Chapter 1: Critical Thinking in Emergencies
A Systematic Approach OBJECTIVES By the end of this chapter, you should be able to Explain how the beginning provider …
A Systematic Approach
By the end of this chapter, you should be able to
- Explain how the beginning provider processes information differently from the expert.
- Describe a situation when home birth would decrease risk to mother and child, and one when it would elevate risk.
- List three antepartal conditions that would necessitate co-management with a physician or transfer of care.
When pregnancy and labor are normal, it is easy to be lulled into assuming that they will remain normal. This assumption is true most of the time and so comforting that it is easy to discount the early signs that a problem is evolving.
Knowledge of pathophysiology is important, but in order to recognize a problem from its earliest presentation, the provider must become a detective who pieces together a story, a pattern, or a diagnosis. Textbooks usually give the most typical presentations of disease processes along with their statistical likelihood. Statistics derived from populations, however, apply to populations, not to individuals. As often as not, when the women and babies in your care develop unexpected problems, their symptoms will not match the textbook, and signs will present with various degrees of ambiguity. Clinical judgment depends on the context of a particular situation.
Although life-threatening problems are uncommon, they carry the highest stakes. When evaluating a problem, always ask yourself, “What is the worst this could be?” and rule out life- threatening conditions first.
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