Transcription:
UK HealthCare's Pediatric Emergency Department

Melanie Cole, MS (Host): I remember when my kids were small. How confused I was when they had certain things like vomiting or a high fever whether to take them to the emergency room. It can be terrifying for parents and you're not quite sure when to take them or if you should take them. My guest today is Dr. Landon Jones. He's the medical director of pediatric emergency medicine at UK Healthcare. Dr. Jones, I'd like to start with difference between urgent care and the emergency room. What’s the difference?

Landon Jones, MD (Guest): Okay. I think the biggest difference, actually, between the two is basically resources. So the things that we have that we can offer in the emergency department is just a larger number of resources and the ability to do additional either testing or diagnostic imaging or something like that.

Host: Well then why don’t you tell us about the facility at UK Healthcare. What services do you offer, and what kinds of testing and scan can you get at ER care?

Dr. Jones: Okay. So we’re the McKenna David Pediatric Emergency Center. We’re the University of the Kentucky. We’re physically right next door to the adult emergency department. The wonderful things that we have is we do have 24-hour a day dedicated pediatric emergency department nursing staff. We have pediatric emergency specialty physicians. Those people basically have a specialty where they’ve done emergency medicine, but we also have additional training in pediatrics as well so that we can offer those services.

The other things that we also have in terms of resources if we do have all like the subspecialty resources. So we have pediatric GI, the ability to at least contact and be in touch with pediatric GI doctors or pediatric surgeons, and we have a pediatric level 1 trauma center. What that means is that we take all the really bad pediatric trauma for the eastern half of the state. We have all of the subspecialty resources. Other really, really cool things that we also have are things in terms of trying to minimize pain for families of little kiddos. Those all involve medicines that can go up the nose, or sometimes we have them drink things that other places will typically give them shots and that kind of thing. So we try to minimize any kind of pain as well.

We also have other resources. We have child life specialists. Those are specialists that can talk with child and sort of walk them through the process and give them a little bit of anticipatory guidance. Not only for the kids, but also for the parents too because this is just as stressful, if not more stressful, for the parents when they bring their kiddo in. So those are sort of the diagnostically—When I say diagnostically, what I mean is imaging kind of stuff. Yes, we have x-rays. Yes, we have CT scans, and we try to minimize the use of any kind of imaging. But one of the other beautiful things that we also have is actually ultrasound. We have basically ultrasound techs and radiologists who are very capable of reading those ultrasounds, but we have a lot of experience with it. So hopefully that would—Ultimately what that really means is that we’re much more comfortable and we use it a lot more often. So it’s something that we have the additional skill at doing that.

Host: I can certainly appreciate when you say how stressful it is for parents. Kids seem to take in their stride, Dr. Jones, unless they're, of course, in a lot of pain. As going to the ER is really scary and stressful, what do you want parents to know about whether they're calling 911 or driving their little ones to the ER. What do you want them to know about what to bring if they have time to grab stuff? What do you want them to know?

Dr. Jones: I think if we had the opportunity to sort of say grab something before you came, I think the biggest thing would honestly be, really, I just want you to know the circumstances of what was going on, but sometimes you do and sometimes you don’t. A lot of times when you're bringing your child in, a lot of things are going on at once. You can't register is all. A small amount of time feels like forever, also. So just trying to really just take a half second breath, and it’s really hard to do that as a parent. I have kids too. It’s really, really difficult. But things like potential medications so we can know like what the medicines are that your child is on. That would be very helpful, but more so I think it’s just the circumstances. Really what we want you to know is that you're coming to us, we’re going to take good care of you.

Host: As far as parents being stressed and scared and hovering around their kids, do you, as an emergency room physician, do you want us to ask questions? Do you want us to be that advocate? Because some parents, I'm sure, can go a little over the top. I feel for all pediatricians because boy, what a loving field dealing with parents. What do you want us to do? Do you want us to be asking questions, looking things up on the internet while you're doing your stuff?

Dr. Jones: Yeah. So we want you to ask questions. We may not have all of the perfect answers for them, but we want you to ask questions. Part of this whole process is also giving like anticipatory guidance. It’s to help allay fears, but we definitely want you to ask the questions. In terms of like googling and doing that kind of thing, listen. Ask the question. We know it happens. No matter what, we know that it happens. But we realized too, and as far as being an advocate I’ll address that in about half a second, but you are your child’s advocate. It is your job to ask questions. The biggest concern to me is the parent that doesn’t care, and heaven forbid that doesn’t happen. But it’s your job. I know that we get to see every child and family member. Especially when you feel like you're a parent and you have no control over the situation. We know that we’re getting to see you on probably the worst day of your life. That you're actually allowing and blessing us to actually be a part of it and try to help you. So we want you to ask questions. We want you to be an advocate for your kids. We understand that if you feel like wow, I'm being overly aggressive or anything, we don’t make any assumptions at all.

Host: Dr. Jones, one question that I think many parents may have is what age do we bring our children in to the pediatric department as opposed to the regular ER?

Dr. Jones: So here at the McKenna David Pediatric Emergency Center, we see children that are under the ages of 18. So if you are basically just born all the way up to 17 years, 364 days. Once you become an 18 year old, that’s when you're transitioned here to the adult emergency department.

Host: Then really what’s considered an emergency? Doctor, as a parent, anything could seem like an emergency. A small cut, a scrape, a high fever that starts to go over 104, 105. Call your pediatrician. You sit there and go, “What should I do?” Vomiting. That’s one that always sort of scares me. Diarrhea, lethargy, febrile seizures. I mean there’s so many things. With adults, you know stroke symptoms, hear attack, we know that’s emergent. But with kids, it’s not always so clear.

Dr. Jones: So emergencies, they're going to be relative for everyone. So one person’s emergency may not be another person’s emergency. I think the most common things that we do, and I can simply say this is what we typically would do first kind of stuff, is for fevers. We would give Tylenol or ibuprofen or even both potentially at the same time, which is perfectly fine as well. We would typically start, for fever stuff, we’d start off there. I'm not really going to be able to give you a perfect example on sort of what would be an emergency.

Things that we get more concerned about, obviously, as difficulty breathing. That’s potentially a reason to see us. That’s all relative too. If your child becomes confused, unresponsive, those kinds of things. Those are things that we most commonly see in the emergency department. I'm not going to have like a perfect example for what’s an emergency and what’s not an emergency because it’s typically an eye of the beholder type of thing.

Host: I hear you there. I know that it is. But like, for an example, stomach aches. Right away we always think appendicitis. Oh my god, you know. Those kinds of things. How do we know a stomach ache or vomiting, any of those things? What do you want us to know about maybe signs and symptoms that would say yeah? You mentioned trouble breathing or a really high fever or something non-responsiveness, yes. But what about things like stomach aches? When do we worry that’s appendicitis?

Dr. Jones: I think the best answer for that is going to be time. So if your child has a stomach ache or has a high fever, you can try things like ibuprofen and acetaminophen. Then unless it’s something you feel like you need to come emergently, wait about 30 minutes. See if the child is actually responding to that because time is really the thing that’s going to be able to give you that best answer and allow you to sort of differentiate and say, “Alright. This is really bad.” Or, “I'm really significantly concerned about this.” Or, “Hey, listen. This isn’t so bad. I initially thought it was bad, but wow they’ve done really well with those simple interventions.”

Host: I think the message there is trust your gut. Try what you think you're supposed to try, right?

Dr. Jones: Yeah, exactly. We were given gut instincts. We were given gestalts for a reason. Use them.

Host: I agree with you. Then there’s one more I want to check with you on, Dr. Jones, is cuts. We try and bandage them up. When do we know if we need to come in and get stitches? I mean is it supposed to stop bleeding or pressure works?

Dr. Jones: If you apply pressure to it and it doesn’t stop bleeding—If you apply pressure to for 10 minutes or so and you're still getting a whole lot of bleeding or a lot of oozing from the wound, that would be the moment where I’d say hey listen. We need to see this most likely. If it’s something where it’s a cut, but the skin is not really sort of gaping or fileted open, and you're able to get the bleeding to stop relatively easily, then it potentially doesn’t need stitches or any kind of basically being closed. So no closure.

Host: What great information, Dr. Jones. Give us your best advice about emergency department pediatric care. What you would like listeners and parents, especially, to know about the McKenna David Pediatric Emergency Center at UK Healthcare. Tell us what you want us to know.

Dr. Jones: Yeah, sure. So we see about 25,000 children a year. We all love what we do. That’s the big thing that we do it. We know that we are blessed with the ability to see kids and their families on what often times is the worst day of their life. So we’re always open. We’re open 365 days a year, 24 hours a day. We’ve got all of these wonderful, wonderful subspecialists that we work alongside with and that we enjoy working with. So we don’t want you to be afraid to actually see us if you need us. Again, any kind of questions, we’re happy to answer. I think the really big take home thing is that listen, we love what we do. We do it for a reason. We know that we’re doing everything that we can to be your kids advocate and to help allay fears, help address issues that you're having. So we absolutely love what we do and that’s why we do it.

Host: That’s great information, and I can hear the passion in your voice Dr. Jones. I can hear that you love what you do. I can only assume that you and your staff are just wonderful with children. Thank you so much for coming on with us today. This is UK Healthcast with the University of Kentucky Healthcare. For more information on the McKenna David Pediatric Emergency Center, you can do to ukhealthcare.uky.edu. That’s ukhealthcare.uky.edu. I’m Melanie Cole. Thanks so much for tuning in.