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Preventing Drowning and Advancements in Reducing Brain Damage: A Conversation with Dr. Ted Wu · Pediatrics Now: Cases Updates and Discussions for the Busy Pediatric Practitioner

• 0:00
  I'm Holly Wehmint, and this is Pediatrics Now, cases, updates,
• 0:04
  and discussions for the busy pediatric practitioner.
• 0:07
  Click on the link in this podcast for free credit that may include CME,
• 0:12
  MOC, or ethics credit, depending on our topic or podcast.
• 0:18
  This is my first time back in the podcast studio after an unintentional injury.
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  Unintentional injuries are the leading cause of death in children.
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  And in my case, it was a snow skiing accident over spring break.
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  And I credit the doctors at UT Health for saving me.
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  Makes me emotional to think about it. So I'm not going to talk about it too
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  much, but it's great to be back.
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  And I'm here with one of our amazing doctors on the pediatric side. It's Dr.
• 0:49
  Ted Wu. Dr. Wu, thank you so much for being here in this podcast studio on Pediatrics Now with me.
• 0:57
  Thanks for inviting me. It's such a tough topic, the unintentional injuries
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  that you see often as the director of the PICU and a professor of pediatric
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  critical care. You've been doing this for 19 years.
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  You see the drownings, near drownings.
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  What do you want to say about that right off the top? Yeah.
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  I mean, it's one of the most preventable things that we can do.
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  I mean, in pediatrics, we always echo that prevention is like our number one
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  education to our families and parents and caregivers, right?
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  So being, you know, it's the summertime now and everyone's out and about enjoying
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  the pool or being close to water.
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  So having a strategy and talking about who's going to watch over the kids while
• 1:45
  they're playing in the water is a much needed role, right?
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  And, And, you know, we all enjoy being around the water and enjoying drinks as well. So I get it.
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  But having a designated role, like we would have a designated driver,
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  we would have a designated role that would watch the kids as they play in a
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  pool or within, you know, a body of water as well.
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  So I can't echo enough about the necessary kind of role for prevention,
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  right, for against drownings as well.
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  Because it can happen in seconds. Yeah, the cases that we see,
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  unfortunately, you know, that come to our pediatric ICU are,
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  yeah, it's always, the stories are all very similar.
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  Toddlers missing for five minutes, you know, just walked off.
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  And the next thing you know, they're
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  on the bottom of a swimming pool and everyone's rushing to get them out.
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  They start some sort of CPR if they know any of it.
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  And yeah, EMS comes about and, you know, they usually get a heart rate back
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  in that resuscitation, those critical like 10, 15 minutes.
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  But that drowning time, water time, that's very variable. And that's,
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  you know, because it's subjective, right? No one's timing.
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  No one's actually witnessed when it happens. So we kind of don't know when that
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  amount of time that we call anoxia or that time of lack of oxygen to the brain,
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  we don't know what that time is, you know, and we know once 10 minutes of anoxia happens,
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  then the brain starts having all these cascades of injury to it.
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  And part of ICU care is kind of limiting the injuries.
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  We're going to talk about advances in post-cardiac arrest care.
• 3:29
  But before that, since it's summertime, for our pediatric practitioner listeners
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  here in the United States and wherever in the world where you're listening,
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  where it's warm weather and people are swimming, is it something that should
• 3:42
  be mentioned to every patient in the precious moments in the exam room or what's
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  your advice? Yeah, exactly.
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  I mean, that's where I remember being a general pediatrician is in the early
• 3:52
  months or even during the summer months.
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  So starting in April, May, when it starts getting warm and people are going
• 3:58
  towards the pools or even during the summer months is they put in the reminder.
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  Right, of, hey, if anyone's going toward the water, making sure everyone's being properly observed.
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  Right. So I'm being safe. And then I know we're pediatricians out there that
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  are doing it because I don't see it as often. but it does happen in a warm state like Texas here.
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  So always an opportunity as part of our, what we call anticipatory guidance
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  for our pediatricians, right?
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  And it should be part of their talk during the summer months.
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  And I was reading that 87% of the drowning deaths happen in pools.
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  Involving kids age one to four. And then for older kids, it's in open water
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  where they're drowning. Yeah.
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  Well, with older kids, it becomes a little bit more cloudy because there's always
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  a mixture, goofy mixture of drugs and alcohol mixed with that.
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  But yeah, you're correct. I mean, a lot of open water, water sports.
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  So we'll have teenagers, you know, doing flips and dips and slides on water,
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  you know, boats and all that.
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  So, yes, then we'll see those types of injuries.
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  Wear the life jacket. Yeah, wear the life jacket. State law.
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  Yeah, state law, you know, for all kids.
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  And I get it. 18 and under, right? Yeah, exactly. So, I get it.
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  There's sometimes with teenagers, it's like wearing a helmet.
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  It's like you're the kid with the helmet and the life jacket,
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  you know, but it's those little kind of reminders for our kids to do those preventative,
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  you know, safety measures. And it saves lives. Yeah, when we do that.
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  And when it's for the younger kids in pools or hot tub, instead of everyone
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  watching the kids, it's one person.
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  You're the person in charge.
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  Or even there's bracelets you can get online or where you could hand off to
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  that person. You're the person watching the child or children in the water.
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  Yeah, yeah. There's a lot of different techniques. You're right.
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  There's either a bracelet or a baton, like flat out, like it looks like a baton.
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  And you are the person that's concentrating on watching everyone in the pool.
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  Yeah. So especially at pool parties. Yeah. So those are some strategies as well.
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  There are some things out there, I don't know, part of your research that looked
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  at safety alarms of when kids, that the kids would wear if they would,
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  you know, fall into the pool.
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  That alerts families on their phones when that happens.
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  Those haven't been validated. They have pretty good marketing in them,
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  but not really validated.
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  So that could be something that could be an option where they wear it in the
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  water. And when they the kids wear like it comes in a like a onesie of some sort or a bracelet.
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  Yeah, as well. And it alerts them when they go into the pool,
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  alerts the parent that they're in the pool.
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  Wow. Yeah. So, again, it's it's not quite validated quite yet,
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  you know, because it hasn't gone to scale.
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  Yeah. So but it is in the efforts to kind of eliminate drowning. Yeah.
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  And then it's like or does it create a false sense of security?
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  Right. Exactly. You just can't be. It'd be another layer, not in place of watching.
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  Correct. Correct. It's another layer of complexity.
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  Are you watching your phone versus just flat out just watching your kid or the
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  kids, you know, playing out in the pool? Right. Yeah. So.
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  I was saying, as a news reporter, we knew so many accidents were going to happen.
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  And it's just, and I know as a critical care doctor, you knew the same.
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  And you guys were, you said, holding your breath.
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  And then, in fact, was it that weekend that a child drowned? Yeah, yeah.
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  It's always like holiday weekend that occurs and where, you know,
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  family and friend gatherings are occurring.
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  Yeah, usually that's when it happens. Yeah, so.
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  And we, did San Antonio see a drowning that weekend or was it just recently?
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  I know there was a child drowned in the spring time, right?
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  Yeah, there's springtime and there was another one, yeah, recently as well.
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  So, and we're only just one hospital.
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  So in the area, there's quite a bit, you know, in the San Antonio area,
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  you know, because we have so many other hospitals here.
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  In talking to the families, is there a common thread or anything that you want
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  to mention to pediatricians to like, do they, are they saying like,
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  I thought someone else was watching. or I just turned away for a second.
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  Yeah, it's always kind of that moment of opportunity that they're distracted.
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  And we live in such a distracted world with our phones.
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  But yeah, it's in all kinds of scenarios.
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  Sometimes they're freakish, you know, in the sense that, oh yeah,
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  I understand if there's another child that they're watching over that's younger,
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  they're watching over them and they're running off.
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  You know, it is an element of distraction. and the timing is right on, you know.
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  So, but it's never, it's seldom just one person, right?
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  If it's just one person watching over the kids, actually that works out okay.
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  It's when a group of people who make the assumption that the other person is
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  watching or if it's, yeah, it's just being distracted really easily.
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  Yeah, so. That's a great point, Ted.
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  I remember when I was a news reporter and we were rushing to the scene where
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  it was in that body of water near the zoo and it was a party happening over...
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  It was Easter Sunday. Oh, man.
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  And it was a nine-year-old who ended up... Who drowned.
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  And I remember getting there and the emergency...
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  People in the water who they had their wetsuits on. And I just remember getting
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  there and it was so quiet and they
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  were getting out of the water and everything. Like, why is it so quiet?
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  And then it was just like, just so heartbreaking. I'll never forget that moment.
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  But it was that where the family was saying, we all thought someone else was
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  watching her and she didn't know how to swim very well.
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  Well, you all are doing such a wonderful job helping children,
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  and we're talking about advances in post-cardiac arrest care.
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  So what are some of the advances you can tell us about? Yeah.
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  So, you know, this kind of comes up from a couple decades worth of literature.
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  What we found was in adult patients that had cardiac arrest,
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  when they used hypothermia after their care or in their care afterwards,
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  they had better neurologic results.
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  They had less disability and mortality from that.
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  With that knowledge, they applied it to babies with suffered birth asphyxia,
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  and they had extreme acidosis when they were born.
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  And when they used hypothermia in the first 72 hours after that birth,
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  they also encountered less morbidity and mortality as well.
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  So a group of us in pediatric critical care now about 10, 15 years ago decided
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  to use the same type of therapy, which is using hypothermia for pediatric cardiac arrest.
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  I actually was doing training in fellowship in California.
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  And again, my attendings and faculty were like, we have a lot of drownings here, you know.
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  And can, is there any utility using hypothermia to lessen the injury from this
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  anoxia to the patient's brains.
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  So it took a while to formulate, but basically we formulated the largest pediatric
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  cardiac arrest group all around
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  the country, and in fact, extending to Canada and Australia as well.
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  Wow. So our first study is called the FAPCA studies, and that's an acronym standing
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  for Therapeutic Hypothermia After Pediatric Cardiac Arrest. arrest.
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  And that was looking at cardiac arrests, whether they happened in hospitals
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  or outside of the hospital, and just compared using hypothermia and normalthermia.
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  And what the past studies had shown was comparing hypothermia versus nothing.
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  And they had showed better outcomes when those studies.
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  But when we compared it just to normalthermia, there was actually no difference.
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  So what that meant to us was that,
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  It was really critical to protect patients' brains after their cardiac arrest
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  and not get them hyperthermic, not having fevers afterwards,
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  and to control their temperature.
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  So this is where we call it targeted temperature management, TTM.
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  So that's one of the major developments that we've seen now that has good outcomes
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  in protecting patients' brains.
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  So, Ted, that's so fascinating. And what does that look like?
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  So say if a child's pulled from the water. Yeah.
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  So once they're pulled from the water, they're actually usually pretty cool.
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  Then their temperatures are usually in the 92, 93 degrees.
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  And a lot of our practice now is we don't actively warm them.
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  In the past, we would actively warm them back to normal, which is 97, 98.
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  Now we just let that be because we kind of think it's protective in that form, right?
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  And then when they come to the ER, and we work with our ER colleagues now to
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  activate cooling then, as soon as we can put them in some kind of,
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  we call it thermal blanket,
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  we wrap them in this blanket that's laced with water that is actively cooled
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  or warmed, depending on what the target temperature is.
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  So we do that starting in the emergency room and then we continue it to the ICU care.
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  So hypothermia and its use has been used for a lot of other diseases,
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  but cardiac arrest seems to be the most benefit of protecting the brain.
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  It's so interesting where it's hypothermia can be its own emergency.
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  It's like inducing this pain.
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  Emergency to help save someone and to help save their brain.
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  Yeah. I mean, it came from, you know, the old tales where, you know,
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  the kid in Lake, you know, drowned in Lake Michigan in the middle of winter
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  and was down for like 30 minutes.
• 14:21
  The divers were going in, they pulled them out and came back and it was absolutely normal. Right.
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  And there were some studies that did older studies that looked at that and found
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  that when they cooled patients too long for like a week, they had worse outcomes.
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  They had worse outcomes with that.
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  So we found out there's probably some utility in using hypothermia,
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  but probably not too long.
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  It has to be the exact right amount. Yeah. And what the right exact amount, we don't know.
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  So that's actually where we're involved now. Now, the same hospitals that did
• 14:56
  the THAPCA studies are doing now what we call a pediatric ice cap study.
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  And it's just looking at, we initiate hypothermia for also pediatric cardiac arrest patients.
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  And they're usually drowners or near drownings.
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  And then cooling them and they get randomized to the duration.
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  So they all get hypothermia, but the duration is where they randomize.
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  To see where the optimal time duration to optimize or lessen their injuries when we look at them.
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  So we will enroll these patients and we follow them a year later.
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  Have them evaluated by our neurologist.
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  And we have a developmental pediatrician who also evaluates them as well,
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  just to kind of see what outcomes come out of that.
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  So that's ongoing right now. And because a lot of families may not realize that
• 15:46
  the child survives, that child may have long-term brain damage.
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  Yeah, brain damage, a lot of developmental disabilities, you know,
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  some disability, and it ranges. That's the hard thing to predict, right?
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  Some could be, you know, not able to walk properly.
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  Some might lose, you know, the ability to speak well, you know,
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  but we don't know what happens with what.
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  There's no enough brain imaging to kind of help predict that as well.
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  We just kind of teach our families that these injuries happened,
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  and then kind of get them to therapy and rehab to help, you know,
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  train or, you know, get those abilities back.
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  But it's hard with toddlers because with toddlers, we kind of didn't know because
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  they're developing as well.
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  So we didn't know what they could developmentally do anyways.
• 16:34
  Right. So, but we try to optimize that while they're recovering.
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  Music.
• 19:23
  Or cardiologists follow, those are the ones that also have cardiac arrests outside of the hospital.
• 19:30
  Okay. And I saw that San Antonio now has its first confirmed case of measles
• 19:36
  and pneumonia is, I think, the most common side effect of measles.
• 19:41
  And hopefully pneumonia will not become more common as we see more cases of measles.
• 19:47
  It's so awful, heartbreaking. Yeah. Yeah.
• 19:50
  Yeah. I mean, as our unvaccinated rates go higher, yeah, we're going to see
• 19:56
  more measles cases. Yeah.
• 19:58
  So. And we do have an episode here in the Pediatrics Now News Feed.
• 20:02
  The episode right before this is a COVID update.
• 20:05
  And we talk about COVID and flu shots with our pediatric infectious disease
• 20:09
  doctor and advice on what does science show, what to say to patients in that regard.
• 20:15
  Ted, is it good for all of us to have cold water, a cold water plunge or get in the cold water?
• 20:22
  Do you want to say anything there? Do you try to do that? No.
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  I mean, I've done half marathons or trained for them. You know,
• 20:31
  I've heard the whole ice cold plunge.
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  I've also read the literature. There's a lot of sports physiology about swimmers
• 20:38
  that swim in cold water, like truly like frigid water.
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  And there is some benefit in definitely making decisions
• 20:50
  energy efficient for oxygen consumption for your muscles, right?
• 20:53
  They don't know if there's some anti-aging effects in that, but I know swimmers,
• 20:59
  as we talked about, you know. Yes, we're both swimmers. Yeah.
• 21:02
  And they live long lives because of that. But that science is really out there.
• 21:08
  So there's still more to come about that. Yeah. So. My son did an outward bound expedition in January,
• 21:15
  which I highly recommend, But he went to an area called the Boundary Waters
• 21:19
  in Minnesota, and it was seven days of dog sledding and cross-country skiing.
• 21:26
  And then at the end, they go into the sauna, and then they do a cold plunge.
• 21:32
  And the maximum I think you could do the cold plunge was stay in for two minutes,
• 21:36
  which he got very close to that. But he loved it.
• 21:38
  He loved it. That was his favorite part. Oh, wow. There you go. And he wants to go back.
• 21:44
  So ted it's such an honor to be talking to you here today and i so appreciate
• 21:49
  you being here in the podcast studio how are things going in the pic you are there any other,
• 21:54
  unintentional injuries you want to mention i mean you know in the pic you especially
• 21:59
  during the summer seasons all of the preventable diseases are preventable injuries
• 22:05
  which are burns and sunburns?
• 22:08
  No, burns from fireworks and outside gatherings, right?
• 22:13
  As we lead into the 4th of July weekend. Right, exactly. So fireworks is the big thing.
• 22:19
  In San Antonio, they are illegal, but outside it is, you know, open flames, I guess.
• 22:26
  But yeah, that's a lot of where our injuries see from our, you know,
• 22:30
  from toddlers, you know, handling, you know, fireworks or sparklers,
• 22:33
  Or teenagers too Or teenagers too, right, exactly And with the teenagers then it gets with
• 22:40
  open fires and adding gasoline to them. We'll see those.
• 22:45
  They add gasoline to the fire? Yeah, they add gasoline to the fire.
• 22:48
  They'll see someone do it, but not knowing how much to do.
• 22:53
  And that's actually still really dangerous to do.
• 22:56
  And the grill and being safe around that. So we'll see various injuries related to fire in that.
• 23:04
  The other one is just flat out family travel, right?
• 23:06
  Making sure all the kids actually are in car seats and not sitting in a family
• 23:13
  member's lap because we see a lot of those types of accidents during the holiday weekend as well.
• 23:19
  So mentioning that, having everyone kind of in a buckle seat and it's not worth
• 23:24
  the, you know, the cram seating in those situations, you know,
• 23:29
  and having, you know, your loved one get really injured because of that, you know.
• 23:33
  So those are the types of things that we'll see during the summertime right now.
• 23:38
  And you're on call tonight, right? Yeah, I am on call tonight, yes.
• 23:41
  I so appreciate you being here as we head into this holiday season,
• 23:45
  which is that travel's already started.
• 23:48
  Yeah, right. That's true. So we'll see.
• 23:51
  What else would you like to say to the pediatric practitioner listener?
• 23:54
  I think it's so incredible and inspiring that we are seeing fewer drownings,
• 24:00
  thanks in a huge part to pediatric practitioners mentioning something to families in the exam room.
• 24:06
  Yeah, you know, I think, you know, as our good general pediatricians are out
• 24:11
  there, you know, counseling our families, never underestimate your advice.
• 24:18
  It still carries a lot of weight.
• 24:20
  Sometimes I feel that our pediatricians might feel that they,
• 24:24
  you know, there's so much information out there and it's so accessible.
• 24:29
  But the pediatrician still has a lot more weight in ways that you probably don't
• 24:35
  know and just being receptive to your families and what they're trying to tell you.
• 24:41
  If they, sometimes if a parent or the patient have suspicions of things,
• 24:47
  it'd be a good opportunity to kind of really delve into that.
• 24:50
  I know sometimes it's really busy to kind of go into the details of things but
• 24:54
  I think sometimes it's worth the time to kind of delve into more of that and that's where we run in.
• 25:00
  For us in the ICU, we see the patients have gone to the pediatrician X amount
• 25:05
  of times and didn't really identify.
• 25:08
  And they have very vague symptoms. I get it. And how do you.
• 25:13
  Weed out all of that, you know, but some, some of our pediatricians out there
• 25:17
  are able to kind of able to ask the right questions and really figures, help figure things out.
• 25:23
  So I think being attuned to that is a good opportunity to talk to your families
• 25:28
  and your patients to do so.
• 25:30
  So, and I know with, with my three kids, I'm every time there might be something
• 25:35
  that I've been talking to them about.
• 25:37
  And then when the pediatrician says it, then they really, that's
• 25:40
  when they really start doing it you know there is that power
• 25:43
  and then we do have a couple of
• 25:46
  episodes in this news feed on motivational interviewing which can
• 25:49
  really help you drill down in that short amount
• 25:52
  of time in the exam room you have to really get to
• 25:55
  the heart of the matter which it can be so tough like you're saying well
• 25:58
  the funny thing about that is that so my wife and
• 26:01
  I are both pediatricians and even with our kids
• 26:04
  we we tell them hey we're gonna let doctor are
• 26:07
  you know your pediatrician know that you're doing this and
• 26:10
  then they're like no no no no no don't let her know oh that's good
• 26:13
  yeah so i was like see you know i so the
• 26:16
  pediatrician does have a lot more you know weight
• 26:19
  you know outside the parent right you
• 26:22
  know so that's great yeah my son
• 26:25
  was so he he had listened to the
• 26:27
  both of our motivational interviewing episodes or the
• 26:30
  all three of the motivational interviewing episodes and then
• 26:33
  i was asking my older daughter about something and then he's like mom why did
• 26:37
  you ask a closed-ended question which is part of it i'm like oh yeah why did
• 26:42
  i and it's a lot of in motivational like interviewing reflecting back like so
• 26:48
  what you're saying is all right and then repeating back so you're understanding it yes so.
• 26:54
  Ted, before we wrap up, do you want to talk about, I like to promote doing stuff
• 26:59
  outside of medicine in this high burnout, high stress career. I know you swim.
• 27:06
  Is there anything else you want to talk about that you do for fun?
• 27:09
  I actually golf, you know, for my fun. I
• 27:12
  like the nature of it's it's so
• 27:15
  hard and difficult but I like
• 27:18
  it because there's not time where you
• 27:20
  can spend so much time outside outside of hiking and
• 27:24
  but but you're kind of always I like how it
• 27:27
  engages your mind and you're trying to
• 27:29
  figure things out it's all every every hole is a
• 27:32
  puzzle once you get part past part the
• 27:35
  part of how to you know hit your golf ball and control it
• 27:38
  but then there's so many other things to it
• 27:41
  that's it's so engaging and
• 27:44
  and mind-boggling so that part i really
• 27:47
  enjoy the swimming part for me is just not only to maintain some fitness and
• 27:52
  stamina but it's also a quiet time as well right so i really enjoy that that
• 27:58
  moving meditation yeah exactly outside that yeah it's really you know daddy
• 28:03
  time with with the kids that's kind of how I maintain some balance there.
• 28:07
  So, yeah. And you're a father of two? Yes. Yes.
• 28:11
  And did you and your wife meet in medical school?
• 28:14
  We met during training. I did my training in Las Vegas, Nevada. Yes. So, yeah.
• 28:19
  And then were you friends first or do you want to talk about that at all?
• 28:23
  Yeah, we were friends first and then we didn't actually start dating until after training.
• 28:28
  Yeah. And then I moved. So I had to do additional training after that training
• 28:33
  and that moved me to Southern California. at Loma Linda.
• 28:36
  So it was not until then we were, we were dating. So, yeah.
• 28:41
  So, and you were talking about golf. My, my son, I've been playing with him
• 28:45
  some, and he told me like, it takes a lot of work to just get to where you're
• 28:49
  bad at golf, but you're playing actually.
• 28:51
  I'm like, oh, great. It's like a little bit intimidating.
• 28:55
  So that's my first goal is to at least be playing, but be bad at golf. Yeah.
• 28:59
  Right. I guess. Yeah, exactly. So there is like This threshold where you put
• 29:05
  in a lot of work just to hit the ball, hit it in some fashion that's consistent.
• 29:12
  But it is so beautiful to be out there. Yeah, I know.
• 29:16
  And Texas is awesome for golf. It is hot, though, but it is pretty awesome for a lot of the golf here.
• 29:25
  Music.
• 29:53
  Department of Pediatrics at UT Health San Antonio and University Health's new
• 29:58
  Women's and Children's Hospital.
• 30:01
  Thank you so much for listening.
• 30:07
  We are so grateful to our listeners and also to the educational grants that
• 30:12
  help support Pediatrics Now.
• 30:14
  Our website is pediatricsnowpodcast.com. For episode ideas or questions, please reach out to me.
• 30:22
  My email address is on there. I'll see you soon.