EMERGENCY DEPARTMENT  SKILLS CHECKLIST
Name:
When completing this ckecklist, please indicate your level of proficiency in each area according to the scale below. Place a check mark in box which best describes your expertiese with each skill.

The scale is as follows:
1. Not performed   2. Intermitten experience   3. Very experienced.
CARDIOVASCULAR
  1. Assessment of CV system   1 2 3
  2. Use of cardiac monitors   1 2 3
  3. 12 lead EKG  
    1. Principles   1 2 3
    2. Recording of EKG   1 2 3
  4. Recognition and treatment of arrhythmias:  
    1. Atrial   1 2 3
    2. Ventricular   1 2 3
    3. Heart blocks   1 2 3
    4. Ventricular tachycardia   1 2 3
    5. Ventricular fibrillation   1 2 3
    6. Aystole   1 2 3
  5. Care of patient with pacemaker   1 2 3
  6. Use of defibrillator   1 2 3
  7. Assist with cardioversion   1 2 3
  8. Use and administration of the following drugs:  
    1. Atropine   1 2 3
    2. Bretylol   1 2 3
    3. Calcium Chloride   1 2 3
    4. Calcium Gluconate   1 2 3
    5. Digoxin   1 2 3
    6. Dopamine   1 2 3
    7. Epinephrine   1 2 3
    8. Inderal   1 2 3
    9. Isuprel   1 2 3
    10. Levophed/Regitine   1 2 3
    11. Lidacaine   1 2 3
    12. Nipride   1 2 3
    13. NTP   1 2 3
    14. Nubain   1 2 3
    15. Pronestyl   1 2 3
    16. Quinidine   1 2 3
    17. Verapmil   1 2 3
    18. Streptokinasc   1 2 3
    19. Sodium Bicarbonate   1 2 3
  9. Knowledge, recognition and treatment of shock:  
    1. Septic   1 2 3
    2. Hypovolmeic   1 2 3
    3. Cardiogenic   1 2 3
  10. CVP:  
    1. Knowledge of normal readings   1 2 3
    2. Assist with insertion   1 2 3
    3. Obtaining readings   1 2 3
  11. Care of patient with:  
    1. Acute MI   1 2 3
    2. CHF   1 2 3
    3. Aneurysm   1 2 3
    4. Emboli   1 2 3
    5. Angina   1 2 3
    6. Hypothermia   1 2 3
  12. Cardiac arrest (Adult)   1 2 3
  13. Cardiac arrest (Pediatric)   1 2 3
  14. Assessment of chest trauma:  
    1. Open chest massage   1 2 3
    2. Use of rib spreader   1 2 3
  15. Care of patient with the following:  
    1. Cardiac tamponade   1 2 3
    2. Cardiac contusion   1 2 3
    3. Lung contusion   1 2 3
    4. Gunshot wound to the heart   1 2 3
    5. Tear of major vessels   1 2 3
GASTROINTESTINAL
  1. Insertion and/or assist with placement of:  
    1. N/G tube   1 2 3
    2. Ewald tube   1 2 3
    3. Blakemore-Sengstaken tube   1 2 3
  2. Gastric lavage   1 2 3
  3. Care of patient with:  
    1. GI bleed   1 2 3
    2. Esophageal varices   1 2 3
    3. Perforated ulcer   1 2 3
    4. Dehiscence   1 2 3
GENITOURANARY
  1. Care of dialysis patient with:  
    1. Shunts and fistulas   1 2 3
    2. Renal calculi   1 2 3
    3. Acute renal failure   1 2 3
    4. Kidney and bladder infection   1 2 3
  2. Male and female disorders   1 2 3
  3. Hemodialysis and peritoneal dialysis   1 2 3
  4. Understanding and ability to perform:  
    1. Bladder instillation   1 2 3
    2. Straight and foley cath   1 2 3
    3. Peritoneal lavage   1 2 3
NEUROLOGY
  1. Assessment of neuro signs   1 2 3
  2. Understanding and use of Glasgow coma scale   1 2 3
  3. Recognition and understanding of:  
    1. Dolls eyes 1 2 3
    2. Battle sign   1 2 3
    3. Racoon eyes   1 2 3
    4. Decerebrate   1 2 3
    5. Decorticate   1 2 3
    6. Increased intracranial pressure   1 2 3
  4. Assisting with insertion of:  
    1. Crutchfield tongs   1 2 3
    2. Halo traction   1 2 3
  5. Care of patient with:  
    1. Seizure activity   1 2 3
    2. Concussion   1 2 3
    3. Head injury-open/closed   1 2 3
    4. Subdural hematoma   1 2 3
    5. CVA   1 2 3
    6. Spinal cord injury   1 2 3
  6. Knowledge and use of:  
    1. Decadron   1 2 3
    2. Dilantin   1 2 3
    3. Pitressin   1 2 3
    4. Mannitol   1 2 3
    5. Valium   1 2 3
    6. Solu-Medrol   1 2 3
  7. Assisting with lumbar puncture   1 2 3
  8. Seizure precautions   1 2 3
ORTHOPEDICS
  1. Stabilization of fracture:  
    1. Spinal   1 2 3
    2. Extremities   1 2 3
  2. Understanding and care of compound fracture   1 2 3
  3. Assisting in reduction of dislocations   1 2 3
  4. Application of:  
    1. Cast   1 2 3
    2. Posterior splints   1 2 3
    3. Knee brace   1 2 3
    4. Clavicle brace   1 2 3
RESPIRATORY
  1. Auscultation   1 2 3
  2. Recognition of rales and rhonchi   1 2 3
  3. Principles of chest percussion   1 2 3
  4. Establishing an airway   1 2 3
  5. Assisting with tracheotomy  
    1. NT suctioning   1 2 3
    2. ET intubation and extubation  
      1. Suction techniques   1 2 3
      2. Checking cuff pressure   1 2 3
      3. Securing of ET tube   1 2 3
  6. Understanding and use of inhalation therapy   1 2 3
  7. Chest tubes  
    1. Assisting with insertion   1 2 3
    2. Understanding and care of H2O seal   1 2 3
    3. Principles and care of chest tube   1 2 3
    4. Use of Pleuravac   1 2 3
  8. ABG:  
    1. Interpretation   1 2 3
    2. Drawing blood sample  
      1. Radial   1 2 3
      2. Brachial   1 2 3
      3. Femoral   1 2 3
      4. Pediatric   1 2 3
  9. Use and administration of these drugs:  
    1. Aminophylline   1 2 3
    2. Atropine   1 2 3
    3. Bronkosol   1 2 3
    4. Terbutaline   1 2 3
    5. Adrenalin   1 2 3
    6. Susphreine   1 2 3
  10. Care of patient with:  
    1. COPD   1 2 3
    2. Asthma   1 2 3
    3. Epiglottitis   1 2 3
    4. Flail chest   1 2 3
    5. Pneumothorax   1 2 3
    6. Hemopneumothorax   1 2 3
    7. Fractured trachea   1 2 3
    8. Inhalation of toxic gases   1 2 3
    9. Obstructed airway   1 2 3
SPECIFIC CONDITIONS
  1. Psychiatric  
    1. Assessment   1 2 3
    2. Application of restraints   1 2 3
    3. Toxicology screen   1 2 3
    4. Crisis intervention   1 2 3
  2. Assist with laceration repair and dressing   1 2 3
  3. Burns:  
    1. Chemical   1 2 3
    2. Thermal   1 2 3
    3. Electrical   1 2 3
  4. Near drowning   1 2 3
  5. Snake bites   1 2 3
  6. Animal bites   1 2 3
  7. AIDS   1 2 3
  8. Sexual assault   1 2 3
  9. Child abuse   1 2 3
  10. Conscious sedation   1 2 3
  11. Overdose:  
    1. Anabuse and/or alcohol   1 2 3
    2. Prescribed and over-the-counter medications   1 2 3
    3. Inhaled or injected substances   1 2 3
  12. Understanding and use of:  
    1. Charcoal   1 2 3
    2. Magnesium sulfate   1 2 3
    3. Narcan   1 2 3
  13. ENT procedures   1 2 3
  14. Eye injuries   1 2 3
USE OF SPECIAL EQUIPMENT/SKILLS
  1. Suture tray   1 2 3
  2. Cut-down tray   1 2 3
  3. Mast trousers   1 2 3
  4. Starting IV’s   1 2 3
  5. Blood/blood products  
    1. Adult   1 2 3
    2. Pediatric   1 2 3
  6. Rotating tourniquet   1 2 3
  7. Tracheotomy   1 2 3
  8. Thoracotomy   1 2 3
  9. Knowledge of:  
    1. Disaster procedures   1 2 3
    2. Triage procedures   1 2 3
    3. AMA   1 2 3
    4. Advanced Directives   1 2 3
    5. Isolation procedure   1 2 3
PROFESSIONAL EXPERIENCE AND CERTIFICATIONS
  1. Are you CPR/BCLS certified? Yes   No
  2. Are you PAL certified? Yes   No
  3. Are you ACLS certified? Yes   No
  4. Are you knowledgeable of EMLA? Yes   No
  5. Do you have CEN? Yes   No
  6. Do you have a certificate for a critical care course? Yes   No
  7. Do you have charge experience? Yes   No
  8. How many years?
  9. Is your experience primarily(check one) Level I   Level II   Level III   Trauma Center
  10. How many years have you worked in ED?
  11. Other certifications?
  12. Have you attended an assaultive behavior management course involving self-protective and therapeutic physical control / restraint yes no techniques? Yes   No
The information I have given is true and accurate to the best of my knowledge. Please sign and date below.
SIGNATURE: (Last 4 digits of your SSN)    Reenter your last 4 digits of your SSN:   DATE:

  
Email:jobs@staffhospital.com  P.O.Box 225216 S.F. CA 94122 Tel:(866)713-4405 Fax:(866)232-3799
Powered by Miphras Database and Web Services. All Rights Reserved.