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Pediatric Emergency Care: Read Blaise's Story
RWJ Hamilton First Stop to Regional Hemophilia Program
Date: 10/1/2011

Four-year-old Blaise Kczarsewski likes SpongeBob, sea life, dinosaurs and red foods most children love.  When the Hamilton child vomited reddish stuff the day after he ate cherry water ice, spaghetti and strawberries, his mom Ashley didn't initially panic.  But Blaise has hemophilia, an inherited bleeding disorder that does not allow his blood to clot — or stop bleeding — properly.  Hemophilia causes bleeding without an obvious reason and increases the chance of bleeding after an injury or surgery.  About one in every 5,000 boys has hemophilia.

"The next day Blaise just laid on the couch.  That's not like him," said Ashley Kczarsewski.  When Blaise tried to eat dinner, he vomited what looked like coffee grounds.  Ms. Kczarsewski knew what that meant: blood in his stomach.  She grabbed a bottle of factor VIII — the clotting factor that is missing or low in people like Blaise with hemophilia A — and rushed him to the emergency department at RWJ Hamilton.  Doctors from the Robert Wood Johnson Health System have been caring for Blaise since he was born.

Hemophilia Requires Emergency Response
"Bleeding in the intestinal track is life threatening," said John Lawrie, MD, an emergency medicine specialist who treated Blaise.  Dr. Lawrie told Ms. Kczarsewski to give Blaise the factor VIII she had brought.  He gave Blaise IV fluid to help lower his heart rate and medicine to make his stomach feel better.  He called the Bristol-Myers Squibb Children's Hospital (BMSCH) at Robert Wood Johnson University Hospital in New Brunswick to have Blaise cared for by leading pediatric specialists there.

Nurse practitioner Kelly Keefe-Marcoux, MSN, CPNP-AC, CCRN, EMT-B, took the call and quickly assembled her team including the head nurse from the pediatric intensive care unit (PICU) and an EMT.  Their mobile PICU is a child-friendly ambulance decorated with a large happy sun and stocked with stuffed animals and a DVD player.

When the Children's Hospital team arrived in Hamilton, they worked with Dr. Lawrie and staff at RWJ Hamilton to make sure Blaise was stable and updated specialists at BMSCH on his condition.  During the ride to New Brunswick, they monitored Blaise and talked to him.  Although they put Kung Fu Panda in the DVD player to entertain Blaise, this wasn't necessary.  "Blaise was sweet and engaging," said Keefe-Marcoux.  "He entertained us."

Regional Specialists Restore Boy's Health
At BMSCH, Blaise went right to the PICU, where the most critically ill or injured patients in New Jersey receive care.  He spent two days there and four days on the hematology/oncology unit, getting a blood transfusion, more factor VIII and medication to heal his stomach.  "Only regional hemophilia centers have the expertise to manage

 Pediatric Emergency Unit at RWJ Hamilton
A new unit to treat our youngest patients in times
of emergency. 

- Treating non-life threatening injuries and illnesses
- Supports the primary emergency department
- Eight dedicated beds
- Staffed with specially-trained physicians and 
nurses

Pediatric emergency care at RWJ Hamilton is
supported by leading sub-specialists at the
Bristol-Myers Squibb Children's Hospital.
hemophilia patients," said Susan M. Murphy, MD, the pediatric he matologist/oncologist who treated Blaise.  Dr. Murphy is part of the New Jersey Regional Hemophilia Program at RWJUH, part of a national network supported by the Centers for Disease Control and Prevention.

Ms. Kczarsewski stayed overnight with Blaise.  When he was moved to the hematology/oncology unit, he spent most of his time in the playroom, making friends and crafts with child life specialists, experts in child development who are trained to help children and families cope with hospitalization.

Blaise is back at home in Hamilton building puzzles and playing Candyland.  But he still talks about throwing up blood and riding in the ambulance.  "The 'hoskital' and the playroom were awesome," said Blaise.  "RWJ truly is an amazing hospital," said Ms. Kczarsewski.  "I appreciate everything that the doctors and nurses there have done for Blaise.  They really cared about my son and his well-being."  Blaise continues to receive comprehensive, ongoing care, education and support through the New Jersey Regional Hemophilia Program.

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