ATLS Instructor Evaluation Form

Patient J - Initial Assessment and Management

YESNO
Perform the assessment and management phases properly and in the correct sequence.
YES
NO
Recognize the need to assist the patient's ventilations to ensure adequate oxygenation and ventilation
YES
NO
Recognize that the patient's respiratory distress is due to the left pneumothorax, and appropriately insert a chest tube
YES
NO
Recognize that the patient is in a coma, has a chest injury, and requires endotracheal intubation to maintain a patent airway
YES
NO
Recognize the patient's hypothermia by indicating the need to deliver warmed IV fluids and place the patient on a warming blanket
YES
NO
Identify and manage the conditions requiring critical treatment decisions in the order listed
YES
NO

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
Recognized pneumothorax in a timely fashion
YES
NO
Did not intubate with aggressive ventilation before tube thoracostomy
YES
NO
Did not rely on the pulse oximeter in the patient with hypothermia
YES
NO
Did not delay transfer while attempting to warm the patient
YES
NO
Did not delay in instituting aggressive rewarming measures
YES
NO
Monitored the patient's temperature while rewarming
YES
NO
Recognized the patient's ischemic right foot
YES
NO
Realigned the right femur and restored circulation
YES
NO
Performed a neurovascular exam before and after leg immobilization
YES
NO
Considered the need for tetanus prophylaxis
YES
NO
Did not delay in recognizing the need for transfer
YES
NO
Did not delay transfer to perform diagnostic tests
YES
NO
Adequately prepared for contingencies during the transfer process, such as continuing the rewarming process to prevent further hypothermia, endotracheal tube malposition, recurrent pneumothorax or tension pneumothorax, and neurologic deterioration
YES
NO