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

Anticipatory vs. reactive 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