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- Title
Exercises in Clinical Reasoning: Beyond the Surface.
- Authors
Salazar, James W.; Minter, Daniel J.; Tseng, Zian H.; Santhosh, Lekshmi
- Abstract
This article explores the diagnostic approach to a sudden collapse and loss of consciousness in a 72-year-old man. The lack of preceding symptoms and blue lips suggest a sudden cardiac event, potentially an arrhythmic event. The clinician recommends initiating CPR and calling for emergency help while considering possible causes such as hypoxemia and thrombosis. The patient's medical history, including a recent heart transplant, complicates the case and raises additional possibilities such as infection, rejection, medication effects, recurrence of the underlying disease, or post-transplant lymphoproliferative disorder. The article highlights the importance of reflection and the use of schemas in the diagnostic process. The patient arrives at the emergency department with ongoing CPR, and further evaluation is needed to determine the cause of the cardiac arrest. The article also emphasizes the significance of autopsies in providing closure to clinicians and family members, as well as improving diagnostic skills. It presents a case study of an elderly man with a history of heart transplant who experienced a cardiac arrest and died. Through a cognitive autopsy, the discussant reflects on potential biases and errors in the diagnostic process. The article underscores the value of autopsies in identifying missed diagnoses and informing future patient care, while also providing teaching points related to non-cardiac causes of sudden cardiac arrest and considerations for heart transplant recipients.
- Subjects
MEDICAL logic; HEART transplant recipients; LOSS of consciousness; HEART transplantation; CARDIAC arrest
- Publication
JGIM: Journal of General Internal Medicine, 2023, Vol 38, Issue 14, p3257
- ISSN
0884-8734
- Publication type
Article
- DOI
10.1007/s11606-023-08365-3