DAFTAR EMERGENCY KIT

TROLLY EMERGENCY IGD 1. TROLLY EMERGENCY IGD

OK 2. TROLLY EMERGENCY OK

BOX EMERGENCY IGD 1. BOX EMERGENCY IGD

2. BOX EMERGENCY NEONATUS
PONEK 3. BOX EMERGENCY PONEK
RANAP 4. BOX EMERGENCY RANAP
HCU 5. BOX EMERGENCY HCU
VK 6. BOX EMERGENCY MATHERNAL (VK)
7. BOX EMERGENCY POLI
AMBULANCE 8. BOX EMERGENCY AMBULANCE 1
9. BOX EMERGENCY AMBULANCE 2
RADIOLOGI 10.BOX EMERGENCY RADIOLOGI

BOX ANAFILAKTIK 1 .IGD

2. RANAP
3. VK

TAS CODE BLUE IGD

 DAFTAR ISI TROLLY EMERGENCY IGD
NO NAMA OBAT / ALKES JML ED NO NAMA OBAT / ALKES JML ED
1 DOBUTAMIN INJ 1 46 SUCTION CATHETER NO 10 1
2 DEXAMETHASON INJ 2 47 SUCTION CATHETER NO 12 1
3 LIDOCAIN INJ 2 48 SUCTION CATHETER NO 14 1
4 DOPAMIN INJ 1 49 NACL 500ML INFUS 2
5 ATROPIN SULFAS INJ 15 50 RL INFUS 2
6 CA GLUCONAS INJ 1 51 RD INFUS 1
7 D40% 2 52 DEXTROSE 5% 1
8 EPHINEFRIN 13 53 INFUSET MAKRO 3
9 DILTIAZEM INJ 2 54 TRANFUSI SET DEWASA 3
10 MEYLON 3 55 TRANFUSI SET ANAK 3
11 NACL 100ML 5 56 YELCO 18 3
12 SPUIT 1CC 2 57 YELCO 20 3
13 SPUIT 3CC 5 58 YELCO 22 3
14 SPUIT 5CC 2 59 YELCO 24 3
15 SPUIT 10CC 2 60 YELCO 26 2
16 ETHYL CHLORIDE SPRAY 1 61 SPALK 15 3
17 SPUIT 50CC LT 1 62 SPALK 20 3
18 SPUIT 50CC CATHETHER TIP 1 63 LARINGOSKOP ANAK 1
19 GUDEL NO 3 2 64 LARINGOSKOP DEWASA 1
20 GUDEL NO 4 1
21 FEEDING TUBE NO. 8 1
22 FEEDING TUBE NO. 16 3
23 CATHETER UMBILICAL NO 3,5 2
24 PEDIATRIC FEEDING TUBE NO 8 1
25 ENDOTRACEAL NON CUFF N0 2,5 1
26 ENDOTRACEAL NON CUFF N0 3 1
27 ENDOTRACEAL NON CUFF N0 3,5 1
28 ENDOTRACEAL NON CUFF N0 4 1
29 ENDOTRACEAL CUFF N0 2,5 1
30 ENDOTRACEAL CUFF N0 3 2
31 ENDOTRACEAL CUFF N0 3,5 1
32 ENDOTRACEAL CUFF N0 4 1
33 ENDOTRACEAL CUFF N0 4,5 1
34 ENDOTRACEAL CUFF N0 5 2
35 ENDOTRACEAL CUFF N0 5,5 1
36 ENDOTRACEAL CUFF N0 6 1
37 ENDOTRACEAL CUFF N0 6,5 2
38 ENDOTRACEAL CUFF N0 7 2
39 CATHETER UMBILICAL N0 5 2
40 ELEKTRODA ECG 1
41 EXTENSION TUBE 2
42 3 WAY STOPCOCK 2
43 SPUIT 20CC LUBANG PINGGIR 1
44 SUCTION CATHETER NO 6 1
45 SUCTION CATHETER NO 8 1
 DAFTAR ISI TROLLY EMERGENCY OK
NO NAMA OBAT / ALKES JML ED NO NAMA OBAT / ALKES JML ED
1 DOBUTAMIN INJ 1 46 SUCTION CATHETER NO 10 1
2 DEXAMETHASON INJ 2 47 SUCTION CATHETER NO 12 1
3 LIDOCAIN INJ 2 48 SUCTION CATHETER NO 14 1
4 DOPAMIN INJ 1 49 NACL 500ML INFUS 2
5 ATROPIN SULFAS INJ 15 50 RL INFUS 2
6 CA GLUCONAS INJ 1 51 RD INFUS 1
7 D40% 2 52 DEXTROSE 5% 1
8 EPHINEFRIN 15 53 INFUSET MAKRO 3
9 DILTIAZEM INJ 2 54 TRANFUSI SET DEWASA 3
10 MEYLON 2 55 TRANFUSI SET ANAK 3
11 NACL 100ML 5 56 YELCO 18 3
12 SPUIT 1CC 2 57 YELCO 20 3
13 SPUIT 3CC 4 58 YELCO 22 3
14 SPUIT 5CC 2 59 YELCO 24 3
15 SPUIT 10CC 2 60 YELCO 26 2
16 ETHYL CHLORIDE SPRAY 1 61 SPALK 15 3
17 SPUIT 50CC LT 1 62 SPALK 20 3
18 SPUIT 50CC CATHETHER TIP 1 63 VERBAN GULUNG 5
19 GUDEL NO 3 1 64 LARINGOSKOP ANAK 1
20 GUDEL NO 4 1 65 LARINGOSKOP DEWASA 1
21 FEEDING TUBE NO. 8 1
22 FEEDING TUBE NO. 16 3
23
24 PEDIATRIC FEEDING TUBE NO 8 1
25 ENDOTRACEAL NON CUFF N0 2,5 1
26 ENDOTRACEAL NON CUFF N0 3 1
27 ENDOTRACEAL NON CUFF N0 3,5 1
28 ENDOTRACEAL NON CUFF N0 4 1
29 ENDOTRACEAL CUFF N0 2,5 1
30 ENDOTRACEAL CUFF N0 3 2
31 ENDOTRACEAL CUFF N0 3,5 1
32 ENDOTRACEAL CUFF N0 4 1
33 ENDOTRACEAL CUFF N0 4,5 1
34 ENDOTRACEAL CUFF N0 5 2
35 ENDOTRACEAL CUFF N0 5,5 1
36 ENDOTRACEAL CUFF N0 6 1
37 ENDOTRACEAL CUFF N0 6,5 2
38 ENDOTRACEAL CUFF N0 7 2
39
40 ELEKTRODA ECG 1
41 EXTENSION TUBE 2
42 3 WAY STOPCOCK 2
43 SPUIT 20CC LUBANG PINGGIR 1
44 SUCTION CATHETER NO 6 1
45 SUCTION CATHETER NO 8 1
DAFTAR ISI BOX EMERGENCY AMBULANCE DAFTAR ISI BOX EMERGENCY HCU
NO NAMA OBAT / ALKES JML ED NO NAMA OBAT / ALKES JML ED
1 AMINOPHILIN INJ 1 1 AMINOPHILIN INJ 1
2 ATROPIN SULFAT INJ 1 2 CA GLUKONAS 1
3 DEXAMETHASON INJ 1 3 DEXAMETHASON INJ 2
4 DEKSTROSE 40% 3 4 DEKSTROSE 40% 1
5 DOPAMIN 1 5 DOPAMIN 1
6 EPHINEPRIN INJ 1 6 D5 INFUS 1
7 FUROSEMID INJ 1 7 EPHINEPRIN INJ 1
8 GUDEL NO 4 1 8 INFUSET MAKRO 1
9 INFUSET MAKRO 1 9 MGSO4 1
10 LIDOCAIN INJ 1 10 NIFEDIPIN TAB 1
11 MGSO4 1 11 RL 1
12 NACL 500ML 1 12 SPUIT 1CC 2
13 NIFEDIPIN TAB 1 13 SPUIT 3CC 2
14 RL 1 14 SPUIT 5CC 1
15 SPUIT 1CC 1 15 SPUIT 10CC 1
16 SPUIT 3CC 2 16 SUCTION NO 8 1
17 SPUIT 5CC 1 17 TRANFUSI SET ANAK 1
18 SPUIT 10CC 1 18 TRANFUSI SET DEWASA 1
19 TRANFUSI SET ANAK 1 19 YELCO NO 20 1
20 TRANFUSI SET DEWASA 1 20 YELCO NO 22 1
21 YELCO NO 20 1 21 YELCO NO 24 1
22 YELCO NO 22 1 22 YELCO NO 26 1
23 VERBAN GULUNG 1

DAFTAR ISI BOX EMERGENCY RANAP DAFTAR ISI BOX EMERGENCY NEONATUS
NO NAMA OBAT / ALKES JML ED NO NAMA OBAT / ALKES JML ED
1 RL 1 1 ATROPIN SULFAT INJ 1
2 D5 1 2 CA GLUCONAS INJ 2
3 TRANFUSI SET ANAK 1 3 DEKSTROSE 40% 1
4 TRANFUSI SET DEWASA 3 4 D5 INFUS 1
5 INFUSET MAKRO 1 5 DOPAMIN INJ 1
6 SUCTION 1 6 EPHINEPRIN INJ 1
7 SPUIT 10CC 1 7 MGSO4 1
8 SPUIT 5CC 1 8 NACL 100ML 1
9 SPUIT 3CC 3 9 NACL 25ML 1
10 SPUIT 1CC 2 10 SPUIT 10CC 1
11 YELCO NO 20 1 11 SPUIT 5CC 1
12 YELCO NO 22 1 12 SPUIT 3CC 2
13 YELCO NO 24 1 13 SPUIT 1CC 1
14 YELCO NO 26 1 14 SUCTION NO 8 1
15 AMINOPHYLIN INJ 1 15 TRANFUSI SET ANAK 1
16 DOPAMIN INJ 1 16 YELCO NO 24 1
17 DEXAMETHASON INJ 2 17 YELCO NO 26 1
18 EPHINEPRIN INJ 2
19 CA GLUCONAS INJ 2
20 NIFEDIPIN TAB 2
21 D40 1
22 MGSO4 1
DAFTAR ISI BOX EMERGENCY IGD DAFTAR ISI BOX EMERGENCY POLI
NO NAMA OBAT / ALKES JML ED NO NAMA OBAT / ALKES JML ED
1 AMINOPHILIN INJ 1 1 AMPICILIN INJ 1
2 ATROPIN SULFAT INJ 1 2 ATROPIN SULFAT INJ 1
3 DEXAMETHASON INJ 1 3 CA GLUCONAS INJ 1
4 DEKSTROSE 40% 3 4 DEKSTROSE 40% 3
5 DOPAMIN 1 5 DOPAMIN 1
6 EPHINEPRIN INJ 1 6 D5 INFUS 1
7 FUROSEMID INJ 1 7 EPHINEPRIN INJ 1
8 GUDEL NO 4 1 8 INFUSET MAKRO 1
9 INFUSET MAKRO 1 9 MGSO4 1
10 LIDOCAIN INJ 1 10 RL 1
11 MGSO4 1 11 SPUIT 1CC 1
12 NACL 500ML 1 12 SPUIT 3CC 2
13 NIFEDIPIN TAB 1 13 SPUIT 5CC 1
14 RL 1 14 SPUIT 10CC 1
15 SPUIT 1CC 1 15 SUCTION NO 8 1
16 SPUIT 3CC 2 16 TRANFUSI SET ANAK 2
17 SPUIT 5CC 1 17 TRANFUSI SET DEWASA 1
18 SPUIT 10CC 1 18 YELCO NO 20 1
19 TRANFUSI SET ANAK 1 19 YELCO NO 22 1
20 TRANFUSI SET DEWASA 1 20 YELCO NO 24 1
21 YELCO NO 20 1 21 YELCO NO 26 1
22 YELCO NO 22 1 22 VERBAN GULUNG 1
23 VERBAN GULUNG 1

DAFTAR ISI BOX EMERGENCY MATHERNAL DAFTAR ISI BOX EMERGENCY RADIOLOGI

NO NAMA OBAT / ALKES JML ED NO NAMA OBAT / ALKES JML ED

1 AMINOPHYLIN INJ 1 1 AMINOPHILIN INJ 1
2 CA GLUCONAS INJ 2 2 ATROPIN SULFAT INJ 1
3 DEXAMETHASON INJ 2 3 DEXAMETHASON INJ 1
4 DEKSTROSE 40% 1 4 DEKSTROSE 40% 3
5 D5 INFUS 1 5 DOPAMIN 1
6 EPHINEPRIN INJ 2 6 EPHINEPRIN INJ 1
7 INFUSET MAKRO 1 7 FUROSEMID INJ 1
8 MGSO4 1 8 GUDEL NO 4 1
9 NIFEDIPIN TAB 2 9 INFUSET MAKRO 1
10 RL 1 10 LIDOCAIN INJ 1
11 SPUIT 1CC 2 11 MGSO4 1
12 SPUIT 3CC 2 12 NACL 500ML 1
13 SPUIT 5CC 1 13 NIFEDIPIN TAB 1
14 SPUIT 10CC 1 14 RL 1
15 SUCTION NO 8 1 15 SPUIT 1CC 1
16 TRANFUSI SET DEWASA 2 16 SPUIT 3CC 2
17 YELCO NO 20 1 17 SPUIT 5CC 1
18 YELCO NO 24 1 18 SPUIT 10CC 1
19 TRANFUSI SET ANAK 1
20 TRANFUSI SET DEWASA 1
21 YELCO NO 20 1
22 YELCO NO 22 1
23 VERBAN GULUNG 1
DAFTAR ISI BOX EMERGENCY PONEK
NO NAMA OBAT / ALKES JML ED
1 AMINOPHYLIN INJ 1
2 CA GLUCONAS INJ 2
3 DEXAMETHASON INJ 2
4 DEKSTROSE 40% 1
5 D5 INFUS 1
6 EPHINEPRIN INJ 2
7 INFUSET MAKRO 1
8 MGSO4 1
9 NIFEDIPIN TAB 2
10 RL 1
11 SPUIT 1CC 2
12 SPUIT 3CC 2
13 SPUIT 5CC 1
14 SPUIT 10CC 1
15 SUCTION NO 8 1
16 TRANFUSI SET DEWASA 2
17 YELCO NO 20 1
18 YELCO NO 24 1
DAFTAR ISI BOX ANAFILAKTIK IGD DAFTAR ISI BOX ANAFILAKTIK RANAP
NO NAMA OBAT / ALKES JML ED NO NAMA OBAT / ALKES JML ED
1 AMINOPHYLIN INJ 1 1 AMINOPHYLIN INJ 1
2 DEXAMETHASON INJ 2 2 DEXAMETHASON INJ 2
3 DIPHENHIDRAMIN INJ 1 3 DIPHENHIDRAMIN INJ 1
4 EPHINEFRIN INJ 1 4 EPHINEFRIN INJ 1
5 PULMICORT 1 5 PULMICORT 1
6 SELANG 02 DEWASA 1 6 SELANG 02 DEWASA 1
7 SPUIT 1CC 1 7 SPUIT 1CC 1
8 SPUIT 3CC 1 8 SPUIT 3CC 1
9 SPUIT 5CC 1 9 SPUIT 5CC 1
10 VENTOLIN 1 10 VENTOLIN 1
11 VELUTIN 1 11 VELUTIN 1
12
DAFTAR ISI BOX ANAFILAKTIK VK
NO NAMA OBAT / ALKES JML ED
1 AMINOPHYLIN INJ 1
2 DEXAMETHASON INJ 2
3 DIPHENHIDRAMIN INJ 1
4 EPHINEFRIN INJ 1
5 PULMICORT 1
6 SELANG 02 DEWASA 1
7 SPUIT 1CC 1
8 SPUIT 3CC 1
9 SPUIT 5CC 1
10 VENTOLIN 1
11 VELUTIN 1
12
 DAFTAR ISI TAS CODE BLUE
NO NAMA OBAT / ALKES JML ED
1 AMBU BAG DEWASA
2 SUNGKUP AMBUBAG DEWASA,
3 STETOSKOP ABN 1/1
4 LARINGOSKOP DEWASA
5 ENDOTRAKEAL TUBE
3 – 3.5 – 4 – 4.5 – 5 – 5.5 – 6 – 6.5 – 7
6 MANDRIN
7 SELANG SUCTION 6/8/10/12/14 1/1/1/1/1
8 SELANG 02 DEWASA 1
9 MAYO ( 0 - 1 – 2 – 3 – 4 – 5 ) 1/1/1/1/1
10 PLESTER 1
11 TRANFUSI SET / INFUS SET DEWASA 1/1/1
12 YELCO 18 – 20 – 22 – 24 1/1/1/1
13 TOURNIKET
14 SPUIT 1CC – 3CC – 5CC – 10CC 2/2/2/2
15 NRM DEWASA 1
16 MASKER APD
17 HANDSCOON STERIL 6.5 / 7 1/1
18 TENSIMETER JARUM 1
19 TERMOMETER 1
20 OKSIMETRI
21 PENLIGHT / SENTER 1
22 ALAT CEK GDS 3
23 ELEKTRODA 3
24 GEL 1
25 HYPAFIX 1
26 ALKOHOL PAD 10
OBAT – OBAT EMERGENCY
27 EPINEFRIN 3
28 SULFAS ATROPIN 3
29 AMIODARON 3
30 CAIRAN INFUS RL 1
 FORM EMERGENCY KIT

FORM PENGECEKAN BOX EMERGENCY FORM PENGAMBILAN SEDIAAN FARMASI

EMERGENCY KIT RANAP
TANGGAL PETUGAS TTTD TANGGAL NAMA PETUGAS TTTD
SEDIAAN

PELAYANAN KEFARMASIAN
Regulasi pengelolaanobat emergensi yang tersedia di unit-unit layanan agar dapat segera dipakai
untuk memenuhi kebutuhan darurat serta upaya pemeliharaan dan pengamanan dari kemungkinan
pencurian dan kehilangan
Daftar obat emergensi disetiap tempat penyimpanan termasuk tanggal kadaluwarsa
Pelaksanaan monitoring suhu dan kelembaban ruangan dan lemari pendingin
Supervisi tentang penyimpanan obat emergensi:
1) Bukti form ceklis
2) Bukti pelaksanaan supervisi
Bukti supervisi apoteker tentang penyimpanan obat emergensi
1) Bukti form ceklis
2) Bukti pelaksanaan supervisi