KARTU LUKA

Data Korban
·        Nama : ....................................................
·        Umur : ....................................................
·        Jenis Kelamin : ....................................................
·        Alamat : ....................................................
Penilaian Dini
·        Kesan Umum : Kasus Trauma / Kasus Medis*
·        Respon : Awas / Suara / Nyeri Tekan / Tidak Respon*
·        Air Way : ....................................................
·        Breathing : ....................................................
·        Circulation : ....................................................
Pemeriksaan Fisik
·        Perubahan Bentuk : ....................................................
·        Luka Terbuka : ....................................................
·        Nyeri Tekan : ....................................................
·        Bengkak : ....................................................
Penanganan
·       Tindakan : ...................................................................
.............................................................................................
.............................................................................................
.............................................................................................
.............................................................................................

Pemeriksaan Tanda Vital

·  Nafas : ............ kali per menit
·  Nadi : ............ kali per menit
·  Suhu : Dingin/Hangat / Panas*...........oC
·  Kondisi Kulit : Lembab/Kering/Berkeringat*
·  Warna Kulit : Biru / Pucat / Merah / Kuning / Biru
Kehitaman*
·  Tekanan Darah : ............ mmHg