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Emergency Care Round-the-Clock

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Here No Matter What

The team at Seattle Children’s Emergency Department stands ready round-the-clock to treat any childhood illness and injury – from the catastrophic to the common.

Enriquez and Keenan

Reviewing the chief complaint list, Dr. Brianna Enriquez (left) and Linda Keenan, RN, see the daunting list of maladies of kids in the ED and on their way. “I’m there for the greatest and worst moments of families’ lives,” says Enriquez. “I always carry that responsibility, and it’s insanely fulfilling.”

When Dr. Brianna Enriquez accepted a job at Seattle Children’s in 2006, she figured she’d seen the worst cases in pediatric emergency medicine. After all, she often treated teenage gang members for gunshot and stab wounds at the tough county hospital in Los Angeles where she practiced.

It took Enriquez just a few days in her new job to understand that Children’s Emergency Department (ED) is in a different league: as the region’s front door for kids in medical crisis, the ED serves the sickest children in one of the nation’s largest geographic areas – Washington, Alaska, Montana and Idaho.

“We have a tracking board in the ED where the nurses note the chief complaints of all the kids, some of whom are being transported to us but haven’t even arrived yet,” she explains. “As the list gets longer and longer throughout the day, I see worst-case words like ‘lethargic, hypoxic and cyanotic.’ If you weren’t used to practicing here and you walked into our ED and looked at that board, it might scare the heck out of you.”

An extension of critical care

Sarah Hand

Being flown by emergency transport to the ED before being admitted to the hospital for brain surgery is a distant memory for Sarah Hand. The 5-year-old now matter-of-factly describes it as “the time I went to Seattle to have the bug taken out of my head.”

Sarah Hand, age 4, was one of nearly 800 critically ill children transported to Children’s in 2011.

Typically very active, the little girl was unusually tired during a trip to Disneyland – her parents even rented a stroller so she could get around the park. Once home in Richland, Wash., Sarah started waking at night, screaming and complaining of headaches.

“She kept telling us that there was a bug in her head,” recalls her dad, Paul Hand. After several doctor visits, Sarah’s parents insisted on a CT scan that revealed a golf ball-sized tumor on her spinal cord at the back of her brain. She was immediately airlifted to Children’s ED with mom Merlita Hand by her side.

Enriquez was first on the scene when Sarah arrived. A quick evaluation revealed abnormally high blood pressure because the tumor was pressing on Sarah’s brain. Enriquez stabilized Sarah by starting medication to decrease the swelling, then quickly consulted with the neurosurgery team and started the admit process with clinicians in critical care.

Emergency medicine doctors like Enriquez are the hospital’s front line for critically ill children. They stabilize and resuscitate kids who arrive needing a higher level of care than their local hospitals can provide.

“We don’t know when you’re coming, we just know it’s the worst day of your life.”

Dr. Brianna Enriquez, pediatric emergency medicine specialist

“Our ED wouldn’t be the best without the expertise of our critical care specialists,” says Enriquez. “And critical care wouldn’t be the best without our ability to get kids stabilized and admitted in the shortest amount of time possible.”

Expert diagnosis

Klein and patient

Dr. Eileen Klein, pictured with Nikoli, 3, is as much a detective as she is a doctor. Her work to diagnose Nikoli’s mysterious symptoms saved his life.

Jenny Hood knew something was very wrong with her 2-year-old son Nikoli when he couldn’t even smile at things that once made him giggle with delight.

“When I’d say something funny, I could see in his eyes that he wanted to smile, but he just didn’t have the energy,” remembers Hood. “He was completely lethargic.”

Nikoli had been sick for several days with various perplexing symptoms – yet the providers Hood consulted had not offered any satisfactory answers.

“At the point he refused to drink water, my mother-in-law and I headed to Children’s,” she says. “I had to find someone who would help my son."

Hood was relieved when the triage nurse in the ED waiting room agreed that the toddler needed immediate assistance. After being ushered into an exam room, they met Dr. Eileen Klein.

“After she examined Nikoli, Dr. Klein kneeled down and looked in our eyes and said ‘I know you’re concerned and so am I. We’re going to test absolutely everything we can think of to figure out what’s wrong so we can start treatment,’” remembers Hood. “Then she leaned over and gave me a hug and said, ‘It’s going to be OK.’”

All Hood could do was cry. “It was such a relief to know that I could just be a mom and comfort my baby and not bear the burden of staying on top of doctors to get answers.”

Building a sense of trust with families – and providing a healthy dose of compassion – defines doctors and nurses alike in the ED.

“One of the things we do best is quickly assess how sick a child is,” explains Klein. “Once we figure that out, we decide if we can handle it on our own or if we need to consult with our colleagues in another specialty at Children’s. You can say we’re specialists at figuring out when a child needs a specialist!”

In Nikoli’s case, Klein called in a cardiologist from the Heart Center to help her figure out why the boy’s chest X-ray showed an enlarged heart.

In the end, Klein’s diagnostic work revealed that Nikoli’s enlarged heart was connected to bacterial meningitis – a potentially deadly infection of the membranes around the brain and spinal cord. He was also suffering from a severe sinus infection and pneumonia.

Hood was right. She did indeed have a very sick boy.

Continuity of care

Seattle Children's clinician on phone

Seattle Children’s specialists answer 3,000 calls each month from clinicians throughout the region who depend on our ED for expert advice on all types of pediatric concerns.

Cindy Small stopped counting after the 50th trip to the ED with her daughter Allison, now 18. Born with hydrocephalus, Allison has severe developmental issues and the mental capacity of a 6-month-old, and needs care 24 hours a day.

“When Ali was one day old, we brought her to Children’s and it’s been one thing after another ever since,” says Small.

For many parents like Small, the ED is the place they count on – especially on nights and weekends – to manage the multiple, complex health needs that result from conditions like hydrocephalus, cancer, pulmonary diseases, diabetes, spinal cord defects, cerebral palsy and issues resulting from premature birth.

“Ali is the type of kid that other emergency departments look at and say, ‘oh my, what do we do with her?’” says Small. The few times she took Ali somewhere else for emergency care, they ended up being sent on to Children’s.

“Kids like Ali who frequently come through our doors aren’t treated like first-time visitors,” Enriquez explains. “We pick up where we left off and we work in tandem with our Medically Complex Child Service to give them the continuity of care they need.”

In November 2011, Small and her family moved from Arlington, Wash., to Idaho. She’s grateful for the years of integrated care at Children’s – and for the ED team who treated Ali just like she was their own.

“The doctors and nurses in the ED acknowledged that I knew my daughter best,” says Small. “They listened and they looked to me for answers. I can’t say enough about how good that made me feel as a parent.”

Easing the anxiety

Abigail Nelson

After falling from play equipment and breaking her arm while in preschool, Abigail Nelson, now 6, got a full-arm cast in the ED and left smiling thanks to the team’s focus on delivering compassionate care.

Megan Nelson was headed to an appointment when she received an urgent call from her daughter’s daycare: Abigail, 5, had fallen when her friend threw a ball and she let go of the climber to catch it.

The ED team manages nearly 40,000 visits each year – top complaints include playground mishaps, sports injuries, respiratory infections, asthma attacks and abdominal pain. In Abby’s case, she broke both bones in her forearm.

Not only does the team want kids like Abby to experience treatment without trauma, they also want them to head home with a smile.

Paul Foster, the ED’s child life specialist, plays an important role. He tells kids what’s happening in words they can understand and uses age-appropriate distractions during procedures, which goes a long way in turning down the volume on fear.

50% of all children in our hospital are admitted from the ED.

For Abby, that meant getting to hold a sample IV tube while Foster showed her how it worked, then reading a fairy book with him while a nurse inserted the IV.

“To this day, I can still see Abby leaving the ED,” remembers Nelson. “She had a cast from her shoulder to her hand and a beaming smile.”

No worse for wear, Abby says she wants to be an emergency room doctor when she grows up because “they are the smartest doctors of all!”

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