Читать книгу Emergency Medical Services - Группа авторов - Страница 342

EMS clinicians can limit errors in their clinical reasoning by recognizing the potential biases that may be present and incorporating certain strategies or heuristics. The science and evidence around heuristics, clinical decision making, and reasoning are in relative infancy and require EMS clinicians to extrapolate from the current and evolving evidence regarding the heuristics of decision making in medicine and emergency medicine, which may include the following [6]:

 Many experts will avoid using a previous diagnosis to influence their current diagnosis – collect a history, conduct a physical exam, employ strategic diagnostic tests, and use clinical knowledge to formulate a diagnosis and management plan.

 Minimize the influence of personal or external biases (e.g., an overzealous partner or other health care practitioner) on clinical decision making.

 Check for critical items in the past medical history or risk factors for serious disease.

 Pay particular attention to the vital signs of the patient.

 Avoid premature closure if the diagnosis is uncertain or undifferentiated.

 Be careful of high‐risk environments and times, such as high‐volume and high‐acuity times of day, and personal and emotional fatigue.

 Be careful of high‐risk patients – refusal of care, abusive/hostile/ violent patients, confrontational and annoying patients, and those with drug intoxications or psychiatric disease.

 Be careful of situations in which the presumptive diagnosis does not match the history, physical exam, or diagnostic test results. Go back to the patient assessment and reformulate a working plan.