Cognitive Bias and Premature Closure
April 26, 2010, 2:42 pm
Life in the Fast Lane discusses an interesting case that demonstrates the danger of premature closure (that is, jumping to conclusions) when evaluating complex acutely ill patients. We had an example of this pitfall — fortunately avoided by the sharp emergency doc — presented at tox rounds this morning. A sixty-year-old man was brought into the emergency department responding only to deep pain and with a pulse of 48 and blood pressure 82/46. With him were two empty pill bottles found at his home — oxycodone and diazepam. Case closed — an obvious example of opiate and benzodiazepine overdose that should respond to supportive care and a touch of naloxone. But a total of 10 mg of naloxone did not have much effect, and the physician astutely realized that an unknown co-ingestant could be responsible for the worrisome bradycardia and hypotension. The patient’s significant other was on multiple cardiac medications. Serum glucose was not elevated, making significant calcium channel blocker toxicity less likely. The doc administered glucagon for possible beta-blocker overdose, with an immediate increase in pulse rate and blood pressure. Further history later revealed that the patient had indeed taken metoprolol in addition to the opiate and benzo.