First, you guys are amazing. I found your podcast after listening to an episode where you guested on the curbsiders, and I’ve been hooked since! I’m working my way through all of the rlr episodes, and recently listened to the episode about a patient with chf and cholesystalgia. The very next week, I saw a patient in my small community ED with days of RUQ pain. Recent history of infective endocarditis, complicated by significant aortic regurgitation requiring valve replacement. Valve replacement surgery complicated by 3rd degree heart block post operatively requiring pacemaker placement. Vitals were stable in triage, physical exam showed well healing surgical incisions, no signs of infection, regular rate and rhythm, mechanical valve clearly auscultated. Patient was tender in RUQ, +Murphys. No rebound or guarding. laboratory workup was unremarkable with the exception of being slightly supratherapeutic on warfarin (INR 3.3 with a target of 2-3) , ruq US showed some gallbladder wall edema, but no stones or pericholecystic fluid. per radiology report, “in the right clinical setting, this could be consistent with acute cholecystitis”.

Something did not quite feel like an acute chole, so I did a quick POCUS and on subxiphoid view I noted a HUGE effusion.

He ended up being transferred to tertiary center for pericardial window placement. I reviewed his op report, he had a 900 cc hemopericardium! Slow bleed after surgery that didn’t resolve due to anticoagulation.

*learns something new on podcast*

Week passes

*opportunity to cement learning walks into ED*

Thank you guys for everything you do! Your work helps create better clinicians!!

Rabih and Reza are all-star clinicians that teach with such authenticity and humbleness the art of clinical reasoning. Learning their diagnostic schemas through videos and diagrams and reinforcing the knowledge in the context of case discussions will give you unparalleled confidence in being complete with your differential diagnosis in such a straight forward and conceptual manner. I have found so much joy in medicine through their resources and discussions!

Fascinating cases and comprehensive discussion! The teaching videos and the reasoning process are amazing! Highly recommend!

I have been listening to the clinical problem solvers, specifically Rabih and Reza for the last 3.5 years. I will forever be climbing Mt Dx for the rest of my career, however I have noticed improvement in myself when it comes to clinical reasoning and creating schemas. This is by far because I have been dedicated to listening to both Rabih and Reza discussing cases, sharing their illness scripts and schemas. They are incredible teachers and physicians but, they are also incredible individuals which makes learning that much more fun!! This is a resource that is a must have for any individual who is taking care of patients!

I have been practicing medicine for a while and Reza and Rabih have really brought the spark back! I work in rural medicine and see a lot of undifferentiated disease, so this resource is truly amazing. And this is just a small part of the efforts of cpsolvers, much of which is provided free to the international medical community. A real inspiration at all levels!