Emergency Care Round-the-Clock

Here No Matter What

The team at Seattle Children’s Emergency Departmentstands ready round-the-clock to treat any childhood illnessand 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

When Dr. Brianna Enriquez accepteda job at Seattle Children’s in 2006, shefigured she’d seen the worst cases inpediatric emergency medicine. Afterall, she often treated teenage gangmembers for gunshot and stab woundsat the tough county hospital inLos Angeles where she practiced.

It took Enriquez just a few days inher new job to understand thatChildren’s Emergency Department (ED)is in a different league: as the region’sfront door for kids in medical crisis, theED serves the sickest children in oneof the nation’s largest geographicareas – Washington, Alaska, Montanaand Idaho.

“We have a tracking board in theED where the nurses note the chiefcomplaints of all the kids, some ofwhom are being transported to us buthaven’t even arrived yet,” she explains. “As the list gets longer and longerthroughout the day, I see worst-casewords like ‘lethargic, hypoxic andcyanotic.’ If you weren’t used topracticing here and you walked into ourED and looked at that board, it mightscare the heck out of you.”

An extension of critical care

Sarah Hand

Being flown by emergency
transport to the EDbefore
being admitted to the hospital
for brainsurgery is a distant
memory for Sarah Hand.The
5-year-old now matter-of-factly
describesit as “the time I went
to Seattle to have the bugtaken
out of my head.”

Sarah Hand, age 4, was one of nearly800 critically ill children transportedto Children’s in 2011.

Typically very active, the little girlwas unusually tired during a trip toDisneyland – her parents even renteda stroller so she could get around thepark. Once home in Richland, Wash.,Sarah started waking at night,screaming and complaining ofheadaches.

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

Enriquez was first on the scenewhen Sarah arrived. A quick evaluationrevealed abnormally high bloodpressure because the tumor was pressing on Sarah’s brain. Enriquezstabilized Sarah by starting medicationto decrease the swelling, then quicklyconsulted with the neurosurgery teamand started the admit process withclinicians in critical care.

Emergency medicine doctors likeEnriquez are the hospital’s front linefor critically ill children. They stabilizeand resuscitate kids who arrive needinga higher level of care than their localhospitals can provide.

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

Dr. Brianna Enriquez, pediatric emergency medicine specialist

“Our ED wouldn’t be the bestwithout the expertise of our criticalcare specialists,” says Enriquez. “Andcritical care wouldn’t be the bestwithout our ability to get kids stabilizedand admitted in the shortest amount oftime possible.”

Expert diagnosis

Klein and patient

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

Jenny Hood knew something was verywrong with her 2-year-old son Nikoliwhen he couldn’t even smile at thingsthat once made him giggle with delight.

“When I’d say something funny, Icould see in his eyes that he wantedto smile, but he just didn’t have theenergy,” remembers Hood. “He wascompletely lethargic.”

Nikoli had been sick for several dayswith various perplexing symptoms – yet the providers Hood consulted hadnot offered any satisfactory answers.

“At the point he refused to drinkwater, my mother-in-law and I headedto Children’s,” she says. “I had to findsomeone who would help my son."

Hood was relieved when the triagenurse in the ED waiting room agreedthat the toddler needed immediateassistance. After being ushered into anexam room, they met Dr. Eileen Klein.

“After she examined Nikoli, Dr. Kleinkneeled down and looked in our eyes and said ‘I know you’re concerned andso am I. We’re going to test absolutelyeverything we can think of to figureout what’s wrong so we can starttreatment,’” remembers Hood. “Thenshe leaned over and gave me a hugand said, ‘It’s going to be OK.’”

All Hood could do was cry. “It wassuch a relief to know that I could justbe a mom and comfort my baby andnot bear the burden of staying on topof doctors to get answers.”

Building a sense of trust withfamilies – and providing a healthy doseof compassion – defines doctors andnurses alike in the ED.

“One of the things we do best isquickly assess how sick a child is,”explains Klein. “Once we figure thatout, we decide if we can handle it onour own or if we need to consult withour colleagues in another specialty atChildren’s. You can say we’re specialistsat figuring out when a child needs aspecialist!”

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

In the end, Klein’s diagnostic workrevealed that Nikoli’s enlarged heartwas connected to bacterial meningitis – a potentially deadly infection ofthe membranes around the brain andspinal cord. He was also suffering froma severe sinus infection and pneumonia.

Hood was right. She did indeed havea 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
regionwho depend on our ED
for expert advice on all types
of pediatric concerns.

Cindy Small stopped counting afterthe 50th trip to the ED with herdaughter Allison, now 18. Born withhydrocephalus, Allison has severedevelopmental issues and the mentalcapacity of a 6-month-old, and needscare 24 hours a day.

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

For many parents like Small, the EDis the place they count on – especiallyon nights and weekends – to managethe multiple, complex health needsthat result from conditions like hydrocephalus, cancer, pulmonarydiseases, diabetes, spinal cord defects,cerebral palsy and issues resultingfrom premature birth.

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

“Kids like Ali who frequently comethrough our doors aren’t treated likefirst-time visitors,” Enriquez explains. “We pick up where we left off and wework in tandem with our MedicallyComplex Child Service to give themthe continuity of care they need.”

In November 2011, Small and herfamily moved from Arlington, Wash.,to Idaho. She’s grateful for the yearsof integrated care at Children’s – andfor the ED team who treated Ali justlike she was their own.

“The doctors and nurses in the EDacknowledged that I knew my daughterbest,” says Small. “They listened andthey looked to me for answers. I can’tsay enough about how good that mademe 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 anappointment when she receivedan urgent call from her daughter’sdaycare: Abigail, 5, had fallen whenher friend threw a ball and she letgo of the climber to catch it.

The ED team manages nearly40,000 visits each year – topcomplaints include playgroundmishaps, sports injuries, respiratoryinfections, asthma attacks andabdominal pain. In Abby’s case, shebroke both bones in her forearm.

Not only does the team want kidslike Abby to experience treatmentwithout trauma, they also want themto head home with a smile.

Paul Foster, the ED’s child lifespecialist, plays an important role.He tells kids what’s happening inwords they can understand and usesage-appropriate distractions duringprocedures, which goes a long wayin turning down the volume on fear.

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

For Abby, that meant getting tohold a sample IV tube while Fostershowed her how it worked, thenreading a fairy book with him whilea nurse inserted the IV.

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

No worse for wear, Abby says shewants to be an emergency room doctorwhen she grows up because “they arethe smartest doctors of all!”