Respiratory Therapy Skills Checklist

Name: ____________________________________________________ AREAS OF EXPERIENCE

Please indicate the number of years of experience for each of the following.

Date: ______________________________

_____ Critical Care Unit _____ Pediatric ICU _____ Emergency Unit _____ Home Care _____ Ambulatory _____ Long Term Care

_____ Coronary Unit _____Neonatal ICU Level II _____Pulmonary Rehab _____Transport _____Clinic / Office _____Subacute

_____ Pediatric Unit _____ Neonatal ICU Level III _____ Sleep Lab _____ Mobile Unit _____ Research _____ Long Term Ventilator Care

Please indicate below your level of experience for each item following the coding: 1 = No experience or only prior observation 3 = One - two years current experience or need minimal assistance 2 = Less than one year current experience 4 = Two plus years of current experience or function independently ASSESSMENTS & INTERPRETATIONS 1 Breath Sounds Coarse breath sounds Rhonchi breath sounds Abnormal breathing Pursed lip breathing Rate & work of breathing Segmental breathing Peak flow monitor Pulmonary function testing Stress testing Chest X-ray Vital capacity VENTILATORS General Set-up & Care Assist / control Bi-PAP CPAP EMCO assistance EMCO operation Flow-by High frequency jet ventilator High frequency oscillator
Intermittent Mandatory Ventilation (IMV)

4 EEG Interpretation EKG Interpretation Holter EKGs Interpretation of arterial blood gases Interpretation of blood chemisty Arterial monitoring Hemondynamic monitoring Pulmonary artery monitoring Cardiac output monitoring Transcutaneous monitoring Central venous pressure (CVP) Dyspnea

Inverse ratio ventilator PEEP Pressure pre-set ventilator Pressure support Pressure vents
Synchronized Intermittent Mandatory Ventilation (SIMV)

Time-cycled ventilators Troubleshooting high pressure alarms Troubleshooting low pressure alarms Ventilate with manual resuscitator Volume pre-set ventilator Volume vents Weaning

Specific Ventilator Experience Babybird Bear 2 Bear 5 Bear cub Bennett MA-1 Bennett MA-2 Bird BP Drager Infant Emerson Engstrom Hamilton Amadeus, Veolar Infant star MA Monoghan Newport Puritan Bennett 7200 series Sechrist Servo 300 Siemens Servo 900 Siemens Portable respiratory equipment

Respiratory Therapy Checklist 1

Respiratory Therapy Skills Checklist

Name: ____________________________________________________ MEDICATIONS & DELIVERY SYSTEMS 1 Aerobid (Vanceril)
Aminophylline / Theodur (Theophylline)

Date: ______________________________

4 Pavulon Petamidine isethionate Propofol Racemic epinephrine (Vaponephrine)

Salbutamol (Albuterol, Proventil, Ventolin)

Anectine Atropine Atropine sulfate Azmacort Bicarbonate Combivent Corticosteroids Cromolyn sodium (Intal) Digitalis Digoxin Dopamine Duramorph Flonase Flovent Heliox therapy Inhaled steroids Ipratropium bromide (Atrovent) Isoetharine (Bronkosol) Isoproterenol (Isuprel) Ketamine Lidocaine Metaproterenol (Alupent) Morphine sulfate Mucomyst Nasalcort Nipride Nitric oxide therapy THERAPEUTICS & PROCEDURES 1 Adult extubation Adult intubation Adult resuscitation Airway management devices Ambulance transport Apnea monitor Arterial line draws/maintenance Arterial line insertion Assist with bronchoscopy Assist with chest tube insertion Brachial artery draws Cardiorespiratory arrest team Check intracuff pressure Chest physiotherapy Croup tent set-up / troubleshoot Endotracheal tubes Femoral artery sticks Incentive spirometer Infection control practices 2 3 4

Terbutaline sulfate (Bricanyl) Valium Versed Aerosol heated/cool Aerosol set up - mask Aerosol set up - trach IPPB Medihaler Metered dose inhalers Pneumatic aerosols Oxygen Therapy Bag & mask Cold nebulizer ET tube External CPAP Face masks Hand held nebulizer Heated nebulizer Nasal cannula Portable oxygen tanks T-piece Trach collar Ultrasonic nebulizer

1 Interarterial balloon pump (IABP) Nasal airway placement Oral airway placement Oximetry Oxygen analysis Patient teaching Percussion & Auscultation Percussion & Vibration Peripheral line draws Postural drainage Pulmonary drainage Radial artery draws / Allen tests Sputum specimen collection Suctioning nasopharyngeal Suctioning oralpharyngeal Thoracentesis assistance Traceostomy tubes Tracheostomy suctioning Venous blood draws

Respiratory Therapy Checklist 2

Respiratory Therapy Skills Checklist

Name: ____________________________________________________ Date: ______________________________

NEONATAL & PEDIATRICS 1 Assist in high risk delivery Assist in normal C-section Capillary blood gases CPT ECMO Neonatal aerosol treatment Neonatal extubation Neonatal intubation Neonatal resusitation O2 to tent Pediatric extubation Pediatric intubation Pediatric resuscitation Umbilical blood gases PATIENT CARE 1 Acute / chronic bronchitis
Adult respiratory distress syndrome (ARDS)

Care of infant or child with Bronchopulmonary dysplasia (BPD) Croup Epiglottitis Failure to thrive Infant respiratory disease syndrome Meconium aspiration Near drowning Neonatal pneumonia Peristent fetal circulation
Persistent pulmonary hypertension (PPHN)

Pulmonary interstitial emphysema (PIE)

Respiratory distress syndrome (RDS) Respiratory syncytial virus Tranient tachypnea of the newborn

4
Hyaline Membrane Disease (HMD/IRDS)

1 Larynospasm Meconium aspiration Myasthenia gravis Open hearts Pacer Pneumonia Pulmonary edema Pulmonary embolism Restrictive pulmonary disease Smoke inhalation Status asthmaticus Tension pneumothorax Thoracotomy Tracheo-esophageal fistula Tuberculosis

Aspiration Asthma Bronchoscopy Cardiac surgery Chest trauma

Chronic obstructive pulmonary disease (COPD)

Congestive heart failure (CHF) Croup Cystic fibrosis Epiglottitis Fem-pop Bypass Fresh tracheostomy Gullian Barre Hemopneumothorax LICENSURE & CERTIFICATION State License (___________________) State License (___________________) State License (___________________) State License (___________________) State License (___________________) EKG/EEG Technician Arterial Blood Gas Technican EMT Registry Eligible Certification Eligible

# ____________ # ____________ # ____________ # ____________ # ____________ Issued ________ Issued ________ Issued ________ YES YES

Exp ______ Exp ______ Exp ______ Exp ______ Exp ______ Exp ______ Exp ______ Exp ______ NO NO

BLS ACLS PALS NRP RRT CRT RRT - NPS CRT - NPS RPFT CPFT

Exp _______ Exp _______ Exp _______ Exp _______ Exp _______ Exp _______ Exp _______ Exp _______ Exp _______ Exp _______

Respiratory Therapy Checklist 3