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 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.
TOTAL: /70 (Worth 15% of your total grade)
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 /
20
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 /
15
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 Samuels case. (200 words provide at least two (2) references to literature
regrading analytical reasoning)
Maximum mark
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