CAMA:________/__________ FECHA INGRESO:______/_____/20__ CAMA:________/__________ FECHA INGRESO:______/_____/20__

NOMBRE:_________________________________________________ EDAD:_______ AÑOS NOMBRE:_________________________________________________ EDAD:_______ AÑOS

APP:_____________________________________________________________ APP: _____________________________________________________________
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P. ACTUAL:________________________________________________________ P. ACTUAL:________________________________________________________
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S.V: TA:_____/_____mmHg FC:______lpm FR:______rpm Temp:_____°C SO2:_____% S.V: TA:_____/_____mmHg FC:______lpm FR:______rpm Temp:_____°C SO2:_____%
E F:____________________________________________________________________ E F:____________________________________________________________________
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DX ACTUALES: 1.-_________________________________________________________ DX ACTUALES: 1.-_________________________________________________________
2-_______________________________ 5-___________________________________ 2-_______________________________ 5-___________________________________
3-_______________________________ 6-___________________________________ 3-_______________________________ 6-___________________________________
4-_______________________________ 7-___________________________________ 4-_______________________________ 7-___________________________________
LABORATORIOS INICIALES (______/____/20__) T. COAG. TP:_____ INR%:______ TTP:______ LABORATORIOS INICIALES (______/____/20__) T. COAG. TP:_____ INR%:______ TTP:______
BH LEUCOS:______ HB:______ HTO:_____ PLAQ:______ NEU%::_____ OTRO:_______________ BH LEUCOS:______ HB:______ HTO:_____ PLAQ:______ NEU%::_____ OTRO:_______________
QS GLUCO:_______ UREA:_______ CREAT:_______ NA:_______ K:______ BD:______BT:______ QS GLUCO:_______ UREA:_______ CREAT:_______ NA:_______ K:______ BD:______BT:______
BI:______ AST:_______ ALT:______ DHL:_______ AMILASA:________ CK:______ CKMB:_____ BI:______ AST:_______ ALT:______ DHL:_______ AMILASA:________ CK:______ CKMB:_____
GASA pH:______ PO2:______ PCO2:_______ HCO3:_______ OTROS:______________________ GASA pH:______ PO2:______ PCO2:_______ HCO3:_______ OTROS:______________________
EGO CETO:___GLUCO:_____ PROTE:____ NITRI:_____ LEUCOS:_____ BACTE:____+ LEVA:____ UROBI:____ EGO CETO:___GLUCO:_____ PROTE:____ NITRI:_____ LEUCOS:_____ BACTE:____+ LEVA:____ UROBI:____
EKG:___________________________________________________________________________ EKG:___________________________________________________________________________
RX/USG/TAC:____________________________________________________________________ RX/USG/TAC:____________________________________________________________________
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LABORATORIOS ACTUALES (______/____/20__) T. COAG. TP:_____ INR%:______ TTP:______ LABORATORIOS ACTUALES (______/____/20__) T. COAG. TP:_____ INR%:______ TTP:______
BH LEUCOS:______ HB:______ HTO:_____ PLAQ:______ NEU%::_____ OTRO:_______________ BH LEUCOS:______ HB:______ HTO:_____ PLAQ:______ NEU%::_____ OTRO:_______________
QS GLUCO:_______ UREA:_______ CREAT:_______ NA:_______ K:______ BD:______BT:______ QS GLUCO:_______ UREA:_______ CREAT:_______ NA:_______ K:______ BD:______BT:______
BI:______ AST:_______ ALT:______ DHL:_______ AMILASA:________ CK:______ CKMB:_____ BI:______ AST:_______ ALT:______ DHL:_______ AMILASA:________ CK:______ CKMB:_____
GASA pH:______ PO2:______ PCO2:_______ HCO3:_______ OTROS:______________________ GASA pH:______ PO2:______ PCO2:_______ HCO3:_______ OTROS:______________________
EGO CETO:___GLUCO:_____ PROTE:____ NITRI:_____ LEUCOS:_____ BACTE:____+ LEVA:____ UROBI:____ EGO CETO:___GLUCO:_____ PROTE:____ NITRI:_____ LEUCOS:_____ BACTE:____+ LEVA:____ UROBI:____
EKG:___________________________________________________________________________ EKG:___________________________________________________________________________
RX/USG/TAC:____________________________________________________________________ RX/USG/TAC:____________________________________________________________________
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TX:___________________________________________________________ ___________ TX:___________________________________________________________ ___________
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PENDIENTES: PENDIENTES:
1.-_________________________ 4.-______________________7.-IC A: _____________ 1.-_________________________ 4.-______________________7.-IC A: _____________
2.-_________________________ 5.-______________________8.-IC A:_____________ 2.-_________________________ 5.-______________________8.-IC A:_____________
3.-_________________________ 6.-______________________9.- SUBE A: __________ 3.-_________________________ 6.-______________________9.- SUBE A: __________