The following checklist is a profile used to assess your Critical Care proficiency and assist in matching your skills with available assignments. Your employment is not dependent upon responses given on this checklist. Please rate your ability as accurately as possible by checking the appropriate option. Step 1 of 4 25% Name* First Middle Last PLEASE MARK YOUR LEVEL OF EXPERIENCE 0 - No Experience 1 - Theory/Observed Only 2 - Intermittent Experience 3 - Moderate Experience 4 - ExpertCardiacArrythmia Analysis01234Artrial Line01234Assist with Central Line Insertion01234Assist with Sheath Removal (A/V)01234Automatic Internal Cardioverter Defib (AICD)01234Basic 12-Lead EKG Interpretation01234Cardiac Arrest / CPR01234Care of patient with Abdominal Aortic Aneurysm01234Care of patient with Acute MI/Unstable Angina01234Care of patient with Cardiogenic/Hypovolemic Shock01234Care of patient with CHF01234Care of patient with heart transplant01234Care of patient with MAST Suit/Rotating Tourniquet01234Care of patient pre-/post- cardiac surgery01234Care of patient pre-/post-PTCA01234Care of patient with Thrombolytic Therapy01234Care of patient with Ventricular Assist Device (RVAD/LVAD)01234Care of patient with Defibrilation / Cardioversion01234Care of patient with Hemodynamic Monitoring interpretation01234Care of patient with Intra Aortic Balloon Pump (IABP)01234Management and Titration of:Cardizem01234Heparin01234Inocor01234Isuprel01234Morphine01234Nipride01234Nitroglycerine01234Pacemakers:External01234Permanent01234Temporary01234Problem Solve PA Catheter Complications01234Sheath Removal - Femoral01234SV02 Monitoring01234Swan Ganz/Pulmonary Artery Catheter01234Transducer Set-up and D/C01234Use and Administration of: Atropine01234Bicarbonate01234Bretylium01234Digoxin01234Dobutamine01234Dopamine01234Epinephrine01234Levophed01234Lidocaine01234Pronestyl01234 GastrointestinalAssessment of Bowel Sounds01234Care of patient with bowel obstrustion01234Care of patient with ERCP01234Care of patient with GI bleed01234Care of patient with liver transplant01234Care of patient with Pancreatitis01234Care of patient with TPN01234Care of patient with tube feeding01234Care of patient with Whipple Procedure01234Care of patient with enterostomal care01234Care of patient with gastronomy/jejunostomy tubes01234Care of patient with NG tube insertion01234Genitourinary/RenalCare of patient with ileal conduit01234Care of patient with nephrostomy/suprapublic cubes01234Care of patient with renal failure (acute/chronic)01234Care of patient with renal transplant01234Care of patient with shunts/fistula01234Care of patient with TURP01234Care of patient with CAVH dialysis01234Care of patient with electrolyte imbalance/replacement01234Care of patient with Foley catheter insertion01234Care of patient with GU irrigation (continuous/intermittent)01234Care with hemodialysis01234Care of patient with peritoneal dialysis01234MiscellaneousAccucheck01234Chemotherapy01234Conscious sedation01234Diabetic teaching01234HIV/AIDS01234Hyperbaric oxygenation01234Isolation techniques01234Obtaining cultures01234Pain management01234PCA pumps01234Pyxis01234Use of restraints01234 NeurologicalAssist with Lumbar Puncture01234Care of patient with CNS infections01234Care of patient in coma01234Care of patient with Crutchfield tongs01234Care of patient with CVA01234Care of patient with halo traction01234Care of patient with neuro injury/trauma01234Care of patient with overdose01234Care of patient pre-/post-neurosurgery01234Care of patient with seizure activity01234Care of patient with spinal cord injury01234Care of patient with ventriculostomy01234Care of patient with epidural medication administration01234Glascow Coma Scale01234Identify and intervene during complications (e.g. CSG leak, clot, herniation)01234Intracranial pressure monitoring01234Perform neuro assessment01234Seizure precautions01234Use of Stryker frame01234PulmonaryAssess lung sounds01234Assist with chest tube insertion/setup/removal01234Assist with Extubation01234Assist with Intubation01234Assist with Thoracentesis01234Care of patient with ARDS01234Care of a patient with Chest Tubes (Pleur-Evac)01234Care of patient with COPD01234Care of patient with inhalation injuries01234Care of patient pre-/post-thoracic surgery01234Care of patient with pneumonia01234Care of patient with pulmonary edema01234Care of patient with pulmonary embolism01234Care of patient with tracheostomy01234Care of patient with ventilator (A/C, IMV, PEEP)01234Weaning Parameters (Pressure Support, CPAP)01234Establish an airway01234Identify and intervene respiratory complications (eg. Tension Pnemothorax, Aspiration, Pulmonary Edema, Laryngospasm)01234Incentive Spirometry01234Interpret ABG results01234Oxygen therapy administration01234Obtain ABG from A-Line01234Problem solve ventilation complications (eg. High Pressure Alarm, Low Exhale Volume)01234Use and Administration of: Aminophylline01234Cortocosteroids01234Nebulizer Treatments01234 VascularAdministration of blood/blood products01234Central line maintenance01234Hickman/Broviac/Groshong catheter01234Infusion pumps01234Normal serum lab values01234Peripheral pulses01234Ultrasonic Doppler01234Start IV01234CertificationsACLS Yes No Expiration Date MM DD YYYY BCLS Yes No Expiration Date MM DD YYYY CCRN Yes No Expiration Date MM DD YYYY CNRN Yes No Expiration Date MM DD YYYY TNCC Yes No Expiration Date MM DD YYYY Other Certifications (not listed above):TypeExpiration Date Types of Critical Care Units WorkedEnter number of years worked in each type of unit. BurnCardiothoracicCardiovascularCoronary CareMedicalNeuroRecovery RoomStepdownSurgicalTraumaEquipment ExperiencePlease list all the brands of equipment you have used.VentilatorInfusionCardiac MonitorsOther MonitorsTotal Number of Years Experience in Critical Care NursingList courses for Critical CareList courses for ArrythmiasAdditional SkillsPlease list any additional experience or skills that have not been included above:The information I have given is true and accurate to the best of my knowledge. In addition, I hearby authorize Fidelis Partners to release this Critical Care Profile to client institutions of Fidelis Partners in consideration of my employment with that institution.SignatureSign using your mouse or finger (if on a mobile or tablet device) to draw your signature.