Adult ETI
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:
Hour
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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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Please Select
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?
*
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
Selects, checks, assembles equipment
BVM with mask and reservoir
Oxygen
Airway adjuncts
Suction unit with appropriate catheters
Laryngoscope and blades
ET tube and stylette
Capnography/capnometry
Prepares patient
Takes appropriate PPE precautions
Manually opens airway
Inserts adjunct (oropharyngeal or nasopharyngeal airway)
Ventilates patient at a rate of 10 – 12/minute and sufficient volume to make chest rise
Attaches pulse oximeter and evaluates SpO2 reading
Preoxygenates patient
Performs Intubation
Positions head properly
Inserts laryngoscope blade and displaces tongue
Elevates mandible with laryngoscope
Inserts ET tube and advances to proper depth
Inflates cuff to proper pressure and immediately removes syringe
Ventilates patient and confirms proper tube placement by auscultation bilaterally over lungs and over epigastrium
Verifies proper tube placement by secondary confirmation such as capnography, capnometry, EDD or colorimetric device
Assesses for hypoxia during intubation attempt
Secures ET tube
Ventilates patient at proper rate and volume while observing capnography/capnometry and pulse oximeter
Suctions secretions from tube
Recognizes need to suction
Identifies/selects flexible suction catheter
Inserts catheter into ET tube while leaving catheter port open
At proper insertion depth, covers catheter port and applies suction while withdrawing catheter
Ventilates/directs ventilation of patient as catheter is flushed with sterile water
Reaffirms proper tube placement
Ventilates patient at proper rate and volume while observing capnography/capnometry and pulse oximeter
Affective
Accepts evaluation and criticism professionally
Shows willingness to learn
Interacts with simulated patient and other personnel in professional manner
Critical Criteria
Failure to initiate ventilations within 30 seconds after taking PPE precautions or interrupts ventilations when SpO2 is less than 90% at any time
Failure to take or verbalize appropriate PPE precautions
Suctions the patient for more than 10 seconds
Failure to preoxygenate patient prior to intubation
If used, stylette extends beyond end of ET tube
Failure to disconnect syringe immediately after inflating cuff of ET tube
Uses teeth as a fulcrum
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
Does not suction the patient in a timely manner
Exhibits unacceptable affect with patient or other personnel
Failure to demonstrate the ability to manage the patient as a minimally competent EMT
Uses or orders a dangerous or inappropriate intervention
Evaluator Comments
Was the student successful or unsuccessful in this skill?
*
Successful
Unsuccessful
Signature
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