Common mistakes in Professional Rescuer CPR skills

This page refers to pages in the American Red Cross CPR/AED for the Professional Rescuer text copyright 2011:

(Lost your CPR Pro text? You can download a free copy. http://editiondigital.net/publication/?i=66319 )

Common mistakes throughout all the skills checkoffs include:

trying to memorize steps without understanding why you are doing what you are doing

forgetting to check the scene for safety

skipping or combining parts because you think it will save time

checking for breathing or pulse for too short a time

anticipating what will happen next and skipping ahead

getting so busy with the physical steps that you forget to have someone call 911

describing to the instructor what you should be doing instead of doing it

forgetting to use protective equipment (breathing barrier / pocket mask and gloves)

not putting the airway (lung bag) into the manikin properly and engaging it with the knob at the back of the manikin face. This will not allow air into the manikin's lungs. See: CPR manikin use for details.

stepping over the victim if you need to move around

mixing up whose pocket mask belongs to who (put your initials on the pocket masks and cases)

failing to carefully clean manikin faces between use when needed

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Primary assessment

Go to page 22 of your book.

At step 1 a common mistake is:

Not using a combination of tapping and shouting

Step 2 Telling someone to "call the police" instead of call 911. Not supporting the victim's head and neck while rolling the victim.

Not rolling the victim as a single unit

Step 3

Not tilting the head back far enough on an adult to open the airway OR tilting it too far on an infant or child

Forgetting to lift the chin

To open the airway, putting your hand under the neck

Incorrect placement of the fingers when lifting the chin, such as putting the fingers on the soft tissues under the jaw instead of under the bony area at the center of the lower jaw

Closing the mouth when lifting the chin

Not placing the ear close enough to the mouth and nose of the victim to check for breathing

Not looking at the chest when checking for breathing (some people look in the wrong direction, out away from the body, as in the photo below).

Not checking long enough for breathing

Agonal breathing is a gasping noise that many people make when they collapse from cardiac arrest. It can be mistaken for breathing. But a gasp or gurgle in the absence of normal breathing is not normal breathing.

(note to professional rescuers - you are taught to do this skill differently than the public, they will not check for a pulse)

When checking for a pulse, not checking for pulse at the groove at the side of the neck on an adult.

Using your thumb to check for pulse instead of your fingers

Forgetting to check brachial pulse on an infant and checking their carotid pulse at the neck instead

Step 4

Forgetting to pop open the pocket mask

Putting the pocket mask on the face in the wrong direction

Not firmly pressing down on a pocket mask or breathing barrier to ensure a tight seal

this is wrong, compare it to the photo in your book:

Not pinching the nose shut (when using certain types of breathing barriers or none at all)

Giving breaths too quickly or forcefully

Breathing too fast or too hard

Not watching to see the chest clearly rise and fall while giving each breath

Not taking a breath before giving each breath

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Recovery Positions (page 26)

A common mistake with the H.A.IN.E.S. position shown below is to move too quickly and not carefully go through the steps, but just roll the victim instead.

Pushing or lifting the victim's head or neck.

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Giving Ventilations (page 27)

Not tilting the head back far enough to get breaths in to make the manikin's chest rise

Not firmly pressing down on a pocket mask or breathing barrier to ensure a tight seal

Trying to use only tips of fingers instead of sides of hands to press down on a pocket mask

Not pinching the nose shut (when using certain types of breathing barriers or none at all)

Giving breaths too quickly or forcefully

Breathing too fast or too hard

Not watching to see the chest clearly rise and fall while giving each breath

Breathing too much on an infant/child or tilting the head as far back as on an adult

Not taking a breath before giving each breath

BVM (page 28)

When using a BVM, concentrating on the use of the bag-valve-mask resuscitator and not tilting the head back far enough.

Step 5

Leaving the breathing barrier, BVM, or pocket mask on the face when checking for breathing

Not rechecking for breathing and a pulse after about two minutes of rescue breathing

Step 6

Not keeping the airway open when/if an unconscious victim starts breathing again

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(Abdominal thrusts, chest thrusts and back blows are equally effective. No one technique is proven better. Frequently, more than one technique is needed to free the obstruction.)

On page 31 it says "if the victim becomes unconscious: carefully lower the victim to the ground and provide care for an unconscious choking victim."

But on page 13 your text says: "Conscious Choking Victim Who Becomes Unconscious. If the victim becomes unconscious, carefully lower the victim to the ground, open the mouth and look for an object. Continue to provide care for an unconscious choking victim."

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Common mistakes in unconscious choking skills (pages 34-35) include:

(A common mistake with an unconscious infant is to mix up the skills for unconscious and conscious.)

Step 1

Not repositioning the airway by retilting the head and giving another ventilation

At any point: Checking for a pulse before the obstruction is cleared and the rescuer is able to breathe air into the victim

Step 2

Not locating the correct hand position to give chest thrusts

for an infant, placing your fingers across/perpendicular to the breastbone instead of in line with it

for an infant, placing fingers more than one inch below the nipple line, or above the nipple line

Step 3

Not looking in the victim's mouth for a foreign object

Step 4

Poking your fingers around in the victim’s mouth if you don’t see anything to take out.

Not using a hooking motion while sliding your finger

Step 6

(if the breaths make the chest clearly rise) Leaving the breathing barrier or pocket mask on the face when checking for breathing

(People who have been previously trained in abdominal thrusts for unconscious choking victims ask why they are now being trained to use chest thrusts. Trials of maneuvers to clear the airway showed that higher airway pressures can be generated by using the chest thrust rather than the abdominal thrust.)

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common mistakes in CPR (page 36) include:

Step 1

(adult/child) Kneeling in the wrong position or place beside the victim

(adult/child) Not properly locating hand position for compressions in the center of the chest. Compressions done out on the ribs or too high or low on the chest will not be effective.

If you could see through to the rib cage, this is what it would look like where you correctly place your hand on the sternum.

Notice in the next picture how big an adult's fingertips are in comparison to an infant's sternum (in this case a 15' tall newborn). Be careful in your placement of fingertips to be certain your compressions will be effective.

for an infant, placing your fingers across/perpendicular to the breastbone instead of in line with it

for an infant, placing fingers more than one inch below the nipple line, or above the nipple line

(adult/child) Placing the palm rather than the heel of the hand on the breastbone when giving compressions.

Not pressing straight down on the chest

(adult/child) not locating your shoulders right over your hands; it is wrong to have your arms at an angle, as in the photo below:

(adult/child) Pressing with bent elbows instead of straight arms and locked elbows

Not giving compressions deep enough - at least 2 inches for an adult, about 2 inches for a child, about 1 1/2 inches for an infant

Jabbing the compressions, that is pushing down faster than you let up. Compressions should be rhythmic, you should spend the same amount of time compressing as you spend releasing.

Rocking while doing compressions

Letting your hands lift off the victim, even slightly, between compressions

Failing to keep your fingers off the chest

(especially on an adult) Trying to use muscular strength to do compressions instead of your body weight

Not letting the chest fully rise to it’s normal position after each compression before pushing down again.

Compressions too fast or slow - at a rate of 100 compressions per minute, 30 compressions should take about 18 seconds. (You can have a partner time you during practice)

Not stopping CPR if you notice an obvious sign of life.

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Common mistakes in two-rescuer CPR (page 38) include:

any of the CPR mistakes above

failing to communicate with each other

failing to call for a change at the right time, after about 2 minutes of compressions and breaths

at the time of a change (step 4)

failing to finish with 2 ventilations

stepping over the victim the change roles

taking more than 7 seconds to change positions

wasting time trying to check for a pulse before continuing CPR after a position change. Changing positions should take LESS than 5 seconds

squeezing the sides of the ribs while giving compressions to an infant

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(Follow the AED prompts when giving care, even if they are different from those above.)

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The Red Cross offers free refreshers for CPR students. Copy and paste this URL into your browser:

www.redcrossrefresher.com/q/cpraed-professional-rescuers-and-health-care-provi/choices/

(Please note that the other refreshers at that page are for Lay Responders and the skills are not the same as for Professional Rescuers.)

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See also:

Why did they change CPR?

How to pass a Red Cross written test

What the AED says as you use it

First Aid for Public Safety Personnel study guide

Simple secondary survey study sheet

Bloodborne Pathogens quick facts

CPR quick facts

AED quick facts

CPR Pro skills review questions