Clinical Approach Flashcards
What is the purpose of a Clinical Approach?
To ensure all patients receive a structured and comprehensive assessment of their health status that leads to their healthcare needs being addressed
What are biases and human factors?
- Cognitive bias and human factors have a significant impact on decision making and should be considered frequently throughout the entire process of patient care.
- Early Diagnostic closure based on dispatch information
- Patients from marginalised populations are at greater risk of harm from unconscious bias. These risks include low socioeconomic status, culturally and linguistically diverse, ATSI, substance affected, have a MH related presentation or BOC
- Human factors and their potential impact on patient care should be considered and acknowledged prior to arrival and throughout patient assessment. (HALTS)
- Hungry
- Angry
- Late
- Tired
- Stressed
What should you do if the patient deteriorates?
Return to the primary survey for reassessment
What is a rapid assessment?
Immediate impression based on the presence of
- Altered conscious state
- Increased work of breathing
- Obvious skin signs (diaphoresis/cyanosis)
This informs
- The need for a formal primary survey
- The urgency with which the patient should be assessed and the need for simultaneous collection of information
Should you interrupt the well patient during initial history taking?
No
History taking in a patient that appears well/non-serious complaint
Avoid concurrent vital signs and other assessment elements where possible to allow for uninterrupted, thorough history taking
History taking in a patient that appears unwell/serious complaint
Concurrent assessment as required
E.g. 12 lead ECG in chest pain or SpO2 in acute SOB
What is the role of P1 during initial assessment
Assess the patient directly, taking the lead in history taking and physical examination
What is the role of P2 in initial assessment
Observes assessment and scene with minimal cognitive load, collects information and identifies missed information, errors or opportunities
When should a BSL be measured?
In patients with
- Altered conscious state
- History of Diabetes
- Medical patients with undifferentiated acute illness
What is a focussed examination?
It is found in specific CPGs indicated for particular complaints
- E.g. ACT-FAST/MASS, AEIOUTIPS,
When should you escalate care?
As soon as possible after recognition of deterioration.
Care can be escalated at any stage and for any reason at the judgement of the paramedic.
What is the minimum standard of VSS?
Minimum 15 minutely.
Where impossible or clinically unnecessary a rationale MUST be documented.
Where a patient deteriorates or is considered unwell, reassessment should be performed more frequently and care escalated as appropriate
On reassessment of VSS what should be included?
- SpO2, HR, BP, RR, GCS and any other observation that was initially found to be abnormal (e.g. Haemorrhage, pain, SOB).
- The efficacy and safety of any treatments (e.g. tourniquets, CPAP, splint, ETT)
Recite the flow chart for the Clinical Approach.
What do you discuss pre-arrival?
Biases & Human Factors
What should you do if the patient deteriorated?
Return t the primary survey for reassessment
What is included in a rapid assessment?
Immediate impression based on the presence of altered conscious state, increased work of breathing and obvious skin signs (e.g. diaphoresis, cyanosis) that informs:
* the need for a formal primary survey
* the urgency with which the patient should be assessed and the need for simultaneous collection of information
When should a BSL be collected?
- Altered conscious state
- Hx Diabetes
- Medical patients with undifferentiated acute illness
What is a focussed examination?
found in specific CPG’s indicated for particular complaints
* e.g. ACT-FAST/MASS, AEIOUTIPS, spinal neurological exmaination etc.
What is safety netting? and when do you apply it?
- A plan to address unexpected but possible adverse events or deterioration.
- Apply the concept of safety netting in all patients who are not transported to hospital.
What barried should be considered in regard to access to care?
- socio-economic status & health literacy
- Logistic issues (e.g. opening times, transport)
- Patientsd location in relation to health services
- Linguistic or cultural barriers
- Disability related barriers
What is the minimum standard for VSS? and what do you do if you cannot meet this requirement?
- 15 minutely
- Where it is impossible or clinically unnecessary, the rationale MUST be documented. Where a patient is considered unwell or deteriorates, reassessment should be performed more frequently and care escalated as appropriate
What should reassessment include?
- SpO2
- HR
- BP
- GCS
- any other observation that was initially found to be abnormal (haemorrgae, pain, SOB)
- the efficacy and safety of any treatments (e.g. tourniquets, CPAP, splint, thoracostomies, ETT)
Recite the entire Clinical Approach
What must be done if a full patient assessment is not completed or deemed unnecessary?
The rationale for not completing the full assessment must be documented.
Name three populations at greater risk of harm from unconscious bias.
Patients with low socioeconomic status, those who are culturally and linguistically diverse, and Aboriginal or Torres Strait Islander individuals.
List three human factors that should be considered before and during patient care.
- Hungry
- Angry
- Late
- Tired
- Stressed
What does the rapid assessment comprise of?
- Alertness
- Skin
- Work of breathing
What is the default action if a patient deteriorates?
Return to the primary survey for reassessment.
What is the minimum standard for reassessment intervals for vital signs?
Every 15 minutes, unless it is clinically unnecessary or impossible, in which case the rationale must be documented.
What should be avoided during patient handover to another healthcare professional?
The transmission of bias through biased language.
What is critical when referring a patient to community care?
Effective transfer of information and direct contact with the healthcare professional when possible.
What does “exposure” refer to in the primary survey, and what precautions should be taken?
Exposure refers to both exposing the patient for assessment (e.g., to locate major hemorrhages) and the patient’s exposure to environmental conditions. Care should be taken to maintain patient dignity and prevent hypothermia.
What is the role of the second attendant during a patient assessment?
The second attendant observes the assessment, collects information, identifies missed information or errors, and minimizes cognitive load.
Name three clinical presentations where blood sugar level (BSL) measurement is mandatory.
- Altered conscious state
- history of diabetes
- medical patients with undifferentiated acute illness.
What barriers should be considered to ensure the care plan is feasible and accessible?
Socio-economic status, health literacy, logistic issues, geographic location, linguistic or cultural barriers, and disability-related barriers.
What does the acronym HALTS (Hungry, Angry, Late, Tired, Stressed) signify in the clinical approach? How can these factors affect care?
HALTS highlights key human factors that can impair decision-making and patient assessment accuracy.
