CLINICAL PATHWAY
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CLINICAL PATHWAYS ANESTESI UMUM 2013 Nama Pasien:
.
Umur:
!!!
.
Berat Badan:
!!!
Diagnosis Awal:
.kg
Tinggi B adan:
!!!
.cm
!!!
Kode ICD 9: R. Rawat .
!!!
Aktivitas Pelayanan
Rencana TIND AKAN : 5 hari Tgl/ Jam msk:
Tgl/ jm klr :
.
Lama R wt
.
!!!
Hari ke-1
Hari ke-2
Kelas
.hari
!!!
.
!!!
!!!
Hari ke-3 (Anestesi Umum ) Jam 1
Jam 2
Jam..
Jam..
A khir Operasi
H ar i ke-4
Hari ke-5
Biaya (Rp): .
!!!
Diagnosis:
• Penyakit Utama
!!!.
• Penyakit Penyerta
!!!.
• Komplikasi
!!!.
• A SA
!!!.
Asessmen Klinis:
• Pemeriksaan dokter anestesi • Konsultasi Ba Bagian La Lain
Visite H-2 Konsul IP IPD/IKA/Kardio
Visite H-1
Visite H+1
Visite H+2
Konsul IP IPD/IKA/Kardio
...........
!!!.
Pemeriksaan Penunjang:
• Laboratorium/Penunjang
Sesuai indikasi
Persiapan Preoperatif
Sesuai indikasi
sesuai indikasi
!!!.
SIA, Puasa 8 jam preoperatif
!!!.
Premedikasi: anti-anxietas Alprazolam 2x1 mg,
!!!.
anti-emetik: Granisetron 1x1mg/Primperan 3x10mg,
!!!.
analgetik: Fentanyl/Petidin drip
!!!.
Tindakan Anestesi Umum ASA...
• Dokter Anestesi
Anestesi Umum
• Monitoring Pre-durante-pascaoperasi
Anestesi Umum Tekanan darah, laju nadi, laju napas, saturasi, EKG, ETCO2,Diuresis, Perdarahan,Suhu
• Induksi
1. Prosedur tindakan anestesi umum 2. Maintenance anestesi umum
Maintenance
Maintenance
• Ekstubasi
SA+Prostigmin
Obat dan Alat: • Aa l t Transfusi set, IV catheter, set epidural,plaster
Accufuser/syringejector/PCA
!!!.
ETT,Oropharing airway,Spuite 3,5,10,50 cc, Suction Catheter, face mask, breathing circuit
• O ba t Propofol 2mg/kg, Atrakurium/vekuronium/
Atrakurium/vekuronium/Ro u m/Rocuronium
At At ra ku ri um/ ve ku ro niu m/ Ro cur on u im
Ro cu ron u i m, Fe Fe nt an yl 3 m cg /k g
F en tan yl 1 m cg /k g
Fentanyl 1 mcg/kg
D ek ek sa sa me me ta ta so so n 2 A mp mp
An al ge tik ; NSAI D( ke to rol ak/ de xke to pr of en )/
A nt nt i- em em et et ik :g :g ra ra ni ni se se tr tr on on 1 mg mg /
An al get k i ;N SAI D( ke to ro a l k/ de xk et op ro fe n) /
Parasetamol iv, Op Opiod (F (Fentanyl/Pethidin/
Parasetamol iv, Op Opiod (F (Fentanyl/Pethidin/
Morphin/T n /Tramadol),Dur l),Durogesic ogesic patch ch
Morphin/T n /Tramado ramadol),Dur l),Durogesic patch patch
............
............
Ondansetron 8 mg
............ Obat emergensi: Adrenalin, noradrenalin,SA, Efedrin
............
• Cairan
Ringer Lactat/ koloid
Ringer Lactat/ koloid
Ringer Lactat/ koloid
............
• Gas
O2:N2O=3:3 L/menit
O2:N2O=3:3 L/menit
O2:N2O=3:3 L/menit
............
Sevofluran/Isofluran/Halotan/Desfluran
Sevofluran/Isofluran/ l uran/Halot H alotan/De a n/Desfluran
Sevofluran/Isofluran/Halotan/Desfluran
PascaOperasi
• Observasi
Aldrette Score
• Puasa Pasca operasi
Puasa s.d sadar penuh
• Posisi
Head Up 45˚
Hasil (Outcome): Varians:
!!!.
!!!.
!!!.
!!!. Jumlah Biaya
Diagnosis Akhir
Nama Perawat:
!!!. Nama Dokter:
!!!.
• Utama • Penyerta
Na ma P el aks an a Ve ri fi ka si:
• K om pl ki asi
!!!.
• ASA
ICD 10
!!!.
Jenis Tindakan
Anestesi Umum
.............. ICD 9
......................
!!!.
!!!.
......................
!!!.
!!!.
......................
!!!.
!!!.
!!!.
!!!.
CLINICAL PATHWAYS ANESTESI REGIONAL SPINAL 2013 Nama Pasien:
.
Umur:
! ! !
.
Berat Badan:
! ! !
Diagnosis Awal:
.kg
Tinggi Badan:
! ! !
.cm
! ! !
Kode ICD 9: R. Rawat .
! ! !
Rencana TINDAKAN: 5 hari Tgl/ Jam msk:
Tgl/ jm klr:
.
Lama Rwt
.
! ! !
Kelas
.hari
! ! !
.
! ! !
! ! !
Aktivitas Pelayanan Hari ke-3 (Anestesi Regional Spinal) Hari ke-1
Hari ke-2
Hari ke-4 Jam 1
Jam 2
Hari ke-5
Akhir Operasi
Biaya (Rp): .
! ! !
Diagnosis: PenyakitUtama
!!!.
PenyakitPenyerta
!!!.
Komplikasi
!!!.
ASA
!!!.
Asessmen Klinis: Pemeriksaan dokter anestesi
Visite H-2
Konsult asi Bagian Lain
Konsul IPD/I KA/Kardio
Visite H+1
Visite H-1
Visite H+2
Konsul IPD/IKA/ Kardio
............
!!!.
Pemeriksaan Penunjang: Laboratorium/Penunjang
Sesuai indikasi
Sesuai indikasi
sesuai indikasi
............
SIA, Puasa 8 jam preoperatif Premedikasi: anti-anxietas Alprazolam 2x1 mg,
............
anti-emetik:Granisetron 1x1mg/Primperan3x10mg,
............
analgetik: Fentanyl/Petidin drip
............
Tindakan Anestesi Spinal ASA... Dokter Anestesi
Anestesi Spinal
Monitoring Pre-durante-pascaopera
Anestesi Spinal
............
Tekanan darah, laju nadi, laju napas, saturasi, EKG, ETCO2,Diuresis, Perdarahan,Suhu
Induksi
1. Preloading:Gelatin/Hes 1L
............
2. Prosedur tindakan spinal 3. Periksa motorik, sensorik, otonom 4. Maintenance: sedasi
sedasi
sedasi
Obat dan Alat:
!!!.
Alat Transfusi set, IV catheter, Jarum spinal
Accufuser/syringejector/PCA
Spuite 3,5,10 cc, Suction Catheter
............ ............
Obat Anestesi lokal: Bupivakain heavy 1 Amp, 9&"'#":$ ; #<6=$
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D126C("3E2#<#41$8A/=21%&?(F 6#'FC
D126C("3E2#<#41$8
Deksametason 2 Amp sedasi: propofol/midazolam/dexmedetomidin
............ sedasi: propofol/midazolam/dexmedetomidin
............
Obat emergensi:Adrenalin, noradrenalin,SA, Efedrin,noradrenalin,dopamin,dobutamin Cairan Gas
............
Ringer Lactat/ koloid
Ringer Lactat/ koloid
O2 3L/menit
O2 3L/menit
............ ............ O2 3L/menit
Observasi
............
Aldrette Score
Puasa Pasca operasi
Tidak puasa
Mobilisasi
12 jam pascaoperasi
Hasil(Outcome): Varians:
!!!.
!!!.
!!!.
!!!.
ICD 10
Jenis Tindakan
JumlahBiaya Nama Perawat:
!!!.
Diagnosis Akhir • Utama
Nama Dokter: • Penyerta
!!!.
!!!.
Anestesi Spinal
.............. ICD 9 .............
............
!!!.
!!!.
............
............
............
............
!!!.
!!!.
Nama Pelaksana Verifikasi:
• Komplikasi
!!!.
!!!.
!!!.
• ASA
!!!.
!!!.
CLINICAL PATHWAYS ANESTESI REGIONAL EPIDURAL 2013 Nama Pasien:
.
Umur:
!!!
.
Berat Badan:
!!!
Diagnosis Awal:
.kg
Tinggi Badan:
!!!
.cm
!!!
Kode ICD 9: R. Rawat .
!!!
Aktivitas Pelayanan
Rencana TINDAKAN: 5 hari Tgl/ Jam msk:
Tgl/ jm klr:
.
Lama Rwt
.
!!!
Hari ke-1
Kelas
.hari
!!!
.
!!!
!!!
Hari ke-3 (Anestesi Regional Epidural)
Hari ke-2
Jam 1
Jam 2
Jam..
Jam..
Hari ke-4
Akhir Operasi
Hari ke-5
Biaya (Rp): .
!!!
Diagnosis: • Penyakit Utama
!!!.
• Penyakit Penyerta
!!!.
• Komplikasi
!!!.
• A SA
!!!.
Asessmen Klinis: • Pemeriksaan dokter anestesi • Konsultasi Bagian Lain
Visite H-2 Konsul IPD/IKA/Kardio
Visite H-1
Visite H+1
Visite H+2
Konsul IPD/IKA/Kardio
...........
!!!.
Pemeriksaan Penunjang: • Laboratorium/Penunjang
Sesuai indikasi
Persiapan Preoperatif
Sesuai indikasi
sesuai indikasi
!!!.
SIA, Puasa 8 jam preoperatif
!!!.
Premedikasi: anti-anxietas Alprazolam 2x1 mg,
!!!.
anti-emetik: Granisetron 1x1mg/Primperan 3x10mg,
!!!.
analgetik: Fentanyl/Petidin drip
!!!.
Tindakan Anestesi Epidural ASA... • Dokter Anestesi
Anestesi Epidural
• Monitoring Pre-durante-pascaoperasi
Anestesi Epidural Tekanan darah, laju nadi, laju napas, saturasi, EKG, ETCO2,Diuresis, Perdarahan,Suhu
• Induksi
1. Preloading:Gelatin/Hes 1L 2. Prosedur tindakan Epidural 3. Periksa motorik, sensorik,otonom 4. Maintenance: sedasi
Sedasi
Sedasi
Obat dan Alat: • A la t Transfusi set, IV catheter, set epidural,plaster
Accufuser/syringejector/PCA
!!!.
Spuite 3,5,10,50 cc, Suction Catheter • O ba t Anestesi lokal:Lidokain 1%3 amp, Bupivakain
Bupivakain0,5%isobarik/Ropivakain
B up v i ak ai n 0 ,5 %i so ba ri k/ Ro pi va ka in
A na g l et k i ; N SA ID ( ke to ro a l k/ de xk et op ro fe n) /
A na lg et ik ; N SA ID ( ke to ro la k/ de xk et op ro fe n) /
0,5% Isobarik/Ropivakain 0,75% 1vial,
Parasetamol iv, Opiod (Fentanyl/ Pethid in/
Parasetamol v i , Opio d (Fenta nyl/P ethid in/
Fentanyl 1 amp
Morphin/Tramadol),Bupivakain 0,5% isobarik/
Morphin/Tramadol),Bupivakain 0,5% isobarik/
Ropivakain 0,75% Deksametason 2 Amp
Anti-emetik:granisetron 1mg/
.. . . . ..
Ropivakain 0,75% ............
Ondansetron 8 mg
sedasi: propofol/ midazolam/dexmedetomidin
sedasi: propofol/ midazolam/dexmedetomidin
sedasi: propofol/midazolam/dexmedetomidin
............
Obat emergensi: Adrenalin, noradrenalin,SA, Efedrin • Cairan • Gas
............
Ringer Lactat/ koloid
Ringer Lactat/ koloid
Ringer Lactat/ koloid
O2 3L/menit
O2 3L/menit
O2 3L/menit
............ O2 3L/menit
............
PascaOperasi • Observasi
Aldrette Score
• Puasa Pasca operasi
Tidak puasa
• Mobilisasi
12 jam pascaoperasi
Hasil (Outcome): Varians:
!!!.
!!!.
!!!.
!!!. Jumlah Biaya
Nama Perawat:
!!!. Nama Dokter:
!!!.
Diagnosis Akhir • Utama • Penyerta
N am aP el aks an aVe ri fik asi :
• Ko mp ilk asi
!!!.
• ASA
ICD 10
!!!.
Jenis Tindakan Anestesi Epidural
.............. ICD 9 ......................
!!!.
!!!.
......................
!!!.
!!!.
......................
!!!.
!!!.
!!!.
!!!.
CLINICAL PATHWAYS ANESTESI REGIONAL KOMBINASI SPINAL- EPIDURAL 2013 Nama Pasien:
.
Umur:
!!!
.
Berat Badan:
!!!
Diagnosis Awal:
.kg
Tinggi Badan:
!!!
.cm
!!!
Kode ICD 9: R. Rawat .
!!!
Aktivitas Pelayanan
Rencana TINDAKAN: 5 hari Tgl/ Jam msk:
Tgl/ jm klr:
.
Lama Rwt
.
!!!
Hari ke-1
Kelas
.hari
!!!
.
!!!
!!!
Hari ke-3 (Anestesi Regional Spinal)
Hari ke-2
Jam 1
Jam 2
Jam..
Jam..
Hari ke-4
Akhir Operasi
Hari ke-5
Biaya (Rp): .
!!!
Diagnosis: • Penyakit Utama
!!!.
• Penyakit Penyerta
!!!.
• Komplikasi
!!!.
• A SA
!!!.
Asessmen Klinis: • Pemeriksaan dokter anestesi
Visite H-2
• K on su tl as i B agi an La n i
K ons ul I PD /I KA /K ar dio
Visite H-1
Visite H+1
Visite H+2
K on su l I PD /I KA /K ar dio
...........
!!!.
Pemeriksaan Penunjang: • Laboratorium/Penunjang
Sesuai indikasi
Persiapan Preoperatif
Sesuai indikasi
sesuai indikasi
!!!.
SIA, Puasa 8 jam preoperatif
!!!.
Premedikasi: anti-anxietas Alprazolam 2x1 mg,
!!!.
anti-emetik: Granisetron 1x1mg/Primperan 3x10mg,
!!!.
analgetik: Fentanyl/Petidin drip
!!!.
T in da ka n An es te si K om bi na si S pi na • Dokter Anestesi
Anestesi Spinal-Epidural
• Monitoring Pre-durante-pascaopera
Tekanan darah, laju nadi, laju napas, saturasi, EKG, ETCO2,Diuresis, Perdarahan,Suhu
• Induksi
1. Preloading:Gelatin/Hes 1L 2. Prosedur tindakan Spinal-Epidural 3. Periksa motorik, sensorik,otonom 4. Maintenance: sedasi
Sedasi
Sedasi
Obat dan Alat: • A la t Transfusi set, IV catheter, set spinal-epidural,plaster
Accufuser/syringejector/PCA
!!!.
Spuite 3,5,10,50 cc, Suction Catheter • O ba t Anestesi lokal:Lidokain 1% 3 amp, Bupivakain
Bupivakain 0,5%isobarik/Ropivakain 0,75%,
B up v i a ka n i 0 ,5% s i ob ar k i / Rop v i ak ain 0 ,7 5% ,
A nal ge tik ; NS AI D (k et or ol ak/ de xke to pr of en )/
A na g l et ki ; NS AI D ( ke to ro a l k/ de xke to pr ofe n) /
0,5% Isobarik/Ropivakain 0,75% 1vial,
Parasetamol v i , Opiod (Fentanyl/Peth idin/
Parasetamol v i , Opiod (Fentanyl/Peth idin/
Bupivakain hiperbarik 1 ampul
Morphin/Tramadol),Bupivakain 0,5% isobarik/
Morphin/Tramadol),Bupivakain 0,5% isobarik/
Ropivakain 0,75% D ek sa me ta so n 2 Am p
A nt i- em et ik :g ra ni se tr on 1m g/
. . . .. . .
Ropivakain 0,75% ............
Ondansetron 8 mg
sedasi: propofol/midazolam/dexmedeto midin
sedasi: propofol/midazolam/dexmedeto midin
sedasi: propofol/midazolam/dexmedetomidin
............
Obat emergensi: Adrenalin, noradrenalin,SA, Efedrin • Cairan • Gas
............
Ringer Lactat/ koloid
Ringer Lactat/ koloid
Ringer Lactat/ koloid
O2 3L/menit
O2 3L/menit
O2 3L/menit
............ O2 3L/menit
............
PascaOperasi • Observasi
Aldrette Score
• Puasa Pasca operasi
Tidak puasa
• Mobilisasi
12 jam pascaoperasi
Hasil (Outcome): Varians:
!!!.
!!!.
!!!.
!!!.
ICD 10
Jenis Tindakan
Jumlah Biaya Nama Perawat:
!!!. Nama Dokter:
!!!.
Diagnosis Akhir • Utama • Penyerta
N am a Pe la ks an a Ve ri fi ka si :
• K om pl ik as i
!!!.
• ASA
!!!.
Anestesi Epidural
.............. ICD 9 ......................
!!!.
!!!.
......................
!!!.
!!!.
......................
!!!.
!!!.
!!!.
!!!.
CLINICAL PATHWAYS COMBINE EPIDURAL-GENERAL ANESTHESIA (CEGA) 2013 Nama Pasien:
.
Umur:
!!!
.
Berat Badan:
!!!
Diagnosis Awal:
.kg
Tinggi Badan:
!!!
.cm
!!!
Kode ICD 9: R. Rawat .
!!!
Aktivitas Pelayanan
Rencana TINDAKAN: 5 hari Tgl/ Jam msk:
Tgl/ jm klr:
.
Lama Rwt
.
!!!
Hari ke-1
Hari ke-2
Kelas
.hari
!!!
.
!!!
!!!
Hari ke-3 (Anestesi CEGA) Jam 1
Jam 2
Jam..
Jam..
Hari ke-4
Akhir Operasi
Hari ke-5
Biaya (Rp): .
!!!
Diagnosis:
• Penyakit Utama
!!!.
• Penyakit Penyerta
!!!.
• Komplikasi
!!!.
• A SA
!!!.
Asessmen Klinis:
• Pemeriksaan dokter anestesi • Konsultasi Bagian Lain
Visite H-2 Konsul IPD/IKA/Kardio
Visite H-1
Visite H+1
Visite H+2
Konsul IPD/IKA/Kardio
...........
!!!.
Pemeriksaan Penunjang:
• Laboratorium/Penunjang
Sesuai indikasi
Persiapan Preoperatif
Sesuai indikasi
sesuai indikasi
!!!.
SIA, Puasa 8 jam preoperatif
!!!.
Premedikasi: anti-anxietas Alprazolam 2x1 mg,
!!!.
anti-emetik: Granisetron 1x1mg/Primperan 3x10mg,
!!!.
analgetik: Fentanyl/Petidin drip
!!!.
Tindakan Anestesi CEGA ASA...
• Dokte r Aneste si
CEGA
• Monitoring Pre-durante-pascaoperasi
CEGA Tekanan darah, laju nadi, laju napas, saturasi, EKG, ETCO2,Diuresis, Perdarahan,Suhu
• Induksi
1. Preloading:Gelatin/Hes 1L 2. Prosedur tindakan Epidural 3. Prosedur tindakan anestesi umum 4. Maintenance anestesi umum
Maintenance
Maintenance
• Ekstubasi
SA+Prostigmin
Obat dan Alat: • A la t Transfusi set, IV catheter, set epidural,plaster
Accufuser/syringejector/PCA
!!!.
ETT,Oropharing airway,Spuite 3,5,10,50 cc, Suction Catheter, face mask, breathing circuit
• O ba t Anestesi lokal:Lidokain 1% 3 amp, Bupivakain
Bupivakain 0,5%isobarik/Ropivakain 0,75
B up v i ak ai n 0 ,5 %i so ba ri k/ Ro pi va ka in
A na lg et ik ; N SA ID ( ke to ro la k/ de xk et op ro fe n) /
0,5% Isobarik/Ropivakain 0,75% 1vial, Propofol 2mg/kg, Atrakurium/vekuronium/ Rocuronium, Fentanyl 3 mcg/kg
D ek sa me ta so n 2 Am p
Parasetamol iv, Opiod (Fentanyl/ Pethidin/ Atrakurium/vekuronium/Rocuronium Fentanyl 1 mcg/kg
A tr ak ur iu m/ ve ku ro ni um /R oc ur on u i m
M or ph n i /T ra ma do l) ,B up v i ak ai n 0 ,5 % i so ba ri k/
Fentanyl 1 mcg/kg
Ropivakain 0,75%
A nt i- em et ik :g ra ni se tr on 1m g/
A na lg et ik ; N SA ID ( ke to ro la k/ de xk et op ro fe n) /
. .. .. .. . .. .
Parasetamol iv, Opiod (Fentanyl/ Peth idin/ M or ph n i /T ra ma do l) ,B up v i ak ai n 0 ,5 % i so ba ri k/ Ropivakain 0,75%
............
Ondansetron 8 mg
............ Obat emergensi: Adrenalin, noradrenalin,SA, Efedrin
............
• Cairan
Ringer Lactat/ koloid
Ringer Lactat/ koloid
Ringer Lactat/ koloid
............
• Gas
O2:N2O=3:3 L/menit
O2:N2O=3:3 L/menit
O2:N2O=3:3 L/menit
............
Sevoflu ran/Isofl uran/Halo tan/Desfl uran
Sevoflu ran/Is ofluran/Halo tan/Desfl uran
Sevofluran/Isofluran/Halotan/Desfluran
PascaOperasi
• Observasi
Aldrette Score
• Puasa Pasca operasi
Puasa s.d sadar penuh
• Posisi
Head Up 45˚
Hasil (Outcome): Varians:
!!!.
!!!.
!!!.
!!!.
ICD 10
Jenis Tindakan
..............
Jumlah Biaya
Nama Perawat:
!!!. Nama Dokter:
!!!.
Diagnosis Akhir
• Utama • Penyerta
!!!.
Anestesi CEGA
ICD 9
......................
!!!.
!!!.
......................
!!!.
!!!.
......................
Na ma Pe a l ks ana Ve ri fik asi :
• Ko mpl k i a si
!!!.
!!!.
!!!.
• ASA
!!!.
!!!.
CLINICAL PATHWAYS ANESTESI BLOK SARAF TEPI 2013 Nama Pasien:
.
Umur:
!! !
.
Berat Badan:
!! !
Diagnosis Awal:
.kg
Tinggi Badan:
!! !
.cm
!! !
Kode ICD 9: R. Rawat .
!! !
AktivitasPelayanan
Rencana TINDAKAN: 5 hari Tgl/ Jam msk:
Tgl/ jm klr:
.
Lama Rwt
.
!! !
Hari ke-1
Hari ke-2
Kelas
.hari
!! !
.
!! !
!! !
Hari ke-3 (Anestesi Blok Saraf Tepi) Jam ke-1
Jam ke-2
Akhir Operasi
Hari ke-4
Hari ke-5
Biaya (Rp): .
!! !
Diagnosis: • Penyakit Utama
!!!.
• PenyakitPenyerta
!!!.
• Komplikasi
!!!.
• ASA
!!!.
Asessmen Klinis: • Pemeriksaan dokter anestesi • Konsultasi Bagian Lain
Visite H-2 Konsul IPD/IKA/Kardio
Visite H-1
Visite H+1
Visite H+2
Konsul IPD/IKA/Kardio
............
!!!.
Pemeriksaan Penunjang: • Laboratorium/Penunjang
Sesuai indikasi
PersiapanPreoperatif
Sesuai indikasi
sesuai indikasi
............
SIA, Puasa 8 jam preoperatif Premedikasi : anti-anxietas Alprazolam 2x1 mg,
............
anti-emetik:Granisetron1x1mg/Primperan3x10mg,
............
analgetik: Fentanyl/Petidin drip
............
Tindakan Anestesi Blok Saraf Tepi ASA... • Dokter Anestesi
Blok saraf tepi
• Monitoring Pre-durante-pascaoperasi
Tekanan darah, laju nadi, laju napas, saturasi, EKG, ETCO2,Diuresis, Perdarahan,Suhu
• Induksi
Blok saraf tepi
............
1. Prosedur tindakan blok saraf tepi 2. Periksa motorik, sensorik, otonom 3. Maintenance: sedasi
sedasi
Obat dan Alat:
!!!.
• A la t Transfusi set, IV catheter,
Accufuser/syringejector/PCA
Jarum stimulasi saraf, Spuite 3,5,10 cc
............ ............
• O ba t Anestesi lokal: Bupivakain 0,5%/ Ropivakain 0,75% 2 vial, Fentanyl 1 amp.
Anti-emetik:granisetron 1mg/
Analgetik; NSAID (ketorolak/dexketoprofen)/
Analgetik; NSAID (ketorolak/dexketoprofen)/
Ondansetron 8 mg
Parasetamol iv, Opiod (Fentanyl/Pethidin/
Parasetamol iv, Opiod (Fentanyl/Pethidin/
Morphin/T ramadol) ,Durogesic patc h
Morphin/Tramadol)
Deksametason 2 Amp sedasi: propofol/ midazolam/dexmedetomidin
• Cairan • Gas
............
............ sedasi: propofol/m idazolam/dexmedetomidin
............
Obat emergensi: Adrenalin, noradrenalin,SA, efedrin
............
Ringer Lactat/ koloid
Ringer Lactat/ koloid
............
O2 3L/menit
O2 3L/menit
O2 3L/menit
............
Pasca Operasi • Observasi
Aldrette Score
• Puasa Pasca operasi
Tidak puasa
• Mobilisasi
motorik pulih
Hasil (Outcome): Varians:
!!!.
!!!.
!!!.
!!!.
ICD 10
Jenis Tindakan
Jumlah Biaya Nama Perawat:
!!!. Nama Dokter:
!!!.
Diagnosis Akhir • Utama • Penyerta
!!!.
Anestesi Blok Saraf Tepi
.............. ICD 9 .............
............
!!!.
!!!.
............
............
............
............
!!!.
!!!.
Na ma Pel ak sana Veri fi kas i:
• Ko mpl ik as i
!!!.
!!!.
!!!.
• ASA
!!!.
!!!.
CLINICAL PATHWAYS SEDASI SEDANG - DALAM 2013 Nama Pasien:
.
Umur:
!! !
.
Tinggi Badan:
!! !
Diagnosis Awal:
Rencana TINDAKAN: 2 hari
R. Rawat
Tgl/ Jam msk:
.
.
!! !
Aktivitas Pelayanan
.cm
!! !
Kode ICD 9:
!! !
Lama Rwt
Kelas
.hari
...............
!! !
Hari ke-2 (sedasi sedang-dalam)
Hari ke-1
Jam 1
Biaya (Rp): Akhir operasi
.
!! !
Diagnosis: Penyakit Utama
!!!.
Penyakit Penyerta
!!!.
Komplikasi
!!!.
ASA
!!!.
Asessmen Klinis: Pemeriksaan dokter anestesi Konsultasi Bagian Lain
Visite preoperatif
............
Konsul IPD/IKA/Kardio
!!!.
Sesuai indikasi
............
Pemeriksaan Penunjang: Laboratorium/Penunjang
SIA, Puasa 8 jam preoperatif Premedikasi: anti-anxietas Alprazolam 2x1 mg,
............
anti-emetik: Granisetron 1x1mg/Primperan 3x10mg,
............
analgetik: Fentanyl/Petidin drip
............
Tindakan Anestesi Spinal ASA... Dokter Anestesi
Sedasi sedang-dalam
Monitoring Pre-durante-pascaoperasi
............
Tekanan darah, laju nadi, laju napas, saturasi, EKG, ETCO2,Diuresis, Perdarahan,Suhu
Induksi
1. Prosedur Sedasi
............
2. Maintenance Obat dan Alat:
!!!.
Alat
Infus set, kateter iv, spuite 3,10 cc
Obat
Propofol/midazolam/ketamin/dexmedetomidin inkremental
........... ...........
Fentanyl 2 mcg/kg
............
Anti-emetik: Granisetron 1x1mg/Primperan 3x10mg,
...........
Obat emergensi: Adrenalin, noradrenalin,SA,efedrin Cairan
Ringer Lactat
Gas
O2 3L/menit
Observasi
............ ............
O2 3L/menit
............
Aldrette Score/ PADDS score
Puasa Pasca operasi
Puasa s.d. Sadar penuh
Mobilisasi
Bila sadar penuh & stabil
Hasil (Outcome): Varians:
!!!.
!!!.
!!!.
Diagnosis Akhir
ICD 10
Jenis Tindakan
Jumlah Biaya Nama Perawat:
!!!. Nama Dokter:
!!!. Nama Pelaks ana Verifi kas i:
• Utama • Penyerta • Kompl ikasi • ASA
Sedasi sedang-dalam
.............. ICD 9 .............
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3F8I65F<8A> "#$&'% = 12h&
3F8I65F<8A> "#$&' % = 3F8I65F<8A> "#$&' % = 3F8I65F<8A> "#$&' % = 3F8I65F<8A> "#$&' % = 3F8I65F<8A> "#$&' % = 3F8I65F<8A> "#$&' % = 3F8I65F<8A> "#$&' % = 3F8I65F<8A> "#$&' % = 3F8I65F<8A> "#$&' % = 3F8I65F<8A> "#$&' % = 12h, 12h12h. 12h/ 12h0 12h1 12h* 12h* 12h2 12h&'
V65>A ]489>9I +49A>)89A69I"# $2% ., 1h/
O8I85 Z8<8:"#$&' % ) O8I85 Z8<8:"#$&' % ) 2' 2& S:FG4J >J
3F8I65F<8A> "#$&' % = 3F8I65F<8A> "#$&' % = 12h&& 12h&,
V65>A ]489>9I +49A> )89A69I"# $2% ., 1h0
+49A> )89A69I"#$2 % .,1h1
+49A> )89A69I"#$2 % .,1h*
+49A> )89A69I"#$2 % .,1h2
+49A> )89A69I"#$2 % .,1h&'
+49A> )89A69I"#$2 % .,1h&&
+49A> )89A69I"#$2 % .,1h&,
+49A> )89A69I"#$2 % .,1h&-
+49A> )89A69I"#$2 % .,1h&.
+49A> )89A69I"#$2 % .,1h&0
+49A> )89A69I"#$2 % .,1h&0
+49A> )89A69I"#$2 % .,1h&1
+49A> )89A69I"#$2 % .,1h&*
+49A> )89A69I"#$2 % .,1h&2
+49A> )89A69I"#$2 % .,1h,'
[4E87 ^N49I49E85>89 V6GH4C"9D4;:>`
-F*,/D)",$
O8I85 Z8<8:"#$&' % ) O8I85 Z8<8:"#$&' % ) 2, 2O8I85 +4<8C
O8I85+4<8C
O 8I 85 W A8 ;
O 8I 85 W A8 ;
O8I85 V>C;658:> "#$&' % O8I85 V>C;658:> "#$&' % = /1h,& = /1h,, -'D/"#"*
389658:> "Y iJ8:F Y498N4C>D4C"#$2 %-*h2389658:> "9AC8KCA4C> "#$2 % -*h2& 389658:> #YN"#$2 % -*h2N4G8:89I89 38A4A4CUC>9 "#$2 % /1h2. N4G8:89I89 Z"Y "#$2 % 2-h2' "9A6H8:>MC8;48"#$2 % 20h'. N4G8:89I89 Y49A>58AFC"#$2 % 20h12 =4:6:>A8:> )89A69IN8C6 "#$2 % 22h0'
3F8I65F<8A> "#$&' % = 3F8I65F<8A> "#$&' % = 12h&12h&.
38E8CR8;A8A e496C69
38E8CR8;A8A e496C69
+4GFE>98G>; VA8H>5
+4GFE>98G>; VA8H>5
+4GFE>98G>; VA8H>5
+4GFE>98G>;VA8H>5
+4GFE>98G>; VA8H>5
34:8E8C89 G4GH8>;
34:8E8C89 G4GH8>;
34:8E8C89 G4GH8>;
34:8E8C89 G4GH8>;
34:8E8C89 G4GH8>;
NCFE6;:> UC>9 b 'B/G5 T3I [[Tf8G
NCFE6;:>UC>9 b'B/ G5 T3I[[T f8G
$8<8A E>:8<>7 Y49A>58AFC
+4GFE>98G>; VA8H>5 34:8E8C89 G4GH8>;
+4GFE>98G>; VA8H>5 34:8E8C89 G4GH8>;
+4GFE>98G>;VA8H>5 34:8E8C89 G4GH8>;
+4GFE>98G>;VA8H>5 34:8E8C89 G4GH8>;
+4GFE>98G>; VA8H>5 34:8E8C89 G4GH8>;
+4GFE>98G>; VA8H>5 34:8E8C89 G4GH8>;
+4GFE>98G>; VA8H>5 34:8E8C89 G4GH8>;
+4GFE>98G>;VA8H>5 34:8E8C89 G4GH8>;
+4GFE>98G>; VA8H>5 34:8E8C89 G4GH8>;
+4GFE>98G>; VA8H>5 34:8E8C89 G4GH8>;
+49A> )89A69I"#$2 % .,1h,&
+49A> )89A69I"#$2 % .,1h,,
ICD 10 - R. 65.2 : CLINICAL PATHWAY SEPSIS BERAT DAN SYOK SEPTIK
=-42 304->-9-.
-.-/.0121 30/04251--. 562.21
=(' !"# %& ' ( ) !"# %& ) ( * !""# %&%'&()*) +*,-.-/%& -&,-/ '(&0%1* )-'2(1 *&3(/)* +%1* #14%& 5%&4 ,(1/(&% +%& 4%&44-%& 3-&4)* #14%& ,(1/%*, )-6- *&,* )-6- *&,*
)-6- *&,*
)-6- *&,*
)-6- *&,*
)-6- *&,*
)-6- *&,*
)-6- *&,*
7%+* 8%.- 7%9%) :(1%.%, ;()%+%1%& <+('% =(/%&%& !1,(1* >(1%,% ?*)*&4 -)-)
7%+* 8%.- 7%9%) :(1%.%, ;()%+%1%& <+('% =(/%&%& !1,(1* >(1%,% ?*)*&4 -)-)
7%+* 8%.- 7%9%) :(1%.%, ;()%+%1%& <+('% =(/%&%& !1,(1* >(1%,% ?*)*&4 -)-)
7%+* 8%.- 7%9%) :(1%.%, ;()%+%1%& <+('% =(/%&%& !1,(1* >(1%,% ?*)*&4 -)-)
7%+* 8%.- 7%9%) :(1%.%, ;()%+%1%& <+('% =(/%&%& !1,(1* >(1%,% ?*)*&4 -)-)
7%+* 8%.- 7%9%) :(1%.%, ;()%+%1%& <+('% =(/%&%& !1,(1* >(1%,% ?*)*&4 -)-)
7%+* 8%.- 7%9%) :(1%.%, ;()%+%1%& <+('% =(/%&%& !1,(1* >(1%,% ?*)*&4 -)-)
7%+* 8%.- 7%9%) :(1%.%, ;()%+%1%& <+('% =(/%&%& !1,(1* >(1%,% ?*)*&4 -)-)
@1#+-/)* A1*& 9(&4*)*%& /%9*"(1
@1#+-/)* A1*& 9(&4*)*%& /%9*"(1 @(&4-/-1%& =(/%&%& B(&% C(&,1%" D=BCE
@1#+-/)* A1*& @1#+-/)* A1*& 9(&4*)*%& /%9*"(1 9(&4*)*%& /%9*"(1 @(&4-/-1%& =(/%&%& B(&% @(&4-/-1%& =(/%&%& B(&% C(&,1%" D=BCE C(&,1%" D=BCE
@1#+-/)* A1*& 9(&4*)*%& /%9*"(1
@1#+-/)* A1*& 9(&4*)*%& /%9*"(1
@1#+-/)* A1*& 9(&4*)*%& /%9*"(1
@(&4-/-1%& =(/%&%& B(&% C(&,1%" D=BCE
@(&4-/-1%& =(/%&%& B(&% C(&,1%" D=BCE
@(&4-/-1%& =(/%&%& B(&% C(&,1%" D=BCE
=(+
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30/04251--. 30.7.!-.8 8(/#)*,
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Lekosit
F*,-&4 G(&*)
Saturasi Oksigen Vena Sentral
Saturasi Oksigen Vena Sentral
Saturasi Oksigen Vena Sentral
F*,-&4 G(&*)
H>@ @1#/%")*,#&*& ;%+%1 I-"% +%1%6 A1(-' +%& /1(%,*&*& J7>
;%+%1 I-"% +%1%6
;%+%1 I-"% +%1%6
;%+%1 I-"% +%1%6
@1#/%")*,#&*& ;%+%1 I-"% +%1%6 A1(-' +%& /1(%,*&*&
=1#'2#)*, ?*"*1-2*& 8%/,%, @('(1*/)%%& ;-",-1 +%& >()*),(&)* <"(/,1#"*,D7%K;KH%KL4KH"E
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;%+%1 I-"% +%1%6
;%+%1 I-"% +%1%6
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@('(1*/)%%& @=K :M:*'(1K N*21*(&
92.:-5-.
@('(1*/)%%& N#,# =#1%/ @('(1*/)%%& <;I @('(1*/)%%&<06#/%1+*#41%3* @('(1*/)%%& A1*& ;%&-"%)* O(&% 9(1*3(1
@('(1*/)%%& N#,# =#1%/
@('%)%&4%& ;%,(,(1 A1*& ;%&-"%)* J&,1% !1,(1* ;%&-"%)* O(&% )(&,1%" @('%)%&4%& 7JB J&,-2%)* =1%/(% @('%)%&4%& B(&,*"%,#1 C(,,*&4 B(&,*"% ,#1 > () -) *, %) * G %& ,- &4 @ %1 -
C(,,*&4 B(&,*"%,#1 > () -) *, %) * G %& ,- &4 @ %1 -
C(,,*&4 B(&,*"%,#1 > () -) *, %) * G %& ,- &4 @ %1 -
C(,,*&4 B(&,*"%,#1 > () -) *, %) * G %& ,- &4 @ %1 -
C(,,*&4 B(&,*"%,#1 > () -) *, %) * G %& ,- &4 @ %1 -
C(,,*&4 B(&,*"%,#1 > () -) *, %) * G %& ,- &4 @ %1 -
C(,,*&4 B(&,*"%,#1 > () -) *, %) * G %& ,- &4 @ %1 -
C(,,*&4 B(&,*"%,#1 > () -) *, %) * G %& ,- &4 @ %1 -
RL 1 ml / Kg BB / Jam
RL 1 ml / Kg BB / Jam
RL 1 ml / Kg BB / Jam
RL 1 ml / Kg BB / Jam
;%&-"%)* FN F>= ?1#&/6#)/#9*
904-32 ;<-9
>()-)*,%)* H%*1%& >8 RS '" Q /4 ?? Q RS '(&*, 2*)% +*-"%&4 D2*"% ,*+%/ %+% 2#"(6 7%H8 SKTUE
RL target nilai tekanan vena sentral 10 - 15 cmH2O
I("%,*& Q !"2-'*& VU +*2(1*/%& )(2%4%* ,%'2%6%& >8 Q 7%H8 SKTU +(&4%& +#)*) )(,%1%
C-99#1,F('#+*&%'*/ W 7#1%+1(&%"*& SKSX M SKV Y 4 Q ;4 ?? Q '(&*,K 2*"% ,*+%/ %+%K +%9%, +*2(1*/%&
W 7#1%+1(&%"*& SKSX M SKV Y 4 Q ;4 ?? Q '(&*,K 2*"% ,*+%/ %+%K +%9%, +*2(1*/%&
RL 1 ml / Kg BB / Jam
RL 1 ml / Kg BB / Jam
W :#9%'*& ZXS Y 4 Q ;4 ?? Q '(&*, 2*"% ,*+%/ %+% 1*)*/# %1*,'*%
WB%)#91()*& SKSR A Q '(&*,
W :#9%'*& ZXS Y 4 Q ;4 ?? Q '(&*, 2*"% ,*+%/ %+% 1*)*/# %1*,'*% W :#2-,%'*& X M [S Y 4 Q ;4 ?? Q '(&*, 2*"% C0B#[ \ ]SU +%& F('%,#/1*, Z RSU
6*+1#/#1,*)#& +#)*) [SS '4Q6%1* /#&,*&*&,1%O(&% 2*"% F2 \ ] 41Q+8 %,%- 6('%,#/1*, \ RSU
-@AB /B%CDE"
W !&,* ?*#,*/%
Sesuai dengan sumber infeksi dan pola kuman setempat (meronem 3 X 1 g) iv , Levofloxacin 1 X 750 mg)
Sesuai dengan sumber infeksi dan pola kuman setempat (meronem 3 X 1 g) iv , Levofloxacin 1 X 750 mg)
Sesuai dengan sumber infeksi dan Sesuai dengan sumber infeksi dan Sesuai dengan sumber infeksi dan pola kuman setempat (meronem 3 X pola kuman setempat (meronem 3 X pola kuman setempat (meronem 3 1 g) iv , Levofloxacin 1 X 750 mg) 1 g) iv , Levofloxacin 1 X 750 mg) X 1 g) iv , Levofloxacin 1 X 750 mg)
W !&,* G%'-1
Elcata 1 X 200 mg / hari iv
Elcata 1 X 200 mg / hari iv
Elcata 1 X 200 mg / hari iv
Elcata 1 X 200 mg / hari iv
Elcata 1 X 200 mg / hari iv
W !&,* B*1-)
Retrovir 500 - 600 mg / hari iv
Retrovir 500 - 600 mg / hari iv
Retrovir 500 - 600 mg / hari iv
Retrovir 500 - 600 mg / hari iv
Retrovir 500 - 600 mg / hari iv
W !&,* L>C!
Linezolid 2 X 600mg iv
Linezolid 2 X 600mg iv
Linezolid 2 X 600mg iv
Linezolid 2 X 600mg iv
Linezolid 2 X 600mg iv
Enteral (EN): 25 Kcal / Enteral (EN): 25 Kcal / Kg BB, 1- 1,5 Enteral (EN): 25 Kcal / Kg BB, 1- 1,5 Enteral (EN): 25 Kcal / Kg BB, 1- 1,5 Enteral (EN): 25 Kcal / Kg BB, 1Kg BB, 1- 1,5 g protein g protein / hari (Sustacal mulai 30cc / g protein / hari (Sustacal mulai 30cc g protein / hari (Sustacal mulai 30cc 1,5 g protein / hari (Sustacal mulai / hari (Sustacal mulai jam, titrasi ^E / jam, titrasi ^E / jam, titrasi ^E 30cc / jam, titrasi ^E 30cc / jam, titrasi ^E
FG .HACBIB
-G -@"JK&AB% G <&CL"I"C%"@ 1%DC M-1
1G 1&L"IB N 9BAC"IB <&CL"I"C%"@ 1%DC 4"#I"O
Enteral (EN): 25 Kcal / Kg BB, 1- 1,5 g protein / hari (Sustacal mulai 30cc / jam, titrasi ^E
N (& ,% &5 " X [ M [ V Y 4 Q . %' * O N (& ,% &5 " X [ M [ V Y 4 Q . %' * O
N (& ,% &5 " X [ M [ V Y 4 Q . % ' * O
N (& ,% &5 " X [ M [ V Y 4 Q . %' * O
N (& ,% &5 " X [ M [ V Y 4 Q . %' * O
N (& ,% &5 " X [ M [ V Y 4 Q . % ' * O
@1(0(+(_ SK[ M SKV Y 4 Q ;4 ?? Q .%' *O
@1(0(+(_ SK[ M SKV Y 4 Q ;4 ?? Q .%' *O
@1(0(+(_ SK[ M SKV Y 4 Q ;4 ?? Q .%' *O
@1(0(+(_ SK[ M SKV Y 4 Q ;4 ?? Q .%' *O
@1(0(+(_ SK[ M SKV Y 4 Q ;4 ?? Q .%' *O
Diprivan 20 mg / Kg BB/ jam iv
Diprivan 20 mg / Kg BB/ jam iv
Diprivan 20 mg / Kg BB/ jam iv
Diprivan 20 mg / Kg BB/ jam iv
@1(0(+(_ SK[ M SKV Y 4 Q ;4 ?? Q .%' *O
Diprivan 20 mg / Kg BB/ Diprivan 20 mg / Kg BB/ jam iv jam iv
9G 90 3CDPBJ"%IBI
Evaluasi Terapi Antimikroba berdasarkan hasil biakkan kuman
lovenox 2 X 0,2 cc sc
lovenox 2 X 0,2 cc sc
lovenox 2 X 0,2 cc sc
lovenox 2 X 0,2 cc sc
lovenox 2 X 0,2 cc sc
lovenox 2 X 0,2 cc sc
< )# '( 91 %` #" X _a S ' 4 * O
< )# '( 91 %` #" X _a S ' 4 * O
< )# '( 91 %` #" X _a S ' 4 * O
< )# '( 91 %` #" X _a S ' 4 * O
< )# '( 91 %` #" X _a S ' 4 * O
< )# '( 91 %` #" X _a S ' 4 * O
Gagal Napas ICD 10 - J 81
Gagal Napas ICD 10 - J 82
Gagal Napas ICD 10 - J 83
Gagal Napas ICD 10 - J 84
Gagal Hepar Gagal Otak
Gagal Hepar Gagal Otak
Gagal Hepar Gagal Otak
Gagal Hepar Gagal Otak
Gagal Sirkulasi ICD 10 - R 57.10
Gagal Sirkulasi ICD 10 - R 57.11
Gagal Sirkulasi ICD 10 - R 57.12
Gagal Sirkulasi ICD 10 - R 57.13
Koagulopati ICD 10 - R 79.2
Koagulopati ICD 10 - R 79.3
Koagulopati ICD 10 - R 79.4
Koagulopati ICD 10 - R 79.5
H en ti Ja nt un g I CD 9 - 42 7. 9
H en ti Ja nt un g I CD 9 - 42 7. 10
H en ti J an tu ng IC D 9 - 42 7. 11
H en ti Ja nt un g I CD 9 - 42 7. 12
Hemodinamik Stabil Kesadaran membaik
Hemodinamik Stabil Kesadaran membaik
Hemodinamik Stabil Kesadaran membaik
Hemodinamik Stabil Kesadaran membaik
=G =&"L &J&Q"IB R)S L&C T 0ID#&UC"VDJ 2M 8G 8JH%DI" 5D@ACDJ
Actrapid 10 unit infusi / jam titrasi target GDS 150-180 mg %
T 2@IHJB@ 2M M-42-.(M-42-.
I%4%" I*&.%" JH: XS M 7 X] Gagal Napas ICD 10 - J Gagal Napas ICD 10 - J 80 80 Gagal Hepar Gagal Hepar Gagal Otak Gagal Otak Gagal Sirkulasi ICD 10 - R Gagal Sirkulasi ICD 10 - R 57.9 57.9 Koagulopati ICD 10 - R Koagulopati ICD 10 - R 79.1 79.1 Sulit Weaning Henti Jantung ICD 9 Henti Jantung ICD 9 - 427.6 427.5
Henti Jantung ICD 9 427.8
Gagal Hepar Gagal Otak Gagal Sirkulasi ICD 10 - R 57.14 Koagulopati ICD 10 - R 79.6 Henti Jantung ICD 9 427.13
Bedah (Pengendalian Sumber Infeksi)
5;.1769-12
KELUARAN
Henti Jantung ICD 9 427.7
Gagal Napas ICD 10 - J 85
Kadar Laktat Menurun Hemodinamik Stabil Kesadaran membaik Produksi Urin > 0,5 ml / Kg BB / jam
;%&-"%)* JB d O%)#91()#1 JH: XS M SScX] ;%&-"%)* B(&% @(1*3(1 JH: T M RbcTR ;%&-"%)* J&,1% !1,(1* JH: T M RbcTX
Kadar Laktat Menurun Hemodinamik Stabil Hemodinamik Stabil Kesadaran membaik Kesadaran membaik Produksi Urin > 0,5 ml / Kg BB / jam
Dapat disapih Ventilator
Hemodinamik Stabil Kesadaran membaik
@('%)%&4%& ;%,(,(1 A1*& JH: T M V]cTa @('%)%&4%& 7JB JH: T M TRcTS J&,-2%)* JH: T M TecSa @('%)%&4%& B(&,*"%,#1 JH: T M Tec]T >()-)*,%)* G%&,-&4 @%1- JH: T TTceS
ICD 10 - R. 65.2 : CLINICAL PATHWAY SEPSIS BERAT DAN SYOK SEPTIK
=(X
=-42 304->-9-.
=(Y
=(Z
=('S
=(''
=('+
=(')
=(',
-.-/.0121
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)-6- *&,*
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)-6- *&,*
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)-6- *&,*
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7%+* 8%.- 7%9%) :(1%.%, ;()%+%1%& <+('% =(/%&%& !1,(1* >(1%,% ?*)*&4 -)-)
7%+* 8%.- 7%9%) :(1%.%, ;()%+%1%& <+('% =(/%&%& !1,(1* >(1%,% ?*)*&4 -)-)
7%+* 8%.- 7%9%) :(1%.%, ;()%+%1%& <+('% =(/%&%& !1,(1* >(1%,% ?*)*&4 -)-)
7%+* 8%.- 7%9%) :(1%.%, ;()%+%1%& <+('% =(/%&%& !1,(1* >(1%,% ?*)*&4 -)-)
7%+* 8%.- 7%9%) :(1%.%, ;()%+%1%& <+('% =(/%&%& !1,(1* >(1%,% ?*)*&4 -)-)
7%+* 8%.- 7%9%) :(1%.%, ;()%+%1%& <+('% =(/%&%& !1,(1* >(1%,% ?*)*&4 -)-)
7%+* 8%.- 7%9%) :(1%.%, ;()%+%1%& <+('% =(/%&%& !1,(1* >(1%,% ?*)*&4 -)-)
7%+* 8%.- 7%9%) :(1%.%, ;()%+%1%& <+('% =(/%&%& !1,(1* >(1%,% ?*)*&4 -)-)
@1#+-/)* A1*& 9(&4*)*%& /%9*"(1 @(&4-/-1%& =(/%&%& B(&% C(&,1%" D=BCE
@1#+-/)* A1*& 9(&4*)*%& /%9*"(1
@1#+-/)* A1*& 9(&4*)*%& /%9*"(1
@1#+-/)* A1*& 9(&4*)*%& /%9*"(1
@1#+-/)* A1*& 9(&4*)*%& /%9*"(1
@(&4-/-1%& =(/%&%& B(&% C(&,1%" D=BCE
@(&4-/-1%& =(/%&%& B(&% C(&,1%" D=BCE @(&4-/-1%& =(/%&%& B(&% C(&,1%" D=BCE @(&4-/-1%& =(/%&%& B(&% C(&,1%" D=BCE
@1#+-/)* A1*& 9(&4*)*%& /%9*"(1 @(&4-/-1%& =(/%&%& B(&% C(&,1%" D=BCE
@1#+-/)* A1*& 9(&4*)*%& /%9*"(1 @(&4-/-1%& =(/%&%& B(&% C(&,1%" D=BCE
@1#+-/)* A1*& 9(&4*)*%& /%9*"(1 @(&4-/-1%& =(/%&%& B(&% C(&,1%" D=BCE
30/04251--. 562.21
30/04251--. 30.7.!-.8
Lekosit F*,-&4 G(&*)
;%+%1 I-"% +%1%6
;%+%1 I-"% +%1%6
@1#/%")*,#&*& ;%+%1 I-"% +%1%6 A1(-' +%& /1(%,*&*&
;%+%1 I-"% +%1%6
;%+%1 I-"% +%1%6
;%+%1 I-"% +%1%6
;%+%1 I-"% +%1%6
;%+%1 I-"% +%1%6
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@('(1*/)%%& N#,# =#1%/
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92.:-5-.
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C(,,*&4 B(&,*"%,#1 > ()- )*, %) *G %& ,- &4 @% 1-
C(,,*&4 B(&,*"%,#1 > () -) *, %)* G% &, -& 4 @% 1-
C(,,*&4 B(&,*"%,#1 > ()- )*, %) *G %& ,- &4 @% 1-
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RL 1 ml / Kg BB / Jam
RL 1 ml / Kg BB / Jam
1HUUDCA =DLB@"#B%
RL 1 ml / Kg BB / Jam
RL 1 ml / Kg BB / Jam
RL 1 ml / Kg BB / Jam
RL 1 ml / Kg BB / Jam
RL 1 ml / Kg BB / Jam
RL 1 ml / Kg BB / Jam
-@AB /B%CDE"
Enteral (EN): 25 Kcal / Kg BB, 1- 1,5 g protein / hari (Sustacal mulai 30cc / jam, titrasi ^E @%1(&,(1%" D@7E f 0"*&*'*_ K *O("*9K 0#'2*9"(_K /%2*O(&
N(&,%&5" X[ M [V Y 4 Q .%' *O
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Sesuai dengan sumber infeksi dan Sesuai dengan sumber infeksi dan Sesuai dengan sumber infeksi dan pola kuman setempat (meronem 3 pola kuman setempat (meronem 3 X pola kuman setempat (meronem 3 X 1 g) iv , Levofloxacin 1 X 750 1 g) iv , Levofloxacin 1 X 750 mg) X 1 g) iv , Levofloxacin 1 X 750 mg) mg)
W !&,* G%'-1
Elc at a 1 X 20 0 m g / hari iv
El cat a 1 X 200 mg / h ari iv
Elc ata 1 X 200 mg / har i iv
El cat a 1 X 200 mg / ha ri iv
W !&,* B*1-)
Retrovir 500 - 600 mg / hari iv
Retrovir 500 - 600 mg / hari iv
Retrovir 500 - 600 mg / hari iv
Retrovir 500 - 600 mg / hari iv
W !&,* L>C!
Linezolid 2 X 600mg iv
Linezolid 2 X 600mg iv
Linezolid 2 X 600mg iv
Linezolid 2 X 600mg iv
FG .HACBIB
!f !&%"4(,*/ f ?(1+%)%1/%& C/#1 N(&,%&5" X[ M [V Y 4 Q .%' *O B!C
lovenox 2 X 0,2 cc sc
Evaluasi Terapi Antimikroba berdasarkan Elcata 1 X 200 mg / hari iv hasil biakkan kuman Retrovir 500 - 600 mg / hari iv Linezolid 2 X 600mg iv
Enteral (EN): 25 Kcal / Kg BB, 1Enteral (EN): 25 Kcal / Kg BB, 11,5 g protein / hari (Sustacal mulai 1,5 g protein / hari (Sustacal mulai 30cc / jam, titrasi ^E 30cc / jam, titrasi ^E
Enteral (EN): 25 Kcal / Enteral (EN): 25 Kcal / Kg BB, 1- 1,5 g protein / Kg BB, 1- 1,5 g protein / hari (Sustacal mulai 30cc hari (Sustacal mulai 30cc / jam, titrasi ^E / jam, titrasi ^E
Enteral (EN): 25 Kcal / Kg BB, 1- 1,5 g protein / hari (Sustacal mulai 30cc / jam, titrasi ^E @%1(&,(1%" D@7E f 0"*&*'*_ K *O("*9K 0#'2*9"(_K /%2*O(&
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Diprivan 20 mg / Kg BB/ jam iv
Diprivan 20 mg / Kg BB/ jam iv
Diprivan 20 mg / Kg BB/ jam iv
Diprivan 20 mg / Kg BB/ jam iv
Diprivan 20 mg / Kg BB/ Diprivan 20 mg / Kg BB/ Diprivan 20 mg / Kg BB/ jam iv jam iv jam iv
9G 90 3CDPBJ"%IBI
lovenox 2 X 0,2 cc sc
lovenox 2 X 0,2 cc sc
lovenox 2 X 0,2 cc sc
lovenox 2 X 0,2 cc sc
lovenox 2 X 0,2 cc sc
lovenox 2 X 0,2 cc sc
lovenox 2 X 0,2 cc sc
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@1(0(+(_ SK[ M SKV Y 4 Q ;4 ?? Q .%' *O Diprivan 20 mg / Kg BB/ jam iv
Enteral (EN): 25 Kcal / Kg BB, 1- 1,5 Enteral (EN): 25 Kcal / Kg BB, 1g protein / hari (Sustacal mulai 30cc 1,5 g protein / hari (Sustacal mulai / jam, titrasi ^E 30cc / jam, titrasi ^E
Sesuai dengan sumber infeksi dan pola kuman setempat (meronem 3 X 1 g) iv , Levofloxacin 1 X 750 mg)
Sesuai dengan sumber infeksi dan pola kuman setempat (meronem 3 X 1 g) iv , Levofloxacin 1 X 750 mg)
@1(0(+(_ SK[ M SKV Y 4 Q ;4 ?? @1(0(+(_ SK[ M SKV Y 4 Q ;4 Q .%' *O ?? Q .%' *O
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I%4%" I*&.%" JH: XS M 7 X] Gag al Nap as IC D 1 0 - J 86
Ga gal Nap as IC D 10 - J 8 0 Ga gal Nap as IC D 10 - J 8 7
Ga ga l Nap as IC D 10 - J 88
Gagal Hepar Gagal Otak Gagal Sirkulasi ICD 10 - R 57.15 Koagulopati ICD 10 - R 79.7
Gagal Hepar Gagal Otak Gagal Sirkulasi ICD 10 - R 57.9 Koagulopati ICD 10 - R 79.1 Sulit Weaning Henti Jantung ICD 9 427.15
Gagal Hepar Gagal Otak
Gagal Hepar Gagal Otak
Gagal Hepar Gagal Otak
Gagal Hepar Gagal Otak
Gagal Sir kula si ICD 10 - R 57.16
Gagal Sir kula si ICD 10 - R 57.17
Gagal Sirkulasi ICD 10 - R 57.18
Gagal Sir kula si ICD 10 - R 57.19
K oa gu lo pa ti IC D 1 0 - R 7 9. 8
K oa gu lo pa ti IC D 1 0 - R 7 9. 9
K oa gu lo pa ti IC D 1 0 - R 7 9. 10
K oa gu lo pa ti IC D 1 0 - R 7 9. 11
Henti Jantung ICD 9 427.14
Gag al Nap as IC D 1 0 - J 89
Ga ga l N ap as IC D 10 - J 90
Gagal Napas ICD 10 - J Gagal Napas ICD 10 - J Gagal Napas ICD 10 - J 91 92 93 Gagal Hepar Gagal Hepar Gagal Hepar Gagal Otak Gagal Otak Gagal Otak Gagal Sirkulasi ICD 10 - Gagal Sirkulasi ICD 10 Gagal Sirkulasi ICD 10 R 57.20 R 57.21 R 57.22 Koagulopati ICD 10 - R Koagulopati ICD 10 - R Koagulopati ICD 10 - R 79.12 79.13 79.14
Sulit Weaning H en ti Ja nt un g I CD 9 - 4 27 .1 6
H en ti Ja nt un g I CD 9 - 4 27 .1 7
H en ti Ja nt un g IC D 9 - 42 7. 18
Hemodinamik Stabil Kesadaran membaik
Hemodinamik Stabil Kesadaran membaik
Hemodinamik Stabil Kesadaran membaik
H en ti J an tu ng IC D 9 - 42 7. 19
Henti Jantung ICD 9 427.20
Henti Jantung ICD 9 427.21
Henti Jantung ICD 9 427.22
5;.1769-12
KELUARAN Hemodinamik Stabil Kesadaran membaik
Hemodinamik Stabil Kesadaran membaik
Hemodinamik Stabil Kesadaran membaik
Hemodinamik Stabil Kesadaran membaik
Hemodinamik Stabil Kesadaran membaik
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CLINICAL PATHWAYS INTRACRANIAL INJURY (ICD 10: S.06) NamaPasien: ………………………………… Diagnosis Awal: Intracranial Injury AktivitasPelayanan AsessmenKlinis:
PemeriksaanPenunj ang:
Umur: ………………
RuangRawat: …………..
Kode ICD 10 :S.06…
HariRawat 1
HariRawat 2
HariRawat 3
Medical record lengkap
Tanda vital GCS Pemeriksaan pupil
Tanda vital GCS Pemeriksaan pupil
Hb, Ht, Leukosit, Trombosit, AGD/BGA,ele ktrolit darah, laktat, GDS, SGOT/SGPT, Ureum, Creatinin, PT/aPTT,Fibri nogen,
AGD/BGA, elektrolit darah, GDS, laktat
Hb, Ht, Leukosit, Trombosit, AGD/BGA, elektrolit darah, laktat, GDS, SGOT/SGP T, Ureum, Creatinin, PT/aPTT,Fi
HariRawat 4 Tanda vital GCS Pemeriksaa n pupil
AGD/BGA, elektrolit darah, GDS, laktat Kultur darah, kultur sputum, kultur urine
Kelas
NomorRekamMedis: ……………………….
Tglmasuk:…………. Jam : HariRawat HariRaw 5 at 6 Tanda Tanda vital ,GCS vital Pemeriksa GCS an pupil Pemeriks aan pupil AGD/BG A, elektrolit darah, GDS, laktat
Hb, Ht, Leukosit , Trombo sit, AGD/B GA,elek trolit darah, laktat, GDS,
Tanggalkeluar Jam HariRa wat 7 Tanda vital GCS Pemeri ksaan pupil AGD/ BGA, ……. elektrol ..… it …… darah, …... GDS, …… laktat ….. …… ….… …….
Tindakan:
Akses vena perifer Intubasi Ventilasi mekanik, Akses vena sentral, Akses arteri, Pasang NGT, Pasang kateter urin Pasang drainase lumbal Operasi bedah saraf
Ventilasi mekanik,
Ventilasi mekanik,
Ventilasi mekanik, akses vena perifer
Ventilasi mekanik, Trakeosto mi
Ventilasi mekanik,
Weanin g ventilasi mekanik
……. .
ObatObatan:
Fentanyl 24mcg/kgBB/ja m, atau Morphine 1-2 mg/jam Midazolam 0,050,1mg/kgBB/ja m Meropenem 3 x 1g Amikasin 1 x 1g Omeprazole 2 x 40 mg NaCl 0,9% nebul Heparin 2 x 5000 Unit
Fentanyl 2Fentanyl 2Fentanyl 24mcg/kgBB/j 4mcg/kgBB/ 4mcg/kgBB am, atau jam, atau /jam, atau Morphine 1-2 Morphine 1- Morphine mg/jam 2 mg/jam 1-2 mg/jam Midazolam Midazolam Midazolam 0,050,050,050,1mg/kgBB/j 0,1mg/kgBB 0,1mg/kgB am /jam B/jam Meropenem 3 Meropenem Meropenem x 1g 3 x 1g 3 x 1g Amikasin 1 x Amikasin 1 Amikasin 1 1g x 1g x 1g Omeprazole 2 Omeprazole Omeprazole x 40 mg 2 x 40 mg 2 x 40 mg NaCl 0,9% NaCl 0,9% NaCl 0,9% nebul nebul nebul Heparin 2 x Heparin 2 x Heparin 2 x 5000 Unit 5000 Unit 5000 Unit
Fentanyl Fentanyl Fentan 22yl 24mcg/kgB 4mcg/kg 4mcg/k B/jam, BB/jam, gBB/ja atau atau m, atau Morphine Morphin Morphi 1-2 e 1-2 ne 1-2 mg/jam mg/jam mg/jam Midazola Midazola Midazo m 0,05m 0,05lam 0,1mg/kg 0,1mg/kg 0,05BB/jam BB/jam 0,1mg/ Meropene Meropen kgBB/j m 3 x 1g em 3 x am Amikasin 1g Merop 1 x 1g Amikasin enem 3 Omeprazo 1 x 1g x 1g le 2 x 40 Omepraz Amika mg ole 2 x sin 1 x NaCl 40 mg 1g 0,9% NaCl Omepr nebul 0,9% azole 2 Heparin 2 nebul x 40 x 5000 Heparin mg Unit 2 x 5000 NaCl Ganti Unit 0,9% antibiotika Fluconaz nebul
……. ..… …… ….. …
Supporting hemodinamik
Cairan: RL Na Cl 0,9% Nutrisi enteral Nutrisi parenteral Koloid (gelatin/starch 130/0.4) Transfusi
Sesuai tanda vital Norepinefrin dosis titrasi Dobutamin dosis titrasi Adrenalin dosis titrasi Insulin dosis titrasi
… cc/jam .. cc/jam …kalori .. kalori .. cc/jam
Sesuai tanda vital Norepinefrin dosis titrasi Dobutamin dosis titrasi Adrenalin dosis titrasi Insulin dosis titrasi
… cc/jam .. cc/jam …kalori .. kalori .. cc/jam
Sesuai tanda vital Norepinefri n dosis titrasi Dobutamin dosis titrasi Adrenalin dosis titrasi Insulin dosis titrasi
Sesuai tanda vital Norepinefri n dosis titrasi Dobutamin dosis titrasi Adrenalin dosis titrasi Insulin dosis titrasi
… cc/jam .. cc/jam …kalori .. kalori ..cc/jam
… cc/jam .. cc/jam …kalori .. kalori ..cc/jam
Sesuai Sesuai tanda vital tanda Norepinef vital rin dosis Norepine titrasi frin dosis Dobutami titrasi n dosis Dobutam titrasi in dosis Adrenalin titrasi dosis Adrenali titrasi n dosis Insulin titrasi dosis Insulin titrasi dosis titrasi
… cc/jam .. cc/jam …kalori .. kalori .. cc/jam
… cc/jam .. cc/jam …kalori .. kalori .. cc/jam
Sesuai tanda vital Norepi nefrin dosis titrasi Dobuta min dosis titrasi Adrena lin dosis titrasi Insulin dosis titrasi ..cc/ja m .. cc/jam …kalor i .. kalori
Hasil(Outcome)
Tanda vital stabil GCS stabil
Tanda vital stabil GCS stabil
Tanda vital stabil GCS stabil
Tanda vital stabil GCS stabil
Tanda vital stabil GCS stabil
Pendidikan/: Rencanaperawatan
Edukasi Rawat inap
-Rawat inap
-Rawat inap
Rawat inap
Varians:
tergantung diagnostic yang terjadi
tergantung diagnostic yang terjadi
tergantung diagnostic yang terjadi
tergantung diagnostic yang terjadi
edukasi Rawat inap tergantung diagnostic yang terjadi
…
………
Nama DPJP …………… Tandatangan
………..
Tanda vital stabil GCS meningk at Rawat inap tergantun g diagnosti c yang terjadi
Tanda vital stabil GCS stabil edukasi Rawat inap tergant ung diagno stic yang terjadi
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