Critical Care Time 5. Zorses and Hebras
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Aug 14, 2023 In this podcast, the hosts discuss the concept of 'zorses and heabras' in relation to common and rare diseases. They explore the potential harm of certain medications and highlight the need to consider encephalitis as a possible cause in ICU patients. The podcast also delves into Wernicke's encephalopathy, contrast-induced acute kidney injury, and fentanyl-widden chest syndrome. The hosts aim to raise awareness about rare medical conditions and improve patient care.
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Occam's Razor Isn't The Whole Story
- The horses-and-zebras adage advises favoring common diagnoses over rare ones as an application of Occam's razor in medicine.
- Nick and Cyrus argue the model is too simplistic because many conditions fall between 'common' and 'rare' and our calibration of frequency is imperfect.
Add Zorses And Hebras To Diagnostic Thinking
- They introduce two new categories: 'zorses' (thought-rare but actually common) and 'hebras' (thought-common but actually rare).
- These terms re-calibrate diagnostic thinking to avoid missing common presentations of atypical conditions or overestimating feared complications.
Suspect Cefepime Neurotoxicity Early
- Consider cefepime neurotoxicity early in ICU patients with altered mental status, especially with AKI or renal impairment.
- Stop or adjust cefepime promptly to see if mental status improves and avoid prolonged diagnostic cascades.