Common mistakes in professional rescuer CPR skills - Lifeguard Training

The 2012 lifeguard manual is at: http://www.instructorscorner.org/media/resources/l/lg_part_manual_landing.html

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

failing to carefully clean manikin faces between use when needed

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INITIAL ASSESSMENT

refer to: Skill Sheet Primary Assessment on page 151 in your text.

At step 1 a common mistake is:

Not using a combination of tapping and shouting

at step 2, telling someone to "call the police" instead of call 911. Remember the exceptions to calling 911 at this point if you are the only rescuer (call first or care first). They are on page 147.

If alone and you must leave the victim to call 911, failing to place an adult/child victim in the recovery position, or H.A.IN.E.S. position shown below,

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 is not normal breathing.

Pressing too hard when checking for a pulse.

Not checking for pulse at the groove at the side of the neck of 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

Giving ventilations, page 181

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)

Step 2

Pursing your lips and blowing at the pocket mask instead of putting your mouth around the pocket mask opening and blowing in to the pocket mask

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

Not tilting the adult 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)

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

Step 3

Not checking for pulse at the groove at the side of the neck of 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

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

Not rechecking for signs of circulation after two minutes of rescue breathing - about 24 breaths for an adult, 40 breaths for a child/infant

Not keeping the airway open, putting them in a recovery posistion when/if an unconscious victim starts breathing again

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When using a BVM, (see page 182) concentrating on the use of the bag-valve-mask resuscitator and not tilting the head back far enough.

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common mistakes in CPR (pages 207 ...) include:

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

Step 1

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

(adult/child) putting the heel of your hand at other than the center of the chest

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

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, but not as low as the xyphoid.

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.

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

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

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 208...) 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 5)

failing to finish with 2 rescue breaths

stepping over the victim the change roles

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

stepping over the victim the change roles

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