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EMT Test 3 > Critical Thinking and Decision Making > Flashcards

Flashcards in Critical Thinking and Decision Making Deck (29)
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1
Q

Diagnosis

A
  • Diagnosis is label for condition
  • Based on history, physical examination, vital signs
  • Involves both physical & intellectual activity

Definition: a description or label for a patients condition that assists a clinician in further evaluation & treatment

2
Q

Traditional approaches to diagnosis

A
  • Assess patient (history, physical exam, vital signs, tests)
  • List of possible causes / diagnoses “Differential diagnosis”
  • Further evaluation
  • Reevaluate the differential
  • Narrow the list / Final diagnosis
3
Q

Emergency Medicine Approach to Diagnosis

A
  • Primary Assessment rule out & treat immediate life threats
  • Stabilize patient
  • Patient Assessment (history, physical exam, vital signs, tests) with special attention to red flags
  • Consider the most serious conditions associated with the patients presentation & rule them in out (rule out the worse case scenario)
  • List of possible causes/diagnoses (differential diagnosis)
  • Further evaluation in light of time & resources available in the ED
  • Consider results of evaluation
  • Narrow the list (may have to re-state the chief complaint as the diagnosis)
  • May be responsible for multiple patients
4
Q

EMS Diagnosis Approach to Diagnosis

A

• Primary Assessment to find & threats to life
• Pt Assessment (history, physical exam, vital signs, tests) with special attention to red flags
Simultaneously the EMT begins tx that may be beneficial & is not harmful
• consider the most serious conditions associated with the pt’s presentation that can be treated in the field & rule them in or out
• List of possible causes/diagnoses (differential diagnosis if time allows
• further evaluation in light of limited time available & restricted resources present in the field
• Consider results of evaluation
• Narrow the list (may have to restate the chief complaint as the diagnosis)

5
Q

Think about it

A

• You can reach a diagnosis, but your work is not done. Why?

6
Q

The experienced clinician

A
  • Experienced clinicians learn heuristics (shortcuts)
  • Pattern recognition
  • Features narrowing possibilities
  • Allows efficient diagnosis and prompt treatment
  • Realizes limitations of shortcuts
  • Understands common biases of heuristics
7
Q

Keys to Thinking Like a Physician

A
  • Love ambiguity
  • Uncertainty natural part of EMS
  • Understand peoples & technologies limitations
  • Utilize different methods
  • No one single way always right
  • Remain open-minded and flexible
  • Learn from others
  • Form strong foundation of knowledge
  • Be familiar with conditions
  • Remain up-to-date
  • Continue learning
  • Be organized
  • Be a lifelong student
  • Reflect on what you have learned
  • Realize that no one strategy works for everything
  • Form a strong foundation of knowledge
  • Organize data in you head
  • Change the way you think
  • Reflect on what you have learned
8
Q

What are some of the important things to remember as you learn how to make a diagnosis and improve your critical thinking skills in EMS?

A

My Answer:
. Focus on the info you have and treat what is in front of you
• Use the information you know to consider other possibilities
• Organize the info in your head
• Continue to learn and be curious

9
Q

Chapter Review - Critical Thinking

A
  • EMTs make some diagnoses in the field, although they are not as extensive or detailed as physicians’ diagnoses.
  • The traditional approach to reaching a diagnosis is to assess the patient, draw up a list of differential diagnoses, assess further to rule in or rule out different conditions, and narrow the list until you reach a conclusion.
  • Highly experienced physicians don’t always use the traditional approach. They use heuristics and their experience and training to speed up the process of reaching a diagnosis.
  • Heuristics has limitations.
  • Learn to think more critically by accepting ambiguity, understanding limitations of people and technology, forming a strong foundation of knowledge, and organizing data in your mind.
  • When considering the cause of a patient’s condition, don’t let your search for a cause delay your treatment of the patient.
10
Q

Remember

A
  • Critical thinking an analytical process.
  • Organized and efficient way to solve problem.
  • Reflective, reasonable, focused thinking.
  • EMT must be efficient, yet accurate.
  • Patients often have more than one thing wrong.
  • Do not stop looking.
11
Q

What is a differential diagnosis based on?

A
My answer:
• list of potential diagnoses
• gather information
• rule in or out causes
• loop again if necessary
12
Q

What is an emergency physician’s first priority when formulating a differential?

A

My answer
• Life threading issues
• Rule out significant issues
• Treat significant issues and send the person to personal physician for follow up

13
Q

How are heuristics helpful in critical thinking?

A

My Answer

• Combine information to rule out diagnoses more quickly and use resources more efficiently

14
Q

EMS Diagnosis / EMT Diagnosis

A

a description or label for a patient’s condition, based on the patient’s history, physical exam, and vital signs, that assists the EMT in further evaluation and treatment. En EMS diagnosis is often less specific than a traditional medical diagnosis.

15
Q

Critical Thinking

A

an analytical process that can help someone think through a problem in an organized & efficient manner

16
Q

Differential Diagnosis

A

a list of potential diagnoses compiled early in the assessment of the patient

17
Q

Red Flag

A

a sign or symptom that suggests the possibility of a particular problem what is very serious

pay particular attention to red flags during the secondary assessment

18
Q

Common Heuristics & Disadvantages

A
  • Representativeness - see a pt with certain signs & symptoms you assume that the pt has the condition - remember pt presentation may not be typical
  • Availability - more easily recalled often because of a recent exposure
  • Overconfidence - be objective & logical
  • Confirmation Bias - looking for evidence to support the Dx you have in mind
  • Illusory Correlation - things that occur together might not be related
  • Anchoring & Adjustment - making a Dx & not reacting to conflicting info
  • Search Satisfying - stop looking for other potential causes as it is satisfying to reach a conclusion
19
Q

Key Concept

A

EMT’s make some dx in the field, although they are not as extensive or detailed as a physicians dx

20
Q

Key Concept

A

The traditional approach to reaching a diagnosis is to assess the patient, draw up a list of differential diagnoses, assess further to rule in or out different conditions, and narrow the list until you reach a conclusion

21
Q

Key Concept

A

Highly experienced physicians don’t always use the traditional approach. The use heuristics (shortcuts, in combination with their experience & training, which speed up the process of reaching a dx

22
Q

Key Concept

A

Shortcoming of heuristics include representativeness, anchoring & adjustment, overconfidence, confirmation bias, illusory correlation & search satisfying

23
Q

Key Concept

A

Learn to think more critically by accepting the ambiguity of EMS working conditions, understanding limitations of people & technology, forming a strong foundation of knowledge, and organizing the data in your head

24
Q

Key Concept

A

When considering the cause of a patients condition don’t let your search for a cause delay your tx to a pt

25
Q

A 52 yr old man complains of chest pain while sitting at his desk at work. He appears alert & oriented. He tells you he thinks it may just be stress.

A

My answer: complete primary assessment and proceed to the Secondary Assessment - Sample, OPQRST, Vital Signs with an emphasis on circulation

26
Q

You are called to a 67 year old man who was reportedly “acting unusually” when he became unresponsive. His wife said he complained of an odd feeling in his arm and his speech was slurred before he became unresponsive

A

My Answer: complete primary assessment, ensure and airway - high priority for transport - call for ALS
Get sample info from his wife and any more background you can.
While waiting for ALS get baseline vitals
Since he is unresponsive you may need a RTE depending on the info given from the wife

27
Q

An 18 yr old snowboarder took a fall and he thinks he may have broken his ankle

A

My Answer: Primary and Secondary Assessment - RTE as he fell and had a traumatic accident
Think abut spinal immobilization
Splint and Transport - special attention to distal circulation before and after splinting

28
Q

A 41 yr old woman has difficulty breathing and a little pain when she breathes in deeply

A

My Answer

Medical Patient - Primary - deliver O2 with a nonrebreather - and Secondary Assessment - Calm approach

29
Q

Key Decisions:

A

• Have I addressed life threats before beginning the assessment and diagnostic process
• Does this pt have an obvious problem or do I need to think more critically
• Are there other causes besides the obvious one for this pt’s condition
• Have I considered other reasonable possibilities?
• What other information should I get to confirm or refute the working diagnosis
How specific does my field dx have to be to determine the right tx
• What is best for the pt