You are on page 1of 2

INITIAL ASSESMENT

No : Tanggal :
Nama : Observer :
Stase : Tanda Tangan :

Elemen Kompetensi Kriteria Unjuk Kerja DILAKUKAN TDK


DILAKUKAN
Triage 1. Triage problem
2. Triage pasien
Proteksi 3. Aman diri
4. Aman pasien
5. Aman lingkungan
Penilaian Awal
Primary Survey 6. APVU (Tingkat Kesadaran)
7. Airway management
8. Breathing management
9. Circulation management
(pencegahan shock
hipovolemik)
10. Disability (penilaian status
neurologis)
11. Exposure (tehnik logroll)
Secondary Survey 12. Pemeriksaan head to toe
13. Pengkajian riwayat
kecelakaan
14. Pengkajian SAMPLE
15. Reassesment ABCDE
16. Dokumentasi

Total Skor = Jml YA


_______
16 Penilai

(.................................)

You might also like