[checklist name= "ICU/Critical Care" mailto="credentialing@teemagroup.com" templatedoc="1icEWY1MF88j31qkwOqr0nEYU1yNmoM5RnMjMH3ckKDg" templatedrive="1LG9WAg21_L3L-ZkZEChBzrYRhBOjpmcc" savedrive="15FFQjDXxe9nC9FkAAcuxbswGy1hq4sWm" sheetid="1xJkggLvktsyYL6zuIhdO-OURJhJTkWdDKunR11agspw"] [checklistHeading title="ICU/Critical Care"] Please rate your experience / frequency (within the last year) using the scale (check the appropriate boxes below) 0 = No theory and/or experience 1 = Limited experience/need supervision and/or support 2 = Experienced/minimal support needed to perform) 3 = Proficient/can perform independently 4 = Expert/very experienced in the field [/checklistHeading] [checklistInputGroup name="Recruiter Information"] [checklistInput type="text"]Recruiter TEEMA email[/checklistInput] [/checklistInputGroup] [checklistInputGroup name="Personal Information"] [checklistInput type="text"]Full Name[/checklistInput] [checklistInput type="email"]Your Email[/checklistInput] [checklistInput type="text"]Your phone number[/checklistInput] [checklistInput type="text"]Last 4 of Social Security Number[/checklistInput] [/checklistInputGroup] [checklistInputGroup name="NEUROLOGY"] [checklistInput type="scale"]Cranial nerve assessment[/checklistInput] [checklistInput type="scale"]Glasgow coma scale[/checklistInput] [checklistInput type="scale"]NIH stroke scale[/checklistInput] [checklistInput type="scale"]NIH stroke certification[/checklistInput] [checklistInput type="scale"]Seizure precautions[/checklistInput] [checklistInput type="scale"]Skeletal traction[/checklistInput] [checklistInput type="scale"]Cervical spine precautions/logroll positioning[/checklistInput] [checklistInput type="scale"]Halo vest/halo traction[/checklistInput] [checklistInput type="scale"]Monitoring of neuromuscular blocking agents/paralytics[/checklistInput] [checklistInput type="scale"]Assist with lumbar puncture[/checklistInput] [checklistInput type="scale"]Ventriculostomy[/checklistInput] [checklistInput type="scale"]Subarachnoid screw/bolt[/checklistInput] [checklistInput type="scale"]Lumbar drains[/checklistInput] [checklistInput type="scale"]Cerebral aneurysm[/checklistInput] [checklistInput type="scale"]Subarachnoid hemorrhage[/checklistInput] [checklistInput type="scale"]Status epilepticus[/checklistInput] [checklistInput type="scale"]TBI (Traumatic Brain Injury)[/checklistInput] [checklistInput type="scale"]Spinal cord injury[/checklistInput] [checklistInput type="scale"]CerebroVascular Accident (CVA)[/checklistInput] [checklistInput type="scale"]Pre/post cranial surgery[/checklistInput] [checklistInput type="scale"]Meningitis[/checklistInput] [checklistInput type="scale"]Myasthenia gravis[/checklistInput] [checklistInput type="scale"]Clipping and/or coilings of aneurysms[/checklistInput] [checklistInput type="scale"]Pituitary Tumor[/checklistInput] [checklistInput type="scale"]Steroids: Decadron, Solu-Medrol[/checklistInput] [checklistInput type="scale"]Anticonvulsants: Dilantin, phenobarbital[/checklistInput] [checklistInput type="scale"]Paralytic Agents: Norcuron, Pavalon, Nimbex, Tracrium, vecuronium[/checklistInput] [checklistInput type="scale"]Mannitol[/checklistInput] [checklistInput type="scale"]Antipsychotics: Haldol[/checklistInput] [/checklistInputGroup] [checklistInputGroup name="PULMONARY"] [checklistInput type="scale"]Assessment of breath sounds[/checklistInput] [checklistInput type="scale"]Oral/NT/ET airway[/checklistInput] [checklistInput type="scale"]Tracheostomy[/checklistInput] [checklistInput type="scale"]Arterial blood gas analysis/interpretation[/checklistInput] [checklistInput type="scale"]Obtaining ABG blood sample/arterial line[/checklistInput] [checklistInput type="scale"]Pulse oximetry[/checklistInput] [checklistInput type="scale"]BiPAP (Bi-level Positive Airway Pressure)[/checklistInput] [checklistInput type="scale"]Oscillation/high-frequency ventilation[/checklistInput] [checklistInput type="scale"]Nitric[/checklistInput] [checklistInput type="scale"]Interpretation of weaning parameters[/checklistInput] [checklistInput type="scale"]Maintenance & management of pleural chest tubes[/checklistInput] [checklistInput type="scale"]Acute respiratory failure[/checklistInput] [checklistInput type="scale"]Adult Respiratory Distress Syndrome (ARDS)[/checklistInput] [checklistInput type="scale"]Sudden Inflammation Respiratory Syndrome (SIRS)[/checklistInput] [checklistInput type="scale"]Inhalation injuries[/checklistInput] [checklistInput type="scale"]Pneumonia[/checklistInput] [checklistInput type="scale"]Pulmonary edema[/checklistInput] [checklistInput type="scale"]Near drowning[/checklistInput] [checklistInput type="scale"]Chronic Obstructive Pulmonary Disease (COPD)[/checklistInput] [checklistInput type="scale"]Pre/post thoracic surgery[/checklistInput] [checklistInput type="scale"]Pulmonary embolism[/checklistInput] [checklistInput type="scale"]Pulmonary/chest trauma[/checklistInput] [checklistInput type="scale"]Pulmonary hypertension[/checklistInput] [checklistInput type="scale"]Status asthmaticus[/checklistInput] [checklistInput type="scale"]Rapid sequence intubation drugs/protocols[/checklistInput] [checklistInput type="scale"]Nebulizer treatments: Ventolin, Atrovent[/checklistInput] [/checklistInputGroup] [checklistInputGroup name="Trauma & Burns"] [checklistInput type="scale"]Mass casualty[/checklistInput] [checklistInput type="scale"]Electrocution[/checklistInput] [checklistInput type="scale"]Amputation[/checklistInput] [checklistInput type="scale"]Gangrene[/checklistInput] [checklistInput type="scale"]Multiple fractures[/checklistInput] [checklistInput type="scale"]Thermoregulation: hypothermia/hyperthermia[/checklistInput] [checklistInput type="scale"]Berdow Formula/ “Rule of Nines”[/checklistInput] [checklistInput type="scale"]Lund and Browder chart[/checklistInput] [checklistInput type="scale"]Fluid resuscitation[/checklistInput] [checklistInput type="scale"]Care & management of burns[/checklistInput] [checklistInput type="scale"]Heparin Drip - Precautions and Maintenance[/checklistInput] [/checklistInputGroup] [checklistInputGroup name="GASTROINTESTINAL"] [checklistInput type="scale"]Small bore feeding tube insertion (Dobhoff or Keofeed)[/checklistInput] [checklistInput type="scale"]Nasogastric tube insertion[/checklistInput] [checklistInput type="scale"]Post pyloric feeding tube insertion[/checklistInput] [checklistInput type="scale"]Gastric lavage[/checklistInput] [checklistInput type="scale"]Use of activated charcoal[/checklistInput] [checklistInput type="scale"]Maintenance of gastric/jejunostomy tube[/checklistInput] [checklistInput type="scale"]Stoma care[/checklistInput] [checklistInput type="scale"]Maintenance & management of enteral tube feedings[/checklistInput] [checklistInput type="scale"]Assisting/monitoring bedside procedures: endo/chest tubes/bronchs/trach insertion/PEG tubes[/checklistInput] [checklistInput type="scale"]Abdominal trauma[/checklistInput] [checklistInput type="scale"]Acute gastrointestinal hemorrhage[/checklistInput] [checklistInput type="scale"]Esophageal varices[/checklistInput] [checklistInput type="scale"]Peritonitis[/checklistInput] [checklistInput type="scale"]Acute pancreatitis[/checklistInput] [checklistInput type="scale"]Bowel obstruction[/checklistInput] [checklistInput type="scale"]Liver/pancreas transplant[/checklistInput] [checklistInput type="scale"]Antiemetics: Reglan, Zofran[/checklistInput] [checklistInput type="scale"]H2 receptor antagonists[/checklistInput] [/checklistInputGroup] [checklistInputGroup name="Intravenous Management"] [checklistInput type="scale"]Starting peripheral IV’s[/checklistInput] [checklistInput type="scale"]Care of patient with Peripherally-Inserted Central Catheter (PICC)[/checklistInput] [checklistInput type="scale"]Administration/monitoring of Total Parenteral Nutrition (TPN)[/checklistInput] [checklistInput type="scale"]Administration of blood/blood products[/checklistInput] [checklistInput type="scale"]Administration of narcotics/sedatives: (fentanyl, Valium, Ativan, Versed, morphine)[/checklistInput] [checklistInput type="scale"]Bispectral monitoring[/checklistInput] [/checklistInputGroup] [checklistInputGroup name="RENAL"] [checklistInput type="scale"]Foley catheter insertion[/checklistInput] [checklistInput type="scale"]Suprapubic tube[/checklistInput] [checklistInput type="scale"]Nephrostomy tube[/checklistInput] [checklistInput type="scale"]Peritoneal dialysis[/checklistInput] [checklistInput type="scale"]Continuous Arteriovenous Hemofiltration (CAVHD, CVVHD, SCUF, CRRT)[/checklistInput] [checklistInput type="scale"]Hemodialysis of the critically ill patient[/checklistInput] [checklistInput type="scale"]Acute renal failure[/checklistInput] [checklistInput type="scale"]Chronic renal failure[/checklistInput] [checklistInput type="scale"]AV fistulas, shunts & dialysis catheters[/checklistInput] [checklistInput type="scale"]Nephrectomy[/checklistInput] [checklistInput type="scale"]Renal transplant[/checklistInput] [checklistInput type="scale"]Renal/urinary tract trauma[/checklistInput] [/checklistInputGroup] [checklistInputGroup name="ENDOCRINE"] [checklistInput type="scale"]Diabetic Ketoacidosis (DKA)[/checklistInput] [checklistInput type="scale"]Hyperosmolar Hyperglycemic Nonketotic Coma (HHNK)[/checklistInput] [checklistInput type="scale"]Diabetes Insipidus (DI)[/checklistInput] [checklistInput type="scale"]Syndrome of Inappropriate Antidiuretic Hormone (SIADH)[/checklistInput] [checklistInput type="scale"]Administration & monitoring of insulin infusion[/checklistInput] [checklistInput type="scale"]Use of Endo tool[/checklistInput] [/checklistInputGroup] [checklistInputGroup name="AGE SPECIFIC COMPETENCIES"] [checklistInput type="scale"]Adolescent (ages 13-21 years)[/checklistInput] [checklistInput type="scale"]Young adult (ages 22-39 years)[/checklistInput] [checklistInput type="scale"]Adult (ages 40-64 years)[/checklistInput] [checklistInput type="scale"]Older adult (ages 65-79 years)[/checklistInput] [checklistInput type="scale"]Elderly (ages 80+ years)[/checklistInput] [/checklistInputGroup] [checklistFooter] [/checklistFooter] [/checklist]