Performance Skill sheet for Health Care Provider CPR

Participants name:___________________________ Date:________________

Performance HPS Score Remarks

Adult Child Infant
1. Check for responsiveness and look at the 10
chest for signs of breathing:
 If the patient is unresponsive
and has normal breathing, place
the victim in the recovery
position, have someone call
emergency response/help, and
monitor the victim for changes.
 If the patient is unresponsive
and has abnormal breathing (not
breathing, or only gasping),
check for a pulse, have someone
call emergency response/help,
and retrieve an AED if available.
2. If a pulse is present but the unresponsive 20
patient is not breathing, perform rescue
breathing:
 Give 1 breath every 5 to 6
seconds for adults,
 Give 1 breath every 3 seconds
for children and infants.
 Each breath lasts 1 second and
should produce visible chest
rise.
3. If a pulse is absent, begin CPR:
 Provide chest compressions
- give 30 chest compressions 20
- hand placement and depth 10
should be appropriate for
the patient's age.
 Open the airway:
- tilt the patient's head back 10
and lift the chin
 Give 2 breaths:
- each breath lasts 1 second 10
and should produce visible
chest rise.
 Time (Perform 2 minutes of CPR 10
(5 cycles of 30 compressions and
2 ventilations).
4. Continue CPR until an AED is available, 10
ALS personnel take over, or the patient
starts to move.
Total 100