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Critical Care Skills Checklist

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My responses in this checklist represent a true reflection of my experience and comfort level.

 

Please self-rate your comfort level in performing tasks in connection with the below checklist.  Rate your level of comfort for each line item by following the below ranking system.  Simply fill in the appropriate option immediately following the rating number.

 

Typed Name (Typing your name below serves as an electronic signature) *      Date*

                                                         

 

Phone*

           

 

 

Certifications: (Check all that apply)

 

      BLS/BCLS/CPR:

      ACLS: 

      CCRN:

      Critical Care Course: 

 

 

 

 

 

Level of Comfort/Experience

N/A=Non-applicable

1=Inexperienced in this area

2=Limited comfort/experience in this area

3=Comfortable/experienced in this area

4=Very comfortable/highly experienced in this area

 

Area

Not Applicable

Inexperienced

Limited

Experienced

Highly Experienced

Cardiovascular

Abnormal heart sounds/murmurs

N/A  

1

2

3

4

Auscultation (rate, rhythm)

N/A  

1

2

3

4

Pulses/circulation checks

N/A  

1

2

3

4

Use of doppler

N/A  

1

2

3

4

Interpretation of cardiac enzymes and isoenzymes

N/A  

1

2

3

4

Interpretation of coagulation studies

N/A  

1

2

3

4

Arterial line insertion

N/A  

1

2

3

4

Central line insertion

N/A  

1

2

3

4

Open Chest emergency

N/A  

1

2

3

4

PA catheter/Swan-Ganz insertion

N/A  

1

2

3

4

Pericardiocentesis

N/A  

1

2

3

4

Automatic internal cardioverter defibrillator

N/A  

1

2

3

4

Cardioversion/Defibrillation

N/A  

1

2

3

4

Cardiac index

N/A  

1

2

3

4

Cardiac output

N/A  

1

2

3

4

CVP monitoring (central venous pressure)

N/A  

1

2

3

4

MAP monitoring (mean arterial pressure)

N/A  

1

2

3

4

PA/Swan-Ganz

N/A  

1

2

3

4

PVR (pulmonary vascular resistance)

N/A  

1

2

3

4

Radial a-line

N/A  

1

2

3

4

SVO2 (mixed venous oxyhemoglobin)

N/A  

1

2

3

4

SVR (systemic vascular resistance)

N/A  

1

2

3

4

Arrhythmia interpretation

N/A  

1

2

3

4

Lead placement

N/A  

1

2

3

4

Rhythm strip assessment

N/A  

1

2

3

4

Set up, run, and interpretation of 12 lead EKG

N/A  

1

2

3

4

Temporary external pacing

N/A  

1

2

3

4

Temporary transvenous

N/A  

1

2

3

4

Temporary epicardial wires

N/A  

1

2

3

4

Permanent

N/A  

1

2

3

4

Abdominal aortic aneurysm repair

N/A  

1

2

3

4

Acute MI

N/A  

1

2

3

4

Cardiac arrest

N/A  

1

2

3

4

Cardiac tamponade

N/A  

1

2

3

4

CHF

N/A  

1

2

3

4

Heart transplant

N/A  

1

2

3

4

Immediate post open-heart surgery

N/A  

1

2

3

4

Infective endocarditis

N/A  

1

2

3

4

Myocardial contusion

N/A  

1

2

3