kartu anestesi fiki

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



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 :

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N5>

al0Iso0In90Se<o

In9us0Trans9usi

77 55>

7> 5>>

2? 4@>

25 4?>

5@ 4@> 47>

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5> 47> 4>>

4? 45> @>

45 4>> ?>

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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…………………………...………….



'. #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>



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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kartu anestesi fiki