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ICU

Information

Name *

Last 4 digits of SSN *

Phone *

Email *

Proficiency Scale

1 = No Experience

2 = Need Training

3 = Able to perform with supervision

4 = Able to perform independently

Cardiac

Defibrillation/Cardioversion *

Assisting with Insertion of Central Lines *

Pacemakers?External *

Permanent or Temporary Pacemaker *

Cardiac Arrest/CPR *

A?Line (Transducer setup?D/C) *

Swan Ganz (Transducer setup?D/C) *

Balloon Pump (IABP) *

SVO2 Monitoring *

Automatic Internal Cardioverter Defib *

Respiratory

Aneurysm *

Acute MI/Unstable Angina *

Cardiogenic/Hypovolemic Shock *

Pre/Post Cardiac Surgery *

Heart Transplant *

PTCA *

COPD *

ARDS *

Pulmonary Embolism *

Pulmonary Edema *

Pneumonia *

Inhalation Injuries *

CVA *

Seizure Disorder *

Overdose *

Neuro Injury/Trauma *

Pre/Post Neuro Surgery *

Cranial Hemorrhage *

Aphasia *

Multiple Sclerosis *

Pancreatitis *

GI Bleed *

Esophageal Bleeding *

Bowel Obstruction *

Liver Transplant *

Paralitic Ileus *

TURP *

Shunts and Fistulas *

Nephrectomy *

Renal Transplant *

Renal Trauma *

Use and Administration of the following

Atropine *

Bretylol *

Bumex *

Digoxin *

Dopamine *

Dobutrex *

Inderal *

Inocor *

Isuprel *

Lidocaine *

Neosynephrine/Nipride *

NTG *

Pronestyl *

Titrate Morphine *

Verapamil *

Thrombolitic Agents *

Prep/Titration of Emergency Drugs *

Aminophylline *

Corticosteroids *

Bronkosol *

Ventolin *

Alupent *

Decadron *

Dilantin *

Magnesium Sulfate *

Phenobarbital *

Steroids *

Valium *

Versed *

Respiratory

Lung Transplant *

Establishing an Airway *

Pulse Oximetry *

Drawing ABG Blood Sample from A?Line *

Incentive Spirometer *

Neurology

Assessment of Neuro Signs *

Use of Glascow Coma Scale *

Seizure Precautions *

Assist with Lumbar Puncture *

ICP Monitoring *

Crutchfield Tongs *

Halo Traction *

Stryker Frame *

Assessment of Sensory?Motor Function *

Cervical Traction *

Cranial Nerve Assessment *

LOC Assessment *

Pre/Post Neuro Surgical Care *

Visual Acuity Measurement *

Vascular

Peripheral Pulses *

Fluid Overload *

Starting IV's *

Subcutaneous Central Line *

Hickman/Broviac/Groshong Catheters *

Maintenance of Heparin Lock *

TPN/Hyperalimentation *

Air Occlusive Dressing *

Infusion Pump *

Peritoneal Dialysis *

Hemodialysis *

Heparin Drip ? Precautions and Maintenance *

Gastrointestinal

NG Tube Insertion *

Gastronomy Tube *

Jejunoostomy Tube *

Enterostomal Care *

Genito Urinary/Renal

Foley Catheter Insertion *

GU Irrigations *

Nephrostomy Tube *

Suprapubic Tube *

Electrolyte Imbalance/Replacement *

Other

Oncology *

Chemotherapy *

Isolation Techniques *

Hyperbaric Oxygenation *

Fingerstick Blood Glucose Monitoring *

Equipment

Bear I *

Bear II *

Bear V *

Bennett 7200 *

CPAP *

Emerson *

EMV *

MA?I *

MA?II *

Monihan *

Ohio 560 *

PEEP *

Pressure Pre?Set *

Servo 900b *

Servo 900c *

Servo 900e *

Siemens *

Hewlett-Packard *

Spacelab *

Marquette *

Mennen *

Lifecare *

Nihon-Koder *

Age Specific Competencies

Infant (Birth - 1 year) *

Preschooler (ages 2-5 years) *

Childhood (ages 6-12 years) *

Adolescents (ages 13-21 years) *

Young Adults (ages 22-39 years) *

Adults (ages 40-64 years) *

Older Adults (ages 65-79 years) *

Elderly (ages 80+ years) *

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