Best Practices Rounds Bottom Lines: January 25, 2023
1. Critically ill pediatric patients:
a. When emergent transportation delays occur, this may be devastating for the patient and care team.
i. This issue will need to be addressed at the system level, ideally through a QAR process.
ii. Consideration may be given under these circumstances to the PICU team travelling independently to the site to assist with resuscitation while awaiting ambulance transfer.
b. Parental presence during resuscitation is generally encouraged, but at times may be obstructive to the necessary care. This is a very difficult situation requiring a nuanced approach by the entire team.
2. Cardiac arrest in pregnancy and perimortem C-section:
a. When a pre-alert of the arrest occurs, advance preparation should include:
i. Stat notification to the obstetrics and NICU teams.
ii. Arranging 2 dedicated trauma rooms and assigning teams based on experience (ie pediatric experience).
iii. Delegation of these tasks to a unit clerk or charge nurse to offload preparations.
b. Review necessary equipment ahead of time:
i. A thoracotomy tray will have necessary retractors if procedure is required prior to obstetrics arriving (they will usually bring their own equipment).
ii. Baby warmer and delivery kit.
c. Recognize that it is difficult, both from a learning as well as closure perspective, to not know the cause of a catastrophic patient outcome. Requesting autopsy results for medical examiner cases only requires completion of a form when you are the attending physician (attached).