AMLS 2 Edition
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Transcript of AMLS 2 Edition
AMLS 2nd Edition
AMLS 2e Agenda
• History of AMLS
• Overview of what’s new and improved
• The course
• Instructor resources
• Support
History of AMLS
• AMLS has been taught throughout the world since 1999.
• AMLS was the first EMS education program that fully addressed how to best manage patients in medical crises.
• In 2011, NAEMT produced an all-new textbook and instructor materials for the course.
• AMLS continues to be endorsed by the National Association of EMS Physicians (NAEMSP) and is accredited by the Continuing Education Coordinating Board for Emergency Medical Services (CECBEMS) and recognized by the National Registry of EMTs (NREMT).
AMLS 2e Committee Members
• Jeff Messerole, Chair
• Les Becker, Vice Chair
• Angus Jameson, MD, Medical Director
• Vince Mosesso, MD, Medical Director
• Anne Bellows
• Leslie Hernandez
What is AMLS?
• AMLS is a sixteen-hour, two-day course
• For BLS and ALS practitioners
• Consists of interactive/case-based lectures and patient simulations
• Emphasis on the AMLS Assessment Pathway
AMLS Pathway
AMLS 2e Instructor Resources
• Lecture presentations
• Patient simulation scenarios
• New assessment videos
• Instructor’s manual
• Equipment list
• Course agenda
• BLS and ALS pre- and posttests
AMLS 2e Course Day 1
• AMLS Video 1 Introduction video and Assessment video—Respiratory
• Respiratory Disorders Lecture • Cardiovascular Disorders Lecture • Respiratory Disorders Stations (2 simulations) • Cardiovascular Disorders Stations (2 simulations) • Shock Lecture • Shock Stations (4 simulations) • Altered Mental Status and Neurologic Disorders Lecture • Endocrine /Metabolic Disorders Lecture • AMS/Neurologic Disorders Practical Stations (2 simulations) • Endocrine /Metabolic Disorders Stations (2 simulations) • Environmental Emergencies Lecture
AMLS 2e Course Day 2
• AMLS Video 2 Introduction video and Assessment video–Altered Mental Status
• Infectious Diseases Lecture
• Abdominal Disorders Lecture
• Environmental Emergencies, Infectious Diseases, Abdominal Discomfort Stations
• Toxicologic Emergencies, Hazardous Materials Lecture
• Toxicologic Emergencies, Hazardous Materials Station (2 simulations)
• Written Evaluation Station
• Final Practical Evaluation Stations
Videos
• New AMLS assessment videos
• Respiratory emergency
• Altered mental status
Sample Assessment Videos
Lecture Presentation
• Case based
• Robust instructor notes
• Consistent lecture structure
• Showcases the use of the AMLS assessment pathway
Sample Lecture Presentation
• The lecture for the Cardiovascular Disorders chapter follows, which includes Case 1.
Chapter 3 Cardiovascular Disorders
Introduction
Objectives • Apply knowledge of anatomy, physiology, and
pathophysiology to patients presenting with chest discomfort.
• Describe the general assessment process for a patient presenting with chest discomfort using the AMLS Assessment Pathway.
• Describe the ongoing assessment of the patient presenting with chest discomfort utilized to rule out or confirm potential diagnoses and adapt treatment and management based on patient response and findings.
Anatomy
Anatomy •The major organs, spaces and pleurae, the
esophagus, and other structures of the mediastinum and the musculoskeletal system. •Chest discomfort is typically the direct result of
stimulation of nerve fibers from damaged or compromised organs. •Although the boundaries of the chest are well-
defined, organs or structures lying close to those boundaries may be served by similar nerve roots.
Anatomy
• The major organs and spaces
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Pathophysiology
• Damage or compromise may be due to mechanical obstruction, inflammation, infection, or ischemia.
• An understanding of somatic vs. visceral pain is important in generating differential diagnoses of chest discomfort.
Case 1
• Dispatch
You respond to a nursing home for a report of a person with chest pain who is having trouble breathing.
What are your concerns as you respond to this call?
AMLS Assessment Pathway
Initial Observations
• Scene safety considerations
Is the scene safe?
Observe the front entrance of the facility.
Initial Observations
• You have responded to this facility in the past.
• You are directed to the day room.
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Initial Observations
• Primary survey Level of consciousness (LOC)—Awake, opens
his eyes to the sound of your voice and makes eye contact.
Airway—Open and patent. Breathing—Respirations rapid, shallow, and
regular; breath sounds diminished on the left apex.
Circulation/perfusion—Rapid radial weak pulse; skin is cool and moist.
First Impression
• Do you identify any life threats?
• Is the patient sick/not sick?
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First Impression
• What are your initial differential diagnoses?
• Which do you think are most likely?
More Likely Less Likely
AMI/unstable angina
Thoracic aortic dissection
Pulmonary embolus a
Pneumothorax Congestive
heart failure COPD
exacerbation Esophageal
rupture
Pneumonia Musculoskeletal
injury
First Impression
Detailed Assessment
• History taking O—Earlier today after a vacuum cleaner that was smoking
triggered a coughing spell. P—Worsens with deep breath, otherwise constant. Q—Sharp. R—Left side of chest; does not radiate. S—Pain is rated as a 6 on a scale of 1 to 10. T—About 45 minutes.
Detailed Assessment
• History taking, continued • S—Left-sided chest pain and shortness of breath
• A—No known drug allergies
• M—Albuterol, prednisone, budesonide inhaled,
roflumilast, aspirin, home oxygen 2 L/min
• P—COPD
• L—2 hours ago
• E—Fire alarm sounded due to smoking vacuum cleaner; triggered coughing
• R—Two packs/day x 40 years; quit 5 years ago
Detailed Assessment
• Secondary survey Vital signs
110
90%
56 mm
Hg
28 142/90 98.6°F (37°C)
Detailed Assessment
Pursed lip breathing, circumoral cyanosis
Scattered wheezes, coarse crackles; breath sounds diminished; absent at left apex; intercostal retractions; barrel chested
Abdomen soft, nontender
Clubbing of the fingers noted
Unremarkable
Circulation, motor, and sensory (CMS) intact
Detailed Assessment— Diagnostics
BLS ALS Critical Care
Blood glucose level • 87 mg/dL (4.8 mmol/L)
Cardiac monitoring • Sinus tachycardia at
110 • 12-lead ECG is
unremarkable • ETCO2 = 56 mm Hg,
Intermittent sharkfin waveform
N/A
Detailed Assessment— Capnograph
AMI/unstable angina
Thoracic aortic dissection
Pulmonary embolus
Pneumothorax Congestive
heart failure COPD
exacerbation Esophageal
rupture
Pneumonia Musculoskeletal
injury
Refine the Differential Diagnosis
Treatment
• Basic life support (BLS) Monitor vital signs. Continue O2 2 L/min via nasal cannula; titrate O2 to SPO2.
• Advanced life support (ALS) Administer nebulized albuterol and ipratropium. Consider corticosteroid administration (e.g., dexamethasone
IV) if respiratory distress worsens. Consider CPAP for severe cases with caution if pneumothorax is
suspected. Consider intubation for respiratory failure.
• Critical care Consider needle decompression if signs of shock evolve
(tension pneumothorax).
Ongoing Management
• Reassess the patient. Further refine the diagnosis. Modify treatment as necessary. Transport decision.
Case Wrap-Up
• Diagnosis: spontaneous pneumothorax
• Case closure: ED physician inserted thoracostomy tube; removed after several days in intermediate care unit.
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urtesy o
f Stuart M
irvis, MD
.
Further Discussion • Using the AMLS assessment pathway should enable you to quickly identify
life threats that should be managed when found.
• Spontaneous pneumothorax (SP) is more common in men than women.
• Smoking is an important risk factor, increasing the incidence by 120% as compared to nonsmokers.
• COPD is the most common underlying cause.
• Status asthmaticus, tuberculosis, and immunodeficiency are also associated with SP.
• Needle aspiration and pigtail catheters (small SPs) or tube thoracostomy (large SPs) are common treatment approaches.
• Oxygen administration hastens absorption of pleural air.
• The patient’s clinical status determines the urgency and type of treatment. Monitor for transition to tension pneumothorax.
Patient Simulations
• All scenarios reviewed, revised, and reformatted
• More than 100 scenarios to choose from
• 25 completely new scenarios for various medical conditions
• All scenarios fit two-sided, single-page format
• Revised AMLS assessment flow chart included
Sample Patient Simulation
Sample Patient Simulation
AMLS 2e Student Resources
AMLS 2e Student Resources
AMLS 2e Student Resources
AMLS Committee Activities
• Develops course materials using best available evidence
• Determines instructor requirements
• Provides advice and guidance to instructors
AMLS Course Delivery
• 16-hour, 2-day program
• Interactive lectures
• Teaching and evaluation stations
• 16-hour hybrid course – coming soon
• 8-hour online
• 8-hour classroom
In Development
• 2e Hybrid course
• 2e BLS course
• 2e Refresher course
• 8-hour course
• All presentations reviewed, revised, and updated
New AMLS Instructor Requirements
• Be a certified/licensed EMS practitioner
• Successful completion of the AMLS course
• Successful completion of the NAEMT Instructor Online course • Needs to be taken one time only
• Initial teaching of the course monitored by an AMLS affiliate faculty*
*New Policy for CoAEMSP accredited sites
NAEMT Course Administration
• NAEMT courses are offered by NAEMT course sites. • Online course site registration process
• Courses are administered with oversight by a course site coordinator. • Online process for course registration
NAEMT Education Support
• Please contact Corine Curd at NAEMT Headquarters:
• To become an AMLS instructor
• To become an NAEMT course site
National Association of Emergency Medical Technicians
Phone: 601-924-7744
NAEMT Education Support Staff
• Sylvia McGowan • Service Center Representative
• Jody Phillips • Service Center Representative
• Stacey Jackson • Service Center Representative
• Keshia Robinson • Service Center Manager
• Corine Curd • Course Site Development Manager
• Tracy Foss • Education Director
Customer Service and Technical Support
• To place orders or check product availability:
• Contact Jones & Bartlett Customer Service • http://www.jblearning.com/aboutus/contactus/
• 1-978-443-5000
• For example, login problems, or error messages
• Contact Jones & Bartlett Technical Support • http://www.jblearning.com/techsupport/
• 1-978-443-5000
U.S. Sales Team
• Jean Auman NC, OH, SC
• Moria D’Ambro ME, UT, VA, VT, WI
• Lori DeGeorge AL, AZ, ND, NE, OK, SD, WV
• Patty Einstein Sales Director
• Korie Gospodarski AK, AR, DE, GA, KY, MD, MN
• Hope Gottlieb CA, WA
U.S. Sales Team
• Jason Hanson CT, IA, KS, LA, MS, NH, NV, RI
• Joy Knobbe ID, IN, MI, MT, OR, WY
• Matt Maniscalco VP of Sales; FL, NJ, NY, PA
• Jane McCluskey IL, MA
• Kathy Roethig CO, HI, MO, NM, TX
Thank you for participating!