ATLS Instructor Evaluation Form

Patient F - Initial Assessment and Management

YESNO
Perform the assessment and management phases properly and in the correct sequence, recognizing that priorities are the same as for the nonpregnant patient.
YES
NO
Assess and secure a patent airway and relate the potential for a cervical spine injury.
YES
NO
Recognize and treat the patient's initial shock, initiating treatment specific to the pregnant trauma patient.
YES
NO
Relate appreciation for and the significance of the patient's recurrent hypotension, identifying a differential diagnosis for the pregnant trauma patient.
YES
NO
Relate the need for early consultation with a general surgeon and an obstetrician.
YES
NO
Relate that the best treatment for the fetus is the optimal treatment of the mother.
YES
NO
Recognize the need for identifying the Rh status and the possible need for Rh immunization.
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
Did not delay in recognizing pregnancy.
YES
NO
Requested early surgical/obstetrical consultation.
YES
NO
Performed vaginal examination in a timely fashion.
YES
NO
Recognized possible uterine hemorrhage in a timely fashion.
YES
NO
Avoided excessive manipulation of the pelvis.
YES
NO
Monitored the fetus.
YES
NO
Recognized the potential for fetal distress.
YES
NO
Ordered Rh immunoglobulin.
YES
NO
Immobilized the right femur fracture.
YES
NO
Performed a neurovascular examination before and after the immobilization.
YES
NO
Protected the patient from hypothermia.
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 hemodynamic deterioration, fetal distress, and the onset of labor.
YES
NO