1	Chapter 4 Clinical Decision Making
2	Topics Paramedics as Practitioners Life-Threatening Conditions Protocols, Standing Orders, Algorithms Critical Thinking Process Six Rs of Putting It All Together
3	Introduction 21st century paramedics are prehospital practitioners of emergency medicine—not field technicians. As a paramedic, you inevitably will face your moment of truth—a critical decision that can mean the difference between life and death.
4	"Making critical decisions" Making critical decisions requires critical judgment— the use of knowledge and experience to diagnose patients and plan their treatment.
5	Critical Decision Making The ability to anticipate The ability to prioritize The ability to problem-solve Relies heavily on knowledge base An ability to learn from past mistakes
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7	A Paramedic …must gather, evaluate, and synthesize a lot of information in very little time. …can then develop a field diagnosis—a prehospital evaluation of the patient’s condition and its causes.
8	Acuity The severity or acuteness of your patient’s condition.
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10	Classes of Acuity Those with obvious life-threats Those with potential life-threats Those with non-life-threatening presentations
11	Obvious life-threats include… Major multi-system trauma Devastating single-system trauma End-stage disease (i.e., renal failure)
12	Potential life-threats include… Serious multi-system trauma Multiple disease etiology
13	Non-life-threats include… Isolated minor illnesses and injuries
14	"Protocols" Protocols, standing orders, and patient care algorithms provide a standardized approach to emergency patient care.
15	Protocol A standard that includes general and specific principles for managing certain patient conditions
16	Standing Orders Treatments you can perform before contacting the medical direction physician for permission
17	Algorithm Schematic flow chart that outlines appropriate care for specific signs and symptoms
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21	Paramedic’s Critical Thinking Skills (1 of 2) Knowing anatomy, physiology, and pathophysiology Focusing on large amounts of data Organizing information Identifying and dealing with medical ambiguity
22	Paramedic’s Critical Thinking Skills (2 of 2) Differentiating between relevant and irrelevant data Analyzing and comparing similar situations Explaining decisions and constructing logical arguments
23	"Be like the duck" Be like the duck— cool and calm on the water’s surface, while paddling feverishly underneath!
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26	Thinking under Pressure With experience, you will learn to manage nervousness and maintain a steadfast, controlled demeanor. Develop a routine mental checklist to stay focused and systematic.
27	Mental Checklist Scan the situation. Stop and think. Decide and act. Maintain control. Re-evaluate.
28	The Critical Decision Process Form a concept. Interpret the data. Apply the principles. Evaluate. Reflect.
29	Putting It All Together The Six Rs Read the scene. Read the patient. React. Re-evaluate. Revise the management plan. Review your performance.
30	Summary Paramedics as Practitioners Life-Threatening Conditions Protocols, Standing Orders, Algorithms Critical-Thinking Process Six Rs of Putting It All Together