Critical Care Skills Checklist Name* First Last Email* Phone*Proficiency: 1 = Minimal Experience 2 = Limited Experience 3 = Competent 4 = Highly SkilledCardiacInterpretation 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 VascularPeripheral 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 GastrointestinalNG 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 / RenalFoley 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 RespiratoryEstablishing 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 This field is hidden when viewing the formPulmonary 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 NeurologyAssessment 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 TransplantsHeart* 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 CompetencyNewborn / 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