Life or death decisions - When to go to take a child to the E.R.

Would you know what to do if your child was choking? What if she swallowed pills, or had a minor burn?

Would you know what to do if your child was choking? What if she swallowed pills, or had a minor burn?

 A new survey finds that many parents are confused about when to go to the emergency room and even a highly-skilled doctor had trouble thinking clearly when came to the life of her own child.
 
In the Children's Hospital Emergency Room,  Dr. Jerussa Aita-Levy treats very sick babies and children, and has been saving lives for nearly 20 years. Even with all of her medical training, teaching, and years of hands-on experience, she was not prepared when her own precious child was in a race against the clock for his life.

 "I am thinking, 'God please save my child. Please let my child live," remembers  Dr. Jerussa Aita-Levy, LSUHSC Associate Professor of Clinical Pediatrics and mother of four sons.

It was years ago when her seventh grade twins were four-years-old. One of their two older brothers was playing soccer. Gabriel and Eli were on the sidelines playing in the grass. After the game, Eli complained he was hurting and itchy.

"And I'm like, 'Oh, you're fine. You were rolling in the grass. It'll be fine. I'll get you Benadryl. We're all set,'" she told her son.

Soon hives followed on his body. He became anxious in his car seat. 

"And I said, 'No, no. Calm down. It's OK. I'm going to get you Benadryl. We're like 10 minutes from the house,'"

Then there was an acute onset of runny nose, coughing, and difficulty breathing. When Eli got home, he collapsed on the sofa, lethargic and wheezing.

"In that moment, I thought, 'Oh, oh my God. I think this could be an anaphylactic reaction,'" Dr. Aita-Levy remembers.

Anaphylaxis is a serious, life-threatening allergic reaction. Without immediate medical treatment, an injection of epinephrine, it can be fatal.

Without treatment, 50 percent die within the first 30 minutes and 75 percent die in first four hours. For Eli, 15 minutes had already passed since he left the soccer field.

"And time was of the essence, and I was praying, 'God, just please don't let my son die,'"

With her mind racing with options: Call 911? Go to the nearest E.R.? Call her husband? Dr. Aita-Levy drove like mad to the nearest pharmacy. Eli's twin Gabriel was in the car too and was petrified.

"I remember saying to my mom, 'Hurry Mommy, hurry,'" Gabriel said.

"'Hurry Mommy hurry. He's my best friend. He's my best friend,'" Dr. Aita-Levy reenacts her son's words.

She was lucky that pharmacy had an EpiPen in stock. Still she had to say she was a doctor, and write a prescription for it before it was handed over. Then there was more panic.

"Because I know how to dose it. I know when to give it. I know the signs, but I myself, have never administered an auto injector to anyone before,"

A crowd gathered. The pharmacist handed her the instructions.

"I am in a full, full pool of tears. I don't know how to read. The letters don't make any sense, and I heard a voice, 'Get a grip. Get a grip,'" she remembers.

Eli gets the shot in his thigh and instantly gets better.

"And Eli took a deep breath and I just remember him saying, 'I feel better Mommy.' And Gabriel turns to his brother and says, 'Good job Eli.'"

Dr. Aita-Levy tells her most difficult story because it is important for parents to know when you must go and when you don't have to go to the ER with your children.

"I would say it's very common. It's a really complicated question and a hard decision for a lot of parents to make. There's a lot of parents who end up making the choice to come to the emergency department when it may very well be handled by their pediatrician in the office the next day," explained  Dr. Anna McFarlin, Assistant Professor of Emergency Medicine and Clinical Pediatrics at LSU Health Sciences Center. She is also the Program Director of the Pediatric Emergency Medicine Residency Program.

Dr. McFarlin specializes in emergency medicine and pediatrics and works with Dr. Aita-Levy in the Children's Hospital ER. She says there are some guidelines. Fever, colds and rashes in older children can wait,  but infants should not.

"Any baby with any fever, so 100.4 or above, who is less than three-months-old, probably needs an evaluation sooner rather than later. Certainly a baby in their first two months needs to get to the ER with a fever for an assessment," Dr. McFarlin said.

She says Tylenol or Motrin can help older children with fever. But go to the ER if symptoms or rashes progress to the full body, if there is acute vomiting or diarrhea, especially with blood in it, if children are no longer urinating, or there is trouble breathing.

"Most rashes probably don't need to come to the emergency department.  Those that do would be worrisome for allergic reactions, so rash plus something else. So rash plus trouble breathing, rash plus vomiting, rash plus high fever," Dr. McFarlin explained.

A good rule of thumb is, is your child still eating and drinking? Can he put weight on that twisted ankle? Those can wait for the pediatrician's office.  But with belly pain that's getting worse, bring them in.

"It's not uncommon for us to have two or three appendicitis a day. It is the most common abdominal emergency as far as surgical emergency in a child by far," Dr. McFarlin added.

She says call poison control for swallowing any liquid or solid objects, otherwise the best advice when in doubt, is call the doctor for advice.

That's exactly what Sarah Babcock  did.

" I was wondering with rapid breathing, so I called a friend who's a physician. He said, 'Watch it. If it continues to get worse, to go to the ER.'  And his cough started to get bad, that he looked like he was about to vomit. He was coughing so hard. That's when we made the decision to come to the hospital," said Sarah Babcock, 31.

Sarah is a first time mom, hoping to legally adopt her toddler foster child. He has asthma that was made worse from smokers in a previous home. She makes sure she gets advice for the new, most beloved person in her life.

"I decided I was ready to be a parent, and just help a child in need," she said through emotional tears of joy.

For Eli, the culprit was one, tiny fire ant bite on his knuckle. Treatments of venom injections lowered Eli's chance of having another reaction. EpiPens are kept everywhere he goes. But parents in this situation should call 911 since EMS has EpiPens.

"I asked my mom, said, 'What would have happen if you did not give me that shot?' She said, 'Well, you would have died,' she said. I said, 'Thank you for saving my life,'" Eli Levy recalls.

"It wasn't until the allergist told me, 'You saved your child's life.' I cried. I cried for hours," said Dr. Aita-Levy.

And doctor's say if a child is choking, there is no time to wait for EMS. Parents need to learn and use the Heimlich maneuver.

For more on the parental survey: https://www.cbsnews.com/news/do-you-know-when-you-should-take-your-child-to-the-er/?ftag=CNM-00-10aab7e&linkId=43572143

American Association of Poison Control Centers:

800-222-1222

© 2017 WWL-TV


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