OBAT EMERGENCY KIT UGD

No. Nama Obat Jumlah Fisik ED

Drugs
1 Epineprine inj 0.1%, 1 ml 2 Ampul
2 SA (Sulfas Atropine) inj 0.25mg/ml, 1 ml 2 Ampul
3 Dexametason inj 5mg/ml, 1 ml 2 Ampul
4 ISDN tablet, 5 mg 10 Tablet
5 Amiodaron HCl (tiaryt) inj 50mg/ml, 3 ml 1 Ampul
6 Dobutamin inj 50mg/ml, 5 ml 1 Ampul
7 Norepineprine inj 1mg/ml, 4 ml 1 Ampul
8 Dopamin inj 40mg/ml, 5 ml 1 Ampul
12 Fargoxin inj 1 Ampul
13 Furosemid inj 1 Ampul
14 Dextrose 40% inf 1 Fles
15 KCl inf 1 Fles
17 MG So4 40% inf 1 Fles
18 Lidocain 2 % inj, 2 ml 2 Ampul
19 Calci Glukonas inj 100mg/ml, 10 ml 1 Ampul
Airway
1 Neck Collar 1 buah
2 Selang Suction No.14 @ 1 buah
3 OPA (Oropharyngeal Airway) atau Guedel No. 5;4 @1 buah
Breathing
1 Ambu Bag dan Sungkup Dewasa 1 buah
2 Ambu Bag dan Sungkup Anak 1 buah
3 Conektor Ambu Bag 1 buah
4 Selang O2 nasal kanul Anak dan Dewasa @ 1 buah
5 Sungkup O2 Anak dan Dewasa @ 1 buah
Circulation
1 Foley Catheter urin No. 14;16 1 buah
2 Urine Bag 1 buah
3 Cairan inf RL; NaCL 0.9%; Dex 5%; Dex 10% @ 1 fles
4 Aquabides 3 Fles
5 Infus Set Makro dan Mikro @ 1 buah
6 Blood Set 1 buah
7 Threeway 1 buah
8 Spuit 1cc; 3 cc; 5cc; 10cc @ 2 buah
9 Spuit 20cc; 50cc @ 1 buah

PAKET ANAFILATIK SYOK

1 Epineprin Injeksi 1 ampul
2 Dipenhydramin Injeksi 1 ampul
3 Methylprednisolon 125mg Injeksi 1 ampul
4 Spuit 3cc OM 3 pcs
5 Spuit 1cc OM 2 pcs

Tgl Alasan Permintaan Segel No Segel

10-Jan-18 Penggantian Obat ED 12026
 OBAT EMERGENCY KIT Lantai II

No. Nama Obat Jumlah Fisik ED

Drugs
1 Epineprin inj 1mg/ml, 1 ml 1 ampul
2 SA (Sulfas Atropine) inj 0.25mg/ml, 1 ml 1 ampul Jun-20
3 Dexametason inj 5mg/ml, 1 ml 1 ampul Apr-20
4 Tiaryt (Amiodaron HCl) inj 50mg/ml, 3 ml 1 ampul Aug-18
5 Dobutamin inj 50mg/ml, 5 ml 1 ampul Jan-19
6 Dopamin inj 40mg/ml, 5 ml 1 ampul Aug-19
7 Furosemid inj/ Uresik inj 1 ampul Apr-19
8 Dextrose 40% inf 1 fles Aug-19
9 KCl inf 1 fles Aug-19
10 Vaskon (Nonepineprin) 1mg/mL 1 ampul May-19
11 MG SO4 40% inf 1 fles Jul-18
12 Lidocain 2 % inj, 2 ml 1 ampul Sep-20
13 Calci Glukonas inj 100mg/ml, 10 ml 1 ampul Dec-20

Airway
1 NGT No.16 @1 buah
Circulation
1 Foley Catheter urin No. 16 1 buah
2 Urine Bag 1 buah
3 Cairan inf RL; NaCL 0.9% 1 fles
4 Infus Set Makro dan Mikro @ 1 buah
5 Blood Set 1 buah
6 Abocet 18,20,24 @ 1 buah

Tgl Alasan Permintaan Segel No Segel

10-Jan-18 Penggantian Obat ED 12130
 OBAT EMERGENCY KIT AMBULANCE

No. Nama Obat Jumlah Fisik ED

Drugs
1 Aminopylin Inj 1 Ampul Mar-21
2 Epineprine inj 0.1%, 1 ml 2 Ampul Oct-21
3 SA (Sulfas Atropine) inj 0.25mg/ml, 1 ml 2 Ampul Jun-20
4 Dexametason inj 5mg/ml, 1 ml 2 Ampul Aug-21
5 ISDN tablet, 5 mg 10 Tablet Jun-21
6 Amiodaron HCl (tiaryt) inj 50mg/ml, 3 ml 1 Ampul Feb-20
7 Dobutamin inj 50mg/ml, 5 ml 1 Ampul Jun-20
8 Norepineprine inj 1mg/ml, 4 ml 1 Ampul Jun-20
9 Dopamin inj 40mg/ml, 5 ml 1 Ampul Agust-19
10 Fargoxin inj 1 Ampul Apr-19
11 Furosemid inj 1 Ampul Oct-20
12 Dextrose 40% inf 1 Fles Dec-20
13 KCl inf 1 Fles Aug-19
14 MG So4 40% inf 1 Fles Aug-20
15 Lidocain 2 % inj, 2 ml 2 Ampul Sep-20
16 Calci Glukonas inj 100mg/ml, 10 ml 1 Ampul Mar-21
17 Spuit 1cc; 3 cc; 5cc; 10cc @ 2 buah
Circulation
3 Cairan inf RL 2 fles
4 Infus Set Makro dan Mikro @ 1 buah
6 Abocet 18,22,20,24 @ 1 buah

PAKET ANAFILATIK SYOK

1 Epineprin Injeksi 1 ampul
2 Methylprednisolon 125mg Injeksi 1 ampul
3
4

Tgl Alasan Permintaan Segel No Segel

10-Jan-18 Penggantian Obat ED 12188
3/23/2019 Penggantian Obat ED 12188
 OBAT EMERGENCY KIT Lantai III
No. Nama Obat Jumlah Fisik ED
Drugs
1 Epineprin inj 1mg/ml, 1 ml 1 ampul
2 SA (Sulfas Atropine) inj 0.25mg/ml, 1 ml 1 ampul Jun-20
3 Dexametason inj 5mg/ml, 1 ml 1 ampul Dec-19
4 Tiaryt (Amiodaron HCl) inj 50mg/ml, 3 ml 1 ampul Oct-18
5 Dobutamin inj 50mg/ml, 5 ml 1 ampul Jan-19
6 Dopamin inj 40mg/ml, 5 ml 1 ampul Aug-19
7 Furosemid inj/ Uresik inj 1 ampul Apr-19
8 Dextrose 40% inf 1 fles Aug-19
9 KCl inf 1 fles Mar-19
10 Vaskon (Nonepineprin) 1mg/mL 1 ampul Mar-19
11 MG SO4 40% inf 1 fles Jul-18
12 Lidocain 2 % inj, 2 ml 1 ampul Sep-20
13 Calci Glukonas inj 100mg/ml, 10 ml 1 ampul Dec-20

Airway
1 NGT No.16 @1 buah
Circulation
1 Foley Catheter urin No. 16 1 buah
2 Urine Bag 1 buah
3 Cairan inf RL; NaCL 0.9% 1 fles
4 Infus Set Makro dan Mikro @ 1 buah
5 Blood Set 1 buah
6 Abocet 18,20,24 @ 1 buah

Tgl Alasan Permintaan Segel No Segel

10-Jan-18 Penggantian Obat ED 12185
 OBAT EMERGENCY KIT OK

No. Nama Obat Jumlah Fisik ED

Drugs
1 Epineprine inj 0.1%, 1 ml 3 Ampul Jan-19
2 Efedrin inj 50mg/ml,1ml 3 Ampul Feb-21
3 Dipenhidramin inj 10mg/ml,1 ml 3 Ampul Jan-20
4 Furosemid inj 10mg/ml 3 Ampul Jan-19
5 Ranitidin inj 25mg/ml 3 Ampul Feb-20
6 SA (Sulfas Atropine) inj 0.25mg/ml, 1 ml 4 Ampul Jun-20
7 Dexametason inj 5mg/ml, 1 ml 4 Ampul Apr-20
8 Amiodaron HCl (tiaryt) inj 50mg/ml, 3 ml 1 Ampul Feb-19
9 Dobutamin inj 50mg/ml, 5 ml 1 Ampul Aug-18
10 Norepineprine/Vaskon inj 1mg/ml, 4 ml 1 Ampul Sep-18
11 Dopamin inj 40mg/ml, 5 ml 1 Ampul Aug-19
12 Dextrose 40% inf 1 Fles Nov-18
13 KCl inf 1 Fles Mar-19
14 MG So4 40% inf 1 Fles Jan-19
15 Lidocain 2 % inj, 2 ml 4 Ampul Aug-20
16 Neostigmin inj 2.5mg/ml 4 Ampul Mar-19
17 Calci Glukonas inj 100mg/ml, 10 ml 1 Ampul May-18
18 Abocet 18,20,22,24 @1 buah
19 Blood Set 1 buah
20 Spuit 1cc; 3 cc; 5cc; 10cc @ 2 buah

Tgl Alasan Permintaan Segel No Segel

12-Jan-18 Penggantian Obat ED 12061
 OBAT EMERGENCY KIT PERI
No. drugs Nama Obat Jumlah Fisik ED
1 Neo K Injeksi 1 Ampul Feb-19
2 Dexametason Injeksi 1 Ampul Apr-20
3 Epineprin Injeksi 2 Ampul Mar-20
4 Dipenhydramin Injeksi 1 Ampul Okt-21
5 Phenytoin Injeksi 1 Ampul Sep-19
6 NaCl 100ml (piggy back) Infus 1 Fles Jun-20
7 Calcii Gluconas Injeksi 1 Ampul Nov-20
8 NaCl 3% Otsu Infus 1 Fles Nov-19
9 KCL Infus 1 Fles Agust-19
10 Atropin Sulfas Injeksi 2 Ampul Mei-20
11

Airway
1 Endotracheal 3.0 1 Pcs Feb-20
2 NGT 3,5 ; 5 1 Pcs Jan-20
Circulation
1 Infus Set Anak OM 1 Pcs Jan-20
2 Dex 10% otsu Infus 1 Fles Jan-20
3 Dex 40% Otsu Infus 2 Fles Agust-20
4 Treeway Ekor 1 Pcs Okt-20
5 Abocath 24G 1 Pcs Feb-22
6 Spuit 1cc, 3cc, 5cc 2 buah Apr-21

Tgl Alasan Permintaan Segel No Segel

 OBAT EMERGENCY KIT HEMODIALISA
No. drugs Nama Obat Jumlah Fisik ED
1 Amiodaron Injeksi 1 Ampul Feb-19
2 Atropin Sulfas inj 2 Ampul Jun-20
3 Aminophylin Inj 1 Ampul Oct-20
4 Calcii Gluconas Inj 1 Ampul des-20
5 Dexametason Inj 1 Ampul Des-19
6 Dobutamin Inj 1 Ampul Jan-19
7 Dopamin Inj 1 Ampul Agust-19
8 Fargoxin Inj 1 Ampul Oct-19
9 Ephineprin Inj 1 Ampul Mar-20
10 ISDN Tab 5mg 10 Tab Jun-21
11 Captopril 25mg Tab 10 Tab Jul-21
12 Lidocain Inj 1 Ampul Mar-20
13 Dipenhydramin Inj 1 Ampul Oct-21
14 Nifedipin Tab 10mg 10 Tab Mei-21
15 Ondansentron Inj 1 Ampul Des-18
16 Sodium Heparin Inj (INVICLOT INJ) 1 Vial Mei -19
17 Ranitidin Inj 1 Ampul Feb-20
18 Vascon Inj 1 Ampul Mar-19
19
20
21

Circulation
1 Blood Set OM' 1 Pcs Jun-22
2 NaCL Otsu Infus / Widarta Infus 500ml 1 Fles Nov-22
3 Dex 40% Otsu Infus 1 Fles Oct-19
4 Treeway 1 Pcs Mar-22
5 Abocath 18G 1 Pcs Sep-19
6 Spuit 1cc, 3cc, 5cc 2 buah

Tgl Alasan Permintaan Segel No Segel

 DAFTAR SEDIAAN FARMASI DEPO FARMASI UNIT OK
NO NAMA SEDIAAN FARMASI JUMLAH FISIK ED
BENANG
1 Safil 1 Bulat HR40S 1 PCS
2 Safil 2/0 Segitiga Tapercoart HRT 37S 1 PCS Des-21
3 Safil 2/0 Bulat HR26 1 PCS Juni-22
4 Safil 3/0 Segitiga DS24 1 PCS Mei-22
5 Safil 3/0 bulat HR26 1 PCS Agust- 22
6 Premilene 3/0 DS24 1 PCS Okt-22
7 Premilene 4/0 DS19 1 PCS April -22
8 Catgut Plain 2/0 Bulat Hr26 1 PCS Juli- 21
Alkes
1 Foley Catetr 16 1 PCS Okt-21
2 Urine Bag OM 1 PCS Juli-22
3 Spuit 20cc TRM 1 PCS Des-21
4 Spuit 10cc OM 2 PCS Nop-22
5 Spuit 3cc OM 2 PCS Agust- 22
6 Spuit 5cc OM 2 PCS Nop-22
7 Spuit 1cc OM 2 PCS Mei-19
8 NGT 14 1 PCS Juni-19
9 NGT 16 1 PCS Mei-22
10 NGT 12 1 PCS Peb-19
11 Klip EKG 6 PCS
INFUS
1 Aquabides 2 Fls Nop-18
2 RL otsu Infus 2 Fls Sept-22
3 Dex 5% Otsu Infus 1 Fls Agust- 20
Lampiran 1
OBAT EMERGENCY KIT Lantai II dan III

No. Nama Obat Jumlah

Drugs
1 Epineprin inj 1mg/ml, 1 ml 2 ampul
2 SA (Sulfas Atropine) inj 0.25mg/ml, 1 ml 1 ampul
3 Dexametason inj 5mg/ml, 1 ml 1 ampul
4 Tiaryt (Amiodaron HCl) inj 50mg/ml, 3 ml 1 ampul
5 Dobutamin inj 50mg/ml, 5 ml 1 ampul
6 Dopamin inj 40mg/ml, 5 ml 1 ampul
7 Furosemid inj/ Uresik inj 1 ampul
8 Dextrose 40% inf 1 fles
9 KCl inf 1 fles
10 Vaskon (Nonepineprin) 1mg/mL 1 ampul
11 MG SO4 40% inf 1 fles
12 Lidocain 2 % inj, 2 ml 1 ampul
13 Calci Glukonas inj 100mg/ml, 10 ml 1 ampul

Airway
1 NGT No.16 @1 buah
Circulation
1 Foley Catheter urin No. 16 1 buah
2 Urine Bag 1 buah
3 Cairan inf RL; NaCL 0.9% 1 fles
4 Infus Set Makro dan Mikro @ 1 buah
5 Blood Set 1 buah
6 Abocet 18,20,24 @ 1 buah
Lampiran I
OBAT EMERGENCY KIT VK ( BAYI)

No. Nama Obat Jumlah

ED
Drugs
1 Epineprin Inj 2 Dec-20
2
Airway
1 Endotracheal 2,5 1pcs Feb-20
2 Laringoskopi Bayi 1pcs
Circulation
1 Infus Set Anak 1 pcs Sep-20
2 Spuit 1cc OM 2 pcs Jan-20
3 Spuit 50cc TRM 1pcs Feb-19
4 Spuit 20cc TRM 1pcs Jan-20
5 Spuit 10cc OM 1pcs Sep-19
6 Abocath 24G 1pcs Dec-20
7 Dex 10% Otsu Infus 1pcs Apr-20
8 Aquabides 1pcs Aug-19
9 Catgut plain 2/0 1pcs Jun-19
10 Treeway Ekor 1pcs Mar-19
11 Kasa 5cm 1pcs -
12 Mess 10 1pcs -

OBAT EMERGENCY KIT VK ( Gine)

No. Nama Obat Jumlah

ED
Drugs
1 Epineprin inj 1mg/ml, 1 ml 2 pcs Dec-20
2 SA (Sulfas Atropine) inj 0.25mg/ml, 1 ml 2 pcs Jun-21
3 Dexametason inj 5mg/ml, 1 ml 1 pcs Feb-21
4 (Amiodaron HCl) inj 50mg/ml, 3 ml 1 pcs Feb-20
5 Dobutamin inj 50mg/ml, 5 ml 1 pcs Mar-20
6 Dopamin inj 40mg/ml, 5 ml 1 pcs Aug-19
11 MG SO4 40% inf 1 pcs Feb-20
13 Calci Glukonas inj 100mg/ml, 10 ml 1 pcs Oct-21
14 Ephedrin Inj 1 pcs Jul-21
15 Aminophilyn Inj 1 pcs Jan-22
Airway
1
2
Circulation
1 Nacl Otsu Infus 1pcs May-23
2 Spuit 5cc OM 1pcs Feb-19
3 Abocath 18G, 20G, 2G, 24G 1pcs Sep-19
4 Treeway 1pcs Jul-22
5 Blood Set 1pcs Dec-21
6
7

OBAT EMERGENCY KIT VK

No. Nama Obat Jumlah

ED
Drugs
1 Epineprin inj 1mg/ml, 1 ml 2 pcs Dec-20
2 SA (Sulfas Atropine) inj 0.25mg/ml, 1 ml 2 pcs Jun-21
3 Dexametason inj 5mg/ml, 1 ml 1 pcs Feb-21
4 (Amiodaron HCl) inj 50mg/ml, 3 ml 1 pcs Feb-20
5 Dobutamin inj 50mg/ml, 5 ml 1 pcs Mar-20
6 Dopamin inj 40mg/ml, 5 ml 1 pcs Aug-19
11 MG SO4 40% inf 1 pcs Feb-20
13 Calci Glukonas inj 100mg/ml, 10 ml 1 pcs Oct-21
14 Ephedrin Inj 1 pcs Jul-21
15 Aminophilyn Inj 1 pcs Jan-22
16
17
18
Airway
1
2
Circulation
1 Nacl Otsu Infus 1pcs May-23
2 Spuit 5cc OM 1pcs Feb-19
3 Abocath 18G, 20G, 2G, 24G 1pcs Sep-19
4 Treeway 1pcs Jul-22
5 Blood Set 1pcs Dec-21
6
7
 OBAT EMERGENCY KIT OK ( Bayi)

No. drugs Nama Obat Jumlah Fisik ED

1 Neo K Injeksi 1 Ampul

2 Dexametason Injeksi 1 Ampul
3 Epineprin Injeksi 2 Ampul
4 Dipenhydramin Injeksi 1 Ampul
5 Phenytoin Injeksi 1 Ampul
6 NaCl 100ml (piggy back) Infus 1 Fles
7 Calcii Gluconas Injeksi 1 Ampul
8 NaCl 3% Otsu Infus 1 Fles
9 KCL Infus 1 Fles
10 Atropin Sulfas Injeksi 2 Ampul
11

Airway
1 Endotracheal 3.0 1 Pcs
2 NGT 3,5 ; 5 1 Pcs
Circulation
1 Infus Set Anak OM 1 Pcs
2 Dex 10% otsu Infus 1 Fles
3 Dex 40% Otsu Infus 2 Fles
4 Treeway Ekor 1 Pcs
5 Abocath 24G 1 Pcs
6 Spuit 1cc, 3cc, 5cc 2 buah

Tgl Alasan Permintaan Segel No Segel