AMLS
Six R's of Rapid Recall - answer1. 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 - answerIncreased respiratory rate
Cause- fever, resp. distress, toxins, hypoperfusion, brain lesion, metabolic acidosis,
anxiety
Bradypnea - answerSlower-than-normal respiratory rate
Cause- narc/sedative drugs, including alcohol, metabolic disorders, hypoperfusion,
fatigue, brain injury
Cheyne-Stoke respiratons - answerResp 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 - answerSimilar 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 - answerDeep and fast breaths lacking any apneic
periods(indicates severe acidosis)
Causes- Metabolic acidosis, renal failure, diabetic ketoacidosis
Apneustic - answerA 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 neurologic hyperventilation - answerA 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 - answerhollow bubbling sound
Stridor lung sound - answerUpper airway- a harsh, high pitched sound heard during
inhalation; indicates narrowing, usually a result of swelling
Viral croup, epiglottitis, foreign body
Wheezing lung sounds - answerLower 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 brinchitis, emphysema, endobronchial
obstruction
Primarily expiration
crackles (rales) lung sounds - answerLower airway- typically described as the sound of
hair rolling between your fingers
Pneumonia, exacerbation of CHF, pulmonary edema
End expiration
Rhonchi lung sounds - answerLower 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 asiration
Primarily Expiration
Pleural rub 'lung' sounds - answerChest wall- absence of fuid between pleural layers
causing pleural friction
Pleuritis, pleurisy, pleural effusion, pneumonia
Insiration or expiration
Decoritcate Posture - answerExtremities pulled inward toward the body
Decerebrate posturing - answerposturing 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 - answerdiaphragm irritation, ruptured spleen, MI
Referred pain- Right shoulder - answerLiver irritation, gallbladder pain, diaphragm
irritation
Referred pain- Right scapular - answerLiver and gallbladder
Six R's of Rapid Recall - answer1. 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 - answerIncreased respiratory rate
Cause- fever, resp. distress, toxins, hypoperfusion, brain lesion, metabolic acidosis,
anxiety
Bradypnea - answerSlower-than-normal respiratory rate
Cause- narc/sedative drugs, including alcohol, metabolic disorders, hypoperfusion,
fatigue, brain injury
Cheyne-Stoke respiratons - answerResp 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 - answerSimilar 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 - answerDeep and fast breaths lacking any apneic
periods(indicates severe acidosis)
Causes- Metabolic acidosis, renal failure, diabetic ketoacidosis
Apneustic - answerA 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 neurologic hyperventilation - answerA 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 - answerhollow bubbling sound
Stridor lung sound - answerUpper airway- a harsh, high pitched sound heard during
inhalation; indicates narrowing, usually a result of swelling
Viral croup, epiglottitis, foreign body
Wheezing lung sounds - answerLower 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 brinchitis, emphysema, endobronchial
obstruction
Primarily expiration
crackles (rales) lung sounds - answerLower airway- typically described as the sound of
hair rolling between your fingers
Pneumonia, exacerbation of CHF, pulmonary edema
End expiration
Rhonchi lung sounds - answerLower 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 asiration
Primarily Expiration
Pleural rub 'lung' sounds - answerChest wall- absence of fuid between pleural layers
causing pleural friction
Pleuritis, pleurisy, pleural effusion, pneumonia
Insiration or expiration
Decoritcate Posture - answerExtremities pulled inward toward the body
Decerebrate posturing - answerposturing 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 - answerdiaphragm irritation, ruptured spleen, MI
Referred pain- Right shoulder - answerLiver irritation, gallbladder pain, diaphragm
irritation
Referred pain- Right scapular - answerLiver and gallbladder
