ICU/Critical Care

    Instruction

    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

Recruiter Information

Recruiter TEEMA email

Personal Information

Full Name

Email

Phone number

Last 4 of Social Security Number

Date

NEUROLOGY

Cranial nerve assessment

Glasgow coma scale

NIH stroke scale

NIH stroke certification

Seizure precautions

Skeletal traction

Cervical spine precautions/logroll positioning

Halo vest/halo traction

Monitoring of neuromuscular blocking agents/paralytics

Assist with lumbar puncture

Ventriculostomy

Subarachnoid screw/bolt

Lumbar drains

Cerebral aneurysm

Subarachnoid hemorrhage

Status epilepticus

TBI (Traumatic Brain Injury)

Spinal cord injury

CerebroVascular Accident (CVA)

Pre/post cranial surgery

Meningitis

Myasthenia gravis

Clipping and/or coilings of aneurysms

Pituitary Tumor

Steroids: Decadron, Solu-Medrol

Anticonvulsants: Dilantin, phenobarbital

Paralytic Agents: Norcuron, Pavalon, Nimbex, Tracrium, vecuronium

Mannitol

Antipsychotics: Haldol

PULMONARY

Assessment of breath sounds

Oral/NT/ET airway

Tracheostomy

Arterial blood gas analysis/interpretation

Obtaining ABG blood sample/arterial line

Pulse oximetry

BiPAP (Bi-level Positive Airway Pressure)

Oscillation/high-frequency ventilation

Nitric

Interpretation of weaning parameters

Maintenance & management of pleural chest tubes

Acute respiratory failure

Adult Respiratory Distress Syndrome (ARDS)

Sudden Inflammation Respiratory Syndrome (SIRS)

Inhalation injuries

Pneumonia

Pulmonary edema

Near drowning

Chronic Obstructive Pulmonary Disease (COPD)

Pre/post thoracic surgery

Pulmonary embolism

Pulmonary/chest trauma

Pulmonary hypertension

Status asthmaticus

Rapid sequence intubation drugs/protocols

Nebulizer treatments: Ventolin, Atrovent

Trauma & Burns

Mass casualty

Electrocution

Amputation

Gangrene

Multiple fractures

Thermoregulation: hypothermia/hyperthermia

Berdow Formula/ “Rule of Nines”

Lund and Browder chart

Fluid resuscitation

Care & management of burns

Heparin Drip ‐ Precautions and Maintenance

GASTROINTESTINAL

Small bore feeding tube insertion (Dobhoff or Keofeed)

Nasogastric tube insertion

Post pyloric feeding tube insertion

Gastric lavage

Use of activated charcoal

Maintenance of gastric/jejunostomy tube

Stoma care

Maintenance & management of enteral tube feedings

Assisting/monitoring bedside procedures: endo/chest tubes/bronchs/trach insertion/PEG tubes

Abdominal trauma

Acute gastrointestinal hemorrhage

Esophageal varices

Peritonitis

Acute pancreatitis

Bowel obstruction

Liver/pancreas transplant

Antiemetics: Reglan, Zofran

H2 receptor antagonists

Intravenous Management

Starting peripheral IV’s

Care of patient with Peripherally-Inserted Central Catheter (PICC)

Administration/monitoring of Total Parenteral Nutrition (TPN)

Administration of blood/blood products

Administration of narcotics/sedatives: (fentanyl, Valium, Ativan, Versed, morphine)

Bispectral monitoring

RENAL

Foley catheter insertion

Suprapubic tube

Nephrostomy tube

Peritoneal dialysis

Continuous Arteriovenous Hemofiltration (CAVHD, CVVHD, SCUF, CRRT)

Hemodialysis of the critically ill patient

Acute renal failure

Chronic renal failure

AV fistulas, shunts & dialysis catheters

Nephrectomy

Renal transplant

Renal/urinary tract trauma

ENDOCRINE

Diabetic Ketoacidosis (DKA)

Hyperosmolar Hyperglycemic Nonketotic Coma (HHNK)

Diabetes Insipidus (DI)

Syndrome of Inappropriate Antidiuretic Hormone (SIADH)

Administration & monitoring of insulin infusion

Use of Endo tool

AGE SPECIFIC COMPETENCIES

Adolescent (ages 13-21 years)

Young adult (ages 22-39 years)

Adult (ages 40-64 years)

Older adult (ages 65-79 years)

Elderly (ages 80+ years)

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I attest that the information I have given is true and accurate to the best of my knowledge and that I am the individual completing this form. I hereby authorize the Company to release this Skills Checklist to the Client facilities in relation to consideration of employment as a Healthcare Professional with those facilities.

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