BMU Admission Form Patient Information ED Zone * - Select Zone - RESUS 1 RESUS 2 YELLOW CLEAN YELLOW EXT YELLOW OBSERVATION YELLOW TENT ISO 1 ISO 2A ISO 2B/2C GREEN ZONE FEVER CENTRE DECON AREA YELLOW PSY Patient Name * Identity Document Type * MYKAD/MYKID PASSPORT ARMY IC POLICE IC BIRTH CERTIFICATE OTHER IC @ Passport * ED RN Gender * - LELAKI (Male) PEREMPUAN (Female) Age * TAHUN (Years) BULAN (Months) HARI (Days) Diagnosis * Admission Date Decision for Admission Primary Team (Discipline) * Ward Class Eligibility * - Select - 1st Class 2nd Class 3rd Class Government (Standard) Acute / Non-Acute Criteria * VENTILATORY SUPPORT (INVASIVE & NIV) INOTROPES SEVERE ACIDOSIS (SERUM HCO3 < 15) DKA ON IV INSULIN UGIB ON IVI PPI MENIGITIS / MENINGOENCEPHALITIS HPT EMERGENCY ON IVI GTN/LABETOLOL SPINE INJURY WITH NEUROLOGICAL DEFICIT POLYTRAUMA (INVOLVE 2 MAJOR BONES) ANTICIPATE AIRWAY COMPROMISE (STRIDOR, LUDWIG, EPISTAXIS WITH NASAL PACK) FOR CLOSE MONITORING POST STROKE THROMBOLYSIS/THROMBECTOMY CAUTION (ABSCOND/SUICIDE/ASSAULT) NON ACUTE Additional notes (if any) Main Building Admission Criteria * - Select - MAIN BUILDING Weight > 120kg Possible Procedure Within 48 Hours None Other Oxygen Requirement * - Select - RA (Room Air) NPO2 (Nasal Prongs O2) Simple Mask Venturi Mask 24% Venturi Mask 28% Venturi Mask 35% Venturi Mask 40% Venturi Mask 60% Non-Rebreather Mask (NRM) High Flow Nasal Cannula (HFNC) BiPAP CPAP NIV Ventilated (ETT) Dialysis Requirement * Yes No Patient Able to Lie on Canvas (ADL Independent)? Yes No ADL Status * - Select - INDEPENDENT SEMIDEPENDENT DEPENDENT Patient Was Sent To Operation Theatre? Yes No Other ATT Given Yes No Other Booked By * 💾 Submit Request
