ANGELES UNIVERSITY FOUNDATION
College of Nursing
                                     Angeles City
                            SKILLS CHECKLIST FOR
                   INFANT CARDIOPULMONARY RESUSCITATION
Name and Signature of Student:_______________________________________
                       One Rescuer Infant BLS Skills Evaluation
 Skill            Critical Performance Criteria             Competent        Not
 Step                                                                      Competent
  1      ASSESSMENT: Checks for response and for no
         breathing or only gasping (at least 5 seconds but no
         more than 10 seconds)
  2      Sends someone to ACTIVATE emergency response
         system.
  3      Checks for PULSE. (No more than 10 seconds)
  4      GIVES HIGH QUALITY CPR:
             • Correct compression FINGER PLACEMENT
             • ADEQUATE RATE: At least 100/min. (i.e.
                Delivers each set of 30 compressions in 18
                seconds or less)
             • ADEQUATE DEPTH: Delivers compressions at
                least 1/3 the depth of the chest. (approx. 4cm
                or 1.5 inches)
             • ALLOWS COMPLETE CHEST RECOIL
             • MINIMIZES INTERRUPTION: Gives 2 breaths
                with pocket mask in less than 10 seconds
                               Two Rescuer CPR and SWITCH
                  th
  5      During 5 set of compressions: Second rescuer arrives
         with bag mask device. RESCUERS SWITCH ROLES.
  6      Both rescuers RESUME HIGH QUALITY CPR
             • SECOND RESCUER gives 15 compressions in
                9 seconds or less by using 2 thumb encircling
                hands technique (for 2 cycles)
             • FIRST RESCUER successfully delivers 2
                breaths with bag mask (for 2 cycles)
               AFTER 2 CYCLES, PROMPT RESCUERS TO SWITCH ROLES
  7      Both rescuers RESUME HIGH QUALITY CPR
             • FIRST RESCUER gives 15 compressions in 9
                seconds or less by using 2 thumb encircling
                hands technique (for 2 cycles)
             • SECOND RESCUER successfully delivers 2
                breaths with bag mask (for 2 cycles)
                                             Remediation (if needed):
Instructor’s Signature:__________________    Instructor’s Signature:__________________
Instructor’s Name:_____________________      Instructor’s Name:_____________________
Date:_____________                           Date:_____________