Pt assess clinical decision making
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Transcript of Pt assess clinical decision making
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Clinical Decision Making
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Topics
Paramedics as Practitioners Life-Threatening Conditions Protocols, Standing Orders,
Algorithms Critical Thinking Process “Six R’s” of Putting It All
Together
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Introduction 21st Century Paramedics are
prehospital practitioners ofemergency medicine—not field technicians.
As a paramedic, you inevitably willface your moment of truth—a critical decision that can mean thedifference between life and death.
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Making critical decisions requires critical
judgment—the use of knowledge
and experience to diagnose patients and plan their treatment.
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A Paramedic
…must gather, evaluate, and synthesize much information in very little time.
…can then develop a field diagnosis—a prehospital evaluation of the patient’s condition and its causes.
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Acuity
The severity or acuteness of your patient’s condition.
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The spectrum of care in the
prehospital setting includes three
general classes of patient acuity.
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Classes of Acuity
Those with obvious life-threats Those with potential life-threats Those with non-life-threatening
presentations
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Obvious life-threats include…
Major multi-system trauma Devastating single-system
trauma End-stage disease
(ie, renal failure)
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Potential life-threats include…
Serious multi-system trauma Multiple disease etiology
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Non-life-threats include…
Isolated minor illnesses andinjuries
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Protocols, standing orders, and patient care algorithms provide
a standardized approach to emergency patient care.
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Protocol
A standard that includes general and specific principles for managing certain patient conditions.
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Standing Orders
Treatments you can perform before contacting the medical control physician for permission.
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Algorithm
Schematic flow chart that outlines appropriate care for specific signs and symptoms.
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To use an algorithm, follow the arrows to your patient’s symptoms and
provide care as indicated.
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While algorithms, standing orders,
and protocols provide
paramedics with guidance…
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Do not allow the linear thinking, or “Cookbook
Medicine” that protocols promote to
restrain you from consulting with your
medical direction physician.
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Paramedic’s Critical Thinking Skills (1 of 2)
Knowing anatomy, physiology, andpathophysiology
Focusing on large amounts of data Organizing information Identifying and dealing with medical
ambiguity
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Paramedic’s Critical Thinking Skills (2 of 2)
Differentiating between relevant and irrelevant data
Analyzing and comparing similar situations
Explaining decisions and constructing logical arguments
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Be like the duck—cool and calm on the water’s
surface, while paddling feverishly underneath!
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Except for safety concerns, never allow anything to distract
you from your most important job—assessing and caring
for your patient.
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Use reflective, anticipatory
thinking when assessing and
treating patients.
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Thinking Under Pressure
With experience, you will learn tomanage nervousness and maintain a steadfast, controlled demeanor.
Develop a routine mental checklistto stay focused and systematic.
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Mental Checklist
Scan the situation Stop and think Decide and act Maintain control Re-evaluate
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The Critical Decision Process
Form a concept Interpret the data Apply the principles Evaluate Reflect
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Putting It All Together
The Six R’s Read the scene Read the patient React Re-evaluate Revise the management plan Review your performance
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Summary
Paramedics as Practitioners Life-Threatening Conditions Protocols, Standing Orders,
Algorithms Critical Thinking Process “Six R’s” of Putting It All
Together