Fillable Infant CPR Skills Testing Checklist (1 of 2) (City of Oakland)

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Infant CPR Skills Testing Checklist (1 of 2) (City of Oakland)

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1
Basic Life Support
Infant CPR
Skills Testing Checklist (1 of 2)
Student Name __________________________________________________  Date of Test __________________________
Hospital Scenario: “You are working in a hospital or clinic when a woman runs through the door, carrying an infant. She
shouts, ‘Help me! My baby’s not breathing.’ You have gloves and a pocket mask. You send your coworker to activate the
emergency response system and to get the emergency equipment.”
Prehospital Scenario: “You arrive on the scene for an infant who is not breathing. No bystander CPR has been provided.
You approach the scene and ensure that it is safe. Demonstrate what you would do next.”
Assessment and Activation
☐ Checks responsiveness ☐ Shouts for help/Activates emergency response system
☐ Checks breathing ☐ Checks pulse
Once student shouts for help, instructor says, “Here’s the barrier device.”
Cycle 1 of CPR (30:2) *CPR feedback devices are required for accuracy
Infant Compressions
☐ Performs high-quality compressions*:
• Placement of 2 fingers or 2 thumbs 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, approximately 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
• Resumes compressions in less than 10 seconds
Cycle 2 of CPR (repeats steps in Cycle 1) Only check box if step is successfully performed
☐ Compressions  ☐ Breaths  ☐ Resumes compressions in less than 10 seconds
Rescuer 2 arrives with bag-mask device and begins ventilation while Rescuer 1 continues compressions with 2 thumb–
encircling hands technique.
Cycle 3 of CPR
Rescuer 1: Infant Compressions
☐ Performs high-quality compressions*:
• 15 compressions with 2 thumb–encircling hands technique
• 15 compressions in no less than 7 and no more than 9 seconds
• Compresses at least one third the depth of the chest, approximately 1½ inches (4 cm)
• Complete recoil after each compression
Rescuer 2: Infant Breaths
This rescuer is not evaluated.
(continued)
© 2020 American Heart Association
2
Basic Life Support
Infant CPR
Skills Testing Checklist (2 of 2)
Student Name __________________________________________________  Date of Test __________________________
(continued)
Cycle 4 of CPR
Rescuer 2: Infant Compressions
This rescuer is not evaluated.
Rescuer 1: Infant Breaths
☐ Gives 2 breaths with a bag-mask device:
• Each breath given over 1 second
• Visible chest rise with each breath
• Resumes compressions in less than 10 seconds
STOP TEST
Instructor Notes
 • Place a check 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 _________________________
© 2020 American Heart Association
Basic Life Support
Infant CPR
Skills Testing Critical Skills Descriptors
1. Assesses victim and activates emergency response system (this must precede starting compressions)
within 30 seconds. After determining that the scene is safe:
• Checks for responsiveness by tapping and shouting
• Shouts for help/directs someone to call for help and get emergency equipment
• 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
• Checks brachial pulse
 – Should be done simultaneously with check for breathing
 – Checks for a minimum of 5 seconds and no more than 10 seconds
2. Performs high-quality chest compressions during 1-rescuer CPR (initiates compressions within 10
seconds after identifying cardiac arrest)
• Correct placement of hands/fingers in center of chest
 – 1 rescuer: 2 fingers or 2 thumbs just below the nipple line
 – If the rescuer is unable to achieve the recommended depth, it may be reasonable to use the heel of
one hand
• Compression rate of 100 to 120/min
 – Delivers 30 compressions in 15 to 18 seconds
• Adequate depth for age
 – Infant: at least one third the depth of the chest (approximately 1½ inches [4 cm])
 – Use of a commercial feedback device or high-fidelity manikin is required
• Complete chest recoil after each compression
• Appropriate ratio for age and number of rescuers
 – 1 rescuer: 30 compressions to 2 breaths
• Minimizes interruptions in compressions
 – Delivers 2 breaths so less than 10 seconds elapses between last compression of one cycle and first
compression of next cycle
3. Provides effective breaths with bag-mask device during 2-rescuer CPR
• Opens airway adequately
• 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. Switches compression technique at appropriate interval as prompted by the instructor (for purposes of
this evaluation). Switch should take no more than 5 seconds.
5. Performs high-quality chest compressions during 2-rescuer CPR
• Correct placement of hands/fingers in center of chest
 – 2 rescuers: 2 thumb–encircling hands just below the nipple line
• Compression rate of 100 to 120/min
 – Delivers 15 compressions in 7 to 9 seconds
• Adequate depth for age
 – Infant: at least one third the depth of the chest (approximately 1½ inches [4 cm])
• Complete chest recoil after each compression
• Appropriate ratio for age and number of rescuers
 – 2 rescuers: 15 compressions to 2 breaths
• Minimizes interruptions in compressions
• Delivers 2 breaths so less than 10 seconds elapses between last compression of one cycle and first
compression of next cycle
© 2020 American Heart Association
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Infant CPR Skills Testing Checklist (1 of 2) (City of Oakland)

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Completed 20 November 2021

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