The following checklist is a profile used to assess your Emergency Room 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 5 20% Name* First Middle Last PLEASE MARK YOUR LEVEL OF EXPERIENCE 0 - No Experience 1 - Theory/Observed Only 2 - Intermittent Experience 3 - Moderate Experience 4 - ExpertTraumaTransport of Trauma patient01234Care of patient with minor trauma01234Care of patient with major trauma01234BurnsCare of patient with burns01234Care of patient with electrocution01234Care of patient with hazardous materials exposure01234RespiratoryCare of patient with pulmonary edema01234Care of patient with COPD01234Care of patient with Pnemothorax01234Assist with intubation and extubation01234Care of patient with ventilator01234Set up for insertion of arterial line01234Care of patient with oxygen01234Use of Ambu bag01234Assist with chest tube insertion01234Use of Pleura vac drainage system01234Gastrointestinal/RenalCare of patient with GI bleed01234Care of patient with abdominal wounds01234Care of patient with GI tubes01234Care of patient with acute abdominal disorders01234Insertion of nasogastric tube01234Assist with gastric lavage01234Care of patient with acute renal failure01234 OrthopedicSet up for cast application01234Check CMS01234Set up for OCL splinting01234Set up for insertion of Steinman Pin/K-wires01234Assist with closed fracture/dislocation reduction01234Application of orthopedic appliances01234ENT DisordersSet up for fluorescein/Woods Lamp exam01234Use of Morgan Lens irrigation01234Ear and Eye irrigation01234Nasal packing01234Remove contact lens01234Assess visual acuity01234LacerationsAssist with sutures and removal01234Assist with staples and removal01234 PediatricCalculate medication dosages01234Care of patient with epiglottitis01234Care of patient with overdose/poison ingestion01234Care of patient with child abuse01234Obstetrics/GynecologyCare of patient with spontaneous abortion01234Care of patient with hemorrhage01234Care of patient with placenta previa01234Care of patient with abruptio placenta01234Care of patient with pre-eclampsia/eclampsia01234Care of patient with emergency delivery01234PsychiatricCrisis intervention01234Upholding patient's rights01234Care of suicidal patient01234Care of patient with overdose01234Care of patient in restraints01234NeurologicalNeuro assessment01234Use of Glasgow Coma Scale01234Care of patient with acute head injury01234Care of patient with acute TIA/CVA01234Care of patient with acute spinal cord injury01234Seizure precautions01234Transport the patient with spinal cord injury01234Assist with lumbar puncture01234Knowledge and use of dilantin01234Knowledge and use of phenobarbital01234Knowledge and use of Decadron01234Knowledge and use of mannitol01234 CardiovascularCare of patient with acute MI01234Care of patient with CHF01234Care of patient with abdominal aortic aneurysm01234Recognize arrhythmias01234Obtain 12 Lead ECG01234Care of patient with cardioversion01234Use of restraints01234Defibrillation01234Assist with insertion of temporary pacemaker01234Set up and use of CVP01234Thrombolytiv therapy01234Care of patient with shocks01234Administration of blood and blood products01234Preparation and calculation of:Lidocaine01234Nipride01234Dopamine01234Isuprel01234Digitalis01234Sodium bicabonate01234Atropine01234Epinephrine01234Dobutrex01234Nitrogycerine01234Sexual Assault/Child AbuseRape kit01234Reporting procedures for acts of violence01234EnvironmentalCare of patient with hypothermia01234Care of patient with heat stroke/exhaustion01234Care of patient with snake/animal bite01234Administration of antivenom01234 Additional SkillsIsolation procedures01234Triage procedures01234Care of patient with AIDS01234Procedure for signing AMA01234Consent for treatment of a minor01234Disaster protocols01234Start adult IV01234Start Pediatric IV01234Age Specific CriteriaPlease check the box corresponding to each age group for which you have expertise in providing age appropriate nursing care. Newborn/Neonatal (birth - 30 days) Infant (30 days - 1 year) Toddler (1 - 3 years) Preschooler (3 - 5 years) School age children (5 - 12 years) Experience with Age GroupsCalculate body weight to verify correct dosing of medication01234Assess immunization status for pediatric and adolescent patients01234Set age appropriate short-term and long-term goals in care planning01234Provide age-appropriate education, considering possible vision and hearing impairment for older than 65 years.01234CertificationsACLS 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 Additional 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 Emergency Room Profile to client institutions of Fidelis Partners in consideration of my employment with that institution.Signature*Sign using your mouse or finger (if on a mobile or tablet device) to draw your signature.
