essay

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 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.  Please look at the attached lectures notes !!!!

QUESTION 1
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)
Maximum mark
20
structure for Q1
–    what decision they made to care for Samuel each crew?
–    How did they get to their diagnosis e.g. asmha musculoskeletal involvement ?
–    Diagnosis and treatment path and link it to literature?
–    At least 2 references.

QUESTION 2
What influence would knowledge and experience of the crew members have on what information they considered relevant in this case? Include reference to bias and how that influences the decision making process. Support your answers using literature and reference to the case. (200 words – provide at least two (2) references to literature regrading analytical reasoning)
Maximum mark
15

Structure for Q2
-Novice VS Expert
-Determine what experiences each crew have that influences their diagnosis
-What type of reasoning they use?

QUESTION 3
Current literature points to a debate surrounding the reliability of intuitive clinical reasoning in comparison to the analytical, hypothetico-deductive, process of reasoning. Discuss the benefits and limitations of both forms of reasoning in relation to Samuel’s case. (200 words – provide at least two (2) references to literature regrading analytical reasoning)
Maximum mark
20
Structure for Q3
-Analytical VS intuitive (pros and cons).
-Relate to the case of Samuel .

QUESTION 4
Describe the factors in Samuel’s case which might affect the clinical decisions and diagnosis. Refer to a least two factors from the following areas a)    Level of knowledge and experience of the practitioner b)    Patient presentation (clinical signs & symptoms) c)Safety & Harm – Clinical Outcomes d)Psychological / Social e)Environmental f) Operational / logistical Support why these factors ‘bound’ or constrain the decision making in this case with reference to literature (200 words – provide at least two (2) references to literature regrading factors that influence clinical reasoning)

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