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High-Functioning CPR Team Evaluation
DRAFT
Date: Location:
Scenario/Patient Background:
1. Patient Assessment and Teamwork
Y Partial N N/A Category Pertinent history obtained by team, including enough information to identify any conditions that require variation in care (e.g. pediatric patient, drowning/hypoxic arrest, hypothermia, trauma arrest)
BLS/ALS Care
Team leader clearly identified and takes charge (^) Teamwork - Leadership Team leader assesses situation and resources and modifies accordingly
Teamwork- Leadership Team leader communicates accurately and concisely while listening and encouraging feedback
Teamwork- Communication Pit crew approach to roles without confusion (^) Teamwork- Situational Awareness Team members maintain situational awareness related to their roles (e.g. team member at head monitors capnography and notifies team leader of reading and significant changes)
Teamwork- Situational Awareness Team members use closed loop communication to acknowledge direction from team leader
Teamwork - Communication Team members report on progress on tasks (^) Teamwork- Communication Team members use appreciative inquiry and openly communicate any patient care or safety concerns
Teamwork- Mutual Respect
Comments:
Global rating: a.) Exceeds expectations b.) Meets expectations c.) Needs improvement
2a. First 4 Cycles - High Performance CPR: Actions
Y Partial N N/A Category Patient placed supine on firm surface (^) CPR Quality Initial 4 cycles of 200 uninterrupted compressions without interruption for ventilation (unless reason for ventilation pauses, e.g. pediatric patient, drowning, etc).
CPR Quality
Continue compressions while AED /defibrillator is charging (but not when AED is analyzing rhythm) BLS/ALS Care Switch to manual defibrillation ASAP, when ALS involved (^) ALS Care When indicated, defibrillate at 360 joules or maximum output allowed by device, in adult patient BLS/ALS Care Compressions immediately after defibrillation with NO pulse check. (^) CPR Quality Place naso/oropharyngeal airway or Alternative Airway (King LT or Combitube) If alternative airway inserted, verify position with waveform capnography and auscultation at epigastrium and bilateral midaxillary line (Goal = verify waveform on fist ventilation)
Airway/Ventilation
Apply oxygen (^) Airway/Ventilation Two-person BVM used (when 3-4 rescuers available) (2-thumbs-up technique) Airway/Ventilation If ventilation via BVM or alternative airway, monitor perfusion with continuous capnography
ALS Care
Either provide NO ventilation or deliver one ventilation every 15 compressions without interrupting compressions Airway/Ventilation Establish IO or IV access and delivers EPINEPHrine (1mg 1:10,000, in adult) immediately after access obtained, then every 3-5 minutes ALS Care Antidysrhythmic given if VF/VT persists after first shock (amiodarone 300 mg or lidocaine 1.5 mg/kg) ALS Care Avoid endotracheal intubation during initial 10 minutes (^) Airway/Ventilation
Comments:
Global rating: a.) Exceeds expectations b.) Meets expectations c.) Needs improvement
4. Post-Resuscitation Care after ROSC
Rescuer Names:
Evaluator Name:
Y Partial N N/A After ROSC, promptly assess full vital signs, mental status, and breath sounds (Goal = within first minute) Provide NSS bolus if BP marginal (SBP <110)
Prepare and start pressor drip (DOPAmine or EPINEPHrine) if SBP <
Obtain 12-lead ECG
Team leader or designee runs Post-ROSC checklist
Package (cover for dignity, but do not bundle warmly), and consider not moving patient until initial ROSC sustained (Goal = ROSC for 10 minutes before moving patient) Contact Medical Command to consider cooling and diversion to PCI/Hypothermia center
Comments:
Global rating: a.) Exceeds expectations b.) Meets expectations c.) Needs improvement
