ACLS Skills Checklist
ACLS Skills Checklist
ACLS Skills Checklist
Student Name: _________________________________________ Test Date: ________________________
ACLS Bag-Mask Ventilation Check if done
correctly
Testing Checklist Performance Guidelines and Critical Actions
BLS Survey and Interventions
Checks for responsiveness
● Taps and shouts, “Are you alright?”
● Scans check for movement (5-10 seconds)
Activates the emergency response system
● Activates the emergency response system and gets the AED
Or
● Directs second rescuer to activate the emergency response system and get the
AED
● Check carotid pulse (5-10 seconds). Note that pulse is present
● Does not initiate check compressions or attach AED
● Performs ventilations at the correct rate of 1 breath every 5-6 seconds (10-12 breaths
per minute)
ACLS Survey Case Skills
Inserts oropharengeal or nasopharengeal airway
Administer oxygen
Performs correct bag-mask ventilation for 1 minute
Critical Actions
Effectively ventilates with a bag-mask device for 1 minute
Gives proper ventilation - rate and volume
ACLS Advanced Cardiac Life Support Skills Checklist
Student Name: _________________________________________ Test Date: ________________________
Check if done
Steps Adult/Child/ BLS - 1 and 2 Responders correctly
First Rescuer Bag-Mask Ventilation
● Note: Evaluate the first rescuer’s ability to give breaths with a bag mask.
Checks for responsiveness: Taps and shouts, “Are you all right?” and scans
1 the chest for movement (5-10 seconds)
2 Tells someone to activate the emergency response system and get an AED
3 Checks carotid pulse (minimum 5 seconds,maximum 10 seconds)
4 Bares patient’s chest and locates CPR hand position
Delivers first cycle of compressions at correct rate (acceptable: 18 seconds or
5 less for 30 compressions)
6 Gives 2 breaths (1 second each)
Delivers second cycle of compressions at correct hand position (acceptable:
7 greater than 23 of 30 compressions)
8 Gives 2 breaths (1 second each) with visible chest rise
▢ PASS ▢ Needs Retest
Instructor Name: _________________________________________ Date: __________________