Raven EMS Education Program ManualBreathing CPAP Evaluation Form
Date:
Student name:
Evaluator name:
Steps:
Take BSI precautions.
Explain the procedure to the patient.
Provide appropriate supplemental oxygen while setting up the CPAP.
Place the patient on the pulse oximeter.
Explain the procedure to the patient (remove dentures if applicable). Note: Do not use CPAP on hypotensive (BP < 90 mm Hg) patients or patients with an altered mental status.
Attach the CPAP face-mask oxygen-connecting tubing to the oxygen tank regulator and adjust to 25 L/min or the mask-specific recommended range.
Set the airway pressure at 3–5 cm H2O.
Assist the patient with holding the mask to the face for a few breaths to acclimate the patient to the mask.
Secure the face mask according to the manufacturer’s directions.
Reassess the patient.
If clinical conditions have not adequately improved, adjust the pressure in 2 cm H2O increments (maximum of 10 cm H2O) until improvement is noted.
Dispose of all equipment properly.
Accepts evaluation and criticism professionally.
Shows willingness to learn/asks appropriate questions.
Interacts with simulated patient and other personnel in a professional manner (ie, uses appropriate name, explains procedures, maintains modesty, is courteous to crew, etc).
Passing criteria:
Pass: At least 70% (? of ?) successfully completed above. Currently at 0% completed.
Fail.
Fails to take BSI precautions prior to performing procedure.
Did not explain and reassure the patient to allow informed consent.
Fails to place patient on pulse oximeter.
Fails to provide supplemental oxygen while setting up CPAP.
Fails to properly connect oxygen tubing and set to appropriate flow rate.
Fails to properly secure device to patient’s face.
Fails to recognize patient’s need for increased pressure, if required.
Fails to ultimately provide the required settings to achieve the desired affect.
Fails to administer CPAP in appropriate manner or for appropriate patient condition.
Fails to dispose of all material in approved technique.
