Parent/Patient Emergency Care Topics: • Asthma Attack • Fever/Infections/Crying • California Poison Control • Abdominal Pain • Is it a Medical Emergency? • Trauma and Wounds • Newborn Questions
	Education: • Ped. Emergency Fellowship   (General Information) • Emergency Medicine Rotation   (Program Website)

Children's Specialists Division of Emergency Medicine staffs the Emergency Care Center at Rady Children's Hospital in San Diego (RCHSD). We are the largest group of board-certified pediatric emergency physicians in San Diego County. Our services are available 24 hours/day, 7 days/week. We are dedicated to providing the highest quality medical care to our young ill and injured patients, who number approximately 60,000 visits per year.

Rady Children's Emergency Care Center and its helipad make up the hub of the region's pediatric emergency care network. Our hospital is the area's only Pediatric Level 1 Trauma Center. Our trauma team treats the most severely injured pediatric patients in San Diego and Imperial Counties. In addition, we interface with the Children's Hospital Emergency Transport (CHET).

We work closely with the other RCHSD physicians and have access to a full spectrum of pediatric subspecialists. Our nurses are highly trained and especially skilled in caring for children. Our team also includes pediatric emergency fellows, pediatric, emergency, and family medicine residents, social workers, and respiratory therapists. Rady Children's is a teaching hospital affiliated with the University of California, San Diego. Many of our physicians have appointments in the Departments of Pediatrics or Emergency Medicine.

Our division has won numerous awards for teaching physicians-in-training. We have had an ACGME-accredited Pediatric Emergency Medicine Fellowship since 2000. In addition, we are constantly working to improve the care we provide to our patients, and, therefore, we are actively involved in research. Current areas of interest include asthma care, meningitis testing, appendicitis diagnosis, Kawasaki Disease, and the use of ultrasound in the Emergency Department.

We have recently added the following innovations to the Emergency Care Center:

• Recently remodeled facility, with expanded triage and redesigned waiting areas, more monitored beds and more bedside televisions and DVD players for patients.

• Rapid Medical Assessment (RMA), where patients may be seen from triage quickly. Patients are seen in an expedited fashion by a skilled clinician. Initial testing and treatment may be ordered, or straight-forward problems can be diagnosed and treated.

• An Intermediate Care section has been added to provide additional coverage by Board Certified/Eligible Pediatricians who are part of our Urgent Care group.

Directions to Rady Children's Hospital Emergency Care Center (located on Main Campus)

Urgent Care:
Our physicians see patients every day at RCHSD Urgent Care Centers in Escondido, Mid-City and La Mesa. Click here for hours, driving directions and what to expect.

Our Physicians:

Emergency Medicine: Ghazala Sharieff, M.D. -Director Joyce Arpilleda, M.D. Krista Caldwell, M.D. Heather Conrad, M.D. Arit Edwin-Enyenihi, M.D. Marc Etkin, M.D. Janet Friday, M.D. Toni Gross, M.D. Jim Harley, M.D., M.P.H. Cynthia Hoecker, M.D. Paul Ishimine, M.D. John Kanegaye, M.D. Jamie Lien, M.D. Simon J. Lucio, M.D. Jamil Madati, M.D. Tia Rajasingham, M.D. Seema Shah, M.D. Stacey Ulrich, M.D. Jennifer Weglowski, M.D.

Urgent Care: Katherine Konzen, M.D., M.P.H.* Brenda Hamer, M.D. Elizabeth Hicks, M.D. Jenny Ilfeld, M.D. A. Teresa Isaias, M.D. Gregory Langley, M.D. Seema Mishra, M.D. Nadia Sarwar, M.D. *Urgent Care Program Director

Frequently asked questions for patients and families:

When should you come to the Emergency Department?

• If your child is having a life-threatening emergency, call 9-1-1 immediately.
• Your child's physician can usually assist you as well. If your child condition is not acutely life-threatening, call your child's doctor's office for advice. Most have advice available 24 hours/day.
• Is it a Medical Emergency? provides guidelines to help answer this question.
• If your child has swallowed a suspected poison or dangerous drug, call the California Poison Control system, at 1-800-222-1222 for instructions, even if your child has no signs or symptoms. Immediate action may be life-saving!  Be ready to provide your child's age, weight, and previous health conditions. Also, give a description of the substance involved, amount taken, and time that it happened.

Should you call an ambulance or drive?

If you answer "yes" to any of the following questions, choose ambulance transportation:

• Could traffic conditions cause an unacceptable delay?
• Is it possible your child's condition could get worse on the way to the hospital?
• Is your child:
  • having difficulty breathing?
  • bleeding heavily?
  • unconscious or exhibiting uncontrollable agitation?
  • having seizures?
  • showing signs of a head, neck, or back injury?
  • showing signs of poor circulation, including pale, cold, clammy skin and a weak and rapid pulse?
• Could your child have significant injuries you cannot see?
• Could your concern for your child affect your ability to drive safely?

What should you bring?

Parents are encouraged to bring the following items to ensure efficiency and accuracy when coming to the Emergency Care Center:

• Your child's immunization history
• Your child's primary physician's name and phone number
• Information about any chronic illness or condition your child may have
• X-rays or lab test results from other hospitals or clinics relating to the child's current illness (if easily available)

What should you expect during your visit to the Emergency Department?

Triage
Triage is the process of evaluating the seriousness of your child's illness or injury. When you first arrive, you and your child will be seen by the triage nurse who is specially trained to take care of children in the Emergency Care Center. This registered nurse will ask you questions about your child's illness or injury, check your child's temperature and weight, and briefly examine your child. It is important to give all the needed information to the triage nurse. If your child has a life-threatening or very serious illness or injury, he or she will be seen by a doctor with the nurse right away. Before you arrive to the Emergency Care Center, your child's primary care provider may have called to tell us about your child and his or her condition.

Waiting Area
You may be asked to stay in the waiting area until an exam room or doctor is available to see your child. Please understand that patients may not be seen in the order of their arrival to the Emergency Department. Patients with the most serious illnesses and injuries will be given priority. A family liaison is available to offer activities, answer questions, and help keep you informed. Feel free to ask a nurse if he/she can give your child something fun to do; we have many toys, books and videos available. While you are in the waiting area, please do not to give your child anything to eat or drink without checking with the triage nurse first. If you notice that your child is getting sicker or is in more pain, tell the triage nurse right away.

Examination
As soon as possible, you and your child will be brought into an exam room. A team of doctors and nurses will care for your child. Your child may be evaluated by more than one doctor. Your child may be initially seen by a resident physician or medical student, who are in training to care for children. Your child will also be seen by an attending physician, who is a medical doctor who is trained to care for children with emergencies. The attending physician supervises the care of your child. Depending on your child's condition, your doctor may order a blood test, x-rays, or other tests to help determine what is wrong with your child. Each test will be fully explained to you before it is performed.

A top priority in our Emergency Care Center is to make sure each child is as comfortable as possible, and to rapidly assess and treat pain. If your child is in any pain, please make sure a doctor or nurse is notified so that the proper medication can be given.

Discharge
When your child's care is complete, the doctor or nurse will give you instructions on how to care for your child's illness or injury. They will also tell you about follow-up care. If you have any questions after you leave, call the Emergency Care Center at (858) 966-8800 or you may also call your child's primary care provider.

Admission to the Hospital
Your doctors may decide that your child needs to stay in the hospital longer for further observation, tests or treatment. Arrangements will be made for your child to be moved to an inpatient bed in the appropriate location as soon as possible.

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