Kartu Penderita PP

KARTU PENDERITA

NAMA : ................................................................
ALAMAT : ................................................................
JENIS KELAMIN : ................................................................
KESAN UMUM : 1. KASUS TRAUMA 2. KASUS MEDIS
KEADAAN KORBAN :
1. SADAR/TIDAK SADAR * (1. AWAS 2. SUARA 3. NYERI 4. TIDAK RESPON)
2. GANGGUAN PERNAPASAN (1. YA 2. TIDAK)
3. GANGGUAN JANTUNG (1. YA 2. TIDAK)
4. CIDERA YANG DIALAMI :
• ..............................................................................................................................
• ..............................................................................................................................
• ..............................................................................................................................
5. PERTOLONGAN PERTAMA YANG DILAKUKAN :
 ..............................................................................................................................
 ..............................................................................................................................
 ..............................................................................................................................
 ..............................................................................................................................
6. TANDA – TANDA VITAL :
• Frekuensi Nafas :.......................................................
• Denyut Nadi : .......................................................
• Suhu Tubuh : .......................................................
• Tekanan Darah : .......................................................
• Warna Kulit : .......................................................

7. RIWAYAT PENDERITA ( KOMPAK ) :
K : ..............................................................................
O : .............................................................................
M : .............................................................................
P : ..............................................................................
A : ..............................................................................
K : ..............................................................................
8. PEMERIKSAAN BERKALA :

Pukul / jam
Frekwensi Nafas
Denyut Nadi
Suhu Tubuh
Tekanan Darah
Warna Kulit

Blitar, ………………………

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