CARL BALITA INSTITUTE OF HEALTH Performance

SCIENCES
Checklist
SCHOOL OF NURSING

Name: Date:

Year level: RLE group:

ADVANCED CARDIAC LIFE SUPPORT

Excellent : 4
Very Satisfactory : 3
Satisfactory : 2
Needs Improvement : 1

PERFORMANCE 4 3 2 1
1 Verify that the scene is safe for you and the victim.
2 Check for responsiveness. Tap the victim’s shoulder and
shout. “Are you OK?”. If the victim is not responsive, shout for
nearby help. If you are alone, get the AED/defibrillator and
emergency equipment. If someone else is available, send that
person to get it.
3 Position yourself on the victim’s side.

4 Check breathing and pulse at the same time not more than 10
seconds. Locate the trachea using 2 or 3 fingers. Slide these 2
or 3 fingers into the groove between the trachea and the
muscles at the side of the neck.
5 If the victim is breathing normally and a pulse is present.
Monitor the victim.
6 If the victim is not breathing, provide rescue breathing. Of one
breath every 5 to 6 seconds, for a rate of 10 to 12 breaths per
minute.
7 Make sure the victim is lying face up on a firm, flat surface. If the
victim is lying facedown, carefully roll him face up. Use the head
tilt chin lift maneuver to open the airway. Place one hand on the
victim’s forehead and apply firm, backward pressure with the
palm to tilt the head back. Place the fingers of the other hand
under the bony part of the lower jaw near the chin and lift the
jaw upward.
8 If you suspect the victim has a head or neck injury, use the jaw-
thrust maneuver to open the airway. Place one hand on each
side of the patient’s head. Rest elbows on the flat surface under
the patient, grasp the angle of the patient’s lower jaw, and lift
with both hands.
9 If the victim is not breathing normally or is only gasping and has
no pulse, Begin high-quality CPR.

10 High quality CPR: 

 Position your hands and body to perform chest
compressions: 
 Put the heel of one hand in the enter of the victim’s chest, on

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 the lower half of the breastbone (sternum), Put the heel of
your other hand on top of the first [Link] your arms
and position your shoulders directly over your hands.
11 Give chest compressions at a rate of 100 to 120/min, Press
down at least 5 cm (2inch) with each compression, and allow
chest recoil. And minimize interruptions.
12 Give two rescue breaths after each set of 30 compressions.
Do five complete cycles of 30 compressions and two
ventilations.
13 Defibrillation should be provided at the earliest possible
moment as soon as AED becomes available. Refer to Skill
Automated External Defibrillation (AHA 2016).
14 ACLS Cardiac Arrest Algorithm
 Provide Oxygen: Deliver oxygen to the patient.
 Attach Monitor/Defibrillator: Apply defibrillator pads.
 Attach a cardiac monitor to assess the heart rhythm.
 Rhythm Check: Pause CPR for no more than 10
seconds to check the rhythm.
15 If the Rhythm is Shockable (VF/pVT)
 Administer Shock: Deliver a shock according to the
defibrillator's guidance.
 Resume CPR: Immediately resume high-quality CPR
for 2 minutes.
 Give Epinephrine: After 2 minutes of CPR, give
epinephrine 1 mg every 3-5 minutes.
 Consider Amiodarone: If the patient remains in
VF/pVT, administer amiodarone or lidocaine.
 Repeat: Continue the cycle of 2 minutes of CPR,
rhythm check, and intervention.
16 If the Rhythm is Not Shockable (Asystole/PEA)
 Give Epinephrine: Immediately give epinephrine 1
mg.
 Resume CPR: Continue high-quality CPR for 2
minutes.
 Rhythm Check: Check the rhythm again.
 Identify and Treat Reversible Causes: Look for the "4
H's and 4 T's" (e.g., hypovolemia, hypoxia, hydrogen
ion acidosis, hypo-/hyperkalemia; tension
pneumothorax, tamponade, toxins, thrombosis).
17 Post-cardiac arrest care once return of spontaneous
circulation (ROSC) is achieved after Advanced
Cardiovascular Life Support (ACLS). The primary goals are
to optimize vital organ perfusion, mitigate the effects of
ischemia and reperfusion injury and identify and treat the
underlying cause of the arrest
 Manage airway and ventilation: Optimize the patient's
airway and breathing, and consider intubation.
 Manage circulation: Titrate fluids and vasopressors to
maintain blood pressure and organ perfusion.
 Perform a 12-lead EKG: Look for evidence of a heart
attack.
 Implement targeted temperature management: For

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 comatose patients, initiate targeted temperature
management to a range of 32–36°C.

REMARKS:

RATING SCALE: DESCRIPTIVE EQUIVALENT

Performs procedures with exceptional accuracy, confidence, and
Excellent 4
independence, adhering to all protocols and ensuring patient comfort.
Very Performs procedures competently with minimal errors, requiring little
3
satisfactory supervision, and communicates effectively with patients.
Performs procedures adequately with some errors, needing occasional
Satisfactory 2
guidance, and demonstrates basic patient communication.
Needs Performs procedures with frequent errors, requiring constant supervision,
1
Improvement and lacks clear or effective patient communication.
Excellent 50 – 60 TOTAL SCORE:
Very satisfactory 38 – 49
Satisfactory 26 – 37
Needs improvement 15 – 25
STUDENT SCORE EQUIVALENT:

EVALUATED BY: CONFORME:

Signature over printed name of Clinical Signature over printed name of Student
Instructor

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