Skill Evolution Sheet

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1 Skill Evolution Sheet Skill Drill 2-1 Proper Removal of Medical Gloves Skill Drill 6-1 Clearing the Airway Using Finger Sweeps Skill Drill 6-2 Inserting an Oral Airway Skill Drill 6-3 Inserting a Nasal Airway Skill Drill 6-4 Performing Mouth-to-Mask Rescue Breathing Skill Drill 6-5 Performing Mouth-to-Barrier Rescue Breathing Skill Drill 6-6 Using a Bag-Mask Device With One Rescuer Skill Drill 6-7 Performing Infant Rescue Breathing Skill Drill 6-8 Managing Airway Obstruction in a Conscious Patient Skill Drill 6-9 Performing Cricoid Pressure Skill Drill 7-1 Performing Adult Chest Compressions Skill Drill 7-2 Performing One-Rescuer Adult CPR Skill Drill 7-3 Performing Two-Rescuer Adult CPR Skill Drill 7-4 Performing One-Rescuer Infant CPR Skill Drill 7-5 Procedure for Automated External Defibrillation Skill Drill 8-1 Performing a Secondary Assessment Skill Drill 13-1 Controlling Bleeding With a Tourniquet Skill Drill 14-1 Checking Circulation, Sensation, and Movement in an Injured Extremity Skill Drill 14-2 Applying a SAM Splint Skill Drill 14-3 Applying a Zippered Air Splint Skill Drill 14-4 Applying a Traction Splint Skill Drill 14-5 Applying an Air Splint to the Leg Skill Drill 14-6 Applying a Pillow Splint for Ankle or Foot Injury 82658_FMxx.indd 1 8/3/10 4:54:19 PM

2 Skill Drill 14-7 Stabilizing the Cervical Spine and Maintaining an Open Airway Skill Drill 14-8 Removing the Mask on a Sports Helmet Skill Drill 14-9 Removing a Helmet Skill Drill 15-1 Putting on Sterile Gloves Skill Drill 15-2 Resuscitating a Newborn Skill Drill 16-1 Inserting an Oral Airway in a Child Skill Drill 18-1 Direct Ground Lift Skill Drill 18-2 Applying a Short Backboard Device Skill Drill 18-3 Four-Person Log Roll Skill Drill 18-4 Preparing a Blanket Roll Skill Drill 18-5 Applying the Blanket Roll to Stabilize the Patient s Head and Neck Skill Drill 20-1 Accessing the Vehicle Through the Window Skill Drill 20-2 Airway Management in a Vehicle Skill Drill 20-3 Turning a Patient in the Water 82658_FMxx.indd 2 8/3/10 4:54:20 PM

3 Skill Drill 2-1 Proper Removal of Medical Gloves Task: Remove gloves. Performance Observations: The candidate shall be able to demonstrate the proper glove removal technique. Candidate Directive: Properly remove gloves. 1. Partially remove the first glove by pinching at the wrist. Be careful to touch only the outside of the glove. 2. Remove the second glove by pinching the exterior with the partially gloved hand. 3. Pull the second glove inside out toward the fingertips. 4. Grasp both gloves with your free hand, touching only the clean interior surfaces, and gently remove the gloves _CH02_SD01.indd 3 8/3/10 4:16:35 PM

4 Skill Drill 6-1 Clearing the Airway Using Finger Sweeps Task: Clear the airway using finger sweeps. Performance Observations: The candidate shall be able to correctly clear the airway using finger sweeps. Candidate Directive: Properly clear the airway using finger sweeps. 1. Turn the patient onto his or her side. 2. Insert your fingers into the patient s mouth. 3. Curve your fingers into a C-shape and sweep them from one side of the back of the mouth to the other side _CH06_SD01.indd 4 8/3/10 4:17:24 PM

5 Skill Drill 6-2 Inserting an Oral Airway Task: Insert an oral airway. Performance Observations: The candidate shall be able to correctly insert an oral airway. Candidate Directive: Properly insert an oral airway. 1. Size the airway by measuring from the patient s earlobe to the corner of the mouth. 2. Insert the oral airway upside down along the roof of the patient s mouth until you feel resistance. 3. Rotate the airway 180º until the flange comes to rest on the patient s lips or teeth _CH06_SD02.indd 5 8/3/10 4:18:01 PM

6 Skill Drill 6-3 Inserting a Nasal Airway Task: Insert a nasal airway. Performance Observations: The candidate shall be able to correctly insert a nasal airway. Candidate Directive: Properly insert a nasal airway. 1. Size the airway by measuring from the earlobe to the tip of the patient s nose. 2. Insert the lubricated airway into the larger nostril. 3. Advance the airway until the flange rests against the nose _CH06_SD03.indd 6 8/3/10 4:19:34 PM

7 Skill Drill 6-4 Performing Mouth-to-Mask Rescue Breathing Task: Perform mouth-to-mask rescue breathing. Performance Observations: The candidate shall be able to correctly perform mouth-to-mask rescue breathing. Candidate Directive: Properly perform mouth-to-mask rescue breathing. 1. Open the airway using the head tilt chin lift maneuver. 2. Or, open the airway using the jaw-thrust technique. 3. Seal the mask against the patient s face. 4. Breathe through the mouthpiece _CH06_SD04.indd 7 8/3/10 4:19:20 PM

8 Skill Drill 6-5 Performing Mouth-to-Barrier Rescue Breathing Task: Perform mouth-to-barrier resuce breathing. Performance Observations: The candidate shall be able to correctly perform mouth-to-barrier rescue breathing. Candidate Directive: Properly perform mouth-to-barrier rescue breathing. 1. Open the airway using the head tilt chin lift maneuver. 2. Place the barrier device over the patient s mouth. 3. Pinch the patient s nostrils together and perform rescue breathing _CH06_SD05.indd 8 8/3/10 4:19:11 PM

9 Skill Drill 6-6 Using a Bag-Mask Device With One Rescuer Task: Use a bag-mask device with one rescuer. Performance Observations: The candidate shall be able to correctly use a bag-mask device with one rescuer. Candidate Directive: Properly use a bag-mask device with one rescuer. 1. Kneel at the patient s head and maintain an open airway. Check the patient s mouth for fluids, foreign bodies, and dentures. 2. Select the proper mask size. 3. Place the mask over the patient s face. 4. Seal the mask. 5. Squeeze the bag with your other hand. Check for chest rise. 6. Add supplemental oxygen _CH06_SD06.indd 9 8/3/10 4:18:58 PM

10 Skill Drill 6-7 Performing Infant Rescue Breathing Task: Perform infant rescue breathing. Performance Observations: The candidate shall be able to correctly perform infant rescue breathing. Candidate Directive: Properly perform infant rescue breathing. 1. Establish the patient s level of responsiveness. 2. Open the infant s airway using the head tilt chin lift maneuver. 3. Check for breathing by looking, listening, and feeling. 4. Perform infant rescue breathing _CH06_SD07.indd 10 8/3/10 4:18:48 PM

11 Skill Drill 6-8 Managing Airway Obstruction in a Conscious Patient Task: Manage airway obstruction in a conscious patient. Performance Observations: The candidate shall be able to correctly manage airway obstruction in a conscious patient. Candidate Directive: Properly manage airway obstruction in a conscious patient. 1. Look for signs of choking. 2. Place your fist with the thumb side against the patient s abdomen, just above the navel. 3. Grasp the fist with your other hand and press into the abdomen with quick inward and upward thrusts _CH06_SD08.indd 11 8/3/10 4:18:39 PM

12 Skill Drill 6-9 Performing Cricoid Pressure Task: Perform cricoid pressure. Performance Observations: The candidate shall be able to correctly perform cricoid pressure. Candidate Directive: Properly perform cricoid pressure. 1. Locate the Adam s apple. 2. Slide your index finger down to the bottom of the larynx and locate the first ring of cartilage below the larynx, which is the cricoid cartilage. 3. Use the tip of your thumb and the tip of your index finger to apply firm pressure on this ring toward the patient s spine (posterior). Maintain this pressure until relieved by another rescuer or until the patient is intubated _CH06_SD09.indd 12 8/3/10 4:18:26 PM

13 Skill Drill 7-1 Performing Adult Chest Compressions Task: Perform adult chest compressions. Performance Observations: The candidate shall be able to correctly perform adult chest compressions. Candidate Directive: Properly perform adult chest compressions. 1. Locate the top and bottom of the sternum. Place the heel of your hand in the center of the chest, in between the nipples. 2. Place your other hand on top of your first hand and interlock your fingers. 3. Compress the chest of an adult 1 1 /2 to 2 straight down _CH07_SD01.indd 13 8/3/10 4:21:05 PM

14 Skill Drill 7-2 Performing One-Rescuer Adult CPR Task: Perform one-rescuer adult CPR. Performance Observations: The candidate shall be able to correctly perform one-rescuer adult CPR. Candidate Directive: Properly perform one-rescuer adult CPR. 1. Establish responsiveness by gently shaking the shoulder. 2. Open the airway. 3. Check for breathing. 4. Perform rescue breathing. 5. Check for circulation. 6. Perform chest compressions _CH07_SD02.indd 14 8/3/10 4:20:55 PM

15 Skill Drill 7-3 Performing Two-Rescuer Adult CPR Task: Perform two-rescuer adult CPR. Performance Observations: The candidate shall be able to correctly perform two-rescuer adult CPR. Candidate Directive: Properly perform two-rescuer adult CPR. 1. Establish responsiveness. 2. Open the airway using the head tilt chin lift or jaw-thrust maneuver. 3. Check for breathing look, listen, and feel. 4. Perform rescue breathing; give two breaths. 5. Check for circulation by feeling the carotid pulse. 6. Begin chest compressions and continue rescue breathing _CH07_SD03.indd 15 8/3/10 4:20:48 PM

16 Skill Drill 7-4 Performing One-Rescuer Infant CPR Task: Perform one-rescuer infant CPR. Performance Observations: The candidate shall be able to correctly perform one-rescuer infant CPR. Candidate Directive: Properly perform one-rescuer infant CPR. 1. Position the infant on a firm surface and establish the infant s level of responsiveness. 2. Open the airway using the head tilt chin lift maneuver. 3. Check for breathing. 4. To breathe for an infant, place your mouth over the infant s mouth and nose and give very small puffs of air, just enough to make the chest rise. 5. Check for circulation. Check the brachial pulse on the inside of the arm. Check for at least 5 seconds but no more than 10 seconds. 6. Begin chest compressions, using the middle and ring fingers to compress the sternum, at the rate of 100 per minute. Continue compressions and ventilations, and reassess the patient after five cycles _CH07_SD04.indd 16 8/3/10 4:31:28 PM

17 Skill Drill 7-5 Procedure for Automated External Defibrillation Task: Perform automated external defibrillation. Performance Observations: The candidate shall be able to correctly perform automated external defibrillation. Candidate Directive: Properly perform automated external defibrillation. 1. Check for responsiveness, airway, breathing, and circulation. 2. If the patient is unresponsive, not breathing, and pulseless, perform CPR for five cycles (about 2 minutes). If arrest is witnessed, proceed to Step Apply the adhesive pads and connect them to the defibrillator. Turn on the AED. Do not touch the patient. Allow the AED to analyze the rhythm. 4. Determine whether a shock is advised by the defibrillator. If shock is advised, defibrillate the patient. 5. As soon as the AED gives the shock, perform five cycles of CPR (about 2 minutes), starting with chest compressions, then analyze the rhythm. If the AED advises no shock, perform five cycles of CPR (about 2 minutes), starting with chest compressions, then analyze the rhythm _CH07_SD05.indd 17 8/3/10 4:20:30 PM

18 Skill Drill 8-1 Performing a Secondary Assessment Task: Perform a secondary assessment. Performance Observations: The candidate shall be able to correctly perform a secondary assessment. Candidate Directive: Properly perform a secondary assessment. 1. Observe and palpate the head. 2. Assess the eyes. 3. Check the nose for blood and drainage. 4. Assess the mouth. 5. Check for unusual breath odors. 6. Assess the neck. 7. Inspect the chest and observe breathing motion. 8. Gently palpate the chest. 9. Assess the abdomen. 10. Gently press on the pelvic bones. 11. Log roll the patient and assess the back. 12. Inspect the extremities _CH08_SD01.indd 18 8/3/10 4:20:21 PM

19 Skill Drill 13-1 Controlling Bleeding With a Tourniquet Task: Control bleeding with a tourniquet. Performance Observations: The candidate shall be able to correctly control bleeding with a tourniquet. Candidate Directive: Properly control bleeding with a tourniquet. 1. Apply direct pressure with a sterile dressing. 2. Apply a pressure dressing. 3. If bleeding continues or recurs, apply a tourniquet above the level of bleeding _CH13_SD01.indd 19 8/3/10 4:20:13 PM

20 Skill Drill 14-1 Checking Circulation, Sensation, and Movement in an Injured Extremity Task: Check circulation, sensation, and movement in an injured extremity. Performance Observations: The candidate shall be able to correctly check circulation, sensation, and movement in an injured extremity. Candidate Directive: Properly check circulation, sensation, and movement in an injured extremity. 1. Check for circulation. If upper extremity injury, check radial pulse. 2. If lower extremity injury, check posterior tibial pulse. 3. Test capillary refill on finger/toe of injured limb. 4. Release pressure. Pink color should return. 5. Check for sensation at fingertips. 6. Check for sensation at toes. 7. Check for movement of the upper extremities by asking the patient to open and close the fist. 8. Check for movement of the lower extremities by asking the patient to extend and flex the ankle _CH14_SD01.indd 20 8/3/10 4:25:04 PM

21 Skill Drill 14-2 Applying a SAM Splint Task: Apply a SAM splint. Performance Observations: The candidate shall be able to correctly apply a SAM splint. Candidate Directive: Properly apply a SAM splint. 1. Stabilize the injured limb. Form the SAM splint. 2. Place the splint under the injured limb. 3. Secure with gauze _CH14_SD02.indd 21 8/3/10 4:24:52 PM

22 Skill Drill 14-3 Applying a Zippered Air Splint Task: Apply a zippered air splint. Performance Observations: The candidate shall be able to correctly apply a zippered air splint. Candidate Directive: Properly apply a zippered air splint. 1. Support the injured limb and apply gentle traction as your partner applies the open, deflated splint. 2. Zip up the splint, inflate it by pump or by mouth, and test the pressure. Check and record distal neurovascular function _CH14_SD03.indd 22 8/3/10 4:24:38 PM

23 Skill Drill 14-4 Applying a Traction Splint Task: Apply a traction splint. Performance Observations: The candidate shall be able to correctly apply a traction splint. Candidate Directive: Properly apply a traction splint. 1. Place the splint beside the uninjured limb, adjust the splint to the proper length, and prepare the straps. 2. Support the injured limb as your partner fastens the ankle hitch about the foot and ankle. 3. Continue to support the limb as your partner applies gentle traction to the ankle hitch and foot. 4. Slide the splint into position under the injured limb. 5. Pad the groin and fasten the strap around the midthigh. 6. Connect the loops of the ankle hitch to the end of the splint as your partner continues to maintain traction. Fasten the support straps so that the limb is securely held in the splint _CH14_SD04.indd 23 8/3/10 4:23:44 PM

24 Skill Drill 14-5 Applying an Air Splint to the Leg Task: Apply an air splint to the leg. Performance Observations: The candidate shall be able to correctly apply an air splint to the leg. Candidate Directive: Properly apply an air splint to the leg. 1. Support the injured limb. Slide the splint under the limb. 2. Place the splint around the limb. 3. Inflate the splint _CH14_SD05.indd 24 8/3/10 4:22:42 PM

25 Skill Drill 14-6 Applying a Pillow Splint for Ankle or Foot Injury Task: Apply a pillow splint to an injured ankle or foot. Performance Observations: The candidate shall be able to correctly apply a pillow splint to an injured ankle or foot. Candidate Directive: Properly apply a pillow splint to an injured ankle or foot. 1. Place a pillow under the injured limb. 2. Secure with cravats, swathes, or bandages. 3. Recheck the pulse, capillary refill, and sensation _CH14_SD06.indd 24 8/3/10 4:22:28 PM

26 Skill Drill 14-7 Stabilizing the Cervical Spine and Maintaining an Open Airway Task: Stabilize the cervical spine and maintain an open airway. Performance Observations: The candidate shall be able to correctly stabilize the cervical spine and maintain and open airway. Candidate Directive: Properly stabilize the cervical spine and maintain an open airway. 1. Stabilize the head and neck in a neutral position. 2. Use the jaw-thrust maneuver to open the airway and avoid head or neck movement _CH14_SD07.indd 25 8/3/10 4:22:21 PM

27 Skill Drill 14-8 Removing the Mask on a Sports Helmet Task: Remove the mask on a sports helmet. Performance Observations: The candidate shall be able to correctly remove the mask on a sports helmet. Candidate Directive: Properly remove the mask on a sports helmet. 1. Stabilize the patient s head and helmet in a neutral, in-line position. Then remove the mask in one of the following two ways. 2. Use a screwdriver to unscrew the retaining clips for the face mask or perform Step Use a trainer s tool designed for cutting retaining clips _CH14_SD08.indd 26 8/3/10 4:22:11 PM

28 Skill Drill 14-9 Removing a Helmet Task: Remove a helmet. Performance Observations: The candidate shall be able to correctly remove a helmet. Candidate Directive: Properly remove a helmet. 1. Kneel down at the patient s head and open the face shield to assess the airway and breathing. Stabilize the helmet by placing your hands on either side of it, ensuring that your fingers are on the patient s lower jaw to prevent movement of the head. Your partner can then loosen the strap. 2. Your partner should place one hand on the patient s lower jaw and the other behind the head at the occiput. 3. Gently slip the helmet off about halfway and then stop. 4. Your partner slides his or her hand from the occiput to the back of the head to prevent the head from snapping back once the helmet is removed. 5. With your partner s hand in place, remove the helmet and stabilize the cervical spine. Apply a cervical collar and then secure the patient to a long backboard _CH14_SD09.indd 27 8/3/10 4:22:03 PM

29 Skill Drill 15-1 Putting on Sterile Gloves Task: Put on sterile gloves. Performance Observations: The candidate shall be able to correctly put on sterile gloves. Candidate Directive: Properly put on sterile gloves. 1. Open sterile glove package. 2. Pick up first glove by grasping it as shown. 3. Put on first glove. 4. Grasp second glove as shown. 5. Put on second glove. 6. Keep gloves as sterile as possible _CH15_SD01.indd 28 8/3/10 4:29:48 PM

30 Skill Drill 15-2 Resuscitating a Newborn Task: Resuscitate a newborn. Performance Observations: The candidate shall be able to correctly resuscitate a newborn. Candidate Directive: Properly resuscitate a newborn. 1. Tilt the infant so the head is down and to the side to clear the airway. 2. Gently snap or flick your fingers on the soles of the infant s feet. 3. Begin rescue breathing. 4. Check for a brachial pulse. 5. Begin chest compressions using the middle and ring fingers _CH15_SD02.indd 29 8/3/10 4:29:32 PM

31 Skill Drill 16-1 Inserting an Oral Airway in a Child Task: Insert an oral airway in a child. Performance Observations: The candidate shall be able to correctly insert an oral airway in a child. Candidate Directive: Properly insert an oral airway in a child. 1. Select the proper size oral airway by measuring from the patient s earlobe to the corner of the mouth. 2. Position the pediatric patient s airway with the appropriate method. 3. Depress the patient s tongue and press the tongue forward and away from the roof of the mouth. Follow the anatomic curve of the roof of the patient s mouth to slide the airway into place _CH16_SD01.indd 30 8/3/10 4:29:15 PM

32 Skill Drill 18-1 Direct Ground Lift Task: Perform the direct ground lift. Performance Observations: The candidate shall be able to correctly perform the direct ground lift. Candidate Directive: Properly perform the direct ground lift. 1. Kneel at the patient s side. 2. Place arms under the patient. 3. Lift the patient. 4. Move the patient to the stretcher _CH18_SD01.indd 31 8/3/10 4:29:00 PM

33 Skill Drill 18-2 Applying a Short Backboard Device Task: Apply a short backboard device. Performance Observations: The candidate shall be able to correctly apply a short backboard device. Candidate Directive: Properly apply a short backboard device. 1. Stabilize the head and apply a cervical collar. 2. Insert the device head first. 3. Apply the middle strap. 4. Apply the other straps. 5. Place wings around the head. 6. Secure the head strap _CH18_SD02.indd 32 8/3/10 4:28:46 PM

34 Skill Drill 18-3 Four-Person Log Roll Task: Perform the four-person log roll. Performance Observations: The candidate shall be able to correctly perform the four-person log roll. Candidate Directive: Properly perform the four-person log roll. 1. Rescuers get into position to roll the patient. 2. Roll the patient onto his or her side. 3. The fourth person slides the backboard toward the patient. 4. Roll the patient onto the backboard. 5. Center the patient on the backboard and secure the patient before moving _CH18_SD03.indd 33 8/3/10 4:28:34 PM

35 Skill Drill 18-4 Preparing a Blanket Roll Task: Prepare a blanket roll. Performance Observations: The candidate shall be able to correctly prepare a blanket roll. Candidate Directive: Properly prepare a blanket roll. 1. Fold a blanket. 2. Insert a rolled towel and roll the blanket from each end. 3. Roll the ends together. 4. Place extra cravats inside. 5. Tie with two cravats _CH18_SD04.indd 34 8/3/10 4:28:19 PM

36 Skill Drill 18-5 Applying the Blanket Roll to Stabilize the Patient s Head and Neck Task: Apply the blanket roll to stabilize the patient s head and neck. Performance Observations: The candidate shall be able to correctly apply the blanket roll to stabilize the patient s head and neck. Candidate Directive: Properly apply the blanket roll to stabilize the patient s head and neck. 1. Stabilize the head. 2. Apply a cervical collar. 3. Place the straps around the backboard and patient. 4. Insert the blanket roll and roll each side of the blanket snugly against the neck and shoulders. 5. Tie two cravats around the blanket roll, then two more around the backboard _CH18_SD05.indd 35 8/3/10 4:28:02 PM

37 Skill Drill 20-1 Accessing the Vehicle Through the Window Task: Access a vehicle through the window. Performance Observations: The candidate shall be able to correctly access a vehicle through the window. Candidate Directive: Properly access a vehicle through the window. 1. Place the spring-loaded center punch at the lower corner of the window. 2. Press on the center punch to break the window. 3. Remove the glass to the outside. 4. Enter the vehicle through the window _CH20_SD01.indd 36 8/3/10 4:27:47 PM

38 Skill Drill 20-2 Airway Management in a Vehicle Task: Manage a patient s airway in a vehicle. Performance Observations: The candidate shall be able to correctly manage a patient s airway in a vehicle. Candidate Directive: Properly manage a patient s airway in a vehicle. 1. Place one hand under the patient s chin and your other hand on the back of the patient s head. 2. Raise the patient s head to a neutral position to open the airway _CH20_SD02.indd 37 8/3/10 4:27:31 PM

39 Skill Drill 20-3 Turning a Patient in the Water Task: Turn a patient in the water. Performance Observations: The candidate shall be able to correctly turn a patient in the water. Candidate Directive: Properly turn a patient in the water. 1. Support the back and head with one hand. Place your other hand on the front of the patient. 2. Carefully turn the patient as a unit. 3. Stabilize the patient s head and neck _CH20_SD03.indd 38 8/3/10 4:27:14 PM

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