CVICU Skills Checklist One program to handle all talent management needs from acquisition to development Personal Information HiddenOverall ScoreOut of 4Name(Required) First Middle Last Last 4 Digits of Social Security Number Email(Required) HiddenDate MM slash DD slash YYYY Proficiency Scale1 – No Experience 2 – Need Training 3 – Able to perform with supervision 4 – Able to perform independentlyNEUROLOGICALCranial Nerves(Required) 1 2 3 4 Glasgow Coma Scale(Required) 1 2 3 4 Level of conciousness(Required) 1 2 3 4 Pathological reflexes(Required) 1 2 3 4 Reflex or communication deficits(Required) 1 2 3 4 Visual or communication deficits(Required) 1 2 3 4 Equipment & ProceduresAssist with lumber puncture(Required) 1 2 3 4 Halo traction / cervical tongs(Required) 1 2 3 4 Intercranial pressure monitoring(Required) 1 2 3 4 Nerve stimulators(Required) 1 2 3 4 Rotating bed(Required) 1 2 3 4 Seizure precautions(Required) 1 2 3 4 Stryker frame(Required) 1 2 3 4 Use of hyper/hypothermia blanket(Required) 1 2 3 4 Care of PatientAneurysm precautions(Required) 1 2 3 4 Basal skull fracture(Required) 1 2 3 4 Closed head injury(Required) 1 2 3 4 Coma(Required) 1 2 3 4 CVA(Required) 1 2 3 4 DT's(Required) 1 2 3 4 Encephalitis(Required) 1 2 3 4 Externalized VP shunts(Required) 1 2 3 4 Increased ICP(Required) 1 2 3 4 Meningitis(Required) 1 2 3 4 Metatastic tumor / cranial tumor(Required) 1 2 3 4 Multiple sclerosis(Required) 1 2 3 4 Post craniotomy(Required) 1 2 3 4 Spinal cord injury(Required) 1 2 3 4 Ventriculostomy(Required) 1 2 3 4 MedicationBarbiturate induced coma(Required) 1 2 3 4 Decadron (Dexamethasone)(Required) 1 2 3 4 Dilantin (Phenytoin)(Required) 1 2 3 4 Epidural administration(Required) 1 2 3 4 Phenobarbital(Required) 1 2 3 4 Valium (Diazepam)(Required) 1 2 3 4 ENDORINE/METABOLIC: 1. Interpretation of Lab ResultsBlood glucose(Required) 1 2 3 4 Thyroid studies(Required) 1 2 3 4 ENDORINE/METABOLIC: 2. Equipment & ProceduresBlood glucose measuring device (type________)(Required) 1 2 3 4 Blood glucose monitoring(Required) 1 2 3 4 Performing finger stick(Required) 1 2 3 4 ENDORINE/METABOLIC: 3. Care of patient with:Diabetes mellitus(Required) 1 2 3 4 Disorders of adrenal gland (Addison’s)(Required) 1 2 3 4 Disorders of the pituitary glad (DI)(Required) 1 2 3 4 Drug overdose(Required) 1 2 3 4 Hyperthyroidism (Graves disease)(Required) 1 2 3 4 Hypothyroidism(Required) 1 2 3 4 Insulin shock(Required) 1 2 3 4 Thyroidectomy(Required) 1 2 3 4 ENDORINE/METABOLIC: 4. MedicationInsulin pump(Required) 1 2 3 4 PULMONARY : 1. AssessmentAdventitious breath sounds(Required) 1 2 3 4 Rate and work of breathing(Required) 1 2 3 4 PULMONARY : 2. Interpretation of lab resultsArterial blood gases(Required) 1 2 3 4 PULMONARY : 3. Equipment & Procedures(i) Air leak troubleshooting:- Medicinal chest tube removal(Required) 1 2 3 4 - Pleural chest tube removal(Required) 1 2 3 4 (ii) Airway management devices/suctioning:- Endotacheal tube/suctioning(Required) 1 2 3 4 - Extubation(Required) 1 2 3 4 - Nasal airway suctioning(Required) 1 2 3 4 - Oximetry(Required) 1 2 3 4 - Sputum specimen collection(Required) 1 2 3 4 - Tracheostomy/suctioning(Required) 1 2 3 4 (iv) Establishing an airway:- Bronchoscope(Required) 1 2 3 4 - Chest tube insertion(Required) 1 2 3 4 - Emergency Trachoestomy(Required) 1 2 3 4 - Thoracentesis(Required) 1 2 3 4 (iii) Assist with:- Assist with intubation(Required) 1 2 3 4 - Laryngospasm(Required) 1 2 3 4 - Tension Pneumothorax(Required) 1 2 3 4 - Use of Pleurevac or Thoraclex drainage(Required) 1 2 3 4 - Use of wather seal drainage(Required) 1 2 3 4 (vi) Ventilator Management:- Ambu bag & mask(Required) 1 2 3 4 - ET Tube(Required) 1 2 3 4 - Face mask(Required) 1 2 3 4 - Nasal Cannula(Required) 1 2 3 4 - Portable O2 tank(Required) 1 2 3 4 - Trach collar(Required) 1 2 3 4 (v) O2 therapy & medication delivery systems:- External CPAP(Required) 1 2 3 4 - High frequency jet ventilation(Required) 1 2 3 4 - IMV(Required) 1 2 3 4 - PEEP(Required) 1 2 3 4 - Pressure Support(Required) 1 2 3 4 - Weaning modes & T-Piece weaning(Required) 1 2 3 4 PULMONARY: 4. Care of patient with:Acute pneumonia(Required) 1 2 3 4 ARDS(Required) 1 2 3 4 Chest trauma(Required) 1 2 3 4 COPD(Required) 1 2 3 4 Fresh Tracheostomy(Required) 1 2 3 4 Lobectomy(Required) 1 2 3 4 Lung Transplant(Required) 1 2 3 4 Pneumonectomy(Required) 1 2 3 4 Pulmonary edema/hypertension(Required) 1 2 3 4 Pulmonary embolism(Required) 1 2 3 4 Status asthmaticus(Required) 1 2 3 4 Thoracotomy(Required) 1 2 3 4 Tuberculosis(Required) 1 2 3 4 PULMONARY: 5. MedicationAlupent (Metaproterenol sulfate)(Required) 1 2 3 4 Bronkosol (Isoetharine Hydrachloride)(Required) 1 2 3 4 Corticisteroids(Required) 1 2 3 4 Venolin (Albuterol)(Required) 1 2 3 4 CARDIOVASCULAR: 1. AssessmentAbnormal heart sounds/murmurs(Required) 1 2 3 4 Auscultation (rate, rhythm, volume)(Required) 1 2 3 4 Blood pressure/non-invasive(Required) 1 2 3 4 Doppler(Required) 1 2 3 4 Pulses/circulation checks(Required) 1 2 3 4 CARDIOVASCULAR: 2. Pulses/circulation checksCardiac enzymes & isoenzymes(Required) 1 2 3 4 Coagulation studies(Required) 1 2 3 4 CARDIOVASCULAR: 3. Equipment & procedures(i) Assist with:- Arterial line insertion(Required) 1 2 3 4 - Central line insertion(Required) 1 2 3 4 - Open chest emergency(Required) 1 2 3 4 - PA catheter/Swan Ganz Insertion(Required) 1 2 3 4 - Pericardocentesis(Required) 1 2 3 4 - Transesophageal echocardiogram(Required) 1 2 3 4 - Automatic internal cardioverter(Required) 1 2 3 4 - Cardioversion(Required) 1 2 3 4 - CAVH-D(Required) 1 2 3 4 (ii) Hemodynamic monitoring:- Cardiac index(Required) 1 2 3 4 - Cardiac output(Required) 1 2 3 4 - CVP monitoring(Required) 1 2 3 4 - Femoral artery sheath removal(Required) 1 2 3 4 - MAP(Required) 1 2 3 4 - PA/Swan-Ganz(Required) 1 2 3 4 - PCW pressure(Required) 1 2 3 4 - PVR(Required) 1 2 3 4 - Radial a-line(Required) 1 2 3 4 - SV02(Required) 1 2 3 4 - SVR(Required) 1 2 3 4 - Intra aortic baloon pump(Required) 1 2 3 4 (iii) Monitoring:- 12 lead EKG interpreatation(Required) 1 2 3 4 - Arthymia interpretation(Required) 1 2 3 4 - Lead placement(Required) 1 2 3 4 - Rhythm strip assessment(Required) 1 2 3 4 - Set up and rerun 12 lead EKD(Required) 1 2 3 4 - Pacemaker(Required) 1 2 3 4 - External(Required) 1 2 3 4 - Temporary(Required) 1 2 3 4 - Permanent(Required) 1 2 3 4 - Transthoracic (epicardial)(Required) 1 2 3 4 - Ventricular assit device (RVAD/LVAD)(Required) 1 2 3 4 CARDIOVASCULAR: 4. Care of patient with:Abdominal aortic aneurysm repair(Required) 1 2 3 4 Acute MI(Required) 1 2 3 4 Cardiac arrest(Required) 1 2 3 4 Cardiac tamponade(Required) 1 2 3 4 Congestiv heart failure(Required) 1 2 3 4 EP study & abalation(Required) 1 2 3 4 Heart transplant(Required) 1 2 3 4 Infective endocarditis(Required) 1 2 3 4 Immediate open heart surgery(Required) 1 2 3 4 Infective endocarditis(Required) 1 2 3 4 Myocardial contusion(Required) 1 2 3 4 Pericarditis(Required) 1 2 3 4 Post AICD insertion(Required) 1 2 3 4 Post artherectomy DCA(Required) 1 2 3 4 Post commssuortomy valve(Required) 1 2 3 4 Post Percutaneous balloon valvuloplasty(Required) 1 2 3 4 Post rotoblade(Required) 1 2 3 4 Pre/post angeoplasty(Required) 1 2 3 4 Pre/post cardiac cath(Required) 1 2 3 4 CARDIOVASCULAR 5.MedicationsAmiodarone (Cordarone)(Required) 1 2 3 4 Atropline(Required) 1 2 3 4 Bicarbonate(Required) 1 2 3 4 Bretylium (Bretylol)(Required) 1 2 3 4 Digoxin (lanoxin)(Required) 1 2 3 4 Diltiazaem (Cardizem)(Required) 1 2 3 4 Dobutamine (Dobutrex)(Required) 1 2 3 4 Dopamine (Intropin)(Required) 1 2 3 4 Epinephrine (Adrenalin)(Required) 1 2 3 4 Inocor (Amirone)(Required) 1 2 3 4 Lidoncane (Xylocane)(Required) 1 2 3 4 Nipride (Nirtoprusside)(Required) 1 2 3 4 Procainamide (Pronestyl)(Required) 1 2 3 4 Reteplase recombinant (Retavase)(Required) 1 2 3 4 Strepokinase(Required) 1 2 3 4 TPA (Alteplase)(Required) 1 2 3 4 Verapamil (Calan, Isoptin, Verelan)(Required) 1 2 3 4 PAIN MANAGEMENT: 1. Assessment of pain level toleranceAssessment of pain level tolerance(Required) 1 2 3 4 PAIN MANAGEMENT: 2. Care of patient with:Epidural anesthesia/analgesia(Required) 1 2 3 4 IV conscious sedation(Required) 1 2 3 4 Patient controlled analgesia(Required) 1 2 3 4 RENAL/GENITOURINARY: 1. AssessmentArterio venous fistula/shunt(Required) 1 2 3 4 Fluid balance(Required) 1 2 3 4 RENAL/GENITOURINARY: 2. Interpretation of lab resultsBUN & creatinine(Required) 1 2 3 4 Electrolytes(Required) 1 2 3 4 RENAL/GENITOURINARY: 3. Equipment & proceduresBladder irrigations(Required) 1 2 3 4 Insertion & care of straight Foley catheter:3-way Foley(Required) 1 2 3 4 - Female(Required) 1 2 3 4 - Male(Required) 1 2 3 4 Supra-pubic(Required) 1 2 3 4 PAIN MANAGEMENT: 4. Care of patients with:Acute renal failure(Required) 1 2 3 4 CAVH Dialysis(Required) 1 2 3 4 Hemodialysis(Required) 1 2 3 4 Nephrectomy(Required) 1 2 3 4 Peritoneal dialysis(Required) 1 2 3 4 Renalrejection syndrome(Required) 1 2 3 4 TURP(Required) 1 2 3 4 Urinary diversion (ileal conduit nephrostomy)(Required) 1 2 3 4 Urinary tract infection(Required) 1 2 3 4 PAIN MANAGEMENT: 5. MedicationAlupent (Metaproterenol sulfate)(Required) 1 2 3 4 Aminophylline (Theophylline)(Required) 1 2 3 4 Bronkosol (Isoetharine Hydrachloride)(Required) 1 2 3 4 Corticisteroids(Required) 1 2 3 4 AuthorizationsLegal Consent(Required) I agree to the terms and conditions.Consumer Disclosure Regarding Conducting Business Electronically, Signing Documents Electronically, and Receiving Electronic Notices and Disclosures Please read the information below, carefully, as it concerns your rights. eSignatures are an efficient way to execute an agreement with the same legal force and effect of a handwritten or “wet ink” signature. By signing this document you are agreeing that you have reviewed this Consumer Disclosure and consent and intend to transact business electronically; to use electronic signatures instead of wet ink signatures and paper documents, and to receive notices and disclosures electronically. 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