GENERAL INFORMATION

Note: * Denotes a required field.

Please enter your full name as it appears on your Social Security Card: First Name   Middle Name   Last Name  * Please enter the Last Four digits of your Social Security Number:  -   -   *       Please check here if you do not hold a valid social security card. Please provide your contact information: Phone Number  * E-mail Address  * Confirm E-mail Address  * Type your e-mail address again above.

This profile is for use by healthcare professionals in the Pediatric Emergency Department discipline and specialty. It will not be a determining factor for the program.

CHECKLIST INSTRUCTIONS

Please mark your level of experience      1. No theory and/or experience      2. Limited experience/need supervision and/or support      3. Experienced/minimal support needed to perform      4. Proficient/can perform independently

CARDIOVASCULAR

1

2

3

4

Cardiac Anomalies

CHF/Pulmonary Edema

Cardiogenic Shock

Cardioversion

Heart Sounds

PULMONARY

1

2

3

4

Reactive Airway Disease

Croup

Pneumonia

Epiglottitis

Aspiration

Airway Obstruction

Hemo/Pneumothorax

Chest Tube Placement/Management

ABG Interpretation

NEUROLOGICAL

1

2

3

4

Meningitis/Encephalitis

Seizures-Febrile/Epileptic

Lumbar Puncture

Migraine

ORTHOPEDIC

1

2

3

4

Fractures/Casting

Open/Complex Fractures

Nursemaid's Elbow

Apply/Manage Splints

Circulation Checks

Crutch Walking

Car Seat Instruction for Casted Patient

GASTROINTESTINAL

1

2

3

4

Abdominal Trauma/Peritoneal Lavage

Abdominal Pain

Constipation

GI Bleeding

Hepatitis/Liver Failure

Poison Ingestion

ENDOCRINE/METABOLIC

1

2

3

4

Hypoglycemia

Hyperglycemia

DKA

GENITOURINARY

1

2

3

4

Acute Renal Failure

UTI/Pyelonephritis

Renal Trauma

Testicular Torsion

OB/GYN

1

2

3

4

Menstrual Pain

Ovarian Cyst

Ectopic Pregnancy

Pelvic Inflammatory Disease/STD

Sexual Assault

Reporting Acts of Violence

EENT

1

2

3

4

Foreign Body - Eye

Foreign Body - Ear

Foreign Body - Nose

Epistaxis

TRAUMA

1

2

3

4

Glasgow Coma/Pediatric Trauma Scale

Trauma Code

Trauma Team Member

Brain Injury

Spinal Cord Injury

Spinal Precautions

Facial/Dental Trauma

Penetrating Trauma

Blunt Trauma

Traumatic Amputation

Hypovolemic Shock

Neurogenic Shock

Anaphylactic Shock

Septic Shock

Burns - 2nd Degree

Burns - 3rd Degree

INFECTIOUS DISEASE/IMMUNOSUPPRESSION

1

2

3

4

Contagious/Infectious Patients

Isolation

Reporting Communicable Disease

Neutropenia/Reverse Isolation

PSYCHIATRIC

1

2

3

4

Drug /ETOH Overdose/Withdrawal

Psychiatric Hold

Suicidal Patient

MEDICATIONS

1

2

3

4

Pediatric Dosage Calculations

Anti-Arrhythmics

Anticoagulants (IV, Oral & Injection)

Anti-Hypertensives

Anti-Psychotics

Anti-Seizure Medications

Benzodiazepines

Continuous IV Paralytics

Continuous IV Sedation

Procedural Sedation - Administration

Ketamine

Emergency Medications

Inhaled Medications

Insulin

IV Vasopressors

Narcotics/Opioid Analgesics (IV, Oral & Injection)

Reversal Agents

Steroids (IV, Oral & Inhaled)

Automated Medication Dispensing (i.e. Pyxis, Omnicell)

PROFESSIONAL KNOWLEDGE AND SKILLS

1

2

3

4

Recognizing/Reporting Abuse

Triage

Ambulance/Paramedic Radio

Charge Experience

EMTALA

National Patient Safety Goals/Core Measures

Fall Risk Assessment/Prevention

Pressure Ulcer Risk Assessment/Prevention

Restraints/Use of Least Restrictive Device

Patient Family Teaching

Car Seat Specific Standards/Teaching

Age/Developmentally Specific/Population Based Care

Pain Assessment and Management - Verbal/Non-Verbal

Interpretation and Communication of Lab Values

EMR

1

2

3

4

EPIC

Cerner

Eclipsys

Meditech

McKesson

Allscripts

Other Computerized System

Computerized Physician Order Entry

Bar Coding for Medication Administration

EMR Conversion

Yes

No

Certifications

1

2

3

4

BLS

PALS

PEARS

ACLS

TNCC

ENPC

CEN

Please read and agree to the statements below by marking the checkbox. You will not be able to submit until you have marked the checkbox. * 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 authorize Hudson Staffing to release this Pediatric Emergency Department Skills Checklist to the client facilities in relation to consideration of employment as a healthcare professional with those facilities.

Privacy Note: Hudson Staffing will record anonymous electronic information about your connection when you click on the submit button. This information is used for security purposes only. This information will include your IP Address (54.80.87.62) which will be used as a digital signature.