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 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:
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