bledsoe et al., paramedic care: principles & practice, volume 2: patient assessment, 3rd ed. ©...
TRANSCRIPT
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Paramedic Care:Principles & Practice
Volume 2 Patient Assessment
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Chapter 4 Clinical Decision Making
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Topics
Introduction to Critical Thinking
Paramedic Practice
Critical Thinking Skills
Thinking Under Pressure
The Critical Decision Process
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Introduction to Critical Thinking
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
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.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Making critical decisions requires clinical judgment—the use of knowledge and
experience to diagnose patients and plan their treatment.
Introduction to Critical Thinking
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Paramedic Practice
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
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.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
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.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
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.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Classes of Acuity
Those with obvious life-threats
Those with potential life-threats
Those with non-life-threatening presentations
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Obvious Life-Threats
Major multi-system trauma
Devastating single-system trauma
End-stage disease (i.e., renal failure)
Acute presentations of chronic diseases
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Potential Life-Threats
Serious multi-system trauma
Multiple disease etiology
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Non-Life-Threats
Isolated minor illnesses and injuries
Majority of calls are non-life threats
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Protocols, standing orders, and patient care algorithms provide
a standardized approach to emergency patient care.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
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.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Standing Orders
Treatments you can perform before contacting the medical direction physician for permission
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Algorithm
Schematic flow chart that outlines appropriate care for specific signs and symptoms
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
While algorithms, standing orders, and protocols provide paramedics with guidance…
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
…do not allow the linear thinking or “cookbook medicine” that protocols promote
restrain you from consulting with your medical direction physician.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Critical Thinking Skills
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Critical Thinking Skills
Knowing anatomy, physiology, andpathophysiology
Focusing on large amounts of data
Organizing information
Identifying and dealing with medicalambiguity
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Critical Thinking Skills
Differentiating between relevant and irrelevant data
Analyzing and comparing similar situations
Explaining decisions and constructing logical arguments
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
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.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Be like the duck—cool and calm on the water’s
surface, while paddling feverishly underneath!
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Thinking Under Pressure
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Thinking Under Pressure
With experience, you will learn tomanage 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.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Useful Management Styles
Situation analysis– Reflective vs impulsive
Data processing– Convergent vs divergent
Decision making– Anticipatory vs reactive
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
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
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
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.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Mental Checklist
Scan the situation
Stop and think
Decide and act
Maintain control
Re-evaluate
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
The Critical Decision Process
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
The Critical Decision Process
Form a concept
Interpret the data
Apply the principles
Evaluate
Reflect
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
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.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
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.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
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.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
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.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Reflect
Discuss events with the physician.
Conduct a run critique with the crew.
Increase your experience base.
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Putting It All Together
The Six RsRead the scene
Read the patient
React
Re-evaluate
Revise the management plan
Review your performance
Bledsoe et al., Paramedic Care: Principles & Practice, Volume 2: Patient Assessment, 3rd Ed.© 2009 by Pearson Education, Inc. Upper Saddle River, NJ
Summary
Introduction to Critical Thinking
Paramedic Practice
Critical Thinking Skills
Thinking Under Pressure
The Critical Decision Process