ALS Competency asessment form
ALS Competency asessment form
ALS Competency asessment form
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Annual Basic & Advanced Life Support Assessment Form 2011<br />
Name: _______________________ Date: ______________<br />
Ward: ____________________ Signature: ______________<br />
Assessor/s: 1) __________________ Signature: ______________<br />
2) __________________ Signature: ______________<br />
To successfully complete this BLS/<strong>ALS</strong> assessment the participant(s) should<br />
demonstrate/describe the following:<br />
1.Basic Life Support<br />
Per<strong>form</strong>ance Criteria<br />
Indicators of Arrest<br />
2.D-Danger - check your environment/hazards<br />
applies personal protective equipment<br />
3.R-Response-assess, touch and talk<br />
4.S-Send for Help-Note Time<br />
5. A-Airway-assessment/management<br />
Positions patient correctly. Maintains an open<br />
airway.<br />
a. Head tilt -chin-lift<br />
b. Jaw thrust<br />
Use of Guedel airway/trache management /<br />
troubleshooting<br />
Differences with children<br />
4. B-Breathing- look, listen, feel<br />
Assess only, if ineffective commence compressions<br />
5. C- CPR<br />
Per<strong>form</strong> compressions<br />
Depth 1/3 of the chest<br />
rate<br />
hand placement<br />
ventilation/compression ratio<br />
Adults<br />
Infants (
6.Advanced Life Support<br />
Identifies the following rhythms:<br />
-Ventricular tachycardia<br />
-Ventricular fibrillation<br />
-Torsades de Pointes<br />
-SVT<br />
-Asystole<br />
-PEA<br />
-Brady arrhythmia<br />
7.Management of Arrest Situations<br />
Describes management of the following arrest<br />
situations (include drugs, doses, indications, actions &<br />
route/s)<br />
-Pulseless VT<br />
-VF<br />
-Asystole/EMD<br />
-Brady arrhythmia (compromised)<br />
8. Defibrillation Technique AED’s<br />
Describe the principles and technique of early<br />
defibrillation<br />
Demonstrate the procedure of defibrillation<br />
Identify the potential complications of<br />
defibrillation and the steps taken to minimise<br />
these<br />
Outline troubleshooting the defibrillator in the<br />
instance of failure of defibrillation<br />
11. Considers and corrects reversible causes<br />
Specifies 4 H’s and 4 T’s<br />
12.Crash Cart<br />
Demonstrates an understanding of its layout<br />
13. Medical Emergency Team<br />
Indicates criteria for calling MET<br />
14. Choking Aware of treatment for a choking patient<br />
BLS / <strong>ALS</strong> assessment outcome: COMPETENT / NOT COMPETENT<br />
Online competency completed: Yes No<br />
ASSESSORS COMMENTS:<br />
R/Medwards/<strong>ALS</strong> Assessment tool
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