chapter 14 critical thinking and clinical decision making
TRANSCRIPT
![Page 1: Chapter 14 Critical Thinking and Clinical Decision Making](https://reader035.vdocuments.site/reader035/viewer/2022081511/56649d955503460f94a7dd6e/html5/thumbnails/1.jpg)
Chapter 14Chapter 14
Critical Thinking and Clinical Decision Making
![Page 2: Chapter 14 Critical Thinking and Clinical Decision Making](https://reader035.vdocuments.site/reader035/viewer/2022081511/56649d955503460f94a7dd6e/html5/thumbnails/2.jpg)
National EMS Education Standard CompetenciesNational EMS Education Standard Competencies
Assessment
Integrate scene and patient assessment findings with knowledge of epidemiology and pathophysiology to form a field impression. This includes developing a list of differential diagnoses through clinical reasoning to modify the assessment and formulate a treatment plan.
![Page 3: Chapter 14 Critical Thinking and Clinical Decision Making](https://reader035.vdocuments.site/reader035/viewer/2022081511/56649d955503460f94a7dd6e/html5/thumbnails/3.jpg)
IntroductionIntroduction
• Paramedics must be able to:− Identify problems.
− Set patient care priorities.
− Develop a care plan.
− Execute the plan.
![Page 4: Chapter 14 Critical Thinking and Clinical Decision Making](https://reader035.vdocuments.site/reader035/viewer/2022081511/56649d955503460f94a7dd6e/html5/thumbnails/4.jpg)
IntroductionIntroduction
• Cookbook medicine can lead to ineffective care.− Patients may present atypically.
− The scene may be unstable.
• You are expected to provide quality patient care.
© M
ark
C.
Ide
![Page 5: Chapter 14 Critical Thinking and Clinical Decision Making](https://reader035.vdocuments.site/reader035/viewer/2022081511/56649d955503460f94a7dd6e/html5/thumbnails/5.jpg)
Gathering, Evaluating, and Synthesizing
Gathering, Evaluating, and Synthesizing
• You must be able to communicate and obtain information from many types of patients, including:− Different age groups
− Different educational backgrounds
− Different abilities to communicate
− Patients who have consumed drugs or alcohol
![Page 6: Chapter 14 Critical Thinking and Clinical Decision Making](https://reader035.vdocuments.site/reader035/viewer/2022081511/56649d955503460f94a7dd6e/html5/thumbnails/6.jpg)
Gathering, Evaluating, and Synthesizing
Gathering, Evaluating, and Synthesizing
• Assess and evaluate gathered information to develop a treatment plan.− Check the validity of information using your
judgment and communication skills.
• Be as objective as possible in the decision-making process.
![Page 7: Chapter 14 Critical Thinking and Clinical Decision Making](https://reader035.vdocuments.site/reader035/viewer/2022081511/56649d955503460f94a7dd6e/html5/thumbnails/7.jpg)
Gathering, Evaluating, and Synthesizing
Gathering, Evaluating, and Synthesizing
• Evaluate the information you obtain from:− The scene
− The patient
− A bystander
• Determine what is valid and invalid.
• Synthesize the information.
![Page 8: Chapter 14 Critical Thinking and Clinical Decision Making](https://reader035.vdocuments.site/reader035/viewer/2022081511/56649d955503460f94a7dd6e/html5/thumbnails/8.jpg)
Gathering, Evaluating, and Synthesizing
Gathering, Evaluating, and Synthesizing
• Example: 64-year-old man reporting chest pains; history includes type 1 diabetes since childhood; long-time smoker; COPD
![Page 9: Chapter 14 Critical Thinking and Clinical Decision Making](https://reader035.vdocuments.site/reader035/viewer/2022081511/56649d955503460f94a7dd6e/html5/thumbnails/9.jpg)
Developing and Implementing a Patient Care Plan
Developing and Implementing a Patient Care Plan
• Treatment plan guided by:− Patient care protocols
− Standing orders
• Protocols or standing orders define the essential standard of care.
![Page 10: Chapter 14 Critical Thinking and Clinical Decision Making](https://reader035.vdocuments.site/reader035/viewer/2022081511/56649d955503460f94a7dd6e/html5/thumbnails/10.jpg)
Developing and Implementing a Patient Care Plan
Developing and Implementing a Patient Care Plan
• Protocols and standing orders specify:− Performance parameters
− When medical control should be contacted
• Protocols promote a standard approach and quality of care.− They do not cover atypical presentations.
![Page 11: Chapter 14 Critical Thinking and Clinical Decision Making](https://reader035.vdocuments.site/reader035/viewer/2022081511/56649d955503460f94a7dd6e/html5/thumbnails/11.jpg)
Using Judgment and Independent Decision Making
Using Judgment and Independent Decision Making
• You must immediately recognize and treat life threats.− Circumstances
determine the treatment plan.
− Use critical-thinking and decision-making skills.
© Jones & Bartlett Learning. Courtesy of MIEMSS.
![Page 12: Chapter 14 Critical Thinking and Clinical Decision Making](https://reader035.vdocuments.site/reader035/viewer/2022081511/56649d955503460f94a7dd6e/html5/thumbnails/12.jpg)
Thinking and Working Under Pressure
Thinking and Working Under Pressure
• To avert disaster, you must have:− Knowledge
− Excellent psychomotor clinical skills
• You must be able to:− Work under extreme pressure
− Think and perform quickly and effectively
![Page 13: Chapter 14 Critical Thinking and Clinical Decision Making](https://reader035.vdocuments.site/reader035/viewer/2022081511/56649d955503460f94a7dd6e/html5/thumbnails/13.jpg)
Range of Patient ConditionsRange of Patient Conditions
• You must be able to determine if the patient is sick or not sick.− If a patient is sick,
quantify how sick.
• Clear thinking in an emergency starts with triage.
© P
eter
Will
ott,
The
St.
Aug
ustin
e R
ecor
d/A
P P
hoto
s
![Page 14: Chapter 14 Critical Thinking and Clinical Decision Making](https://reader035.vdocuments.site/reader035/viewer/2022081511/56649d955503460f94a7dd6e/html5/thumbnails/14.jpg)
Range of Patient ConditionsRange of Patient Conditions
• Critical patients
• Serious patients
• Mortally wounded or dead
• “Walking wounded” or minimally injured
• Critical life threats include:− Major multisystem
trauma
− Devastating single-system trauma
− End-stage disease presentations
− Acute presentations of chronic conditions
![Page 15: Chapter 14 Critical Thinking and Clinical Decision Making](https://reader035.vdocuments.site/reader035/viewer/2022081511/56649d955503460f94a7dd6e/html5/thumbnails/15.jpg)
Range of Patient ConditionsRange of Patient Conditions
• Serious conditions include:− Serious multisystem
trauma
− Acute presentations of “first-time” medical events
− Multiple disease etiologies
• Non-life-threatening injuries include:− Simple abrasions
− Partial-thickness burns of an extremity, with less than 5% body surface area
− Small lacerations with only capillary bleeding
![Page 16: Chapter 14 Critical Thinking and Clinical Decision Making](https://reader035.vdocuments.site/reader035/viewer/2022081511/56649d955503460f94a7dd6e/html5/thumbnails/16.jpg)
Concept FormationConcept Formation
• First stage in prehospital care
• Gather information from your senses and diagnostic tools.
• Begins as the paramedic arrives at the scene© Craig Jackson/InTheDarkPhotography.com
![Page 17: Chapter 14 Critical Thinking and Clinical Decision Making](https://reader035.vdocuments.site/reader035/viewer/2022081511/56649d955503460f94a7dd6e/html5/thumbnails/17.jpg)
Concept FormationConcept Formation
• Primary assessment identifies medical condition and threats.
• Secondary assessment determines: − Pertinent medical history
− Any medications the patient is taking
− The patient’s affect
• Vital signs are then taken.
![Page 18: Chapter 14 Critical Thinking and Clinical Decision Making](https://reader035.vdocuments.site/reader035/viewer/2022081511/56649d955503460f94a7dd6e/html5/thumbnails/18.jpg)
Data InterpretationData Interpretation
• Second stage of the critical-thinking process
• Evaluate all gathered information.− Understand how the body works.
− Have a background in anatomy, physiology, and pathophysiology.
− Have a good attitude
![Page 19: Chapter 14 Critical Thinking and Clinical Decision Making](https://reader035.vdocuments.site/reader035/viewer/2022081511/56649d955503460f94a7dd6e/html5/thumbnails/19.jpg)
Application of PrincipleApplication of Principle
• Third stage of critical-thinking process
• Initial field impression becomes a working diagnosis
• The treatment plan is determined by patient care protocols, or standing orders.
![Page 20: Chapter 14 Critical Thinking and Clinical Decision Making](https://reader035.vdocuments.site/reader035/viewer/2022081511/56649d955503460f94a7dd6e/html5/thumbnails/20.jpg)
Reflection in ActionReflection in Action
• Fourth step
• Treat patients while monitoring intervention effects.− Avoid tunnel vision. © Craig Jackson/InTheDarkPhotography.com
![Page 21: Chapter 14 Critical Thinking and Clinical Decision Making](https://reader035.vdocuments.site/reader035/viewer/2022081511/56649d955503460f94a7dd6e/html5/thumbnails/21.jpg)
Reflection on ActionReflection on Action
• Last stage
• Occurs after the call is over
• Reflect on and learn from the decisions and actions taken on each call.
![Page 22: Chapter 14 Critical Thinking and Clinical Decision Making](https://reader035.vdocuments.site/reader035/viewer/2022081511/56649d955503460f94a7dd6e/html5/thumbnails/22.jpg)
Reflection on ActionReflection on Action
• Elements that contribute to critical thinking:− Knowledge in medical sciences
− Ability to gather and organize data
− Ability to focus on specific and multiple data
− Ability to identify medical ambiguity
− Ability to understand relevant/irrelevant data
− Ability to analyze and compare situations
− Ability to explain reasoning
![Page 23: Chapter 14 Critical Thinking and Clinical Decision Making](https://reader035.vdocuments.site/reader035/viewer/2022081511/56649d955503460f94a7dd6e/html5/thumbnails/23.jpg)
From Theory to Practical Application
From Theory to Practical Application
• Each call has unique circumstances.
• Checklist to support thinking under pressure:− Scan situation.
− Stop and think.
− Move forward, make decisions.
− Stay calm.
− Continue reevaluation.
![Page 24: Chapter 14 Critical Thinking and Clinical Decision Making](https://reader035.vdocuments.site/reader035/viewer/2022081511/56649d955503460f94a7dd6e/html5/thumbnails/24.jpg)
The Six RsThe Six Rs
• Read the scene.− Overall safety
− Environmental conditions
− Immediate surroundings
− Access and egress
− Mechanism of injury
© Jones & Bartlett Learning. Courtesy of MIEMSS.
![Page 25: Chapter 14 Critical Thinking and Clinical Decision Making](https://reader035.vdocuments.site/reader035/viewer/2022081511/56649d955503460f94a7dd6e/html5/thumbnails/25.jpg)
The Six RsThe Six Rs
• Read the patient.− Observe the
patient.
− Talk to the patient.
− Touch the patient.
− Auscultate lung sounds.
− Identify life threats.
− Obtain vital signs.
© Mark C. Ide
![Page 26: Chapter 14 Critical Thinking and Clinical Decision Making](https://reader035.vdocuments.site/reader035/viewer/2022081511/56649d955503460f94a7dd6e/html5/thumbnails/26.jpg)
The Six RsThe Six Rs
• React.− Treat any life-threatening problems.
− Develop a working diagnosis or provide care based on presenting signs and symptoms.
• Reevaluate.− Follow up on interventions.
![Page 27: Chapter 14 Critical Thinking and Clinical Decision Making](https://reader035.vdocuments.site/reader035/viewer/2022081511/56649d955503460f94a7dd6e/html5/thumbnails/27.jpg)
The Six RsThe Six Rs
• Revise the plan.− Be open to changing working diagnosis.
• Review the performance.− Continuous quality improvement (CQI) meeting
− Informal discussions with partners
![Page 28: Chapter 14 Critical Thinking and Clinical Decision Making](https://reader035.vdocuments.site/reader035/viewer/2022081511/56649d955503460f94a7dd6e/html5/thumbnails/28.jpg)
SummarySummary
• The first cornerstone of the paramedic’s practice is the ability to gather, evaluate, and synthesize information.
• A paramedic needs to assess and evaluate the validity of information and its impact on the patient care plan.
• After evaluation, the information must be processed (synthesized).
![Page 29: Chapter 14 Critical Thinking and Clinical Decision Making](https://reader035.vdocuments.site/reader035/viewer/2022081511/56649d955503460f94a7dd6e/html5/thumbnails/29.jpg)
SummarySummary
• The second cornerstone of paramedic practice is the development and implementation of a patient care plan.
• The patient care plan is defined by protocols and standing orders of the paramedic’s EMS system.
• The third cornerstone is judgment and making independent decisions.
![Page 30: Chapter 14 Critical Thinking and Clinical Decision Making](https://reader035.vdocuments.site/reader035/viewer/2022081511/56649d955503460f94a7dd6e/html5/thumbnails/30.jpg)
SummarySummary
• The fourth cornerstone of practices is the ability to think and work under pressure.
• The first stage in prehospital care critical thinking is gathering initial information through the five senses and diagnostic tools, using the process of concept formation.
![Page 31: Chapter 14 Critical Thinking and Clinical Decision Making](https://reader035.vdocuments.site/reader035/viewer/2022081511/56649d955503460f94a7dd6e/html5/thumbnails/31.jpg)
SummarySummary
• Data interpretation is the second stage of the critical-thinking process and occurs when the paramedic evaluates the gathered information.
• The third stage of the critical-thinking process is the review after the call is completed.
![Page 32: Chapter 14 Critical Thinking and Clinical Decision Making](https://reader035.vdocuments.site/reader035/viewer/2022081511/56649d955503460f94a7dd6e/html5/thumbnails/32.jpg)
SummarySummary
• The six Rs will help the paramedic determine the steps to a call:− Read the scene.
− Read the patient.
− React.
− Reevaluate.
− Revise the plan.
− Review the performance.
![Page 33: Chapter 14 Critical Thinking and Clinical Decision Making](https://reader035.vdocuments.site/reader035/viewer/2022081511/56649d955503460f94a7dd6e/html5/thumbnails/33.jpg)
SummarySummary
• Paramedics should maintain an attitude that is open to learning in order to constantly improve their practice and maintain excellence in prehospital care.
![Page 34: Chapter 14 Critical Thinking and Clinical Decision Making](https://reader035.vdocuments.site/reader035/viewer/2022081511/56649d955503460f94a7dd6e/html5/thumbnails/34.jpg)
CreditsCredits
• Chapter opener: © Jones & Bartlett Learning. Courtesy of MIEMSS.
• Backgrounds: Purple—Courtesy of Rhonda Beck; Green—Courtesy of Rhonda Beck; Gold—Jones & Bartlett Learning. Courtesy of MIEMSS.
• Unless otherwise indicated, all photographs and illustrations are under copyright of Jones & Bartlett Learning, courtesy of Maryland Institute for Emergency Medical Services Systems, or have been provided by the American Academy of Orthopaedic Surgeons.