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    Lembar Triage

    Uploaded by

    Eliana Muis
    This document is a triage form from Puskesmas Batua Makassar containing information about a patient's visit. It includes sections for the patient's name, date of birth, medical record number, gender, triage date and time. There are also sections to document the patient's chief complaint, medical history, and examination findings related to things like airway, breathing, circulation, disability level, and vital signs. The form also has space to indicate the triage priority level assigned (urgent, emergency, etc.) and areas to document the triage nurse and physician's assessments, any pain scale used, and handover information for the medical staff taking over care.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Lembar Triage

    Uploaded by

    Eliana Muis
    465 views1 page
    This document is a triage form from Puskesmas Batua Makassar containing information about a patient's visit. It includes sections for the patient's name, date of birth, medical record number, gender, triage date and time. There are also sections to document the patient's chief complaint, medical history, and examination findings related to things like airway, breathing, circulation, disability level, and vital signs. The form also has space to indicate the triage priority level assigned (urgent, emergency, etc.) and areas to document the triage nurse and physician's assessments, any pain scale used, and handover information for the medical staff taking over care.

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    This document is a triage form from Puskesmas Batua Makassar containing information about a patient's visit. It includes sections for the patient's name, date of birth, medical record number, gender, triage date and time. There are also sections to document the patient's chief complaint, medical history, and examination findings related to things like airway, breathing, circulation, disability level, and vital signs. The form also has space to indicate the triage priority level assigned (urgent, emergency, etc.) and areas to document the triage nurse and physician's assessments, any pain scale used, and handover information for the medical staff taking over care.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    465 views1 page

    Lembar Triage

    Uploaded by

    Eliana Muis
    This document is a triage form from Puskesmas Batua Makassar containing information about a patient's visit. It includes sections for the patient's name, date of birth, medical record number, gender, triage date and time. There are also sections to document the patient's chief complaint, medical history, and examination findings related to things like airway, breathing, circulation, disability level, and vital signs. The form also has space to indicate the triage priority level assigned (urgent, emergency, etc.) and areas to document the triage nurse and physician's assessments, any pain scale used, and handover information for the medical staff taking over care.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    RM.

    1/UGD/2015

    PUSKESMAS BATUA MAKASSAR


    LEMBAR TRIAGE
    Nama Pasien :
    Tanggal Lahir :

    No. RM
    :
    Jenis Kelamin :

    Trige Tanggal :

    Anamnese

    Jam :

    Keluhan Utama

    WITA

    L/P

    Oleh Dokter Triage/Perawat :

    Anamnese Terpimpin :
    PEMERIKSAAN
    (Examination)
    JALAN NAFAS
    (airway)

    PERNAFASAN
    (Breathing)

    RESUSITAS
    (P1)

    EMERGENCY
    (P2)

    TANDA
    VITAL
    (Vital Sign)

    NON URGENT
    (P5)

    Bebas
    (Patient)

    TD:
    (BP)
    ..mmHg

    Bebas
    (Patient)

    Bebas
    (Patient)

    Bebas
    (Patient)

    Henti nafas
    (breathing Arrest)
    Frek. Nafas (RR)
    <10x/mnt
    Sianosis

    Frek. Nafas (RR)


    >32x/mnt
    Wheezing

    Frek. Nafas
    (RR)
    x/mnt

    Frek. Nafas (RR)


    24-32x/mnt
    Wheezing

    Normal

    Normal

    Neonatus
    Apneu/megap;megap
    Trek. Nafas <60x/mnt
    Sinosis sentral, menetap
    dengan 02

    Neonatus
    Frek. Nafas
    >80x/mnt atau
    <40x/mnt

    Normal

    Normal

    Neonatus
    CRT>3detik
    Gcs >13

    Gcs 15

    Gcs 15

    Neonatus
    <37,50C atau
    <36,50C

    Neonatus
    36,50C atau
    37,50C

    Neonatus
    36,50C atau 37,50C

    Henti jantung
    (Cardiac Arrest)
    Nadi tidak teraba
    (Pulsene)

    KESADARAN
    (Disability)

    LESS URGENT
    (P4)

    Sumbatan
    (obstruction)

    Neonatus
    Trek. Nafas
    >60x/mnt
    Sinosis sentral,
    menetap dengan
    02

    Sinosis sentral,
    menetap dengan 02
    SIRKULASI
    (Circulation)

    URGET
    (P3)

    Nadi teraba lemah


    (weakness pulse)
    Frek nadi
    (HR)<50x/mnt
    Frek nadi
    (HR)>150x/mnt(Dw)

    Neonatus
    Trek. Nadi <60x/mnt

    Neonatus
    Trek. Nadi (HR)
    <100x/mnt

    Pucat (pale)

    Pucat (pale)

    Akral dingin
    (Clammy)
    Neonatus
    CRT>3detik
    GCS <9

    Akral dingin
    (Clammy)
    CRT<2detik
    Neonatus
    CRT>3detik
    GCS 9-12

    Neonatus
    <36,50C

    Neonatus
    <36,50C

    Frek nadi
    (HR)
    x/mnt

    Frek nadi (HR)


    120-150x/mnt
    Neonatus
    Trek. Nadi
    (HR)>60x/mnt
    TD
    Sist>160mmHg
    TD Diast >100
    mmHg

    SUHU,
    (Tempt)

    Skala Nyeri : . (Meode VAS/BPJS/NIPS/FLACC)


    Perawat (nurse) TRIAGE :

    Area Nyeri :
    Dokter (psysycian) TRIAGE :

    HAND OVER TIM JAGA :


    RUANG PERAWATAN

    TANDA TANGAN DOKTER :


    (SIGNATURE)

    Lingkaran Kesimpulan

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