ml 515 MgSo4 20 % 2

DRAWER II16 KY Jelly 117 ETT No. 2,5 118 ETT No. 3,0 119 ETT No. 3,5 120 ETT No. 4,0 121 ETT NO. 4,5 122 ETT NO. 5,0 123 ETT NO. 5,5 124 ETT NO. 6,0 1


25 ETT NO. 6,5 126 ETT NO. 7,0 127 ETT NO. 7,5 128 ETT NO. 8,0 129 Intubating Stylet Portex S / M / L 130 Magil forceps child/Adult 131 Syringe Terumo 20 ml 132 Suction Cath N0 : 6,14 133 Penlight 134 Lidocain 2% Spray 1

DRAWER III

NO Nama obat/barang Jumlahtgl tgl tgl

35 Dispo syringe 20 ml 536 Dispo syringe 50 ml 237 Infution set Dewasa 138 Surflo 18 ; 20 ; 22 ;24 239 Abbocath No. 26 240 Gunting 141 Hypafix 142 Tourniquit 143 Alas plastik 144 Needle No. 18 G 245 Needle No. 23 G 346 Extention Tube ET-1 147 Tegaderm 1610 ; 1633 248 3 way stopcock 149 Alkohol Swab 10

DRAWER IV

NO Nama obat/barang JumlahTanggal dan No.Kunci

tgl tgl tgl50 Mask Rebreating child ; adult 151 Mask Non Rebraething child ; Adult 1



52 Nasal Oxygen Child ; Adult 153 Suction Conecting Funnel 154 NaCl 0,9 % - 500 ml 255 Suction Bottle 156 Regulator Suction 157 Oxygen Flowmeter 158 Feeding Tube ;6 ;8; 10 159 Stomach Tube 12 ; 14 ; 16 160 Urine Bag 161 Syringe 50 ml Cath Tip 162 Glove Non Steril 163 Aquasonic 164 Maskerearlop 1

NAMA PASIENNO.RMALASAN DIBUKANo.KunciDiperiksa Oleh : Nursing

(Paraf dan nama jelas)Farmasi


UGD,Kamar Operasi,

tgl tgl tgl tgl tgl tgl

tgl tgl tgl tgl tgl tgl

Tanggal dan No.Kuncitgl tgl tgl tgl tgl tgl

Drawer I (Drugs) Jumlah DRAWER III1 Amiodarone 150 mg/3 ml 5 352 Epinephrine 0,1 % - 1 mg/ml 15 363 NaCl 0,9 % - 25 ml 5 374 Sulfas Atropin 15 385 Ca Gluconas 100 mg/ml 2 396 Dextrose 40 % -25 ml 2 407 Dobutamin 250 mg/ 10 ml 1 418 Dopamin 200 mg/ 10 ml 1 429 Midazolam 5 mg 2 43

10 Herbesser 50 mg inj 1 4411 Meylon 8,4 % - 25 ml 4 4512 Dexametasone 5 mg/ml 2 4613 D5% 100 ml 1 4714 Lidocain 2 % ,2 ml 5 4815 MgSo4 20 % 2 49

50DRAWER II Jumlah

16 KY Jelly 1 DRAWER IV17 ETT No. 2,5 1 5018 ETT No. 3,0 1 5119 ETT No. 3,5 1 5220 ETT No. 4,0 1 5321 ETT NO. 4,5 1 5422 ETT NO. 5,0 1 5523 ETT NO. 5,5 1 5624 ETT NO. 6,0 1 5725 ETT NO. 6,5 1 5826 ETT NO. 7,0 1 5927 ETT NO. 7,5 1 6028 ETT NO. 8,0 1 6129 Intubating Stylet Portex S / M / L @ 1 6230 Magil forceps child/Adult @ 1 6331 Syringe Terumo 20 ml 1 6432 Suction Cath N0 : 6,14 @ 133 Penlight 134 Lidocain 2% Spray 1

DRAWER III JumlahDiispon syringe 3 ml,5 ml,10 ml @ 5Dispo syringe 20 ml 5Dispo syringe 50 ml 2Infution set Dewasa 1Surflo 18 ; 20 ; 22 ;24 @ 2Abbocath No. 26 2Gunting 1Hypafix 1Tourniquit 1Alas plastik 1Needle No. 18 G 2Needle No. 23 G 3Extention Tube ET-1 1Tegaderm 1610 ; 1633 @ 23 way stopcock 1Alkohol Swab 10

DRAWER IV JumlahMask Rebreating child ; adult @ 1Mask Non Rebraething child ; Adult @ 1Nasal Oxygen Child ; Adult 1Suction Conecting Funnel 1NaCl 0,9 % - 500 ml 2Suction Bottle 1Regulator Suction 1Oxygen Flowmeter 1Feeding Tube ;6 ;8; 10 @ 1Stomach Tube 12 ; 14 ; 16 @ 1Urine Bag 1Syringe 50 ml Cath Tip 1Glove Non Steril 1Aquasonic 1Maskerearlop 1

ceck list trolley emergency.xlsx

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