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EMERGENCY TROLLEY (ADULT & P

Diperiksa sebulan sekali/set


UGD,Kamar Operasi,
NO

Nama obat/barang

TOP SHELF / IV POLE


1 Oxygen Supply tubing
2 Aquasonic Jelly
3 Electrode infant dan adult
4 oropharyngeal airway no 0,1,2,3,4,5
5 Resusitator face mask adult,infant,neonate
6 Handle Laringoscope infant & adult
7 Blade laringoscope No, 0,1,2,3,4,5
8 Back up blade laringoscope/disposible No. 3,4
9 Baterai AA dan Medium
10 Resusitator bag : infant,paed,adult
11 o2 tabung
12 unit Defibrilator
13 ECG paper
Drawer I (Drugs)
14 Amiodarone 150 mg/3 ml
15 Epinephrine 0,1 % - 1 mg/ml
16 NaCl 0,9 % - 25 ml
17 Sulfas Atropin
18 Ca Gluconas 100 mg/ml
19 Dextrose 40 % -25 ml
20 Dobutamin 250 mg/ 10 ml
21 Dopamin 200 mg/ 10 ml
22 Midazolam 5 mg
23 Herbesser 50 mg inj
24 Meylon 8,4 % - 25 ml
25 Dexametasone 5 mg/ml
26 D5% 100 ml
27 Lidocain 2 % ,2 ml
28 MgSo4 20 %
DRAWER II
29 KY Jelly
30 ETT No. 2,5
31 ETT No. 3,0
32 ETT No. 3,5
33 ETT No. 4,0
34 ETT NO. 4,5
35 ETT NO. 5,0

Jumlah
1
3 pcs
1 pc
1 pc
1 pc
1 pc
1 pc
1 pc
2 pc
1 pc
1
1
1
5
15
5
15
2
2
1
1
2
1
4
2
1
5
2
1
1
1
1
1
1
1

Keterangan/
(Exp Date)

36 ETT NO. 5,5


37 ETT NO. 6,0
38 ETT NO. 6,5
39 ETT NO. 7,0
40 ETT NO. 7,5
41 ETT NO. 8,0
42 Intubating Stylet Portex S / M / L
43 Magil forceps child/Adult
44 Syringe Terumo 20 ml
45 Suction Cath N0 : 6,14
46 Penlight
47 Lidocain 2% Spray
DRAWER III
NO

Nama obat/barang

48 Dispo syringe 20 ml
49 Dispo syringe 50 ml
50 Infution set Dewasa
51 Surflo 18 ; 20 ; 22 ;24
52 Abbocath No. 26
53 Gunting
54 Hypafix
55 Tourniquit
56 Alas plastik
57 Needle No. 18 G
58 Needle No. 23 G
59 Extention Tube ET-1
60 Tegaderm 1610 ; 1633
61 3 way stopcock
62 Alkohol Swab
DRAWER IV
NO

Nama obat/barang

63 Mask Rebreating child ; adult


64 Mask Non Rebraething child ; Adult
65 Nasal Oxygen Child ; Adult
66 Suction Conecting Funnel
67 NaCl 0,9 % - 500 ml
68 Suction Bottle
69 Regulator Suction
70 Oxygen Flowmeter
SIDE DRAWER
NO

Nama obat/barang

71 Feeding Tube ;6 ;8; 10

1
1
1
1
1
1
1
1
1
1
1
1
Jumlah

Keterangan/
(Exp Date)

5
2
1
2
2
1
1
1
1
2
3
1
2
1
10
Jumlah

Keterangan/
(Exp Date)

1
1
1
1
2
1
1
1
Jumlah
1

Keterangan/
(Exp Date)

72 Stomach Tube 12 ; 14 ; 16
73 Urine Bag
74 Syringe 50 ml Cath Tip
75 Glove Non Steril
76 Aquasonic
77 Maskerearlop
NAMA PASIEN
NO.RM
ALASAN DIBUKA
No.Kunci
Diperiksa Oleh :

1
1
1
1
1
1

Nursing
Farmasi

(Paraf dan nama jelas)

GENCY TROLLEY (ADULT & PAED)CHECK LIST


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Tanggal dan No.Kunci


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