Instructor Evaluation Form

Patient B - Initial Assessment and Management

YESNO
Adhere to the appropriate priority sequence in management.
Have an organized approach to patient treatment
Perform the assessment and management phases properly and in the correct sequence.
Recognize the patient's airway obstruction as a result of the maxillofacial trauma and quickly perform a cricothyroid-otomy while protecting the patient's cervical spine. This is the only acceptable method to secure a patent airway in this patient.
Recognize that the patient has a potential cervical spine injury, exercise the appropriate precautionary measures.
Recognize and indicate the need for ventilatory assistance and oxygenation.
Recognize the patient's hemorrhagic shock, and initiate appropriate resuscitative therapy, including hemmorrhage control and vigorous, warmed fluid therapy.
Recognize the source of the patient's hemorrhage as being arterial bleeding from the femur and scalp and apply appropriate measures to control the hemorrhage.
Identify the patient's open head injury and take the necessary steps to prevent secondary brain injury.
Identify and manage the conditions requiring critical treatment decisions in the order listed.

Potentials for Adverse Outcome: If the student's performance is borderline and the student fails to recognize or perform one or more of the items below, the instructor may determine that the student's overall performance is unsuccessful.

YESNO
Restricted spinal motion
Performed cricothyroidotomy in timely fashion.
Provided assisted ventilation.
Ordered blood transfusion in timely fashion.
Controlled external hemorrhage early.
Applied a traction splint to control hemorrhage and restore circulation early.
Recognized/immobilized the left wrist fracture.
Did not perform and nasal instrumentation, such as insertion of a nasogastric tube.
Identified a depressed skull fracture and protected the wound from contamination.
Protected the patient from hypothermia.
Considered the need for tetanus prophylaxis.
Recognized the need for transfer.
Did not delay transfer to perform diagnostic tests.
Adequately prepared for contingencies during the transfer process, such as malfunction of the cricothyroidotomy, chest tube malfunction, and deterioration in neurologic status.