FOOTHILL COLLEGE
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.
Notes: