BLS Checklist PDF
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Summary
This document is a checklist for assessing and evaluating basic life support and cardiopulmonary resuscitation skills. It includes criteria for assessment, performance, and defibrillation. The target audience is likely medical or nursing students in the Philippines.
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FM-LPU-NRSG-06/05 College of Nursing Telephone No. (043) 723-0706 loc. 109 / 110 PERFORMAN...
FM-LPU-NRSG-06/05 College of Nursing Telephone No. (043) 723-0706 loc. 109 / 110 PERFORMANCE EVALUATION CHECKLIST NCM 118 – Critical Care & Emergency Nursing Basic Life Support / Cardiopulmonary Resuscitation Name of Student: ________________________________________________ Year / Clinical Group: ______________ Rating______________ Legend: 2 Progress Acceptable (Performance is usually effective and efficient) 1 Needs Improvement (Progress in performance is too slow to judge satisfactorily; task performance is not done properly for majority of the time) CRITERIA PASS REPEAT REMARKS 1. Assessment Tap and shout, “Are you alright?” Check for pulse (carotid for adult & children, brachial for infant) and no breathing, only gasping (scanning the chest for movement about 5 to 10 seconds) Call for HELP (activate emergency response system and bring AED) 2. Performance (CAB sequence) Circulation (If no pulse within 10 seconds, start CPR (30:2) beginning with chest compressions a. Compression Rate: 120 beats per minute b. Compression Depth: Adult & Children: 2 inches Infant: 1.5 inches c. Chest Recoil (allow complete recoil between compressions ) Switch provider about every 2 minutes d. Compression Interruptions Limit interruption to < 10 seconds Airway Head Tilt-Chin Lift Maneuver Breathing Mask (observe for chest rise) Bag mask (5-6 seconds) Ventilation with advance airway 1 breath every 6-8 seconds Avoid excessive ventilation If there is a pulse, start rescue breathing at 1 breathe every 5 to 6 seconds (10 to 12 breaths per minute). Check pulse about every 2 minutes. Defibrillation If no pulse, check for a shockable rhythm with an AED/ Defibrillator as soon as it arrives Provide shocks as indicated Follow each shock with CPR, beginning with compressions Total Score Over-all Performance Rating ____________________ % Evaluatee: Evaluator: ___________________________________ ___________________________________________ Signature of Student Over Printed Name Signature of Clinical Instructor Over Printed Name Date ______________________________ Date ______________________________________ Capitol Site, Batangas City Telephone No. +6343 723-0706 / 2441 Fax No. 723-0595 www.lpu.edu.ph
