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MOUTH TO MASK WITH SUPPLEMENTAL OXYGEN

Start Time: Stop Time: Candidate's Name: Evaluator's Name: Takes, or verbalizes, body substance isolation precautions Connects one-way valve to mask Opens patient's airway or confirms patient's airway is open (manually or with adjunct) Establishes and maintains a proper mask to face seal Ventilates the patient at the proper volume and rate Connects the mask to high concentration or oxygen Adjusts flow rate to at least 15 liters per minute Continues ventilation of the patient at the proper volume and rate Note: The examiner must witness ventilations for at least 30 seconds Total: Critical Criteria Did not take, or verbalize, body substance isolation precautions Did not adjust liter flow to at least 15 liters per minute Did not provide proper volume per breath

(more than 2 ventiliation errors per minute)

Date:

Points Possible 1 1 1 1 1 1 1 1 8

Points Awarded

Did not ventilate the patient at a rate of 10-12 breaths per minute Did not allow for complete exhalation

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