Persistent hypoxia in a pediatric patient following a house fire

A 5-year-old female presented to the pediatric emergency department from a community emergency department for persistent hypoxia in the setting of inhalational exposure due to a house fire. The patient had refractory hypoxia despite routine interventions in the referring emergency department. After a thorough physical exam, and further lab work-up, it was determined that the child had complex congenital heart disease that was yet undiagnosed, and her hypoxia was unrelated to her inhalational exposure. This case demonstrates the risk of anchoring bias and premature closure in the emergency department. By maintaining a broad differential diagnosis, this patient received the appropriate care for her complex congenital heart condition. Providers should self-evaluate for early closure and anchoring bias to minimize morbidity and mortality risk to patients. Through an understanding of adult learning and thought-processing patterns, providers can assess their biases and maintain broad differential diagnoses when presented with information contrary to their first impression.