Fillable Infant CPR Skills Testing Checklist (Hutchinson Community College)

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Infant CPR Skills Testing Checklist (Hutchinson Community College)

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Infant CPR
Skills Testing Checklist
Student Name __________________________________________________ Date of Test _______________________________
Scenario: “While you are pushing a baby in a stroller at the park, you notice something is wrong with the baby. You do
not have a phone nearby. You ensure that the scene is safe and take the baby out of the stroller. Demonstrate what you
would do next.”
Assessment and Activation
☐
Checks responsiveness
☐
Shouts for help
☐
Checks breathing
Cycle 1 of CPR (30:2) *CPR feedback devices preferred for accuracy
Infant Compressions
☐
Performs high-quality compressions*:
• Placement of 2 ngers in the center of the chest,
just below the nipple line
• 30 compressions in no less than 15 and no more
than 18 seconds
• Compresses at least one third the depth of the
chest, about 1½ inches (4 cm)
• Complete recoil after each compression
Infant Breaths
☐
Gives 2 breaths with a barrier device:
• Each breath given over 1 second
• Visible chest rise with each breath
• Gives 2 breaths in less than 10 seconds
Cycle 2 of CPR (repeats steps in Cycle 1) Only check box if step is successfully performed
☐
Gives 30 high-quality compressions
☐
Gives 2 effective breaths
Once student shouts for help, instructor says, “No one is around to help.”
STOP TEST
Instructor Notes
• Place a ✓ in the box next to each step the student completes successfully.
• If the student does not complete all steps successfully (as indicated by at least 1 blank check box), the student must receive
remediation. Make a note here of which skills require remediation (refer to Instructor Manual for information about remediation).
Test Results
Check
PASS or NR to indicate pass or needs remediation: PASS NR
Instructor Initials __________ Instructor Number _____________________________ Date _____________________________
© 2016 American Heart Association
Cycle 3 of CPR (repeats steps in Cycle 1) Only check box if step is successfully performed
☐
Gives 30 high-quality compressions
☐
Gives 2 effective breaths
Instructor says, “You have just completed 5 sets of 30 compressions and 2 breaths.”
Activates Emergency Response System (9-1-1)
☐
Verbalizes the need to leave to phone 9-1-1
Infant CPR
Skills Testing Critical Skills Descriptors
1. Assesses infant and activates emergency response system (this must precede starting compressions) within
a maximum of 30 seconds. After determining that the scene is safe:
• Checks for responsiveness by tapping and shouting
• Shouts for help
• Checks for no breathing or no normal breathing (only gasping)
– Scans from the head to the chest for a minimum of 5 seconds and no more than 10 seconds
2. Cycle 1: Performs high-quality chest compressions (initiates compressions immediately after recognition of
cardiac arrest)
• Correct placement of fingers in center of chest
– 2 fingers just below the nipple line
• Compression rate of 100 to 120/min
– Delivers 30 compressions in 15 to 18 seconds
• Compression depth and recoil—compress at least one third the depth of the chest, about 1½ inches (4 cm)
– Use of a commercial feedback device/manikin is highly recommended
– Complete chest recoil after each compression
3. Cycle 1: Provides 2 breaths by using a barrier device
• Opens airway adequately
– Uses a head tilt–chin lift maneuver
• Delivers each breath over 1 second
• Delivers breaths that produce visible chest rise
• Avoids excessive ventilation
• Resumes chest compressions in less than 10 seconds
4. Cycle 2: Performs same steps for compressions and breaths as in Cycle 1
5. Cycle 3: Performs same steps for compressions and breaths as in Cycle 1
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Completed 25 July 2020

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