LEMBAR MONITORING ALKES BOX EMERGENCY

MELATI CHILDREN’S HOSPITAL

BULAN :
RUANG : AMBULANCE

JUMLA MINGGU
NO LIST OBAT KETERANGAN
H 1 ED 2 ED 3 ED 4 ED 5 ED
1 Antrain 500mg/ml 1 amp
2 Asam tranexamat 1 amp
500mg/5ml
3 Atropine 0,25mg/ml 4 amp
Dexamethason 5mg/ml 4 amp
Diazepam 10mg/2ml 1 amp
4 Diphenhidramin 1 amp
10mg/ml
5 Ephineprint 1mg/ml 2 amp
6 Kalsium glukonas 10% 1 fls
7 Lidocain 2% 1 amp
8 KCL 7,46 % 1 fls
9 MgSO4 20% 1 fls
10 MgSO4 70% 1 fls
11 Water for injection 4 fls
Paraf
 LEMBAR MONITORING ALKES BOX EMERGENCY
MELATI CHILDREN’S HOSPITAL

BULAN :
RUANG : AMBULANCE

MINGGU
NO LIST ALKES JUMLAH KETERANGAN
1 ED 2 ED 3 ED 4 ED 5 ED
1 Alkohol swab 8 lembar
2 Bloodset 1 pcs
3 Benang jarum 1 pcs
4 Handscone 6,5 1 pcs
5 Handscone 7 1 pcs
6 Handscone 7,5 1 pcs
7 Handscone 8 1 pcs
8 IV Catheter 14 1 pcs
9 Nasal Canula dewasa 1 pcs
10 NRBM anak 1 pcs
11 NRBM dewasa 1 pcs
12 Spuit 1 cc 1 buah
13 Spuit 3 cc 2 buah
14 Spuit 5 cc 2 buah
15 Spuit 10 cc 1 buah
16 Urine bag 1 pcs
17 Infuse Dextose 40% 1 fls
18 Infuse D5 1 fls
19 Infuse RD5 1 fls
20 Infuse Ringer Lactat 1 fls
21 Infuse NaCl 0,9% 1 fls
Paraf

Mengetahui,
Kepala Instalasi Farmasi

(Apt.Chariztabella DN., S.Farm.)