Paramedic Care: Principles & Practice. Volume 2 Patient Assessment

Transcription

1 Paramedic Care: Principles & Practice Volume 2 Patient Assessment

2 Chapter 4 Clinical Decision Making

3 Topics Introduction to Critical Thinking Paramedic Practice Critical Thinking Skills Thinking Under Pressure The Critical Decision Process

4 Introduction to Critical Thinking

5 Introduction to Critical Thinking As a paramedic, you inevitably will face your moment of truth. A critical decision can mean the difference between life and death. Twenty-first-century paramedics are prehospital practitioners of emergency medicine not field technicians.

6 Introduction to Critical Thinking Making critical decisions requires clinical judgment the use of knowledge and experience to diagnose patients and plan their treatment.

7 Paramedic Practice

8 Paramedic Practice As a paramedic, you must gather, evaluate, and synthesize much information in very little time. Requires the use of all senses. The differential diagnosis is a preliminary list of possible causes for your patient s problem. By conducting a history and physical exam the paramedic will arrive at a field diagnosis.

9 Paramedic Practice The paramedic will apply clinical experience and exercise independent decision-making in order to develop and implement a management plan. Paramedics perform procedures in various uncontrolled and unpredictable environments.

10 Patient Acuity The severity or acuteness of your patient s condition. The spectrum of care in the pre-hospital setting includes three general classes of patient acuity.

11 Classes of Acuity Those with obvious life-threats Those with potential life-threats Those with non-life-threatening presentations

12 Obvious Life-Threats Major multi-system trauma Devastating single-system trauma End-stage disease (i.e., renal failure) Acute presentations of chronic diseases

13 Potential Life-Threats Serious multi-system trauma Multiple disease etiology

14 Non-Life-Threats Isolated minor illnesses and injuries Majority of calls are non-life threats

15 Protocols, standing orders, and patient care algorithms provide a standardized approach to emergency patient care.

16 Protocol A standard that includes general and specific principles for managing certain patient conditions. Protocols are also for special situations such as physician on-scene, radio failure, and termination of resuscitation.

17 Standing Orders Treatments you can perform before contacting the medical direction physician for permission

18 Algorithm Schematic flow chart that outlines appropriate care for specific signs and symptoms

19 While algorithms, standing orders, and protocols provide paramedics with guidance

20 do not allow the linear thinking or cookbook medicine that protocols promote restrain you from consulting with your medical direction physician.

21 Critical Thinking Skills

22 Critical Thinking Skills Knowing anatomy, physiology, and pathophysiology Focusing on large amounts of data Organizing information Identifying and dealing with medical ambiguity

23 Critical Thinking Skills Differentiating between relevant and irrelevant data Analyzing and comparing similar situations Explaining decisions and constructing logical arguments

24 Useful Thinking Styles A paramedic must stay calm and not panic. The key is focusing on the task and blocking out the distractions. Assume and plan for the worst. Establish and maintain a systematic assessment pattern.

25 Be like the duck cool and calm on the water s surface, while paddling feverishly underneath!

26 Thinking Under Pressure

27 Thinking Under Pressure With experience, you will learn to manage nervousness and maintain a steadfast, controlled demeanor. Except for safety concerns, never allow anything to distract you from your most important job assessing and caring for your patient.

28 Useful Management Styles Situation analysis Reflective vs impulsive Data processing Convergent vs divergent Decision making Anticipatory vs reactive

29 Thinking Under Pressure Physical influences Autonomic response Sympathetic response is useful Increases visual, auditory, reflexes, and muscular strength Sympathetic response may be detrimental Diminish ability to concentrate

30 Mental Checklist Developing a routine mental checklist as a good way to stay focused and systematic. Develop acronyms and mnemonics to remember critical elements during stressful incidents. SAMPLE, OPQRST-ASPN, AVPU, etc.

31 Mental Checklist Scan the situation Stop and think Decide and act Maintain control Re-evaluate

32 The Critical Decision Process

33 The Critical Decision Process Form a concept Interpret the data Apply the principles Evaluate Reflect

34 Form a Concept Observe patient s mental status, skin color, positioning, and note any deformities or asymmetry. Conduct an initial assessment. Ascertain your patient s history. Conduct a focused physical exam of the appropriate areas.

35 Interpret the Data Interpret all of your data in light of your knowledge and experience. Your attitude toward managing patients with these symptoms also becomes a factor. Determine the most common and statistically probable conditions that fit your patient s initial presentation.

36 Apply the Principles Devise a management plan that covers all contingencies. Use written protocols, standing orders, and all the interventions at your disposal to manage your patient s particular problem. Consult medical direction for atypical presentations.

37 Evaluate Reassess your patient s condition and the effects of interventions. Initial impressions may be altered. A detailed exam may be conducted to find less obvious conditions.

38 Reflect Discuss events with the physician. Conduct a run critique with the crew. Increase your experience base.

39 Putting It All Together The Six Rs Read the scene Read the patient React Re-evaluate Revise the management plan Review your performance

40 Summary Introduction to Critical Thinking Paramedic Practice Critical Thinking Skills Thinking Under Pressure The Critical Decision Process