Ficha de avaliação e acompanhamento UTI Adulto

Nome:_______________________________________________________

Sexo:____ Idade:____ DN:___/___/___ FIA:____________

Internação no Hospital: ___/___/___ Especialidade: __________

ADM na UTI ___/___/___ Alta da UTI ___/___/___

HD:__________________________________________________________________________

HMA:________________________________________________________________________
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AP:__________________________________________________________________________

DADOS PARA VENTILAÇÃO MECÂNICA

Altura:_____ __ 4 ml/kg _____ 5 ml/kg _____ 6 ml/kg _____ 7 ml/kg _____ 8 ml/kg _____

Data da Intubação: ___/___/___ COT: _____ RL: _____ TQT ___/___/___

Data da Extubação: ___/___/___ Falha na Extubação ___/___/___ Motivo: ________________

Reintubação: ___/___/___ Falha na Extubação ___/___/___ Motivo: ____________________

Observações:

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Data ____/____/____ Horário: ____:_____ Fisioterapeuta:
PCV ⃝ PSV⃝ SIMV ⃝ PH: HB: _____________________________________
Pinsp:____ PEEP:_____ PaO2: HT: _____________________________________
FR: ___/____ FiO2:___ PaCO2: PLAQ: _____________________________________
TI: ____ VC____ HCO3: LEU: _____________________________________
FC_____ SPO_____ BE: U: _____________________________________
PA ____x____ SAT: CR: _____________________________________
Na: _____________________________________
K:
Data ____/____/____ Horário: ____:_____ Fisioterapeuta:
PCV ⃝ PSV⃝ SIMV ⃝ PH: HB: _____________________________________
Pinsp:____ PEEP:_____ PaO2: HT: _____________________________________
FR: ___/____ FiO2:___ PaCO2: PLAQ: _____________________________________
TI: ____ VC____ HCO3: LEU: _____________________________________
FC_____ SPO_____ BE: U: _____________________________________
PA ____x____ SAT: CR: _____________________________________
Na: _____________________________________
K:
Data ____/____/____ Horário: ____:_____ Fisioterapeuta:
PCV ⃝ PSV⃝ SIMV ⃝ PH: HB: _____________________________________
Pinsp:____ PEEP:_____ PaO2: HT: _____________________________________
FR: ___/____ FiO2:___ PaCO2: PLAQ: _____________________________________
TI: ____ VC____ HCO3: LEU: _____________________________________
FC_____ SPO_____ BE: U: _____________________________________
PA ____x____ SAT: CR: _____________________________________
Na: _____________________________________
K:
Data ____/____/____ Horário: ____:_____ Fisioterapeuta:
PCV ⃝ PSV⃝ SIMV ⃝ PH: HB: _____________________________________
Pinsp:____ PEEP:_____ PaO2: HT: _____________________________________
FR: ___/____ FiO2:___ PaCO2: PLAQ: _____________________________________
TI: ____ VC____ HCO3: LEU: _____________________________________
FC_____ SPO_____ BE: U: _____________________________________
PA ____x____ SAT: CR: _____________________________________
Na: _____________________________________
K:
Data ____/____/____ Horário: ____:_____ Fisioterapeuta:
PCV ⃝ PSV⃝ SIMV ⃝ PH: HB: _____________________________________
Pinsp:____ PEEP:_____ PaO2: HT: _____________________________________
FR: ___/____ FiO2:___ PaCO2: PLAQ: _____________________________________
TI: ____ VC____ HCO3: LEU: _____________________________________
FC_____ SPO_____ BE: U: _____________________________________
PA ____x____ SAT: CR: _____________________________________
Na: _____________________________________
K:
Data ____/____/____ Horário: ____:_____ Fisioterapeuta:
PCV ⃝ PSV⃝ SIMV ⃝ PH: HB: _____________________________________
Pinsp:____ PEEP:_____ PaO2: HT: _____________________________________
FR: ___/____ FiO2:___ PaCO2: PLAQ: _____________________________________
TI: ____ VC____ HCO3: LEU: _____________________________________
FC_____ SPO_____ BE: U: _____________________________________
PA ____x____ SAT: CR: _____________________________________
Na: _____________________________________
K:
Data ____/____/____ Horário: ____:_____ Fisioterapeuta:
PCV ⃝ PSV⃝ SIMV ⃝ PH: HB: _____________________________________
Pinsp:____ PEEP:_____ PaO2: HT: _____________________________________
FR: ___/____ FiO2:___ PaCO2: PLAQ: _____________________________________
TI: ____ VC____ HCO3: LEU: _____________________________________
FC_____ SPO_____ BE: U: _____________________________________
PA ____x____ SAT: CR: _____________________________________
Na: _____________________________________
K:
Data ____/____/____ Horário: ____:_____ Fisioterapeuta:
PCV ⃝ PSV⃝ SIMV ⃝ PH: HB: _____________________________________
Pinsp:____ PEEP:_____ PaO2: HT: _____________________________________
FR: ___/____ FiO2:___ PaCO2: PLAQ: _____________________________________
TI: ____ VC____ HCO3: LEU: _____________________________________
FC_____ SPO_____ BE: U: _____________________________________
PA ____x____ SAT: CR: _____________________________________
Na: _____________________________________
K:
Data ____/____/____ Horário: ____:_____ Fisioterapeuta:
PCV ⃝ PSV⃝ SIMV ⃝ PH: HB: _____________________________________
Pinsp:____ PEEP:_____ PaO2: HT: _____________________________________
FR: ___/____ FiO2:___ PaCO2: PLAQ: _____________________________________
TI: ____ VC____ HCO3: LEU: _____________________________________
FC_____ SPO_____ BE: U: _____________________________________
PA ____x____ SAT: CR: _____________________________________
Na: _____________________________________
K:
Data ____/____/____ Horário: ____:_____ Fisioterapeuta:
PCV ⃝ PSV⃝ SIMV ⃝ PH: HB: _____________________________________
Pinsp:____ PEEP:_____ PaO2: HT: _____________________________________
FR: ___/____ FiO2:___ PaCO2: PLAQ: _____________________________________
TI: ____ VC____ HCO3: LEU: _____________________________________
FC_____ SPO_____ BE: U: _____________________________________
PA ____x____ SAT: CR: _____________________________________
Na: _____________________________________
K:
Data ____/____/____ Horário: ____:_____ Fisioterapeuta:
PCV ⃝ PSV⃝ SIMV ⃝ PH: HB: _____________________________________
Pinsp:____ PEEP:_____ PaO2: HT: _____________________________________
FR: ___/____ FiO2:___ PaCO2: PLAQ: _____________________________________
TI: ____ VC____ HCO3: LEU: _____________________________________
FC_____ SPO_____ BE: U: _____________________________________
PA ____x____ SAT: CR: _____________________________________
Na: _____________________________________
K:
Data ____/____/____ Horário: ____:_____ Fisioterapeuta:
PCV ⃝ PSV⃝ SIMV ⃝ PH: HB: _____________________________________
Pinsp:____ PEEP:_____ PaO2: HT: _____________________________________
FR: ___/____ FiO2:___ PaCO2: PLAQ: _____________________________________
TI: ____ VC____ HCO3: LEU: _____________________________________
FC_____ SPO_____ BE: U: _____________________________________
PA ____x____ SAT: CR: _____________________________________
Na: _____________________________________
K:
Data ____/____/____ Horário: ____:_____ Fisioterapeuta:
PCV ⃝ PSV⃝ SIMV ⃝ PH: HB: _____________________________________
Pinsp:____ PEEP:_____ PaO2: HT: _____________________________________
FR: ___/____ FiO2:___ PaCO2: PLAQ: _____________________________________
TI: ____ VC____ HCO3: LEU: _____________________________________
FC_____ SPO_____ BE: U: _____________________________________
PA ____x____ SAT: CR: _____________________________________
Na: _____________________________________
K:
Data ____/____/____ Horário: ____:_____ Fisioterapeuta:
PCV ⃝ PSV⃝ SIMV ⃝ PH: HB: _____________________________________
Pinsp:____ PEEP:_____ PaO2: HT: _____________________________________
FR: ___/____ FiO2:___ PaCO2: PLAQ: _____________________________________
TI: ____ VC____ HCO3: LEU: _____________________________________
FC_____ SPO_____ BE: U: _____________________________________
PA ____x____ SAT: CR: _____________________________________
Na: _____________________________________
K:
Data ____/____/____ Horário: ____:_____ Fisioterapeuta:
PCV ⃝ PSV⃝ SIMV ⃝ PH: HB: _____________________________________
Pinsp:____ PEEP:_____ PaO2: HT: _____________________________________
FR: ___/____ FiO2:___ PaCO2: PLAQ: _____________________________________
TI: ____ VC____ HCO3: LEU: _____________________________________
FC_____ SPO_____ BE: U: _____________________________________
PA ____x____ SAT: CR: _____________________________________
Na: _____________________________________
K: