RSUD BOLMUT Nomor RM :

Jl. Talaga tomoagu kec.bolangitang barat

Kode pos 95764

ANESTHESIA RECORD
Name Of Patient :
DATE REMARKS MONITORING
TIME am pm
Stethoscope : Esoph Pre

ECG DOPPLER DINAMAP

Bp Cuff Radial Line

T Esoph Rectal Tymp

CVP Sp02 ETC0

CHAT CODE 0C 240

42 220
Oper O
41 200
Anesth x
40 180
Resp
39 160
Pulse
38 140
BP
37 120
Intub T
36 100
Extub Ʇ
35 80

60

40

20

0 PREMEDICATION
FLUIDS
Blood Loss (cc)
Blood Repl
Posisition
Regional Block
Urine cc Spinal Epidural
NG Tube cc Caudal Axillary
Proposed Operation Agent :
operation
Pre-Op Diagnosis Needle Gauge :
Post-Op Diagnosis Interspace
Surgeons Dermatome Level
anesthetist Paresthesia : yes No
INTAKE TOTAL
INTAKE TOTAL
Dokter Anestesi
OUTPUT TOTAL
OUTPUT TOTAL