Senarai Semak Code Blue Bag

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SENARAI SEMAK CODE BLUE BAG

UNIT KECEMASAN DAN TRAUMA


BULAN/TAHUN :
NO

ITEM

Airway
000
00
0
1
2
3
4
2
Bag Valve Mask
(BVM)
Infant
Paeds
Adult
3
Oxygen Therapy
Device
Nasal Prong
Face mask
High Flow mask
4
Glucometer (DXT)
5
Oxygen Tank
6
Automated External
Defibrillator (AED)
7
Eskot Kit
Tandatangan Pemeriksa

STO
CK

TARIKH PEMERIKSAAN

1
1
1
1
1
1
1

1
1
1

2
2
2
1
1
1
1

SENARAI SEMAK CODE BLUE BAG


UNIT KECEMASAN DAN TRAUMA
BULAN/TAHUN :
NO

ITEM

Airway
000
00
0
1
2
3
4
Bag Valve Mask
(BVM)
Infant
Paeds
Adult
Oxygen Therapy
Device
Nasal Prong
Face mask
High Flow mask
Glucometer (DXT)
Oxygen Tank
Automated External
Defibrillator (AED)

4
5
6

STO
CK
1
1
1
1
1
1
1

1
1
1

2
2
2
1
1
1

TARIKH PEMERIKSAAN

7
Eskot Kit
Tandatangan Pemeriksa

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