INSTRUCTIONS for Skills Testing - ACLS-PALS-BLS.com...PALS MEGACODE - Tachyarrhythmia An 11-year-old...
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© 2019 United Medical Education 1 INSTRUCTIONS for Skills Testing: The Examiner is to read the case scenarios aloud to the examinee. As the examinee works through each step in a scenario, the examiner is to mark each corresponding step on the checklist as Complete or Incomplete. Items marked as Complete are to be performed correctly without guidance. If the examinee needs guidance through a step, the step must be marked as Incomplete and the skills test should be repeated. No additional guidance should be given to the examinee beyond the information provided in italics. Areas needing improvement should be reviewed before retesting. Take approximately 10 minutes to complete each scenario. *Have a PALS provider with current certification administer the test. *Randomly select one BLS scenario for testing, and one respiratory arrest or megacode scenario for testing.
Transcript of INSTRUCTIONS for Skills Testing - ACLS-PALS-BLS.com...PALS MEGACODE - Tachyarrhythmia An 11-year-old...
© 2019 United Medical Education 1
INSTRUCTIONSforSkillsTesting:TheExamineristoreadthecasescenariosaloudtotheexaminee.Astheexamineeworksthrougheachstepinascenario,theexamineristomarkeachcorrespondingsteponthechecklistasCompleteorIncomplete.ItemsmarkedasCompletearetobeperformedcorrectlywithoutguidance.Iftheexamineeneedsguidancethroughastep,thestepmustbemarkedasIncompleteandtheskillstestshouldberepeated.Noadditionalguidanceshouldbegiventotheexamineebeyondtheinformationprovidedinitalics.Areasneedingimprovementshouldbereviewedbeforeretesting.Takeapproximately10minutestocompleteeachscenario.*HaveaPALSproviderwithcurrentcertificationadministerthetest.*RandomlyselectoneBLSscenariofortesting,andonerespiratoryarrestormegacodescenariofortesting.
© 2019 United Medical Education 2
BLSSCENARIO-Childover1yearSingleRescuerYouareadaycareprovidercaringforchildrenthatareplayingatapark.Suddenly,youwitnessa4-year-oldcollapsetotheground.
1. Examineesecuresthescene.(Sceneissafe)
2. Assessespatientresponsiveness.(Nopulsepresent,nobreathsobserved)
3. CallsforhelpandgetsAEDfirst,thenbeginsCPR.
4. DemonstratescorrectCPRhandplacement,onepalmorbothpalmsoneovertheother,on
lowersternumbetweenthenipples.
5. PerformssinglerescuerCPR:30compressions/2breathsfor5cycles(2min).
6. Demonstratescorrectcompressionrate,depthandcompletechestrecoil.
7. Opensairway,giveseffectivebreaths,andobservesvisiblechestrise.(Helparriveswithan
AED.)
8. DemonstratescorrectplacementofAEDpads.
9. Clearofthepatientduringrhythmanalysis/shock.
10. ContinuesCPRimmediatelyaftershockdelivery.
© 2019 United Medical Education 3
BLS - Skills Verification Checklist Skill Tested
Completed
Yes No
Establishesscenesafety.
Assessespatientresponsiveness(stimulate/speaktochild,check
breathing/pulse)
Collapsewitnessed:Callsemergencyresponse,getsAED,thenstartsCPR.
Demonstratescorrecthandplacement(oneorbothpalmsoneoverthe
other,onlowersternumbetweenthenipples.)
Delivers30compressions/2breathsover,5cycles(2min).
DemonstratescorrectCPRrate:(100-120/min.)anddepth(2inches).
Allowscompleterecoilofchestbetweencompressions.
Opensairwayappropriately(headtilt/chinlift,jawthrust).
Delivers2breathswithvisiblechestrise.
PerformscorrectAEDplacement.
Staysclearofpatientforrhythmanalysisandshock.
ImmediatelyresumesCPRaftershock.
© 2019 United Medical Education 4
BLSSCENARIO-Childover1yearTwoRescuersYouandafriendarewatchingchildrenplayinapublicpool.Thepoolisverybusywithseveralfamiliesswimming.Suddenlyyounoticea3-year-oldlyingfacedowninthepoolmotionless.
1. Establishesscenesafety.(Sceneissafe.)
2. Assesseschild’sresponsiveness.(Nopulsedetected.patientisnotbreathing.Thereare
severaladultstherereadytohelp.)
3. ExamineedirectsbystandertocallforhelpandgetAED,whileexamineebegins2provider
CPR.
4. DemonstratescorrectCPRhandplacement:onepalmorbothpalmsoneovertheother,on
lowersternumbetweenthenipples.
5. Provides15compressions/2breaths,for10cycles(2min).
6. Demonstratescorrectcompressionrate,depth,andallowsforcompletechestrecoil.
7. Opensairwayappropriately,andobservesvisiblechestrisewithbreaths.(Bystanderhas
returnedwithAED.)
8. Examineeswitchesrolewithsecondprovider.Secondprovidernowperformsopposite
role(compressionsorbreaths).
9. ExamineedemonstratescorrectplacementofAEDwithoutinterruption.
10. Examineedirectseveryonetobeclearofpatientduringrhythmanalysisandshock.
11. ContinuesCPRimmediatelyaftershockdelivered.
© 2019 United Medical Education 5
BLS - Skills Verification Checklist Skill Tested
Completed
Yes No
Establishesscenesafety.
Assessespatientresponsiveness.(Stimulatesandspeakstochild.Checksfor
breathingandapulse.)
DirectsbystandertocallemergencyresponseandgetAED,andbeginstwo-
providerCPR.
Demonstratescorrecthandplacement:oneorbothpalmsoneovertheother,
onlowersternumbetweenthenipples.
Performs15compressionsto2breathesfor10cycles(2min).
DemonstratescorrectCPRrate(100-120/min.)anddepth(2inches).
Allowscompleterecoilofchestbetweencompressions.
Opensairwayappropriately.(headtilt/chinliftorjawthrust-ifcervical
injuryisnotruledout)
Delivers2breathswhilewatchingforvisiblechestrise.
Providersswitchat2minutes.
CorrectlyplacesAEDwithoutdisruptingcompressions.
Staysclearofpatientforrhythmanalysisandshock.
ImmediatelyresumesCPRaftershock.
© 2019 United Medical Education 6
BLSSCENARIO-Infant0to1yearSingleRescuerYouarebabysittinga4-month-oldinfantthatislyinginhiscrib.Yougotoprepareabottleofmilkandwhenyoureturntheinfantappearstobeunresponsive.
1. Theexamineeshouldsecurethescene.(Sceneissafe)
2. Assessespatientresponsiveness.(Nopulsepresent,nobreathsobserved)
3. Commences2minCPRfirst,thencallsforhelp/getsAED.
4. DemonstratescorrectCPRhandplacement-twofingersoversternumofchest.
5. PerformssinglerescuerCPR:30compressions/2breathsfor5cycles.
6. Demonstratescorrectcompressionrate,depthandcompletechestrecoil.
7. Opensairway,giveseffectivebreaths,andobservesvisiblechestrise.(Helparriveswithan
AED)
8. DemonstratescorrectplacementofAEDpads.
9. Staysclearofthepatientduringtherhythmanalysisandshock.
10. ContinuesCPRimmediatelyaftershockdelivery.
© 2019 United Medical Education 7
BLS - Skills Verification Checklist Skill Tested
Completed
Yes No
Establishesscenesafety.
Assesspatientresponsiveness.(stimulatesandspeakstoinfant,check
breathingandpulse)
Collapseun-witnessed:Perform2minutesofCPRfirst,thencallsemergency
responseandretrievestheAED.
Demonstratescorrecthandplacement.(twofingersonsternumoflower
chest)
Delivers30compressionsto2breathsover5cycles(2minutes).
DemonstratescorrectCPRrate(100-120/min.)anddepth(1.5in.or1/3of
chest).
Allowscompleterecoilofchestbetweencompressions.
Airwayopenedappropriately(headtilt/chinlift,jawthrust).
Delivers2breathswithvisiblechestrise.
CorrectAEDplacementwithoutdisruptingcompressions.
Staysclearofpatientforrhythmanalysisandshock.
CPRimmediatelyresumedaftershock.
© 2019 United Medical Education 8
BLSSCENARIO-Infant0to1yearTwoProviderRescueYouandanothernursearegettingdinnerafterashiftwhenawomanyellsforhelp.Her3-montholdinfanthasbecomeunresponsive.
1. Establishesscenesafety.(Sceneissafe)
2. Assessesinfant’sresponsiveness.(Nopulsedetected,notbreathing)
3. ExamineedirectsmothertocallforhelpandgetAED,andproceedstoperformtwo-
providerCPR.
4. DemonstratescorrectCPRhandplacement,havingthehandsencircletheinfant’storso
withthumbsmidlineoversternum,1cmbelownippleline.
5. Gives15compressionsto2breathsfor10cycles.
6. Demonstratescorrectcompressionrate,depth,andallowsforcompletechestrecoil.
7. Opensairway,andobservesforvisiblechestrisewithbreathsgiven.(motherhasreturned
withAED).
8. Examineeswitchesroleswithsecondprovider.SecondprovidernowperformsCPR
compressions.
9. ExamineedemonstratescorrectplacementofAEDpads,withoutdisruptingcompressions.
10. Examineedirectseveryonetobeclearofpatientduringrhythmanalysisandshock.
11. ContinuesCPRimmediatelyaftershockdelivered.
© 2019 United Medical Education 9
BLS - Skills Verification Checklist Skill Tested
Completed
Yes No
Establishesscenesafety.
Assessespatientresponsiveness.(Stimulatesandspeakstoinfant.Checksfor
breathingandpulse.)
Startstwo-providerCPR.
Demonstratescorrecthandplacement(handsencircleinfant’storsowith
boththumbspositionedmidlineoverthesternum,1cmbelownipples.)
Performs15compressionsto2breathesfor10cycles(2min).
DemonstratescorrectCPRrate(100-120/min.)anddepth(1.5in.or1/3of
chest).
Allowsforcompleterecoilofthechestbetweencompressions.
Openstheairwayappropriately(headtilt/chinlift,jawthrust).
Delivers2breathswithvisiblechestrise.
ProvidersswitchCPRrolesat2minutes(10cycles).
PlacestheAEDpadsonthepatientcorrectly,withoutdisrupting
compressions.
Staysclearofpatientforrhythmanalysisandshock.
ResumesCPRimmediatelyaftershock.
© 2019 United Medical Education 10
RESPIRATORYARRESTSCENARIOYouarewatchinga2-year-oldthatissittingatthetableeatinggrapes.Afewmomentslateryounoticeheissilent,andappearscyanotic.
1. Assessesairway,breathing,andcirculation.(Patientunabletomakenoise,notbreathing,pulsepresent)
2. Distinguishesbetweencompleteandpartialairwayobstruction.3. Initiatesemergencyresponseandcallsforhelp.4. Recognizesneedforintervention:Heimlichmaneuver5. DemonstratesHeimlichmaneuvercorrectlybyplacingarmsaroundthepatient’swaist,
havingtheirhandoverfist,withthumbsideoffistabovenaval,andthenprovidesfastupwardabdominalthrusts.
YouareperformingtheHeimlichmaneuverbutthechildsuddenlybecomesunresponsive
6. BeginsCPRimmediately:singlerescuerCPR30:2ratio7. Priortorescuebreaths,checksforobstructioninpatient’smouth(After2cycles:You
noticethegrapeisnowvisibleinthemouth.)8. Removestheobstructionfromthepatient’smouth.9. ContinuesCPR.(Patientnowbreathingspontaneously,strongpulsepresent).10. Monitorspatientconditionuntilparamedicsarrive.
© 2019 United Medical Education 11
PALS Skills Verification Checklist - Airway Management Skill Tested
Completed
Yes No
Assessairway,breathing,andcirculation.
Identifiescompleteairwayobstruction.(abletodistinguishbetweenpartial
andcomplete)
Activatesemergencyresponseandcallsforhelp.
Identifiescorrectintervention:Heimlichmaneuver.
PerformsHeimlichmaneuvercorrectly:armsaroundwaist,handoverfist,
thumbsideoffistabovenaval,fastupwardabdominalthrusts.
BeginsCPRoncepatientbecomesunresponsive.
Checksforobstructioninmouthpriortogivingrescuebreaths.
Removesobstructiononceitisvisible.
ContinuesCPR.
Monitorspatientconditionuntilhelparrives.
© 2019 United Medical Education 12
PALSMEGACODE-TachyarrhythmiaAn11-year-oldboyisbroughtintotheERforheartpalpitations,shortnessofbreathandfeelingfatigued.
1. Evaluates/assessesairway,breathing,andcirculation.(Patientappearssluggishbutanswersquestions,increasedrespiratoryeffortandnasalflaring,coolskin.)
2. Performsimmediateinterventions:maintainairway,placecardiacmonitor,BPcuff,pulseox,givesupplementaloxygen,startIV,ECG.
Patient’svitalsigns:HR-210bpm,BP-84/62,RR-30/min,spO2-91%.Therhythmonthecardiacmonitorshowsthefollowing:
3. ShowexamineerhythmstripforSVT;AskexamineetoidentifybetweenwideornarrowQRS.
4. HaveexamineeidentifybetweensinustachycardiaandSVT.5. Haveexamineeidentifybetweenstableorunstable.
PatientisinSVTwithpoorperfusion.Cardioversionisnotimmediatelyavailable.Whatinterventionswillyouattemptfirst?
6. Attemptvagalmaneuversfirst.(Vagalmaneuversunsuccessful)7. Administersadenosine.Verbalizescorrectinitialdose-0.1mg/kg,max6mg.(Nochangein
patientconditionafterinitialdose)8. Administersseconddoseadenosine,verbalizes0.2mg/kg,max12mg.(Adenosineis
ineffective)9. Performssynchronizedcardioversion.Verbalizescorrectdose0.5-1J/Kg
Patienthasconvertedbacktonormalsinusrhythm
10. Reassesses/monitorspatientcardiopulmonarystatus.Evaluateforsignsofheartfailure,ECG,orderslabtests,etc.
© 2019 United Medical Education 13
PALS Skills Verification Checklist - Tachyarrhythmia Skill Tested
Completed
Yes No
Initialassessment:airway,breathingandcirculation
Initiatesappropriateinterventionsfortachyarrhythmia:
Maintainsairway,providessupplementaloxygen,placescardiacmonitor,
pulseox,BPcuff,initiatesIV,ECG
CorrectlyidentifiesnarrowQRS
CorrectlydistinguishesbetweensinustachycardiaandSVT
CorrectlydistinguishesbetweenstableorunstableSVT
Performsvagalmaneuvers
Administersadenosine,verbalizescorrectdoses.1stdose:.01mg/kg(6mg
max)2nddose:0.2mg/kg(12mgmax)
Performscardioversion,verbalizescorrectdose0.5-1J/Kg
Reassesses/monitorspatientstatuspost-conversion.
© 2019 United Medical Education 14
PALSMEGACODE-BradyarrhythmiaYourparamedicteamiscalledtothesceneofa7yea-oldgirlhavingaseizure.
1. Assessesairway,breathing,andcirculation.(Patientexhibitsdecreasedrespiratoryeffort,weakpulse,nonresponsive.)
2. Performsimmediateinterventions:maintainairway,givesupplementaloxygen,placecardiacmonitor,BPcuff,pulseox,startIV,placedefibpads.
Patient’svitalsigns:HR-44bpm,BP-84/52,RR-8/min,spO2-75%,Temp-99.9F.Cardiacmonitorshowsfollowingrhythm(showrhythmstripforsinusbradycardia)
3. Examineecorrectlyidentifiescardiacrhythmandpatientstateofhypoxemia.4. Identifiescorrectintervention:needforoxygenation/ventilationwithnon-rebreather
mask.
Despiteoxygenationandventilationpatientcontinuestohavepoorperfusion.Newvitals:HR-58,spO2-85%,BP-84/56.
5. IdentifiesCPRneededtotreatbradycardia,beginsCPR(Bradycardiapersists)6. PerformscorrectCPRratio15:2for10cycles(2min)7. Givesepinephrine.Verbalizescorrectdose-0.01mg/kg,every3-5min
Atrhythmcheckthereisnopulse,themonitorshowsthefollowingrhythm(showrhythmstripforVT)
8. Recognizespulselessarrestandidentifiesshockablerhythm.9. Deliversshock,verbalizescorrectdose-firstshock2J/kg10. Makessureeveryoneisclearofpatient.11. Continues2minCPR,immediatelyaftershock.(Whatinterventionmayyouconsider
duringCPR?Advancedairway)AtnextrhythmcheckpatienthasachievedROSC.
12. Identifiespost-arrestcare:optimizeventilation/oxygenation,identify/treatreversiblecausesH&T’s,considersfluidbolus,monitor/treatseizures.
© 2019 United Medical Education 15
PALS Skills Verification Checklist - Bradyarrhythmia Skill Tested
Completed
Yes No
Assessesairway,breathingandcirculation
Initiatesappropriateinterventions:Maintainsairway,providessupplemental
oxygen,placescardiacmonitor,pulseox,BPcuff,IV,defibpads
Correctlyidentifiessymptomaticbradycardia
Identifiescorrectimmediateintervention:oxygenation/ventilation
IdentifieswhenCPRisneededtotreatbradycardia
PerformscorrectCPRratio15:2for10cycles(2min)
GivesEpinephrine.Verbalizescorrectdose-0.01mg/kg
Recognizespulselessarrestandidentifiesshockablerhythm
Deliversshock,verbalizescorrectdose.Firstshock2J/kg
Ensuresclearofpatientbeforeadministeringshock
ContinuesCPRimmediatelyaftershock.Considersadvancedairway?
Identifiespost-arrestcare:optimizeventilation/oxygenation,identify/treatreversiblecausesH&T’s,considersfluidbolus,monitor/treatseizures.
© 2019 United Medical Education 16
MEGACODE RHYTHM STRIPS (Key is on the next page.) 1.
2.
3.
© 2019 United Medical Education 17
MEGACODE RHYTHM STRIPS KEY:
1. Supraventricular Tachycardia (SVT) 2. Ventricular Tachycardia – Monomorphic (VT) 3. Sinus Bradycardia
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I, __________________________, the examiner, attest that I am currently certified in Pediatric Advanced Life support (PALS), and that the examinee has successfully completed all aspects of the PALS live skills test as provided by United Medical Education, in accordance with the current international CPR and ECC guidelines. Examinee Name: _______________________ Examinee Signature: __________________________ Date Signed: ______________ Examiner Name: ________________________ Examiner Signature: __________________________ Date Signed: ______________ Corresponding Provider Card Verification Number (VN): _____________________ This sheet is to be kept with the corresponding PALS provider card of the examinee.
