Paramedical Micro Lecture: Reflective Action – Reassessing the Patient

Micro Lecture by the Australian Paramedical College

In this micro lecture we’re going to talk about the process of reassessing your patient and ways this can be improved.

In today’s micro lecture we’re going to talk about the process of reassessing your patient. Now time and time again, when the students come to the workshops, they do some great things in practically demonstrating patient assessment, and you’re given case studies, and off you go treating and assessing patient, but something that always requires some improvement is the process of reassessing the patient. That usually requires significant prompting from the tutor. Now let’s take a step outside of the classroom and put you in a situation whereby you’re treating real human beings. Now that’s a big responsibility.

Now I’m going to give you the case study. You’re called to a 56-year-old male with chest pains.

You arrive on scene. You’re doing your primary survey.

You’ve established that the chest pains that they are experiencing are caused by an acute coronary syndrome so you go about doing your primary survey. You give them the medications using your safe group processes.

Once you’ve given the drugs, if not before, you need to be reassessing the patient. Okay, airway, breathing, circulation. Ask your patient, “How are you feeling, sir?, has anything changed at all?”.

You’re constantly reflecting on what you’re doing, asking yourself can I be doing anything different? That’s called reflective in action. Reflected on action is when you finished the case and you’re looking back, but you’re reflecting in action. Of course, reflection means looking back.

You’re thinking to yourself, am I doing everything correct? You go ahead and you give the pharmacology, you give the drugs to help your patient with their acute coronary syndrome, and you mobilize the patient. You put them in your carry chair because of course you don’t really want to be walking a patient who’s got an acute coronary syndrome, place them carefully into the carry chair, and then reassess again because you’ve given them some drugs.

You need to make sure that you’re constantly aware that if anything changes you’re going to be all over.

In other words, if they’re going to collapse you need to help them down to the floor, manage their airway, and monitor them just in case they do go into cardiac arrest. Once you’ve got the patient into the back of the ambulance, the ambulance doors are closed.

The first thing you should be checking is airway, breathing, circulation. In other lectures we tell you how to do that by the processes of measuring rates, and regularities, and strengths, but for now you just need to know you do it just before you give drugs, just after you’ve given drugs, that way you’ve mobilized your patient with the carry chair.

Once you’ve got them into the back of the ambulance, several times on the journey to hospital, and just before you pull up to hospital, there have been known incidents of paramedics arriving at hospital who have been distracted by something else going on in the ambulance and the patient conditioned has deteriorated and they haven’t picked it up in time, and the patient care has suffered as a result of that.

Of course, we teach you these things to be safe so that your patient can be safe and so that you can be safe. Reassess, reassess, reassess.

It’s a constant ongoing thing so that you can be flexible to the situation that you have in front of you. My name’s Sam Willis and I hope you’ve enjoyed this micro lecture.

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