NAME:_________________________ ❑ RN SS#____________________________
P.O. Box 3597 • Peoria, IL 61612 • 800.836.7633 • FAX 309.691.8328
SKILL SHEETS - EMERGENCY ROOM PLEASE TYPE OR PRINT NEATLY LEVEL OF EXPERIENCE (please place an "x" in the appropriate box):
1. No contact with equipment or this patient situation. No knowledge of procedure.
2. Understand procedure and patient situation, but never performed task.
3. Have performed this task infrequently and would need supervision.
4. Have performed this task frequently and can perform independently. TRAUMA/SHOCK 1 2 3 4 LENGTH OF EXPERIENCE
Assessment: Champion trauma score Poison index TriageEquipment & Procedures: Air transport of trauma patient Application of mast suit Ground transportCare of the patient with: Bites, animal Bites, human Bites, venomous snake Bites, venomous spider Burns, rule of nines Burns, first degree Burns, second degree Burns, third degree Dehydration Electrocution Gunshot/stab wounds Hazardous material exposure Heat exhaustion/stroke Hypothermia Major trauma Minor trauma Radiation exposure Shock: Anaphylactic
- Cardiogenic- Hypovolemic- Neurogenic- Septic
Traumatic amputation INFECTIOUS DISEASES Interpretation of lab values – CBC, SMA 7 Equipment & Procedures: Fever management Isolation Care of the patient with AIDS PAIN MANAGEMENT Assessment of pain level/tolerance Care of the patient with: Epidural anesthesia/analgesia IV Conscious sedation CARDIOVASCULAR 1 2 3 4 LENGTH OF EXPERIENCE
Assessment Auscultation (rate/rhythm) Doppler Heart sounds/murmursEquipment and Procedures: Assist with the insertion and set up of
- Arterial line- Central venous line- PA catheter/Swan-ganz insertion- Pacemaker
Cardioversion Interpretation of waveforms & values
- Basic 12 lead interpretation- Basic arrhythmia interpretation
Care of the patient with: Acute MI Aneurysm Angina Cardiac arrest Congestive heart failure (CHF) Myocarditis MEDICATIONS ACLS Drugs: Atropine Bretylium (Bretylol) Epinephrine (Adrenalin) Lidocaine (Xylocaine) Procainamide (Pronestyl) Sodium bicarbonate Adenosine (Adenocard) Amiodarone (Cordarone) Digoxin (Lanoxin) Diltiazem (Cardizem) Dobuamine (Dobutrex) Dopamine (Intropin) Esmolol (Brevibloc) Lasix (Furosemide) Nitroglycerin (Tridil) Nitroprusside (Nipride) Thrombolytic therapy PULMONARY Assessment: Adventitious breath sounds Rate and work of breathing Interpretation of Lab Results: Arterial blood gases Equipment & Procedures: Airway management devices/suctioning
Endotracheal tube/suctioningNasal airway/suctioningOropharyngeal/suctioningSputum specimen collectionTracheostomy/suctioning
Assist with extubation Assist with intubation Assist with thoracentesis Care of the patient on a ventilator
PULMONARY (cont.) 1 2 3 4 LENGTH OF EXPERIENCE
Assist with set up & insertionMeasuringRemoval
Measure peak flow Obtaining arterial blood gases
Oxygen therapy & medication delivery systems
Bag and maskET tubeExternal CPAPFace masksInhalersNasal cannula
Oxygen therapy & medication delivery systems
NebulizerPortable O2 tankT-pieceTrach collar
Pulse oximetry Trouble shooting high-pressure alarms Trouble shooting low-pressure alarms Care of the patient with: Aspiration COPD Hemopneumothorax Laryngospasm Pneumonia Pneumothorax Pulmonary edema Pulmonary embolism Tension pneumothorax Tuberculosis Medications: Aminophylline (Theophylline) Bronkosol (Isoetharine hydrochloride) Epinephrine (Adrenalin) Isuprel (Isoproterenol hydrochloride) Steroids Terbutaline NEUROLOGICAL Assessment: Advanced neuro assessment
Glasgow coma scaleReflex/motor deficitsVisual or communication deficits
Level of consciousnessEquipment & Procedures: Assist with lumbar puncture Increased ICP management
MedicationsPositioningRegulation of ICPTemperature controlVentilation
Intracranial pressure monitoringCare of the patient with: Basal skull fracture
NEUROLOGICAL (cont.) 1 2 3 4 LENGTH OF EXPERIENCE
Closed head injury CVA DTs Encephalitis Externalized VP shunts Meningitis Neuromuscular disease Overdose Seizures Spinal cord injury Medications: Decadron (Dexamethasone) Dilantin (Phenytoin) Mannitol (Osmitrol) Solu-Medrol Phenobarbital ORTHOPEDICS Assessment: Circulation checks Gait Range of motion Skin Equipment & Procedures Assist with placement of cast Support devices
Cane/crutchCervical collarSlingTransfer boards
Care of the patient with: Ankle brace Ankle splint Cast Knee immobilizer Pinned fractures Amputation Wrist splint GASTROINTESTINAL Assessment: Abdominal/bowel sounds Fluid balance Nutritional status Interpretation of blood chemistry Equipment & Procedures: Placement of nasogastric tube Salem sump to suction Saline lavage Care of the patient with: Abdominal trauma Bowel obstruction GI bleeding Hepatitis Liver failure Medications: Antiemetics Antispasmodic Charcoal Ipecac MISCELLANEOUS AMA procedures Suicide precautions PHELBOTOMY/IV THERAPY 1 2 3 4 LENGTH OF EXPERIENCE
Equipment & Procedures: Administration of blood/blood products
- Autotransfusion- Cryoprecipitate- Packed red blood cells- Plasma/albumin- Whole blood
Assist with cut down Drawing venous blood Starting IVs
Care of the patient with: Angiography Central line/catheter/dressing
- Broviac/Hickman- Groshong- PICC- Portacath
Pericardiocentesis RENAL/GENITOURINARY Assessment: Fluid balance Interpretation of lab results: BUN & creatinine Electrolytes Equipment & Procedures: Insertion & care of straight and Foley cathater
Urine specimen collection Care of the patient with: Acute renal failure Peritoneal lavage Renal trauma Urinary tract infection ENDOCRINE/METABOLIC Assessment: S/S diabetic coma S/S insulin reaction Equipment & Procedures: Blood glucose measuring device: Blood glucose monitoring Performing finger stick Care of the patient with: Diabetes ketoacidosis Medications: Insulin Oral hypoglycemics EENT Assessment: Set up fluorescent/Woods lamp exam Visual acuity Equipment & Procedures: Application of eye patch Ear irrigation Eye irrigation Morgan lens irrigation Nasal packing Removal of contact lens WOUND MANAGEMENT/SURGERY 1 2 3 4 LENGTH OF EXPERIENCE
Equipment & Procedures: Application of Steristrips Assist with staples Assist with sutures Culdocentesis tray Set up suture tray Staple removal Suture removal PEDIATRICS Equipment & Procedures: Child abuse/recognition/reporting Obtaining consent to treat Pediatric arrest Care of the patient with: Epiglottitis Near drowning Overdose/poison ingestion Status asthmaticus Statue epilepticus WOMEN'S HEALTH Assessment – Assist with pelvic exam Equipment & Procedures: Pelvic tray Rape kit Reporting acts of violence Care of the patient with: Abruptio placenta DIC Hemorrhage Placenta previa Precipitous delivery Preeclampsia/eclampsia Spontaneous abortion ASSIGNMENTS WILLING AND QUALIFIED TO PERFORM: LICENSE AND CERTIFICATION INFORMATION:
State/License #___________________________Expiration Date:____________________________
State/License #___________________________Expiration Date:____________________________
State/License #___________________________Expiration Date:____________________________
Expiration Date__________________________________
A___ I____ P____Expiration Date___________________
Expiration Date__________________________________
Expiration Date__________________________________
Fixed Wing Aircraft_____ Mobile Intensive Care _____
❑ Yes ❑ No Specify__________________________________
Has your license ever been under investigation? ❑ Yes ❑ No
If yes, explain______________________________________________________________________________________________
SHIFT PREFERENCE: 1st choice_______________________ 2nd choice_____________________________ The statements made in this application are true to the best of my knowledge. I understand that any falsification will be basis for disqualification of employment or
termination of services. Falsification of professional documents by ommission or false statements is an offense reportable to the state board(s).
SIGNATURE___________________________________________DATE_________________________________
THE AFIB REPORT Your Premier Information Resource for Lone Atrial Fibrillation Publisher: Hans R. Larsen MSc ChE VIRTUAL LAF CONFERENCE SUBJECT: LAF & ANTIDEPRESSANTS An afibber recently reported to me that he could prevent atrial flutter from turning into atrial fibrillation by taking two 530 mg capsules of the herb valerian. Another has reported that the use of Effexo