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Emergency / Children's Transcript

Emergency/ Children’s – Nick Borm, MD Video

Opening screen with title “American Health Journal” and swirling graphics in motion over blurred images of physicians.

[Serious music]

Announcer (V.O.): Emergency departments have specific requirements when treating pediatric patients. Children need special treatment both in their medical needs and emotional support. At Valley Presbyterian Hospital, we spoke with emergency medicine specialist Dr. Nick Borm who discusses the common reasons a parent would bring their child into the emergency room.

V.O. visuals: Exterior hospital sign with “Emergency Entrance – Basic Emergency Medical Service – Physician On Duty 24 Hours”; interior of hospital with pan of emergency beds; healthcare worker treating a toddler laying on an emergency bed; close-up of nurses hands attaching an IV to a young patient; exterior entrance of Valley Presbyterian Hospital; Dr. Borm being interviewed in a dark studio with a blue and black background; Dr. Borm in a white coat in the Emergency Department sanitizing his hands.

Nick Borm, M.D.: Kids are coming into the emergency room for a number of different reasons. Most predominantly we see, especially at Valley Presbyterian, fever, cough. We see abdominal pain, rashes and nausea.

V.O. visuals: Closeup of Borm in the studio, wearing a suit and tie. He is introduced with the title “Nick Borm, MD, Valley Presbyterian Hospital” in the lower-third.

Borm (V.O.): We’ll also see things like traumatic injuries, falls, broken bones, lacerations.

V.O. visuals: Toddler playing with toys in his bedroom; healthcare worker wraps gauze around a young male patient’s head wound.

Announcer (V.O.): Dr. Borm examines the symptoms children exhibit when they have breathing problems.

V.O. visual: Borm in emergency department speaking with another male doctor behind a computer monitor.

Borm: When you’re dealing with breathing issues in children or respiratory issues in children, there are a couple of things that I think that parents can be aware of that may help identify that trigger point and say, ‘I need to go to the emergency room, I need to seek care for my child.’ When we look at children a couple of things…

Borm (V.O.): …regarding the respiratory system. We look for what we call work (inaudible) breathing. We’ll look at their nose and look for flaring of the nostrils. So, nostrils will flare out and that’s an indication that the child…

V.O. visuals: Close-up of female hands using stethoscope on baby’s chest; young boy in hospital bed breathing into tube for testing respiratory issues.

Borm: …is working a little hard to breath. We look at the little area between the collarbones and we look for some tugging of the skin, the skin will pull in a little bit and that’s another sign to us that the child is working hard…

Borm (V.O.): …using what we call accessory muscles to help breathe. The other thing we look for is intercostal retraction. That’s a fancy term that just means the sucking in of the muscles around the ribs. You’ll start to see the ribs during every breath.

V.O. visuals: Toddler sitting on his mother’s lap, having difficulty breathing; close-up of baby lying on his back with stomach muscles contracting as he gasps for air.

Borm: Turning blue around the lip, or cyanosis, and then again, we get back to a change in they typical behavior of your child. If they’re just not acting right, they’re not feeding…

Borm (V.O.): …they won’t take a bottle, those are other signs, or warning signs that there may be a more serious respiratory illness.

V.O. visuals: Baby in emergency room resisting a bottle from his father, as emergency room nurse uses oxygen tube on his nose.

Announcer (V.O.): Dr. Borm recommends ways parents can help streamline the process to have their child evaluated in the ER.

V.O. visual: Camera pans as Borm walks out of emergency department exit into parking lot with sign “Ambulance Entrance Only” and “No Smoking."

Borm (V.O.): I think it’s really important for parents to prepare for an emergency room visit. So…

V.O. visual: Interior signage with “Emergency Waiting Room – Sala de Espera de Emergencia."

Borm: …things like medications that the child usually takes, allergies to any medications, a birth history…

Borm (V.O.): …or medical history would be very important. These are things that can be brought along, say it’s a medication, of course bring that medication in.

V.O. visuals: Two young boys playing with toys on the floor; close-up of a bottle of oral suspension medication; close-up of two bottles.

Borm: What we’ve been seeing with our patients is that as technology is progressing and everybody has a smart phone, simply taking a picture of that medication.

Announcer (V.O.): Hospitals are working to help children to feel less overwhelmed in the emergency department.

V.O. visual: Young boy in ER bed smiles as doctor talks with him and uses stethoscope on his chest.

Borm (V.O.): We have an evaluation room that’s a little more quiet and secluded, and so the initial evaluation of the child will be in a more private area.

V.O. visual: Health care worker escorting a young boy through the emergency department to an evaluation room.

Borm: We have certain programs in place like the POKE plan, or the P-O-K-E plan, where we have a specific child life specialist. That’s somebody who…

Borm (V.O.): …specializes in helping patients, particularly children, and their families approach a difficult situation, whether it’s an IV, whether it’s a painful procedure, they’re able to come down and help with distraction techniques, educate the family members and most important involving the family members…

V.O. visuals: Nurse attaching an IV to baby in his mother’s arms; another nurse writes on clipboard and takes temperature of the young man holding a bandage to his head wound; a nurse starts the IV process with a baby while a child life specialist attempts to distract him.

Borm: …in the care of their children. We’ve found that it’s extremely successful and helps with a lot of both the emotional and physical trauma that can occur with children being evaluated in an emergency room.

Announcer (V.O.): Dr. Borm discusses the increasing incidents of psychiatric problems in children.

V.O. visual: Close-up of Borm in the ED speaking with another doctor off camera.

Borm (V.O.): We’re starting to see a large population, especially in our children under the age of fourteen that have…

V.O. visual: Camera pulls back to reveal other doctor sitting behind ED desk as they talk.

Borm: …psychiatric illness. These patients often require emergent evaluation. They either become threatening to the family or…

Borm (V.O.): …it's a situation where the family just feels uncomfortable handling at home. You don’t know when these cases are going to come in. Our solution to this has been telemedicine, and ultimately what happens is a board certified psychiatrist will be able to beam in almost like Skype, through a video chat…

V.O. visuals: Borm looking at computer monitor in the ED; another angle that displays various patient conditions on the monitor; interior of ED room a teenage female patient lying in bed looking at tele-monitor screen of off-site doctor speaking with her.

Borm: …and actually evaluate that patient in real time. There will be a medical screening examination to make sure there is not a medical emergency and then the psychiatrist is able to perform a timely evaluation. They’re able to access the patient…

Borm (V.O.): …discuss the case with the patient’s family and as well as the emergency provider.

V.O. visual: Borm walking through ED hallway toward and past camera.

Announcer (V.O.): Emergency departments are working to achieve the best treatment for the children they see.

V.O. visual: Male healthcare worker kneeling and talking to a toddler boy sitting on an ED bed.

Borm (V.O.): Programs like our telemedicine psychiatry program - we also have telemedicine neurology - are able to connect providers to patients in a more efficient manner.

V.O. visuals: Nurse pushes telemedicine machine through the ED; close-up of telemedicine screen; interior of ED room a teenage female patient lying in bed looking at tele-monitor screen of off-site doctor speaking with her; camera zooms in for close-up of doctor on video.

Borm: Those tools and those technologies have not only increased our ability to provide excellent care for our patients, but also provide efficient care for them as well.