Instructions:

Please rate your experience / frequency (within the last year) using the following scale (check the appropriate boxes below):

  • 0 = No Experience / Observed Only
  • 1 = Limited Experience / Rarely Done (<6 times/year)
  • 2 = May Need Some Review / Occasionally Done (1 - 2 times/month)
  • 3 = Experienced / Frequently Done (daily or weekly)
    		•
    TYPES OF ER EXPERIENCE
    Level 1 Trauma Center
    Level 2 Trauma Center
    Level 3 Trauma Center
    Pediatric ED
    AGE OF PATIENTS CARED FOR
    Newborn/Neonate (birth to 30 days)
    Infant (31 days to 12 months)
    Toddler/Preschool (13 months to 5 years)
    School Age Child/adolescent (6 years to 18 years)
    Young Adults/ Middle Adult (19 years to 64 years)
    Older Adults/Elderly (65+ years)
    GENERAL SKILLS
    Care of Patient in Restraints
    Automated Med Dispensing Systems
    Other Automated Med Dispensing Systems:
    Electronic Documentation
    Other Electronic Documentation:
    IV Pumps
    Other IV Pumps:
    Peripheral IV Insertion, Care and Maintenance
    Access/Management of Implanted Ports
    Access/Management of Central Lines (CVL, Hickman, Broviac, Groshong, etc.)
    Intraosseus Line
    Cardiac Monitoring/Interpretation
    Rapid Fluid Infuser
    Titration of drips
    Administration of Blood/Blood Products
    Knowledge of "Do Not Use Abbreviations"
    Do you have charge/supervisor experience?
    Knowledge of current Joint Commission National Patient Safety Goals
    Knowledge/familiarity with HCAHPS scores
    MEDICATION ADMINISTRATION
    Moderate/Conscious Sedation
    Sedation Reversal Agents
    Antibiotics IM/IV
    Antiemetics
    Adenosine
    Aminophylline(Theophylline)
    Atropine
    Anticoagulants
    Anticonvulsants
    Antihypertensives
    Barbituate Induced Coma
    Charcoal
    Cardizem
    Cordarone (amiodorone)
    Decadron
    Dilantin
    Dopamine
    Diuretics
    Epinephrine
    Inotropes (Digoxin,Dobutamine,Primacor)
    Inocor (amrinone)
    Insulin Infusions
    Isuprel
    Kayexelate
    Lidocaine
    Mannitol
    Narcotic Analgesia
    Nitroglycerin
    Nipride
    Steroids
    Thrombolytic Therapy
    Vasopressin
    Ventolin (Albuterol)
    Racemic Epinephrine
    CARDIOVASCULAR
    Care of the Patient With:
    Continuous Cardiac Monitoring
    Obtaining 12 lead EKG
    Abdominal Aortic Aneurysm
    Acute MI
    Angina
    Cardiac Arrest
    Cardioversion/defibrillation
    CHF
    Bacterial Endocarditis
    Myocarditis
    Synchronized Cardioversion
    Defibrillation
    Emergent Chest Thoracotomy
    Cardiac Isoenzymes
    Troponin
    BNP
    Shock:
    Anaphylactic
    Cardiogenic
    Hypovolemic
    Neurogenic
    Septic
    Pacemaker:
    External
    Permanent
    Temporary
    Transthoracic
    Hemodynamic Monitoring:
    Set up, use and Interpreation of Reading of CVP
    Set up, use and Interpretation of Reading of PA/Swan-Ganz
    Set up and use of Arterial Line
    PULMONARY
    Care of the Patient With:
    Ventilator/Weaning
    Asphyxiation (Near Drowning)
    Oral Airway
    Endotracheal Tube
    Laryngeal Spasm
    Tracheostomy
    Epistaxis
    Aspiration
    ARDS
    COPD
    Lobectomy
    Pneumonectomy
    Pneumothorax/Tension Pneumothorax
    Hemothorax
    Pneumonia
    Assist with Emergency Tracheostomy
    Thoracentesis
    Inhalation Injuries
    Pulmonary Edema
    Pulmonary Embolism
    Status Asthmaticus
    Tuberculosis
    Chest Tube (pleurevac/Thoraclex)
    Assist with Intubation
    Assist with Chest Tube Insertion
    ABG Interpretation
    NEUROLOGICAL
    Acute Head Injury
    Intracranial Pressure Monitoring
    Management of Increased ICP
    Basal Skull Fracture
    Acute CVA/TIA
    Heat Exhaustion
    Multiple Sclerosis
    Psychiatric Disorders
    Aneurysm Precautions
    Coma
    Encephalitis
    Delirium Tremors
    Meningitis
    Seizures/Seizure Precautions
    Status Epilepticus
    Spinal Cord Injury
    Cranial Nerve Assessment
    Reflex/Motor Deficits
    Assist with Lumbar Puncture
    Externalized VP Shunts
    Overdose
    ORTHOPEDICS
    Fracture/Dislocation
    Traumatic Amputation
    Brace/Splint Application
    Halo Traction
    Crutchfield Tongs
    Set up for Insertion of Steinman Pins
    Hare Traction
    GASTROINTESTINAL
    Gastric Lavage
    Nasogastric Tube
    Salem Sump
    PEG Tube
    Acute Cholecystitis
    Bowel Obstruction
    Cirrhosis
    GI Bleed
    GI Surgery
    Pancreatitis
    Liver Failure
    Liver Transplant
    Acute Abdominal Pain
    Blunt Abdominal Trauma
    Penetrating Abdominal Trauma
    Evisceration
    Esophageal Bleeding
    RENAL/GENITOURINARY
    AV Fistula
    Suprapubic Catheter
    Hemodialysis
    Peritoneal Dialysis
    Nephrostomy Tube
    Peritoneal Lavage
    Acute Renal Failure
    Renal Transplant
    Nephrectomy
    TURP
    Pyelonephritis/UTI
    Renal Calculi
    ENDOCRINE/METABOLIC
    Adrenal Disorders (Addison's Disease)
    Diabetic Ketoacidosis
    Diabetes Mellitus
    Hypothyroidism
    Hyperthyroidism (Graves Disease)
    Pituitary Disorders
    Thyroidectomy
    INFECTIOUS DISEASE
    Hepatitis
    HIV
    MRSA
    CRE
    VRE
    C Difficile
    Tuberculosis
    Isolation Precautions/Procedures
    ONCOLOGY
    Chemotherapy
    Bone Marrow Transplants
    Leukemia
    Lymphoma
    Radiation Implants
    WOUND MANAGEMENT
    Multiple Abdominal Wounds and Drains
    Gunshot Wound
    Stab Wound
    Lacerations
    Hazardous Material Exposure
    Radiation Exposure
    Set up and assist with Staples/Sutures
    Suture Removal
    Staple Removal
    Application of Steri-strips
    Burns:
    First Degree
    Second Degree
    Third Degree
    Rule of Nines
    Fluid Resuscitation Burn Formula
    Electrical Burns
    PEDIATRIC
    Pediatric Arrest/Resuscitation
    Calculating Emergency Medication Dosages
    Braslow Tape
    Knowledge of Normal lab Values
    Near Drowning
    Overdose/Poison Ingestion
    Asthma
    Bronchiolitis
    Epiglottitis
    Reporting of Suspected Child Abuse
    HEENT
    Ear irrigation
    Eye irrigation
    Removal of Contact lens
    Visual Acuity Check
    Set up for Fluorescein/Woods Lamp
    Nasal packing
    Application of Eye Medication
    Use of Morgan lens irrigation
    Le Fort Fracture I, II, III, IV
    MISCELLANEOUS
    Administration of Antivenom
    Animal Bites
    Triage procedures
    Procedure for patient leaving AMA
    Consent for Treatment of a Minor
    Organ/Tissue Donation