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Emergency Room Skills Checklist

 

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*

           

 

My Recruiting Professional at Health Source Group is:

 

 

 

Certifications: (Check all that apply)

 

     BLS/BCLS/CPR:

     ACLS:

     TNCC:

     TNS:

     CEN:

     MAB:

     PALS:

     ENPC:

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

Obtain 12 lead EKG

N/A  

1

2

3

4

Basic 12 lead interpretation

N/A  

1

2

3

4

Basic arrhythmia interpretation

N/A  

1

2

3

4

Heart sounds and murmurs

N/A  

1

2

3

4

Heart rate and rhythm

N/A  

1

2

3

4

Presence and characteristics of chest pain

N/A  

1

2

3

4

CPR

N/A  

1

2

3

4

Cardioversion/Defibrillation

N/A  

1

2

3

4

ABG’s

N/A  

1

2

3

4

Electrolytes

N/A  

1

2

3

4

Cardiac enzymes

N/A  

1

2

3

4

Acute MI

N/A  

1

2

3

4

Angina

N/A  

1

2

3

4

Cardiac arrest

N/A  

1

2

3

4

Congestive heart failure (CHF)

N/A  

1

2

3

4

Use of cardiac monitor

N/A  

1

2

3

4

Use of doppler

N/A  

1

2

3

4

Atropine

N/A  

1

2

3

4

Digoxin (Lanoxin)

N/A  

1

2

3

4

Epinephrine (Adrenalin)

N/A  

1

2

3

4

Lidocaine (Xylocaine)

N/A  

1

2

3

4

Sodium Bicarbonate

N/A  

1

2

3

4

 

Pulmonary

Assessment of breath sounds

N/A  

1

2

3

4

Airway management and suctioning:

N/A  

1

2

3

4

Endotracheal tube

N/A  

1

2

3

4

Nasal airway

N/A  

1

2

3

4

Oropharyngeal

N/A  

1

2

3

4

Tracheostomy

N/A  

1

2

3

4

Care of the patient with a chest tube

N/A  

1

2

3

4

Sputum specimen collection

N/A  

1

2

3

4

Set up and assist with intubation

N/A  

1

2

3

4

Assist with extubation

N/A  

1

2

3

4

Assist with thoracentesis

N/A  

1

2

3

4

Care of the patient on a ventilator

N/A  

1

2

3

4

Ambu bag

N/A  

1

2

3

4

Face masks

N/A  

1

2

3

4

Nasal cannula

N/A  

1

2

3

4

Trach Collar

N/A  

1