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Skill Assessment Form Cricothyrotomy

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posted:
10/19/2011
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Palm Beach County Fire Rescue

Paramedic Graduate School

Skills Assessment Evaluation









Name: _________________________________ Skill: Cricothyrotomy



Date: ________________ Total Points Page 1: ______



Performance Objective:

Given all the necessary equipment, the paramedic will recognize the need for and be able to

properly perform a cricothyrotomy.



Reference:

1998 D.O.T. Paramedic Curriculum

Florida Regional Common EMS Protocols 2004



Therapeutic Effects: V P P

Establish and maintain an open airway 1



Indications:

Relief of life-threatening upper airway obstruction in which 1

manual maneuvers to establish an airway, endotracheal intubation,

is not possible and attempts at ventilation have failed.

Severe laryngeal edema or facial and upper laryngeal trauma that 1

prevent successful intubation by direct visualization.



Contraindications:

Needle cricothyrotomy is recommended when unable to 1

oxygenate/ventilate children less than 12 years of age.



Side Effects:

Hemorrhage 1

False Passage 1

Subcutaneous or mediastinal emphysema 1

Damage to Thyroid or Parathyroid glands 1









Revised 08/05 1

Palm Beach County Fire Rescue

Paramedic Graduate School

Skills Assessment Evaluation



Name: _________________________________ Skill: Cricothyrotomy



Date: ________________ Total Points Page 2: ______





Demonstration of the Procedure V P P

Takes or verbalizes appropriate Body Substance Isolation (BSI) 2

precautions

Hyperextends the neck unless contraindicated 2

Identifies the Cricothyroid Membrane 2

Retracts the skin and preps with Betadine solution 2

Using a scalpel, makes a vertical incision through the skin and a 2

horizontal incision just large enough to accommodate a 6.0 ETT

through the cricothyroid membrane

Once the scalpel blade has passed through the membrane, inserts 2

hemostats into the incision to maintain the opening

Removes the scalpel blade and inserts the 6.0 ETT caudally 2

through the incision

Ventilates patient with 100% oxygen at the appropriate rate and 2

depth

Verifies proper ETT placement via bilateral breath sounds, 2

absent epigastric sounds, ETCO2 detector, equal chest rise,

direct visualization, ETT fogging, pulse oximetry, etc.

Inflates the cuff with 10cc’s of air and secures the tube in place 2

Properly disposes of the scalpel in an approved container 2



Bolded are mandatory placement verification methods.



Page 1 Possible Points: 8

Page 2 Possible Points: 22

Total Possible Points: 30

Successful completion minimum (80%) 24



Total points received: ________________









Revised 08/05 2

Palm Beach County Fire Rescue

Paramedic Graduate School

Skills Assessment Evaluation









Name: _________________________________ Skill: Cricothyrotomy



Date: ________________





Critical Criteria:

_____Did not take or verbalize BSI precautions.

_____Failure to exercise aseptic technique.

_____Incorrectly identifies membrane.

_____Failure to properly complete the procedure.

_____Failure to properly dispose of the scalpel.







Evaluator Signature: _____________________________ Date: ____________________



Evaluator Print: _______________________________





Evaluator Signature: _____________________________ Date: ____________________



Evaluator Print: _______________________________









Revised 08/05 3


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