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Expert clinicians utilize targeted debiasing strategies almost instinctively
@rabihmgeha at #SGIM23 employing “What can’t I explain?” for a pt w “CHF exacerbation” hypoxic to 70% on RA, improved to 92% on 3L
Photo from my recent Cognitive M&M courtesy of @UABMedPeds @uabimres
@rabihmgeha at #SGIM23 employing “What can’t I explain?” for a pt w “CHF exacerbation” hypoxic to 70% on RA, improved to 92% on 3L
Photo from my recent Cognitive M&M courtesy of @UABMedPeds @uabimres
He emphasized: the crux of the case probably lies in this one point.
That you went from “may need to intubate” to “looks great” with only 3Lnc?
Doesn’t add up…
Consider an alternative etiology for his hypoxemia — notably, w such profound response to minimal O2, hypercarbia
That you went from “may need to intubate” to “looks great” with only 3Lnc?
Doesn’t add up…
Consider an alternative etiology for his hypoxemia — notably, w such profound response to minimal O2, hypercarbia
Spot on, as always!
Pt admitted for diuresis. Became progressively somnolent - gas showed marked respiratory acidosis, CTH w cerebral edema — all d/t hypercarbia 2/2 OSA
So. Anytime I utilize “What can’t I explain?” in a diagnostic timeout, I create a new brief script.
Pt admitted for diuresis. Became progressively somnolent - gas showed marked respiratory acidosis, CTH w cerebral edema — all d/t hypercarbia 2/2 OSA
So. Anytime I utilize “What can’t I explain?” in a diagnostic timeout, I create a new brief script.
In this case: SpO2 improvement out of proportion to supplemental O2 — consider hypercarbia/hypo ventilation as etiology of hypoxemia
Q: When to apply “what can’t I explain”?
A: OOPS (out of proportion s/sx)
- Tachypnea OOP to hypoxemia
- ^^SpO2 response OOP to suppl O2
- etc
Q: When to apply “what can’t I explain”?
A: OOPS (out of proportion s/sx)
- Tachypnea OOP to hypoxemia
- ^^SpO2 response OOP to suppl O2
- etc
• • •
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