1. CLINICAL DECISION MAKING

2. 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”

3. 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

4. Synthesize
To form by combining parts or elements

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

6. Critically life-threatening
Potentially life-threatening
Non-life-threatening
Protocols and algorithms
Protocols
Standing orders
algorithms

7. 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}

8. 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

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

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

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

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

13. 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

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

15. 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

16. 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

17. 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

18. THE 6 Rs
Read the scene
Read the patient
React
Reevaluate
Revise
review