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Biochemistry HB
HCT
Pre-Operative Diagnosis Status
Age Sex Height Weight Temp. Poise Resp. B.P. Proposed Operation
HOURS
AGENTS
FLUIDS
37 37
BP X
36 240 36 240
PULSE O
35 220 35 220
RESP. O
34 200 34 200
TEMP. A
33 180 33 180
CVP. V
32 160 32 160
31 140 31 140
30 120 30 120
29 100 29 100
28 80 28 80
27 60 27 60
Chance
Canister
26 40 26 40
Suction
Suction
25 20 25 20
Recroom
R
SYMBOLS
ANESTHETIC AGENT DETAILED TECHNIQUE