King LT (S)-D
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Minutes
What class is the student in?
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A
B
C
Evening
A Shift
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Please Select
Brown
Crown
Downs
Friedman
Fuentes
Gonzales
Gosnell
Lombardi
Mccolgan
Patterson
Robinson
Stidham
B Shift
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Chimenian
Clark
Collins
Cooper
Fowler
Lally
Pauley
Pavelka
Staub
Stoddard
Sword
C Shift
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Please Select
Begosh
Decker
Eckroade
Keeney
Kough
Leonard
Peterson
Santucci
Shaffer
Swann
Wigmore
Evening Class
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Please Select
Ale
Dana
Decamp
Flanary
Gunawardana
Hunt
Kaffi
Knoyer
Lopez-Puentes
Manon
Mejias
Olson
Sahadzic
Sakaria
Who is the Evaluator?
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Instructor
A Shift Student Evaluator
B Shift Student Evaluator
C Shift Student Evaluator
Evening Class Student Evaluator
Instructor
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Please Select
Burkhammer, Michele
Cleveland, Susan
Cordero, Jennifer
Cousins, Robert
Dugan, Pete
Gorodetsky, Nelly
Hayunga, Joe
Herman, Geoffrey
Hutchinson, David
Kauffman, Mike
Kinna, Donald
Le Renard, Yann
Leigh, Michael
Lipp, Troy
Lofland, Larry
Luger, Brian
Martino, Chris
Newman, David
Ney, Kirk
Nosbisch, Nick
Oliveira, Rae
Ruff, Greg
Scott, Tony
Shawl, Jon
Singer, Arye
Stottlemyer, Ty
Sweder-Gold, David
Touzeau, Chris
Turcotte, Jeremy
Weinstock, Sam
Wooden, Andrew
Zea, Alejandro
A Shift Student Evaluator
*
Please Select
Brown
Crown
Downs
Friedman
Fuentes
Gonzales
Gosnell
Lombardi
Mccolgan
Patterson
Robinson
Stidham
B Shift Student Evaluator
*
Please Select
Chimenian
Clark
Collins
Cooper
Fowler
Lally
Pauley
Pavelka
Staub
Stoddard
Sword
C Shift Student Evaluator
*
Please Select
Begosh
Decker
Eckroade
Keeney
Kough
Leonard
Peterson
Santucci
Shaffer
Swann
Wigmore
Evening Class Student Evaluator
*
Please Select
Ale
Dana
Decamp
Flanary
Gunawardana
Hunt
Kaffi
Knoyer
Lopez-Puentes
Manon
Mejias
Olson
Sahadzic
Sakaria
Prepares patient
Takes or verbalizes appropriate PPE precautions
Inserts adjunct (nasopharyngeal airway)
Ventilates at a rate of 10 - 12/minute and sufficient volume to make chest rise
Attaches pulse oximeter and notes SpO2
Preoxygenates patient using BVM and NODESAT method
Auscultates breath sounds
Performs Intubation
Gathers and checks equipment
Removes oral adjunct airway (if in place)
Positions head properly (sniffing)
Performs a tongue-jaw lift
Aligns blue orientation line with corner of the mouth
Advances tube, rotates back to midline
Inserts device until base of connector aligns with teeth
Inflates cuff with proper volume and immediately removes syringe
Ventilates patient and confirms proper ventilation [correct lumen and proper insertion depth] by auscultation bilaterally over lungs and over epigastrium
Comfirm correct placement via ETCO
Withdraws tube while bagging until ventilation is easy and free flowing
Secure device
Affective
Accepts evaluation and criticism professionally
Shows willingness to learn
Interacts with simulated patient and other personnel in professional manner
Critical Criteria
Interrupts ventilations at any time when SpO2 is less than 90%
Failure to take or verbalize appropriate PPE precautions
If used, suctions the patient for more than 10 seconds
Failure to preoxygenate patient prior to intubation
Failure to disconnect syringe immediately after inflating cuff of either tubes
Failure to properly inflate either cuff
Failure to assure proper tube placement by auscultation bilaterally and over the epigastrium
Failure to voice and ultimately provide high oxygen concentration [at least 85%]
Failure to ventilate the patient at a rate of at least 10/minute and no more than 12/minute
Failure to provide adequate volumes per breath [maximum 2 errors/minute permissible]
Insertion or use of any adjunct in a manner dangerous to the patient
Failure to demonstrate the ability to manage the patient as a minimally competent EMT
Exhibits unacceptable affect with patient or other personnel
Uses or orders a dangerous or inappropriate intervention
Evaluator Comments
Was the student successful or unsuccessful in this skill?
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Successful
Unsuccessful
Signature
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