Category Archives: reflections

Personal reflection – Cognitive bias

Case of acute and evolving intrinsic cord lesion in pregnancy presenting as unusually bizarre, but evolving neurology, referred as ‘cauda equina?’

When faced with an unusual presentation, particularly if it does not fit with anything ever seen before, and even if on probability it is very unlikely to be pathalogical, need to exclude the relevant and not be biased towards preliminary diagnosis planted by others. Consider Bayesian modelling.

Have an open mind and think broader than the problem presented. Is this something that we have neither yet considered nor ever seen before? How to prove/disprove this? Consider safety nets and worst case scenario. Accept uncertainty in an uncommon, undeclared situation rather than over-confidence. Observe evolution over time with multiple snap shots and opinions.

Time to muscle relaxation for intubation

I tended to attempt intubation prematurely… 3 minutes feels like a long time.  That’s why, when starting at least, the second person came along and stuck the tube down with ease due to the improved intubating conditions i.e. muscle relaxation!  As for sux, if possible, wait for longer than ‘end of fasciculations’ . JC enforces timing 60 seconds!  Especially important in difficult intubations in elective situations.