By Dr. Sarah Kay Herrera, a CHOC Children’s pediatrician
At CHOC Children’s, we know that parents want to be confident they’re giving their child the best care. In order to do that, you need to know where to bring them when they’re sick, but the problem is there are so many options: Do I bring them to the pediatrician’s office? Urgent care? Emergency department? This can make you feel overwhelmed and confused – especially with cold and flu season just around the corner.
We believe parents should have peace of mind they are getting their child the best care. We know it can be scary, stressful and sad to have a sick child. That’s why our Primary Care Network has 16 convenient locations throughout Orange County and beyond. CHOC Children’s Hospital in Orange offers the only emergency department in Orange County that’s just for kids. At the Mission Hospital Emergency Department, in partnership with CHOC Children’s at Mission Hospital, kids and families have access to pediatric-trained nurses, physicians and specialists.
To help you make decisions about where to go for care, consult this guide:
Your pediatrician’s office is not only a place for check-ups, but your primary resource for sick visits as well. Your child’s pediatrician is the doctor who already knows your child’s medical history.
You will need to set an appointment for a sick visit, which could include symptoms like fever, runny nose, cough, ear pain, headaches, sore throat, rashes or abdominal pain.
If your child is experiencing a chronic lingering issue such as abdominal pain or headaches, it is best to see your pediatrician as they can provide ongoing care and find a pattern in the symptoms, which is important for more complex illnesses.
Urgent care offices are usually open after business hours, which is typically after 5 p.m. and weekends.
Most are walk-in clinics and do not take appointments. This means you can usually expect long wait times. This is the best place to go for acute illness such as fevers, ear pain, runny nose, cough, sore throat, vomiting, diarrhea, minor falls, and stitches.
Sometimes your pediatrician or an urgent care provider may decide your child is too ill to go home and they may send you to the emergency department for further treatment or testing.
In some cases, it’s best to go straight to the emergency department for apparent life-threatening events, which could include rapid and fast breathing, head trauma, trauma with loss of consciousness or vomiting, motor vehicle accidents, severe abdominal pain or dehydration.
An infant less than 28 days old with a fever of 100.4 degrees or higher is considered an emergency and should be taken directly to the ED.
Not all urgent care clinics and emergency rooms take care of children on a regular basis. It is best to go somewhere that specializes in children’s health. Pediatric-focused facilities have specialized training and equipment to offer the best care for your child.
Most pediatrician offices have a phone triage line to help parents decide which place may be best for their child.
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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.
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.
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.
“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.
Staffed around the clock by our world-class team of pediatric emergency medicine physicians, pediatric nurses and other specially trained healthcare professionals, the Julia and George Argyros Emergency Department opens in ...
“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.”
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.
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.
“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.”
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.
“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.”
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.