AMLS Study Guide Exam: 400 Questions and Answers, Exams of Nursing

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AMLS – ACTUAL STUDY GUIDE EXAM

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When you use an interpreter to question a 42-year-old female about her abdominal pain, what is the best way to ensure information has been conveyed accurately and completely? - ANSWER Let the patient write her answers, and have the interpreter restate them so you will have a recored of her statements for your report. (yeah right) Which agency oversees the compliance, tracking and reporting, and guidelines for preventing transmission of bloodborne pathogens in the workplace? - ANSWER OSHA Which assessment evaluates at least one aspect of cranial nerve function? - ANSWER Cincinnati Prehospital Stroke Scale Which assessment finding(s) should you anticipate in a patient who has myxedema? - ANSWER Dry yellow skin Healthcare providers are managing a patient presenting with substernal chest discomfort. They describe the pain as "pressure- like" and it radiates to the jaw and left arm. The discomfort subsides with rest, oxygen and administration of nitroglycerin. What is the most likely working diagnosis? - ANSWER Myocardial infarction Which infectious disease must have oxygen present to survive? - ANSWER Tuberculosis

Which best practices help to prevent the spread of infectious disease? - ANSWER Handwashing before and after all patient contact and standard precautions. Continuous positive airway pressure would be most appropriate in treating which patient? - ANSWER 22 year old with severe asthma and not responding to nebulizer treatments A patient has attempted suicide by ingesting ethylene glycol about 20 hours prior to arriving for treatment. Lung sounds reveal bilateral crackles and respirations of 30 with symptoms of pulmonary edema and cyanosis of the lips. The ECG reveals ventricular tachycardia. Which stage of ethylene glycol poisoning has occurred? - ANSWER 2 A patient with a history of Grave's disease presents with anxiety, profuse sweating and a palpable goiter. Vitals are P 151, R 35 and labored, BP 84/42. Which working diagnosis is most likely? - ANSWER Thyrotoxicosis A patient experiences unilateral facial weakness and droop, garbled speech, altered sense of taste and no extremity weakness. The patient has a history of Lyme's disease. What condition is the patient likely experiencing? - ANSWER Meningitis Which component of the history is most crucial when assessing a potential stroke patient? - ANSWER Time of onset The determination of a working diagnosis is dependent on the provider's assessment, critical thinking and ____________________ __________________________ skills. - ANSWER Pattern recognition

When performing a patient assessment, what information provides the most essential information in determining a working diagnosis?

• ANSWER Medical history Clinical reasoning requires the healthcare provider to: - ANSWER Process relevant information, filter out irrelevant information According to the AMLS Assessment Pathway, determining whether a patient is "Sick or Not Sick" is initially done which component of the assessment process? - ANSWER First impression Select an example of a communication barrier that impairs an efficient and thorough assessment process. - ANSWER The patient can't find his hearing aid Healthcare providers are treating an unresponsive patient who overdosed on lorazepam. What intervention should be initiated? - ANSWER Airway support Addison Disease s/s - ANSWER chronic fatigue, and weakness, loss of appetite with consequent weight loss, hyperpigmentation of the skin Aldosterone - ANSWER causes the kidneys to reabsorb sodium from the renal tubules, sodium carries water back into the vasculature to help increase BP, also creates sensation of thirst which is the first sign of shock. Alpha & Beta Response to Shock - ANSWER Alpha1-triggers vasoconstriction Beta 1- stimulates heart rate and cardiac contractility Anaphylactic Treatment - ANSWER Epi: 1:1,000- 0.3-0.5mg SQ every 5 - 15min prn

Epi: 1:10,000-0.3-0.5mg IV ovr 3-10 min every 15min prn Bendryl 25-50mg Angioedema - ANSWER sudden swelling of head or neck structure such as lip,earlopes,tongue,uvula, assoc. with rash,dyspnea,anxiety,stridor,wheezing BP for fluid challenge - ANSWER 80-90 Systolic BP for Neuro Problems - ANSWER 110-120 Systolic Cardiogenic Shock - ANSWER cool,clammy,pale,cyanotic,tachypnea,tachycardia or abnormal rythm, decreased BP TX- 5 - 10 ML/KG fluid challenge Cauda Equina Syndrome - ANSWER nerves exiting the lumbar spine become compressed, causing lower extremity pain, paralysis from trauma,tumor,disk hernaition Criteria to Establish Ventilation - ANSWER Paco2 <55 mm Hg Paco2 > 50 PH < 7. Croup - ANSWER Infection leading to swelling in the throat, pt presents with "barking" cough, stridor, hoarseness Distributive Shock (dilated vessels) - ANSWER Septic,anaphylactic,neurogenic,toxins Graves Disease - ANSWER increase in thyroid hormones, an autoimmune disease which disease which produces antibodies Head Injuries with Increasing Icp - ANSWER Hyperventilate

Hypercarbia - ANSWER Physical condition of having the presence of an abnormally high level of carbon dioxide in the circulating blood. Hyponatremia - ANSWER Is an electrolyte disturbance in which the sodium ion concentration in the serum is lower than normal. Hypovolemic Shock - ANSWER cool,clammy,pale,cyanotic,decreased BP,ALOC,decreased cap. refill TX-20 ML/KG fluid challenge Life Threats - ANSWER Upper Airway Obstruction (noise/swelling) Severe decrease in consciousness Ludwigs Angina - ANSWER infection of the anterior neck below the mandible swelling of the tongue,drooling,airway obstruction Normal Capnography Reading - ANSWER 32-43 mm HG. Obstructive Shock - ANSWER Decreased BP, difficulty breathing, tachycardia,tachypnea,JVD,decreased breath sounds,muffled heart tones. PEEP Common Settings - ANSWER 5-20 cm H2O PEEP - ANSWER Positive End Expiratory Pressure delivered at the end of exhalation. Pericarditis S/S - ANSWER sitting forward or sleep propped up with pillows fever,chills,fatigue,malaise, global ST elevation Pert. Negative & Positives - ANSWER Recent Illness/Injury

N/V

Head Ache/Chills Abdom. Pain/Chest Pain/SOB Pedal Edema Stool & Urine Normal Eat & Drinking Normally Renin-Angiotensin - ANSWER renin-angiotensin-tirggers vasoconstriction to vessels farthest away from vital organs, to keep perfusion going to brain,heart,lungs and liver causing other organs to become ischemic ABDOMEN: Boerhaaves Syndrome - ANSWER Spontaneous rupture of the esophagus S/S - mediastinitis, sepsis, and shock. Swallowing often aggravates the pain ABDOMEN: Cholangitis - ANSWER infection of the common bile duct; the tube that carries bile from the liver to the gall bladder ABDOMEN: Coffee Ground Emesis - ANSWER Vomiting of partially digested blood - (GI BLEEDING) ABDOMEN: Colitis - ANSWER Clostridium difficile (C. diff) a. s/s - n/v, foul smelling, watery, green, diarrhea, fever, loss of appetite, abd pain b. Tx - PPE, IV clean all equipment very good c. Antibiotic therapy, which suppresses the normal flora in the GI tract and allows C. diff to predominate

ABDOMEN:

Cullen Sign - ANSWER bruising around the belly button that may indicate intra-abdominal bleeding or PANCREATITIS.

• Cullen's got the belly button tattoos (bruises) and pancreas is in the middle ABDOMEN: Diverticultis - ANSWER Diverticulum is a weak area in the colon that begins to have small outcroppings that turn into pouches. These become inflamed. ABDOMEN: Feculant Vomiting - ANSWER - Foul Smelling vomit with a feculent odor- (BOWEL OBSTRUCTION) ABDOMEN: Gray turners sign - ANSWER bruising in the flanks, indicative of pancreatitis ABDOMEN: Hemataemesis- - ANSWER vomiting of blood-(UPPER GI BLEEDING) BRIGHT RED - INDICATIVE OF ACTIVE BLEEDING ABDOMEN: Hematochezia - ANSWER bright red blood in the stool. (LOWER GI BLEEDING) INDICATIVE OF ACTIVE BLEEDING ABDOMEN: Hepatic Encephalopathy - ANSWER Decreased brain function caused by diminished liver functions S/S: confusion, LOC, Coma, as a result of liver failure

ABDOMEN:

Identify the Signs/Symptoms and Treatment for the following medical condition: Appendicitis - ANSWER INFLAMMATION OF THE APPENDIX: periumbilical pain. n/v, low grade fever, loss of appetite. Pain rlq, rebound tenderness

• Fecal matter or other material accumulates in the appendix. Pressure builds and decreases blood flow. This causes an uncontrolled rise in bacteria TX: pain and anti nausea meds ABDOMEN: Identify the Signs/Symptoms and Treatment for the following medical condition: Bowel Obstruction - ANSWER S/S: crampy abdominal pain, constipation or diarrhea, inability to pass flatus, distended abdomen, absent or high-pitched bowel sounds. tx: administer oxygen, place pt in comfortable position, establish iv, give nothing PO ABDOMEN: Identify the Signs/Symptoms of Gastroenteritis - ANSWER Abdominal pain/tenderness, myalgia, and headache. Vomiting may occur, followed by colitis, which causes visible Blood in the stool. (3- 7 days). Watery, yellow, green, or bloody stool, or stools containing pus. Also look for signs of dehydration or shock ABDOMEN: Kehrs Sign - ANSWER Abdominal pain that radiates to the Left Shoulder, could indicate irritation of the DIAPHRAGM OR SPLEEN INVOLVEMENT (Irritants in the peritoneal cavity)
• Steve Kerr shoots the ball goofy and from his abdomen to the left shoulder

ABDOMEN:

Liver Abscess - ANSWER puss-filled mass inside the liver ABDOMEN: Mallory Weiss Syndrome - ANSWER - A condition in which the junction between the esophagus and the stomach (Cardiac Sphincter) tears, causing severe bleeding and potentially death

• Secondary to eating disorders, caused by alcoholism, retching, coughing or vomiting. ABDOMEN: Melena - ANSWER black tarry feces that contains digested blood - (UPPER GI BLEEDING). Which diagnostic test most accurately assesses the presence and magnitude of anaerobic metabolism? - ANSWER Lactic acid Which gland is responsible for some of the vasoconstriction in shock? - ANSWER Pituitary Which intervention for patient in shock prevents an increase in myocardial oxygen demand? - ANSWER Maintain normal body temperature Which is the most reliable indicator that ventilation should be assisted in a patient with altered mental status? - ANSWER End-tidal CO2 is 60 mm Hg Which of the following biological warfare agents causes serious neurologic symptoms that may include paralysis? - ANSWER botulism

Which of the following describes a behavior that represents normal mental status? A person who: - ANSWER Is drowsy and slow to respond to questions after awakening from a nap. Which of the following findings indicates the need to increase the rate of ventilation in a intubated patient you suspect to have an epidural hematoma? - ANSWER Unilateral blown pupil Which of the following is an occupational exposure incident? - ANSWER Blood sprays in your face when a child with a face laceration sneezes Which of the following patients is at highest risk for pericardial tamponade? - ANSWER 55-year-old with end-stage lung cancer Which of the following physical findings points most specifically to increased intracranial pressure? - ANSWER Respiratory rate is 8 and irregular. Which patient is at highest risk for non traumatic obstructive shock?

• ANSWER 22-year-old who is 38 weeks pregnant Which patient would be an appropriate candidate for immediate intravenous administration of sodium bicarbonate? - ANSWER 45- year-old who complained of chest pain and is now in cardiac arrest and unresponsive to treatment Which sign or symptom can help diagnose headache from meningococcal meningitis? - ANSWER Petechial rash Which source provides the most detailed information related to hazardous materials? - ANSWER Material Safety Data Sheets

While treating a trauma patient, you lacerate your hand. Your bleeding hand comes in contact with the blood of the patient. What action is most important to increase your chance of appropriate follow-up? - ANSWER Notify the receiving facility and your designated infection control officer immediately. You are transferring a 65-year-old female with renal failure from the nursing home. She has a history of "abnormal lab values" and is drowsy and weak. You note the following lab values: serum calcium 10.0 mg/dL (0.55 mmol/L), pH 7.28, potassium 6.1 mEq/L. The patient goes into cardiac arrest after you load her into the ambulance. After epinephrine, you should first consider giving her: - ANSWER Magnesium sulfate You are treating a patient who has been diagnosed with herpes simplex type 1. He exhibits no signs or symptoms at this time. He is in which stage of the communicable disease? - ANSWER Latent You evaluate the patient's environment to assess for: - ANSWER all of the above; Safety concerns, Room Temp, Assistive devices You respond to a warehouse for "multiple patients with difficulty breathing." From a hallway, you see your patient lying in a room with two other people who don't seem to be breathing. He calls out to you, saying he can't breathe. You should first: - ANSWER Stage at a safe distance. Your adolescent patient presents with a fever, malaise, sneezing, and paroxysmal spasmodic coughing phases. Which infectious disease would you suspect? - ANSWER Pertussis Your patient complains of discomfort in his hand as you inflate the cuff to asses the blood pressure. You note flexion of the wrist and

adduction of his fingers. What endocrine disorder do you suspect? - ANSWER Hypoparathyroidism Your patient is agitated and sweaty. Her vital signs are BP 107/ mmHG, P 132 bpm, and R 20/min. Her pupils are dilated, and her hands are trembling. These signs and symptoms may be associated with: - ANSWER Alcohol withdrawal Your patient is complaining of a cramping pain around her umbilical area that "won't let up." This is most suggestive of disease involving the: - ANSWER Appendix Your patient is reported is reported to have taken an overdose. She has a history of anxiety disorder and depression. She is unresponsive, and vital signs are BP 110/70, P 125 bpm, R 20/min. Her ECG shows right bundle branch block. You expect she has taken:

• ANSWER Amilytriptyline List 7 Red Flags for Breathing - ANSWER 1. Reduced consciousness

2. Cyanosis
3. SpO2 29
4. Asymmetrical movement
5. Tracheal deviation and distress
6. Inability to count to five in a single breath List 7 Red Flags for Circulatory Problems - ANSWER 1. Reduced consciousness

2. Profound pallor
3. Marked sweating
4. Systolic BP 140
5. Skin mottling
6. Dysrhythmia & hypotension List 5 Red Flags for Airway Assessment - ANSWER 1. Reduced consciousness
7. Stridor
8. Snoring
9. Voice change
10. Tongue swelling List 5 Red Flags of Disability Assessment - ANSWER 1. Hypoglycaemia
11. Reducing level of consciousness
12. Persistent fitting
13. Progression of signs (e.g. headache, lateralization)
14. P,U or not localizing pain List 3 Red Flags on General Assessment - ANSWER 1. Purpuric rash
15. Erythrodermia
16. Core temperature 40deg

List 11 immediately life-threatening causes of airway obstruction - ANSWER 1. Tongue swelling (pharynx)

2. Swelling of the epiglottis or soft tissues (pharynx)
3. Oedema of the larynx
4. Laryngospasm (spasm of the vocal cords)
5. Foreign body in larynx
6. Laryngeal trauma
7. Subglottic secretions or foreign body
8. Subglottic swelling
9. Bronchial aspiration
10. Tension pneumothorax
11. Bronchial foreign body List 7 immediately life-threatening causes of breathlessness - ANSWER 1. Airway obstruction
12. Acute severe asthma
13. Acute exacerbation of COPD
14. Pulmonary oedema
15. Tension pneumothorax
16. Critical oxygen desaturation

7. Circulatory shock List 5 Life-threatening conditions that present with cutaneous manifestations - ANSWER 1. Anaphylaxis
8. Angio-oedema
9. Meningococcal sepsis
10. Gonococcal sepsis
11. Cellulitis
12. Erythroderma List 10 danger signs/reasons to admit a severe asthmatic to ICU - ANSWER 1. Hypoxaemia (PaO2 0,6)
13. Hypercapnia (PaCO2 > 6 kPa)
14. Acidaemia
15. Exhaustion
16. Altered level of consciousness (confused, drowsy, unconscious)
17. Respiratory arrest
18. Silent chest
19. Tachycardia > 130/min
20. Bradycardia
21. Peak expiratory flow < 33% of predicted

List 5 medicines that cause dilatation of the pupils - ANSWER 1 Tricyclic antidepressants

2. Anticholinergics
3. Antihistamines
4. Ephedrine
5. Amphetamines
6. Cocaine List 5 substances that can cause coma - ANSWER 1. Barbiturates
7. Tricyclic antidepressants
8. Opioids
9. Benzodiazepines
10. Ethanol List 5 non-traumatic life-threatening disorders of the circulatory system - ANSWER 1. Airway obstruction
11. Acute severe asthma
12. Pulmonary oedema
13. Tension pneumothorax
14. Circulatory shock Name 5 non-traumatic life threatening disorders of the neurological system~1. Stroke
15. Subarachnoid haemorrhage

3. Meningitis
4. Encephalitis
5. Cerebral abscess
6. Cerebral malaria
7. Intracerebral tumour List 8 life-threatening conditions presenting with abdominal pain - ANSWER 1. Gastrointestinal bleeding
8. Aortic dissection
9. Ectopic pregnancy
10. Acute pancreatitis
11. Small bowel infarction
12. Sepsis
13. Acute myocardial infarction
14. Diabetic ketoacidosis A 28 year old female is being evaluated for an acute onset of an alteration in mentation. She complained of a stiff neck and persistent headache. Vital signs are P112, R22 and regular, BP 144/88, SpO2 95% and T 102.3°F (39°C). The healthcare provider should observe for which complication? - ANSWER Seizure

A 45 year old patient is found supine on the floor of the Triage area. Healthcare providers note pinpoint pupils, shallow respirations and vomitus in and around the mouth. What course of action should be implemented next? - ANSWER Supplemental oxygen and suction Patients with a history of chronic bronchitis that present with shortness of breath are likely to have which condition? - ANSWER Pulmonary embolism Acute Respiratory Distress Syndrome (ARDS) is characterized by what pathological change? - ANSWER Breakdown of the alveolar- capillary membrane An anxious male complains of a sore throat, fever, chills, dental pain and dyspnea. the patient has a firm, red pronounced swelling in the sublingual anterior throat area and tongue. What diagnosis is most likely? - ANSWER Ludwig's angina Patients on mechanical ventilation may have hypoxemia due to alveolar collapse from mucous plugging. The best treatment for this is: - ANSWER Administer PEEP Anaphylaxis is most associated with which physiological event? - ANSWER Vasodilation An elderly patient in an assisted living facility presents with a diminished level of consciousness and elevated white blood count. Assessment reveals pale, clammy skin and a urinary catherter with dark colored urine. Vital signs are P132, R 38 and shallow, BP 78/46, SpO2 91% and T 100.8°F (32.8°C). What classification of shock is the patient most likely experiencing? - ANSWER Distributive

Healthcare providers are assessing a patient with pronounced jugular vein distention and muffled heart tones. Vitals are P 128, R 26, BP 74/52. What classification of shock should be suspected? - ANSWER Obstructive During compensatory shock, the renin-angiotensin-aldosterone system is activated to cause a/an: - ANSWER Increase in preload, afterload and re-absorption of sodium A 42 year old patient with a history of rheumatoid arthritis is taking glucocorticoids. Over the past two weeks, she complains of chronic fatigue, weakness, and loss of appetite with weight loss. Lab results indicate hyponatremia and hyperkalemia. What underlying diagnosis is suspected? - ANSWER Adrenal insuffiency Which condition should the healthcare provider consider to usually be a non-emergent, non-life threatening illness? - ANSWER Thoracic outlet syndrome Healthcare providers should use extreme caution with nitroglycerin when ST elevation is present in which ECG leads? - ANSWER II, III, aVF Which is a high-risk factor for intracerebral hemorrhage? - ANSWER Cocaine drug abuse What is the initial treatment for a patient experiencing Hyperosmolar Hyperglycemic Nonketotic Syndrome (HHNS)? - ANSWER Crystalloid IV fluid resuscitation What condition is most likely to cause respiratory acidosis? - ANSWER narcotic overdose

What is the most effective treatment for an unconscious patient in respiratory acidosis? - ANSWER Assisted bag-mask ventilation An autoimmune disease which produces antibodies that mimic the role of TSH and cause an increase in thyroid hormones is: - ANSWER Grave's disease Glucagon may not be effective treatment for a patient with hypoglycemia if they also have which underlying illness? - ANSWER Alcoholism A 24 year old has completed a triathlon on a hot, humid day. The athlete complains of a severe headache, muscle cramps and abdominal pain. As the patient history is obtained, the athlete becomes lethargic. What underlying electrolyte disturbance should the healthcare provider most likely suspect? - ANSWER Hyponatremia What is the sign on the ECG that will indicate a patient is experiencing hyperkalemia? - ANSWER Peaked T waves An 82 year old alcoholic complains of nausea, non-bloody vomiting and severe epigastric and right upper quadrant pain that radiates to the back. Palpation reveals epigastric tenderness without peritoneal signs. What working diagnosis should be considered most likely? - ANSWER Acute pancreatitis A 23 year old male complains of a productive cough, fever, chills and pleuritic chest pain that has worsened over 3 days. A physical exam reveals unilateral wheezing with shallow respirations. Vitals are P 128, R 26, BP 144/88, SpO2 90%, and T 102°F (38.8°C). What treatment should be performed? - ANSWER Supplemental oxygen and immediate transport

A patient with suspected gallbladder disease is asked to take a deep breath while the provider presses upward into the upper right quadrant. If the patient ceases inspiration due to increase pain while being examined, this is known as: - ANSWER Muphy's sign The patient is alert and oriented presenting with hypotension, bradycardia, normal capillary refill and warm, dry skin. These are cardinal signs of which type of distributive shock? - ANSWER Neurogenic During what period of the communicable disease process will antibodies begin to reach detectable levels and the infected blood will test positive for exposure to a pathogen? - ANSWER Incubation The patient presents with a history of headache, weight loss, chest discomfort, night sweats and a persistent cough for several weeks. Which infectious disease is most likely occurring? - ANSWER Tuberculosis A lethargic patient presents with dilated pupils and vital signs of P 122, R 26 and BP 130/80. He admits to excessive ingestion of diphenhydramine. What response is the cause for the presenting signs and symptoms? - ANSWER Anticholinergic Organophosphate poisoning will present with which signs and symptoms? - ANSWER Salivation and incontinence of urine and liquid stool What medication classification should be administered to an uncooperative, agitated patient? - ANSWER Benzodizepine A patient presents with mildly decreased mental status, slow respirations, bradycardia, hypotension, has a blood sugar of

42mg/dl (2.3 mmol/L). This is most likely caused from excessive ingestion of: - ANSWER Beta blockers The patient complains of a deep burning discomfort diffusely throughout the epigastrium. This is an example of which type of pain? - ANSWER Visceral A 24 year old female presents with lower right quadrant abdominal pain. Her skin is hot to the touch and she exhibits a Psoa Sign. She complains of nausea and vomiting for 2 days. What diagnosis is suspected? - ANSWER Appendicitis A known chronic alcoholic complains of the constant, severe mid- epigastric pain, nausea and blood-streaked emesis. The patient has a temperature of 101.9°F (38.8°C) and severe abdominal tenderness. What underlying diagnosis should be suspected? - ANSWER Pancreatitis What component of a patient's past medical history is most helpful in considering myocardial infarction as a working diagnosis? - ANSWER Familial heart disease history A patient describes an "aching" sensation in his chest. It occurred suddenly while resting and radiates to the jaw. He self administered 1 nitroglycerin tablet without relief and the 12 lead reveals a normal sinus rhythm with ST elevation in leads II, III, and aVF. What working diagnosis is most likely? - ANSWER Inferior wall myocardial injury ABDOMEN: Murphy's Sign - ANSWER Press firmly upward into the RUQ and ask the patient to take a deep breath. Arrest of inspiration because of pain is a positive finding. This could indicate a GALL BLADDER OR HEPATIC PROBLEM

• Dale Murphy took a fastball in RUQ and knocked wind out of him (RUQ is where gall bladder is) ABDOMEN: Pancreatitis - ANSWER S/S- pain to epigastric area or RUQ, radiate to back, n/v fever, tachycardia, hypotension, muscle spasms to ext, Cullen, grey turners TX:- IV, pain management. CAUSE: Inflammation of the pancreas caused by blockage of the tube that carries enzymes away from the pancreas CULLEN AND GREY TURNERS SIGNS ABDOMEN: Peptic Ulcer Disease - ANSWER The protective layer of mucous lining in the stomach and duodenum erode, allowing the acid to eat into the organ itself. ABDOMEN: Psoa's Sign - ANSWER Place the patient in the Left Lateral Decubitus position, and extend the right leg at the hip. An increase of pain in the RLQ is a positive finding. Commonly associated with APPENDICITIS (Soooo uhhh let's go for a walk (pregnant woman) on your left lateral recumbent side and if RLQ hurts - appendicitis)) ABDOMEN: Pyelonephritis - ANSWER Inflammation of the kidney linings, usually from untreated UTI's S/S - dysuria ABDOMEN:

Rovsing's sign - ANSWER Palpate the LLQ of the abdomen. Pain or tenderness elicited in the RLQ is a positive finding. Suggests APPENDICITIS

• Ruh rov... U pressed on my LLQ and my RLQ began to sing in pain (RLQ is where appendix is) ABDOMEN: Somatic Pain - ANSWER Well LOCALIZED and described as sharp in nature. comes from skin and muscle as well as joints, ligaments, tendons
• somatic = specific ABDOMEN: Visceral Pain - ANSWER - Originates within the chest and abdomen, and is often described as heaviness, pressure, aching, or burning that is NOT EASY TO PIN POINT! Visceral pain may also radiate to other areas of the body. It comes from organs inside the body with injury or illness.
• visceral = vague pain ALTERED MENTAL STATUS: Identify a systematic approach to treatment for Altered Mental Status Presentations - ANSWER Alcohol, anaphylaxis, AMI Epilepsy, Endocrine, Electrolytes Insulin Opiates Uremia Trauma Intercranial infection (tumor, hemorrhage, htn) Poisoning Seizure, Sepsis

Angioedema - ANSWER a. Vascular reaction characterized by severe swelling, often around the eyes and lips. Swelling may involve the tongue and mouth. Usually an allergic reaction and can extend to lower airway. ASSESSMENT: In the AMLS Patient Assessment Pathway - What is included in the First Impression Section? - ANSWER - Identify and treat life threats immediately

• Generate Differential Diagnosis ASSESSMENT: In the AMLS Patient Assessment Pathway - What is included in the Initial Observations Section? - ANSWER Scene - Safety threats to crew, and Situation Patient - Cardinal Presentation, and Primary Survey ASSESSMENT: What is the order of events in the AMLS Patient Assessment Pathway? - ANSWER 1) Initial Observations - Scene and Patient

2. First Impression - Sick or Not Sick?
3. Detailed Assessment - Hx, Secondary Ass, Diagnostics
4. Refine Differential Diagnosis (Based on Accumulated Data and Clinical Reasoning)
5. Ongoing Management ASSESSMENT: Identify communication barriers that affect obtaining thorough medical history? - ANSWER your own specialized knowledge, social barriers, linguistic barriers, behavioral barriers, psychological barriers, cultural differences, sensory impairment