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.
Assess and secure a patent airway and relate the potential for a cervical spine injury.
Recognize and treat the patient's initial shock, initiating treatment specific to the pregnant trauma patient.
Relate appreciation for and the significance of the patient's recurrent hypotension, identifying a differential diagnosis for the pregnant trauma patient.
Relate the need for early consultation with a general surgeon and an obstetrician.
Relate that the best treatment for the fetus is the optimal treatment of the mother.
Recognize the need for identifying the Rh status and the possible need for Rh immunization.
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
Did not delay in recognizing pregnancy.
Requested early surgical/obstetrical consultation.
Performed vaginal examination in a timely fashion.
Recognized possible uterine hemorrhage in a timely fashion.
Avoided excessive manipulation of the pelvis.
Monitored the fetus.
Recognized the potential for fetal distress.
Ordered Rh immunoglobulin.
Immobilized the right femur fracture.
Performed a neurovascular examination before and after the immobilization.
Protected the patient from hypothermia.
Considered the need for tetanus prophylaxis.
Did not delay in recognizing the need for transfer.
Did not delay transfer to perform diagnostic tests.
Adequately prepared for contingencies during the transfer process, such as hemodynamic deterioration, fetal distress, and the onset of labor.