Amanda Wilde (Host): This is BayCare HealthChat. Join us as we explore the essential service of pediatric emergency care with pediatric emergency medicine physician Dr. Juan Carlos Abanses. I'm Amanda Wilde, your host. Dr. Abanses, thank you so much for being here

Dr. Juan Carlos Abanses: Thank you for having me.

Amanda Wilde (Host): Can you explain the difference, first of all, between what you are, a pediatric emergency room physician, versus a pediatrician?

Dr. Juan Carlos Abanses: Sure. So, for pediatric emergency medicine, there's two ways of going into it, but either way, you have to do a residency first, and then you have to do a fellowship. So, you either have to do a pediatric residency, which is what the majority of the physicians of pediatric emergency medicine do, so they usually go on to do a pediatric residency, which is three years of training, followed by another three years of a pediatric emergency medicine fellowship.

You can do emergency medicine residency first and then go into pediatric emergency medicine, which is another two years. So, it's either five or six years of training. So, it's a level training much higher than a regular ER doctor or a regular pediatrician in the community because you have to do this extra how pediatric ERs are specially designed to care for children how pediatric fellowship, which is an additional two to three years, depending on which avenue you took first.

Amanda Wilde (Host): So, there's a difference between pediatrician and pediatric emergency care physician. Can you explain the difference between pediatric emergency training and general emergency training?

Dr. Juan Carlos Abanses: Yeah, so if you take your child to see a general ER physician, they did three years of training in residency, and so with three years of training, they have to do internal medicine, surgery, geriatrics, OBGYN, all those things. So really the amount of training is probably several months, like six months, maybe nine months, in pediatrics.

But to see a pediatric emergency medicine physician, the difference is you had three years of pediatrics to become a pediatrician, and then three more years of taking care of these sickest children that come into a pediatric hospital. So, you have six years of training, versus a couple months worth of training in pediatrics.

So, it's a big difference, it is just the only thing that we have focused on our entire lives is how to take care of that child as opposed to taking care of everybody and everything kind of stuff.

Amanda Wilde (Host): So that's how you're really unique as a pediatric emergency care doctor and sounds ultra specialized, although your knowledge for emergency rooms always has to be quite broad. Let's talk about the environment and also the equipment. How is the equipment in a pediatric emergency department different from that in a general ER?

Dr. Juan Carlos Abanses: This is a big focus around the entire country, is pediatric readiness, in emergency departments because it does take very specialized equipment because children are much smaller. So, you have to have very small equipment that is capable of producing the results that you need. So, in order to intubate a patient, which to put a breathing tube down for them to put them on a ventilator, you have to have ventilators that have smaller capabilities.

You have to have intubation tubes that are much smaller. You have to have all the things to be able to see the vocal cords, the glidodoscopes, and those that are much smaller also. So, you have to be properly equipped, but then also there's differences just in the trauma rooms. For example, in our resuscitation rooms, the rooms are much, much warmer because kids have a bigger body surface area, and so they give off their heat quicker, and so you need to have that room warmer than in a regular adult emergency department. So, in the pediatric trauma room or resuscitation room, it's gonna be a much warmer room to try to keep that child warmer in addition to it.

And then we also have a lot of other things that are very specialized for children because of their smaller volume. So for example, if you're an adult trauma and you need blood, it can give you blood very quickly using a level one infuser, which just squeezes one entire pint of blood just straight into you quickly. In children, if it's a small child, you can't do that. It has to be measured precisely given to them, but it also needs to be warm. So, we have specialized machines that give a specific amount very quickly, very rapidly, but help to warm up the blood before it goes in. And it's very precise on how much we give children. So, everything about children, it's a little bit different because they're much smaller. You have to be more prepared, you have to have a lot more specialized equipment, to be prepared to handle their emergencies.

Amanda Wilde (Host): So really specialized equipment down to the rooms and the environment. Can you give us a sense of what the environment in a pediatric emergency department is like?

Dr. Juan Carlos Abanses: Yeah, so we take care of children all the way up until they're in college. So, we'll take them all the way up to 21 years of age, so we will see whatever happens to children. That's the sickest children in the whole Tampa Bay area. We will take care of them and help to resuscitate them and get them better.

So, whatever the worst cases are in the area, they'll oftentimes will get transferred to us. And it takes a pretty special department to do that because the neat thing is, is that everybody in our emergency department is specifically trained to take care of kids. So, the nurses don't really work on adults, and they just work on kids, which is something you want because you want them to have that capability of when you have an IV.

An IV in a little one month old baby is much different than getting an IV in a 55-year old male. So, it's very different. They have different training and you have to do everything just a little bit different. So, we have Child Life that sometimes helps us to talk to kids and help prepare them for procedures or prepare them for CT scans and help them not be so afraid.

So, you have to overcome children's fears, and you also have to speak very differently to kids. For example, kids are very straightforward. So for example, if I have a child who has a broken arm who I think needs to be sedated in order to reduce the arm to kind of straighten that arm out, I don't ever tell them I'm putting them to sleep because sleep has a negative connotation.

For example, nobody likes to go sleep at night kind of thing, but other kids have actually had their dogs put to sleep and they have a really negative connotation about that. So, we don't use the word sleep. We tell them that they're going to take a little nap. Or for stitches, we don't call them stitches because stitches always have a negative conation.

It's always, snitches get stitches or stitches are scary, all that kind of stuff. So we call them string band-aids. So, everything about the environment, we try to make it a friendlier environment, more colorful. We have different lights in there for autistic children. We have a lot of different lights on the walls.

We have things that they can be touching, things that they can feel so that they can not be so scared of their environment. We try to make everything that they do, just a little bit nicer, softer, and just helps distract them a little bit more. And I think that's a real big benefit of going to a pediatric emergency department.

It is designed to take care of those kids and help them feel more comfortable.

Amanda Wilde (Host): It really sounds like you've achieved that. In terms of supportive services for families, what can families expect in a pediatric emergency setting?

Dr. Juan Carlos Abanses: Yeah, so I think the biggest thing is that oftentimes, parents come to an emergency room because they're scared or something bad happened. Those are the two things, and so one of the biggest things that we try to teach all the physicians that kind of come through here, including residents and all that, is that you really have to find what the parent's underlying fear is.

And so one of the big things is we try to make parents more comfortable about their child. And so we really talk a lot about what their child is, how they're doing now, what to look for, what's gonna happen next and just kind of help them through the process because you really have to guide the parents because the parents are more concerned about their child than they would ever be about themselves even so this is their love of their life.

This is their children. This is everything to them. So you have to just help guide them kind of slowly through the process and really talk them through on how things are going to work and everything else. And then I think they see how we take care of the kids with Child Life and how we help them calm and soothe the child.

And we do all different things. So, before we put an IV in, we use special distracting things like a buzzy, which is a little bee that helps to distract a child, by shaking so they don't feel the IV as much. We use special cold spray so that you don't feel the IV as much. So, we do all these special things to try to help their children that you don't really see in an adult ER.

And so I think that's one of the big things the parents can expect. They can expect us to really focus on the child at the same time, help them to understand what's going on with their child better and reduce their fear of what's happening with their child as well.

Amanda Wilde (Host): This is so sensitive to the patients with all these positive attributes. I'm wondering how common are pediatric emergency rooms around the country?

Dr. Juan Carlos Abanses: So, specialized pediatric emergency rooms, they're not as common. They've been growing over the last couple years, but it's really a field that has started to grow really since the nineties. So it's still relatively young compared to the rest of medicine. And learning that specialized care for pediatric patients is still relatively new.

So, really, it's still found mainly in the larger hospitals at mainly academic teaching centers, and larger hospitals, and it's very specialized training. So what happens is a lot of the outside hospitals will take initial care of a sick child that has to be stabilized, and then transfer them to us for that further care, or they'll see the child and send them right to us so that we can get that specialized care to them.

But it is primarily more of the pediatric emergency departments are seen primarily in the larger areas. Now we have started to try to make models where we are expanding here at BayCare, some of our pediatric emergency rooms to the community and starting to open up more of them in the community, and that's one of the things that we're transitioning to help get that expertise out to the other areas as well.

Amanda Wilde (Host): Well, Dr. Abanses, we hope we never have to bring our children to the ER, but if we do, it's really comforting to know we have one here specifically for pediatric trauma for children and families. Thank you for all you do to help children and families with emergency pediatric care.

Dr. Juan Carlos Abanses: Sure. Well thank you so much for your time, and the listeners for their time, and hopefully we don't have to see them, but if we do, we're here for them.

Amanda Wilde (Host): That was pediatric emergency room physician Dr. Juan Carlos Abanses. That wraps up this episode of BayCare HealthChat. Head on over to our website at BayCare.org for more information and to get connected with one of our providers. Please remember to subscribe, rate, and review this podcast and all other BayCare podcasts.

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