MedRP International



Nurse: ___________________________________

Date: ____________________________________

|CHECK PROFICIENCY |1 |2 |3 |4 |

|TRAUMA/SHOCK |

|1. Assessment |

|Champion trauma score | | | | |

|Poison index | | | | |

|Triage | | | | |

|2. Equipment & procedures |

|Air transport trauma patient | | | | |

|Application of mast suit | | | | |

|Ground transport | | | | |

|3. Care of patient with: |

|Bites: |

| Animal | | | | |

| Human | | | | |

| Venomous snake | | | | |

| Venomous spider | | | | |

|Burns: |

| Rule of nines | | | | |

| 1st degree | | | | |

| 2nd degree | | | | |

| 3rd degree | | | | |

|Dehydration | | | | |

|Electrocution | | | | |

|Gunshot Wounds | | | | |

|Hazardous material exposure | | | | |

|Heat exhaustion/stroke | | | | |

|Hypothermia | | | | |

|Major trauma | | | | |

|Minor trauma | | | | |

|Radiation exposure | | | | |

|Shock: |

| Anaphylactic | | | | |

| Cardiogenic | | | | |

| Hypovelmic | | | | |

| | | | | |

|Trauma/shock (continued) |

| Neurogenic | | | | |

| Septic | | | | |

|Stab wounds | | | | |

|Traumatic Amputation | | | | |

|WOMEN’S HEALTH |

|1. Assessment |

|Assist with pelvic exam | | | | |

|2. Equipment and Procedures |

|Pelvic tray | | | | |

|Rape kit | | | | |

|Reporting acts of violence | | | | |

|3. Care of patient with: |

|Abruption placenta | | | | |

|DIC | | | | |

|Hemorrhage | | | | |

|Placenta previa | | | | |

|Preeclampsia/eclampsia | | | | |

|Spontaneous abortion | | | | |

|PHLEBOTOMY/IV THERAPY/INVASIVE PROCEDURE |

|1. Equipment & procedures |

|Administration of blood/blood products: |

| Auto transfusion | | | | |

| Cryoprecipate | | | | |

| Packed red blood cells | | | | |

| Whole Blood | | | | |

|Assist with cutdown | | | | |

|Drawing venous blood | | | | |

|Starting IV’s: |

| Angiocath | | | | |

| Butterfly | | | | |

| Heparin lock | | | | |

|2. Care of the patient with: |

|Angiography | | | | |

|Central line/catheter/dressing: |

| Broviac | | | | |

| Groshong | | | | |

| Hickman | | | | |

| PICC | | | | |

| Portacath | | | | |

|Pericardocentesis | | | | |

| | | | | |

| | | | | |

|OTHOPEDICS |

|1. Assessment |

|Circulation checks | | | | |

|Gait | | | | |

|Range of motion | | | | |

|Skin | | | | |

|2. Equipment & procedures |

|Assist with placement of cast | | | | |

|Support devices: |

| Cane/crutch | | | | |

| Cervical collar | | | | |

| Sling | | | | |

| Transfer boards | | | | |

|3. Care of the patient with: |

|Ankle brace | | | | |

|Ankle sprint | | | | |

|Cast | | | | |

|Knee immobilizer | | | | |

|Pinned fractures | | | | |

|Wrist Splint | | | | |

|WOUND MANAGEMENT |

|1. Equipment & Procedures |

|Application of Steristrips | | | | |

|Assist with Staples/sutures | | | | |

|Culdocentesis tray | | | | |

|Set up Suture Tray | | | | |

|Staple/Suture Removal | | | | |

|CARDIOVASCULAR |

|1. Assessment |

|Auscultation (rate, rhythm) | | | | |

|Doppler | | | | |

|Heart sounds/murmurs | | | | |

|2. Equipment & Procedures |

|Assist with insertion and set up: |

| Arterial line | | | | |

| Central line | | | | |

| PA Catheter/Swan Ganz Insertion | | | | |

| Pacemaker | | | | |

|Interpretation of wave forms and values: |

| A-line | | | | |

| CVP | | | | |

|Cardioversion | | | | |

|Monitoring: |

| Basic 12 lead interpretation | | | | |

| Basic arrhythmia interpretation | | | | |

|3. Care of patient with: |

|Acute MI | | | | |

|Aneurysm | | | | |

|Angina | | | | |

|Cardiac arrest | | | | |

|Congestive heart failure (CHF) | | | | |

|Myocarditis | | | | |

|4. Medications |

|ACLS drugs: |

| Atropine | | | | |

| Bretylium (Bretylol) | | | | |

| Epinephrine (Adrenalin) | | | | |

| Lidocaine (Xylocaine) | | | | |

| Procainamide (Pronestyl) | | | | |

| Sodium Bicarbonate | | | | |

|Other Drugs: |

| Adenosine (Adenocard) | | | | |

| Amiodarone (Cordarone) | | | | |

| Digoxin (Lanoxin) | | | | |

| Diltiazem (Cardizem) | | | | |

| Dobutamine (Dobutrex) | | | | |

| Dopamine (Intropin) | | | | |

| Esmolol (Brevibloc) | | | | |

| Lasix (Furosemide) | | | | |

| Nitroglycerine (Tridil) | | | | |

| Nipride (Nitroprusside) | | | | |

| Thrombolytic therapy | | | | |

|INFECTIOUS DISEASES |

|1. Interpretation of lab values |

|CBC, SMA 7 | | | | |

|2. Equipment & Procedures |

|Fever management | | | | |

|Isolation | | | | |

|3. Care of patients with AIDS | | | | |

|PULMONARY |

|1. Assessment |

|Breath sounds | | | | |

|Rate and work of breathing | | | | |

|2. Interpretation of lab results |

|Arterial blood gases | | | | |

| | | | | |

|PULMONARY (continued) |

|3. Equipment & Procedures |

|Airway management devices/suctioning: |

| Endotracheal tube/suctioning | | | | |

| Nasal airway/suctioning | | | | |

| Oropharyngeal/suctioning | | | | |

| Sputum specimen collection | | | | |

|Assist with extubation | | | | |

|Assist with intubation | | | | |

|Assist with Thoracentesis | | | | |

|Care of patient on a ventilator | | | | |

|Care of patient with a chest tube: |

| Assist with setup and Insertion | | | | |

| Measuring | | | | |

| Removal | | | | |

|Measuring peak flow | | | | |

|Obtaining blood gasses: |

| Arterial line | | | | |

| Femoral artery | | | | |

| Radial artery | | | | |

|Oxygen therapy & delivery systems: |

| Bag & mask | | | | |

| ET Tube | | | | |

| CPAP (external) | | | | |

| Face Masks | | | | |

| Inhalers | | | | |

| Nasal cannula | | | | |

| Nebulizer | | | | |

| Portable oxygen | | | | |

| T-piece | | | | |

| Trach collar | | | | |

|Pulse oximetry | | | | |

|Trouble shooting high pressure alarms | | | | |

|Trouble shooting low pressure alarms | | | | |

|4. Care of patient with: |

|Aspiration | | | | |

|COPD | | | | |

|Hemopneumothorax | | | | |

|Laryngospasm | | | | |

|Pneumonia | | | | |

|Pneumothorax | | | | |

|Pulmonary edema | | | | |

|Pulmonary embolism | | | | |

|Tension pneumothorax | | | | |

|Tuberculosis | | | | |

|5. Medications |

|Epinephrine (Adrenalin) | | | | |

|Aminophylline (Theophylline) | | | | |

|Bronkosol (Isoetharine hydrochloride) | | | | |

|Isuprel (Isoproterenol hydrochloride) | | | | |

|Steroids | | | | |

|Terbutaline | | | | |

|NEUROLOGICAL |

|1. Assessment |

|Advanced neuro assessment: |

| Glasgow coma scale | | | | |

| Reflex/motor deficits | | | | |

| Visual or communication deficits | | | | |

|Level of consciousness | | | | |

|2. Equipment & procedures |

|Assist with lumber puncture | | | | |

|Insertion & care of: |

| Medications | | | | |

| Positioning | | | | |

| Regulations of ICP | | | | |

| Temperature control | | | | |

| Ventilation | | | | |

|3. Care of patient with: |

|Basal skull fracture | | | | |

|Closed head injury | | | | |

|CVA | | | | |

|DTs | | | | |

|Encephalitis | | | | |

|Externalized VP shunts | | | | |

|Meningitis | | | | |

|Neuromuscular disease | | | | |

|Overdose | | | | |

|Seizures | | | | |

|Spinal cord injury | | | | |

|4. Medication: |

|Decadron (Dexamethasone) | | | | |

|Dilantin (Phenytoin) | | | | |

|Mannitol (Osmitrol) | | | | |

|Phenobarbital | | | | |

|RENAL/GENITOURINARY |

|1. Assessment – fluid balance | | | | |

|2. Interpretation of lab results |

|BUN & creatinine | | | | |

|Electrolytes | | | | |

|3. Equipment & procedures |

|Insertion & care of straight & Foley: |

| Female | | | | |

| Male | | | | |

|Urine specimen collection | | | | |

|4. Care of the patient with: |

|Acute renal failure | | | | |

|Peritoneal lavage | | | | |

|Renal trauma | | | | |

|Urinary tract infection | | | | |

|EENT |

|1. Assessment |

|Set up florescent/Woods lamp exam | | | | |

|Visual acuity | | | | |

|2. Equipment & Procedures |

|Application of eye patch | | | | |

|Ear irrigation | | | | |

|Eye irrigation | | | | |

|Morgan lens irrigation | | | | |

|Nasal packing | | | | |

|Removal of contact lens | | | | |

|ENDORINE/METABOLIC |

|1. Assessment |

|S/S diabetic coma | | | | |

|S/S insulin reaction | | | | |

|2. Equipment & procedures |

|Blood glucose monitoring | | | | |

|Electronic measuring device (specify)_______________ |

|Performing finger stick | | | | |

|3. Care of patient with: |

|Diabetic ketoacidosis | | | | |

|4. Medication |

|Insulin | | | | |

|Oral hypoglycemics | | | | |

| | | | | |

|GASTROINTESTINAL |

|1. Assessment |

|Abdominal/bowel sounds | | | | |

|Fluid balance | | | | |

|Nutritional status | | | | |

|2. Interpretation of blood chemistry | | | | |

|3. Equipment & procedures |

|Placement of nasogastric tube | | | | |

|Salem sump to suction | | | | |

|Saline lavage | | | | |

|4. Care of the patient with: |

|Abdominal trauma | | | | |

|Bowel obstruction | | | | |

|GI bleeding | | | | |

|Hepatitis | | | | |

|Liver Failure | | | | |

|5. Medications |

|Antimetica | | | | |

|Antispasmodic | | | | |

|Charcoal | | | | |

|Ipecac | | | | |

|IV conscious sedation | | | | |

|PEDIATRICS |

|1. Equipment & procedures |

|Child Abuse: |

| Recognition | | | | |

| Reporting | | | | |

|Obtaining consent to treat | | | | |

|Pediatric arrest | | | | |

|2. Care of patient with: |

|Epiglottitis | | | | |

|Near drowning | | | | |

|Overdose | | | | |

|Poison ingestion | | | | |

|Status Asthmaticus | | | | |

|Status epilepticus | | | | |

Total Number of Years in Emergency Room: __________________

|YEARS OF EXPERIENCE BY FIELD IN EMERGENCY ROOM SPECIALTIES |

|Field |Years |

|Trauma Center (Level 1) | |

|Trauma Center (Level II) | |

|Community ER (Level II) | |

|Rural ER | |

|YEARS OF EXPERIENCE BY AGE GROUP |

|Age Group |Years |

|Newborns (birth – 30 days) | |

|Infants (30 days – 1 year) | |

|Toddler (1-3 years) | |

|Preschooler (3-5 years) | |

|School Children (5-12 years) | |

|Adolescents (12-18 years) | |

|Young Adults (18-39 years) | |

|Middle aged adults (39-64 years) | |

|Senior Adults (64+ years) | |

The information I have provided is true and accurate to the best of my knowledge. I authorize Northwest Nurse Staffing. to release this Skills Checklist to client hospitals as needed in relation to my employment.

Print name:

Signature: _________________________________

Date: _____________________________________

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Key: 1 = No Experience

2 = Little Experience

3 = Moderate Experience

4 = Extensive Experienced

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