Critical Care Skills Checklist

Name*
First Last
Email*
Phone*
Proficiency:
1 = Minimal Experience
2 = Limited Experience
3 = Competent
4 = Highly Skilled
Cardiac
Interpretation of 12 Lead EKG*
- 1
- 2
- 3
- 4
Interpretation of Arrhythmias*
- 1
- 2
- 3
- 4
Defibrillation / Cardioversion*
- 1
- 2
- 3
- 4
Assisting with Insertion of Central Lines*
- 1
- 2
- 3
- 4
External Pacemakers*
- 1
- 2
- 3
- 4
Permanent Pacemakers*
- 1
- 2
- 3
- 4
Temporary Pacemakers*
- 1
- 2
- 3
- 4
Cardiac Arrest / CPR*
- 1
- 2
- 3
- 4
Interpretation of Hemodynamic Monitoring*
- 1
- 2
- 3
- 4
Art-Line (Transducer set-up, D/C)*
- 1
- 2
- 3
- 4
Swan-Ganz (Transducer set-up, D/C)*
- 1
- 2
- 3
- 4
Balloon Pump (IABP)*
- 1
- 2
- 3
- 4
SVO2 Monitoring*
- 1
- 2
- 3
- 4
Sheath Removal - Femoral*
- 1
- 2
- 3
- 4
Automatic Internal Cardioverter Defib*
- 1
- 2
- 3
- 4
Aneurysm*
- 1
- 2
- 3
- 4
Acute MI / Unstable Angina*
- 1
- 2
- 3
- 4
CHF*
- 1
- 2
- 3
- 4
Cardiogenic / Hypovolemic Shock*
- 1
- 2
- 3
- 4
Pre / Post Cardiac Surgery*
- 1
- 2
- 3
- 4
PTCA*
- 1
- 2
- 3
- 4
Atropine*
- 1
- 2
- 3
- 4
Bretylol*
- 1
- 2
- 3
- 4
Amiodarone*
- 1
- 2
- 3
- 4
Digoxin*
- 1
- 2
- 3
- 4
Dopamine*
- 1
- 2
- 3
- 4
Dobutrex*
- 1
- 2
- 3
- 4
Bicarbonate*
- 1
- 2
- 3
- 4
Inocor*
- 1
- 2
- 3
- 4
Diltiazem*
- 1
- 2
- 3
- 4
Lidocaine*
- 1
- 2
- 3
- 4
Neosynephrine / Nipride*
- 1
- 2
- 3
- 4
Nitroglycerin*
- 1
- 2
- 3
- 4
Pronestyl*
- 1
- 2
- 3
- 4
Titrate Morphine*
- 1
- 2
- 3
- 4
Verapamil*
- 1
- 2
- 3
- 4
Esmolol*
- 1
- 2
- 3
- 4
Metoprolol*
- 1
- 2
- 3
- 4
Retavase*
- 1
- 2
- 3
- 4
Epinephrine*
- 1
- 2
- 3
- 4
Phenobarbital*
- 1
- 2
- 3
- 4
Streptokinase*
- 1
- 2
- 3
- 4
Valium*
- 1
- 2
- 3
- 4
Versed*
- 1
- 2
- 3
- 4
Alteplase*
- 1
- 2
- 3
- 4
Vascular
Peripheral Pulses*
- 1
- 2
- 3
- 4
Fluid Overload*
- 1
- 2
- 3
- 4
Ultrasonic Doppler*
- 1
- 2
- 3
- 4
Starting IV's*
- 1
- 2
- 3
- 4
Assist with IV Cutdown*
- 1
- 2
- 3
- 4
Subcutaneous Central Line*
- 1
- 2
- 3
- 4
Hickman / Broviac / Groshong Catheters*
- 1
- 2
- 3
- 4
Maintenance of Heparin Lock*
- 1
- 2
- 3
- 4
TPN / Hyperalimentation*
- 1
- 2
- 3
- 4
Air Occlusive Dressing*
- 1
- 2
- 3
- 4
Knowledge of Normal Serum Lab Values*
- 1
- 2
- 3
- 4
Administration of Blood & Blood Products*
- 1
- 2
- 3
- 4
Infusion Pump*
- 1
- 2
- 3
- 4
Peritoneal Dialysis*
- 1
- 2
- 3
- 4
Hemodialysis*
- 1
- 2
- 3
- 4
Heparin Drip (Precautions & Maintenance)*
- 1
- 2
- 3
- 4
Gastrointestinal
NG Tube Insertion*
- 1
- 2
- 3
- 4
Gastrostomy Tube*
- 1
- 2
- 3
- 4
Jejunostomy Tube*
- 1
- 2
- 3
- 4
Enterostomal Care*
- 1
- 2
- 3
- 4
Pancreatitis*
- 1
- 2
- 3
- 4
GI Bleed*
- 1
- 2
- 3
- 4
Esophageal Bleeding*
- 1
- 2
- 3
- 4
Bowel Obstruction*
- 1
- 2
- 3
- 4
Whipple Procedure*
- 1
- 2
- 3
- 4
Liver Transplant*
- 1
- 2
- 3
- 4
Paralytic Ileus*
- 1
- 2
- 3
- 4
E.R.C.P.*
- 1
- 2
- 3
- 4
Genitourinary / Renal
Foley Catheter Insertion*
- 1
- 2
- 3
- 4
GU Irrigations*
- 1
- 2
- 3
- 4
Nephrostomy Tube*
- 1
- 2
- 3
- 4
Suprapubic Tube*
- 1
- 2
- 3
- 4
Electrolyte Imbalance / Replacement*
- 1
- 2
- 3
- 4
T.U.R.P.*
- 1
- 2
- 3
- 4
Shunts & Fistulas*
- 1
- 2
- 3
- 4
Nephrectomy*
- 1
- 2
- 3
- 4
Renal Transplant*
- 1
- 2
- 3
- 4
Renal Failure*
- 1
- 2
- 3
- 4
Renal Trauma*
- 1
- 2
- 3
- 4
Respiratory
Establishing an Airway*
- 1
- 2
- 3
- 4
Ambuing Techniques*
- 1
- 2
- 3
- 4
Chest Tubes (Emerson / Pleur-evac)*
- 1
- 2
- 3
- 4
Pulse Oximetry*
- 1
- 2
- 3
- 4
Interpretation of ABG*
- 1
- 2
- 3
- 4
Drawing ABG Blood Sample from Art-Line*
- 1
- 2
- 3
- 4
Use of IPPB*
- 1
- 2
- 3
- 4
Use of Pressure Support*
- 1
- 2
- 3
- 4
Incentive Spirometer*
- 1
- 2
- 3
- 4
COPD*
- 1
- 2
- 3
- 4
ARDS*
- 1
- 2
- 3
- 4
Pre / Post Thoracic Surgery*
- 1
- 2
- 3
- 4
Pulmonary Embolism*
- 1
- 2
- 3
- 4
Pulmonary Edema*
- 1
- 2
- 3
- 4
Pneumonia*
- 1
- 2
- 3
- 4
Inhalation Injuries*
- 1
- 2
- 3
- 4
Aminophylline*
- 1
- 2
- 3
- 4
Corticosteroids*
- 1
- 2
- 3
- 4
Bronkosol*
- 1
- 2
- 3
- 4
Bentolin*
- 1
- 2
- 3
- 4
Alupent*
- 1
- 2
- 3
- 4
Neurology
Assessment of Neuro Signs*
- 1
- 2
- 3
- 4
Glasgow Coma Scale*
- 1
- 2
- 3
- 4
Seizure Precautions*
- 1
- 2
- 3
- 4
Assist with Lumbar Puncture*
- 1
- 2
- 3
- 4
ICP Monitoring*
- 1
- 2
- 3
- 4
Crutchfield Tongs*
- 1
- 2
- 3
- 4
Halo Traction*
- 1
- 2
- 3
- 4
Stryker Frame*
- 1
- 2
- 3
- 4
CVA*
- 1
- 2
- 3
- 4
Seizure Activity*
- 1
- 2
- 3
- 4
Overdose*
- 1
- 2
- 3
- 4
Neuro Injury / Trauma*
- 1
- 2
- 3
- 4
Pre / Post Neuro Surgery*
- 1
- 2
- 3
- 4
Cranial Hemorrhage*
- 1
- 2
- 3
- 4
Transplants
Heart*
- 1
- 2
- 3
- 4
Lung*
- 1
- 2
- 3
- 4
Other*
- 1
- 2
- 3
- 4
Oncology*
- 1
- 2
- 3
- 4
Chemotherapy*
- 1
- 2
- 3
- 4
Isolation Techniques*
- 1
- 2
- 3
- 4
Diabetic Teaching*
- 1
- 2
- 3
- 4
Hyperbaric Oxygenation*
- 1
- 2
- 3
- 4
Accucheck*
- 1
- 2
- 3
- 4
Age Specific Competency
Newborn / Neonate (Birth - 30 days)*
- 1
- 2
- 3
- 4
Infant (30 days - 1 year)*
- 1
- 2
- 3
- 4
Toddler (1 - 3 years)*
- 1
- 2
- 3
- 4
Preschooler (3 - 5 years)*
- 1
- 2
- 3
- 4
School Age Children (5 - 12 years)*
- 1
- 2
- 3
- 4
Adolescents (12 - 18 years)*
- 1
- 2
- 3
- 4
Young Adults (18 - 39 years)*
- 1
- 2
- 3
- 4
Middle Adults (39 - 64 years)*
- 1
- 2
- 3
- 4
Older Adults (64 - 79 years)*
- 1
- 2
- 3
- 4
Elderly Adults (Over 79+ years)*
- 1
- 2
- 3
- 4

Proficiency:

Cardiac

Vascular

Gastrointestinal

Genitourinary / Renal

Respiratory

Neurology

Transplants

Age Specific Competency