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Thanks to Dr. Patrick for her expertly-presented M&M today.Key points from today’s discussion:* Diagnostic inertia, or the persistence of a diagnosis and treatment plan based on that diagnosis despite discordant evidence, is a powerful driver for bad outcomes in the emergency department. We are particularly susceptible to this type of cognitive error, which is closely related to early diagnostic closure or diagnostic anchoring, because we hand off patients to incoming providers and cede control over patients to consultants and admitting services while we manage the front door. When a patient’s course is not as expected, retreat from the plan and reconsider the presumptive diagnosis.* Pericardial tamponade is an immediately life-threatening diagnosis. When point of care ultrasound demonstrates a pericardial effusion in a crashing patient, immediate pericardiocentesis performed by the emergency physician is warranted.* When point of care ultrasound demonstrates a pericardial effusion in patient who is not crashing but shows any clinical signs of tamponade (most importantly hypotension or tachycardia but also JVD and evidence of end-organ hypoperfusion such as elevated lactate, renal failure, chest pain or mental status changes) an immediate cardiology consultation is warranted to perform formal echocardiography and assess for tamponade physiology.* Patients with chronic effusions can develop rapidly evolving tamponade.* Dialysis is not usually an appropriate therapy for an unstable patient. Most patients who require dialysis to address conditions that have made them clinically unstable require medical optimization prior to dialysis.* When overwhelmed in the resuscitation area, consider recruiting help from the zone (MDs, RNs, technicians).* Consultants often do not appreciate the environment in which we work. Bringing them to the ED for an in-person assessment may optimize their perspective and may occasionally be helpful as a patient management resource.