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FORM MONITORING ANESTESI LOKAL.docx
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FORM MONITORING ANESTESI LOKAL.docx
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Asep Sofyan
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Monitoring FORMULIR Jam mulai sedasi
:
Tanggal
:
No.
Nama Obat Yang Diberikan
Nama Pasien : Tanggal Lahir Th No. RM Ruang Rawat/Kelas : Alamat ( Tempelkan Stiker
Dosis
R R 8 1 0 1 2 1 4 1 6 1 8 2 0 2 2 2 4 2 6 2 8
Saturasi O₂
:
:
L/P /Usia :
:
No. Registrasi
Pada Anestesi Lokal :
PEMANTAUAN ANESTESI LOKAL : Identitas Pasien )
Vital Sign TD HR S D 22 220 0 20 200 0 18 180 0 16 160 0 14 140 0 12 120 0 10 100 0 80 80 60
60
40
40 20
5’
10 ’
15 ’
2 0’
25 ’
TIME 3 35 0’ ’
40 ’
4 5’
50 ’
55 ’
60 ’
Kesadaran : Jam selesai operasi : PERAWAT
(
)
DOKTER
(
)
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