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EMT Critical Thinking PPT

EMT Critical Thinking PPT

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  • Advance Preparation
    Invite your medical director in to discuss critical thinking.
    Invite experienced EMS providers to class to share the lessons of experience.
    Research and prepare non-EMS-related clinical thinking/decision-making resources.
  • These videos appear later in the presentation; you may want to preview them prior to class to ensure they load and play properly. Click on the links above in slideshow view to go directly to the slides.
  • Planning Your Time: Plan 40 minutes for this chapter.
    EMT Diagnosis and Critical Thinking (10 minutes)
    How a Clinician Reaches a Diagnosis (15 minutes)
    How an EMT Can Learn to Think Like an Experienced Physician (15 minutes)
    Note: The total teaching time recommended is only a guideline.
  • Teaching Time: 10 minutes
    Teaching Tips: Break old assumptions. EMTs do diagnose. Critical thinking is an essential tool for the EMS provider. Make judgment and critical thinking an ongoing part of your course. When practicing scenarios (in any lesson), add elements of critical thinking and decision making.
  • Points to Emphasize: A diagnosis is the conclusion that the EMT reaches, after assessing a patient, about the nature of the patient’s condition. Critical thinking is an analytical process that can help to solve problems in an organized and efficient manner. EMTs must use critical thinking to arrive at a diagnosis.
    Talking Points: Diagnosis for the EMT is called “presumptive diagnosis,” “field diagnosis,” or “working diagnosis.” It can be difficult to differentiate between all the information received; therefore the EMT must simultaneously use critical thinking to determine what information is pertinent.
    Discussion Topics: Define diagnosis. Discuss what is meant by critical thinking. Describe its role in EMS.
    Class Activity: Hand out a patient scenario that includes signs and symptoms and assessment findings. Have students develop a diagnosis and defend their conclusions.
    Knowledge Application: Have a class discussion on critical thinking. Brainstorm important elements of critical thinking and discuss how they relate to making a diagnosis.
    Critical Thinking: Some say EMTs cannot diagnose. Discuss why their arguments might or might not be true.
  • Video Clip
    Obstacles to Problem Solving
    In what ways can we solve problems?
    What obstacles do people encounter when solving problems?
    Why it is important for an EMT to be able to solve problems?
  • Teaching Time: 15 minutes
    Teaching Tips: Consider inviting your medical director or other physicians to discuss their approach to making a diagnosis. Use real-world examples to demonstrate the issues involved in making a diagnosis in the world of emergency medicine. Spend time discussing the traits of experienced clinicians. Use specific examples and build a strategy out of the individual components. Present the good and bad habits of experienced providers. Teach the limitations of diagnostic shortcuts.
  • Talking Points: The first steps are to gather information, consider possibilities, and reach a conclusion. How these steps are implemented varies significantly among traditional clinicians, emergency medicine clinicians, and EMS clinicians.
  • Point to Emphasize: The availability of resources is what often guides the approach to making a diagnosis.
    Talking Points: Further evaluation involves diagnostic tests such as laboratory values or x-rays and may sometimes lengthen the differential diagnosis or (“differential” for short).
    Discussion Topic: Contrast the traditional diagnostic method with the techniques of emergency providers. How do they differ, and why?
  • Point to Emphasize: Emergency physicians and EMS providers must account for immediate life threats in their diagnostic procedures.
    Talking Points: Information gathered from the history and physical can guide the ED physician toward a differential and the ordering of specific tests. However, the ED physician does not have as many testing modalities available as the traditional clinician. This may require only the most serious of differentials to be resolved leaving the less significant for follow-up.
    Discussion Topic: Discuss how experienced providers approach making a diagnosis. What specific traits do they use in their technique?
    Class Activity: Discuss problem solving with your medical director. What insights might this person have?
  • Talking Points: The EMT has a great deal in common with the emergency physician. Both have limited resources, must act quickly and efficiently, and have limited treatment options. The EMT, however, is not burdened with multiple types of patients at the same time which adds its own limitations. EMTs face adverse conditions and have very limited options at their disposal. EMT education is focused on certain conditions with high morbidity and mortality.
    Knowledge Applications: Have students work in small groups to examine particular diagnostic methods (traditional, emergency physician, and EMT). Have groups present and discuss their findings. Have students interview experienced providers about how they reach a diagnosis. Discuss students’ findings.
  • Talking Points: The list of diagnoses may often be short or general. Through re-evaluation and reassessment the EMT may gather additional information leading to a restatement of the chief complaint.
    Discussion Topic: Contrast the traditional diagnostic method with the techniques of emergency providers. How do they differ, and why?
    Class Activity: Challenge students with exceptionally difficult scenarios. The point is not necessarily to reach the correct diagnosis, but rather to develop a working strategy. Discuss.
    Critical Thinking: What are the bad diagnostic habits of the experienced provider? How might you avoid these habits as you develop in your career?
  • Talking Points: You must continually look for information that will rule in/rule out your conclusions. Patients may have more than one thing wrong with them, so you can’t stop looking.
  • Point to Emphasize: Experienced clinicians develop key traits in the diagnostic approach.
    Talking Points: Shortcuts in critical thinking are called heuristics. The more time a clinician spends providing care and experiencing different patients, the more information becomes available to them for critical thinking and diagnosis. They begin to see patterns and similarities that can help steer them in a particular direction. These patterns can also lead to biases that can affect judgment. Biases include representativeness, anchoring and adjustment, overconfidence, confirmation bias, illusory correlation, and search satisfying.
    Discussion Topics: Describe the pitfalls of diagnostic shortcuts. How might they actually limit an EMTs ability to make an accurate diagnosis? Discuss how experienced providers approach making a diagnosis. What specific traits do they use in their technique?
    Knowledge Application: Work in small groups. Assign each group a particular diagnostic trait of an experienced provider. Ask them to discuss that trait and present their findings to the class. Findings must include advantages, disadvantages, and applicability to EMS.
  • Video Clip
    Decision-Making Information
    Why is it important to cast away underlying assumptions when making a decision?
    What is the difference between decision making and problem solving?
    Why is it important to define a problem?
    Discuss the steps in solving a problem.
    What is group think?
  • Teaching Time: 15 minutes
    Teaching Tips: Since students like things to be clear cut, instructors often make the mistake of trying to make everything completely objective. Imprint early on that medicine is, in many ways, a subjective science. Demonstrate that good providers are flexible. Medicine constantly changes. Invite experienced providers to class. Have them discuss the lessons that they have learned and validate the traits discussed in this section.
  • Points to Emphasize: There are critical thinking traits that EMTs can learn from experienced providers. Adopting these attitudes can improve their capability to solve problems and work through difficult issues. Ambiguity and uncertainty will always be present in medicine. This is true in the back of an ambulance as well.
    Talking Points: Understand the limits of your knowledge and realize you won’t always have the answer you seek. When you get a vital sign or a value that doesn’t seem right, don’t assume it’s wrong. Investigate it.
    Discussion Topics: Describe the role of ambiguity in the diagnostic process. How do the limitations of technology impact an EMT’s diagnostic technique?
  • Points to Emphasize: Many of the attitudes and understandings of experienced clinicians focus upon flexibility. This is an extremely important trait for a new EMT to develop.
    Talking Points: Medicine is an ever-changing field. As a clinician, you must stay up-to-date with information and continually strive to learn. One of the requirements of licensure is continuing education. Utilize continuing education to remain ahead of the new information concerning treatment, research in EMS, and updates on protocols. No matter your experience, seek methods from other providers and listen to suggestions from all experience levels.
  • Discussion Topics: How do both a strong foundation of learning and continued education improve an EMT’s ability to diagnose? Define and discuss the term elaborated knowledge.
    Class Activity: Discuss problem solving with an experienced EMS provider. What lessons has this person learned from experience?
    Knowledge Application: Have students work in small groups. Assign each group an attitude or understanding of an experienced clinician. Have the groups present ways in which those traits improve diagnostic technique.
    Critical Thinking: This section presents “learning from others” as a positive trait used to improve diagnostic technique. What actual steps might you use on the job to realize this strategy?
  • Talking Points: Reaching a diagnosis is a process that can be learned. Critical thinking comes from study, practice, and reflection. It is a skill that takes time. Know the boundaries of your knowledge. Don’t let a diagnosis attempt delay your patient care.
  • Video Clip
    Leadership
    What are the desired outcomes of effective leadership?
    Why is it important for an EMT to be an effective leader?
    List qualities of an outstanding leader.
    When providing emergency care, why must an EMT balance the needs of others?
    Discuss some roles associated with different levels of management.
  • Video Clip
    Delegating Authority
    What is delegation?
    Who is accountable when a task has been delegated to another person?
    What can delegation accomplish?
    Why should an EMT be able to delegate tasks to others effectively?
    What factors might negatively impact effective delegation?
    Why is praise from a leader essential?
  • Talking Points: A differential is based on history, physical exam, and vital signs and includes both physical and intellectual activity.
    The first priority in emergency medicine is finding and alleviating all life threats.
    Heuristics allow an experienced provider to utilize shortcuts to reach a diagnosis, saving time and ultimately benefiting the patient.
    By embracing ambiguity, understanding limitations, utilizing different methods, forming a strong foundation of knowledge, being organized, and being a lifelong student as well as reflecting on what we have learned, we can think like experts.
  • Talking Points: The complaint of chest pain should encourage you to ask additional questions. “Stress” should not be the diagnosis and the complaint of chest pain should be taken seriously. Consider immediate life threats, then additional resources. The next step is to assess the patient and begin to draw some conclusions. What might some of those conclusions be?
  • Please visit our web site at www.bradybooks.com and click on the mykit links to access content for this text. Under Instructor Resources, you will find curriculum information, lesson plans, PowerPoint slides, TestGen, and an electronic version of this instructor’s edition. Under Student Resources, you will find quizzes, critical thinking scenarios, weblinks, animations, and videos related to this chapter—and much more.
  • Transcript

    • 1. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Introduction to EmergencyIntroduction to Emergency Medical CareMedical Care 11
    • 2. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson OBJECTIVESOBJECTIVES 16.1 Define key terms introduced in this chapter. Slides 14–16 16.2 Compare and contrast EMTs’ and physicians’ diagnoses. Slides 12–16 16.3 Explain the relationship between critical thinking and diagnosis. Slide 9 16.4 Explain typical steps used in the basic approach to reaching diagnoses. Slide 13 continued
    • 3. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson OBJECTIVESOBJECTIVES 16.5 Explain how diagnosis in emergency situations may differ from traditional approaches to diagnosis. Slides 14–16 16.6 Identify some of the special challenges to EMS providers in the diagnostic process. Slides 14–15 16.7 Discuss the relationship between diagnosis and treatment in emergency situations. Slide 18 continued
    • 4. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson OBJECTIVESOBJECTIVES 16.8 Discuss the benefits and pitfalls of diagnostic shortcuts (heuristics). Slide 18 16.9 Identify heuristics commonly used by highly experienced physicians. Slide 18 16.10 Describe ways in which EMTs can improve their critical thinking processes. Slides 21–23
    • 5. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson MULTIMEDIAMULTIMEDIA • Slide 10Obstacles to Problem Solving Video • Slide 19Decision-Making Information Video • Slide 25 Leadership Video • Slide 26 Delegating Authority Video
    • 6. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson CORE CONCEPTS • What an EMT diagnosis is • The role of critical thinking in EMS • How you as an EMT can improve your critical thinking skills
    • 7. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson TopicsTopics • EMT Diagnosis and Critical Thinking • How a Clinician Reaches a Diagnosis • How an EMT Can Learn to Think Like an Experienced Physician
    • 8. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson EMT Diagnosis and CriticalEMT Diagnosis and Critical ThinkingThinking
    • 9. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson EMT DiagnosisEMT Diagnosis and Critical Thinkingand Critical Thinking • Diagnosis is label for condition • Based on history, physical examination, vital signs • Involves both physical and intellectual activity
    • 10. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Obstacles toObstacles to Problem Solving VideoProblem Solving Video Click here to view a video on the subject of solving problems. Back to Directory
    • 11. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson How a Clinician Reaches aHow a Clinician Reaches a DiagnosisDiagnosis
    • 12. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson How a ClinicianHow a Clinician Reaches a DiagnosisReaches a Diagnosis • Clinicians have different levels of training, experience, time, resources • Techniques vary among types of clinicians
    • 13. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson TraditionalTraditional Approach to DiagnosisApproach to Diagnosis • Assess patient • List of conditions or diagnoses – “Differential diagnosis” • Further evaluation – Reevaluate the differential • Final diagnosis
    • 14. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Emergency MedicineEmergency Medicine Approach to DiagnosisApproach to Diagnosis • Quickly rule out and treat immediate life threats – Stabilize patient • Return to gather additional information • Focus on ruling out worst-case scenario – Red flags suggest problem serious • May be responsible for multiple patients
    • 15. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson EMS Approach to DiagnosisEMS Approach to Diagnosis • Must be very efficient – Be available for another call as soon as possible • Work in uncontrolled environment • Limited tools and skill set • Narrow educational focus continued
    • 16. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson EMS Approach to DiagnosisEMS Approach to Diagnosis • Follows same steps as emergency physician – Most are abbreviated or limited • Considers most serious conditions associated with patient – Rules them in or out • Creates a differential
    • 17. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Think About ItThink About It • You can reach a diagnosis, but your work is not done. Why?
    • 18. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson The Experienced ClinicianThe 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
    • 19. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Decision-MakingDecision-Making Information VideoInformation Video Click here to view a video on the subject of making decisions. Back to Directory
    • 20. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson How an EMT Can Learn toHow an EMT Can Learn to Think Like an ExperiencedThink Like an Experienced PhysicianPhysician
    • 21. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Thinking Like anThinking Like an Experienced PhysicianExperienced Physician • Love ambiguity – Uncertainty natural part of EMS • Understand limitations – People’s limitations – Technology’s limitations continued
    • 22. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson continued Thinking Like anThinking Like an Experienced PhysicianExperienced Physician • 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
    • 23. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Thinking LikeThinking Like an Experienced Physicianan Experienced Physician • Be organized • Be a lifelong student • Reflect on what you have learned
    • 24. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Think About ItThink About It • 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?
    • 25. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Leadership VideoLeadership Video Click here to view a video on the subject of effective leadership. Back to Directory
    • 26. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Delegating Authority VideoDelegating Authority Video Click here to view a video on the subject of delegation. Back to Directory
    • 27. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Chapter ReviewChapter Review
    • 28. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Chapter ReviewChapter Review • EMTs make some diagnoses in the field, although they are not as extensive or detailed as physicians’ diagnoses. continued
    • 29. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Chapter ReviewChapter Review • 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. continued
    • 30. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Chapter ReviewChapter Review • 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. continued
    • 31. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Chapter ReviewChapter Review • 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.
    • 32. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson RememberRemember • 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.
    • 33. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Questions to ConsiderQuestions to Consider • What is a differential diagnosis based on? • What is an emergency physician’s first priority when formulating a differential? • How are heuristics helpful in critical thinking? • How can we as providers enhance our critical thinking and diagnostic skills?
    • 34. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Critical ThinkingCritical Thinking • A 52-year-old man complains of chest pain while sitting at his desk at work. He appears alert and oriented. He tells you he thinks it may “just be stress.” How would you arrive at a diagnosis?
    • 35. Copyright ©2012 by Pearson Education, Inc. All rights reserved. Emergency Care, Twelfth Edition Limmer • O’Keefe • Dickinson Please visit Resource Central on www.bradybooks.com to view additional resources for this text.

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