Mouth to Mask Ventilation

Candidate Name: _________________________________________ Date: ______________________

Examiner Name and Signature: _________________________________________________________

Time Started: __________ Time Ended: __________ Points: _____/7 PASS/FAIL (Circle One)

Points Possible Points Awarded
Maintains the head in a neutral position if a cervical spine injury is suspected. 1
Assembles the pocket mask correctly. 1
Connects the pocket mask to an oxygen source and sets flow of oxygen to 10 to 15 LPM. (If Available) 1
Effectively opens the patient's airway. 1
Correctly inserts the oropharyngeal airway (OPA) or nasopharyngeal airway (NPA) 1
Places the pocket mask over the patient's mouth and nose and ensures a proper seal. 1
Allows for adequate exhalation between ventilations. 1

Points Possible: 7                      Total Points Awarded_______________

Critical Criteria

☐ Failure to ensure proper seal of pocket mask.

☐ Failure to effectively ventilate patient.


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