course material

1. CLINICAL REASONING “ HEURISTICS AND ANALYTICAL REASONING IN
HIGH ACUITY CASES.
CLINICAL REASONING “ HEURISTICS AND ANALYTICAL REASONING IN HIGH ACUITY
CASES. SHORT ANSWER QUESTIONS READ THE FOLLOWING CASE AND ANSWER THE 4
QUESTIONS. CASE: ˜ Samuel’ Paramedics have been dispatched to a residential address at
03.47 hours for a 10 year old boy who has woken with extreme shortness of breath. On
arrival The patient (Samuel) is sitting on his bed. Both parents are with Samuel and have
been attempting to slow down his breathing and administer more Ventolin with limited
success. Background Samuel has a history of asthma and has been admitted to hospital
twice before at the ages of 6 and 9 years old. Both admissions resulted in prolonged
management of chest infections and associated severe asthma. Earlier in the evening he had
taken both his preventative corticosteroid medication and his Ventolin inhaler which had
limited effect in relieving the tightness in his chest. He woke after fitful sleep at
approximately 02.00 with increasing shortness of breath and pain down his left side of his
chest. Samuel has been complaining of discomfort down his left side for the last 10-12
hours. The parents are worried that this may be another chest infection in conjunction with
his asthma, but he does not appear to have any fever or productive cough. The parents state
Samuel normally gets a fever and productive cough when he is fighting an infection. Any
sign of colds or infection they treat early with the help of their local GP because of the
increasing severity if left. On Examination Samuel is leaning forward, appears pale and
using accessory muscles to breath. He is breathing in rapid shallow breaths with audible
wheeze. Respiratory Rate 32 / shallow and rapid Pulse Rate 110 / bounding SO2 90% on air
Blood Pressure 95 / 65 Auscultation reduce air entry on both left and right lung fields/
Audible respiratory wheeze Pain score 8 /10 on left side Skin / integumentary pale, dry,
warm During WEEK ONE tutorials you will be given details of the experience and
knowledge base of the crew attending this case and their provisional diagnosis e.g. the
paramedics may be a combination of a recent graduate who is three months into their
internship and a paramedic who has seven years’ experience. The following 4 questions
will explore your explanation (with links to literature) regarding the decision process
behind their diagnosis and treatment pathways.The explanation should reference the
concepts of intuitive (or non- analytical) and analytical reasoning, bias in decision making
and the differences regarding novice to expert practitioner and the effects this has on
clinical decision making. Crew member descriptions for module 1 clinical reasoning

2. assignment CREW MEMBER 1 Joshua ?????Joshua is a 25 year old graduate with a Bachelor
Degree in paramedicine. ?????He has been working for the last 3 years as a paramedic
within the metropolitan area. ?????He has worked as a volunteer firefighter and ambulance
officer for 2 years before completing his degree. ?????He is currently living in a house share
situation with two other friends while he looks to buy and finance his own home.
POTENTIAL DIAGNOSIS: SEVERE ASTHMA ATTACK WITH POSSIBLE MUSCULOSKELTAL
INVOLVEMENT TREATMENT: OXYGEN, NEBULISED SALBUTAMOL, POSTURING CREW
MEMBER 4 Tanya ??Tanya is 22 years old and has just finished her internship. ??She has
been a first aid volunteer at community events for the last 3 years and has been an
ambulance volunteer for the past year. ??She has recently been working with her team
leader to develop material for new internship participants and enjoys being part of the
guideline/ policy development committee. ??She has recently started renting a unit with her
older brother that is close to her work. POTENTIAL DIAGNOSIS: ASTHMA ATTACK
TREATMENT: OXYGEN, POSTURING, IM ADRENALINE Question 1: Student Description:
Describe the reasoning pathway that each of the crew members might have taken to reach
their potential diagnosis for this case? Describe how intuitive / pattern recognition may
influence their diagnosis. Describe how analytical (or hypothetico-deductive) reasoning
might be used to eliminate other potential diagnosis Support your discussion using
literature. (400 words “ provide at least two (2) references to literature on intuitive &
analytical reasoning) (20 marks) Grade Key points F not answered no outline of the
potential clinical reasoning pathway for the given diagnosis or reference to the case, unclear
explanation of intuitive and analytical reasoning, poor evidence to support the discussion
regarding clinical reasoning and the use of mental short cuts, rationales and explanation of
analytical reasoning is not clear or absent P clinical reasoning pathways mentioned but not
outlined or discussed, definition of intuitive and analytical reasoning given but with no
development of the discussion or links to the case, rationales and explanation given but not
discussed, reference quality marginal CR clinical reasoning pathways are well explained
with some analysis & synthesis, intuitive and analytical reasoning well defined and
explained, the use of analytical reasoning well supported, good references DN excellent
explanation of the clinical reasoning pathways with in-depth discussion and links to the
case, intuitive and analytical reasoning defined, explained and discussed with clear
reference to the case/clinician knowledge and experience, thoughtful rationales which
support discussions and use of analytical reasoning, excellent references HD as DN above,
but with outstanding synthesis and exploration of concepts Question 2: StudentDescription:
What influence would knowledge and experience of the crew members have on what
information they considered relevant in this case? Include reference to bias and how that
influences the decision making process. Omar3888@hot¦ Support your answers using
literature and reference to the case. (200 words “ provide at least two (2) references to
literature regrading bias in clinical Grade Key points F not answered, the difference
between novice to experienced / expert practitioner not clearly defined or discussed,
knowledge base and experience of practitioner in relation to clinical reasoning not
discussed, no reference to bias and the relationship to clinical reasoning P the difference
between novice and experienced / practitioner defined but not discussed, knowledge base

3. and experience of practitioner in relation to clinical reasoning mentioned but not discussed,
reference to bias but not to how it effects clinical reasoning, reference quality marginal CR
the difference between novice and experienced / practitioner defined and discussed in
relation to the case and the practitioners, knowledge base and experience of practitioner in
relation to clinical reasoning discussed and beginning links to the case and practice made,
reference to bias and links made to the effects on clinical reasoning, Good references DN
excellent explanation of the difference between novice and experienced / practitioner and
discussed in relation to the case and the practitioners, thoughtful discussion of the
relationship between knowledge base and experience of the practitioner and clinical
reasoning with links to the case and practice made, Links and discussion of bias and the
effects on clinical reasoning, excellent references HD as DN above, but with outstanding
synthesis and exploration of concepts Question 3: Student Description: Current literature
points to a debate surrounding the reliability of intuitive clinical reasoning in comparison to
the analytical (hypothetico-deductive) process of reasoning. Discuss the benefits and
limitations of both forms of reasoning in relation to Samuel’ s case. (200 words “ provide at
least two (2) references to literature regarding the benefits and limitations of both forms of
reasoning) (20 marks) Grade Key points F not answered no reference to literature that
discusses the reliability of intuitive vs analytical reasoning, benefits and limitations not
identified (intuitive reasoning), benefits and limitations not identified (analytical
reasoning), no links made to the case P literature that discusses the reliability of intuitive vs
analytical reasoning is introduced but not discussed, benefits and limitations identified
(intuitive reasoning), benefits and limitations identified (analytical reasoning) , links made
to the case, reference quality marginal CR literature that discusses the reliability of intuitive
vs analytical reasoning is introduced and discussed, benefits and limitations identified
(intuitive reasoning) and discussed, benefits and limitations identified (analytical
reasoning) and discussed, links made to the case and the relationship between benefits and
limitations, good references DN excellent explanation of the literature that discusses the
reliability of intuitive vs analytical reasoning and critically discussed, benefits and
limitations of both analytical and intuitive reasoning are critically discussed, Clear and
thoughtful links are made between benefits and limitations and the case and the effect on
reasoning, excellent references HD as DN above, but with outstanding synthesis and
exploration of concepts Question 4: Student Description: Describe the factors in Samuel’ s
case which might affect the clinical decisions and diagnosis. Refer to a least two factors from
the following areas; Level of knowledge and experience of the practitioner Patient
presentation (clinical signs & symptoms) Safety & Harm “ Clinical Outcomes Psychological
/ Social Environmental Operational / logistical Support why these factors ˜ bound’ or
constrain the decision making in this case with reference to literature (200 words “ provide
at least two (2) references to literature regrading factors that influence clinical reasoning)
(15 marks) Grade Key points F not answered, none or only one factor identified, no
discussion of the effect on clinical decision making P two factors are identified but not
clearly related to the case and practitioner diagnosis, the factors are defined but not
discussed or linked to how they affect the decision making, reference quality marginal CR
two factors are identified and discussed in relation to the case & practitioner diagnosis, the

4. factors are defined and linked to how they affect the decision making, Good references DN
excellent explanation of the two factors and in-depth discussion in relation to the case &
practitioner diagnosis, thoughtful and in-depth discussion of the relationship between the
factors and their effect on the case and practitioner diagnosis, excellent references HD as
DN above, but with outstanding synthesis and exploration of concepts