EMT 155 - Advanced Medical Life Support (AMLS) Provider

1. Perform a pragmatic approach and systematic format regarding medical patient assessment.
2. Implement patient management through formulation of a general impression.
3. Determine the patient’s stability.
4. Explore the possibilities of differential diagnoses and treatment plans.

1. Given an assessment of the medical patient scenario, the participant will be able to apply critical thinking skills to integrate pathophysiology with assessment and history findings to determine actual and potential patient problems, differential diagnoses, and management strategies. 
   1. Demonstrate with proficiency an appropriate, safe scene size up.
   2. Differentiate treatment and transport criteria for stable and unstable adult patients with medical complaints.
   3. Obtain a comprehensive patient assessment using appropriate interviewing techniques.
   4. Demonstrate the ability to recognize and explain different pathophysiology responses found during the comprehensive assessment of patients with medical complaints.
   5. Describe the rationale for assessment modifications used for the elderly patient.
   6. Describe the rationale for assessment modifications used for the elderly patient.
   7. Demonstrate an efficient, focused physical examination technique for evaluating patients with neurological, respiratory, cardiac, and abdominal complaints.
2. Given an airway management, ventilation, and oxygen therapy scenario, the participant will be able to apply critical thinking skills to integrate pathophysiology with assessment and history findings to determine actual and potential problems, differential diagnoses, and management strategies.
   1. Demonstrate with proficiency an appropriate, safe scene size up.
   2. Demonstrate the ability to recognize patient presentations that require the need for aggressive airway management.
   3. Identify different clinical situations that determine utilization of a variety of options for airway management devices.
   4. Explain the indications and contra-indications for each airway management technique or device.
   5. Demonstrate with proficiency the appropriate use of airway management techniques that include: oral tracheal intubation, nasal tracheal intubation, rapid sequence intubation, digital intubation, lighted stylet intubation, alternative airway devices ( PtL, Combitube, LMA) and surgical airway alternatives.
3. Given a hypoperfusion (shock) scenario, the participant will be able to apply critical thinking skills to integrate pathophysiology with assessment and history findings to determine actual and potential problems, differential diagnoses, and management strategies.
   1. Demonstrate with proficiency an appropriate, safe scene size up.
   2. Identify differences in patient presentations in compensated, progressive, irreversible shock.
   3. Use, with proficiency, a comprehensive assessment technique to identify differences in patient presentations and management strategies for hypovolemic, obstructive, distributive, and cardiogenic shock.
   4. Identify and explain different pathophysiological responses found during the comprehensive assessment of patients exhibiting hypovolemic, obstructive, distributive, and cardiogenic shock.
   5. Develop management alternatives for probable differential diagnoses of hypoperfusion to include as needed: airway management, respiratory and/or ventilatory support, fluid therapy, pharmacological support, and transportation to an appropriate facility.
4. Given a dyspnea scenario, the participant will be able to apply critical thinking skills to integrate pathophysiology with assessment and history findings to determine actual and potential problems, differential diagnoses, and management strategies.
   1. Demonstrate with proficiency an appropriate, safe scene size up.
   2. Identify differences in patient presentation and management strategies for patients that exhibit respiratory distress and respiratory failure.
   3. Determine and explain with accuracy different pathophysiological responses found during the comprehensive assessment of patients exhibiting airway obstruction, asthma, chronic obstructive pulmonary disorder (COPD), pneumonia, pleural effusion, tension Pneumothorax, pulmonary embolism, pleuritis, ARDS, CHF, AMI, neuromuscular dystrophies, hyperthyroidism, and psychogenic etiologies.
   4. Use a comprehensive assessment technique to identify differences in patient presentations and management strategies for airway obstruction, asthma, chronic obstructive pulmonary disorder (COPD), pneumonia, pleural effusion, tension Pneumothorax, pulmonary embolism, pleuritis, ARDS, CHF, AMI, neuromuscular dystrophies, hyperthyroidism, and psychogenic etiologies.
   5. Develop management alternative for probable differential diagnoses of dyspnea to include as needed: airway management, respiratory and/or ventilatory support, fluid therapy, pharmacological support, and transportation to an appropriate facility.
5. Given a chest pain scenario, the participant will be able to apply critical thinking skills to integrate pathophysiology with assessment and history findings to determine actual and potential problems, differential diagnoses, and management strategies.
   1. Demonstrate with proficiency an appropriate, safe scene size up.
   2. Identify differences in patient presentation and management strategies for patients that exhibit AMI, unstable angina, aortic dissection, pulmonary embolism, esophageal disruption, cardiac tamponade, pericarditis, costochondritis, gastrointestional disease, and mitral valve prolaspe.
   3. Determine and explain with accuracy different pathophysiological responses found during a comprehensive assessment of patients exhibiting AMI, unstable angina, aortic dissection, pulmonary embolisim, esophageal disruption, cardiac tamponade, pericarditis, costochondritis, gastrointestional disease, and mitral valve prolapse.
   4. Develop management alternatives for probable differential diagnoses of chest pain to include as needed: airway management, respiratory and/or ventilatory support, fluid therapy, pharmacological support, and transportation to an appropriate facility.
6. Given an altered mental status scenario, the participant will be able to apply critical thinking skills to integrate pathophysiology with assessment and history findings to determine actual and potential problems, differential diagnoses, and management strategies.
   1. Demonstrate with proficiency an appropriate, safe scene size up.
   2. Identify differences in patient presentation and management strategies for patients that exhibit a cerebral vascular accident (CVA), transient ischemic attack (TIA), cranial infections, cranial tumors, diabetes mellitus, hyperglycemic hyperosmolar nonketotic syndrome, hepatic encephalopathy, uremic encephalopathy, electrolyte imbalances, acidodsis and alkalosis, thyroid disorders, Wernicke’s encephalopathy, Korsakoff’s psychosis, toxicologic encephalopathy, and environmental etiologies.
   3. Identify and explain with accuracy different pathological responses found during the comprehensive assessment of patients exhibiting a cerebral vascular accident (CVA), transient ischemic attack (TIA), cranial infections, cranial tumors, diabetes mellitus, hyperglycemic hyperosmolar nonketotic syndrome, hepatic encephalopathy, uremic encephalopathy, electrolyte imbalances, acidodsis and alkalosis, thyroid disorders, Wernicke’s encephalopathy, Korsakoff’s psychosis, toxicologic encephalopathy, and environmental etiologies.
   4. Develop management alternatives for probable differential diagnoses of alter mental status to include as needed airway management, respiratory and/or ventilatory support, fluid therapy, pharmacological support, and transportation to an appropriate facility.
7. Given a seizures and seizure disorders scenario, the participant will be able to apply critical thinking skills to integrate pathophysiology with assessment and history findings to determine actual and potential problems, differential diagnoses, and management strategies.
   1. Demonstrate with proficiency an appropriate, safe scene size up.
   2. Identify differences in patient presentation and management strategies for patients that exhibit generalized, simple or partial complex seizures, status epilepticus, metabolic disorders, and infectious diseases.
   3. Identify and explain with accuracy different pathophysiological responses found during a comprehensive assessment of patients exhibiting generalized simple or partial complex seizures, status epilepticus, metabolic disorders, and infectious diseases.
   4. Develop management alternatives for probable differential diagnoses of alter mental status to include as needed airway management, respiratory and/or ventilatory support, fluid therapy, pharmacological support, and transportation to an appropriate facility.
8. Given an acute abdominal pain and GI bleeding scenario, the participant will be able to apply critical thinking skills to integrate pathophysiology with assessment and history findings to determine actual and potential problems, differential diagnoses, and management strategies.
   1. Demonstrate with proficiency an appropriate, safe scene size up.
   2. Identify differences in patient presentation and management strategies for patients that exhibit right and left hypochondriac, epigastric, umbilical, hypogastric, aortic aneurysm, gastric-esophageal reflux disease (GERD), and right and left iliac region etiologies.
   3. Identify differences in patient presentation and management strategies for patients that exhibit right and left hypochondriac, epigastric, umbilical, hypogastric, aortic aneurysm, gastric-esophageal reflux disease (GERD), and right and left iliac region etiologies.
   4. Identify and explain with accuracy different pathophysiological responses found during a comprehensive assessment of patients exhibiting right and left hypochondriac, epigastric, umbilical, hypogastric, aortic aneurysm, gastric-esophageal reflux disease (GERD), and right and left iliac region etiologies.
   5. Identify anatomical locations that are at risk for gastrointestinal bleeding.
   6. Determine and explain with accuracy different pathophysiological responses found during a comprehensive assessment of patients exhibiting presentations and predisposing conditions to gastrointestional bleeding.
   7. Develop management alternatives for probable differential diagnoses of acute abdominal pain and gastrointestinal bleeding to include as needed: airway management, respiratory and/or ventilatory support, fluid therapy, pharmacological support, and transportation to an appropriate facility.
9. Given a syncope scenario, the participant will be able to apply critical thinking skills to integrate pathophysiology with assessment and history findings to determine actual and potential problems, differential diagnoses, and management strategies.
   1. Demonstrate with proficiency an appropriate, safe scene size up.
   2. Identify differences in patient presentation and management strategies for patients that exhibit vasovagal and vasopressor syncope, orthostatic hypotension, and metabolic and neurologic syncope etiologies.
   3. Identify and explain with accuracy different pathophysiological responses found during a comprehensive assessment of patients exhibiting vasovagal and vasopressor syncope, orthostatic hypotension, and metabolic and neurologic syncope etiologies.
   4. Develop management alternatives for probable differential diagnoses of syncope to include as needed: airway management, respiratory and/or ventilatory support, fluid therapy, pharmacological support, and transportation to an appropriate facility.
10. Given a headache, nausea, and vomiting scenario, the participant will be able to apply critical thinking skills to integrate pathophysiology with assessment and history findings to determine actual and potential problems, differential diagnoses, and management strategies.
    1. Demonstrate with proficiency an appropriate, safe scene size up.
    2. Identify differences in patient presentation and management strategies for patients that exhibit tension headaches, migraine, subarachnoid and intracerebral hemorrhage, subdural hematoma, meningitis, pre-eclampsia, carbon monoxide poisoning, and brain abscess, nausea, and vomiting.
    3. Identify and explain with accuracy different pathophysiological responses found during a comprehensive assessment of patients exhibiting tension headaches, migraine, subarachnoid and intracerebral hemorrhage, subdural hematoma, meningitis, pre-eclampsia, carbon monoxide poisoning, and brain abscess, nausea, and vomiting.
    4. Develop management alternatives for probable differential diagnoses of headache, nausea, and vomiting to include as needed: airway management, respiratory and/or ventilatory support, fluid therapy, pharmacological support, and transportation to an appropriate facility.

1. Assessment of the Medical Patient
   1. Components of the medical assessment
   2. Dispatch information
   3. Scene size-up
   4. Physiologically stable or unstable criteria
   5. Initial assessment
   6. Focused history and physical exam
   7. Possibilities to probabilities: forming a differential field diagnosis
   8. Detailed exam
   9. Ongoing assessment
2. Airway Management, Ventilation, and Oxygen Therapy
   1. Anatomy and physiology
   2. Oxygen supplementation
   3. Airway management
3. Ventilation Equipment and Techniques
   1. Tracheal Intubation
   2. Equipment
4. Alternative Methods of Intubation
   1. Alternative airway devices
   2. Surgical techniques of airway control
   3. Rapid sequence intubation
   4. Guidelines for airway and ventilation support
5. Access and Medication Administration
   1. Medication administration
   2. Medication administration methods
   3. Venous access
   4. Intraosseous infusion
   5. Delivering medications by injection
   6. Other methods of medication administration
6. Hypoperfusion (Shock)
   1. Defining hypoperfusion and shock
   2. Anatomy and physiology of tissue perfusion
   3. Pathophysiology of shock
   4. Differential diagnosis
   5. Assessment priorities
   6. Management priorities
7. Dyspnea, Respiratory Distress, or Respiratory Failure
   1. Anatomy and physiology
   2. Determining the severity of respiratory distress or failure
   3. Differential diagnosis and management priorities
8. Chest Discomfort or Pain
   1. Anatomy and physiology
   2. Initial approach to chest discomfort or pain
   3. Differential diagnoses and management priorities     
   4. Altered mental status
   5. The pathophysiology of altered mental status
   6. General assessment and management of altered mental status
   7. Differential diagnosis: intracranial causes of altered mental status
   8. Differential diagnosis: extra-cranial causes of altered mental status
9. Acute Abdominal Pain
   1. Anatomy and physiology of the abdomen
   2. Pathophysiology of the abdomen
   3. Differential diagnosis
   4. Assessment
   5. Treatment
10. Gastrointestional Bleeding
    1. Anatomy, physiology, and pathophysiology
    2. Characteristics of blood in the GI tract
    3. Assessment
    4. Treatment
11. Seizures and Seizure Disorders
    1. Anatomy and physiology of the brain
    2. Classification and terminology
    3. Pathophysiology
    4. Differential diagnosis
    5. Assessment and management priorities
12. Syncope
    1. Pathophysiology
    2. Mechanism of syncope
    3. Patient assessment and differential diagnosis
    4. Prehospital management
13. Headache, Nausea, and Vomiting
    1. Headache
    2. Nausea and Vomiting
14. Putting It All Together:  Scenarios
    1. Difficulty breathing
    2. Difficulty breathing
    3. Shock
    4. Shock
    5. Abdominal pain
    6. Altered mental status
    7. Altered mental status
    8. Chest pain
    9.     Sudden onset paraplegia
    10. Unconscious women