Clinical Approach

Question 1

What is the purpose of a Clinical Approach?

Answer 1

To ensure all patients receive a structured and comprehensive assessment of their health status that leads to their healthcare needs being addressed

Question 2

What are biases and human factors?

Answer 2

• 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

Question 3

What should you do if the patient deteriorates?

Answer 3

Return to the primary survey for reassessment

Question 4

What is a rapid assessment?

Answer 4

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

Question 5

Should you interrupt the well patient during initial history taking?

Answer 5

No

Question 6

History taking in a patient that appears well/non-serious complaint

Answer 6

Avoid concurrent vital signs and other assessment elements where possible to allow for uninterrupted, thorough history taking

Question 7

History taking in a patient that appears unwell/serious complaint

Answer 7

Concurrent assessment as required

E.g. 12 lead ECG in chest pain or SpO2 in acute SOB

Question 8

What is the role of P1 during initial assessment

Answer 8

Assess the patient directly, taking the lead in history taking and physical examination

Question 9

What is the role of P2 in initial assessment

Answer 9

Observes assessment and scene with minimal cognitive load, collects information and identifies missed information, errors or opportunities

Question 10

When should a BSL be measured?

Answer 10

In patients with

• Altered conscious state
• History of Diabetes
• Medical patients with undifferentiated acute illness

Question 11

What is a focussed examination?

Answer 11

It is found in specific CPGs indicated for particular complaints
- E.g. ACT-FAST/MASS, AEIOUTIPS,

Question 12

When should you escalate care?

Answer 12

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.

Question 13

What is the minimum standard of VSS?

Answer 13

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

Question 14

On reassessment of VSS what should be included?

Answer 14

• 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)

Question 15

Recite the flow chart for the Clinical Approach.

Question 16

What do you discuss pre-arrival?

Answer 16

Biases & Human Factors

Question 17

What should you do if the patient deteriorated?

Answer 17

Return t the primary survey for reassessment

Question 18

What is included in a rapid assessment?

Answer 18

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

Question 19

When should a BSL be collected?

Answer 19

• Altered conscious state
• Hx Diabetes
• Medical patients with undifferentiated acute illness

Question 20

What is a focussed examination?

Answer 20

found in specific CPG’s indicated for particular complaints
* e.g. ACT-FAST/MASS, AEIOUTIPS, spinal neurological exmaination etc.

Question 21

What is safety netting? and when do you apply it?

Answer 21

• 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.

Question 22

What barried should be considered in regard to access to care?

Answer 22

• 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

Question 23

What is the minimum standard for VSS? and what do you do if you cannot meet this requirement?

Answer 23

• 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

Question 24

What should reassessment include?

Answer 24

• 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)

Question 25

Recite the entire Clinical Approach

Answer 25