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Should I Bring My Kid to Primary Care, Urgent Care, or the Pediatric ED?
Where should I go when my child is sick or injured? Fortunately, there are lots of resources for medical care at Maimonides. Dr. Alexander Arroyo discusses these options and how to know whether to bring your child to a primary care physician, urgent care, or a pediatric emergency department.
Featured Speaker:
Alexander Arroyo, MD
Dr. Arroyo focuses on pediatric sedation and wound management. Dr. Arroyo is a pediatric advance life support instructor. He has done research in the area of infrared non-contact temperature monitoring. Transcription:
Should I Bring My Kid to Primary Care, Urgent Care, or the Pediatric ED?
Amanda Wilde (Host): Where should I go when my child is sick or injured? Fortunately, there are lots of resources for medical care. Dr. Alexander Arroyo, Director of Pediatric Emergency Medicine at Maimonides
Health is here to discuss those options.
This is Maimo Med Talk. I'm your host, Amanda Wilde. Dr. Arroyo, thank you for being here. You're the Director of Pediatric Emergency Medicine. What does that mean? What do you do at Maimonides?
Alexander Arroyo, MD (Guest): Hi, Amanda. Pleasure to meet you. Thanks for having me. So my job entails the direction of the Pediatric Emergency Medicine Department. So that means basically, I'm in charge of running any kind of emergency that would come through the pediatric ED and also the medical directorship of that as well as the day to day of what happens in an emergency department. So I work clinically a lot as well, so I see patients. I'm also behind the scenes kind of managing the the rest of my group who a work at the hospital.
Host: So when I have an emergency for my child, how do I decide whether it's better to go to primary care or to urgent care or to the emergency room?
Dr. Arroyo: That's kind of a difficult question to answer because parent's reactions to things sometimes can be very, very different. You know, we've seen many, many times that a very small cut thing could get a very big reaction because it's your child and they're injured and they're hurting. You kind of don't know what to do. So, you know, we never discourage anyone from coming to the emergency department and we never, you know, get angry if they come there for something that doesn't seem to be an emergency, because anything, anybody brings their kid in for is going to be an emergency for them and we take all that seriously, but if you're gonna, you know, boil it down to things that you should be coming to the emergency department for, I would say a severe allergy, especially if it involves difficulty breathing, it involves swelling of the face. Your child can't speak because of that. I definitely think that is an emergency department problem. Bleeding that doesn't stop
fairly immediately. So if someone gets injured at home and there's a significant amount of bleeding, that's happening, wherever it is, either from a laceration or from a cut, however it is inflicted. Those should definitely come to the emergency department as well. You know, patients who have chest pain, patients who have difficulty breathing, whether it be asthma. Sometimes kids get sick from viruses over the winter time and they get difficulty breathing, and especially traumas, lots of traumas, especially major traumas should be definitely coming to the emergency department. your child gets hit by a car, clearly that should be seen in the emergency department a lot of gray areas as well, too, when it comes to things like abdominal pain, if it's a severe stomach ache where they're just continually vomiting and they haven't had any urine output in a significant period of time, greater than like six hours, I'd bring them to the emergency department. Your primary care doctor could be a great resource as well to inform you as to what your next step should be. So there should be a service line open 24 hours a day to your doctor, that you can give them a call and get somebody from the practice, either a physician or a nurse who can guide you as where you should go and what you should do.
Host: It sounds like Maimonides pediatric emergency is a place you can go though for anything. But what are you capable of caring for? Can you treat the most serious trauma?
Dr. Arroyo: So Maimonides is currently as a level two pediatric trauma center. And what that means is that we take care of pretty much every single traumatic injury that you could imagine. So whether it's fall out of a window, hit by a car, any of those we, we take care of on a daily basis and we have the specialists, the trauma surgeons, the orthopedic surgeons, the vascular surgeons, as well as the emergency medicine staff and the equipment to be able to take care of all of that. Our operating rooms run 24/7. You know, if God forbid a patient needs a surgery when they come in with a traumatic injury, we could deal with that. So, we're fully staffed to deal with all of those traumatic injuries, plus all medical injuries as well. Asthma attacks, strokes, appendicitis if a patient comes in with that, that needs to go to the operating room. For the most part, any kind of injury that you would come in for, any kind of illness we could take care of at Maimonides Medical Center.
Host: What is the most common emergency that parents bring in their children for, to the pediatric ED?
Dr. Arroyo: my business is very seasonal. So in the summertime we see a lot of trauma. We see a lot of patients who come in, who have fallen down, broken wrist, broken an arm. And then in the wintertime, it kind of flips to looking at all the respiratory illnesses that we see. So kids who wind up picking up a virus from school or you know, the little ones, the infants pick it up from their siblings or the parents. And they come in with difficulty breathing. They come in with fevers, but if I had to pin down one thing that we see on a regular basis, day in and day out, it's going to be fever.
Again, it's somewhat of a, of a difficult thing because kids, I have two kids and, luckily enough, I'm able to keep a level head when it comes to when they get injured. My wife was also a pediatric emergency medicine doctor does the exact opposite and she has a very difficult time, when it comes to our kids, of, seeing what the issue truly is because it's your children. And when, when it's your kids things are a little bit different and you get nervous, really fast. Anything that involves breathing, I would bring them right to the emergency department. If there is severe pain from an injury, I'd bring them to the emergency department. If they have a limb that's deformed that when they fell you know, their elbow doesn't look like it's pointing in the right direction, they should go to the emergency department. Some small lacerations, like a scalp laceration, or a forehead laceration, or even extremity lacerations, you can get taken care of an urgent care department. Urgent care is very, very good at that stuff. If you sprained your ankle, they're also good at that stuff. Just call ahead to make sure that they have x-ray capabilities, foot injury, finger injuries. We see a lot of patients who come in from sports injuries who have injured their hands or their feet from a sports injury. And that's for sure, easily taken care of in the urgent care center. Things that I would lean more towards primary care would be, fevers, febrile illnesses. Especially if a patient looks otherwise okay. If they're drinking okay. If they're not having any significant vomiting or diarrhea, if they look lethargic, or, you know, really not responsive that should come to the emergency department, but if they are otherwise awake, you give them Tylenol and Motrin and they feel better and they look okay. They could wait the next day. A lot of things we see, like ear pain, ear pain that, you know, three o'clock in the morning, if you can give your child Motrin or Tylenol, at 3:00 AM and they can go comfortably, go back to sleep, you could probably see your primary care doctor in the morning or the urgent care and not have to run in and rush in to the ED at three AM for ear pain, which is rarely an emergency when it comes to that.
You know, some people, scheduling wise kind of have to lean on the ED when it comes to that, the emergency department when it comes to that. We get it. We understand that, but if you want to save yourself a trip, you know, trialing some Motrin, Tylenol when it comes to ear pain or throat pain, or even some belly pain, and then seeing what happens with your child and potentially take them to the regular doctor in the morning, who knows them, who knows the history a lot better, that you guys have a therapeutic relationship with is always the best bet.
Host: Well, saving a trip to the ER, can save a lot of distress, right? So what's the most important tip you can give parents on how to keep their kids out of the ER?
Dr. Arroyo: That's a question that's near and dear to my heart. There's lots of things you could at home. Those, those baby recommendations that you see on Amazon or on, on different websites for like bumpers around the coffee table, bumpers around hard edges, toilet seat locks, also cabinet locks. These are all important things that happen, in the home when you, kind of turn your back on, on toddlers, they're fast and they're sneaky and they will get into things in seconds.
So if you you know, the valuables and the breakables locked up, that they can't get to them. It, it will save you a trip to the emergency department when they drop a bottle it cuts their foot, They sell those electrical socket plugs as well, the plastic ones that kind of prevent, you know, your toddler from sticking anything inside there, which is also a big one, too safety gates are, I just took my safety gate down because my daughter finally figured out how to navigate the stairs. So it's gone now. I'm a little less worried about tumbling down the steps, but we see that a lot. So safety gates, make sure you close your doors behind you when, when you exit a door. We see a lot, lot of toddlers fall down flights of stairs and they come in you know, big hematomas on their heads or broken clavicles. That's also a massive one. And also when they're outside is also a big thing too. The monkey bars in general generate a lot of money for the emergency department. It's a structure that I would love to remove from every single park in the world, because I don't think I've ever seen more children get hurt than from, the structure of doom as I like to call it, which is the monkey bars.
They fall down, they invariably break their elbow. And usually that includes some surgery to get a pin placed in there to get it reset. So monkey bars, I would keep my kids off of that 24/7, or actually just hold them underneath there while, while they're going. Because at any moment they could slip and their instinct is going to be to stick their hands out. And they're going to break their elbow. Helmets on bicycles or scooters is also a big thing, too. We see that frequently when patients come in, who have head injuries from falling off their bikes. So, I mean, these are the things that I tell parents at every safety visit. Every time they come in with an injured child that they should be doing and should be using to keep their kids safe.
Host: That's a great list of preventive measures that we can take. How else can I be prepared in advance for an emergency? Like, is there information I should have ready to bring with me if I go to the emergency room or what kind of information might I have on hand for if there's a babysitter and I'm out?
Dr. Arroyo: Yeah, absolutely. The important thing for us with a lot of patients their history. Luckily enough, pediatrics kids really don't have enough time in their life to develop such a massive medical history, like say an 80 year old would, they're not on very many medications, at this point, usually, but if your child does have any health history, especially things like allergies or surgeries, it's good to have that give it to your babysitter or have it somewhere in a note folder on your phone, we all have smartphones at this point. And we all have a note folder that we could actually enter data in because during an emergency, it's very difficult to remember these things. And during an emergency, it's difficult to remember to grab that paper that sits by the door that you could bring with you to the hospital.
So if your babysitter has that on their phone, you know, my child's allergic to penicillin. My child had open heart surgery. These are the following medications, things like that are tremendously helpful to us while we're waiting for those critical minutes for someone to get here, who actually knows the child's history.
So if you have those handy and ready before an emergency happens, we don't have to scramble and look around for that stuff prior. And it's really difficult to kind of rely on our medical record from having it, because it may not be there. You may be at a different hospital that doesn't have your medical records because hospitals usually don't share medical records. So having that and readily available before the emergency happens, is an important thing.
Host: That is great advice. And then if we end up in the ER, what's the most important thing we parents can do while we're in the ER?
Dr. Arroyo: So the most important thing I could probably say is to try to stay calm. We need you as a partner with us to take care of your child. Unfortunately, a lot of kids come in and they're sick and we have to do a lot of things to them that are not very, it's hard to say, the word nice to them because you know, getting stuck with an IV is a painful thing.
You know, sometimes resetting a bone is a painful thing, watching your child get painful things done to them. Obviously we're giving them pain medication and we're trying to take care of them as best as possible, prior to that is a difficult thing to see. If you stay calm and you work with us as a team, that is the absolute best thing that we could do.
And also have patience because, you know, if you walk in the door, your child has a sprained ankle and they're otherwise pretty stable. And the wait's a little bit long it's probably because we're dealing who someone else who has a significant life-threatening medical emergency you know, our team is focused on. The thing about the pediatric ED is that there may be four or five doctors there, there may be six or seven nurses there, but when a sick baby comes in, we all basically swarm on that child to actually take care of them because there's one physician doing one thing, there's another doing another thing. There's one nurse doing something. There's another nurse doing another thing.
So all our resources are usually tied up in that one sick child that comes to the door. And so please have patience with us. I promise we've, we've looked around and we've seen who could wait a little bit versus those who cannot wait, because there are a lot of people who come into the emergency department who just cannot wait to be seen. And it's never, oh, I got here first, it's who is the sickest that I need to take care of. And if you think that somehow we've missed seeing that your child is sick. Please come talk to us, please come tell us because we will immediately come see you and determine at that point it's possible it happened, but we will immediately reassess your child and determine, where we should put them the, in the triage process where they should be seen.
Host: What else would you like parents to know about what you do or you don't do in the ER?
Dr. Arroyo: We pretty much do everything. it depends on what's happening. A few things that I think sometimes parents have expectations of that may be a little, a little lofty. So if you come into the emergency department and it's three o'clock in the morning and you looking for a plastic surgeon, you're probably not going to find them. People don't sit in the emergency department and wait there for patients to come in. Specialists usually they're all home sitting in bed. So the only physician that you're going to see is likely me. We have a surgeon in house as that will be there for specific emergencies like traumas. A lot of times people come in and be like, oh, I'm here to see the plastic surgeon. You know, in the emergency department and very frequently all the wounds that people come in with though, they may seem large and scary to, to the parents are very easily dealt with by, by an emergency medicine physician. You know, we're trained to take care of any kind of significant wound, laceration to the face, to the arm, to the hand. And usually we know when to call a specialist and if we have any significant issues, so let's say, for instance, if the laceration is very, very deep and long and crosses some of the muscle borders, then that may be better served by a plastic surgeon and we can get them involved. If a wound is crossing the hand and hits a tendon, obviously that's an issue. And we want a surgeon to see that patient as well. Parents always have know, the right to ask for a plastic surgeon, if they want to go that route. But the issue is is that if it's three o'clock in the morning, very frequently, they may not come in and they may want to see you tomorrow in you're in your office. So you kind of have to play the Jack of all trades when it comes to emergency medicine and be someone's plastic surgeon, someone's GI doctor, someone's pulmonologist, somebody else's dermatologist when you're sitting inside there. You know, we have training in all those fields and we can get the basics done from there.
But frequent times we have to call a specialist in and consult with them,
Host: yeah, because the emergency room is your physicians or your first line of defense, and then you do the assessments.
Dr. Arroyo: Absolutely.
Host: It's reassuring to know our kids are in capable hands with you. Thank you for helping us understand and be prepared to deal with emergency care for our kids.
Dr. Arroyo: It's our pleasure. It's a labor of love. And I you know, my staff will tell you there are times when you sit back there and say, why did I do this to myself? But then you realize, because it's such a really rewarding job and it's a job that I think when you go home, you really good about the thing that you've done. And the people that you helped because, children really, really just want to get better. And they want to get back to doing the things that they love to do. So, sometimes all it takes is a lollipop or a sticker.
Host: Thank you, Dr. Arroyo. To learn more about Maimonides Medical Center, please visit maimo. org. That's M-A-I-M-O.org. This has been Maimo Med Talk. I'm Amanda Wilde. Stay well.
Should I Bring My Kid to Primary Care, Urgent Care, or the Pediatric ED?
Amanda Wilde (Host): Where should I go when my child is sick or injured? Fortunately, there are lots of resources for medical care. Dr. Alexander Arroyo, Director of Pediatric Emergency Medicine at Maimonides
Health is here to discuss those options.
This is Maimo Med Talk. I'm your host, Amanda Wilde. Dr. Arroyo, thank you for being here. You're the Director of Pediatric Emergency Medicine. What does that mean? What do you do at Maimonides?
Alexander Arroyo, MD (Guest): Hi, Amanda. Pleasure to meet you. Thanks for having me. So my job entails the direction of the Pediatric Emergency Medicine Department. So that means basically, I'm in charge of running any kind of emergency that would come through the pediatric ED and also the medical directorship of that as well as the day to day of what happens in an emergency department. So I work clinically a lot as well, so I see patients. I'm also behind the scenes kind of managing the the rest of my group who a work at the hospital.
Host: So when I have an emergency for my child, how do I decide whether it's better to go to primary care or to urgent care or to the emergency room?
Dr. Arroyo: That's kind of a difficult question to answer because parent's reactions to things sometimes can be very, very different. You know, we've seen many, many times that a very small cut thing could get a very big reaction because it's your child and they're injured and they're hurting. You kind of don't know what to do. So, you know, we never discourage anyone from coming to the emergency department and we never, you know, get angry if they come there for something that doesn't seem to be an emergency, because anything, anybody brings their kid in for is going to be an emergency for them and we take all that seriously, but if you're gonna, you know, boil it down to things that you should be coming to the emergency department for, I would say a severe allergy, especially if it involves difficulty breathing, it involves swelling of the face. Your child can't speak because of that. I definitely think that is an emergency department problem. Bleeding that doesn't stop
fairly immediately. So if someone gets injured at home and there's a significant amount of bleeding, that's happening, wherever it is, either from a laceration or from a cut, however it is inflicted. Those should definitely come to the emergency department as well. You know, patients who have chest pain, patients who have difficulty breathing, whether it be asthma. Sometimes kids get sick from viruses over the winter time and they get difficulty breathing, and especially traumas, lots of traumas, especially major traumas should be definitely coming to the emergency department. your child gets hit by a car, clearly that should be seen in the emergency department a lot of gray areas as well, too, when it comes to things like abdominal pain, if it's a severe stomach ache where they're just continually vomiting and they haven't had any urine output in a significant period of time, greater than like six hours, I'd bring them to the emergency department. Your primary care doctor could be a great resource as well to inform you as to what your next step should be. So there should be a service line open 24 hours a day to your doctor, that you can give them a call and get somebody from the practice, either a physician or a nurse who can guide you as where you should go and what you should do.
Host: It sounds like Maimonides pediatric emergency is a place you can go though for anything. But what are you capable of caring for? Can you treat the most serious trauma?
Dr. Arroyo: So Maimonides is currently as a level two pediatric trauma center. And what that means is that we take care of pretty much every single traumatic injury that you could imagine. So whether it's fall out of a window, hit by a car, any of those we, we take care of on a daily basis and we have the specialists, the trauma surgeons, the orthopedic surgeons, the vascular surgeons, as well as the emergency medicine staff and the equipment to be able to take care of all of that. Our operating rooms run 24/7. You know, if God forbid a patient needs a surgery when they come in with a traumatic injury, we could deal with that. So, we're fully staffed to deal with all of those traumatic injuries, plus all medical injuries as well. Asthma attacks, strokes, appendicitis if a patient comes in with that, that needs to go to the operating room. For the most part, any kind of injury that you would come in for, any kind of illness we could take care of at Maimonides Medical Center.
Host: What is the most common emergency that parents bring in their children for, to the pediatric ED?
Dr. Arroyo: my business is very seasonal. So in the summertime we see a lot of trauma. We see a lot of patients who come in, who have fallen down, broken wrist, broken an arm. And then in the wintertime, it kind of flips to looking at all the respiratory illnesses that we see. So kids who wind up picking up a virus from school or you know, the little ones, the infants pick it up from their siblings or the parents. And they come in with difficulty breathing. They come in with fevers, but if I had to pin down one thing that we see on a regular basis, day in and day out, it's going to be fever.
Again, it's somewhat of a, of a difficult thing because kids, I have two kids and, luckily enough, I'm able to keep a level head when it comes to when they get injured. My wife was also a pediatric emergency medicine doctor does the exact opposite and she has a very difficult time, when it comes to our kids, of, seeing what the issue truly is because it's your children. And when, when it's your kids things are a little bit different and you get nervous, really fast. Anything that involves breathing, I would bring them right to the emergency department. If there is severe pain from an injury, I'd bring them to the emergency department. If they have a limb that's deformed that when they fell you know, their elbow doesn't look like it's pointing in the right direction, they should go to the emergency department. Some small lacerations, like a scalp laceration, or a forehead laceration, or even extremity lacerations, you can get taken care of an urgent care department. Urgent care is very, very good at that stuff. If you sprained your ankle, they're also good at that stuff. Just call ahead to make sure that they have x-ray capabilities, foot injury, finger injuries. We see a lot of patients who come in from sports injuries who have injured their hands or their feet from a sports injury. And that's for sure, easily taken care of in the urgent care center. Things that I would lean more towards primary care would be, fevers, febrile illnesses. Especially if a patient looks otherwise okay. If they're drinking okay. If they're not having any significant vomiting or diarrhea, if they look lethargic, or, you know, really not responsive that should come to the emergency department, but if they are otherwise awake, you give them Tylenol and Motrin and they feel better and they look okay. They could wait the next day. A lot of things we see, like ear pain, ear pain that, you know, three o'clock in the morning, if you can give your child Motrin or Tylenol, at 3:00 AM and they can go comfortably, go back to sleep, you could probably see your primary care doctor in the morning or the urgent care and not have to run in and rush in to the ED at three AM for ear pain, which is rarely an emergency when it comes to that.
You know, some people, scheduling wise kind of have to lean on the ED when it comes to that, the emergency department when it comes to that. We get it. We understand that, but if you want to save yourself a trip, you know, trialing some Motrin, Tylenol when it comes to ear pain or throat pain, or even some belly pain, and then seeing what happens with your child and potentially take them to the regular doctor in the morning, who knows them, who knows the history a lot better, that you guys have a therapeutic relationship with is always the best bet.
Host: Well, saving a trip to the ER, can save a lot of distress, right? So what's the most important tip you can give parents on how to keep their kids out of the ER?
Dr. Arroyo: That's a question that's near and dear to my heart. There's lots of things you could at home. Those, those baby recommendations that you see on Amazon or on, on different websites for like bumpers around the coffee table, bumpers around hard edges, toilet seat locks, also cabinet locks. These are all important things that happen, in the home when you, kind of turn your back on, on toddlers, they're fast and they're sneaky and they will get into things in seconds.
So if you you know, the valuables and the breakables locked up, that they can't get to them. It, it will save you a trip to the emergency department when they drop a bottle it cuts their foot, They sell those electrical socket plugs as well, the plastic ones that kind of prevent, you know, your toddler from sticking anything inside there, which is also a big one, too safety gates are, I just took my safety gate down because my daughter finally figured out how to navigate the stairs. So it's gone now. I'm a little less worried about tumbling down the steps, but we see that a lot. So safety gates, make sure you close your doors behind you when, when you exit a door. We see a lot, lot of toddlers fall down flights of stairs and they come in you know, big hematomas on their heads or broken clavicles. That's also a massive one. And also when they're outside is also a big thing too. The monkey bars in general generate a lot of money for the emergency department. It's a structure that I would love to remove from every single park in the world, because I don't think I've ever seen more children get hurt than from, the structure of doom as I like to call it, which is the monkey bars.
They fall down, they invariably break their elbow. And usually that includes some surgery to get a pin placed in there to get it reset. So monkey bars, I would keep my kids off of that 24/7, or actually just hold them underneath there while, while they're going. Because at any moment they could slip and their instinct is going to be to stick their hands out. And they're going to break their elbow. Helmets on bicycles or scooters is also a big thing, too. We see that frequently when patients come in, who have head injuries from falling off their bikes. So, I mean, these are the things that I tell parents at every safety visit. Every time they come in with an injured child that they should be doing and should be using to keep their kids safe.
Host: That's a great list of preventive measures that we can take. How else can I be prepared in advance for an emergency? Like, is there information I should have ready to bring with me if I go to the emergency room or what kind of information might I have on hand for if there's a babysitter and I'm out?
Dr. Arroyo: Yeah, absolutely. The important thing for us with a lot of patients their history. Luckily enough, pediatrics kids really don't have enough time in their life to develop such a massive medical history, like say an 80 year old would, they're not on very many medications, at this point, usually, but if your child does have any health history, especially things like allergies or surgeries, it's good to have that give it to your babysitter or have it somewhere in a note folder on your phone, we all have smartphones at this point. And we all have a note folder that we could actually enter data in because during an emergency, it's very difficult to remember these things. And during an emergency, it's difficult to remember to grab that paper that sits by the door that you could bring with you to the hospital.
So if your babysitter has that on their phone, you know, my child's allergic to penicillin. My child had open heart surgery. These are the following medications, things like that are tremendously helpful to us while we're waiting for those critical minutes for someone to get here, who actually knows the child's history.
So if you have those handy and ready before an emergency happens, we don't have to scramble and look around for that stuff prior. And it's really difficult to kind of rely on our medical record from having it, because it may not be there. You may be at a different hospital that doesn't have your medical records because hospitals usually don't share medical records. So having that and readily available before the emergency happens, is an important thing.
Host: That is great advice. And then if we end up in the ER, what's the most important thing we parents can do while we're in the ER?
Dr. Arroyo: So the most important thing I could probably say is to try to stay calm. We need you as a partner with us to take care of your child. Unfortunately, a lot of kids come in and they're sick and we have to do a lot of things to them that are not very, it's hard to say, the word nice to them because you know, getting stuck with an IV is a painful thing.
You know, sometimes resetting a bone is a painful thing, watching your child get painful things done to them. Obviously we're giving them pain medication and we're trying to take care of them as best as possible, prior to that is a difficult thing to see. If you stay calm and you work with us as a team, that is the absolute best thing that we could do.
And also have patience because, you know, if you walk in the door, your child has a sprained ankle and they're otherwise pretty stable. And the wait's a little bit long it's probably because we're dealing who someone else who has a significant life-threatening medical emergency you know, our team is focused on. The thing about the pediatric ED is that there may be four or five doctors there, there may be six or seven nurses there, but when a sick baby comes in, we all basically swarm on that child to actually take care of them because there's one physician doing one thing, there's another doing another thing. There's one nurse doing something. There's another nurse doing another thing.
So all our resources are usually tied up in that one sick child that comes to the door. And so please have patience with us. I promise we've, we've looked around and we've seen who could wait a little bit versus those who cannot wait, because there are a lot of people who come into the emergency department who just cannot wait to be seen. And it's never, oh, I got here first, it's who is the sickest that I need to take care of. And if you think that somehow we've missed seeing that your child is sick. Please come talk to us, please come tell us because we will immediately come see you and determine at that point it's possible it happened, but we will immediately reassess your child and determine, where we should put them the, in the triage process where they should be seen.
Host: What else would you like parents to know about what you do or you don't do in the ER?
Dr. Arroyo: We pretty much do everything. it depends on what's happening. A few things that I think sometimes parents have expectations of that may be a little, a little lofty. So if you come into the emergency department and it's three o'clock in the morning and you looking for a plastic surgeon, you're probably not going to find them. People don't sit in the emergency department and wait there for patients to come in. Specialists usually they're all home sitting in bed. So the only physician that you're going to see is likely me. We have a surgeon in house as that will be there for specific emergencies like traumas. A lot of times people come in and be like, oh, I'm here to see the plastic surgeon. You know, in the emergency department and very frequently all the wounds that people come in with though, they may seem large and scary to, to the parents are very easily dealt with by, by an emergency medicine physician. You know, we're trained to take care of any kind of significant wound, laceration to the face, to the arm, to the hand. And usually we know when to call a specialist and if we have any significant issues, so let's say, for instance, if the laceration is very, very deep and long and crosses some of the muscle borders, then that may be better served by a plastic surgeon and we can get them involved. If a wound is crossing the hand and hits a tendon, obviously that's an issue. And we want a surgeon to see that patient as well. Parents always have know, the right to ask for a plastic surgeon, if they want to go that route. But the issue is is that if it's three o'clock in the morning, very frequently, they may not come in and they may want to see you tomorrow in you're in your office. So you kind of have to play the Jack of all trades when it comes to emergency medicine and be someone's plastic surgeon, someone's GI doctor, someone's pulmonologist, somebody else's dermatologist when you're sitting inside there. You know, we have training in all those fields and we can get the basics done from there.
But frequent times we have to call a specialist in and consult with them,
Host: yeah, because the emergency room is your physicians or your first line of defense, and then you do the assessments.
Dr. Arroyo: Absolutely.
Host: It's reassuring to know our kids are in capable hands with you. Thank you for helping us understand and be prepared to deal with emergency care for our kids.
Dr. Arroyo: It's our pleasure. It's a labor of love. And I you know, my staff will tell you there are times when you sit back there and say, why did I do this to myself? But then you realize, because it's such a really rewarding job and it's a job that I think when you go home, you really good about the thing that you've done. And the people that you helped because, children really, really just want to get better. And they want to get back to doing the things that they love to do. So, sometimes all it takes is a lollipop or a sticker.
Host: Thank you, Dr. Arroyo. To learn more about Maimonides Medical Center, please visit maimo. org. That's M-A-I-M-O.org. This has been Maimo Med Talk. I'm Amanda Wilde. Stay well.