Emergency Room Skills Checklist Name* First Last Email* Phone*Proficiency: 1 = Minimal Experience 2 = Limited Experience 3 = Competent 4 = Highly SkilledTraumaAir Transport of Trauma Patient* 1 2 3 4 Major Trauma* 1 2 3 4 Minor Trauma* 1 2 3 4 M.A.S.T. Suit* 1 2 3 4 BurnsFirst Degree* 1 2 3 4 Second Degree* 1 2 3 4 Third Degree* 1 2 3 4 Electrocution* 1 2 3 4 Dressing Procedure* 1 2 3 4 Hazardous Materials Exposure* 1 2 3 4 Radiation Exposure* 1 2 3 4 RespiratoryPulmonary Edema* 1 2 3 4 C.O.P.D.* 1 2 3 4 Pneumothorax* 1 2 3 4 Assisting with Intubation* 1 2 3 4 Assisting with Extubation* 1 2 3 4 T-Piece* 1 2 3 4 Obtaining Arterial Blood Gases* 1 2 3 4 From Radial Artery* 1 2 3 4 From Femoral Artery* 1 2 3 4 From Arterial Line* 1 2 3 4 Setting Up of Arterial Line* 1 2 3 4 Ventilator* 1 2 3 4 O2 Mask* 1 2 3 4 O2 Cannula* 1 2 3 4 Venturi Mask* 1 2 3 4 Ambu Bags* 1 2 3 4 O2 Cylinders* 1 2 3 4 Nebulizer Set-Up* 1 2 3 4 Oropharyngeal Suction* 1 2 3 4 Nasotracheal Suction* 1 2 3 4 Endotracheal Suction* 1 2 3 4 Assisting with Chest Tube Insertion* 1 2 3 4 Use of Pleuravac Drainage System* 1 2 3 4 Use of Emerson Drainage System* 1 2 3 4 GastrointestinalG.I. Bleed* 1 2 3 4 Abdominal Wounds* 1 2 3 4 G.I. Tubes* 1 2 3 4 This field is hidden when viewing the formAcute Abdominal Disorders* 1 2 3 4 Insertion of Nasogastric Tube* 1 2 3 4 Gastric Lavage* 1 2 3 4 RenalAcute Renal Failure* 1 2 3 4 Chronic Renal Failure* 1 2 3 4 Peritoneal Dialysis* 1 2 3 4 OrthopedicSet-up for Cast Application* 1 2 3 4 Checking C.M.S.* 1 2 3 4 Set-up for OCL Splinting* 1 2 3 4 Set-up for Insertion of Steinman Pin / K-Wires Insertion* 1 2 3 4 Assist with Closed Fracture / Dislocation Reduction* 1 2 3 4 Sedation Monitoring* 1 2 3 4 Application of Orthopedic Appliances* 1 2 3 4 EENT DisordersSet-up for Fluorescein / Woods Lamp Exam* 1 2 3 4 Use of Morgan Lens Irrigation* 1 2 3 4 Ear Irrigations* 1 2 3 4 Eye Irrigations* 1 2 3 4 Eye Patch Application* 1 2 3 4 Nasal Packing* 1 2 3 4 Remove Contact Lens* 1 2 3 4 Visual Acuity* 1 2 3 4 LacerationsSetting up Suture Tray* 1 2 3 4 Assist with Sutures* 1 2 3 4 Assist with Staples* 1 2 3 4 Suture Removal* 1 2 3 4 Staple Removal* 1 2 3 4 Steri Strips* 1 2 3 4 PediatricCalculating Emergency Medication Dosages* 1 2 3 4 Knowledge of Normal Serum Lab Values* 1 2 3 4 Pediatric Arrest / Resuscitation* 1 2 3 4 Epiglottitis* 1 2 3 4 Overdose / Poison Ingestion* 1 2 3 4 Near Drowning* 1 2 3 4 Child Abuse* 1 2 3 4 Miscellaneous Instruments / TraysPelvic Tray* 1 2 3 4 Cut Down Tray* 1 2 3 4 Procto Tray* 1 2 3 4 CVP Tray* 1 2 3 4 Trach Tray* 1 2 3 4 Culdocentesis Tray* 1 2 3 4 This field is hidden when viewing the formThis field is hidden when viewing the formThoracentesis Tray* 1 2 3 4 Obstetrics / GynecologySpontaneous Abortion* 1 2 3 4 Hemorrhage* 1 2 3 4 Placenta Previa* 1 2 3 4 Abruptio Placenta* 1 2 3 4 Pre-eclampsia / Eclampsia* 1 2 3 4 Emergency Delivery* 1 2 3 4 Communicable Diseases* 1 2 3 4 PsychiatricCrisis Intervention* 1 2 3 4 Upholding Patient's Rights* 1 2 3 4 Suicidal Patient* 1 2 3 4 Patient with Overdose* 1 2 3 4 Patient in Restraints* 1 2 3 4 NeurologicalNeuro Assessment* 1 2 3 4 Monitoring Neuro Signs* 1 2 3 4 Use of Glasgow Coma Scale* 1 2 3 4 Acute Head Injury* 1 2 3 4 Acute T.I.A. / C.V.A.* 1 2 3 4 Acute Spinal Cord Injury* 1 2 3 4 Seizure Precautions* 1 2 3 4 Observing for Increased Intracranial Pressure* 1 2 3 4 Application for Orthopedic Appliances* 1 2 3 4 Transport of Patient with Spinal Cord Injuries* 1 2 3 4 Assist with Lumbar Puncture* 1 2 3 4 Dilantin* 1 2 3 4 Phenobarbital* 1 2 3 4 Decadron* 1 2 3 4 Mannitol* 1 2 3 4 Solu-Medrol* 1 2 3 4 CardiovascularAcute MI, CHF, Angina* 1 2 3 4 Abdominal Aortic Aneurysm* 1 2 3 4 Cardiac Monitoring* 1 2 3 4 Recognizing Arrhythmias* 1 2 3 4 Obtaining 12 Lead EKG's* 1 2 3 4 Cardiopulmonary Arrest* 1 2 3 4 Cardioversion* 1 2 3 4 Defibrillation* 1 2 3 4 Open Chest Heart Massage* 1 2 3 4 Permanent Pacemakers* 1 2 3 4 Temporary Pacemakers* 1 2 3 4 Trans-thoracic Pacemakers* 1 2 3 4 This field is hidden when viewing the formThis field is hidden when viewing the formPervenous Pacemakers* 1 2 3 4 Set-up & Use of CVP* 1 2 3 4 Interpretation of CVP Readings* 1 2 3 4 Interpretation of Swan-Ganz Readings* 1 2 3 4 Thrombolytic Therapy* 1 2 3 4 Anaphylactic Shock* 1 2 3 4 Cardiogenic Shock* 1 2 3 4 Septic Shock* 1 2 3 4 Hypovolemic Shock* 1 2 3 4 Administration of Blood & Blood Products* 1 2 3 4 Lidocaine* 1 2 3 4 Bretylium* 1 2 3 4 Nipride* 1 2 3 4 Dopamine* 1 2 3 4 Isuprel* 1 2 3 4 Digitalis* 1 2 3 4 Sodium Bicarbonate* 1 2 3 4 Atropine* 1 2 3 4 Epinephrine* 1 2 3 4 Dobutrex* 1 2 3 4 Tridil / Nitroglycerine* 1 2 3 4 Sexual Assault / Child AbuseSexual Assault Kit* 1 2 3 4 Reporting Procedures for Acts of Violence* 1 2 3 4 EnvironmentalHypothermia* 1 2 3 4 Heat Stroke* 1 2 3 4 Heat Exhaustion* 1 2 3 4 Snake Bite* 1 2 3 4 Administration of Antivenom* 1 2 3 4 Animal Bite* 1 2 3 4 Poison Index* 1 2 3 4 Additional E.R. SkillsIsolation Procedures* 1 2 3 4 Triage Procedures* 1 2 3 4 Care of Patient with AIDS* 1 2 3 4 Lab Values* 1 2 3 4 Procedure for Patient Signing AMA* 1 2 3 4 Consent for Treatment of Minor* 1 2 3 4 Disaster Protocols* 1 2 3 4 Heparin / Saline Lock* 1 2 3 4 Starting IV's* 1 2 3 4 Adult IV's* 1 2 3 4 Pediatric IV's* 1 2 3 4 Universal Precautions* 1 2 3 4 Assist with Peritoneal Lavage* 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