A magical emergency department visit

When 3-year-old Vinny and his mom Nikki visited CHOC for the first time, they didn’t expect a calming experience thanks to a magic show, or that staff would go above and beyond to make them feel comfortable.  

 Vinny had a fever, and his pediatrician suspected pneumonia. After a few days of antibiotics, the fever returned, prompting his trip to the Julia and George Argyros Emergency Department at CHOC Hospital. 

“His pediatrician had told us that if Vinny didn’t seem to get better, we should rush him to CHOC,” Nikki says. 

Nikki called the emergency department before bringing Vinny in, to check on COVID-19 visitor requirements. His fever was nearly 104 degrees when they left the house for their first-ever visit to CHOC. 

 Nikki and Vinny remember feeling nervous, stressed and scared when they arrived, but appreciated how CHOC staff reassured the two from the very beginning.  

“Everyone had a very palpable sense of confidence that they will take care of the children, while also being super soothing and calming in their attitude and demeanor,” Nikki says. 

In the emergency department, Vinny was given a COVID-19 test. He’d had one before but had a much smoother experience this time. 

“Vinny has had a test done elsewhere prior to being at CHOC and that experience was traumatic for him,” Nikki says. “The test done at CHOC was faster and went smoothly thanks to the child life specialists who helped distract him.” 

Vinny’s vitals and stats were checkedand he was prepared for a chest X-ray. The X-rays showed that he not only had pneumonia, but also pleural effusion, a buildup of excess fluid in the lungs. 

Dr. Seth Brindisa board-certified pediatric emergency medicine specialist is an expert in taking care of sick kids. But before he discussed the X-rays results with Nikkihe put Vinny at ease with something else he excels in — magic tricks. He greeted Vinny by pulling a coin from behind the 3-year-old’s ear. That trick was followed by a series of magic tricks that brightened Vinny’s evening, and eventually, his entire experience at CHOC. 

Vinny pictured outside CHOC
Vinny smiles behind his mask outside CHOC, after being discharged.

Aside from magic tricks, Dr. Brindis also had a treatment plan up his sleeve. He sent Vinny home with a prescription for stronger antibiotics and ainhaler. He also explained to Nikki what should and should not happen with Vinny while he healed at home. 

choc emergency department
Dr. Seth Brindis often performs magic tricks for his patients.

“From early on, CHOC always had a future plan, and communicated that to us,” Nikki says. “I was always able to ask whatever questions, and they had answers.” 

Nikki and Vinny went home, but four days later his fever returned, and he was unable to breathe, so they returned to CHOC’s emergency department.  

This time, doctors determined that Vinny needed to be admitted to CHOC Hospital for further evaluation and treatment. As part of this process, he was tested a third time for COVID, an experience that again went smoothly, thanks to the child life specialists of the Cherese Mari Laulhere Child Life Department. 

Vinny stayed at CHOC for a week for stronger antibiotics, monitoring and supplemental oxygen. Throughout his stay, he was under the care of a multidisciplinary team of pediatric experts. This included Dr. Antonio Arrieta, medical director of infectious diseases, who was determined to help Vinny feel better. This level of care helped Vinny’s mom feel better, too. 

Dr. Antonio Arrieta
Dr. Antonio Arrieta, medical director of infectious disease at CHOC

Dr. Arrieta was truly one of the most intelligent human beings I’ve ever had a conversation with, and we felt extremely comfortable in his care and that of his whole team,” Nikki says. 

Being in a hospital for the first time was not easy for Vinny. He’s a naturally active child, but due to his compromised lungs and playrooms being temporarily closed due to the pandemic, he was unable to play in areas outside of his room. Luckily, Child Life had just the thing for him. A specialist showed up to his room with a box full of plastic bowling pins and a ball. Vinny was thrilled, and so was his mom 

“Every single nurse, respiratory therapist, child life specialist and doctor we met was just amazing,” Nikki says. “The only thing you truly want in a situation like this as a parent is for your child to be healing and comfortable, and they all worked to make that happen daily.” 

Vinny’s treatment plan was successfulAfter his fever subsided and his symptoms improved greatly, he was able to go back home. 

“Bringing my child to the hospital for the first time was scary at first, especially during a pandemic,” Nikki says. “I will always remember the kindness and world-class expertise that helped my son feel better and get back to being a kid. Vinny will never forget how a doctor turned into a magician right before his eyes. 

Health Workers on Alert for Measles

New measles cases continue to be reported in Measles_alertOrange County, leaving health care providers on alert for potential cases of the contagious disease.

“Any one case is troubling,” says Dr. Antonio Arrieta, CHOC director of infectious diseases. ”We shouldn’t be seeing measles in the U.S.”

The state has seen an increase in measles cases this year: Less than four months into the year, California has seen more measles cases in 2014 than in the entire year of 2010, the most recent year of available data.

Symptoms begin with high fever, transition to rash

Highly contagious, measles is transmitted through the air, Dr. Arrieta says. The disease is also strong: Contagions can remain in the air for hours after an infected person leaves an area, he says.

Symptoms typically begin to surface eight to 10 days after initial exposure to the virus, and then develop in stages. Early symptoms include a high fever – typically between 103 and 105 degrees Fahrenheit – cough, watering eyes and runny nose. A rash becomes apparent around the third day of symptoms, worsening the next day and continuing to spread over the body as the disease progresses.

People are contagious about four days before the rash begins and four days afterward, according to the Centers for Disease Control (CDC).

Measles is not treated. Instead, physicians allow the disease to run its course, while monitoring for possible complications, which are more dangerous than the disease itself. Dr. Arrieta says that most children with measles will develop pneumonia, which the CDC reports as the complication most likely to cause death in youth. One in 10 measles cases leads to ear infections, and 8 percent of sufferers report diarrhea, the CDC says.

A child with measles. Source: Centers for Disease Control
A child with measles. Source: Centers for Disease Control

Further, one child in every 1,000 measles cases will develop a brain inflammation that can lead to convulsions, the CDC reports.

Immunity ‘critical mass’ is necessary

“This highlights the problem that if you’re not immunized, you are at risk,” Dr. Arrieta says.

Dr. Arrieta emphasizes that the vaccine is safe and readily available. Following the vaccination, some children have mild reactions, such as a short-lived, low-grade fever.

Ninety percent of the population must be immune to measles to stop or prevent the spread of the disease – and that rate must factor people who cannot have the vaccine for health reasons or age, or those who don’t develop immunity from the vaccine, says Dr. Arrieta.

“If you account for many people who are not immune because they are too young, or have a condition that prevented them from getting the vaccines, then you are in a constant state of being close to that critical 90 percent,” he says. “If you account for all of those who can’t have the vaccine, and those who don’t want to, you’re getting even closer to going below 90 percent. In that case, at any given time, it will spread.”

The MMR vaccination – which covers measles, mumps and rubella – is administered in two doses. The first is given between 12 and 15 months of age, and yields a 90 percent chance of developing immunity against measles. The second dose can be given four weeks later, but is typically administered at age 4 or 5, and pushes the likelihood of measles immunity to 95 percent.

Measles widespread in foreign countries

Most measles cases in the United States – including two of Orange County’s reported cases in 2014 – are contracted by international travel, according to the CDC.

The CDC reports that measles is widespread throughout the world, including parts of Europe, Asia, the Pacific and Africa. Dr. Arrieta cautions parents that even developed countries report measles cases.

“Oftentimes, people don’t recognize that the countries they are traveling to have frequent measles cases,” he says. “Cases come from Europe, where people don’t think they’re at risk. It is a very small world these days.”

Learn more about the infectious diseases division at CHOC.

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