First time working with a 1st-year fellow. I had to issue my now-standard warning: don't dismiss/deflect #consults on first contact. Nowadays, many/most of the folks calling you have not had internal medicine or residency training, and they don't even know what the question is Or how to approach the problem in general. So you cannot discern, using telephone queries, whether it's a serious or trivial matter. You cannot even be sure the question being posed is the real question. You have to go see the patient, understand the clinical context...

You’ve heard the saying “ uncommon presentations of common diseases are more common than common presentations of uncommon diseases.”

Here is a picture that explains the adage followed by a more in-depth explanation

#clinicalreasoning #medicaldecisionmaking The argument is a #Bayesian one. Look at the #bellcurve drawn for #sepsis of urinary origin: there is an enormous area under that curve because sepsis Is so common, at approximately 747 cases/100,000 people per year and about one quarter or more of those will be urinary origin

#ICUchecklist is to make sure the plane doesn’t crash, not to assure the stewardesses don’t run out of Diet Coke on the way to Los Angeles. If the checklist gets too long, it becomes pro forma, and is rattled off without attention. The picture shows a cumbersome #checklist It seems to imply that the individual patient and their disease process does not matter, you simply have to check some boxes like you were starting a plane or baking some cookies. It seems also to imply that we will forget to monitor medications and labs and…everything

This just out: Physicians do not logically/correctly estimate the probability of outcomes resulting from sequences of events - a thread. #conjunctionfallacy #probability #medicaldecisionmaking #clinicalreasoning #innumeracy #numeracy jamanetwork.com/journals/jaman… @JAMANetworkOpen In this article, we showed that physicians estimated the probability of two events both occurring as *more* likely than one or both of the individual events. This is logically impossible and consistent with the #conjunctionfallacy. This #bias can lead to catastrophic outcomes

PSA: You *CANNOT* use a "bougie" or Eschmann Intubating Stylet to do an endotracheal tube exchange. I have seen this mistake twice in the past 6 months. You will lose the airway. A simple look at the length of the bougie and an #ETT will make this clear. The length of an adult ETT is about 32 cm and the length of the #eschmannstylete is 70 cm. This leaves no room in the center for you to grab it. When you retract the #ETT to the end of the stylet, its distal tip is still in the patient's mouth & entire stylet is covered

Write this down: “The purpose of daily rounds & presentation (& progress note) is to *document the behavior of the disease under observation and treatment*.” This is the paramount philosophical purpose. You can include superfluous and redundant boilerplate (eg RRR no MGR no CCE) But your presentation MUST contain all the data from the patient/exam/labs etc which allow an assessment (explicit or intuitive) of whether the patient is getting better or worse or not progressing, whether the expected is happening or not, & whether there r unexpected findings

This 30ish woman of mean height has a recurrent right spontaneous #PTX 18 months after the first. She has a history of thoracic pain receiving spinal steroid injections; o/w healthy. The best way to get the #diagnosis is (poll next) The best way to get the diagnosis is:

Do you know all of these nuances of #pleuraldisease? Why is an #empyema distinct from a complicated #parapneumoniceffusion? What is #contarinisyndrome #explosivepleuritis #chyliform #pseudochylous? Are all #chylothorax milky? #pccm #pulmcrit #pulmonary #pleuraldisease is fascinating and nuanced. First step is #lightscriteria which give favor to finding #exudates which tend to be more urgent. You only need one criterion, which maximizes #sensitivity. Meaningless statement: "It's an exudate only by protein." One criterion=exudate

“Research finds that the best people at making predictions (did you know that there are prediction tournaments?) aren’t those who are smartest but rather those who weigh evidence dispassionately and are willing to change their minds.” #cromwellsrule nytimes.com/2021/03/03/opi… “Likewise, math whizzes excel at interpreting data — but only so long as the topic is banal, like skin rashes. A study found that when the topic was a hot one they cared about, like gun policy, they blundered. Passion swamped expertise.”

Floating the big yellow bird today. (#swanganz #SCG #PAC). Always remember to “lift it, flick it, flush it” and watch the results on the monitor before you set it a sail to make sure you’re on the right channel and you’re scale is correct. #zentensivist @doc_BLocke Irony is I get flask for not doing bronchs where I rarely find anything and I get flak for doing Swans where, as in this case, I often find useful things