Risk Management Pitfalls in Management of Pediatric Patients With Cold Injuries
6. “I obtained an initial temperature but did not continuously monitor it.”
Continuous temperature monitoring will indicate whether the interventions are working or more aggressive therapy is needed. Having an appropriate probe for monitoring core body temperature is imperative; the temperature measurement method may need to be changed, based on the rewarming method being used.
7. “I was 2 boluses in before I remembered to give heated IV fluids.”
Do not forget to prewarm isotonic fluids before administering a bolus. Cold IV fluids can cancel the benefits of other rewarming therapies. If there is time, prewarm the fluids so that they are ready on the patient’s arrival.
10. “I didn’t think getting the patient to an ECMO center would make a difference.”
If you identify a patient who needs ECMO and it is not available at your center, transfer the patient as early as possible. Contacting the ECMO center yourself can help facilitate the transfer and prepare the accepting hospital’s ECMO team. As a hospital system, performing in situ simulation for a critically ill patient in need of ECMO will help prepare for the infrequent times it occurs. For high-acuity, low-frequency emergencies like this, simulation can identify process and management issues in your hospital.
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