What Every Parent Should Know About Emergency Departments During Flu Season

This year, thousands of people are packing their local emergency department during flu season. As the region’s only pediatric-dedicated facility, the Julia and George Argyros Emergency Department at CHOC Children’s Hospital is seeing an extremely high number of patients, from infants to teens. Our physicians and staff understand how anxious and scared parents and children can get when faced with a trip to the emergency department. They offer the following information and tips for parents coming to the emergency department during the busy flu season:

  • Be prepared to see a full lobby, including people seated in chairs down hallways and in additional areas throughout the department. Typically, the department gets busier as the day progresses. CHOC has added staff to help manage wait times.
  • Leave siblings and other family members at home, if possible. This will help ease crowding, but more importantly, keeps well children from being exposed to sick ones. Also, parents’ attention should be focused on their ill or injured children.
  • Patients are seen based on how sick or injured they are, not on the order they arrived in the emergency department. Please keep in mind there are patients who arrive in ambulances – admitted in an area beyond your view. Our staff must treat the sickest first. If you’ve been waiting and are concerned your child’s condition is getting worse, please ask a nurse to reassess her.
  • Hold off on giving food or drink to your child until she’s been seen by the doctor. A full stomach can delay procedures and the use of sedatives.
  • There are nurses and emergency medical technicians (EMT) who work in the lobby and have different roles. Nurses, dressed in maroon scrubs, help screen and assess patients; some will assist with lab work or X-rays. EMTs, dressed in tan scrubs, can only take vitals and measure height and weight. EMTs will notify the nurses in the lobby of any changes they observe in patients’ conditions.
  • Don’t expect a prescription for antibiotics, which aren’t always the answer. Antibiotics can only treat infections caused by bacteria. Cold illness caused by viruses can’t be cured with an antibiotic.
  • Try to stay calm. Children can pick up on their parents’ fear and anxiety. Take deep breaths for your and your child’s sake.
Download a checklist of what to bring to the emergency department

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CHOC Emergency Department Honored for Exceptional Practice and Innovative Performance

The Julia and George Argyros Emergency Department at CHOC Children’s Hospital is one of only three emergency departments in California — and 22 in the country — to be named a 2017 Lantern Award recipient from the Emergency Nurses Association.

The honor recognizes emergency departments across the nation for demonstrating excellence and innovation in leadership, practice, education, advocacy and research.

Recipients of the award went through a rigorous application process, during which they had to provide outcome metrics, as well as descriptive examples that highlighted the following:

  • Practice – qualities that foster professional pride, confidence and a community of support for emergency nurses
  • Leadership – operational improvement initiatives, including new systems and processes that positively impact department operations
  • Education – quality and accessible education that instills knowledge and enhances competencies
  • Advocacy – efforts that enhance the emergency nursing profession and quality patient care
  • Research – quality improvement research and the evaluation of clinical outcomes

“Our team is dedicated to providing safe, quality care based on evidence-based practices.  We are honored to have our commitment recognized by the Emergency Nurses Association, and will continue to push ourselves to provide the best possible emergency medicine and trauma services to the children and families who depend on us,” says Frank Maas, RN, BSN, MBA, director of the CHOC ED.

The 22,000-square-foot, full-service CHOC ED is exclusively dedicated to the treatment of pediatric patients.  It features 31 treatment rooms, including several rapid evaluation and discharge rooms and three triage suites.

The department will be presented with its Lantern Award at the Emergency Nursing Conference 2017 in St. Louis, Missouri this month.

The Lantern Award honors the legacy of Florence Nightingale, referred to as the “Lady of the Lamp” for her actions during the Crimean War.  Working throughout the night, she would bring a lantern to help her see and tend to the wounded soldiers.  She is credited with changing nursing from an untrained job to a skilled, science-based profession.

Learn more about emergency services at CHOC Children's

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Meet Dr. Seth Brindis

In addition to providing high-quality medical care, physicians and staff at the Julia and George Argyros Emergency Department at CHOC Children’s Hospital strive to make the experience less stressful for children and families. One physician has a few tricks to ease his patients’ fear and anxiety. Dr. Seth Brindis, a board-certified pediatric emergency medicine specialist and medical director of informatics, performs magic for his patients.

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Physicians in the CHOC emergency department strive to make the experience less stressful for children. Dr. Seth Brindis often performs magic tricks for his patients.

“For me, magic makes my job easier, instantly transforming what can be a scary experience for children to something fun. I incorporate magic into my physical exam as it makes the exam easier and more reliable when patients are comfortable with me and distracted. I tend to use coin tricks because they appeal to a wider range of ages, with the added benefit that the coins can be disinfected between patient contacts.”

Luckily, it doesn’t have to be an emergency in order to see Dr. Brindis’ magic. With help from child life, he occasionally puts on impromptu magic shows in the CHOC theater for inpatients, their siblings and parents.

Dabbling in magic since childhood, Dr. Brindis’ interest in magic was revitalized while in residency at Harbor-UCLA Medical Center, where he realized that simple tricks with cards and coins could help make connections with patients and staff. Since then, he has continued to study magic, even taking courses tailored for magic in medicine. Seeing thousands of patients each year, Dr. Brindis gets ample time to try out new tricks and help patients and their families leave with positive experiences and smiles on their faces.

Exclusively dedicated to the treatment of pediatric patients, CHOC’s ED features 31 exam rooms, including two trauma bays, and three triage suites. The ED is staffed with doctors who are board-certified in emergency medicine and specially trained nurses who provide the very best patient- and family-centered care. Child life specialists work with patients to help them feel safe and secure, and make the process a lot less stressful for the entire family.

“The ED is often the gateway for many families who are coming to our organization for the first time. We’re working together to deliver the best care to those who need it most. My job is to understand what is distressing to a parent in the middle of the night and either educate and reassure the family or intervene when called for.”

As the only trauma center in Orange County dedicated exclusively for kids, CHOC is ready to treat injuries 24 hours a day. The trauma team is trained to care for children and their unique physiological, anatomical and emotional needs, and CHOC’s protocols and equipment are specially designed for pediatrics.

The ED saw over 49,000 patients in the first year it opened. This year, it’s on pace to see more than 85,000 patients – an incredible rate of growth, which Dr. Brindis credits to the coordination and cooperation between the ED physicians, EMSOC leadership, and nursing, as well as CHOC administration.

“I love being a part of this team. I feel like we provide exemplary care to every person who enters our doors. Often, I feel like the conductor of an orchestra of care. There is no way I could do my job without the incredible people I work with. It really is impressive to watch our team working in concert to stabilize a really sick child.”

Dr. Brindis received his medical degree from Vanderbilt University. He completed his pediatric residency and pediatric emergency medicine fellowship training at Harbor-UCLA Medical Center in Torrance. In addition to caring for patients in the ED, he is actively involved with the training and teaching of pediatric and emergency medicine residents as well as fellows.

In his spare time, Dr. Brindis enjoys spending time with his wife, son and daughter. He also enjoys cooking, painting and, of course, working on his magic.

Learn more about emergency services at CHOC Children's

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CHOC Walk in the Park 2017: Why I Walk – Team Miranda

Seven years ago, Miranda woke up screaming in the middle of the night from unbearable head pain. She couldn’t move or recognize her parents, and then she collapsed.

Miranda’s parents rushed her, a 10-year-old at the time, to a local hospital. Physicians there initially told them to wait three days for observation.

Dr. Jason Knight, a CHOC Children’s pediatric critical care specialist and medical director of CHOC’s emergency transport services, was on call at that hospital that day, and met with Miranda’s parents, Regina and John.

An Emergency Transport to CHOC

“Dr. Knight explained what was happening better than anyone else at the hospital,” Regina remembers. “He suggested we transport her to CHOC so she could be seen by pediatric specialists. We were scared to move her, so we asked Dr. Knight if he would transport Miranda if she were his own daughter. He said yes, and we trusted him.”

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Dr. Jason Knight, critical care specialist, chair of the department of medicine, and medical director of emergency transport services at CHOC Children’s

Dr. Knight recalls, “As the physician covering the local hospital that day, it was my responsibility to assure that Miranda received the appropriate care in a timely manner. As soon as I assessed her condition and reviewed the CT scan of her brain, it was clear to me that Miranda needed to be transferred to CHOC immediately. I contacted Dr. Michael Muhonen, a pediatric neurosurgeon at CHOC, and coordinated Miranda’s transfer to CHOC.”

Scans revealed she had an arteriovenous malformation (AVM), a tangle of weakened blood vessels that had ruptured and started to bleed in her brain. Upon arrival at CHOC, Miranda immediately underwent neurosurgery with Dr. Muhonen, medical director of the neuroscience institute at CHOC.

“Miranda was critically ill upon arrival to CHOC. She reminded me of my own three daughters― innocent, beautiful and vulnerable. It was with this in mind that I approached her operation― do what it takes to keep her brain alive and functional,” recalled Dr. Muhonen.

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Dr. Michael Muhonen, medical director of the neuroscience institute and director of neurosurgery at CHOC Children’s

After a successful four-hour surgery, Miranda was placed in a medically-induced coma for several days. Her parents didn’t know if she would survive.

“When Miranda was in a coma, I told Dr. Knight that I wanted to take a photo of her so that I could show her when she woke up, but that I didn’t want to take it if she wasn’t going to make it,” recalls Regina. “For a few days, he wouldn’t let me take the photo because he wasn’t sure if Miranda was going to survive. Then one day, Dr. Knight told me it was ok to take a photo of her, and I knew that meant she was going to make it.”

John adds, “My family is intact today because of wonderful doctors like Dr. Knight, Dr. Muhonen and their teams. It’s just amazing what CHOC does. We are so blessed.”

The Long Road to Recovery

Miranda’s recovery process included child life specialists, physical therapy and rehabilitation. She spent one month at an inpatient rehabilitation facility followed by an additional three months of outpatient care learning how to walk and talk again.

The first year after surgery was critical. Miranda saw Dr. Muhonen every few months for checkups to monitor her brain, as well as a CHOC ophthalmologist to make sure her sight was progressing.

“The AVM and the clot were removed successfully, and Miranda has recovered with minimal long-term deficit,” says Dr. Muhonen. “My reward is not only seeing a disease-free brain on the post-operative MRI, it is the omnipresent smile and effervescent personality that Miranda still has, despite her near-death experience.”

Everything came back except her sight. She lost 25 percent of her vision in both eyes, but that hasn’t stopped her from dancing, her favorite activity since age 8. Miranda’s parents had to supervise her at all times for the first year after surgery to make sure she didn’t have a seizure (a possible side effect of brain surgery), which meant that her mom went to every dance practice and every pool party to ensure her daughter’s continued safe healing.

Giving Back to CHOC

A few months after Miranda’s surgery, her family was invited to participate in CHOC Walk in the Park by friends.

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Miranda and her family at their first CHOC Walk in the Park, just a few months after her emergency neurosurgery

“After what we went through, we felt closely tied to CHOC. We walked that year and fell in love with the event. We realized this was an affordable way to give back to CHOC,” recalls John. “My favorite memory was our very first CHOC Walk. Miranda walked alongside us, which was a huge accomplishment. A couple months before that, we weren’t sure if she was ever going to walk again. To see her walk on her own was the most memorable moment for me.”

The family’s first CHOC Walk was especially impactful for Miranda herself.

“I will never forget attending my first CHOC Walk one year after my surgery. I remember seeing other patients participating in the walk with their own team just like me, only they needed walkers or wheelchairs to have the capability of walking the entire distance. Seeing other patients that were struggling to do the simple task of walking, something that people take for granted, made me reflect back to being a patient at CHOC, where I once struggled with relearning how to walk during physical therapy,” recalls Miranda. “From that moment on, I promised myself I would always participate in the CHOC Walk and give back as much as I could, not only to represent the patients who couldn’t recover as fast as I did, but also for the patients that don’t make it. I am reminded every day by the scar on the back of my head of how blessed I am to have been a patient at CHOC.”

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Every year since her emergency surgery, Miranda’s family rallies dozens of friends to participate in CHOC Walk in the Park.

Every year since then, Miranda’s parents gather dozens of friends, family and co-workers to join Team Miranda, the CHOC Walk team they formed in honor of their daughter. They formed their team with the help of the Littlest Angel Guild, a philanthropic group that raises funds to support the mission of CHOC.

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Miranda and her family at the 2012 CHOC Walk in the Park

“We encourage people we meet to participate in CHOC Walk to help provide the best medical care for the children in our community. You never know if or when CHOC’s services will be needed for your children, for your friend’s children, for your neighbor’s children, or even a stranger,” says John, whose employer, Hill Brothers Chemical Company also sponsors CHOC Walk, in addition to the other philanthropic events benefiting CHOC. “We learned firsthand how much everyone at CHOC cares – the doctors, the nurses, the administrators, and staff throughout CHOC all genuinely care about the children and their families.”

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Team Miranda at the 2013 CHOC Walk in the Park

Experience at CHOC Inspires Future Career

Now a senior in high school, Miranda is preparing for graduation and heading off to college. Inspired by her experiences at CHOC, she is planning to major in psychiatry and dreams of becoming a pediatric optometrist.

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Meet Dr. Mary Jane Piroutek

CHOC Children’s wants its patients and families to get to know its specialists. Today, meet Dr. Mary Jane Piroutek, a pediatric emergency medicine specialist who has been on staff at CHOC for five years. Dr.  Piroutek graduated from the University of California, Irvine School of Medicine. She completed her pediatric residency at CHOC Children’s and a pediatric emergency medicine fellowship at Loma Linda University Medical Center. She’s also an assistant professor in the department of emergency medicine at Loma Linda University.

Dr. Mary Jane Piroutek
Dr. Mary Jane Piroutek

Q: What are your special clinical interests?

A:  I am especially interested in pediatric trauma, environmental injuries, and endocrine emergencies.

Q: What are some new programs or developments within your specialty?

A:  CHOC’s emergency department became a level II pediatric trauma center in 2015. We are the only trauma center in Orange County dedicated exclusively to kids. Or trauma team consists of physicians, nurses, pharmacists, radiology technicians, respiratory therapists, social workers, child life, and a hospital chaplain.

Q: What are your most common diagnoses?

A:  Abdominal pain (from gastroenteritis to appendicitis), seizures, traumatic injuries (lacerations, closed head injuries, fractured arms and legs), and respiratory illnesses (bronchiolitis, asthma, and pneumonia).

Q: What would you most like patients and families to know about you or your division at CHOC?

A:  At CHOC, our emergency department is staffed with fellowship-trained pediatric emergency medicine specialists. Our dual training makes us especially knowledgeable and skilled in caring for your child during their visit. CHOC Children’s is the only emergency department in Orange County that exclusively treats children. Treating children in an environment created especially for them makes what could be a scary experience into something more enjoyable.

Q:  What inspires you most about the care being delivered here at CHOC? 

A:  CHOC delivers the highest level of pediatric care while embracing and caring for the entire family.

Q: Why did you decide to become a doctor? 

A:  In high school I volunteered in a community hospital in the labor and delivery unit. I really enjoyed being part of a family’s joyous occasion. In college I volunteered in the emergency department and marveled at the fast pace, acuity and unpredictably of what the next patient’s case would bring. My academic love for science and solving problems made becoming a physician a very natural fit.

Q: If you weren’t a physician, what would you be and why?

A:  I honestly don’t know. Once I decided that I wanted to be a doctor, I never really considered anything else. I put all of my energy and focus into medicine.

Q: What are your hobbies/interests outside of work?

A:  I like spending time with family and friends and traveling. I am also an avid Anaheim Ducks hockey fan.

Q: What have you learned from your patients? 

A:  Children are brave and have a remarkable capacity for resilience. This is evident in the child that sustains a broken leg playing soccer and is unafraid and eager to play again. Or the teenage cancer patient that is most concerned about how their family is being affected by and is dealing with their illness. My patients are humbling and help me to be a better person.

Q: What was the funniest thing a patient told you?

A:  Kids say funny things all the time. One of my favorites was a little 4 year old girl that had ingested coins and they were stuck in her esophagus. When I asked her what happened she shrugged her shoulder and with a mischievous look in her eyes said, “I ate the money, I’m not supposed to eat the money.”  Also recently a patient told me I looked like Snow White (which I don’t) and she called me Dr. Snow White the whole time I took care of her.

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