TROLLEY EMERGENCY

CODE BLUE
(HENTI JANTUNG HENTI NAFAS
 DRAFT FORM MONITORING
NO NAMA BARANG JML KET TGL & NO
KUNCI
TGL:
NO:
 Emergency Trolley Check List
Diperiksa sebulan sekali atau setelah dibuka

• TOP DRAWER = OBAT-OBAT

• TOP SHELF/IV POLE =
• DRAWER I
• DRAWER II
• BOTTOM DRAWER
• SIDE DRAWER I
• SLIDE DRAWER II – KOSONG
• SLIDE DRAWER III = GLOVE NON STERILE
 TOP DRAWER
1. Atropin sulfat 0,25 mg/ml 15
2. Ca glugonas 100 mg/ml 2
3. Cordarone 150 mg/3 ml 2
4. Dextrose 40% 25 ml 2
5. Dobutamin 250 mg/10ml 1
6. Dopamin 200 mg/10 ml 1
7. Dormicum 5 mg/5 ml 2
 TOP DRAWER
8. Epinephrine 0,1 % - 1 mg/ml 15
9. Herbesser 50 mg inj 2
10. Meylon 8.4 % - 25 ml 4
11. NaCl 0.9% - 25 ml 5
12. Oradexon 5 mg/ml 2
13. Xylocard 100 mg/ 5 ml 2
 TOP SHELF/IV POLE
• O2 supply tubing 1
• ECG paper 1
• Aquasonic jelly 1
• Electrode C 3 1
• Guedel 40, 50, 60, 70, 80, 90 mm 1
• Air cusion Mask Adult S, M, L 1
• Air cusion Mask Infant & Paed 1
• Larongoscope 1
• Blade Laringoscope 0,1,2,3,4 1
• Blade Laringoscope 0,1,2,3,4 1
• Baterai AA/Medium 2
 DRAWER 1
• Instilagel 11 ml 1
• ETT 2,5: 3-8 1
• Intubating Stylet P: S, M, L 1
• Magi/Forceps Dewasa 1
• Syringe Terumo 20 ml 1
• Suction cath 6-14 1
• Penlight/senter 1
 DRAWER II
• Syringe Terumo 3, 5, 10 ml 5
• Syringe Terumo 10 ml 2
• Syringe Terumo 50 ml 1
• Infuset/Blood Tronsfusion set 2
• Adsyte/Vasofix safety 18, 20, 22 1
• IV-catheter 14, 16, 26 G 1
• Gunting 1
• Micropore 0,5 – 1” 1
 DRAWER II
• Torniquit/alas plastik 1/1
• Needle 23 3
• Extention tube EY -1 1
• 3-way stop cock Tail 1
• 3-way stop cock 1
• Tegaderm 1623/1633 2
• Alcohol swab 10
• First Aids 2
 BOTTOM DRAWER
• Mask Rebreast Child & Adult 1
• Suction Connecting Funnel 1
• NaCl 0,9 % 2
• Suction bottle 1
• Oxygen flowmeter 1
 SIDE DRAWER - 1
• Feeding tube 6, 8, 10 1
• Stomach tube 12, 14, 16 1
• Urinbag 2000 ml 1
• Syringe Terumo 50 ml Cath Tip 1
 SIDE DRAWER – III
• KOSONG
 SIDE DRAWER - III
• Glove Non Steril
 BOTTOM NOTE
• Nama pasien :
• No. RM :
• Alasan dibuka :
Ward Clerck
Diperiksa oleh :
(Paraf & Nama terang)
Nursing

Pharmacy