ITLS SCENARIO GRADE SHEET
Student Name:
Time
Started:
Date:
Time
Primary completed:
ACTION
9
[ ] Basic
[ ] Advanced
Scenario #:
Time
Transported:
COMMENTS
[ ] Practice
ACTION
Baseline Vital Signs HR, RR, BP
Scene Size-up
Standard precautions
History SAMPLE
Scene Hazards
IF ALTERED MENTAL STATUS
Pupils Size? Reactive? Equal?
9
COMMENTS
9
COMMENTS
Glasgow Coma Scale
Need for More Help or Equipment
Orientation, emotional state
Mechanism of Injury
Signs of cerebral herniation
General Impression
Age, Sex, Weight
Medical identification devices
Blood glucose
General Appearance
Body Position
Critical transport decision
Position in Environment
ACTION
Patient Activity
PATIENT ASSESSMENT - SECONDARY SURVEY
Obvious Injury or Bleeding
Repeat Initial Assessment
Repeat vital signs
LOC A.V.P.U.
Consider Cardiac monitor, Sp02, EtCO2
Airway Snoring, Gurgling, Stridor, Silence
LOC
AVPU
Breathing Present? Rate, Depth, Effort
If conscious, orientation and emotional state
Radial/Carotid Pulses
Present? Rate, Rhythm, Quality
If altered mental status, GCS
Skin Color, Temp, Moisture, Capillary Refill
If altered mental status, blood glucose
Uncontrollable external hemorrhage?
If altered mental status, Sp02
Head and Neck
Major facial injuries
If altered mental status, consider naloxone
Pupils size, equality, response to light
Bruising, swelling, penetrations
Motor move fingers and toes?
Subcutaneous emphysema?
Sensation feel fingers and toes?
Neck vein distention?
If unconscious, respond to pinch?
Tracheal deviation?
Head
DCAP-BTLS
Chest Look: Asymmetry, Contusion,
Penetrations, Paradoxical Motion, Chest Rise
Raccoon eyes
Feel: Tenderness, Instability, Crepitation
Battle’s signs
Breath Sounds
Present? Equal?
Drainage from ears or nose
If decreased breath sounds, percussion
Mouth
Reassess airway
Heart Tones
Neck
DCAP-BTLS
Abdomen
Look: bruising, penetration/evisceration
Neck vein distention?
Gently palpate: tenderness, rigidity, distention
Tracheal deviation?
Chest
DCAP-BTLS, paradoxical movement
Pelvis Deformity, penetrating wounds, TIC
Lower Extremities
Upper: swelling, deformity, TIC
Instability and crepitation
Lower: scan wounds, swelling, deformity
Breath sounds present? equal? quality?
Motor, sensory before transfer to backboard
If decreased breath sounds, percussion
Upper Extremities
Scan wounds, swelling, deformity
Heart sounds
Recheck wound seals, injuries
Motor, sensory before transfer to backboard
Abdomen
Signs of blunt or penetrating trauma
Posterior Penetrations, deformity, edema
Palpate all quadrants for tenderness, rigidity
Pelvis and Extremities
DCAP-BTLS
IF CRITICAL, TRANSFER TO AMBULANCE
GRADE KEY:
[ ] RT
Time
Secondary completed :
PATIENT ASSESSMENT - PRIMARY SURVEY
Number of Patients
[ ] Test
[ 9 ] Completed, skill performed in sequence
[ D ] Delayed, performed out of sequence
[ X ] Skill not performed, too late or incorrectly
PMS distal to injuries on extremities
July 2007
IF CRITICAL, TRANSPORT IMMEDIATELY
ACTION
9
COMMENTS
CRITICAL ACTIONS
ONGOING ASSESSMENT
Completes Scene Size-up and uses universal precautions
Subjective Ask patient if changes in how feels
Performs initial assessment and interacts with patient
Reassess mental status LOC, pupils
Performs organized Rapid Trauma Survey or Focused Exam
If altered mental status Recheck GCS
Ensures spinal motion restriction
Reassess airway
Ensures appropriate oxygenation and ventilation
Reassess breathing and circulation
Recheck vital signs
Recognizes and treats all life-threatening injuries
Uses appropriate equipment and techniques
Skin color, condition, temperature
Recognizes critical trauma, time and transport priorities
Check for neck vein distention
Performs Secondary Survey (when time permits)
Check for tracheal deviation
IMPORTANT ACTIONS
Recheck chest
Performs Ongoing Exam (when time permits)
Breath sounds quality? equal?
Utilizes time efficiently
Reassess heart sounds
If critical, notifies medical direction early
Reassess abdomen - if possible injury
Development of tenderness, distention, rigidity
Gives appropriate report to medical direction
Demonstrates acceptable skill techniques
Check all identified injuries
For example:
Lacerations for bleeding
PMS distal to injuries on extremities
Flail segments
Pneumothorax
Open chest wounds
Displays leadership and teamwork
ADDITIONAL ACTIONS
Finish bandaging and splinting after Secondary Survey (when time permits)
Vital signs every 5 minutes for critical patents, every 15 minutes for stable
Check all interventions
For example:
ET tube for patency and position
Oxygen for flow rate
IVs for patency and fluid rate
Seals on sucking chest wounds
Patency of decompression needle
Splints and dressings
Impaled objects for stabilization
If pregnant, body position
Cardiac monitor, Sp02, EtCO2
GRADE KEY:
Repeats Ongoing Exam each time patient moved or intervention performed
Repeats Ongoing Exam if patient condition worsens
Appropriately interacts with patient, family and bystanders
[ 9 ] Completed, skill performed in sequence
[ D ] Delayed, performed out of sequence
[ X ] Skill not performed, too late or incorrectly
July 2007
INSTRUCTOR COMMENTS
OVERALL GRADE
[
] Excellent
[
] Good
[
Further Comments:
Lead Instructor Name (print):
Signature:
Instructor Name (print):
Signature:
Instructor Name (print):
Signature:
] Adequate
[
] Inadequate