AARC CEU EVALUATION FORM

1 = Poor 2 = Fair 3 = Good 4 = Excellent

PRESENTER

ORGANIZATION

CONTENT

DELIVERY
JoLynn Johnston
Chuck Campbell
Dr. Eric Blom

1 = Poor 2 = Fair 3 = Good 4 = Excellent
Overall value of clinical demonstrations (with Todd C Huntley, MD; Jeffrey Attwood, RRT;
Kimberly Appel, SLP and patients James E Parton, Sr and Carl R Gannon): _____

I ACHIEVED THESE EDUCATIONAL OBJECTIVES
Agree Disagree
Introduction
1. State the name of the
featured product

Current Communication
Devices
1. List three current methods by
which ventilator dependent
patients may communicate

The Blom Tracheostomy Tube
System
1. Identify the parts and
accessories of the Blom
Tracheostomy Tube System

Inner Cannula Functions
1. Explain the structure and
function of the Subglottic
Suctioning Cannula

Speech Cannula Function
1. Describe the structure and
function of the Speech
Cannula
2. State supervision
requirements when using the
Speech Cannula

Patient Candidacy
1. State 2 reasons patients may
not be candidates to use the
Speech Cannula











Procedure for Placement and
Therapy
1. List 2 methods to ensure the
presence of airflow via the
upper airway when the
Speech Cannula is in place.
2. Identify the EVR and explain
its function


Indicate your agreement with the following statement by checking the appropriate response:
The content of this course was presented without bias of any commercial product
or drug
Strongly Agree____ Agree _____ Disagree_____ Strongly Disagree____

Please list any comments/suggestions for improving the Blom Tracheostomy Tube Training
Video:







Please mail to: Certification
Pulmodyne, Inc.
2055 Executive Drive
Indianapolis, IN 46241

Fax to: 317-246-5501

E-mail to: lbrock@Pulmodyne.com