Peds M&M - Dr. Mofield

Case - 7 month old male - hx of complex congenital heart disease

• Presented with hypoxia, unresponsiveness and cyanosis
• On arrival to OSH, patient was looking better, had CXR which showed prominent perihilar opacities, sats in high 90s on 4 L NC after one neb treatment and was DC'ed home.
  

• Note states mom was demanding and refused admission
• > 1 hr later arrived at our ED - sats have dropped to 70-80s with increased WOB;tachycardic with crackles throughout with systolic ejection murmur - per mom child missed one dose of lasix
  

• Mom is refusing IV access! 
  

           * Discussion - How do deal with difficult interactions in the pediatric ED - Dr. MacNeill:
                - Be on the same team as the parent - you both want the kid to live
                - Be aware of the limitations of the members of your team and if things aren’t going well, rearrange things
                - Be empathetic - If you can’t make it, fake it!

• Be aware of affective bias - KNOW when a patient is irritating or difficult, be aware how that is impacting your care and change your perception and management if necessary
• Often the "difficult" parents have been made difficult by the medical system and the inherent issues with having their child in the hospital for extended times with various levels of care and consistency.
  

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