* Please note that fields marked with a * are required.
Date
* Applicant's Name: Last
Middle Initial
* First
To ArdorHealthSolutions Healthcare Professionals:
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 in this checklist. Please rate your ability as accurately as possible by checking the appropriate box.
The information I have given here is true and accurate to the best of my knowledge. In addition, I also authorize ArdorHealthSolutions to release this Critical Care Profile to client institutions of ArdorHealthSolutions in relation to my employment with that institution.
* Signature (Please Type Full Name)
* Date
Please Mark Your Level of Experience 1 - No Experience: Theory / Observed Only 2 - Intermittent Experience: < 5 Times Per Year; Needs Review 3 - Moderate Experience: > 5 Times Per Year; May Need Minimal Resource 4 - Competent: Performs on Daily or Weekly Basis; Proficient
Cardiac
1
2
3
4
Arrhythmia Analysis
Arterial Line
Assist with Central Line Insertion
Assist with Sheath Removal (A/V)
Automatic Internal Cardioverter Defib (AICD)
Basic 12-Lead EKG Interpretation
Cardiac Arrest / CPR
Care of the Patient With:
Abdominal Aortic Aneurysm
Acute MI/Unstable Angina
Cardiogenic/Hypovolemic Shock
CHF
Heart Transplant
MAST Suit/Rotating Tourniquets
Pre-/Post-Cardiac Surgery
Pre-/Post-PTCA
Thrombolytic Therapy
Ventricular Assist Device (RVAD/LVAD)
Defibrillation / Cardioversion
Hemodynamic Monitoring Interpretation
Intra Aortic Balloon Pump (IABP)
Management and Titration of:
Cardizem
Heparin
Inocor
Isuprel
Morphine
Nipride
Nitroglycerine
Pacemakers:
External
Permanent
Temporary
Problem Solve PA Catheter Complications
Sheath Removal - Femoral
SVO2 Monitoring
Swan Ganz / Pulmonary Artery Catheter
Transducer Set-Up and D/C
Use and Administration of:
Atropine
Bicarbonate
Bretylium
Digoxin
Dobutamine
Dopamine
Epinephrine
Levophed
Lidocaine
Pronestyl
Gastrointestinal
Assessment of Bowel Sounds
Bowel Obstruction
ERCP
GI Bleed
Liver Transplant
Pancreatitis
TPN
Tube Feedings
Whipple Procedure
Enterostomal Care
Gastrostomy/Jejunostomy Tubes
NG Tube Insertion
Genitourinary/Renal
leal Conduit
Nephrostomy/Suprapubic Tubes
Renal Failure (Acute/Chronic)
Renal Transplant
Renal Trauma
Shunts/Fistulas
TURP
CAVH Dialysis
Electrolyte Imbalance/Replacement
Foley Catheter Insertion
GU Irrigation (Continuous/Intermittent)
Hemodialysis
Peritoneal Dialysis
Miscellaneous
Accucheck
Chemotherapy
Conscious Sedation
Diabetic Teaching
HIV/AIDS
Hyberbaric Oxygenation
Isolation Techniques
Obtaining Cultures
Pain Management
PCA Pumps
Pyxis
Use of Restraints
Neurological
Assist with Lumbar Puncture
CNS Infections
Coma
Crutchfield Tongs
CVA
Halo Traction
Neuro Injury/Trauma
Overdose
Pre-/Post-Neuro Surgery
Seizure Activity
Spinal Cord Injury
Ventriculostomy
Epidural Medication Administration
Glascow Coma Scale
Identify and Intervene During Complications (eg. CSF Leak, Clot, Herniation)
Increased ICP Management (eg. Positioning, Temperature Regulation and Medication)
Intracranial Pressure Monitoring
Perform Neuro Assessment
Seizure Precautions
Use of Stryker Frame
Pulmonary
Assess Lung Sounds
Assist with Chest Tube Insertion / Set Up / Removal
Assist with Extubation
Assist with Intubation
Assist with Thoracentesis
ARDS
Chest Tubes (Pleur-Evac)
COPD
Inhalation Injuries
Pneumonia
Pre-/Post-Thoracic Surgery
Pulmonary Edema
