General Discussion

Clinical Judgement Questions

• Worth 38-42% of the exam

• 4-8 total scenarios

• Each scenario has 6-11 questions in each scenario=60-70 questions

Clinical Judgement Scenarios

• Don't look at or read the question first!!! Read the dispatch notes, the on scene note, or the post scene information before reading the actual question, and start to breakdown and interpret the info

Always pay attention to the following:

• Who you are working with (Another Medic, AEMT, EMT)-delegation, additional resources

• The time of day (Night, Afternoon, Morning)

• The Weather & Road Conditions

• Patient's allergies

• The age, history, risk factors and home medications of the patient

• The ETA in time/miles or minutes of your destination hospitals

• If the ETA is ever >30 min-Consider a helicopter (Medical or Trauma)-Weather permitting (Raining, Snowing, Storming)

EXTREMELY IMPORTANT!!!!

• If you are going to do an intervention or give a medication, make for DAMN SURE there are NO contraindications or allergies

DON'T GET LOST!!!!

• ALWAYS keep track of what you have done throughout the scenario and pay attention if the patient is improving or getting worse. Use the whiteboard provided

• Always check for additional information from 1 question to the next

• Do NOT re-invent the wheel (If they have done something or are doing something in the question, and it is NOT working, don't turn around and choose the same or similar intervention

• Know your treatment algorithms and apply them to the scenario!!!

• Overall, ask yourself 1 question-What will help and benefit my patient the most???

Example-Near Drowning

• Pt. has Dyspnea, SOB, audible crackles=rales=Pulmonary edema

CPAP/BiPap Contraindications

• SBP less than 100 mmHg

• AMS

• Apnea

• Unable to remain in a seated position

• Chest, face, or head trauma

Trauma-30 m-fell off a mountain bike

• 8/10 pain-deformity to the upper arm and tib/fib

Analgesic (Pain med)-Fentanyl, Morphine

• Allergy

• Respiratory depression

• SBP less than 100 mmHg

• Shock

• Head Injury

• AMS or ALOC

Use of the whiteboard

Part 1-Answered-Extra resources-BLS engine

Part 2-O2 NC 4 L, IV, NTG x 1

COPD-Chronic Obstructive pulmonary disease

1. Chronic bronchitis

2. Emphysema

Causes

1. Most common cause-Smoking

2. Environmental-Who work in garages, around chemicals, mechanics, mines

Chronic Bronchitis (Blue Bloaters)

Patho-Chronic inflammation in the bronchioles, causing an accumulation of thick mucus

Signs/Symptoms

• A problem getting air in!!!!!

• Hypoxia

• Cyanosis

• SOB & Dyspnea

• Low Spo2

• Productive cough

• Obese/Heavy

• Rhonchi & Wheezing

Emphysema (Pink Puffers)

Patho-Destruction to the alveoli, causing a decreased surface area and elasticity, resulting in "Air trapping"

• A problem getting air out

• Elderly

• very thin

• Barrel chest

• Hypoxic Drive-Normal Spo2-88-91%

• No high flow O2-It will kick them out of that drive

• Quiet chest or diminished or slight wheezing

Dangerous words to avoid

• Always

• Never

• Only

• Solely

• Sometimes

• Usually

• Probably

• Every time

Differential Diagnosis

• Exacerbation of emphysema-low spo2

  
  

• Asthma-low spo2

Atmospheric oxygen

• 21% Fio2-Fractional Inspired Oxygen

Nasal Cannula

1 L-24%

2 L-28%

3 L-32%

4 L-36%

5 L-40%

6 L-44%

Simple Face mask (Partial rebreather)

• 6-10 L

• 6 L-44%

• 7 L-48%

• 8 L-52%

• 9 L-56%

• 10 L-60%

part 4-Increased Fio2/Albuterol x 1

Bleb-An air or a fluid filled sac or blister in an area of the lung

• Caused by COPD and Infections