DAFTAR INVENTARIS AMBULANCE KIT I

BULAN : TAHUN : 2017

UNIT : UGD
TANGGAL
NO NAMA OBAT DAN ALKES JML EXPIRED DATE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
OBAT
1 Adalat 5 mg tab 2
2 Captopril 25 mg tab 2
3 Captopril 12.5 mg tab 2
4 Catapres 75 mcg tab 2
5 Cedocard 5 mg tab 2
6 Aminophylin 240 mg 1
7 Atropin Sulfat 0.25 mg 10
8 Phinev / Epinephrin 1 mg 20
9 Ca Gluconas 1 gr 1
10 Cedocard 10 mg inj 2
11 Cordaron inj 150 mg 2
12 Catapres 150 mcg inj 1
13 Dormicum/sedacum 5 mg 1
14 Inotrop Dobutamine HCI 25mg/ml 1
15 Dormicum/sedacum 15 mg 1
16 Dopamin / Dopac 200 mg 1
17 Kalmethasone/Cortidex5 mg 1
18 Lodomer 5 mg 1
19 Narfoz 4 mg 1
20 Narfoz 8 mg 1
21 Novalgin 1 gr 1
22 Nokoba 0.8 mg (2 ml) 1
23 Perdipine 10 mg 1
24 Raivas 4 mg 1
25 Remopain 30 mg 1
26 Stesolid 10 mg 1
27 Dextrose 40% 2
28 KCL 25 Mcg 2
29 MgSo4 40% 2
30 Meylon 8.4% 2
31 Nacl 25 ml 2
32 WFI 25 ml 2
33 Stesolid Rectal Tube 5mg 2
FORM 171/MOPK/RSABBKS
 Rev. 00

DAFTAR INVENTARIS AMBULANCE KIT I

BULAN : TAHUN: 2017
UNIT : UGD
TANGGAL
NO NAMA OBAT DAN ALKES JML EXPIRED DATE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
ALAT MEDIS
1 Spuit 3 cc 2
2 Spuit 5 cc 2
3 Spuit 10 cc 2
4 Spuit 20 cc 2
5 Spuit 50 cc 2
6 Needle No 18 3
7 NGT No 12 1
8 NGT No 14 1
9 NGT No 16 1
10 Cateter tip 1
11 Tegaderm 1633 1
12 Tegaderm 1610 1
13 3 way buntut 2
14 3 way stopcock 2
15 Venflon 18 1
16 Venflon 20 1
17 Venflon 22 1
18 Venflon 24 1
19 Venflon 26 1
20 Pastik / Alkohol swab 10
21 Elektroda EKG dewasa 3
22 Elektroda EKG anak 3
23 Extention tube 1
24 Intrafix Air 1
25 Micro set 1
26 Blood set 1
27 ETT No 2.5 1
28 ETT No 3 1
29 ETT No 3.5 1
30 ETT No 4 1
31 ETT No 4.5 1
32 ETT No 5 1
33 ETT No 5.5 1
34 ETT No 6 1
35 ETT No 6.5 1
FORM 171/MOPK/RSABBKS
 Rev. 00
DAFTAR INVENTARIS AMBULANCE KIT I
BULAN : TAHUN: 2017
UNIT : UGD
TANGGAL
NO NAMA OBAT DAN ALKES JML EXPIRED DATE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
36 ETT No 7 1
37 ETT No 7.5 1
38 ETT No 8 1
39 Mandrein No 10 1
40 Xylocain Jelly 2
41 NPA No 7 1
42 Folley cateter No 14 1
43 Folley cateter No 16 1
44 Urine bag 1
45 Suction cateter No 6 1
46 Suction cateter No 8 1
47 Suction cateter No 10 1
48 Suction cateter No 12 1
49 Suction cateter No 14 1
50 Gammex No 6.5 1
51 Gammex No 7 1
52 Gammex No 7.5 1
53 Guedel No 0 (40 mm) 1
54 Guedel No 00 (50 mm) 1
55 Guedel No 000 (60 mm) 1
56 Gudel No 1 (70 mm) Putih 1
57 Gudel No 2 (80 mm) Hijau 1
58 Gudel No 3 (90 mm) Kuning 1
59 Gudel No 4 (100 mm) Merah 1
60 Elastis Verban 7.5 cm x 4.5 m 1
61 Elastis Verban 10 cm x 4.5 m 1
62 Elastis Verban 15 cm x 4.5 m 1
63 Reabreathing Mask Adult 1
64 Reabreathing Mask Pead 1
65 Non Reabreathing Mask Adult 1
66 Non Reabreathing Mask Ped 1
67 Simple Mask Adult 1
68 Simple Mask Pead 1
69 Nasal canul adult 1
70 Nasal canul pead 1
71 Oksigen tubing 1
72 Suction connecting 1
FORM 171/MOPK/RSABBKS
Rev. 00
 DAFTAR INVENTARIS AMBULANCE KIT I

BULAN : TAHUN: 2017

UNIT : UGD
TANGGAL
NO NAMA OBAT DAN ALKES JML EXPIRED DATE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
CAIRAN
1 Dextrose 5 % 500 ml 1
2 NaCl 0.9 % 500 ml 1
3 Ringer Laktat 500 ml 1
4 Ring As 500 ml 1
5 NaCl 100 ml 1
6 Water for injection 1000 ml 1
7 Gelofusin 500 ml 1

LAIN - LAIN
1 Gunting 1
2 Torniquet 1
3 Micropore 2
4 Tabung sample darah 8

Nomor Segel

Nama Perawat

FORM 171/MOPK/RSABBKS
Rev. 00