EM Reflections – November 2015

Thanks to Dr Joanna Middleton for her M&Ms presentation today.

Here are the top tips from M and M’s this month.  Thanks to everyone who participated.

1.  Anchoring bias was present in a few of the cases this month.  Try to keep an open mind and look for alternate diagnoses when seeing patients with recurrent visits for similar complaints. Get a list of decision making errors here. Also a nice blog post on this subject from the short coatand finally for the last word on clinical decision making in Emergency Medicine, watch these free lectures by Pat Crosskerry and see his full list of biases below.

Download (PDF, 172KB)

2.  Elderly patients often have multiple complaints and issues when they are admitted to hospital.  When discussing with the admitting physician, please try to communicate the significant/potentially life-threatening abnormal findings that are present during your work-up. See the current guidelines from the CFPC – GUIDE TO ENHANCING REFERRALS AND CONSULTATIONS BETWEEN PHYSICIANS  

3.  Below-knee DVT’s – 10-20% risk of extension/embolization. See UpToDate article. Management options are repeat/serial ultrasounds in low risk patients, vs anti-coagulation in higher risk patients (high clot load, pregnancy, cancer patients etc).  A recent article published in Blood, by Gualtiero Palareti gives an excellent evidence-based insight, with case examples, into this issue. A proposed management algorithm was included.



4.  Undiagnosed diabetics can present with really vague complaints  (see this patient point of view) – have a low threshold for getting an accu-check.

5.  If you have a DKA patient, use the DKA protocol! (Adult DKA, Pediatric DKA) That is why we have a PROTOCOL.  If potassium is low (<3.3) remember to replace prior to starting insulin infusion.  The insulin causes intracellular shift of potassium and resulting arrhythmias/death.

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