Clinicical Decision Making

Clinical Decision Making : 

Clinical Decision Making EMS Professions Temple College

Topics to Discuss : 

Topics to Discuss Why Clinical Decision Making Skills? Influencing Factors Patient Acuity Methods for Clinical Decision Making Critical Thinking Process Impact of the Sympathetic Nervous System Putting It All Together

Scenario 1 : 

Scenario 1 Dispatch to rural residence 30-year-old Black woman c/o chest pain and SOB CAD indicates poss drug seeking patient at this address Patient in obvious distress Onset 1/2 hr ago. Sharp pain in chest & back Has had less severe episodes in past. No known history of cardiac disease. No private MD Denies recreational drug use Only med history = “Lupus”

Scenario 1 : 

Scenario 1 What key pieces of data do we have? What additional data would you like? How will you determine whether this is an acute MI or something else? How will you decide whether to give pain medication? If you have a protocol system, which protocol does this patient require?

Why Clinical Decision Making Skills? : 

Why Clinical Decision Making Skills? Decision Making is an expectation of health care providers Early Paramedics vs. Present/Future The Paramedic’s Expected Role Assess to obtain data Analyze data to form an initial Dx Develop a treatment plan appropriate for THIS PATIENT In some cases, these must be rapid

Group Exercise: What is Clinical Judgment? : 

Group Exercise: What is Clinical Judgment? Discuss these two questions in your groups. Then, you will discuss your findings with the class. Where does it come from? What can I (a paramedic student) do to improve my clinical judgment and decision making skills?

Influencing Factors : 

Influencing Factors What factors in these categories influence the practice of the paramedic as compared to the in-hospital clinician? Environment & Setting Diagnostic Data Patient Acuity “Scope of Practice” Interpersonal Relationships

Patient Acuity : 

Patient Acuity Three General Classes Life Threatening Potentially Life Threatening Non-life Threatening What do I need to know in order to differentiate between patients with varying acuity?

Methods of Clinical Decision Making : 

Methods of Clinical Decision Making Examples Protocols Standing Orders Algorithms Mixture

Algorithms : 

Algorithms

Methods of Clinical Decision Making : 

Methods of Clinical Decision Making Class Exercise Alternating between Pros and Cons, give one example of each related to the paramedic’s use of protocols, standing orders and/or algorithms

Critical Thinking Process Considerations : 

Critical Thinking Process Considerations Decision Making Requirements Fundamental Knowledge Focus on & Organize a large amount of data Identify ambiguities Determine relevancy Analyze & Compare to similar situations Explain decisions and construct logical arguments

Critical Thinking Process Considerations : 

Critical Thinking Process Considerations Scan the situation Remain Calm Gain control Focus on the Task Remove distractions Systematically gather information & Evaluate (Think) Consider options Risk vs Benefit Decide & Act (Plan) Act immediately as necessary Communicate your actions Listen to others Think ahead Reevaluate During After

Effect of the SNS : 

Effect of the SNS “Fight or Flight” What happens to the body? What is the intent of the “fight or flight” response? How does this affect the paramedic’s ability to make critical decisions in the clinical setting?

Critical Decision Making Process : 

Critical Decision Making Process Form a Concept Gather information Interpret the Data Differential Dx Apply Known Principles Treatment Plan Evaluate Reevaluate constantly Reflect

Critical Thinking Process : 

Critical Thinking Process Memory Aid - “The Six Rs” Read the scene Read the patient React appropriately Reevaluate Revise the plan Review performance critically