AMLS Webinar

AMLS

nd 2

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 welldefined, organs or structures lying close to those boundaries may be served by similar nerve roots.

Anatomy

• The major organs and spaces

From PHTLS: Prehospital trauma life support, ed 6, St. Louis, MO, 2007, Mosby

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. © Jennifer A. Walz/Shutterstock.

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 © Mark Bowden/iStock/Getty.

• Do you identify any life threats? • Is the patient sick/not sick?

First Impression • What are your initial differential diagnoses? • Which do you think are most likely? More Likely

Less Likely

First Impression

AMI/unstable angina Thoracic aortic dissection Pulmonary embolus a

Pneumothorax Congestive heart failure COPD exacerbation Esophageal rupture

Pneumonia Musculoskeletal injury

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

Circulation, motor, and sensory (CMS) intact

Abdomen soft, nontender

Clubbing of the fingers noted

Unremarkable

Detailed Assessment— Diagnostics BLS

ALS

Blood glucose level Cardiac monitoring • 87 mg/dL (4.8 mmol/L) • Sinus tachycardia at 110 • 12-lead ECG is unremarkable • ETCO2 = 56 mm Hg, Intermittent sharkfin waveform

Critical Care

N/A

Detailed Assessment— Capnograph

Refine the Differential Diagnosis

AMI/unstable angina Thoracic aortic dissection Pulmonary embolus

Pneumothorax Congestive heart failure COPD exacerbation Esophageal rupture

Pneumonia Musculoskeletal injury

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 Courtesy of Stuart Mirvis, MD.

• Diagnosis: spontaneous pneumothorax • Case closure: ED physician inserted thoracostomy tube; removed after several days in intermediate care unit.

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 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 [email protected]

NAEMT Education Support Staff • Sylvia McGowan

• Service Center Representative

• Jody Phillips


• Stacey Jackson


• 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 • [email protected]

• 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 • Moria D’Ambro • Lori DeGeorge SD, WV • Patty Einstein • Korie Gospodarski MD, MN • Hope Gottlieb

NC, OH, SC ME, UT, VA, VT, WI AL, AZ, ND, NE, OK, Sales Director AK, AR, DE, GA, KY, CA, WA

U.S. Sales Team • Jason Hanson NH, NV, RI • Joy Knobbe WY • Matt Maniscalco NY, PA • Jane McCluskey • Kathy Roethig

CT, IA, KS, LA, MS,

ID, IN, MI, MT, OR, VP of Sales; FL, NJ, IL, MA CO, HI, MO, NM, TX

Thank you for participating!

AMLS Webinar

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