RCEM Learning April 2025
Apr 8, 2025
Maegan Ladell, a pediatric emergency medicine physician and patient safety researcher, shares her insights on fostering a culture of patient safety. She delves into the complexities of diagnostic errors, emphasizing the influence of hindsight bias in high-stakes decision-making. Ladell critiques traditional error analysis methods and advocates for a systems-thinking approach that considers the interplay of human behavior and healthcare systems. This engaging discussion highlights the necessity for a more nuanced understanding of medical errors to improve patient care in emergency settings.
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Beta Blockers in Sepsis Mechanism
- Beta blockers may help control heart rate in septic shock by reducing tachycardia, improving cardiac filling and coronary perfusion.
- Ultra short-acting beta blockers like Landiolol target heart rate with less negative impact on heart contractility.
Cautious Beta Blocker Use Advice
- Use selective beta-1 antagonists carefully, as open-label trials have limitations and inclusion criteria can be subjective.
- Avoid rushing beta blocker use in ED septic patients without robust outcome evidence.
Value of Mortality Reviews
- Reviewing all ED deaths, including expected and palliative, provides valuable learning beyond just identifying errors.
- Good care should also be shared and praised in mortality reviews.