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When I was a medical student, I learned not to withdraw more than 1500cc during a thora lest I risk re-expansion pulmonary edema.

When I was a resident, I decided to investigate the data that supported that 'teaching pearl' first hand.... [thread]
I quickly discovered that the data supporting the pearl was absolutely unreliable; and disputable

For interested parties, @PulmCrit wrote a nice summary here: emcrit.org/pulmcrit/large…

but I am going in a different direction...
Of course, I started to look into other 'pearls' I had been given, and realized that many were the cheap plastic kind

But what I didn't understand was the sociology, the psychology, the culture around where the pearls originated
at some point in medical history, a bunch of well intentioned docs must have codified the 'fake pearl' and started passing it along.

What does that process look like?

What motivated it?

How did it happen?
Turns out COVID19 has provided the opportunity for me to witness first hand how these 'pearls' are constructed

Every meeting to discuss whether we ought to (insert change to our usual clinical practice) because of or in response to COVID19 is almost always..
.. a discussion of utterly unreliable information, abject speculation, and frankly illogical thinking.

hence I at last have seen the origin of the 'pearl'

#classiccovid
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