Age of Patients Cared ForNewborn/Neonate (birth to 30 days)* 1 2 3 4 Infant (1 month to 1 year)* 1 2 3 4 Toddler (1 year to 3 years)* 1 2 3 4 Preschooler (3 years to 5 years)* 1 2 3 4 School Age Child (5 years to 12 years)* 1 2 3 4 Adolescents (12 years to 18 years)* 1 2 3 4 Young Adults (18 years to 39 years)* 1 2 3 4 Middle Adults (39 years to 64 years)* 1 2 3 4 Older Adults (64 years to 79 years)* 1 2 3 4 Elderly Adults (over 79+ years)* 1 2 3 4 General SkillsIsolation Precautions* 1 2 3 4 Pediatric Respiratory/Cardiac Arrest* 1 2 3 4 Adult Respiratory/Cardiac Arrest* 1 2 3 4 Crash Carts* 1 2 3 4 Defibrillators* 1 2 3 4 Care of Patents in Restraints* 1 2 3 4 Pain Management* 1 2 3 4 Automated Med Dispensing Systems* 1 2 3 4 List Types:Care Planning and Discharge Planning* 1 2 3 4 Patient/Family Education* 1 2 3 4 Patient Heat to toe Assessment* 1 2 3 4 Peripheral IV Insertion, Care and Maintenance* 1 2 3 4 Triage Procedures* 1 2 3 4 Lab Values* 1 2 3 4 Procedure for Patient Signing AMA* 1 2 3 4 Consent for Treatment of Minor* 1 2 3 4 Disaster Protocols* 1 2 3 4 Crisis Intervention* 1 2 3 4 Upholding Patient's Rights* 1 2 3 4 Care of Patients with Infectious Diseases* 1 2 3 4 Care of Patients with Central Line* 1 2 3 4 Reporting Procedure for Acts of Violence* 1 2 3 4 ImmunocompromisedCare of Patients with Cancer* 1 2 3 4 Care of Patients with HIV/Aids* 1 2 3 4 Care of Patients with Hepatitis* 1 2 3 4 Care of Patients with TB* 1 2 3 4 Heent Disorders-Care of Patient with:Set-Up for Lamp Exam* 1 2 3 4 Use of Morgan Lens Irrigation* 1 2 3 4 Ear Irrigations* 1 2 3 4 Eye Patch Application* 1 2 3 4 Eye Irrigations* 1 2 3 4 Epistaxis/Nasal Packing* 1 2 3 4 Pulmonary-Care of Patients with:Pulmonary Edema* 1 2 3 4 Pulmonary Embolis* 1 2 3 4 ARDS* 1 2 3 4 Trach* 1 2 3 4 COPD* 1 2 3 4 Aspiration* 1 2 3 4 Tuberculosis* 1 2 3 4 Pneumothorax* 1 2 3 4 Intubation/Extubation* 1 2 3 4 T-Piece* 1 2 3 4 Obtaining Arterial Blood Gases* 1 2 3 4 Setting Up of Arterial Line* 1 2 3 4 Ventilator* 1 2 3 4 O2 Mask and Cannula* 1 2 3 4 O2 Cylinders* 1 2 3 4 Nebulizer Set-Up* 1 2 3 4 Oropharyngeal Suction* 1 2 3 4 Endotracheal Suction* 1 2 3 4 Assisting with Chest Tube Insertion* 1 2 3 4 Use of Pleuravac Drainage System* 1 2 3 4 Use of Emerson Drainage System* 1 2 3 4 Cardiovascular - Care of Patient with:Acute MI, Angina* 1 2 3 4 CHF* 1 2 3 4 Abdominal Aortic Aneurysm* 1 2 3 4 Cardiac Monitoring* 1 2 3 4 Recognizing Arrhythmias* 1 2 3 4 Obtaining 12 Lead EKG's* 1 2 3 4 Cardioversion* 1 2 3 4 Open Chest Heart Massage* 1 2 3 4 Assist with Insertion of Pacemakers* 1 2 3 4 Set-Up and Use of CVP* 1 2 3 4 Interpretation of CVP Readings* 1 2 3 4 Interpretation of Swan-Ganz Readings* 1 2 3 4 Thrombolytic Therapy* 1 2 3 4 Anaphylactic Shock* 1 2 3 4 Cardiogenic Shock* 1 2 3 4 Septic Shock* 1 2 3 4 Hypovolemic Shock* 1 2 3 4 Administration of Blood and Blood Products* 1 2 3 4 Knowledge of Use of:Heparin* 1 2 3 4 Sodium Bicarbonate* 1 2 3 4 Lidocaine* 1 2 3 4 Bretylium* 1 2 3 4 Nipride* 1 2 3 4 Dopamine* 1 2 3 4 Isuprel* 1 2 3 4 Digitalis* 1 2 3 4 Sodium Bicarbonate* 1 2 3 4 Atropine* 1 2 3 4 Epinephrine* 1 2 3 4 Dobutrex* 1 2 3 4 Tridil/Nitroglycerine* 1 2 3 4 Laryngectomy* 1 2 3 4 Neurological - Care of Patient with:Spinal Precautions* 1 2 3 4 Neuro Assessments* 1 2 3 4 Use of Glascow Coma Scale* 1 2 3 4 Acute Head Injury* 1 2 3 4 Acute TIA/CVA* 1 2 3 4 Acute Spinal Cord Injury* 1 2 3 4 Observing for Increased Intracranial Pressure* 1 2 3 4 Assist with Lumbar Puncture* 1 2 3 4 Seizure Precautions* 1 2 3 4 Knowledge and User of:Narcan* 1 2 3 4 Dilantin* 1 2 3 4 Phenobarbital* 1 2 3 4 Decadron* 1 2 3 4 Mannitol* 1 2 3 4 Solu-Medrol* 1 2 3 4 Gastrointestinal - Care of Patient with:GI Bleed* 1 2 3 4 Abdominal Wounds* 1 2 3 4 Acute Abdominal Disorders* 1 2 3 4 Gastric Lavage* 1 2 3 4 Insertion of Nasogastric Tube* 1 2 3 4 Renal - Care of Patient with:Renal Failure* 1 2 3 4 Peritoneal Dialysis* 1 2 3 4 Renal Calculi* 1 2 3 4 Pyelonephritis/UTI* 1 2 3 4 Obstetrics/Gynecology Care of Patient with:HELLP Syndrome* 1 2 3 4 Spontaneous Abortion* 1 2 3 4 Hemorrhage* 1 2 3 4 Placenta Previa* 1 2 3 4 Placental Abruption* 1 2 3 4 Pre-eclampsia* 1 2 3 4 Emergency Delivery* 1 2 3 4 Fetal Heart Tones* 1 2 3 4 Sexually Transmitted Disease* 1 2 3 4 Psychiatric - Care of Patient with:Suicidal Patient* 1 2 3 4 Overdose* 1 2 3 4 Emergency Police Hold* 1 2 3 4 ETOH Abuse* 1 2 3 4 Eye* 1 2 3 4 Orthopedic - Care of Patient with:Traction* 1 2 3 4 Cast Application* 1 2 3 4 OCL Splinting* 1 2 3 4 Pins/Wires* 1 2 3 4 Closed Fracture/Dislocation Reduction* 1 2 3 4 Application of Orthopedic Appliances* 1 2 3 4 Lacerations - Care of Patient with:Setting up Suture Tray* 1 2 3 4 Assist with Sutures/Staples* 1 2 3 4 Steri Strips* 1 2 3 4 Trauma - Care of Patient with:Air Transport of Trauma Patient* 1 2 3 4 Major Trauma* 1 2 3 4 Minor Trauma* 1 2 3 4 MAST Suit* 1 2 3 4 Burns - Care of Patient with:First Degree* 1 2 3 4 Second Degree* 1 2 3 4 Third Degree* 1 2 3 4 Electrocution* 1 2 3 4 Radiation Exposure* 1 2 3 4 Hazardous Materials Exposure* 1 2 3 4 Pediatric General SkillsAbuse Reporting* 1 2 3 4 Vital Sign Parameters for Pediatric Patients* 1 2 3 4 Calculating Pediatric Medication Dosages* 1 2 3 4 Knowledge of Normal Serum Lab Values* 1 2 3 4 Pediatric - Care of Patient with:Febrile Seizure* 1 2 3 4 Epoglottitis* 1 2 3 4 Overdose/Poison Ingestion* 1 2 3 4 Asthma* 1 2 3 4 Near Drowning* 1 2 3 4 Environmental - Care of Patient with:Hypothermia* 1 2 3 4 Heat Stroke/Exhaustion* 1 2 3 4 Snake Bite* 1 2 3 4 Administration of Antivenim* 1 2 3 4 Animal Bite* 1 2 3 4 Pediatric Respiratory/Cardiac Arrest* 1 2 3 4 Knowledge and Use of:Antibiotics* 1 2 3 4 Analgesics* 1 2 3 4 Antiemetics* 1 2 3 4 Sedatives* 1 2 3 4 Medication Titraction and Calculations* 1 2 3 4 Reversal Agents* 1 2 3 4 Miscellaneous Instruments/TraysPelvic Tray* 1 2 3 4 Cut Down Tray* 1 2 3 4 Procto Tray* 1 2 3 4 CVP Tray* 1 2 3 4 Trach Tray* 1 2 3 4 Culdocentesis Tray* 1 2 3 4 Thoracentesis Tray* 1 2 3 4 Please list the EMR systems you have used** I attest that the information I have given is true and accurate to the best of my knowledge and that I am the individual completing this form.** I hereby consent to allow CrossMed Healthcare Staffing Solutions to release these skills checklist to the client facilities.*Name* First Last Email* Phone*TODAY'S DATE* MM slash DD slash YYYY
