Desaturation during the pandemic: Covid or cognitive bias?

The coronavirus pandemic has put an unprecedented strain on our health care system. An urgent need for timely and accurate diagnosis coupled with an inordinate caseload and myriad overlapping signs and symptoms with other differentials is leaving physicians fatigued. This often leads to the use of mental shortcuts - "heuristics" by the strained mind and the inadvertent use of intuitive thought processes rather than the more controlled analytical thinking to cope and speed up the decision-making process. Availability bias - making a recent or vivid patient diagnosis more readily accessible to the mind - and anchoring bias - relying too heavily on a single symptom for deducing diagnosis - are among the most prevalent cognitive biases. Therefore, it is not unexpected that any new cases of acute onset respiratory illness may be mis-diagnosed as coronavirus disease 2019 during the pandemic, significantly impacting the morbidity and mortality of true diagnosis. To reduce the risk of patient harm, it is therefore imperative that medical practitioners be aware of the existence and influence of cognitive bias in clinical decision making and maintain sight of a variety of differential diagnoses to ensure that no adverse condition is overlooked.

Seizure-Induced Hemoptysis in a Pediatric Patient.

Hemoptysis can complicate seizures, albeit rarely. This unfamiliar presentation, reported infrequently in adults, can also affect children. This remains a rare clinical entity in pediatrics and we report one such case and its association with sterol carrier protein (SCP) gene mutation. We present a case of a 16-year-old male with recurrent episodes of hemoptysis following seizures. The diagnostic workup for etiology of the hemoptysis was unrevealing and he was ultimately treated for neurogenic pulmonary edema as a diagnosis of exclusion. He achieved complete resolution with supportive care and diuretics. Our case report describes the clinical and radiological presentation and overall management of post-ictal pulmonary hemorrhage and edema in a pediatric patient. In addition, it reports a new finding of possible association with sterol carrier protein (SCP2) carrier status. It also highlights a rare but potentially life-threatening consequence of inadequate seizure control in pediatric patients.