ATLS Instructor Evaluation Form

Patient G - Initial Assessment and Management

YESNO
Perform the assessment and management phases properly and in the correct sequence.
YES
NO
Recognize the need to establish a definitive airway while restricting cervical spinal motion.
YES
NO
Recognize the presence of hypotension and the need to rapidly administer warmed crystalloid fluids.
YES
NO
Appreciate the potential significance of the bloody otorrhea and Battle's sign, and avoid inserting a nasogastric tube.
YES
NO
Recognize the presence of a widened mediastinum, obtain appropriate radiographic studies to diagnose ruptured aorta, and prepare the patient for transport and/or operation.
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 perform and nasal instrumentation, such as insertion of nasogastric tube.
YES
NO
Recognized basilar skull fracture and cerebrospinal fluid otorrhea.
YES
NO
Performed angiography after checking surgical capabilities to repair the injury.
YES
NO
Restricted spinal motion.
YES
NO
Properly immobilized the left femur fracture.
YES
NO
Performed a neurovascular exam of left leg 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 a neurologic deterioration, seizure activity, combative patient, endotracheal tube malposition, and hemodynamic deterioration.
YES
NO