Annie Duke, a former World Series of Poker champion, details some of the psychology of decision making in the high-risk gambling in her book, Thinking in Bets. In poker, important decisions must be made quickly in the midst of extreme uncertainty and repeated in rapid succession with each new hand. To learn and improve in this environment, these players learn to embrace uncertainty, tease the luck out of their outcomes and avoid common biases when reviewing their prior performance.  As doctors working in Emergency Medicine we often have do the same thing and the wrong decision could potentially be fatal.

In this episode of Rebel Reflections, four Emergency Medicine Physicians, Jacob White, Marco Propersi, Dan Wolf and Will Smith, discuss how thinking in bets while dealing with levels of uncertainty can benefit our performance and learning in the Emergency Department.

• • How does “resulting” or the tendency to equate a decision’s quality with its outcome affect learning in and after residency?
  • How does thinking on the spectrum of more or less right impact our utilization of new research or of implementing a consultant’s recommendations?
  • How do you avoid decision fatigue during a long shift?

We will discuss these topics and many more on this episode of REBEL Reflections!

Thinking in Bets on Amazon.com

Swami chats with Brendan Freeman, Emergency doc and medical education fellow at Staten Island University Hospital about improving our sleep hygiene.

There is a shifting paradigm towards shorter durations of antibiotics in pediatric infections. Conflicting international guidelines recommend treatment of urinary tract infection (UTI) with antibiotic courses ranging from just 3 days to 7–14 days. Antimicrobial resistance is a global health crisis, underscoring the importance of antibiotic stewardship. Investigators in the SCOUT Trial examine the impact of short-course (5 day) antibiotic therapy in UTI, with potentially far reaching implications.

https://rebelem.com/pediatric-utis-short-course-vs-standard-course-antibiotics-is-it-time-for-a-change/

Community-acquired pneumonia (CAP) can lead to pulmonary and systemic inflammation, resulting in impaired gas exchange, sepsis, organ failure, and an increased risk of death. Corticosteroids have excellent anti-inflammatory and immunomodulatory effects that could mitigate some of the inflammation caused by pneumonia. There have been several randomized trials that have shown glucocorticoids have positive effects in patients with CAP. However, except for one trial, none showed a between-group difference regarding mortality.  We now have the Community-Acquired Pneumonia: Evaluation of Corticosteroids (CAPE COD) Trial.

https://rebelem.com/corticosteroids-in-severe-community-acquired-pneumonia-could-cape-cod-catalyze-a-change-in-critical-care-management/