Cadaver Lab Follow-Up

Intubation Data Collection Sheet

Instructions: Please provide accurate information regarding the following questions with regards to your first 15 intubations after cadaver lab training. If you need to provide more comments, please record them in the final question.

Disclosure: This data will be used for internal review at the present time. If we obtain IRB/QI approval, we will seek confirmatory reports from supervising attending physicians and medical records.

Question Title

* 1. Fellows name:

Question Title

* 2. Attending:

Question Title

* 3. Date and Time:

Date

Time

AM/PM

Question Title

* 1. Fellows name:

Question Title

* 2. Attending:

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* 3. Date and Time:

Question Title

* 4. MRN