CF Paramedic Program Lab Skills Book · CF Paramedic Program Lab Skills Book Semester One ... Skill Page Autovent Usage 7 Capnography (EtCO2) Application and Interpretation 9 Dosage

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CF Paramedic Program Lab Skills Book

Semester One

“Skills”

Name: ______________________________ ©2014 McGinnes, Ramsey, Bledsoe, Gesner, Leinas, Reyes, Graves, Watts

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If found please call 352-291-4440 or return to College of Central Florida, Emergency Medical Services Program 3001 SW College Rd. Ocala, FL 34474 Thank You

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Table of Contents:

Skill PageAutovent Usage 7 Capnography (EtCO2) Application and Interpretation 9 Dosage Calculations 11 Endotracheal Medication Administration - Adult, Pediatric 12 Endotracheal Tube Suction 13 Foreign Body Airway Obstruction (FBAO) Retrieval with Direct Laryngoscopy: Infant, Child

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Intramuscular Injection: Adult, Child, Infant 15 Intraosseous Insertion 16 Intubation: Digital 17 Intubation: Extubation 18 Intubation: Nasotracheal 19 Intubation: Oral 20 Intubation: Child, Infant, Neonate 21 Intubation: Trauma 22 Needle Cricothyrotomy: Child, Infant 23 Intravenous Insertion 24 Intravenous Insertion: External Jugular 25 Intravenous Meds: Bolus 26 Intravenous Meds: Drip 27 Supraglotic Airway (KING Tube) Insertion 28 Metered Dose Inhaler Administration - Adult, Child Infant 29 Nasogastric Tube Insertion: Adult, Child Infant 30 Nasogastric Tube Medication Administration 31 Nebulizer Medication Administration: Adult, Child Infant 32 Oral Medication Administration: Adult, Child Infant 33 Orogastric Tube Insertion: Adult, Child Infant 34 Orogastric Tube Medication Administration: Adult, Child Infant 35 Oxygen Administration Blow-By: Child, Infants 36 Oxygen Administration: Pediatric Non-Rebreather Mask 37 Patient Assessment Medical: Adult 38 Patient Assessment Medical: Child, Infant 40 Patient Assessment Trauma: Adult 42 Patient Assessment Trauma: Child, Infant 44 Pneumocentesis 46 Rapid Sequence Intubation (RSI) 47 Rectal Medication Administration: Adult, Child, Infant 48 SaO2 Monitor 49 Sublingual Medication Administration 50 Subcutaneous Injection: Adult, Child, Infant 51 Suctioning - Nasal: Child, Infant 52 Suctioning - Oral: Child, Infant 53 Suctioning - Bulb Syringe: Child, Infant 54 Surgical Cricothyroidotomy 55 Transdermal Medication Administration 56 Venipuncture: Adult, Child, Infant 57 Contrived Experience Lab 58 Airway Management Log 62

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First Semester Lab Objective Completion List

StudentName:___________________________________ Term:_____________ (PLEASE PRINT)

Please submit your final lab notebook organized in the following order. Include a title page with tab for each unit. 1. Report Cover, with your name and course number on outside 2. First Semester objective completion checklist (this sheet) 3. First Semester Lab Skills Sheets (You MUST demonstrate competence in ALL skills and scenarios listed to receive a passing grade)

a. EMS 2611L Skills: i. Personal Protection / BSI _______ Demonstrated Competence

ii. Dosage Calculation _______ Demonstrated Competence iii. ET Med Administration _______ Demonstrated Competence iv. IM Med Administration _______ Demonstrated Competence v. Intraosseous Infusion _______ Demonstrated Competence

vi. IV: External Jugular _______ Demonstrated Competence vii. IV: Peripheral _______ Demonstrated Competence

viii. IV Med Admin: Bolus _______ Demonstrated Competence ix. IV Med Admin: Drip _______ Demonstrated Competence x. Metered Dose Med Administration _______ Demonstrated Competence

xi. Nebulized Med Administration _______ Demonstrated Competence xii. NG Tube Med Administration _______ Demonstrated Competence

xiii. NG Tube Placement _______ Demonstrated Competence xiv. OG Tube Med Administration _______ Demonstrated Competence xv. OG Tube Placement _______ Demonstrated Competence

xvi. Oral Med Administration _______ Demonstrated Competence xvii. Rectal Med Administration _______ Demonstrated Competence

xviii. SL Med Administration _______ Demonstrated Competence xix. SQ Med Administration _______ Demonstrated Competence xx. Transdermal Med Administration _______ Demonstrated Competence

xxi. Venipuncture and Blood Draw _______ Demonstrated Competence

All Completed = 100. One or more not completed = 0. Score: _____ This score is 21% of your grade _____ / 21%

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b. EMS 2612 L Skills: i. Autovent _______ Demonstrated Competence

ii. Capnography (EtCO2) _______ Demonstrated Competence iii. ET: Medication Administration _______ Demonstrated Competence iv. ET: Digital _______ Demonstrated Competence v. ET: Extubation _______ Demonstrated Competence

vi. ET: Nasal _______ Demonstrated Competence vii. ET: Oral _______ Demonstrated Competence

viii. ET: Child, Infant Neonate _______ Demonstrated Competence ix. ET: Transillumination _______ Demonstrated Competence x. ET: Trauma _______ Demonstrated Competence

xi. ET: Suctioning _______ Demonstrated Competence xii. FBOA Retrieval w/ Direct Laryngoscopy _______ Demonstrated Competence

xiii. Supraglotic Airway (King Tube) _______ Demonstrated Competence xiv. Needle Cricothyroidotomy _______ Demonstrated Competence xv. Oxygen Admin Blow-By _______ Demonstrated Competence

xvi. Oxygen Admin: Ped Non-Rebreather _______ Demonstrated Competence xvii. Pneumocentesis _______ Demonstrated Competence

xviii. RSI _______ Demonstrated Competence xix. SaO2 Monitor (Pulse Oximetry) _______ Demonstrated Competence xx. Surgical Cricothyroidotomy _______ Demonstrated Competence

All Completed = 100. One or more not completed = 0. Score: _____ This score is 21% of your grade _____ / 21%

Contrived Experience Lab: Scenario One: IBM Score: _____ / 4% _____ / 4% Scenario Two: Difficult Airway Score: _____ / 4% _____ / 4%

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Professional Behavior Evaluation, Lab Coach: Score: _____ / 22 This score is 4% of your grade _____ / 4%

Professional Behavior Evaluation, Lead Instructor: Score: _____ / 22 This score is 4% of your grade _____ / 4%

Trauma Final Scenario Score: Score: _____ / 100 = _____ This score is 21% of your grade _____ / 21%

Medical Final Scenario Score: Score: _____ / 100 = _____ This score is 21% of your grade _____ / 21%

4. Behavioral Counselings: _____ Positive Follow up _____ _____ Score: BC - PF = _____ This score subtracts 1% from your grade per point.

5. Unexcused Absences: _____ _____ Score: _____ This score subtracts 3% per unexcused absence from your grade. (Note: Absences, excused or unexcused do NOT excuse you from completing the required competencies)

6. Late Arrivals _____ Early Departures _____ _____ Score: LA+ED=_____

This score subtracts 1% per occurrence from your grade.

*Note: If you miss more than 50% of the lab, the occurrence counts as an absence, not a late arrival or early departure.

Total: ___/100%

I DO HEREBY ATTEST THAT ALL INFORMATION CONTAINED ON THIS FORM AND IN THE DOCUMENTATION IN THIS NOTEBOOK IS TRUE AND ACCURATE. _____________________________ ______________________________ _____/_____/_____ STUDENT PRINTED NAME SIGNATURE DATE

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CF Paramedic Program Procedure: Autovent Usage

Rating Scale: √: Skill performed appropriately and following accepted technique X: This step was omitted or not performed correctly

Steps in the Procedure or Task: Rating

Equipment and Patient Preparation:

Student washes hands

Student gathers appropriate equipment

Student identifies the patient, his or her self, and his or her student status

Student explains the procedure to the patient and confirms the patient’s understanding

Implementation and Assessment:

Performs BLS airway maneuvers and ventilates the patient with the BVM, 100% O2

Assembles and checks all equipment for proper function

Correctly intubates the patient and confirms proper tube placement

Instructs assistant to ventilate the patient while preparing the ventilator

Removes the ventilator from its container and checks the hoses for kinks and the connections to assure that they are tight

Attaches the ventilator to the oxygen source properly and turns on the oxygen cylinder

Checks that the cylinder is full and that the flow regulator is set at zero

If the Autovent is so equipped, sets the inspiratory time dial to adult or child as appropriate

Estimates the patient’s weight, and calculates both 10mL/kg and 15mL/kg and indicates that these are the minimum and maximum inspiratory volumes, respectively

Sets the tidal volumes on the ventilator at the maximum inspired volume calculated above

Sets the breaths per minute control knob at 12 breaths per minute (bpm) for adults or 20 bpm for pediatric patients initially

Places his or her hand at the exhalation port to confirm air flow and proper rate. Failure of the ventilator to deliver the air flow correctly indicates a ventilator malfunction

Occludes the expiration port and listens for the pressure limit alarm. Failure of the alarm to activate indicates a ventilator malfunction

Once proper function of the ventilator has been confirmed, student directs the assistant to stop ventilations and remove the Bag-Valve device. The student then attaches the ventilator to the ET tube

As the ventilator cycles, student carefully observers chest rise to assure that chest rise is adequate but not maximal, and that exhalation appears to complete before the next inhalation begins

Verbalizes that if the pressure alarm sounds at the beginning of inspiration this indicates the airway is not patent

Verbalizes that if the pressure alarm sounds at the end of inspiration this is an indication the tidal volume is set too high, and needs to be decreased

Auscultates lung sounds bilaterally, and over the epigastrium after the ventilator is operating properly to confirm ventilator function and tube placement

Confirms that the patients ventilatory rate matches the set rate by watching chest rise and counting respirations

Follow-up:

Continually monitors for proper chest rise and ET tube placement

Disposes of contaminated items properly

Documents the procedure appropriately

Cont. on Page 2

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CF Paramedic Program Procedure: Autovent Usage: Page 2

Final Grade First Attempt

Second Attempt

Third Attempt

Evaluator Initials

Student demonstrates competency.

Student does not demonstrate competency

Student: _________________________________________________________

Evaluator Printed Name: _________________ Evaluator Signature: _________________ Date: _________

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CF Paramedic Program Procedure: Capnography (EtCO2)









Student identifies the need for capnographic monitoring

Student correctly applies capnographic sampling to patients with adjunct airways

Student correctly applies capnographic sampling to spontaneously breathing patients (Nasal Cannula)

Student demonstrates the ability to obtain a capnographic waveform on the cardiac monitor

Student demonstrates an understanding of what the wave form and EtCO2 value represent.

Student demonstrates an understanding of what high and low levels represent, and how to alter their patient care accordingly

Student correctly identifies the following wave forms and the corrective actions indicated by them: (See next page) Normal Wave Form Rebreathing Bronchospasm with plateau Bronchospasm with loss of plateau (shark’s fin) Respiratory failure Patient talking artifact Return of spontaneous circulation

Student demonstrates an ability to normalize the patient’s EtCO2 level by effectively altering the patient’s ventilations

Follow-up:




Second Attempt

Third Attempt

Evaluator Initials



Student: ________________________________________________________


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CF Paramedic Program Procedure: Dosage Calculations

Rating Scale: √: Step performed appropriately and following accepted technique X: This step was omitted or not performed correctly

Steps in the Procedure or Task: Rating Implementation and Assessment: Student correctly solves one each of the following types of drug calculation problems Conversion between prefixes Pounds to Kilograms weight conversions Volume for liquid oral medication, based on dose and concentration Volume to be injected based on dose and concentration Weight based volume to be administered based on dose per Kg, and concentration Infusion rates based on dose per minute, concentration and drip factor Weight based infusion rates based on dose per Kg per minute, concentration and drip factor


Second Attempt

Third Attempt

Evaluator Initials



Student: ________________________________________________________________


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CF Paramedic Program Procedure: Endotracheal Medication Administration: Adult, Infant, Child


Steps in the Procedure or Task: Rating Equipment and Patient Preparation: Student washes hands Student gathers appropriate equipment Student identifies the patient, his or her self, and his or her student status Student explains the procedure to the patient and confirms the patient’s understanding

Implementation and Assessment: Confirms correct Pt, medication, dose, route, time, and expiration date Verbalizes that dose is to be doubled and delivered in 10mL of Saline Verbalizes the correct list of medications that can be given by this route Directs the assistant to hyperventilate the patient for 30 seconds Stops CPR and ventilation Inserts the needle into the end of the ET tube and injects the medication into the tube quickly Instructs the assistant to reattach the Bag-valve device and hyperventilate for 30 seconds before re-initiating CPR

Instructs the assistant to re-initiate CPR after the 30 seconds ends

Follow-up: Disposes of contaminated items properly Monitor the patient’s response to the medication Documents the procedure appropriately


Second Attempt

Third Attempt

Evaluator Initials



Student: ________________________________________________________


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CF Paramedic Program Procedure: Endotracheal Tube Suction: Adult, Infant, Child


Steps in the Procedure or Task: Rating Equipment and Patient Preparation:






Selects a suction catheter sized appropriately for the patient’s ET tube

Measures the suction catheter against an ET tube of the same size as the one in the patient, partially opens the package for the suction catheter and marks the suction catheter so that the distance from the mark to the end of the suction catheter matches the length of the ET tube

Instructs the assistant to hyperoxygenate the patient for 30 seconds and then remove the bag- valve device from the ET tube

Removes the suction catheter from the packaging, maintaining its medical cleanliness and inserts it into the ET tube

Stops inserting the catheter when he or she reaches the mark

Covers the “whistle-stop” port with the suction turned on and slowly withdraws the catheter

Instructs the assistant to reinitiate ventilation with the bag-valve device

Purges the catheter with sterile water and repeats the process if necessary

Follow-up:


Monitors patient’s ventilatory status



Second Attempt

Third Attempt

Evaluator Initials



Student: ________________________________________________________


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CF Paramedic Program Procedure: Foreign Body Airway Obstruction (FBAO) Retrieval with Direct Laryngoscopy: Infant, Child



Equipment and Patient Preparation: Student washes hands Student gathers appropriate equipment Student identifies the patient, his or her self, and his or her student status Student explains the procedure to the caregiver and confirms their understanding

Implementation and Assessment: Student assures the scene is safe, applies the appropriate BSI (infection control precautions) Attempt foreign body airway obstruction using “blind” procedure Hold laryngoscope in left hand, insert straight blade into patient’s mouth Hold Magill Forceps in your right hand Use lighted tip to explore patient’s mouth and anterior pharynx for any foreign objects If no foreign objects are seen, move deeper into the pharynx and toward trachea When foreign object is visualized, insert Magill forceps into patient’s mouth Grasp foreign object, retrieve the foreign object from the patient’s mouth

Follow-up: Continually monitors patient for improvement Disposes of contaminated items properly Documents the procedure appropriately


Second Attempt

Third Attempt

Evaluator Initials



Student: _________________________________________________________________


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CF Paramedic Program Procedure: Intramuscular Injection: Adult, Infants, Child



Implementation and Assessment: Confirms correct Pt, medication, dose, route, time, and expiration date Locates the appropriate site Preps the site with antiseptic Maintains medical cleanliness of the site Retracts the skin Inserts the needle into the muscle Aspirates for blood return If there is no return on aspiration, injects medication gently Removes the needle Applies pressure and works the muscle back and forth Applies band aid as needed

Follow-up: Monitor the patient’s response to the medication Disposes of sharps and contaminated items properly Documents the procedure appropriately


Second Attempt

Third Attempt

Evaluator Initials



Student: ________________________________________________________


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CF Paramedic Program Procedure: Intraosseous Insertion: Adult, Infant, Child



Implementation and Assessment: Checks all equipment for proper function Positions the patient appropriately Able to correctly identify the proper location for insertion on an adult and on a child Able to identify the proper location on the chicken leg if applicable Cleanses the site with an antiseptic Maintains medical cleanliness at the puncture site Inserts IO needle into the tibial tuberosity perpendicular to the skin Uses a boring motion to advance the needle into the marrow Stops advancing the needle when resistance decreases Removes trocar Attaches syringe and aspirates bone marrow into saline filled syringe Infuses saline to clear needle and confirm placement Attaches IV tubing Checks for patency and sets flow rate Secures IO needle with gauze and tape, and confirms flow rate

Follow-up: Monitors the limb for signs of extravasation Disposes of sharps and contaminated items properly Documents the procedure appropriately


Second Attempt

Third Attempt

Evaluator Initials



Student: ________________________________________________________


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CF Paramedic Program Procedure: Intubation: Digital









Performs BLS airway maneuvers and ventilates the Pt with the BVM, 100% O2


Lubricates the ET tube with KY and places it back in the sterile packaging until ready for insertion, maintaining the medical cleanliness of the tube

Turns on the suction and applies the proper tip

Hyperoxygenates the patient for 30 seconds

Kneels beside the patient, facing his or her head, and places a bite block between the patient’s teeth

Has an assistant hold the patient’s head in a neutral position

Inserts the left middle and index fingers in the patient’s mouth, pinning the epiglottis against the anterior oropharynx with the middle finger (the student may use the other hand to grab the tongue and pull it out of the way if necessary)

Introduces the ET tube with the right hand and uses the fingers of the left hand to guide the ET tube into the trachea

Holds the tube in place by hand continually until it is properly secured

Directs the assistant to attach the bag-valve device and begin hyperventilating the patient

Inflates the cuff with 5 to 10mL of air, listens for leaks and then removes the syringe

Checks tube placement by listening for bilateral lung sounds, the absence of gastric sounds over the epigastrium, and EtCO2.

Hyperventilates the patient with 100% O2 via bag-valve device, looking for condensation in the tube and symmetrical chest rise to confirm tube placement

Secures tube with tape or commercial tube holder

Frequently re-assesses lung sounds, chest rise, and EtCO2 to confirm tube placement

Follow-up:




Second Attempt

Third Attempt

Evaluator Initials



Student: ________________________________________________________


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CF Paramedic Program Procedure: Intubation: Extubation



Implementation and Assessment: Insures that the patient is properly oxygenated and that he or she is prepared to re-intubate the patient if necessary

Prepares intubation equipment and suction Confirms patient responsiveness, proper skin color, and pulse oximetry reading Turns on the suction unit and suctions the oropharynx of necessary Deflates the cuff Removed the ET tube on cough or exhalation Reassesses the patient’s ventilatory status

Follow-up: Disposes contaminated items properly Monitors patient’s ventilatory status Documents the procedure appropriately


Second Attempt

Third Attempt

Evaluator Initials



Student: ________________________________________________________


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CF Paramedic Program Procedure: Intubation: Nasotracheal









Verbalizes that the procedure requires that the patient have spontaneous respirations

Performs BLS airway maneuvers and assists ventilations with the Bag-valve device


Lubricates the ET tube with anesthetic (Lidocaine) jelly and places it back in the sterile packaging until ready for insertion, maintaining the medically cleanliness of the tube

Inspects the nose and selects the more patent nare

Inserts the ET tube into the nostril with the bevel facing down or medially

Gently guides the tube in until it reaches the oropharynx and he or she begins to hear breath sounds through the tube

Adjusts the depth of insertion to where breath sounds are the loudest

Waits for the patient to inhale and attempts to push the tube into the trachea

Verbalizes that if resistance is felt and tenting is noted lateral to the Adam’s apple that the tube should be withdrawn and another attempt made

Successfully passes the tube into the glottic opening

Verbalizes that he or she would observe for indications that the tube has found its target and mentions looking for condensation in the tube on expiration, coughing, absence of vocal sounds, and felt expired air from the tube.




Checks tube placement by listening for bilateral lung sounds, the absence of gastric sounds over the epigastrium and EtCO2.

Hyperoxygenates the patient with 100% O2 via bag-valve device, looking again for condensation in the tube and symmetrical chest rise to confirm tube placement



Follow-up:




Second Attempt

Third Attempt

Evaluator Initials



Student: ________________________________________________________


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CF Paramedic Program Procedure: Intubation: Oral









Performs BLS airway maneuvers and ventilates the pt with the Bag-valve mask


Lubricates the ET tube with KY and places it back in the sterile packaging until ready for insertion, maintaining the medically cleanliness of the tube


Hyperventilates the patient for 30 seconds

Places the Pt in the sniffing position and removes dentures or partial plates

Grasps the laryngoscope in the left hand

Inserts the blade into the right side of the Pt’s mouth, sweeping the tongue to the left

Advances the curved blade until the tip is in the vallecula, or the straight blade until the tip is under the epiglottis

Suctions fluid from the airway if present

Lifts the handle upward without prying or putting pressure on the patient’s teeth and visualizes the glottis

Guides the ET tube through the glottic opening and into the trachea


Directs the assistant to attach the bag-valve device and begin hyper-oxygenating the patient






Follow-up:




Second Attempt

Third Attempt

Evaluator Initials



Student: ________________________________________________________


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CF Paramedic Program Procedure: Intubation: Child, Infant, Neonate









Performs BLS airway maneuvers and ventilates the pt with the BVM, 100% O2


Verbalizes the correct method of determining tube size in pediatric patients



Hyperventilates the patient for 30 seconds

Places the Pt in the sniffing position


Inserts the straight blade into the right side of the Pt’s mouth, sweeping the tongue to the left

Advances the blade until the tip is under the epiglottis



Guides the ET tube through the glottic opening and into the trachea until either the proximal end of the cuff on a cuffed tube or the black ring on an uncuffed tube passes beyond the patient’s vocal cords

Verbalizes that he or she would not force the tube through this region of avoid laryngeal trauma



If applicable, inflates the cuff with just enough air to prevent leakage around the tube and listens for leaks, then removes the syringe


Hyperventilates the patient with 100% O2 via bag-valve device, looking for condensation in the tube, symmetrical chest rise and EtCO2 to confirm tube placement


Frequently re-assesses lung sounds, chest rise, to confirm tube placement

Utilizes mnemonic “DOPE” to manage intubation complications (Dislodged tube, Obstructed tube, Pneumothorax, Equipment failure)

Follow-up:




Second Attempt

Third Attempt

Evaluator Initials



Student: ________________________________________________________


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CF Paramedic Program Procedure: Intubation: Trauma









Performs BLS airway maneuvers and ventilates the pt with the Bag-valve device

Asks assistant to maintain inline stabilization throughout the procedure

Demonstrates due care in avoiding manipulating the patient’s c-spine throughout the procedure




Hyperoxygenates the patient for 30 seconds

Places the Pt in the sniffing position and removes dentures or partial plates


Inserts the blade into the right side of the Pt’s mouth, sweeping the tongue to the left

Advances the curved blade until the tip is in the vallecula or the straight blade until the tip is under the epiglottis



Guides the ET tube through the glottic opening and into the trachea


Directs the assistant to attach the bag-valve device and begin hyper-oxygenating the patient






Follow-up:




Second Attempt

Third Attempt

Evaluator Initials



Student: ________________________________________________________


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CF Paramedic Program Procedure: Needle Cricothyrotomy: Child, Infant









Performs BLS airway maneuvers and ventilates the pt with the BVM, 100% O2


Student is able to recall the indications for needle Cricothyrotomy: Pt under 12 years old, unable to ventilate by other means,

Student places the patient in the supine position with the neck in the neutral position

Student prepares the site with antiseptic swabs

Student locates the appropriate landmark, stabilizes the trachea with the thumb and forefinger, stretching the skin taut.

Student applies a 14 gauge needle to a 10cc syringe with approximately 1cc of sterile saline in it.

Student punctures the skin with a 14 gauge needle, directs the needle 45 degrees caudally while applying negative pressure to the syringe.

Student notes the aspiration of air as the needle advances into the trachea.

Student removes the syringe and carefully advances the catheter into the trachea while removing the needle.

Student attaches a 3mm ET adapter to the hub of the catheter and connects the hub to a BVM or automatic ventilator.

Student ventilates while assessing chest rise, lung sounds and indications of improper placement

Student applies EtCO2

Student secures the catheter with tape.

Frequently re-assesses lung sounds, chest rise, to confirm placement

Utilizes mnemonic “DOPE” to manage intubation complications (Dislodged airway, Obstructed airway, Pneumothorax, Equipment failure)

Follow-up:




Second Attempt

Third Attempt

Evaluator Initials



Student: ________________________________________________________


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CF Paramedic Program Procedure: IV Insertion: Adult, Child, Infant, Neonate



Implementation and Assessment: Checks all equipment for proper function Positions the patient appropriately Applies tourniquet and identifies vein Cleanses the area with antiseptic Maintains medically clean puncture site Retracts the skin distally Punctures the skin quickly and advances until flashback is obtained Advances catheter and removes needle Draws blood sample Removes tourniquet Attaches IV tubing Checks for patency and sets flow rate Secures IV and confirms flow rate

Follow-up: Monitors IV site for signs of extravasation Disposes of sharps and contaminated items properly Documents the IV appropriately


Second Attempt

Third Attempt

Evaluator Initials



Student: ________________________________________________________


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CF Paramedic Program Procedure: IV Insertion: External Jugular



Implementation and Assessment: Checks all equipment for proper function Positions the patient appropriately Identifies vein Cleanses the area with antiseptic Maintains medically clean puncture site Retracts the skin Punctures the skin quickly and advances until flashback is obtained Advances catheter and removes needle Draws blood sample Attaches IV tubing Checks for patency and sets flow rate Secures IV and confirms flow rate

Follow-up: Disposes of sharps and contaminated items properly Documents the procedure appropriately


Second Attempt

Third Attempt

Evaluator Initials



Student: ________________________________________________________


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CF Paramedic Program Procedure: IV Medication Administration: Bolus



Implementation and Assessment: Confirms correct Pt, medication, dose, route, time, and expiration date Assures that the patient’s IV line is patent Draws up the medication and confirms that the dose is correct Cleanses the medication port nearest the patient with an antiseptic Inserts the needle into the medication port Occludes the IV line above the medication port Injects the medication at the appropriate rate Removes and properly disposes of the needle and syringe Flushes the IV with 20mL of IV fluid



Second Attempt

Third Attempt

Evaluator Initials



Student: _______________________________________________________


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CF Paramedic Program Procedure: IV Medication Administration: Drip



Implementation and Assessment: Confirms correct Pt, medication, dose, route, time, and expiration date Assures that the patient’s IV line is patent Draws up the appropriate medication from its source Cleanses the IV bag’s med port with an antiseptic Injects the appropriate quantity of medication into the bag Agitates the bag to mix the contents Labels the bag appropriately Connects the appropriate drip set to the medication bag Puts a needle on the end of the med administration drip set Cleanses the main IV’s medication port and inserts the medication set’s needle Secures the needle with tape Shuts down the primary IV line and adjusts the medication set to the correct drip rate



Second Attempt

Third Attempt

Evaluator Initials



Student: ________________________________________________________


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CF Paramedic Program Procedure: Supraglottic Airway (King Airway) Insertion


Steps in the Procedure or Task: RatingEquipment and Patient Preparation: Student washes hands Student gathers appropriate equipment Student identifies the patient, his or her self, and his or her student status Student explains the procedure to the patient and confirms the patient’s understanding

Implementation and Assessment: Checks all equipment for proper function. Performs BLS airway maneuvers and ventilates the Pt with the BVM, 100% O2 Student is able to Identify all contraindications for placement, to include… i.e., Intact gag reflex, known esophageal disease, caustic substance ingestion.

Student chooses the correct King airway based on patient height: (4’-5’=Size 3, 5’-6’=Size 4, > 6’=Size 5)

Student tests the cuffs by inflating them and checking for leaks or defects. Student applies lubricant to the tip and posterior part of the tube. Student ensures that there is a back-up King or other airway available and prepared for immediate use.

Student pre-oxygenates the patient. Student positions the patient’s head in the sniffing OR neutral position. Student holds the tube in his or her dominant hand and opens the pt’s mouth with the non-dominant hand.

With the King airway rotated laterally 45 to 90°, so the blue line on the airway is touching the corner of the mouth, student introduces the tip of the airway into the mouth and advances it to behind the base of the tongue.

As the tube passes under the tongue, the student rotates the tube back to midline while inserting the airway without using excessive force until the base of the connector aligns with the teeth.

Student fully inflates the cuffs using the maximum volume of the syringe included with the airway. Student attaches BVM and assesses ventilations. Student withdraws the tube until ventilation is easy and free flowing, then notes the depth markings at the teeth.

Student verifies tube placement via lung sounds, chest rise AND EtCO2 Student readjusts cuff inflation to 60cmH2O or to just seal volume. Student continuously monitors Pt’s airway status.

Follow-up: Disposes of contaminated items properly Documents the procedure appropriately


Second Attempt

Third Attempt

Evaluator Initials



Student: ________________________________________________________


29

CF Paramedic Program Procedure: Metered Dose Inhaler Administration: Adult, Child, Infant



Implementation and Assessment: Confirms correct Pt, medication, dose, route, time, and expiration date Removes mouthpiece cap and applies a spacer if one is provided Gently shakes the inhaler for 2 to 5 seconds Instructs the patient to exhale forcefully Places the mouth piece at the patients lips and has the patient close his or her lips around it Activates the aerosol container as the patient inhales Asks the patient to hold his or her breath for a few seconds Remove the inhaler from the patient’s mouth



Second Attempt

Third Attempt

Evaluator Initials



Student: ________________________________________________________


30

CF Paramedic Program Procedure: Nasogastric Tube Insertion: Adult, Child, Infant



Implementation and Assessment: Determines the correct length of the tube by placing the distal end at the patient’s nose, and measuring to the tip of the earlobe and continuing to just below the xiphoid

Places a piece of tape at the measured point to mark the maximum insertion length Places the patient in the sitting or semi-fowler’s position and inspects the nares, looking for the one that appears to be most patent

Lubricates the distal 3 to 6 inches of the tube with water based lubricant Places one hand at the back of the patients head, flexing it forward Places the tip of the tube in the selected nostril and advances it straight back Begins rotating the tube back and forth while advancing the tube Encourages the patient to drink and / or swallow as the tube reaches the posterior nasopharynx Advances the tube gently as the patient swallows Advances the tube until the tape placed earlier reaches the patient’s nose Confirms tube placement by injecting 20 to 30mL of air into the tube while auscultating over the epigastrium

Verbalizes that gastric sounds over the epigastrium confirms that the tube is in the correct place Draws back on the syringe while looking for gastric contents in the tube and syringe to further conform placement

Verbalizes that the tube is to be removed if placement cannot be confirmed Properly secures the NG tube with tape Verbalizes that suctioning from the NG tube should only be done with low pressure suction units or by syringe to avoid damage to the stomach lining



Second Attempt

Third Attempt

Evaluator Initials



Student: ________________________________________________________


31

CF Paramedic Program Procedure: Nasogastric Tube Medication Administration



Implementation and Assessment Confirms correct Pt, medication, dose, route, time, and expiration date Confirms tube placement by injecting air into the tube while auscultating over the epigastrium, and then withdrawing the plunger until gastric contents are seen in the tube

Irrigates the tube with 50 to 100mL of saline Confirms that the medication is not in enteric coated or extended release form Crushes the medication in 30mL of warm water Clamps off tube and avoids applying suction for 30 minutes after instilling the medication



Second Attempt

Third Attempt

Evaluator Initials



Student: ________________________________________________________


32

CF Paramedic Program Procedure: Nebulizer Medication Administration: Adult, Child, Infant



Implementation and Assessment: Confirms correct Pt, medication, dose, route, time, and expiration date Assembles the nebulizer chamber Pours the medication into the nebulizer chamber Completes the assembly of the nebulizer and attaches the oxygen tubing Sets the oxygen source regulator for 5 to 8 liters per minute (Lpm) Places the nebulizer in the patient’s mouth Makes sure the patient seals his or her lips around the mouthpiece and breathes deeply Continue until the medication is completely gone

Follow-up: Disposes of contaminated items properly Monitors the patient’s response to the medication Documents the procedure appropriately


Second Attempt

Third Attempt

Evaluator Initials



Student: ________________________________________________________


33

CF Paramedic Program Procedure: Oral Medication Administration: Adult, Child, Infant



Implementation and Assessment: Confirms correct Pt, medication, dose, route, time, and expiration date Confirms that the Pt can take medications orally, is alert and oriented, and has an adequate gag reflex

Places the patient in the sitting or semi-fowler’s position Hands the patient the medication and some water Instructs the patient to swallow the medication



Second Attempt

Third Attempt

Evaluator Initials



Student: ________________________________________________________


34

CF Paramedic Program Procedure: Orogastric Tube Insertion: Adult, Child, Infant



Implementation and Assessment Determines the correct length of the tube by placing the distal end at the patient’s nose, and measuring to the tip of the earlobe and continuing to just below the xiphoid process

Places a piece of tape at the measured point to mark the maximum insertion length Places the patient in the sitting or semi-fowler’s position and inspects the mouth, looking for any caustic lesions

Lubricates the distal 3 to 6 inches of the tube with water based lubricant Places one hand at the back of the patients head, flexing it forward Places the tip of the tube in the oral cavity and advances it straight back Begins rotating the tube back and forth while advancing the tube Encourages the patient to drink and/or swallow as the tube reaches the posterior oropharynx Advances the tube gently as the patient swallows Advances the tube until the tape placed earlier reaches the patient’s nose Confirms tube placement by injecting 20 to 30mL of air into the tube while auscultating over the epigastrium

Verbalizes that gastric sounds over the epigastrium confirms that the tube is in the correct place Draws back on the syringe while looking for gastric contents in the tube and syringe to further conform placement

Verbalizes that the tube is to be removed if placement cannot be confirmed Properly secures the NG tube with tape Verbalizes that suctioning from the NG tube should only be done with low pressure suction units or by syringe to avoid damage to the stomach lining



Second Attempt

Third Attempt

Evaluator Initials



Student: ________________________________________________________


35

CF Paramedic Program Procedure: Orogastric Tube Medication Administration



Implementation and Assessment Confirms correct Pt, medication, dose, route, time, and expiration date Confirms tube placement by injecting air into the tube while auscultating over the epigastrium, and then withdrawing the plunger until gastric contents are seen in the tube

Irrigates the tube with 50 to 100mL of saline Confirms that the medication is not in enteric coated or extended release form Crushes the medication in 30mL of warm water Clamps off tube and avoids applying suction for 30 minutes after instilling the medication



Second Attempt

Third Attempt

Evaluator Initials



Student: ________________________________________________________


36

CF Paramedic Program Procedure: Oxygen Blow-By Administration: Child, Infant




Implementation and Assessment: Student assures the scene is safe, applies the appropriate BSI (infection control precautions) Attach oxygen tubing to oxygen tank Set oxygen flow to minimum of 5Lpm If possible oxygen should be warmed and humidified Hold end of tubing so that oxygen will blow across the patient’s face Never hold tubing directly at the patient’s face

Oxygen percentage delivered to patient 2” yields 40% 1” yields 60% ½” yields 80%

Continue oxygen administration until patient’s color improves and pulse returns to normal



Second Attempt

Third Attempt

Evaluator Initials



Student: _________________________________________________________________


37

CF Paramedic Program Procedure: Oxygen Administration: Pediatric Non-Rebreather Mask




Implementation and Assessment: Student assures the scene is safe, applies the appropriate BSI (infection control precautions) Attach non-rebreather oxygen tubing to oxygen tank Set oxygen flow to minimum of 10Lpm Check one-way exhaust valves are in place at each side of mask and are undamaged If possible oxygen should be warmed and humidified Place thumb over one-way inlet valve to fully inflate reservoir bag Place mask over patient’s mouth and nose and slip elastic strap over patient’s head Tighten elastic strap as needed

Slightly squeeze pliable metal strip to form mask to patient’s face as needed Adjust Lpm flow as needed to ensure bag remains partially inflated at peak inspiration



Second Attempt

Third Attempt

Evaluator Initials



Student: _________________________________________________________________


38

CF Paramedic Program Procedure: Patient Assessment: Adult Medical


Steps in the Procedure or Task: Rating Equipment and Patient Preparation: Student washes hands Student gathers appropriate equipment Student identifies the patient, his or her self, and his or her student status Student explains the procedure to the patient and confirms the patient’s understanding Implementation and Assessment: Scene Assessment: Identifies all threats to scene safety and responds accordingly Determines mechanism of injury or nature of illness Determines number of patients and calls for other resources if needed Considers stabilization of the spine Initial patient Assessment: Verbalizes general impression of the patient’s condition Determines LOC / responsiveness A V P U Determines chief complaint and identifies apparent threats to life Assesses Airway and Breathing: Assesses airway status and corrects any compromise Assesses breathing Rate? Rhythm? Quality? Begins appropriate oxygen therapy Assesses Circulation: Assesses skin Color? Condition? Temp? Assesses pulse Rate? Rhythm? Quality? Looks for and controls major bleeding

Identifies patient priorities, makes correct transport decision S: Obtains Signs and Symptoms Signs and Symptoms? Respiratory Cardiac Altered

Mental Status

Allergic Reaction

Poisoning/ Overdose

Environmental Emergencies

Obstetrics Behavioral

Onset? Provokes? Quality? Radiation? Severity? Time? Intervention?


Description of the incident?

Onset? Duration? Associated symptoms?

Evidence of trauma? Seizures? Fever? Sugar?

History of allergies? Exposure? Effects? Progression? Interventions?

Substance? When exposed? How much exposure? Effects?

Type of exposure?

Duration of exposure? Loss of consc? Local or systemic effects?

Due date? Pain or contractions? Bleeding or discharge? Last menstrual period? Crowning? Prenatal care?

Suicidal? Sugar? Threat? Medical problem? Interventions?

A: Obtains allergies M: Obtains medication history P: Obtains past medical history L: Obtains last oral intake info E: Asks about events leading to the present illness

39

Patient Assessment: Adult Medical - Page 2 V: Obtains baseline vitals Pulse? BP? Respiratory Rate? SaO2? EtCO2? I: Interventions: Makes transport appropriate decision Provides appropriate interventions T: Transport Completes detailed physical exam O: Ongoing assessment Repeats initial assessment Repeats vitals and assessment of injuries or chief complaint Checks intervention Care: Manages patient appropriately based on assessment Reassessment: Re-assesses vitals, medical devices already in place, and patient condition frequently


Second Attempt

Third Attempt

Evaluator Initials



Student: ________________________________________________________


40

CF Paramedic Program Procedure: Patient Assessment: Child, Infant Medical


Steps in the Procedure or Task: Rating Equipment and Patient Preparation: Student washes hands Student gathers appropriate equipment Student identifies the patient, his or her self, and his or her student status Student explains the procedure to the patient and confirms the patient’s understanding Implementation and Assessment: Scene Assessment: Identifies all threats to scene safety and responds accordingly Determines mechanism of injury or nature of illness Determines number of patients and calls for other resources if needed Considers stabilization of the spine Initial patient Assessment: Verbalizes general impression of the patient’s condition Determines LOC / responsiveness A V P U Determines chief complaint and identifies apparent threats to life Assesses Airway and Breathing: Assesses airway status and corrects any compromise Assesses breathing Rate? Rhythm? Quality? Begins appropriate oxygen therapy Assesses Circulation: Assesses skin Color? Condition? Temp? Assesses pulse Rate? Rhythm? Quality? Looks for and controls major bleeding

Identifies patient priorities, makes correct transport decision S: Obtains Signs and Symptoms Signs and Symptoms? Respiratory Cardiac Altered

Mental Status

Allergic Reaction

Poisoning/ Overdose

Environmental Emergencies

Obstetrics Behavioral



Description of the incident?

Onset? Duration? Associated symptoms?

Evidence of trauma? Seizures? Fever? Sugar?

History of allergies? Exposure? Effects? Progression? Interventions?

Substance? When exposed? How much exposure? Effects?

Type of exposure?

Duration of exposure? Loss of consc? Local or systemic effects?

Due date? Pain or contractions? Bleeding or discharge? Last menstrual period? Crowning? Prenatal care?

Suicidal? Sugar? Threat? Medical problem? Interventions?

A: Obtains allergies M: Obtains medication history P: Obtains past medical history L: Obtains last oral intake info E: Asks about events leading to the present illness

41

Patient Assessment: Child, Infant Medical - Page 2 V: Obtains baseline vitals Pulse? BP? Respiratory Rate? SaO2? EtCO2? I: Interventions: Makes transport appropriate decision Provides appropriate interventions T: Transport Completes detailed physical exam O: Ongoing assessment Repeats initial assessment Repeats vitals and assessment of injuries or chief complaint Checks intervention Care: Manages patient appropriately based on assessment Reassessment: Re-assesses vitals, medical devices already in place, and patient condition frequently


Second Attempt

Third Attempt

Evaluator Initials



Student: ________________________________________________________


42

CF Paramedic Program Procedure: Patient Assessment: Adult Trauma


Steps in the Procedure or Task: Rating Equipment and Patient Preparation:

Student washes hands Student gathers appropriate equipment Student identifies the patient, his or her self, and his or her student status Student explains the procedure to the patient and confirms the patient’s understanding


Scene Assessment: Identifies all threats to scene safety and responds accordingly Determines mechanism of injury Determines number of patients and calls for other resources if needed Considers stabilization of the spine Initial Patient Assessment: Verbalizes general impression of the patient’s condition Determines LOC A V P U Determines chief complaint and identifies apparent threats to life Airway and Breathing: Assesses airway status and corrects any compromise Assesses breathing Rate? Rhythm? Quality? Begins appropriate oxygen therapy Circulation: Assesses skin Color? Condition? Temp? Assesses pulse Rate? Rhythm? Quality? Looks for and controls major bleeding Identifies Patient Priorities, makes correct transport decision

Focused Exam and History: Selects appropriate exam (focused or rapid) Obtains baseline vitals Obtains S.A.M.P.L.E. history Detailed Assessment:

Head: Inspects and palpates scalp for Deformities, Contusions, Abrasions, Punctures, Burns, Tenderness, Lacerations or Swelling (DCAP-BTLS)

Inspects eyes for DCAP-BTLS, PERRL, foreign bodies, blood in anterior chamber Assesses ears, nose for drainage, DCAP-BTLS Assesses mouth for DCAP-BTLS, loose teeth, foreign objects, swelling of tongue, breath odor Neck: Inspects and palpates the neck for DCAP-BTLS Looks for JVD and tracheal deviation Chest: Inspects, palpates for DCAP-BTLS, auscultates and percusses the chest Visualizes chest rise and checks for symmetry, flail segments or deformity Abdomen and Pelvis: Inspects for DCAP-BTLS and palpates the abdomen for tenderness, rigidity and distention Inspects and palpates the pelvis for DCAP-BTLS Inspects pelvis for instability, crepitus

43

Patient Assessment: Trauma - Page 2 Extremities: Inspects each extremity for DCAP-BTLS Assesses motor, sensory and circulatory status of each extremity Posterior: Inspects for DCAP-BTLS Inspects for rectal bleeding Care: Manages patient appropriately based on assessment Reassessment: Re-assesses vitals, medical interventions and patient condition frequently


Second Attempt

Third Attempt

Evaluator Initials



Student: ________________________________________________________


44

CF Paramedic Program Procedure: Patient Assessment: Child, Infant Trauma


Steps in the Procedure or Task: Rating Equipment and Patient Preparation: Student washes hands

Student gathers appropriate equipment Student identifies the patient, his or her self, and his or her student status Student explains the procedure to the patient and confirms the patient’s understanding


Scene Assessment: Identifies all threats to scene safety and responds accordingly Determines mechanism of injury Determines number of patients and calls for other resources if needed Considers stabilization of the spine Initial Patient Assessment: Verbalizes general impression of the patient’s condition Determines LOC A V P U Determines chief complaint and identifies apparent threats to life Airway and Breathing: Assesses airway status and corrects any compromise Assesses breathing Rate? Rhythm? Quality? Begins appropriate oxygen therapy Circulation: Assesses skin Color? Condition? Temp? Assesses pulse Rate? Rhythm? Quality? Looks for and controls major bleeding Identifies Patient Priorities, makes correct transport decision

Focused Exam and History: Selects appropriate exam (focused or rapid) Obtains baseline vitals Obtains S.A.M.P.L.E. history Detailed Assessment:

Head: Inspects and palpates scalp for Deformities, Contusions, Abrasions, Punctures, Burns, Tenderness, Lacerations or Swelling (DCAP-BTLS)

Inspects eyes for DCAP-BTLS, PERRL, foreign bodies, blood in anterior chamber Assesses ears, nose for drainage, DCAP-BTLS Assesses mouth for DCAP-BTLS, loose teeth, foreign objects, swelling of tongue, breath odor Neck: Inspects and palpates the neck for DCAP-BTLS Looks for JVD and tracheal deviation Chest: Inspects, palpates for DCAP-BTLS, auscultates and percusses the chest Visualizes chest rise and checks for symmetry, flail segments or deformity Abdomen and Pelvis: Inspects for DCAP-BTLS and palpates the abdomen for tenderness, rigidity and distention Inspects and palpates the pelvis for DCAP-BTLS Inspects pelvis for instability, crepitus

45

Patient Assessment: Child. Infant Trauma - Page 2 Extremities: Inspects each extremity for DCAP-BTLS Assesses motor, sensory and circulatory status of each extremity Posterior: Inspects for DCAP-BTLS Inspects for rectal bleeding Care: Manages patient appropriately based on assessment Reassessment: Re-assesses vitals, medical interventions and patient condition frequently


Second Attempt

Third Attempt

Evaluator Initials



Student: ________________________________________________________


46

CF Paramedic Program Procedure: Pneumocentesis








Implementation and Assessment: Locates the second or third intercostal space at the midclavicular line or the fifth or sixth intercostal space at the midaxillary line

Cleanses the site thoroughly with an antiseptic and maintains the medical cleanliness of the site

Selects a 2” angiocath 14ga or larger for insertion Student either holds the angiocath directly in his or her hand, or attaches a 10cc syringe to the angiocath for better control, removing the plastic cap from the needle in either case

Pulls plunger to the half way point if using a syringe Holds the needle perpendicular to the skin and inserts it into the intercostal space, riding over the top of the lower rib

Advances the needle until a pop is felt as the needle enters the intercostal space Observes for air rush or movement of the plunger and identifies this as confirmation of a pneumothorax if it occurs

Removes the syringe, if applicable, advances the catheter into the patient’s chest and removes the needle

Secures the catheter to the patient’s chest, making sure it isn’t kinked Adds a one way valve to the device to keep air out of the pleural space Re-assesses compliance and lung sounds

Follow-up: Disposes of contaminated items properly Periodically re-assesses compliance and lung sounds Documents the procedure appropriately


Second Attempt

Third Attempt

Evaluator Initials



Student: ________________________________________________________


47

CF Paramedic Program Procedure: Rapid Sequence Intubation (RSI)



Equipment and Patient Preparation: Student washes hands Student gathers appropriate equipment Student identifies the patient, his or her self, and his or her student status Student explains the procedure to the patient and confirms the patient’s understanding

Implementation and Assessment: Pre-oxygenate the patient Prepare your equipment 1 or 2 IV lines, Intubation equipment, Suction, Cardiac Monitor and SAO2 Draw and label meds

Pre-medicate: If the patient is alert, sedate with Versed 1 to 5 mg or similar dose of benzodiazepine Max dose 10 mg

Apply cricoid pressure until tube placement is confirmed Pre-medicate: Consider lidocaine 1.0 to1.5 mg/kg for head injury or Atropine 0.02 mg/kg for patients 2 y/o and younger Minimum atropine dose 0.1 mg, max 0.5 mg

Administer Succinylcholine 1.5 mg/kg IV bolus Intubate the patient Re-ventilate after 30 seconds

Confirm placement 5 point Lung auscultation, Capnography, Chest expansion, EDD

Release cricoid pressure Secure the ET Tube, place a bite block Continuously assess the tube Consider Vecuronium 0.1 mg/kg Sedation needed if Vecuronium is used



Second Attempt

Third Attempt

Evaluator Initials



Student: _________________________________________________________________


48

CF Paramedic Program Procedure: Rectal Medication: Adult, Child, Infant


Steps in the Procedure or Task: Rating Equipment and patient preparation: Student washes hands Student gathers appropriate equipment Student identifies the patient, his or her self, and his or her student status Student explains the procedure to the patient and confirms the patient’s understanding

Implementation and Assessment: Confirms correct Pt, medication, dose, route, time, and expiration date Place the catheter from a 14ga angiocath (without the needle) on the end of a syringe Insert the catheter into the patient’s rectum and inject the medication, keeping the medication in the lower part of the patient’s rectum.

Withdraw the catheter and hold the patient’s buttocks together to allow retention and absorption

Follow-up: Disposes of contaminated items properly Monitor patient condition Documents the procedure appropriately


Second Attempt

Third Attempt

Evaluator Initials



Student: ________________________________________________________


49

CF Paramedic Program Procedure: SaO2 Monitor


Steps in the Procedure or Task: Rating Equipment and patient preparation: Student washes hands Student gathers appropriate equipment Student identifies the patient, his or her self, and his or her student status Student explains the procedure to the patient and confirms the patient’s understanding

Implementation and Assessment: Attaches the probe to the patient correctly Checks the heart rate on the SaO2 monitor against the patient’s actual heart rate to confirm accuracy

Is able to read the displayed SaO2 correctly off the monitor Verbalizes the correct ranges for SaO2 readings 95 to 100% is normal 91 to 94% indicate mild hypoxia 86 to 91% indicates moderate hypoxia 85% or lower indicates severe hypoxia

Verbalizes causes of false readings: Hypovolemia Anemia Carbon Monoxide exposure High intensity lighting

Does not bypass a careful assessment of the Pt’s respiratory status based on the SaO2 monitor

Continues to monitor the patient carefully

Follow-up: Monitor patient condition Documents the procedure appropriately


Second Attempt

Third Attempt

Evaluator Initials



Student: ________________________________________________________


50

CF Paramedic Program Procedure: Sublingual Medication



Implementation and Assessment: Confirms correct Pt, medication, dose, route, time, and expiration date Places the patient in the sitting or semi-fowler’s position Instructs the patient to open his or her mouth and lift his or her tongue Administers one spray or tablet at the base of the Pt’s tongue Instructs the patient to avoid swallowing the medication

Follow-up: Monitor the patient’s response to the medication Disposes of contaminated items properly Documents the procedure appropriately


Second Attempt

Third Attempt

Evaluator Initials



Student: ________________________________________________________


51

CF Paramedic Program Procedure: Subcutaneous Injection (SQ): Adult, Child, Infant



Implementation and Assessment: Confirms correct Pt, medication, dose, route, time, and expiration date Locates the appropriate site Preps the site with antiseptic Maintains medical cleanliness of the site Retracts the skin Inserts the needle into the skin at a 45 degree angle Aspirates for blood return If there is no return on aspiration, injects medication gently Removes the needle Applies pressure to the site Applies band aid as needed

Follow-up: Monitor the patient’s response to the medication Disposes of sharps and contaminated items properly Documents the procedure appropriately


Second Attempt

Third Attempt

Evaluator Initials



Student: ________________________________________________________


52

CF Paramedic Program Procedure: Suctioning - Nasal: Child, Infant




Implementation and Assessment: Student assures the scene is safe, applies the appropriate BSI (infection control precautions) Connect catheter to the suction tube Check that suction is present while covering the whistle-stop port Determine correct length of catheter Measure from patient’s tip of nose to tip of ear lobe

Lube end of catheter with water soluble lubricant Insert catheter to measured depth, apply suction by covering whistle-stop port Withdrawal suction catheter, gently rotate the catheter during withdrawal Flush, clean, and rinse catheter by inserting suction end into container of sterile water Repeat procedure as needed to suction all fluids from patient’s nasal passage



Second Attempt

Third Attempt

Evaluator Initials



Student: _________________________________________________________________


53

CF Paramedic Program Procedure: Suctioning - Oral: Child, Infant




Implementation and Assessment: Student assures the scene is safe, applies the appropriate BSI (infection control precautions) Connect catheter to the suction tube Check that suction is present while covering the whistle-stop port Determine correct length of catheter: Measure from patient’s edge of mouth to tip of ear lobe

Insert catheter along patient’s medical plane to measured depth, apply suction by covering whistle-stop port

Move catheter around inside of patient’s mouth, suctioning for no more than 5 to 10 seconds Withdrawal suction catheter, gently rotate the catheter during withdrawal Flush, clean, and rinse catheter by inserting suction end into container of sterile water Repeat procedure as needed to suction all fluids from patient’s nasal passage



Second Attempt

Third Attempt

Evaluator Initials



Student: _________________________________________________________________


54

CF Paramedic Program Procedure: Suctioning - Bulb Syringe: Child, Infant




Implementation and Assessment: Student assures the scene is safe, applies the appropriate BSI (infection control precautions) Squeeze bulb fully before inserting into patient’s nares Insert tip of bulb syringe into patient’s nare and release. This creates a suction to withdrawal fluids and foreign material into the bulb syringe

Ensure the bulb syringe is never squeezed while inserted in the patient’s nare Withdraw syringe tip from nare, point away from patient, again squeeze bulb completely several times

Keep bulb squeezed after expelling in preparation for the next suctioning attempt Insert tip of bulb into other nare, release bulb to create suction Withdraw syringe tip from nare, point away from patient, again squeeze bulb completely several times

Keep bulb squeezed after expelling in preparation for the next suctioning attempt Insert tip into patient’s mouth, release bulb to create suction Withdraw syringe tip from mouth, point away from patient, again squeeze bulb completely several times

Repeat the process as needed until patient is able to breathe clearly without signs of upper airway obstruction in the nasal or oral cavities



Second Attempt

Third Attempt

Evaluator Initials



Student: _________________________________________________________________


55

CF Paramedic Program Procedure: Surgical Cricothyrotomy




Student washes hands Student gathers appropriate equipment Student identifies the patient, his or her self, and his or her student status Student explains the procedure to the patient and confirms the patient’s understanding


Student verbalizes that this procedure should only be attempted if it has been determined that all other means would not provide a patent airway

Places the patient in the supine position and hyperextends the neck if not contraindicated by C-Spine precautions

Manages the patients airway with BLS procedures while preparing equipment

Correctly locates the cricothyroid membrane Cleans the area with Povidone-iodine solution Stabilizes the larynx with one hand and uses the other to make a 1 to 2cm vertical incision in the skin over the cricoid membrane, avoiding the thyroid gland above the membrane

Finds the cricoid membrane inside the incision and makes a 1 cm horizontal incision through the membrane while avoiding nearby veins, arteries and nerves

Inserts a curved hemostat or the blunt end of the scalpel into the membrane incision and spreads it open

Inserts a 5 to 7mm ET tube into the opening until the distal end of the cuff passes into the trachea, directing it down the trachea and being careful to avoid perforating the posterior of the trachea

Inflates the cuff and begins to ventilate the patient with a Bag-Valve device

Confirms ET tube placement by auscultation, visualizing chest rise, Pt’s condition, and attaching EtCO2 detector

Secures the tube with gauze and tape

Follow-up: Disposes of contaminated items properly

Periodically re-assesses tube placement and adequacy of ventilations Documents the procedure appropriately


Second Attempt

Third Attempt

Evaluator Initials



Student: ________________________________________________________


56

CF Paramedic Program Procedure: Transdermal Medication



Implementation and Assessment: Confirms correct Pt, medication, dose, route, time, and expiration date Cleans and dries the skin at the administration site Applies the medication to a site specified by the manufacturer Leaves the medication in place for the required time



Second Attempt

Third Attempt

Evaluator Initials



Student: ________________________________________________________


57

CF Paramedic Program Procedure: Venipuncture: Adult, Child, Infant



Implementation and Assessment: Checks all equipment for proper function Positions the patient appropriately Applies tourniquet and identifies vein Cleanses the area with antiseptic Maintains medically clean puncture site Enters the vein bevel up, and obtains a blood sample Withdraws the needle and applies pressure to the site with a gauze pad Transfers blood from syringe to blood tubes if appropriate

Follow-up: Disposes of sharps and contaminated items properly Labels samples with pt’s name, time, date, and student’s initials Documents the procedure appropriately


Second Attempt

Third Attempt

Evaluator Initials



Student: ________________________________________________________


58

CF Paramedic Program Contrived Experience Lab

Scenario Evaluation Sheet: Incredible Barfing Man

Implementation and assessment: Possible points

Points earned

Did the student approach the patient safely and in proper PPE? No: Critical Failure Yes: 1 Point

Did the student treat the patient, bystanders and co-workers with dignity and respect? No: 0 Points Yes: 1 Point

Did the student address immediate life threats in a timely manner? Not Applicable: No possible points, and no points earned No: Critical Failure Yes, with errors that would likely have endangered the patient’s life: Critical Failure Yes, but with errors that could adversely affect the patient’s outcome: 1 Point Yes, but with errors that would not adversely affect patient’s outcome: 6 Points Yes, with no errors: 10 Points

Did the student obtain an accurate and complete history on the patient? Not obtainable: No possible points, and no points earned No: Critical Failure Yes, with errors that would likely have endangered the patient’s life: Critical Failure Yes, but with errors that could adversely affect the patient’s outcome: 1 Point Yes, but with errors that would not adversely affect patient’s outcome: 6 Points Yes, with no errors: 10 Points

Did the student do an appropriate assessment (vital signs, ekg, blood glucose, correct physical assessment, etc)? No: Critical Failure Yes, with errors that would likely have endangered the patient’s life: Critical Failure Yes, but with errors that could adversely affect the patient’s outcome: 1 Point Yes, but with errors that would not adversely affect patient’s outcome: 6 Points Yes, with no errors: 10 Points

Did the student develop a complete and accurate field diagnosis of the patient’s condition? No: Critical Failure Yes, with errors that would likely have endangered the patient’s life: Critical Failure Yes, but with errors that could adversely affect the patient’s outcome: 1 Point Yes, but with errors that would not adversely affect patient’s outcome: 6 Points Yes, with no errors: 10 Points

Did the student treat the patient’s condition in accordance with the current standard of care? No: Critical Failure Yes, with errors that would likely have endangered the patient’s life: Critical Failure Yes, but with errors that could adversely affect the patient’s outcome: 1 Point Yes, but with errors that would not adversely affect patient’s outcome: 6 Points Yes, with no errors: 10 Points

59

Contrived Experience Lab: Page 2 Possible points

Points earned

Did the student perform the necessary procedures (IV insertion, Intubation, etc) safely, correctly and in a timely manner? No: Critical Failure Yes, with errors that would likely have endangered the patient’s life: Critical Failure Yes, but with errors that could adversely affect the patient’s outcome: 1 Point Yes, but with errors that would not adversely affect patient’s outcome: 6 Points Yes, with no errors: 10 Points

Did the student identify and promptly call any alerts specific to the patient’s condition (Cardiac alert, trauma alert, etc)? No: 0 Points Yes: 5 Points

Did the student properly address the patient’s comfort (Position, pain management, etc)? No: 0 Points Yes: 5 Points

Did the student choose an appropriate transportation destination? No: 0 Points Yes: 5 Points

Did the student begin transport in a timely manner? No: Critical Failure Yes, but with errors that could adversely affect the patient’s outcome: 1 Point Yes, but with errors that would not adversely affect patient’s outcome: 6 Points Yes, with no errors: 10 Points

Did the student adequately reevaluate the patient after treatment? No: Critical Failure Yes, with errors that would likely have endangered the patient’s life: Critical Failure Yes, but with errors that could adversely affect the patient’s outcome 1 Point Yes, but with errors that would not adversely affect patient’s outcome: 6 Points Yes, with no errors: 10 Points

Did the student address changes in patient’s condition in accordance with the current standard of care? Not applicable: No possible points, and no points earned No: Critical Failure Yes, with errors that would likely have endangered the patient’s life: Critical Failure Yes, but with errors that could adversely affect the patient’s outcome: 1 Point Yes, but with errors that would not adversely affect patient’s outcome: 6 Points Yes, with no errors: 10 Points

Was the student’s documentation of the incident complete and accurate? No: 0 Points Yes: 5 Point

Comments:


Second Attempt

Third Attempt

Evaluator Initials

Score: Points earned / Possible points x 100 =

Student: _________________________________________________________________


60

CF Paramedic Program Contrived Experience Lab

Scenario Evaluation Sheet: Difficult Airway

Implementation and assessment: Possible points

Points earned

Did the student approach the patient safely and in proper PPE? No: Critical Failure Yes: 1 Point

Did the student treat the patient, bystanders and co-workers with dignity and respect? No: 0 Points Yes: 1 Point

Did the student address immediate life threats in a timely manner? Not Applicable: No possible points, and no points earned No: Critical Failure Yes, with errors that would likely have endangered the patient’s life: Critical Failure Yes, but with errors that could adversely affect the patient’s outcome: 1 Point Yes, but with errors that would not adversely affect patient’s outcome: 6 Points Yes, with no errors: 10 Points

Did the student obtain an accurate and complete history on the patient? Not obtainable: No possible points, and no points earned No: Critical Failure Yes, with errors that would likely have endangered the patient’s life: Critical Failure Yes, but with errors that could adversely affect the patient’s outcome: 1 Point Yes, but with errors that would not adversely affect patient’s outcome: 6 Points Yes, with no errors: 10 Points

Did the student do an appropriate assessment (vital signs, ekg, blood glucose, correct physical assessment, etc)? No: Critical Failure Yes, with errors that would likely have endangered the patient’s life: Critical Failure Yes, but with errors that could adversely affect the patient’s outcome: 1 Point Yes, but with errors that would not adversely affect patient’s outcome: 6 Points Yes, with no errors: 10 Points

Did the student develop a complete and accurate field diagnosis of the patient’s condition? No: Critical Failure Yes, with errors that would likely have endangered the patient’s life: Critical Failure Yes, but with errors that could adversely affect the patient’s outcome: 1 Point Yes, but with errors that would not adversely affect patient’s outcome: 6 Points Yes, with no errors: 10 Points

Did the student treat the patient’s condition in accordance with the current standard of care? No: Critical Failure Yes, with errors that would likely have endangered the patient’s life: Critical Failure Yes, but with errors that could adversely affect the patient’s outcome: 1 Point Yes, but with errors that would not adversely affect patient’s outcome: 6 Points Yes, with no errors: 10 Points

61

Contrived Experience Lab: Page 2 Possible points

Points earned

Did the student perform the necessary procedures (IV insertion, Intubation, etc) safely, correctly and in a timely manner? No: Critical Failure Yes, with errors that would likely have endangered the patient’s life: Critical Failure Yes, but with errors that could adversely affect the patient’s outcome: 1 Point Yes, but with errors that would not adversely affect patient’s outcome: 6 Points Yes, with no errors: 10 Points

Did the student identify and promptly call any alerts specific to the patient’s condition (Cardiac alert, trauma alert, etc)? No: 0 Points Yes: 5 Points

Did the student properly address the patient’s comfort (Position, pain management, etc)? No: 0 Points Yes: 5 Points

Did the student choose an appropriate transportation destination? No: 0 Points Yes: 5 Points

Did the student begin transport in a timely manner? No: Critical Failure Yes, but with errors that could adversely affect the patient’s outcome: 1 Point Yes, but with errors that would not adversely affect patient’s outcome: 6 Points Yes, with no errors: 10 Points

Did the student adequately reevaluate the patient after treatment? No: Critical Failure Yes, with errors that would likely have endangered the patient’s life: Critical Failure Yes, but with errors that could adversely affect the patient’s outcome 1 Point Yes, but with errors that would not adversely affect patient’s outcome: 6 Points Yes, with no errors: 10 Points

Did the student address changes in patient’s condition in accordance with the current standard of care? Not applicable: No possible points, and no points earned No: Critical Failure Yes, with errors that would likely have endangered the patient’s life: Critical Failure Yes, but with errors that could adversely affect the patient’s outcome: 1 Point Yes, but with errors that would not adversely affect patient’s outcome: 6 Points Yes, with no errors: 10 Points

Was the student’s documentation of the incident complete and accurate? No: 0 Points Yes: 5 Point

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Second Attempt

Third Attempt

Evaluator Initials

Score: Points earned / Possible points x 100 =

Student: _________________________________________________________________


62

Airway Management Log Student Name: Lead Instructor:

Date: Instructor: Scenario Name?: Successful?

Place: (Circle) Airway Type (Circle one) OPA NPA Oral ET Nasal ET Digital ET Supraglotic Surgical Needle Yes

OR ED LAB AMBU Distractions (Circle one) Noise Lighting Position Obstruction Age (Circle one) Adult Child Infant No

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