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  1. <HTML><HEAD>  <META NAME="GENERATOR" CONTENT="Adobe PageMill 2.0 Win">  <TITLE>Untitled Document</TITLE></HEAD><BODY TEXT="#bafddc" BGCOLOR="#006666" LINK="#ffcc66" ALINK="#fb1814" VLINK="#5cf373"><FORM><H1><FONT COLOR="#eca413">Skill Performance Sheets</FONT></H1><P>Student Name______________________ Date ____________</P>
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  3. <P><TABLE WIDTH="400" BORDER="1" CELLSPACING="2" CELLPADDING="0"><CAPTION ALIGN="BOTTOM"><P ALIGN=LEFT>*If victim is breathing or resumes effective breathing, placein recovery position.</CAPTION><TR><TD COLSPAN="2"><FONT COLOR="#f38568" SIZE=+1> <B>Child Foreign-Body Airway <BR></B></FONT><B> <FONT COLOR="#f38568" SIZE=+1>Obstruction — Conscious</FONT></B></TD></TR><TR><TD WIDTH="80%"><B><FONT COLOR="#ffff3f"> Performance Guidelines</FONT></B></TD><TD WIDTH="20%" ALIGN="CENTER"><B><FONT COLOR="#ffff3f">Performed</FONT></B> </TD></TR><TR><TD WIDTH="75%"> <B><FONT COLOR="#ffff3f">1.</FONT></B> Ask "Are you choking?"</TD><TD ALIGN="CENTER"><INPUT TYPE="checkbox" NAME="checkbox" VALUE="checkbox"></TD></TR><TR><TD> <B><FONT COLOR="#ffff3f">2.</FONT></B> Give abdominal thrusts.</TD><TD ALIGN="CENTER"><INPUT TYPE="checkbox" NAME="checkbox" VALUE="checkbox"></TD></TR><TR><TD> <B><FONT COLOR="#ffff3f">3.</FONT></B> Repeat thrusts until effectiveor victim<BR>     becomes unconscious.</TD><TD ALIGN="CENTER"><INPUT TYPE="checkbox" NAME="checkbox" VALUE="checkbox"></TD></TR><TR><TD COLSPAN="2"> <B><FONT COLOR="#f38568" SIZE=+1>Child Foreign-Body Airway Obstruction—<BR></FONT><FONT SIZE=+1> </FONT><FONT COLOR="#f38568" SIZE=+1>Victim BecomesUnconscious</FONT></B></TD></TR><TR><TD> <B><FONT COLOR="#ffff3f">4.</FONT></B> If second rescuer is available,have him<BR>     or her activate the EMS system.</TD><TD ALIGN="CENTER"><INPUT TYPE="checkbox" NAME="checkbox" VALUE="checkbox"></TD></TR><TR><TD> <B><FONT COLOR="#ffff3f">5.</FONT></B> Perform a tongue-jaw lift,and if you see<BR>     the object, perform a finger sweep to<BR>     remove it.</TD><TD ALIGN="CENTER"><INPUT TYPE="checkbox" NAME="checkbox" VALUE="checkbox"></TD></TR><TR><TD> <B><FONT COLOR="#ffff3f">6.</FONT></B> Open airway and try to ventilate;if still<BR>     obstructed, reposition head and try to<BR>     ventilate again.</TD><TD ALIGN="CENTER"><INPUT TYPE="checkbox" NAME="checkbox" VALUE="checkbox"></TD></TR><TR><TD> <B><FONT COLOR="#ffff3f">7.</FONT></B> Give up to 5 abdominal thrusts.</TD><TD ALIGN="CENTER"><INPUT TYPE="checkbox" NAME="checkbox" VALUE="checkbox"></TD></TR><TR><TD> <B><FONT COLOR="#ffff3f">8.</FONT></B> Repeat steps 5 through 7 untileffective.*</TD><TD ALIGN="CENTER"><INPUT TYPE="checkbox" NAME="checkbox" VALUE="checkbox"></TD></TR><TR><TD> <B><FONT COLOR="#ffff3f">9.</FONT></B> If airway obstruction is notrelieved after<BR>     about 1 minute, activate the EMS system.</TD><TD ALIGN="CENTER"><INPUT TYPE="checkbox" NAME="checkbox" VALUE="checkbox"></TD></TR></TABLE></P>
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  5. <P>Comments _________________________________________</P>
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  7. <P>__________________________________________________</P>
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  9. <P>__________________________________________________</P>
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  11. <P>Instructor __________________________________________</P>
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  13. <P><B>Circle one:</B>      Complete      Needsmore practice</FORM></BODY></HTML>