Skill Station C – Circulation

ATLS Instructor Evaluation Form

Skill Station C – Circulation

Ονοματεπώνυμο *

Skill Performance Circulation

Diagnose the presence of shock, both compensated and uncompensated. *

	Fail	Incomplete	Satisfactory	Instructor Potential
Result	FailResult Fail	IncompleteResult Incomplete	SatisfactoryResult Satisfactory	Instructor PotentialResult Instructor Potential

Determine the type of shock present (e.g., hemorrhagic, obstructive, septic). *

	Fail	Incomplete	Satisfactory	Instructor Potential
Result	FailResult Fail	IncompleteResult Incomplete	SatisfactoryResult Satisfactory	Instructor PotentialResult Instructor Potential

Choose the appropriate fluid resuscitation. *

	Fail	Incomplete	Satisfactory	Instructor Potential
Result	FailResult Fail	IncompleteResult Incomplete	SatisfactoryResult Satisfactory	Instructor PotentialResult Instructor Potential

Demonstrate on a model the application of a staged approach to control external hemorrhage utilizing direct pressure, wound packing, and application of a tourniquet. *

	Fail	Incomplete	Satisfactory	Instructor Potential
Result	FailResult Fail	IncompleteResult Incomplete	SatisfactoryResult Satisfactory	Instructor PotentialResult Instructor Potential

Demonstrate on a model placement of intraosseous access and discuss other options for vascular access and their indications. *

	Fail	Incomplete	Satisfactory	Instructor Potential
Result	FailResult Fail	IncompleteResult Incomplete	SatisfactoryResult Satisfactory	Instructor PotentialResult Instructor Potential

Demonstrate the application of a pelvic stabilization device for pelvic fractures and understand the indications and contraindications for use of a traction device for femur fractures. *

	Fail	Incomplete	Satisfactory	Instructor Potential
Result	FailResult Fail	IncompleteResult Incomplete	SatisfactoryResult Satisfactory	Instructor PotentialResult Instructor Potential

Recognize the need for patient reassessment and for additional resuscitation based on the patient's response to treatment. *

	Fail	Incomplete	Satisfactory	Instructor Potential
Result	FailResult Fail	IncompleteResult Incomplete	SatisfactoryResult Satisfactory	Instructor PotentialResult Instructor Potential

Recognize which patients require definitive hemorrhage control (operative and/or catheter-based) and/or transfer to a higher level of care. *

	Fail	Incomplete	Satisfactory	Instructor Potential
Result	FailResult Fail	IncompleteResult Incomplete	SatisfactoryResult Satisfactory	Instructor PotentialResult Instructor Potential

Describe and demonstrate (optional) the indications and techniques of central intravenous access, peripheral venous cut down, diagnostic peritoneal lavage (DPL), and pericardiocentesis. *

	Fail	Incomplete	Satisfactory	Instructor Potential
Result	FailResult Fail	IncompleteResult Incomplete	SatisfactoryResult Satisfactory	Instructor PotentialResult Instructor Potential

Demonstrates / instructs others in skill *

	Fail	Incomplete	Satisfactory	Instructor Potential
Result	FailResult Fail	IncompleteResult Incomplete	SatisfactoryResult Satisfactory	Instructor PotentialResult Instructor Potential

Overall: knowledge, skills, attitude for this skill. *

	Fail	Incomplete	Satisfactory	Instructor Potential
Result	FailResult Fail	IncompleteResult Incomplete	SatisfactoryResult Satisfactory	Instructor PotentialResult Instructor Potential

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