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  • Rs Royal Surabaya Perfusion Data Record

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    This document is a perfusion data record for a patient undergoing a procedure requiring cardiopulmonary bypass. It includes fields for the patient's name, age, sex, medical record number, weight, height, body surface area and blood volume. Diagnostic information such as catheterization results and echo findings are noted. Laboratory results including hemoglobin, hematocrit, renal and liver function are documented. Details about the perfusion circuit are provided including oxygenator type, tubing size, prime solution composition and cardioplegia administration details.

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    Lem Baran

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    This document is a perfusion data record for a patient undergoing a procedure requiring cardiopulmonary bypass. It includes fields for the patient's name, age, sex, medical record number, weight, height, body surface area and blood volume. Diagnostic information such as catheterization results and echo findings are noted. Laboratory results including hemoglobin, hematocrit, renal and liver function are documented. Details about the perfusion circuit are provided including oxygenator type, tubing size, prime solution composition and cardioplegia administration details.

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    © All Rights Reserved
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    14 views1 page

    Rs Royal Surabaya Perfusion Data Record

    Uploaded by

    gusmargono
    This document is a perfusion data record for a patient undergoing a procedure requiring cardiopulmonary bypass. It includes fields for the patient's name, age, sex, medical record number, weight, height, body surface area and blood volume. Diagnostic information such as catheterization results and echo findings are noted. Laboratory results including hemoglobin, hematocrit, renal and liver function are documented. Details about the perfusion circuit are provided including oxygenator type, tubing size, prime solution composition and cardioplegia administration details.

    Copyright:

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

    RS ROYAL SURABAYA

    PERFUSION DATA RECORD


    Date :

    PATIENT DATA
    Name

    Age

    F/M

    No. MR :
    BW

    Kg

    HT

    Cm

    BSA

    M2

    BV

    Blood Group / Rh

    DIAGNOSTIC DATA
    Cath.

    Echo

    History

    Anesthetist

    Perfusionist

    Diagnose

    Procedure

    LABORATORY
    Hb

    Ht

    Ureum

    Creatinine

    CCT

    Albumin

    Blood Sugar :
    CK / CKMB :

    CI
    3
    2.8
    2.4
    2
    1.8
    1.5

    Surgeon

    Flow
    (L/menit)
    ________
    ________
    ________
    ________
    ________
    ________

    PT

    APTT

    Cannulae : Aortic

    Fr

    Venous

    Fr
    Fr

    Oxygenator

    CARDIOPLEGIA
    L

    :
    :
    :
    :
    :
    :

    S/N

    Tubing : Neo 1/2/3/Infant/Ped/Adult

    PRIME SOLUTION
    Crystalloid
    Colloid
    L
    Mannitol
    Bicarb
    Heparin
    Blood
    Others

    L
    Meq
    U
    mL

    Blood / Crystalloid
    Antegrade / Retrograde
    Continous / Intermittent
    Warm / Cold
    Heparine

    mG

    Protamina

    mG

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