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					BLS for Healthcare Providers

CPR Critical Skills Testing Checklist
Name: _______________________________________ Date of Test: ______________________

Test Summary
PASS = Steps all checked (done correctly) NR = Needs remediation

Adult/Child 1-Rescuer CPR Skills Test
Skill Critical Performance Steps Step
Infant 1R + 2R CPR PASS NR
☑ if done correctly

Indicate PASS or NR: 1R CPR PASS NR 2R CPR + AED PASS NR

1 2 3 4

Checks for response Activates emergency response system/calls for AED Opens airway using head tilt–chin lift Checks breathing Minimum 5 seconds; maximum 10 seconds Gives 2 breaths (1 second each) Checks carotid pulse Minimum 5 seconds; maximum 10 seconds Locates CPR hand position Delivers first cycle of compressions at correct rate Acceptable <23 seconds for 30 compressions Gives 2 breaths (1 second each) Delivers second cycle of compressions at correct hand position Acceptable >23 compressions Gives 2 breaths (1 second each)

Instructor’s signature affirms that skills tests were done according to AHA guidelines. Instructor’s Signature: __________________________________ Print Instructor’s Name: ________________________________ Date: _________________________________________________

5 6 7 8 9 10 11

The next step is done only with a manikin with a feedback device, such as a clicker or light. If no feedback manikin, STOP THE TEST.

12

Delivers third cycle of compressions of adequate depth with full chest recoil Acceptable >23 compressions STOP THE TEST PASS NR

© 2006 American Heart Association, Inc. Reproduction permitted only for American Heart Association Instructor Updates or Provider Course Bridge Materials. All other uses are prohibited.

Adult 2-Rescuer CPR + AED Skills Test
Skill Step Critical Performance Steps
☑ if done correctly

Infant 1- and 2-Rescuer CPR Skills Test
Skill Step Critical Performance Steps
Checks for response Activates emergency response system Opens airway using head tilt–chin lift Checks breathing Minimum 5 seconds; maximum 10 seconds Gives 2 breaths (1 second each) with visible chest rise Checks brachial pulse Minimum 5 seconds; maximum 10 seconds Locates CPR finger position Delivers first cycle of compressions at correct rate Acceptable <23 seconds for 30 compressions Gives 2 breaths (1 second each) with visible chest rise

☑ if done correctly

Rescuer arrives with AED while CPR is in progress.

1 2 3 4 5 6 7 8 9

1 2 3 4 5

Turns AED on Selects proper AED pads and places pads correctly Clears victim to analyze (must be visible and verbal check) Clears victim to shock/presses shock button (must be visible and verbal check) Maximum time from AED arrival <90 seconds Resumes chest compressions after 1 shock

Student being tested continues chest compressions; other student does breathing with bag mask. Test only student doing compressions.

6 7 8 9

Delivers cycle of compressions at correct rate Acceptable <23 seconds for 30 compressions Pauses to allow other rescuer to give 2 breaths Delivers cycle of compressions using correct hand position Pauses to allow other rescuer to give 2 breaths

Second rescuer arrives and takes over breathing with bag mask. Test only first rescuer.

10 11 12 13

Switches places with little interruption. Student being tested takes over breathing using bag mask. Students perform 2 more cycles of CPR. Test only student giving breaths.

1st rescuer delivers cycle of compressions at correct finger position Acceptable >11 of 15 compressions 1st rescuer pauses to allow 2nd rescuer to give 2 breaths 1st rescuer delivers cycle of compressions Measure depth only if using instrumented manikin; otherwise observe that compressions are given. 1st rescuer pauses to allow 2nd rescuer to give 2 breaths

10

Gives 2 breaths during pauses in compressions using bag mask (2 cycles) STOP THE TEST PASS NR

Rescuers switch places with little interruption. 1st rescuer takes over breathing using bag mask. Students perform 2 more cycles of CPR. Test only 1st rescuer.

14

1st rescuer gives 2 breaths during pauses in compressions using bag mask (2 cycles) STOP THE TEST PASS NR

© 2006 American Heart Association, Inc. Reproduction permitted only for American Heart Association Instructor Updates or Provider Course Bridge Materials. All other uses are prohibited.

RECORD ALL TEST RESULTS ON SIDE ONE.

BLS for Healthcare Providers

Adult/Child 1-Rescuer CPR Student Practice Check Sheet for Remediation
Step
1 2 3

Critical Performance Steps
_____ Check for response _____ Activate emergency response/tell someone to get AED _____ Open airway using head tilt–chin lift

Details
Tap the victim. Ask if the person is “all right” or “OK,” speaking loudly and clearly. Direct someone to perform BOTH actions. Place palm of one hand on forehead. Place fingers of other hand under the lower jaw to lift the chin. Mouth is not completely closed. Obvious movement of the head back toward the hand on the forehead. Place face near the victim’s nose and mouth. Look at chest. Continue for at least 5 seconds but no more than 10 seconds. Use pocket mask; seal mouth around tube of pocket mask and exhale into mask. Your exhaled breaths should take approximately 1 second each. Look for chest rise. If no chest rise, reposition the airway and try again. Take no more than 10 seconds to accomplish 2 breaths. Place 2 or 3 fingers of other hand on Adam’s apple (windpipe) and slip fingers into the groove between Adam’s apple and muscles on the side of the neck. Check pulse for at least 5 seconds but no more than 10 seconds. Place heel of one hand in the center of chest, between the nipples. Place the other hand on top of the first hand (or use second hand to grasp wrist of first hand). Extend or interlace fingers but keep them off the chest. Kneel alongside victim and place hands in proper place on sternum. Give 30 compressions in less than 23 seconds. Push hard; push fast; allow chest to return to normal between compressions. Use pocket mask; seal mouth around tube of pocket mask and exhale into mask. Your exhaled breaths should take approximately 1 second each. Look for chest rise. If no chest rise, reposition the airway and try again. Take no more than 10 seconds to accomplish 2 breaths. Push hard, push fast; allow chest to return to normal between compressions. Must have your hands in the correct position more than 23 times. Use pocket mask; seal mouth around tube of pocket mask and exhale into mask. Your exhaled breaths should take approximately 1 second each. Look for chest rise. If no chest rise, reposition the airway and try again. Take no more than 10 seconds to accomplish 2 breaths. Push hard, push fast; allow chest to return to normal between compressions. You must do at least 23 of 30 compressions correctly: adequate depth and allowing the chest to return to normal between compressions.

4

_____ Check breathing

5

_____ Give 2 breaths (1 second each)

6

_____ Check carotid pulse

7

_____ Locate CPR hand position

8

_____ Deliver first cycle of 30 compressions at the correct rate

9

_____ Give 2 breaths (1 second each)

10

_____ Deliver cycle of compressions using correct hand position _____ Give 2 breaths (1 second each)

11

12

_____ Deliver third cycle of compressions of adequate depth with full chest return

© 2006 American Heart Association, Inc. Reproduction permitted only for American Heart Association Instructor Updates or Provider Course Bridge Materials. All other uses are prohibited.
BLS_PrctcSheets_ic.indd 41 1/4/06 8:30:37 AM

BLS for Healthcare Providers

Adult 2-Rescuer CPR With AED Student Practice Check Sheet for Remediation
Step
1 2

Critical Performance Steps
_____ Turn AED on _____ Select proper pads and place pads correctly _____ Clear victim to analyze

Details
Stop CPR and press button to turn AED on (or make sure that AED case is open if your AED has an automatic ON feature). Recognize the difference between adult pads and child pads, select the proper pad size for the manikin, and apply the pads to the chest exactly as prescribed by the pad diagrams or AED instructions. Show a visible sign of clearing the victim along with a verbal indication of clearing the victim such as “I’m clear, you’re clear, everybody’s clear” or simply “Clear” or similar statement with an obvious gesture to ensure that all are clear. Show a visible sign of clearing the victim along with a verbal indication of clearing the victim such as “I’m clear, you’re clear, everybody’s clear” or simply “Clear” or similar statement with an obvious gesture to ensure that all are clear. Press shock button when prompted and after clearing. Time from arrival of AED to first shock must be less than 90 seconds.

Someone is doing CPR and you arrive with an AED.

3

4

_____ Clear victim to shock/press shock button

5

_____ Resume chest compressions after 1 shock

Follow AED/instructor prompts to resume CPR by getting into proper position, placing hands in proper place on the chest, and beginning chest compressions. Kneel alongside victim and place hands in proper place on sternum. Give 30 compressions in less than 23 seconds. Push hard, push fast; allow chest to return to normal between compressions. Pause compressions to allow 2nd rescuer to give 2 breaths with bag mask. Push hard; push fast; allow chest to return to normal between compressions. Must have your hands in the correct position more than 23 times. Pause compressions to allow 2nd rescuer to give 2 breaths with bag mask. Use bag mask, seal mouth properly, and squeeze bag. There should be clearly visible chest rise with each of 2 breaths. Breaths should take approximately 1 second each. You may make multiple attempts to reposition head or improve seal. Repeat 2 breaths for 2 cycles with 2nd rescuer doing chest compressions.

Second rescuer will help perform CPR, taking over breathing and using a bag mask. 6 _____ Deliver cycle of 30 compressions at the correct rate

7 8

_____ Pause to allow other rescuer to give 2 breaths _____ Deliver cycle of compressions using correct hand position _____ Pause to allow other rescuer to give 2 breaths _____ Give 2 breaths during pauses in compressions using bag mask (2 cycles)

9

Switch places with little interruption. You take over breathing using bag mask. Perform 2 more cycles of CPR. 10

© 2006 American Heart Association, Inc. Reproduction permitted only for American Heart Association Instructor Updates or Provider Course Bridge Materials. All other uses are prohibited.
BLS_PrctcSheets_ic.indd 42 1/4/06 8:30:39 AM

BLS for Healthcare Providers

Infant 1- and 2-Rescuer CPR Student Practice Check Sheet for Remediation
Step
1 2 3

Critical Performance Steps
_____ Check for response _____ Activate emergency response system _____ Open airway using head tilt–chin lift Tap infant and shout loudly.

Details
Tell bystander to activate appropriate emergency response. Push back on forehead, place fingers on the bony part of the victim’s chin, and lift the victim’s chin. Do not press the soft tissues of the neck or under the chin. Lift the jaw upward by bringing the chin forward. Do NOT hyperextend the neck. Place face near the victim’s nose and mouth. Look at chest. Continue for at least 5 seconds but no more than 10 seconds. Use pocket mask; seal mouth around tube of pocket mask and exhale into mask. Your exhaled breaths should take approximately 1 second each. Clearly visible chest rise occurs twice. Take no more than 10 seconds to accomplish 2 breaths. Locate the brachial pulse in the manikin’s upper arm closer to you, using the fingers to feel the pulse between the biceps muscle and the humerus. Feel pulse with gentle touch for at least 5 seconds but no more than 10 seconds. Place 2 fingers on the sternum just below the nipple line. Give 30 compressions in less than 23 seconds. Push hard, push fast; allow chest to return to normal between compressions. Use pocket mask; seal mouth around tube of pocket mask and exhale into mask. Your exhaled breaths should take approximately 1 second each. Clearly visible chest rise occurs twice. Take no more than 10 seconds to accomplish 2 breaths. Compress chest with 2-thumb–encircling hands technique over lower ½ of sternum. Pause compressions to allow 2nd rescuer to give 2 breaths with bag mask. Push hard, push fast; allow full chest recoil between compressions. Do 30 compressions. Pause compressions to allow 2nd rescuer to give 2 breaths with bag mask. Use bag mask, seal mouth properly, and squeeze bag. There should be clearly visible chest rise with each of 2 breaths. Breaths should take approximately 1 second each. You may make multiple attempts to reposition head or improve seal. (Sounds of leakage can be present as long as there is visible chest rise.) Repeat 2 breaths for 2 cycles with 2nd rescuer doing chest compressions.

4

_____ Check breathing

5

_____ Give 2 breaths (1 second each) with visible chest rise

6

_____ Check brachial pulse

7 8

_____ Locate CPR finger position _____ Deliver first cycle of 30 compressions at the correct rate _____ Give 2 breaths (1 second each) with visible chest rise

9

Second rescuer will help perform CPR, taking over breathing and using a bag mask. 10 _____ Deliver second cycle of compressions using 2-thumb— encircling hands technique _____ Pause to allow 2nd rescuer to give 2 breaths _____ Deliver third cycle of compressions of adequate depth with full chest recoil _____ Pause to allow 2nd rescuer to give 2 breaths _____ Give 2 breaths during pauses in compressions using bag mask (2 cycles)

11 12

13

Switch places with little interruption. You take over breathing using bag mask. Two more CPR cycles are performed. 14

© 2006 American Heart Association, Inc. Reproduction permitted only for American Heart Association Instructor Updates or Provider Course Bridge Materials. All other uses are prohibited.
BLS_PrctcSheets_ic.indd 43 1/4/06 8:30:40 AM


				
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