NREMT EMT 7: Medical Quizzes and Glossary - Clinical Reasoning and Critical Thinking in Prehospital Care

Clinical Reasoning and Critical Thinking in Prehospital Care

Clinical reasoning and critical thinking are essential skills for EMTs to make quick, accurate decisions in emergency situations. Imagine you're at a concert and someone suddenly collapses – you need to act fast to help them. Clinical reasoning is like being a detective, gathering clues and piecing together the puzzle to figure out what's happening. Critical thinking is like being a filter, sorting through information to make the best decision.

Key Steps / Core Facts

• Assessment: Gather information about the patient's condition, including their medical history, symptoms, and vital signs. This helps you identify the problem and create a plan. (SAMPLE)
  • S: Signs and symptoms
  • A: Allergies
  • M: Medications
  • P: Past medical history
  • L: Last meal or drink
  • E: Events leading up to the emergency
• Airway, Breathing, Circulation (ABCs): Check the patient's airway, breathing, and circulation to determine if they're stable. (ABCs)
  • Airway: Make sure the patient's airway is clear (no blockages)
  • Breathing: Check the patient's breathing rate and depth
  • Circulation: Check the patient's pulse and blood pressure
• Vital Signs: Take the patient's vital signs, including their temperature, pulse, breathing rate, and blood pressure. (Vital Signs)
  • Normal temperature: 97.7°F - 99.5°F (36.5°C - 37.5°C)
  • Normal pulse: 60-100 beats per minute
  • Normal breathing rate: 12-20 breaths per minute
  • Normal blood pressure: 90/60 - 120/80 mmHg
• Pain Assessment: Use the OPQRSTI method to assess the patient's pain. (OPQRSTI)
  • O: Onset (when did the pain start?)
  • P: Provocation (what makes the pain worse?)
  • Q: Quality (what does the pain feel like?)
  • R: Region (where is the pain located?)
  • S: Severity (how bad is the pain?)
  • T: Time (how long has the pain been going on?)
  • I: Intensity (how often does the pain occur?)
• CPR Compression Depth: Compress the patient's chest at least 2 inches (5 cm) to ensure effective CPR. (CPR)
  • Like pushing down a soda can
• CPR Rate: Compress the patient's chest at a rate of 100-120 compressions per minute. (CPR)
  • Like a metronome
• Shock: Identify signs of shock, including pale skin, cool skin, and decreased urine output. (Shock)
  • Red flag: decreased urine output
• Seizure: Identify signs of a seizure, including convulsions and loss of consciousness. (Seizure)
  • Red flag: convulsions
• Trauma: Identify signs of trauma, including bleeding and deformity. (Trauma)
  • Red flag: bleeding

What Laypeople Can Do

• If someone collapses, first check for danger (oncoming traffic, fire). Then shout and tap their shoulder to try to rouse them.
• If someone is choking, encourage them to cough or try to dislodge the object with their fingers.
• If someone is bleeding, apply pressure to the wound with a clean cloth or gauze.
• If someone is having a seizure, move them to a safe area and try to keep them calm.
• If someone is experiencing cardiac arrest, call 911 and start CPR if you're trained.

Common Mistakes

• Mistake: Not assessing the patient's airway, breathing, and circulation (ABCs) first.
  • Fix: Always check the ABCs before doing anything else.
• Mistake: Not using the OPQRSTI method to assess the patient's pain.
  • Fix: Use the OPQRSTI method to get a clear picture of the patient's pain.
• Mistake: Not recognizing signs of shock.
  • Fix: Look for signs of shock, including pale skin, cool skin, and decreased urine output.
• Mistake: Not recognizing signs of a seizure.
  • Fix: Look for signs of a seizure, including convulsions and loss of consciousness.
• Mistake: Not recognizing signs of trauma.
  • Fix: Look for signs of trauma, including bleeding and deformity.

Quick Practice Scenarios

1. A patient comes in with a severe headache and is vomiting. What should you do first?
   • Answer: Assess the patient's airway, breathing, and circulation (ABCs).
   • Reason: You need to make sure the patient is stable before doing anything else.
2. A patient is having a seizure and is convulsing. What should you do first?
   • Answer: Move the patient to a safe area and try to keep them calm.
   • Reason: You need to protect the patient from injury and try to calm them down.
3. A patient is experiencing cardiac arrest and is not breathing. What should you do first?
   • Answer: Start CPR.
   • Reason: You need to try to restore the patient's breathing and circulation.

Last-Minute Exam Cram

• Normal vital sign ranges:
  • Temperature: 97.7°F - 99.5°F (36.5°C - 37.5°C)
  • Pulse: 60-100 beats per minute
  • Breathing rate: 12-20 breaths per minute
  • Blood pressure: 90/60 - 120/80 mmHg
• Drug doses:
  • Epinephrine: 1 mg IV every 3-5 minutes
  • Atropine: 0.5-1 mg IV every 3-5 minutes
• Mnemonics:
  • SAMPLE: S - Signs and symptoms, A - Allergies, M - Medications, P - Past medical history, L - Last meal or drink, E - Events leading up to the emergency
  • OPQRSTI: O - Onset, P - Provocation, Q - Quality, R - Region, S - Severity, T - Time, I - Intensity
• Assessment sequences:
  • Airway, Breathing, Circulation (ABCs)
  • Vital signs
  • Pain assessment (OPQRSTI)
• Common "trick" questions:
  • Agonal breathing is NOT normal breathing – start CPR
  • A patient with a severe headache and vomiting may have a stroke – assess their ABCs first