AMLS:ADVANCED MEDICAL LIFE
SUPPORT
Six R's of Rapid Recall - ANS -1. Read the scene- observe environmental conditions, safety
hazards, and likely MOIs
2. Read the patients- assess the patient's condition, take their vital signs, treat life threats,
review CC, and record general impression
3. React- manage life threats and treat pt based on their cardinal presentation
4. Reevaluate- reassess vitals, reconsider medical management
5. Revise management plan- on the basis of you reevaluation and additional historical data,
physical exam findings, diagnostic test results, and pt response to early interventions, revise
plan according to pts new clinical picture
6. Review performance- critiquing the call or pt encounter gives you a chance to reflect on your
clinical decision making and target areas in which more advanced skills or a deeper level of
knowledge are needed
Tachypnea - ANS -Increased respiratory rate
Cause- fever, resp. distress, toxins, hypoperfusion, brain lesion, metabolic acidosis, anxiety
Bradypnea - ANS -Slower-than-normal respiratory rate
Cause- narc/sedative drugs, including alcohol, metabolic disorders, hypoperfusion, fatigue,
brain injury
Cheyne-Stoke respirations - ANS -Resp pattern with alternating periods of increased and
decreased rate and depth with brief periods of apnea
Causes- increased ICP, CHF, renal failure, toxin, acidosis
*may indicate spinal injury
Biot's respirations - ANS -Similar to Cheyne-Stokes but with an irregular pattern instead of a
repeating pattern
Causes- meningitis, increased ICP, neurological emergency
*think of it as the afib of the respiratory system
Kussmaul's respirations - ANS -Deep and fast breaths lacking any apneic periods(indicates
severe acidosis)
Causes- Metabolic acidosis, renal failure, diabetic ketoacidosis
Apneustic - ANS -A long, gasping inspiration followed by a very short expiration in which the
breath is not completely expelled. Result is chest hyperinflation.
Causes- brain lesion
*causes severe hypoxemia
, Central neurogenic hyperventilation - ANS -A very deep, rapid respiratory rate(>25 breaths/min)
Causes- tumor or lesion of the brainstem that causes increased intracranial pressure or direct
injury to the brainstem, stroke
*CNS acidosis triggers rapid, deep breathing leading to systemic alkalosis
Gurgling lung sounds - ANS -hollow bubbling sound
Stridor lung sound - ANS -Upper airway- a harsh, high pitched sound heard during inhalation;
indicates narrowing, usually a result of swelling
Viral croup, epiglottitis, foreign body
Wheezing lung sounds - ANS -Lower airway- High-pitched, whistling sounds made by air being
forced through narrowed airways, which makes them vibrate; wheezing suggests the bronchi
are swollen and constricted, such as in patients with asthma and foreign body obstruction
Reactive airway disease, asthma, CHF, chronic bronchitis, emphysema, endobronchial
obstruction
Primarily expiration
crackles (rales) lung sounds - ANS -Lower airway- typically described as the sound of hair
rolling between your fingers
Pneumonia, exacerbation of CHF, pulmonary edema
End expiration
Rhonchi lung sounds - ANS -Lower airway- low-pitched crackles caused by secretions in the
larger airways; rhonchi can be a sign of COPD or infectious process such as bronchitis
Bronchitis, cystic fibrosis, frank aspiration
Primarily Expiration
Pleural rub 'lung' sounds - ANS -Chest wall- absence of fuid between pleural layers causing
pleural friction
Pleuritis, pleurisy, pleural effusion, pneumonia
Insiration or expiration
Decoritcate Posture - ANS -Extremities pulled inward toward the body
Decerebrate posturing - ANS -posturing in which the neck is extended with jaw clenched; arms
are pronated, extended, and close to the sides; legs are extended straight out; more ominous
sign of brain stem damage. Most Severe.
Referred pain- Left shoulder - ANS -diaphragm irritation, ruptured spleen, MI
Referred pain- Right shoulder - ANS -Liver irritation, gallbladder pain, diaphragm irritation
SUPPORT
Six R's of Rapid Recall - ANS -1. Read the scene- observe environmental conditions, safety
hazards, and likely MOIs
2. Read the patients- assess the patient's condition, take their vital signs, treat life threats,
review CC, and record general impression
3. React- manage life threats and treat pt based on their cardinal presentation
4. Reevaluate- reassess vitals, reconsider medical management
5. Revise management plan- on the basis of you reevaluation and additional historical data,
physical exam findings, diagnostic test results, and pt response to early interventions, revise
plan according to pts new clinical picture
6. Review performance- critiquing the call or pt encounter gives you a chance to reflect on your
clinical decision making and target areas in which more advanced skills or a deeper level of
knowledge are needed
Tachypnea - ANS -Increased respiratory rate
Cause- fever, resp. distress, toxins, hypoperfusion, brain lesion, metabolic acidosis, anxiety
Bradypnea - ANS -Slower-than-normal respiratory rate
Cause- narc/sedative drugs, including alcohol, metabolic disorders, hypoperfusion, fatigue,
brain injury
Cheyne-Stoke respirations - ANS -Resp pattern with alternating periods of increased and
decreased rate and depth with brief periods of apnea
Causes- increased ICP, CHF, renal failure, toxin, acidosis
*may indicate spinal injury
Biot's respirations - ANS -Similar to Cheyne-Stokes but with an irregular pattern instead of a
repeating pattern
Causes- meningitis, increased ICP, neurological emergency
*think of it as the afib of the respiratory system
Kussmaul's respirations - ANS -Deep and fast breaths lacking any apneic periods(indicates
severe acidosis)
Causes- Metabolic acidosis, renal failure, diabetic ketoacidosis
Apneustic - ANS -A long, gasping inspiration followed by a very short expiration in which the
breath is not completely expelled. Result is chest hyperinflation.
Causes- brain lesion
*causes severe hypoxemia
, Central neurogenic hyperventilation - ANS -A very deep, rapid respiratory rate(>25 breaths/min)
Causes- tumor or lesion of the brainstem that causes increased intracranial pressure or direct
injury to the brainstem, stroke
*CNS acidosis triggers rapid, deep breathing leading to systemic alkalosis
Gurgling lung sounds - ANS -hollow bubbling sound
Stridor lung sound - ANS -Upper airway- a harsh, high pitched sound heard during inhalation;
indicates narrowing, usually a result of swelling
Viral croup, epiglottitis, foreign body
Wheezing lung sounds - ANS -Lower airway- High-pitched, whistling sounds made by air being
forced through narrowed airways, which makes them vibrate; wheezing suggests the bronchi
are swollen and constricted, such as in patients with asthma and foreign body obstruction
Reactive airway disease, asthma, CHF, chronic bronchitis, emphysema, endobronchial
obstruction
Primarily expiration
crackles (rales) lung sounds - ANS -Lower airway- typically described as the sound of hair
rolling between your fingers
Pneumonia, exacerbation of CHF, pulmonary edema
End expiration
Rhonchi lung sounds - ANS -Lower airway- low-pitched crackles caused by secretions in the
larger airways; rhonchi can be a sign of COPD or infectious process such as bronchitis
Bronchitis, cystic fibrosis, frank aspiration
Primarily Expiration
Pleural rub 'lung' sounds - ANS -Chest wall- absence of fuid between pleural layers causing
pleural friction
Pleuritis, pleurisy, pleural effusion, pneumonia
Insiration or expiration
Decoritcate Posture - ANS -Extremities pulled inward toward the body
Decerebrate posturing - ANS -posturing in which the neck is extended with jaw clenched; arms
are pronated, extended, and close to the sides; legs are extended straight out; more ominous
sign of brain stem damage. Most Severe.
Referred pain- Left shoulder - ANS -diaphragm irritation, ruptured spleen, MI
Referred pain- Right shoulder - ANS -Liver irritation, gallbladder pain, diaphragm irritation
