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7/24/2019 kartu anestesi fiki
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KARTU ANESTESI
CITO
ELEKTIF
KETERANGAN UMUM
Nama : …………………………………………. Tanggal : ……………………….
Umur : …………………………………………. No.Anestesi : ……………………….
e!er"aan : …………………………………………. No.R.M : ……………………….
Alamat : …………………………………………. #agian : ……………………….
A$li #e%a$ : …………………………………………. A$li.Anestesi : ……………………….
Ass.#e%a$ : …………………………………………. r&t.Anestesi : ……………………….
'iagnosa (ra)*e%a$ : …………………………………………………………………………….
+enis (em*e%a$an : …………………………………………………………………………….
'iagnosa (as,a - *e%a$ : …………………………………………………………………………….
A. KETERANGAN RA)#E'A
Kea%aan umum : gi/i !urang gemu! anemis ……………….
Na%i :……………0mt : !e,il ,u!u( ti%a! teratur teratur
Te!. 'ara$ :……….mmg erna(asan……………0mt Su$u ………….oC
##………..!g T.# …………..,m Golongan 'ara$
*……….gr1 Le!o………….0mm2 C3………………1
'iuresis : ……………..,,0"am Urine………………
Ele!trolit : …………………………………………………..
Lain - lain : …………………………………………………..
engo*atan seta$un tera!$ir : 4…………………………………………………………………………
5………………………………………………………..2………………………………………………
en6a!it ) (en6a!it lain :4…………………………………5…………………………………………..
2……………………………………..7…………………………………8……………………………...
STATUS FISIK : ASA I II III I3 3 E
engo*atan (ra)*e%a$ : oral re,tal IM0I3
4………………………………………………….5……………………………………………………..
2………………………………………………….7……………………………………………………..
#. ROSE'UR ANESTESI
METO'A : umum *lo,!a%e regional men%am(ingi
REMI'IKASI : ………………"am IM I3 re,tal
4……………………………………………………5……………………………………………………
2……………………………………………………7……………………………………………………
asil : memuas!an %e(resi sir!ulasi %e(resi (erna(asan %e9resi (si!is
ta,$6,ar%ia !enai!an su$u *a%an
7/24/2019 kartu anestesi fiki
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C. ANESTESI UMUM
In%u!si : sem(urna e!sitasi munta$ *atu! s(asme
Ta!ni! : o(er %ro(0insu99alation; semi)o(en non re*reat$ing;
Semi),lose% ,lose% a*sor(tion to an% 9ro
A*sor(tion ,ir,le IM I3 re,tal
engaturan na(as : s(ontan assiste% ,ontrolle%3entilator : (ressure ,ontrolle% <olume ,ontrolle% lain)lain
Te!ni! !$usus : $i(otermi $i(otensi *6)(ass lain)lain
MONITORING
=AKTU :
O5
N5>
al0Iso0In90Se<o
In9us0Trans9usi
77 55>
7> 5>>
2? 4@>
25 4?>
5@ 4@> 47>
57 4?> 45>
5> 47> 4>>
4? 45> @>
45 4>> ?>
@> 7>
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S(O5
TAN'A - TAN'A NA'I o ERNAASAN B TEK.'ARA B MULAI AN DB AKIR AN
>MULAI O D> AKIR O INFUS TRANFUSI
ME'IKASI
4……………………...……………..…………………………
2…………………………………………….…………………
8…………………………….………………………………………………………………………….……………………….
H………………………………………….……………………..
4>………………………………………...……………………..
42……………………………………………...………………..
5……………………………….……………………………
7………………………………………….…………………
?…………………………………………………….………@……………………………………………………………
4>………….………..………………………………………
45…………………...………………………………………
47……………………………...……………………………
EM#ERIAN CAIRAN
4 ……………......……..…………...…
7 …………………..…..……...………
………………………...……………
4>………………………...……...……
42……………………………………..
5………………………………………….
8………………………………………….
@………………………………………….
44……………..………………………….
47…………………..…………………….
2………….…………………………….
?……………….……………………….
H…………………….………………….
45………………………...…………….
48…………………………...………….
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'. #LOKA'E REGIONAL
Te$ni! : ,au%al ,au%al transa,ral intra<enous regional e(i%ural0(eri%ural
*lo,!a%e s6ara9 te(i s(inal su*ara,$noi%; to(i,al lain)lain
Lo!alisasi tusu!an0ta( : L 5)2 L 2)7 L 7)8
Analgesia setinggi segmen :………………….
Anestesi lo,al : (ro,ain0no<a,aine tetra,aine0(onto,ain li%o,aene0B6lo,aineme(i<a,aine0,ar*o,aine *u(i<a,aine0mar,aine
(rilo,aine0,itanest eti%o,aine0%uranest lain)lain
Konsentrasi : ………….1 +umla$ :………..,,
3aso!onstri!tor : a%renalin nor)a%renali ti%a! (a!ai
Konsentrasi :……………………………….
=a!tu mulai : Sunti!an "am :………......
Analgesia "am :…………..laman6a :………… "am ………mt
O(erasi "am : …………….laman6a ………….."am ………mt
Tin%a!an anestesi tam*a$an : a%a ti%a! a%a
E. KEA'AAN SELAMA OERASI
Leta! (en%erita : terlentang telung!u( lit$otomi,
'u%u!09ol&er miring tren%elen*urg
Knee - ,$est "a,! - !ni9e lain - lain
Intu*asi : oral nasal *lin% ti%a! %i intu*asi
No.tu*e :………… *alon (olos s(iral
en6ulit Intu*asi : ti%a! a%a sulit (er%ara$an0trauma
(ata$ gigi
en6ulit &a!tu anestesi0o(erasi : ti%a! a%a a%a
………………………………………………………………………………………………….
………………………………………………………………………………………………….
………………………………………………………………………………………………….
Tin%a!an : ………………………………………………………………………………………
………………………………………………………………………………………………….
………………………………………………………………………………………………….
Lama anestesi : 4 "am 4)5 "am 5)7 "am le*i$ 7 "am
+umla$ (en%ara$an : ……………….,, engeluaran ,airan : ………………..,,
KEA'AAN #AI : $i%u( la$ir mati mati %alam !an%ungan
#erat *a%an …………gr (an"ang *a%an …………..,m
A(gar s,ore : 4 menit > )2 7)? )4>
A(gar s,ore : 8 menit >)2 7)? )4>
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F. KEA'AAN ASCA - #E'A
4. KAMAR EMULI R.R;
Masu! "am J …………………….. tanggal :……………………
Kea%aan umum : sa%ar *elum sa%ar a%a re9le! (anas
#elum a%a re9le! s,$o! ………………
Na%i :…………0mt !e,il ,u!u( teratur ta! teratur
Te!anan %ara$ : …………..mm$g su$u *a%an :…………..>
Cerna(asan : *ai! sesa! ter(asang tu*e en%otra$eal
Fa,e mas! assisrte% <ent
Controlle% <ent ……………………
Kesan : *ai! sangsi *uru!
en6ulit : munta$ gelisa$0%elir ,6anosis
en%ara$an a(noe ,ar%ia, - arrest ………………..
Tin%a!an : ………………………………………………………………………………
………………………………………………………………………………
………………………………………………………………………………
in%a$0(ulang : "am………………. Ke : ……………..
Kesan a!$ir : *ai! sangsi *uru!
5. RUANG0INTENSI3E CARE UNIT ,oret 6ang ti%a! (erlu;
Masu! "am : ……………………… tanggal : …………………..
Kesan : *ai! sangsi *uru!
KEMATIAN &a!tu %an se*a*)se*a*n6a;
…………………………………………………………………………………
…………………………………………………………………………………
LAIN - LAIN :
……………………………………………………………………………………
……………………………………………………………………………………
MONITORING
57>
72o 55>
75o 5>>
74o 4@>
7>o
4?>2Ho 47>
2@o 45>
2o 4>>
2?o @>
28o ?>
27o 7>
22o 5>
Catatan - ,atatan :
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