Patient Assessment | Clinical Decision Making

Clinical Decision Making

Ability to quickly integrate an enormous amount of information from multiple sources to form a correct treatment plan

Practice Environment: the field is a unique environment to apply medical skill and therapies.

Major Trauma: injuries or mechanisms that place the patient at great risk of death or disability

Major Medical: patient can also be at great risk, and can have multiple presentations

Protocols/Standing Orders/Algorithms: provide well-defined guidelines for specific patient problems/presentations

Critical Thinking: Concept formation is a pattern of understanding based on initial info gathered:

  • First impression
  • Info from dispatch
  • Patient environment
  • Patient’s chief complaint
  • Mental status (affect)

Data Interpretation: comparison of current info with past education and experience to draw conclusions

Application of the principle: formulate a working diagnosis. Initial interventions are selected on cumulative interpretation

Evaluation: Constantly reassess vital signs and physical stats

Reflection: constantly reassess yourself and your training/responses/correct diagnosis

Fundamental Elements of Critical Thinking:

  • Adequate fund of knowledge
  • Focus on specific and multiple elements of data
  • Information stimuli
  • Identify and deal with medical ambiguity
  • Differentiate between relevant and irrelevant data
  • Analysis and comparison with similar situations
  • Recall of contrary situations
  • Articulate assessment-based decisions and construction of arguments

Patient acuity spectrum: wide range of patient presentation, illness or injury and people respond to all of these with varying degrees of pain, anxiety and fear

Biggest Challenge: moderately ill or injured patient can be the most difficult to correctly identify and treat

Think under pressure: develop habits of evaluation and management. Technical aspects and procedures should be second nature.

Mental Checklist:

  • Stop and think
  • Scan
  • Decide and act
  • Maintain clear and concise control
  • Regular continual re-evaluation

Facilitating Behaviors: patterns and actions that promote efficient and appropriate patient care

  • Stay calm
  • Anticipate change
  • Ask yourself 2 questions
    • What is the current working diagnosis and the best treatment plan
    • What additional problems could the patient potentially develop and how should they be treated?

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