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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 Image
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
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.
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