M01 Flashcards
Clinical Approach Care Objective
To ensure all patients receive a structured and comprehensive assessment of their health status that
leads to their healthcare needs being addressed.
Clinical Approach Intended Pt Group
All patients
Clinical Approach Pre-Arrival Special Notes
Cognitive bias and human factors have a significant impact on decision making and should be
considered and discussed frequently throughout the entire process of patient care.
Early diagnostic closure based on dispatch information presents a particular risk to patient safety.
Patients from marginalised populations are at greater risk of harm from unconscious bias.
These risks include low socioeconomic status, culturally and linguistically diverse, Aboriginal or Torres Strait
Islander, substance affected, have a mental health related presentation or behaviours of concern.
Human factors and their potential impact on patient care should be considered and acknowledged
prior to arrival and throughout patient assessment:
Clinical Approach HALTS
Hungry Angry Late Tired Stressed
Clinical Approach 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
Clinical Approach Primary Survey
If a patient deteriorates the default position should be to return to the primary survey for
reassessment.
Clinical Approach Exposure
Refers to both exposing the patient for assessment (e.g. to locate possible major
haemorrhage) and exposure to environmental conditions. Patient dignity should be maintained as
much as possible while managing the risk of potential life-threatening conditions. Prevent
hypothermia following exposure
Clinical Approach Hx of Presenting Illness Mgx
Avoid interrupting or redirecting the patient where possible during initial history taking.
Appears well / non-serious complaint: Avoid concurrent vital signs and other assessment elements
where possible to allow for uninterrupted, thorough history taking.
Appears unwell / serious complaint: Concurrent assessment as required (e.g. 12 lead ECG in chest
pain, SpO2
in acute SOB).
Clinical Approach Attendant Roles
Attendant 1: Assess the patient directly, taking the lead in history taking and physical examination.
Attendant 2: Observes assessment and scene with minimal cognitive load, collects information and
identifies missed information, errors or opportunities.
BSL must be taken in Pts:
Altered conscious state
History of diabetes
Medical patients with undifferentiated acute illness
Clinical Approach Physical Examination
Focussed examination: found in specific CPGs indicated for particular complaints (e.g. ACTFAST/MASS, AEIOUTIPS, Spinal neurological examination, etc.)
General physical examination (Secondary Survey): Any other physical assessment informed by the paramedic’s
evolving understanding of the patient’s presenting illness
Clinical Approach Social/environmental factors
May present a range of hazards and health risks which influence their care plan as much as the
diagnosis or clinical problems.
Clinical Approach Diagnosis
Diagnosis: Any clinically useful characterisation of the patient’s health status that leads to a care
plan that meets the patient’s needs. This includes a likely underlying pathology and/or a simple
statement of clinical problems to be addressed.
All stages of the diagnostic process should be discussed between AV staff and with the patient /
family where possible and appropriate
Clinical Approach Risks
The identification of risk and the subsequent escalation of care is more important than a precise
diagnosis and allows for safe decision making where there is diagnostic uncertainty (this is expected
to be frequent).
Initial assessment captures a single moment in time. The patient’s trajectory or expected clinical
course should be considered despite an unremarkable initial assessment.
Clinical Approach Differential Diagnosis
Diagnostic uncertainty is common and should be acknowledged. Where the underlying cause is
uncertain, a care plan may be based on clinical problems (e.g. hypotension) and/or risks (e.g. elderly
and frail).
Clinical Approach - Clinical Judgement
Clinical judgement is a subjective process to establish the most appropriate and accurate
characterisation of the patient’s condition that leads to a safe and effective care plan.
Most appropriate diagnosis based on a balance of the urgency and likelihood of possible
conditions
A hierarchy of clinical problems requiring management
The risks to patient safety
Expert consultation and/or the escalation of care (e.g. transport) is recommended where clinical
judgement does not lead to a satisfactory diagnosis, clinical problem and risk profile (e.g. staff on
scene cannot agree).
Clinical Approach Care Pathways
Treatment: Apply the appropriate CPG, CWI, direct care (e.g. wound dressing) or the patient’s own
care plan as required (e.g. palliative patients, medically prescribed crisis medications)
