Published: 4 March 2021
Author(s): Alfred Lumala, John Kellett, Jelmer Alsma, Christian H Nickel
Issue: May 2021
Section: Letter to the Editor

The rapid identification at low cost of patients at risk is particularly important in emergency departments in low- and middle-income countries, which may lack experienced emergency healthcare providers and cannot afford to waste scarce resources [1]. Within seconds some clinicians use fast System 1 thinking to determine if a patient is sick or not [2], a judgement often based on the patient's facial expression and their behaviour [3]. Supine emergency room patients with crossed ankles, crossed hands behind the neck, or folded hands over the upper abdomen, as if they were relaxing on a beach, have been reported to be highly unlikely to have any acute critical condition [4].

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