Critical Thinking and Decision Making Flashcards
Diagnosis
- 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
Traditional approaches to diagnosis
- 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
Emergency Medicine Approach to Diagnosis
- 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
EMS Diagnosis Approach to Diagnosis
• 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)
Think about it
• You can reach a diagnosis, but your work is not done. Why?
The experienced clinician
- 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
Keys to Thinking Like a Physician
- 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
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?
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
Chapter Review - Critical Thinking
- 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.
Remember
- 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.
What is a differential diagnosis based on?
My answer: • list of potential diagnoses • gather information • rule in or out causes • loop again if necessary
What is an emergency physician’s first priority when formulating a differential?
My answer
• Life threading issues
• Rule out significant issues
• Treat significant issues and send the person to personal physician for follow up
How are heuristics helpful in critical thinking?
My Answer
• Combine information to rule out diagnoses more quickly and use resources more efficiently
EMS Diagnosis / EMT Diagnosis
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.
Critical Thinking
an analytical process that can help someone think through a problem in an organized & efficient manner
