1. CRITICAL THINKING Dr. Samah Mohammed 2015- 2016 EMS LECTURE (7)

2. Learning Objectives 1.Definition of critical thinking. 2.Important critical thinking. 3.Explain the four key elements of paramedic practice. 4.Discuss limitations of protocols, standing orders, algorithms. 5.Explain distinguish patients with critical life threats and non life threats. 6.Describe six elements needed for effective critical thinking.

3. What is critical thinking? Many Definitions:- 1.Commonly called “problem solving” 2.The ability to suspend judgment. 3.The ability to consider alternatives. 4.The ability to analyze and evaluate. 5.Purposeful, goal-directed thinking. 6.careful analysis of the situation.

4. When is Critical Thinking Important? Rare EMS call = life threat. Minor trauma / medical calls require little critical thinking (easy decisions) Obvious life threats also not very challenging (fit standard treatments). Patients between minor and life-threatening are critical thinking challenges!

5. Goal For Every Paramedic Paramedics must be able to: 1.Identify problems (develop Differential Diagnosis). 2.Set patient care priorities. 3.Develop a care plan. 4.Implement a treatment strategy. 5.Execute the plan. 6.Reassess & re-evaluate

6. Elements of Effective Paramedic Practice 1.Gather, evaluate, synthesize information. 2.Develop and implement patient management plans. 3.Apply judgment and independent decision making. 4.Think and work effectively under pressure

7. 1.Gathering, Evaluating, and Synthesizing You must be able to communicate and obtain information from many types of patients, including a.Different age groups. b.Different educational backgrounds. c.Different abilities to communicate. d.Patients who have consumed drugs or alcohol.

8. Gathering, Evaluating, and Synthesizing Assess and Evaluate the information to develop a treatment plan from: 1.The scene 2.The patient 3.A bystander Determine what is valid and invalid.

9. 1.Gathering, Evaluating, and Synthesizing Example: 64-year-old man reporting chest pains; history includes type 1 diabetes since childhood; long- time smoker; COPD

10. 2. Developing and Implementing a Patient Care Plan Protocols or standing orders define the essential standard of care. Protocols and standing orders specify:  Performance parameters  When medical control should be contacted Protocols promote a standard approach and quality of care. – They do not cover atypical presentations.

11. 3.Using Judgment and Independent Decision Making You must immediately recognize and treat life threats. A.Circumstances determine the treatment plan. B.Use critical- thinking and decision-making skills.

12. 4.Thinking and Working Under Pressure 1.To avoid disaster, you must have:  Knowledge  Excellent psychomotor clinical skills 2.You must be able to:  Work under extreme pressure  Think and perform quickly and effectively

13. CRITICAL THINKING Protocols, standing orders, and patient-care algorithms provide a standardized approach to emergency patient care

14. PROTOCOL AND STANDING ORDERS Protocol defined as: A standard that includes general and specific principles for managing certain patient conditions. Standing orders defined as: Treatments you can perform before contacting the medical direction physician for permission

15. Algorithm Graphic flow chart that outlines appropriate care for specific signs and symptoms. To use an algorithm, follow the arrows to your patient’s symptoms and provide care as indicated. While algorithms, standing orders, and protocols provide paramedics with guidance.

16. Range of Patient Conditions You must be able to determine if the patient is sick or not sick. – If a patient is sick, quantify how sick. Clear thinking in an emergency starts.

17. Distinguish between serious condition and nonlife threatening Serious conditions include: 1.Serious multisystem trauma. 2.Acute presentations of “first-time” medical events 3.Multiple disease etiologies Non-life-threatening injuries include: 1. Simple abrasions 2. Partial-thickness burns of an extremity, with less than 5% body surface area 3. Small lacerations with only capillary bleeding

18. Stages of critical thinking

19. 1. Concept Formation 1. First stage in prehospital care. Gather information from your senses and diagnostic tools. Begins as the paramedic arrives at the scene. Elements  Scene assessment  Chief complaint  History  Affect  Initial assessment  Physical exam  Diagnostic tests

20. 2.Data Interpretation 2. Second stage of the critical-thinking process 1.Evaluate all gathered information.  Understand how the body works.  Have a background in anatomy, physiology, and path physiology.  Have a good attitude 2.Experience of paramedic

21. 3. Application of Principle 3. Third stage of critical-thinking process. Initial field impression becomes a working diagnosis. The treatment plan is determined by patient care protocols, or standing orders.

22. 4. Reflection in Action evaluation Fourth step Treat patients while monitoring intervention effects.

23. 5. Reflection on Action 5. Last stage 1.Reflect on and learn from the decisions and actions taken on each call. 2.Addition to/modification of paramedic experience base 3.Run critique

24. Reflection on Action Elements that contribute to critical thinking: 1.Knowledge in medical sciences. 2.Ability to gather and organize data. 3.Ability to focus on specific and multiple data. 4.Ability to identify medical ambiguity. 5.Ability to understand relevant/irrelevant data. 6.Ability to analyze and compare situations. 7.Ability to explain reasoning.

25. Good Critical Thinkers 1.Have knowledge. 2.See problems as exciting challenges. 3.Have understanding as a goal. 4.Use evidence to make judgments. 5.Are interested in others’ ideas. 6.Think before acting. 7.Avoid emotionalism 8.Keep an open mind

26. Checklist to support thinking under pressure 1.Scan situation. 2.Stop and think. 3.Decide and act. 4.Stay calm. 5.Continue re - evaluation.

27. Four Aspects of Critical Thinking 1. Abstract Thinking: thinking past what your senses tell you 2. Creative Thinking: thinking “out of the box,” create 3. Systematic Thinking: organizing your thoughts into logical steps 4. Communicative Thinking: being share in giving your ideas to others.

28. The Six Rs 1. Read the scene.  Overall safety  Environmental conditions  Immediate surroundings  Access and egress  Mechanism of injury

29. The Six Rs 2. Read the patient.  Observe the patient.  Talk to the patient.  Touch the patient.  Auscultate lung sounds.  Identify life threats.  Obtain vital sign s

30. The Six Rs 3. React.  Treat any life-threatening problems.  Develop a working diagnosis or provide care based on presenting signs and symptoms. 4.Reevaluate. o Follow up on interventions.

31. The Six Rs 5. Revise the plan.  Be open to changing working diagnosis. 6. Review the performance.  Continuous quality improvement (CQI) meeting  Informal discussions with partners