Objective Mobilization while receiving life support interventions, including mechanical ventilation and extracorporeal membrane oxygenation (ECMO), is a recommended intensive care unit (ICU) intervention to maintain physical function. The purpose of this case report is to describe a novel approach to implementing early mobility interventions for a patient who was pregnant and receiving ECMO while continuing necessary infectious disease precautions because of diagnosed coronavirus disease-19 (COVID-19). Methods (Case Description) A 27-year old woman who was pregnant was admitted to the ICU with COVID-19 and rapidly developed acute respiratory failure requiring 9 days of ECMO support. After a physical therapist consultation, the patient was standing at the bedside by hospital day 5 and ambulating by hospital day 9. Results The patient safely participated in physical therapy during ICU admission and was discharged to home with outpatient physical therapy follow-up after 14 days of hospitalization. Conclusion Early mobility is feasible during ECMO with COVID-19, and active participation in physical therapy, including in-room ambulation, may facilitate discharge to home. Innovative strategies to facilitate routine activity in a patient who is critically ill with COVID-19 require an established and highly trained team with a focus on maintaining function. Impact Early mobility while intubated, on ECMO, and infected with COVID-19 is feasible while adhering to infectious disease precautions when it is performed by an experienced interdisciplinary team.

The use of heuristics, cognitive rules of thumb or shortcuts, are a common part of medical decision making. While using heuristics lessens the cognitive burden of decision making and often comes up with the correct answer, reliance on heuristics can also lead to medical errors. In this introduction we will define heuristics and discuss some of the more common heuristics/biases that may lead to biased decision making and patient harm. We will also look at the use of language in medicine and how that can lead us to make diagnostic errors.

This publication is a continuation of the article published in the 4th issue of the journal Russian family doctor for 2020 Heuristics, language and medical errors, which described the ways of making medical decisions that can lead to errors in patient management tactics, in particular affect of heuristics / visceral bias, attribution error, frame of reference, availability bias, one-word-one-meaning-fallacy. This article discusses additional sources of diagnostic error, including diagnosis momentum, confirmation bias, representativeness, and premature closure also the conflict that arises from diagnostic uncertainty is discussed. All errors in the tactics and the diagnostic process are illustrated by clinical cases from the personal practice of the author of the article.