Emergency Room Skills Checklist

Transcription

1 _ XXX-XX- Print Name Last 4 of SS # Date Completed Directions Please circle a value for each question to provide us and the interested facilities with an assessment of your clinical experience. These values confirm your strengths within your specialty and assist the facility in the selection process of the healthcare professional. 1 - No (has never done or observed) 2 - Requires Training (In-Service) - not performed within last 36 months 3 - Limited (requires assistance or training) - performed within the last 24 months 4 - d (routinely performs without assistance) - performed within the last 12 months 5 - Able to Supervise, Precept and Teach - performed within the last 6 months P - Pediatric A - Adult RESPIRATORY ASSESSMENT OF BREATH SOUNDS P A ADMINISTER O2 (NC, MASK) P A PULSE OXIMETRY P A NEBULIZER SET-UP P A RE-BREATHER MASK P A VENTURI MASK P A VENTILATE WITH AMBU-BAG P A ASSIST WITH INTUBATION P A RAPID SEQUENCE INDUCTION P A CARE OF INTUBATED PATIENT P A SUCTIONING P A ASSIST NEEDLE THORACOSTOMY P A TROUBLESHOOT VENTILATOR PROBLEMS P A DRAW BLOOD FROM ARTERIAL LINE P A INTERPRET ARTERIAL BLOOD GASES P A ASSIST WITH EMERGENCY TRACH P A ASSIST WITH EMERGENCY CRIC P A Version: 07/03/2012 Page 1 out of 8

2 RESPIRATORY ASSIST WITH THORACENTESIS P A ASSIST WITH BRONCHOSCOPY P A ASTHMA P A PULMONARY EDEMA P A CHEST INJURY P A CHEST TUBES / PLEUREVAC P A ASSESS RESP COMPLICATIONS P A GASTROINTESTINAL ASSESS ABD & BOWEL SOUNDS P A IDENTIFICATION OF ABNORMALITIES P A INSERT / MAINTAIN NG TUBES P A INSERT / MAINTAIN EWAL TUBE P A GASTRIC LAVAGE P A NG MEDS (IE:ACTIVATED CHARCOAL) P A DRUG OVERDOSE / DTS P A GASTROSTOMY / JEJUNOSTOMY TUBE P A GI BLEED P A ACUTE PANCREATITIS P A OPEN ABD WOUND / INCISION P A ABDOMINAL AORTIC ANEURYSM P A NEUROLOGY NEURO ASSESSMENT / VITAL SIGNS P A GLASGOW COMA SCALE P A ASSIST WITH LUMBAR PUNCTURE P A IDENTIFY NEURO COMPLICATIONS P A SEIZURE PRECAUTIONS P A ANEURYSM PRECAUTIONS P A Version: 07/03/2012 Page 2 out of 8

3 OPEN / CLOSED HEAD INJURY P A ACUTE CVA P A ACUTE SPINAL CORD INJURY P A INCREASED ICP P A HALO TRACTION / CERVICAL TONGS P A CNS INFECTIONS P A MUSCULOSKELETAL IMMOBILIZATION & SPLINTING P A ICE BAG APPLICATION P A FIT / INSTRUCT CRUTCH WALKING P A ASSIST W/ CAST APPLICATION P A CAST REMOVAL P A ASSIST W/ EXTERNAL FIXATION PINS P A ASSIST W/ NERVE BLOCKS P A APPLICATION & ASSISTANCE ACE WRAPS P A POSTERIOR SPLINT P A CLAVICLE STRAP P A SHOULDER IMMOBILIZER P A KNEE IMMOBILIZER P A GENITO-URINARY INSERTION OF MALE CATHETER P A INSERTION OF FEMALE CATHETER P A SETUP / ASSIST WITH VAGINAL EXAMS P A ASSIST WITH SEXUAL ASSAULT EXAMS P A EVIDENCE COLLECTION / DOCUMENTION P A KNOWLEDGE OF PROCEDURE EVAL OF ABD PAIN P A GYN HISTORY / PRENATAL ASSESS P A PRECIPITOUS DELIVERY P A Version: 07/03/2012 Page 3 out of 8

4 KNOWLEDGE OF PROCEDURE SPONTANEOUS AB P A CARE OF NEWBORN P A ASSIST WITH SUCTION CURETTAGE P A RENAL - ACUTE RENAL FAILURE P A CHRONIC RENAL FAILURE P A HEMODIALYSIS P A PERITONEAL DIALYSIS P A RENAL TRANSPLANT P A CARDIAC ASSESSMENT OF HEART SOUNDS P A PLACE CARDIAC MONITOR / TELEMETRY P A TROUBLESHOOT MONITOR / TELEMETRY P A IDENTIFY LETHAL DYSRHYTHMIAS P A PERFORM 12-LEAD EKG P A BASIC 12-LEAD INTERPRETATION P A ASSIST WITH ARREST / RESUSC P A DEFIBRILLATION / CARDIOVERSION P A AUTOMATIC EXTERNAL DEFIB (AED) P A ANGINA P A ACUTE MI P A CONGESTIVE HEART FAILURE P A ANEURYSM P A PERMANENT PACEMAKER P A TEMPORARY PACEMAKER P A AUTOMATIC IMPLANTED DEFIBRILLATOR P A HEART TRANSPLANT P A SEPTIC SHOCK P A HYPOVOLEMIC SHOCK P A Version: 07/03/2012 Page 4 out of 8

5 CARDIOGENIC SHOCK P A ANAPHYLACTIC SHOCK P A EMERGENCY MEDICATION ADMINISTRATION EPINEPHRINE P A BICARBONATE P A ATROPINE P A LIDOCAINE P A STREPTOKINASE (INDICATION / MANAGE) P A TPA (INDICATION / MANAGEMENT) P A INFUSION MED ADMINISTRATION BRETYLIUM P A DOPAMINE P A INSULIN P A PRONESTYL P A INTEGUMENTARY WOUND ASSESS & DRESSINGS P A WOUND CULTURES P A WOUND IRRIGATION P A SUTURE SETUP & ASSIST P A LOCAL ANSESTHETICS P A TETANUS PROPHYLACTICS P A VENOMOUS BITES P A PEDIATRICS PRINCIPLES OF GROWTH & DEVLEOPMENT P A VITAL SIGNS / NORMAL VALUES FOR AGE P A CARE OF FEBRILE PATIENT P A LEGAL PRINCIPLES RE: CHILD ABUSE P A INFUSION THERAPY INFUSION PUMP P A SYRINGE PUMP P A Version: 07/03/2012 Page 5 out of 8

6 INFUSION THERAPY BLOOD / BLOOD PRODUCTS ADMIN P A INSERT PERIPHERAL IV / HEPLOCK P A DISCONTINUE PERIPHERAL IV / HEPLOCK P A ACCESS / CARE / BLOOD DRAWS VENIPUNCTURE P A HICKMAN / BROVIAC P A GROSHONG P A IMPLANTED PORTS P A PICC / MIDLINE P A ASSIST WITH INSERTION AND SETUP CUTDOWN P A ARTERIAL LINES P A CENTRAL VENOUS CATHETER P A PULMONARY ARTERY CATHETER P A EXTERNAL PACEMAKER P A TEMPORARY TRANSVENOUS PACER P A PERICARDIOCENTESIS P A INTRAOSSEOUS INFUSIONS P A AUTOTRANSFUSE P A TRAUMA CARE TRAUMA ASSESSMENT P A PRIMARY SURVEY P A SECONDARY SURVEY P A TRAUMA SCORE P A PEDIATRIC TRAUMA SCORE P A PRINCIPLES OF FLUID RESUSCIT P A PRINCIPLES OF C-SPINE IMMOB P A USE OF PHILADELPHIA COLLAR P A USE OF BACKBOARD P A PRINCIPLES OF FLUID RESUSCIT P A Version: 07/03/2012 Page 6 out of 8

7 TRAUMA CARE USE OF RAPID / PRESSURE INFUSER P A PRINCIPLES OF FLUID RESUSCIT P A GUNSHOT WOUND P A STAB WOUND P A BLUNT CHEST TRAUMA P A BLUNT ABDOMINAL TRAUMA P A MAST SUIT P A HYPOTHERMIA P A FROSTBITE P A CHEMICAL BURN P A ELECTRICAL BURN P A THERMAL BURN P A ASSIST WITH DIAGNOSTIC PERITONEAL LAVAGE P A CHEST TUBE INSERTION P A THORACOTOMY P A EAR-NOSE-THROAT (ENT) EYE IRRIGATIONS P A EAR IRRIGATIONS P A VISUAL ACUITY P A REMOVE CONTACT LENS P A EPISTAXIS P A AGE APPROPRIATE CARE NEWBORN (BIRTH-30 DAYS) P A INFANT (30 DAYS - 1 YEAR) P A TODDLER (1-3 YEARS) P A PRESCHOOLER (3-5 YEARS) P A SCHOOL AGE (5-12 YEARS) P A ADOLESCENTS (12-18 YEARS) P A Version: 07/03/2012 Page 7 out of 8

8 AGE APPROPRIATE CARE YOUNG ADULTS (18-39 YEARS) P A MIDDLE ADULTS (39-64 YEARS) P A OLDER ADULTS (64+ YEARS) P A The information represented above is true and correct to the best of my knowledge. I also authorize Specialty Professional Services, Corp to share the above skills checklist with its facility clients. Signature Date Completed Fax: Version: 07/03/2012 Page 8 out of 8