Maxim Physician Resources
Emergency Medicine
Skills Checklist
Enter the appropriate provider code in the blank next to the procedure. Failure to fill this
out correctly can delay the screening process.
Provider Codes
1 Fully competent to perform
2 Competent with supervision
3 Not requested due to lack of expertise
Please mark all that apply to your scope of practice.
General Procedures Customary to the Practice of Emergency Medicine
___ Outpatient
Specific Procedures
1. Neurological, CNS
___ A. Placement of Gardner Wells Tongs
___ B. Drainage epidural/subdural hematoma
___ C. Lumbar Puncture
___ D. Nerve Blocks
___ 1. Supraorbital
___ 2. Infraorbital
___ 3. Mandibular
___ 4. Mental
___ 5. Digital
___ 6. Wrist
___ 7. Elbow
___ 8. Axillary
___ 9. Intercostal
___ 10. Ankle
___ E. Nitrous Oxide Administration
____ F. Sedation
2. Otolaryngology
___ A. Emergency myringotomy
___ B. I&D Abscess External Auditory Canal
___ C. Anterior Nasal Pack
___ D. Posterior Nasal Pack
___ E. I&D Septal Hematoma or Abscess
___ F. I&D Peritonsillar abscess
___ G. Indirect laryngoscopy
___ H. Direct Laryngoscopy
3. Ophthalmology
___ A. Slit Lamp Examination
___ B. Removal Conjuctival Foreign Body
___ C. Removal Corneal Foreign Body
___ D. I&D chalazion
___ E. I&D hordeolum
4. Cardiopulmonary
___ A. Emergency Thoracotomy
___ B. Endotracheal Intubation
___ C. Nasotracheal Intubation
___ D. Cricothyroidotomy
___ E. Emergency Tracheotomy
___ F. Tube Thoracostomy
___ G. Thoracentesis
___ H. Transvenous pacemaker insertion
___ I. Transthoracic pacemaker insertion
___ J. Pericardicentesis
___ K. Cardiopulmonary Resuscitation
___ L. DC Cardioversions
___ M. Arterial Cannulation
___ N. Subclavian Vein Cannulation
___ O. Internal Jugular Vein Cannulation
___ P. Venous Cutdown
5. Gastrointestinal
___ A. Gastric Lavage
___ B. Paracentesis
___ C. Peritoneal Lavage
___ D. I&D Pilonidal Cyst Abscess
___ E. Anoscopy
___ F. Sigmoidoscopy
___ G. Removal Rectal Foreign Body
___ H. Ligation, External Hemorrhoid
___ I. I&D thrombosed external hemmorrhoid
___ J. I&D Perianal Abscess
6. Urology
___ A. Urethrogram
___ B. Cystogram
___ C. Intravenous pyelogram
___ D. Insertion urethral catheter
___ E. Insertion Urethral Catheter, Filiforms and Followers
7. OBGYN
___ A. Emergency Vaginal Delivery
___ B. Culdocentesis
___ C. Para Cervical Nerve Block
___ D. Diliation and Curettage
___ E. I&D Bartholin's Cyst Abscess
8. Surgery-Integument
___ A. I&D Sebaceous Cyst Abscess
___ B. I&D Sebaceous Cyst with Sac Removal
___ C. I&D Removal of Subcutaneous Foreign Body
___ D. I&D Removal of Muscular Foreign Body
___ E. I&D Subungal Hematoma
___ F. I&D Sbcutaneous Abscess
___ G. I&D Felon
___ H. Removal Benign Skin Lesion
___ I. Laceration Repair - Simple
___ J. Laceration Repair - Intermediate
___ K. Laceration Repair - Complex
___ L. Pinch skin graft
___ M. Split thickness skin graft
___ N. Full thickness skin graft
___ O. Debride Second and Third Degree Burns
9. Orthopedic Surgery
___ A. Injection for Tendon Sheath, Bursa and Trigger Point
___ B. Injection, Intra-Articular
___ C. Arthrocentesis
___ D. Repair Extensor Tendon Laceration
___ E. Closed reduction
___ 1. DIP or PIP (finger) Dislocation
___ 2. Phalanx (finger) Fracture
___ 3. MCP Dislocation
___ 4. Metacarpal Fracture
___ 5. Carpal-Metacarpal Dislocation
___ 6. Wrist Dislocation
___ 7. Distal Radius or Ulna Fracture
___ 8. Radius or Ulna Shaft Fracture
___ 9. Elbow Dislocation
___ 10. Humerus Fracture
___ 11. Shoulder Dislocation
___ 12. Hip Dislocation
___ 13. Knee Dislocation
___ 14. Tibia/Fibula Fracture
___ 15. Ankle Dislocation
___ 16. Tarsal-Metatarsal Fracture
___ 17. Metatarsal Fracture
___ 18. Metatarsal - Phalangeal Dislocation
___ 19. DIP or PIP (toe) Dislocation
___ 20. Phalanx (Toe) Fracture
___ F. Cast and splint application
___ 1. Short Arm Splint
___ 2. Short Arm Cast
___ 3. Long Arm Splint
___ 4. Long Arm Cast
___ 5. Cylinder Cast (Long Leg)
___ 6. Short Leg Splint
___ 7. Short Leg Cast
___ 8. Short Leg Cast, Walking
___ 9. Long Leg Splint
___ 10. Bivalving or Removal of Cast