Lecture Mosby's paramedic textbook (4th ed) - Chapter 59: Putting it all together

9/11/2012 1 Chapter 59 Putting It All Together 2 Learning Objectives • Discuss how assessment‐based management contributes to effective patient and scene assessment. • Describe factors that affect assessment and decision making in the prehospital setting. • Outline effective techniques for scene and patient assessment and choreography. 3 Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company 1 9/11/2012 Learning Objectives • Identify essential take‐in equipment for general and selected patient situations. • Outline strategies for patient approach that promote an effective patient encounter. • Describe techniques to permit efficient and accurate presentation of the patient. 4 Effective Assessment • Assessment‐based management – Describes comprehensive care based on patient assessment – Effective assessment depends on patient’s history and physical examination – Paramedic’s knowledge of disease allows him or her to hold high degree of suspicion for possible illness • Helps to focus history toward patient`s complaint and associated problems 5 Effective Assessment • Paramedic must focus physical examination toward body systems associated with complaint – Some field situations may impair thoroughness of examination • Unsafe scenes or entrapment may hinder process – Paramedic must not overlook importance of physical examination nor perform it hastily 6 Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company 2 9/11/2012 Pattern Recognition • Once paramedics obtain patient’s history and perform physical examination, can compare information gathered with their knowledge base of medical illness and disease – Must ask whether history and physical examination match recognized pattern of illness • Pattern recognition 7 Pattern Recognition • Pattern recognition – Makes it possible for paramedic to form field impression and to begin treatment plan – Greater knowledge base and quality of assessment, greater probability of appropriate decision making and quality patient care 8 How can pattern recognition lead you down the wrong path? 9 Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company 3 9/11/2012 Field Impression and Action Plan • Paramedic forms field impression of patient’s condition from pattern recognition and from "gut instinct" that comes from experience – After making field impression, it must be confirmed through patient history and physical examination – Then, paramedic can formulate action plan • Based on patient’s condition and environment 10 11 Field Impression and Action Plan • Following field impression and action plan, paramedic provides basic and advanced life support treatment – These treatments are based on knowledge of protocols and on judgment • Knowing when and how to apply protocols – Judgment also involves knowing when appropriate to deviate from protocols 12 Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company 4 9/11/2012 13 Field Impression and Action Plan • Deviate from protocols – Example: administration of nitroglycerin to 58‐ year‐old man complaining of ischemic chest pain • His BP is within normal range, but during patient history he reveals he has taken Viagra within past 18 hours • Administration of nitroglycerin can cause lethal drop in BP in these patients • Good judgment in this case would lead paramedic to deviate from common protocol used to manage normotensive patients with ischemic chest pain 14 How can you continue to improve your patient care judgment? 15 Copyright © 2013 by Jones & Bartlett Learning, LLC, an Ascend Learning Company 5 ... - tailieumienphi.vn