ATLS Instructor Evaluation Form

Patient G - Initial Assessment and Management

YESNO
Perform the assessment and management phases properly and in the correct sequence.
Recognize the need to establish a definitive airway while restricting cervical spinal motion.
Recognize the presence of hypotension and the need to rapidly administer warmed crystalloid fluids.
Appreciate the potential significance of the bloody otorrhea and Battle's sign, and avoid inserting a nasogastric tube.
Recognize the presence of a widened mediastinum, obtain appropriate radiographic studies to diagnose ruptured aorta, and prepare the patient for transport and/or operation.
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 perform and nasal instrumentation, such as insertion of nasogastric tube.
Recognized basilar skull fracture and cerebrospinal fluid otorrhea.
Performed angiography after checking surgical capabilities to repair the injury.
Restricted spinal motion.
Properly immobilized the left femur fracture.
Performed a neurovascular exam of left leg 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 a neurologic deterioration, seizure activity, combative patient, endotracheal tube malposition, and hemodynamic deterioration.