| Patient Details Patient Name: Age: Hospital Number: |
FLUID CHART Part One | Part TwoDATE: WARD: Emergency Dept. |
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| INPUT (MLS) | OUTPUT (MLS) | ||||||||
| Time | IV Fluids | Other (write) | DRUG (write) Noradrenaline Rate/Volume |
Hourly Total | Running Total | Urine | Hourly Total | Running Total | +VE or -VE |
| 19:00 | 1000 | 30 (tazocin) |
1030 | 1030 | ++ incontinent | ||||
| 20:00 | 750 | 750 | 1780 | ||||||
| 21:00 | 250 1000 |
100 (gentomicin) |
4 | 1350 | 3132 | 50 residual 10 |
60 | 60 | |
| 22:00 | 166 | 6 | 172 | 3304 | 15 | 15 | 75 | ||
| 23:00 | 166 | 8 | 174 | 3478 | 15 | 15 | 90 | ||
| 24:00 | 166 | 10 | 176 | 3654 | 20 | 20 | 110 | +ve 3544 | |
Fluid Chart for (from 19:00)
