Medical Surgeries Skills Checklist Name First Last Title Date MM slash DD slash YYYY Level of Proficiency 1 = Proficient 2 = Knowledgeable 3 = Little or No Experience Application / Use OfAce Wrap 1 2 3 Cast Cutter 1 2 3 Cervical Collar / Philadelphia Collar 1 2 3 Clavicle Strap 1 2 3 Finger Splint 1 2 3 Forearm Splint 1 2 3 Hare Traction 1 2 3 Ice Bag 1 2 3 Knee Immobilizer 1 2 3 Ring Cutter 1 2 3 Sand Bags 1 2 3 Sling 1 2 3 Sling and Swath 1 2 3 Steri Strips 1 2 3 CardiacPrinciples of 12 Lead EKG 1 2 3 Interpretation of Arrhythmias 1 2 3 Defibrillation / Cardioversion 1 2 3 Use of Cardiac Monitors 1 2 3 Telemetry 1 2 3 Perform CPR 1 2 3 Pacemaker - Permanent 1 2 3 Pacemaker - Temporary 1 2 3 Cardiac Arrest 1 2 3 CVP Readings 1 2 3 A-Line (transducer set-up) 1 2 3 Principles of Hemodynamic Monitoring 1 2 3 Balloon Pump 1 2 3 Lead Placement of Electrodes 1 2 3 Use of Ambu Bag 1 2 3 Ability to Run 12 Lead EKG 1 2 3 Recognition / Management of Dehydration 1 2 3 Care of Patient WithAneurysm 1 2 3 Acute MI 1 2 3 Pre-Post Cardiac Surgery 1 2 3 Heart Transplant 1 2 3 Anaphylactic Shock 1 2 3 Cardiogenic Shock 1 2 3 Hypovolemic Shock 1 2 3 Neurogenic Shock 1 2 3 Septic Shock 1 2 3 Use & Admin. of these DrugsAtropine 1 2 3 Adenosine 1 2 3 Digoxin 1 2 3 Dopamine 1 2 3 Inderal 1 2 3 Isuprel 1 2 3 Lidocaine 1 2 3 NTG 1 2 3 Pronestyl 1 2 3 Quinidine 1 2 3 Preparation of Emergency Drugs 1 2 3 Lasix 1 2 3 Morphine 1 2 3 Nitroprusside IV 1 2 3 Pain Management 1 2 3 Verapamil 1 2 3 Care of Patients WithAIDS 1 2 3 Carbon Monoxide Poisoning 1 2 3 Pneumathorax 1 2 3 Pulmonary Edema 1 2 3 Status Asthmaticus 1 2 3 Chest Tubes 1 2 3 Drains / Suction 1 2 3 Thorancentesis 1 2 3 Tracheotomy 1 2 3 Asthma 1 2 3 Bone Marrow Transplant 1 2 3 Broncho-Pulmonary Dysphasia 1 2 3 Cardiac Surgery 1 2 3 CHF 1 2 3 Cystic Fibrosis 1 2 3 Diabetes Melitus 1 2 3 Epiglottiditis 1 2 3 Failure to Thrive 1 2 3 Leukemia 1 2 3 Meningitis 1 2 3 Near Drowning 1 2 3 Overdose / Poison Ingestion 1 2 3 PDA Ligation 1 2 3 Post Harrington Rod Insertion 1 2 3 RDS 1 2 3 Reye's Syndrome 1 2 3 Sickle Cell Disease 1 2 3 Spinal Bifida 1 2 3 Tracheoesophogeal Fistual 1 2 3 Drug CalculationsMcg / min 1 2 3 Mcg / Kg / min 1 2 3 Mg / min 1 2 3 EquipmentA-Line 1 2 3 CVP 1 2 3 Chest Tray 1 2 3 Chest Tube 1 2 3 Cut Down 1 2 3 Debridement 1 2 3 Intubation 1 2 3 Lumbar Puncture 1 2 3 NG Tube Insertion 1 2 3 Pacemaker 1 2 3 Pelvic Tray 1 2 3 Procto Set 1 2 3 Suture Tray 1 2 3 Trach Tray 1 2 3 GenitourinaryFoley Catheter Insertion 1 2 3 Ileosotomy 1 2 3 G.U. Irrigations 1 2 3 Nephrostomy Tube 1 2 3 Suprapubic Tube 1 2 3 Care of Patient WithShunts & Fistulas 1 2 3 Renal Transplant 1 2 3 Nephrectomy 1 2 3 GastrointestinalNG Tube 1 2 3 Gastronomy Tube 1 2 3 T-Tube 1 2 3 G > I > Bleed 1 2 3 Miller-Abbott / Cantor 1 2 3 Colostomy Care 1 2 3 Dehiscence 1 2 3 G I DrugsAntacids 1 2 3 Antiemetic 1 2 3 Anti Spasmodic 1 2 3 Charcoal 1 2 3 Glucagon 1 2 3 Insulin 1 2 3 GynecologyEndometriosis 1 2 3 Gyn Exam / PAP 1 2 3 Self Breast Exam 1 2 3 Mastectomy 1 2 3 Hysterectomy 1 2 3 Instruction on Care of WoundsCast Care 1 2 3 Crutch Walking 1 2 3 Wound Care 1 2 3 IntegumentaryLocal Anesthetics 1 2 3 Ointments 1 2 3 Tetanus Prohyloctics 1 2 3 Knowledge OfAMA 1 2 3 Advanced Directives 1 2 3 Answering Information Calls 1 2 3 Consent for Treatment of Minor 1 2 3 Disaster Protocols 1 2 3 Reporting Acts of Violence 1 2 3 Adult Abuse 1 2 3 Child Abuse 1 2 3 Contagious Disease 1 2 3 Universal Precautions 1 2 3 Maternal-Child NursingMagnesium Sulfate Therapy 1 2 3 Labor Suppressants (Ritodrine) 1 2 3 Oxytocin Induction / Augmentation 1 2 3 Assist with Vaginal Delivery 1 2 3 Forceps Vaginal Delivery 1 2 3 Circulate for Caesarean Section 1 2 3 Scrub for Caesarean Section 1 2 3 Internal Monitor / Lead Connection & Calibrating 1 2 3 Assist with placement of Intrauterine Pressure Catheter 1 2 3 Assist with the Fetal Scalp Blood Sampling 1 2 3 Labor Assessment 1 2 3 Vaginal Exams 1 2 3 Use of FHR Patterns 1 2 3 Provide Intrapartun Care to Patient WithPregnancy-Induced Hypertension 1 2 3 Preeclampsia 1 2 3 Multiple Gestation 1 2 3 Placenta Previa 1 2 3 Abruptio Placenta 1 2 3 Malpresentations 1 2 3 Premature Labor 1 2 3 Diabetes Mellitus 1 2 3 Infectious Disease 1 2 3 Sickle Cell Disease 1 2 3 Rh Incompatibilities 1 2 3 Postpartum AssessmentFundus Consistency 1 2 3 Lochia 1 2 3 Bladder Distension 1 2 3 Episotomy / Incision for Caesarean 1 2 3 Immediate Neonate CareAssign Apgar Scores 1 2 3 Suction 1 2 3 Eye Prophylaxis 1 2 3 Collect Cord Blood Samples 1 2 3 Newborn CareNeonate Level I 1 2 3 Neonate Level II 1 2 3 Neonate Level III 1 2 3 Draw Blood from U-Line 1 2 3 Suction with Catheter 1 2 3 Cord & Circumcision Care 1 2 3 Phototherapy 1 2 3 NG Feedings 1 2 3 Admin. Blood & Blood Products 1 2 3 Use of EquipmentCardiac Monitors 1 2 3 Apnea Monitors 1 2 3 Oxyhood 1 2 3 Ventilators 1 2 3 NeurologyAssessment of Neuro Signs 1 2 3 Assist with Lumbar Puncture 1 2 3 Burr Holes 1 2 3 Crutchfield Tongs 1 2 3 Glasgow Coma Scale 1 2 3 Halo Traction 1 2 3 ICP Monitoring 1 2 3 Immobilization 1 2 3 Seizure Precautions 1 2 3 Transport of Cervical / Spinal Injury 1 2 3 Care of Patient WithSeizure Activity 1 2 3 Overdose 1 2 3 Spinal Cord Injury 1 2 3 Neuro Trauma 1 2 3 Pre / Post Neuro Surgery 1 2 3 CVA / TIA 1 2 3 Open and Closed Head Injuries 1 2 3 Use & Administration of these DrugsDecadron 1 2 3 Dilantin 1 2 3 Magnesium Sulfate 1 2 3 Phenobarbital 1 2 3 Valium 1 2 3 Mannetol 1 2 3 Raboxin 1 2 3 Novocain 1 2 3 Other 1 2 3 1 2 3 1 2 3 OrthopedicTotal Knee Replacement 1 2 3 Bucks Extension 1 2 3 Crutch Walking 1 2 3 K-Wires 1 2 3 Spika Casts 1 2 3 Body Casts 1 2 3 Circo-Electric Bed 1 2 3 Total Hip Replacement 1 2 3 Arthroscopy / Arthrotomy 1 2 3 Care of Patient WithAmputation 1 2 3 Trauma 1 2 3 Skeletal Traction 1 2 3 Lacerations 1 2 3 PediatricsCalculation of Pedi Dosages 1 2 3 Starting IV Therapy 1 2 3 Scalp Veins 1 2 3 Apnea Monitor 1 2 3 Cardiac Monitor 1 2 3 CPR-Infant / Child 1 2 3 Preparation of Emergency Drugs 1 2 3 Tracheotomy Care & Suctioning 1 2 3 Assist with Lumbar Puncture 1 2 3 Use of Oxygen 1 2 3 Use of Croup Tent 1 2 3 Use of Ventilators 1 2 3 Care of Patient WithAsthma 1 2 3 Bone Marrow Transplant 1 2 3 Broncho-Pulmonary Dysplasia 1 2 3 Cardiac Surgery 1 2 3 CHF 1 2 3 Cystic Fibrosis 1 2 3 Diabetes Melitus 1 2 3 Epiglottiditis 1 2 3 Failure to Thrive 1 2 3 Leukemia 1 2 3 Meningitis 1 2 3 Near Drowning 1 2 3 Overdose / Poison Ingestion 1 2 3 PDA Ligation 1 2 3 Post Harrington Rod Insertion 1 2 3 RDS 1 2 3 Spinal Bifida 1 2 3 Tracheoesophogeal Fistula 1 2 3 PulmonaryAirway Management 1 2 3 Principles of Chest Percussion 1 2 3 Establishing an Airway 1 2 3 Ambuing Technique 1 2 3 Chest Tubes 1 2 3 Various Types of O2 Admin. 1 2 3 Nasal Cannula 1 2 3 Face Mask 1 2 3 ET Intubation / Extubation 1 2 3 VentilatorsUse & Complications of PEEP 1 2 3 Use & Complications of CPAP 1 2 3 Use & Complications of IMV 1 2 3 Weaning 1 2 3 ABGInterpretation 1 2 3 Drawing Blood Sample 1 2 3 Care of Patient WithAIDS 1 2 3 COPD 1 2 3 ARDS 1 2 3 Pre / Post Thoracic Surgery 1 2 3 Tracheotomy 1 2 3 Pulmonary Emboli 1 2 3 Use & Admin. of these DrugsAnimophylline 1 2 3 Atropine 1 2 3 Bronkosol 1 2 3 Terutaline 1 2 3 Endotracheal SuctioningNasotracheal 1 2 3 Oropharyngeal 1 2 3 VascularPeripheral Pulses 1 2 3 Fluid Overload 1 2 3 Ultrasonic Doppler 1 2 3 Starting IV's 1 2 3 Heparin Locks 1 2 3 TPN / Hyper Alimentation 1 2 3 Knowledge of Normal Serum Lab Values 1 2 3 Obtaining Venous Blood Samples 1 2 3 Admin. of Blood & Blood Products 1 2 3 Infusion Pumps 1 2 3 Hickman / Brovaic Catheters 1 2 3 Hemodialysis 1 2 3 Peritoneal Dialysis 1 2 3 IV TherapyCertified to Start IV Therapy 1 2 3 A-Line (assist with Insertion & Maintenance) 1 2 3 Intracath 1 2 3 Jelco 1 2 3 PiCC Lines 1 2 3 Portacath, Hickman, Brovic 1 2 3 Scalp Vein 1 2 3
