Title Page

  • Conducted on

  • Evaluator You must be on this list to perform Credentialing skills evaluations. If you are not on the approved list, see your training officer before continuing.

  • Home Department of Candidate:

  • Candidate Name *If the Candidate’s name does not appear in the list, select “*Not Available”

  • Type Candidate's name in the following format: Last Name, First Name, License #

  • Level of Credential

Assessment

Instructions

  • READ TO CANDIDATE: Demonstrate the steps of inserting an emergency percutaneous airway with the given equipment. You can assume that all other appropriate assessments and interventions have been performed to determine that placing an emergency percutaneous airway is the appropriate next course of action.

Assessment

  • Locate cricothyroid membrane and clean insertion site with alcohol or betadine

  • Begins with point of catheter at 90° to skin and advances through cricothyroid membrane

  • Insert device into trachea while aspirating free air

  • Remove red stopper and advance fully into trachea

  • Remove needle and dispose in sharps container

  • Confirm placement by auscultating breath sounds and attaching ETCO2 device

  • Secure device

Completion

  • Successfully completed all steps

  • Explain what was not completed correctly

  • Safely completed all steps

  • Explain what was not completed safely

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.