CLINICAL DECISION MAKING

CLINICAL DECISION MAKING

Critical Decision Making • You will confront a situation that requires you to make a critical decision EMT-B as pre-hospital practitioners of emergency medicine • Need for critical decision making • Situations will appear totally unfamiliar • “patients do not read the textbook”

Clinical Judgment • The use of knowledge and experience to diagnose patients and plan their treatment EMT-B Practice • You must gather, evaluate and synthesize information

Synthesize To form by combining parts or elements http://dictionary.reference.com/browse/synthesize

EMT-B Practice • Field diagnosis • Developing and implementing management plan Classes of patient acuity {the severity or acuteness of your patients’ condition}

Critically life-threatening • Potentially life-threatening • Non-life-threatening Protocols and algorithms • Protocols • Standing orders • algorithms

Critical Thinking Skills • The ability to think under pressure and make decisions that cannot be taught; it must be developed Fundamental knowledge and abilities • Knowing anatomy, physiology and pathophysiology {disturbance of body functions}

Focusing on large amounts of data • Organizing information • Identifying and dealing with medical ambiguity • Differentiating between relevant and irrelevant data • Analyzing and comparing similar situations • Explaining decisions and constructing logical arguments

Differential field diagnosis Facilitating behaviors • Stay calm • Plan for the worst • Work systematically • Remain adaptable

Useful thinking styles • Reflective vs. impulsive Reflective Acting thoughtfully, deliberately and analytically Impulsive Acting instinctively, without stopping to think

Divergent vs. convergent Divergent Taking into account all aspects of a complex situation Convergent Focusing on only the most important aspect of a critical situation

Anticipatory vs. reactive Anticipatory Looking ahead proactively to potential ramifications of actions Reactive Responding to events after they happen

Thinking Under Pressure • When you must make a critical decision, physical influences may help or hinder your ability to think clearly • Autonomic Nervous System • Pseudo-instinctive Learned actions that are practiced until they can be done without thinking

Mental Check List • Scan the situation • Stop and think • Decide and act • Maintain control • Reevaluate

Critical Decision Process Your ability to analyze data effectively and devise a practical management plan optimizes patient care Form a concept • Scene size-up and initial assessment • Focused history and physical exam

Interpret the Data • Consider the most serious condition that fits your patients’ situation • When clear diagnosis is unclear, base treatment on presenting signs and symptoms Apply the principles • Devise management plan that covers all contingencies

Contingency: An event (as an emergency) that may but is not certain to occur <trying to provide for every contingency> • Evaluate Perform on-going assessment • Reflect Consult Emergency Physician Consult crew

THE 6 Rs • Read the scene • Read the patient • React • Reevaluate • Revise • review

CLINICAL DECISION MAKING