The Learning Curve

Summary:
Dr. Irtaza Asar and returning guest Dr. Hitesh Gidwani discuss how to manage physiologically unstable pulmonary embolism (PE), from activating a PE response team (PERT) to choosing among anticoagulation, thrombolysis, thrombectomy, surgery, and ECMO. They focus on bedside assessment and practical preparation, including the high-risk decision to intubate a patient with right ventricular strain.
Key Takeaways
The Power of PERT: Dr. Hitesh Gidwani explains how Pulmonary Embolism Response Teams bring together multidisciplinary expertise to coordinate timely, individualized care for patients with significant PE.
Risk Stratification Beyond the Guidelines: The discussion compares traditional European risk categories with the newer AHA/ACC classification, emphasizing that clinical judgment and bedside assessment remain essential.
Treat the Patient, Not the Classification: Management should be guided by the patient's clinical trajectory, hemodynamics, oxygenation, contraindications, procedural risks, and available resources rather than risk categories alone.
ECMO as a Bridge: In patients with cardiac arrest or profound hemodynamic instability, ECMO may provide temporary circulatory support and serve as a bridge to definitive intervention in appropriately selected patients.
Knowing When Not to Intervene: Many intermediate-risk PE patients can be safely managed with anticoagulation and close monitoring. Dr. Gidwani emphasizes avoiding unnecessary interventions driven by clinician anxiety rather than patient deterioration.
Choosing the Right Reperfusion Strategy: The conversation explores systemic thrombolysis, catheter-directed therapies, mechanical thrombectomy, and surgical embolectomy, highlighting their potential benefits, procedural risks, and the limitations of comparative evidence.
Optimizing the Failing Right Ventricle: Early hemodynamic monitoring, cautious fluid administration, thoughtful oxygenation strategies, and selective use of inhaled pulmonary vasodilators can help support patients with significant RV dysfunction.
The High-Risk Airway: Intubation in patients with severe PE can precipitate cardiovascular collapse. When unavoidable, clinicians should optimize hemodynamics before induction, anticipate the effects of positive-pressure ventilation, and prepare rescue strategies.
 

Summary: 
What happens when we find a diagnosis that fits—and stop looking?
In this episode of The Learning Curve, Dr. Asar explores premature closure, a common cognitive bias that can lead clinicians to miss life-threatening diagnoses.
Using an ED chest pain case, we break down how anchoring, confirmation bias, and rapid pattern recognition can interfere with clinical reasoning.
Three strategies to avoid premature closure:
Ask: What else could this be?
Challenge: What findings don't fit my diagnosis?
Pause: What dangerous diagnosis could I be missing?
The takeaway: Finding an answer doesn't mean you've finished thinking. In emergency medicine, speed matters—but so does knowing when to question your first impression.
#EmergencyMedicine #MedicalEducation #CognitiveBias #ClinicalReasoning #PrematureClosure #TheLearningCurve

Summary:
In this episode of TSN5, Dr. Jenna Watts explains how to recognize spinal epidural abscess before neurological damage occurs. Learn why severe or unusual back pain, infection risk factors, elevated inflammatory markers, and a normal neurologic exam can still warrant urgent MRI—and why clinicians should never wait for paralysis to make the diagnosis.

Summary:
Pediatric sepsis just got a major rewrite. In this episode, Dr. Irtaza explains why the old SIRS-based model fell short and breaks down the 2024 Phoenix Sepsis Score. Learn how the new definition focuses on life-threatening organ dysfunction across four systems: respiratory, cardiovascular, coagulation, and neurologic. Key takeaways include a Phoenix score of 2 or more indicates pediatric sepsis, one cardiovascular point signals septic shock, and Phoenix should not be used as an early screening tool. A clear, practical update for anyone caring for acutely ill children.

Summary:
In this episode of The Learning Curve, host Dr. Irtaza Asar is joined by Dr. Jesse Pines for a conversation about the rapidly evolving role of artificial intelligence in medical education and how these technologies are beginning to reshape the way clinicians learn, teach, and make decisions.
Dr. Pines explores the opportunities AI offers for personalized learning, clinical reasoning, knowledge synthesis, feedback, and curriculum development, while also addressing the limitations and potential risks of relying too heavily on these tools. The discussion highlights practical ways educators and learners can thoughtfully integrate AI into their everyday workflows, from generating educational content and accelerating literature review to supporting clinical decision-making and creating more individualized learning experiences.
Ultimately, the conversation moves beyond the hype to examine how AI can be used responsibly—not as a replacement for physicians or educators, but as a powerful tool to augment learning, improve efficiency, enhance teaching, and help shape the future of medical education.
 
Key Takeaways:
AI is shifting medical education from memorization to judgment
AI works best when used for edge cases, not just routine ones
Just-in-time learning is more powerful than after-the-fact studying
The biggest risk is not wrong answers, but missing information
AI use is already happening, so education must focus on literacy, not prohibition
Prompting is becoming a real clinical skill
AI can make teaching more adaptive and personalized
Dr. Pines podcast: Healthcare AI Pioneers

Structural bias can shape patient outcomes through barriers such as delayed interpreter access, limited resources, inconsistent protocols, and unequal access to care. In this episode of TSN 5, Dr. Ryan McLoughlin explains how clinicians can recognize these system-level gaps, respond in real time, and use small, intentional actions to create more equitable care.