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Clinical Decision Making. Topics . Paramedics as Practitioners Life-Threatening Conditions Protocols, Standing Orders, Algorithms Critical Thinking Process “Six R’s” of Putting It All Together. Introduction.

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Topics
Topics

  • Paramedics as Practitioners

  • Life-Threatening Conditions

  • Protocols, Standing Orders,Algorithms

  • Critical Thinking Process

  • “Six R’s” of Putting It AllTogether


Introduction
Introduction

  • 21st Century Paramedics areprehospital 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.


Making critical decisions requires critical judgment—the use of knowledge and experience to diagnose patients and plan their treatment.


A paramedic
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.


Acuity
Acuity

  • The severity or acuteness of your patient’s condition.


The spectrum of care in the prehospital setting includes three general classes of patient acuity.


Classes of acuity
Classes of Acuity

  • Those with obvious life-threats

  • Those with potential life-threats

  • Those with non-life-threatening presentations


Obvious life threats include
Obvious life-threats include…

  • Major multi-system trauma

  • Devastating single-system trauma

  • End-stage disease (ie, renal failure)


Potential life threats include
Potential life-threats include…

  • Serious multi-system trauma

  • Multiple disease etiology


Non life threats include
Non-life-threats include…

  • Isolated minor illnesses andinjuries


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

emergency patient care.


Protocol
Protocol

  • A standard that includes general and specific principles for managing certain patient conditions.


Standing orders
Standing Orders

  • Treatments you can perform before contacting the medical control physician for permission.


Algorithm
Algorithm

  • Schematic flow chart that outlines appropriate care for specific signs and symptoms.


To use an algorithm, follow the arrows to your patient’s symptoms and provide care as indicated.



Do not allow the linear thinking, or “Cookbook Medicine” that protocols promote to restrain you from consulting with your medical direction physician.


Paramedic s critical thinking skills 1 of 2
Paramedic’s Critical that protocols promote to restrain you from consulting with your medical direction physician.Thinking Skills(1 of 2)

  • Knowing anatomy, physiology, andpathophysiology

  • Focusing on large amounts of data

  • Organizing information

  • Identifying and dealing with medicalambiguity


Paramedic s critical thinking skills 2 of 2
Paramedic’s Critical that protocols promote to restrain you from consulting with your medical direction physician.Thinking Skills(2 of 2)

  • Differentiating between relevant and irrelevant data

  • Analyzing and comparing similar situations

  • Explaining decisions and constructing logical arguments


Be like the duck— that protocols promote to restrain you from consulting with your medical direction physician.cool and calm on the water’s surface, while paddling feverishly underneath!


Except for safety concerns, never allow anything to distract you from your most important job—assessing and caring for your patient.



Thinking under pressure
Thinking Under Pressure treating patients

  • With experience, you will learn tomanage nervousness and maintain a steadfast, controlled demeanor.

  • Develop a routine mental checklistto stay focused and systematic.


Mental checklist
Mental Checklist treating patients

  • Scan the situation

  • Stop and think

  • Decide and act

  • Maintain control

  • Re-evaluate


The critical decision process
The Critical Decision Process treating patients

  • Form a concept

  • Interpret the data

  • Apply the principles

  • Evaluate

  • Reflect


Putting it all together
Putting It All Together treating patients

The Six R’s

  • Read the scene

  • Read the patient

  • React

  • Re-evaluate

  • Revise the management plan

  • Review your performance


Summary
Summary treating patients

  • Paramedics as Practitioners

  • Life-Threatening Conditions

  • Protocols, Standing Orders,Algorithms

  • Critical Thinking Process

  • “Six R’s” of Putting It AllTogether


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