CRITICAL CARE FLOW CHART

SUNRISE
HOSPITALS
CO-EXISTING
INPUT
::
DATE
BLOOD
GROUP
: PROBLEMS

NAME :
1.

AGE / SEX :
HT :

WT :

2.

BMI :

OUTPUT ::
DOA
HIV

DRAIN
3. IP.NO
HBSAG

CONSULTANT NAME :

4.

DEPARTMENT :

5.

::

BALANCE :

CHART
HCV NO :

:
:
:

DIAGNOSIS :
-------------------------------------------------------------------------------------------------------------------------------------------------------------------------INPUT
TIM

TEM

SPO

CV

IV

RT

FLUIDS

FEED
S

8AM
9AM
10A
M
11AM
12
1PM
2PM
3PM
4PM
5PM
6PM
7PM
8PM
9PM
10PM
11PM
12A

INFUSIONS

TPN

HRLY

M
1AM
2AM
3AM
4AM
5AM
6AM
7AM

VENTILATOR
TIME

TIME

LINES
1.
ETT : 2.
3.
RYLES 4.
TUBE :
5
FOLEYS :

PH

DATE OF
INSERTIO
N

PCO2

LINES

DVT
PROPHYLA
XIS :
ORAL CARE
EYE CARE

CVP :

PROPPED
UP
POSITION

PERIPHER
AL - 1

BED SORES

PERIPHER
AL - 2
DIALYSIS
CATH :
OTHERS :

NEBULISAT
ION :

ABG

PO2

HCO3

BE

DATEPRECAUTIONS
OF
INSERTIO
N

TIME

MODE

FIO2

RATE

HB

CREAT

NA

TB

TLC

B.UREA

IDB

PLATELET
COUNT

CUE

CL

SGOT

ESR

SMEAR FOR MP

CALCIU
M

SGPT

RBS

PROCALCITONI
N

LDH

ALBUMI
N

NURSESING STAFF NAME :

MORNING -------------------------------------------------------------NOON -----------------------------------------------------------NIGHT
---------------------------------------------------------