7/29/2019 Selfassessment From CC Website

1/1

Self-Assessment Form for ICU Name: _________________________Program: ___________________

Prerequisite for PGY2 and aboveYes No Completed ACLS course within last 3 years.

Basic Competencies These are expected PRIOR to the ICU rotation.Yes No Can do a history and physical.

Yes No Have an approach to interpretation of an electrocardiogram.

Yes No Have an approach to interpretation of a chest radiograph.

Yes No Have an approach to interpretation of blood gases.

Yes No Can present a case in an organized fashion.

Yes No Can develop a problem list.

Yes No Know the algorithms of ACLS for resuscitation.

Yes No Can interpret an electrocardiogram and diagnose a myocardial infarction.

Yes No Can identify common rhythm disturbances from a electrocardiogram.

Note: If you cannot answer YES to ALL of the above you should improve your skills BEFORE coming

to ICU. Discuss the issue with your program director!

Yes No Did Medicine CTU during PGY1

Yes No Did ICU rotation during PGY1

Directions for completion of Advanced Competencies Section of Self Assessment FormLeave all blank if you do not have this competency.

Darken the first square if you have only rudimentary knowledge in this area.

Darken first two if you are convinced you have adequate knowledge but lack experience.

Darken all squares if you feel you have adequate knowledge and experience.

Advanced Competencies Many of these are expected to develop DURING the ICU rotationsCan classify shock and outline hemodynamic patterns

Can manage the initial stabilization and assessment of a critically ill patient

Can maintain a clear airway

Knows indications for and can perform a tracheal intubation

Knows methods of confirming endotracheal tube position

Knows indications for and methods of providing ventilatory support

Can provide ventilator orders for most patients

Knows indications and techniques of arterial line insertion

Knows indications and techniques of central line insertion

Can be team leader for a Code Blue

Can provide emergency management of acute respiratory failure

Can provide emergency management of tachycardia

Can provide emergency management of hypertension

Can provide emergency management of hypotension

Can provide emergency management of myocardial infarction

Candiagnose and treat acid base disorders

Candiagnose and treat Acute Lung Injury (ARDS)

Can manage an epicardial pacemaker

Insert and manage a transvenous pacemaker

Knows principles of ICP management and monitoring

Rationally select inotropes and vasodilators

Send a copy of this form to Maryanne Henderson GE706 HSC (Fax 787-3069) before the rotation starts!!!