The school year is starting, bringing with it many changes and new experiences for young children. Emergency care doctors like Dr. Josyann Abisaab know that this is a vital time to go over safety rules regarding transportation and play.
The National Safety Council recently released a back-to-school safety checklist for parents and family members:
- “Review your family’s walking safety rules: walk on the sidewalk, if one is available. When on a street with no sidewalk, walk facing the traffic. Before you cross the street, stop and look all ways to see if car are coming. Never dart out in front of a parked car.
- Practice walking to school with your child.
- Make sure your child always wears a helmet when leaving the house. (When riding a bike)
- Teach your children the rules of the road they need to know to ride their bicycles.
- Go to the bus stop with your child to teach them the proper way to get on and off the bus.
- Make sure your children stand six feet away from the curb.
- If your child and you need to cross the street in front of the bus, walk on the side of the road until you are at least 12 feet ahead of the bus. You always should be able to see the bus driver, and the bus driver always should be able to see you.”
No one wants to be in a position in which they have to go to the emergency room, but each year 135m+ Americans do end up making a visit. Given this large number, it is probably worth reading up on some tips on how to make it as smooth an experience as possible. The less anxious the patient and the individual taking them are when going to the ER, the better for everyone.
With this in mind, the American College of Emergency Physicians (ACEP) put together “ER 101,” on “What to Expect,” offering easy-to-understand tips for the situation. In addition, it makes it much easier for physicians like Dr. Josyann Abisaab – an ER doctor at the New York-Presbyterian Hospital – when dealing with their patients. The better prepared the patient’s escort is, the easier it is for them to receive adequate treatment.
According to the ACEP’s guidelines, it is a good idea to bring an overnight bag for patients who are older and frailer, since they have a greater chance of being admitted to the hospital. The patient should try to avoid food and drink before being assessed by a physician (unless there are extenuating circumstances such as diabetes). For children, a lot of ERs have a “Welcome to the Emergency Department,” coloring book facilitating the process. The ACEP’s guidelines also includes advice on: what to expect when one arrives; what information is useful to take along; where to get medical history forms; important questions to ask before leaving the ER and more.
Perhaps somewhat frightening to hear, very year, Americans incur 6,000+ snakebites. The good news is that, according to The American Family Physician, fewer than 12 of these (0.25 percent) have fatalistic snake venom poisoning consequences. The issue however is that most people will not know the difference between a fatalistic bite and the less dangerous ones. That is why it is essential that if one is bitten, they follow a set of established guidelines.
First, if you’re outside, get inside as quick as possible (to the car). Limit use of the bitten area as much as possible. Then figure out how to get to the ER to get assessed and treated. Most Emergency Room physicians – such as Dr. Josyann Abisaab who works at the New York-Presbyterian Hospital – have encountered many snakebites and will be able to administer the correct course of treatment. Patients invariably do not; thus any suspicious snakebite needs to be assessed as soon as possible by those who are qualified.
No matter the time of year, there are many ways that children can get hurt and end up in the emergency room. One of these hazards involves the pushing lawn mower. While parents often want their children to have chores around the house, it’s important to think about which chores are appropriate for which ages.
Emergency room doctors like Dr. Josyann Abisaab see a surprising 17,000 children a year who require emergency room care because of lawn mower accidents – and certainly some of these are quite serious.
Page Geske of Safe Kids Magic Valley says, “kids under 12 shouldn’t be allowed to operate a pushing lawn mower and some of the recommendations are children shouldn’t drive a lawn mower, a riding lawn mower until age 16.” Many safety experts recommend that children under six shouldn’t even be outside when the law mower is being used, as it’s hard to keep a constant watch on kids and they can easily get their hands caught in the machine.
When confronted in the emergency room with a patient who is suspected of having elevated intracranial pressure, a physician like Dr. Josyann Abisaab will likely reach for one of the most useful tools available to her, and that is the ultrasound machine. This amazing piece of modern hospital equipment is an excellent way to discover whether or not there is dangerous pressure building up inside the skull.
According to many emergency room physicians the ultrasound is “a tremendous -triage tool with high sensitivity to detect people who need moremonitoring.”
The value of the ultrasound is highlighted even more when the emergency room is confronted with the ever-increasing problem of limited resources.
“Even at a Level I trauma center, when you have multiple patients waiting for a head CT, we need to know who we should be most concerned about and who needs to go to the operating room immediately. This helps us decide who needs to go first,” one emergency room specialist explained.
The summer months are a time to enjoy the great outdoors. This opportunity also comes with risks, however, and they need to be closely understood to prevent accidents. Even the family backyard can become a location for accidents and emergency room visits.
Anyone who has a trampoline, for instance, should know that they can be extremely dangerous. The US Consumer Product Safety Commission estimated that in 2010, over 92,000 hospital room visits were due to trampoline accidents. In order to avoid injuries, families need to limit the number of people allowed on the trampoline at one time and make sure that an adult is always around to supervise. There should also be a safety net around the trampoline to keep children from falling to the ground.
The swing set also poses potential dangers. The set should be checked before children get onto it, to make sure that the normal wear and tear that it receives hasn’t created any dangers. Since wood can rot over the winter, the owners should check for decay as the summer starts. Bolts should be replaced if they are rusty and children should always be watched.
All of these suggestions will help families to have a safe time playing at home during the summer and to avoid emergency room visits to Dr. Josyann Abisaab and the many emergency room doctors like her.
Many people suffering from arthritis feel especially stiff upon waking in the morning. It can be difficult to get going with your day when it takes longer to loosen your joints and alleviate the aches and pains these illnesses cause.
Although there is very little scientific evidence that cold weather directly causes arthritis or alters its course, there is no doubt that the cold makes arthritis feel worse.
When air pressure drops, as it does on cold winter days, this can affect the balloon like tissue surrounding the joints. Lower air pressure means the balloon can expand a little, which places additional pressure on already sensitive joints. People can actually feel the pressure around them changing in their joints. This is the reason many people say they can predict coming bad weather in their joints.
One doctor from the National Institutes of Health suggests:
“Do what you can to keep warm. Bundle up from head to toe in several layers, preheat the car before getting into it and make sure your home or apartment is kept warm.”
Additional suggestions are: Sleep under an electric blanket, warm clothing in the dryer before dressing and drink warm or hot drinks, such as coffee, tea or hot chocolate.
It can also be helpful to keep the joints moving. Before going out in the cold, warm up your joints, and a regular, yearlong exercise program can also be extremely helpful to relieve the extra joint pain of winter.
Dr. Josyann Abisaab is an emergency room physician at the Presbyterian Hospital of New York, wishing you a warm, pain free winter.
Winter is fast approaching, and along with cold, stormy weather comes the influenza virus. To be more accurate, the flu is actually a group of many different viruses which all cause similar symptoms. Each winter international teams of researchers and doctors estimate which types and strains of viruses will spread the most widely throughout the world in any given year, and then vaccines are prepared to protect against the three strains of flu considered most dangerous or likely to spread worldwide.
There are three ways to receive a flu shot which are delivered via needle, usually in the arm: the normal shot which is approved for all people older than 6 months; a high-dose vaccine which is approved for those over 65 years old; and an intradermal shot for those between 18 and 64 years old.
Also available for use in healthy people ages 2 to 49 who are not pregnant is the nasal-spray flu vaccine. This is made with live, but weakened flu viruses, as opposed to the ‘shot’ which uses killed viruses. The nasal spray is also called LAIV, which stands for “Live Attenuated Influenza Vaccine.”
The best time to get vaccinated is as soon as the vaccine comes available. It takes about two weeks after administration of the shot to develop immunity to the flu, so the sooner the vaccine is given, the sooner people are protected. However, just because it may be late in the season is not a reason to refrain from getting the flu shot. The CDC recommends getting vaccinated from October all the way to May, reasoning that different viruses circulate in different places at different times, and it is always wise to get protection.
Josyann Abisaab, MD wishes all a healthy flu season this winter.
Knowing when to go, and when to refrain from going to the emergency room can not only save you time, and money, but it can also save your life.
When the flu strikes there is no question that you should be examined by a health care professional, but the question is how urgent is it that you are checked immediately, or can you wait to make a short-notice appointment with your doctor?
The determination of whether or not to go to the emergency room should be based on how ill you are. Also, if there are other chronic conditions present as well. For instance, if someone with diabetes, asthma, COPD or congestive heart failure develops flu symptoms, he/she should be seen within one day by their regular doctor. If a short-notice appointment cannot be made, then a trip to the emergency room is in order.
Pregnant women should also take the flu seriously, more so than non-pregnant women. Other generally healthy people, including children are usually better off staying home, even if they are not eating during their illness. As long as the patient is holding down liquids, there is no immediate health threat if a person, including a child, does not eat for a week, or even two.
The following symptoms may indicate that the patient may need antiviral drugs like Tamiflu, or even the need for hospitalization:
• Fever of 102 degrees or higher
• Serious fatigue
• Stubborn cough with either yellow or green phlegm
• Difficulty breathing, shortness of breath
• Feeling light-headed or thirsty from dehydration which can be caused by vomiting and/or diarrhea.
Josyann Abisaab, MD, is an emergency room physician at New York-Presbyterian, as well as an Assistant Professor of Clinical Medicine at the Weill Cornell Medical College.
New York-Presbyterian Hospital offers New Yorkers and others from nearby locations cutting edge emergency medical care at no less than three locations: Weill Cornell at 525 East 68th Street; Columbia Hospital at 622 West 168th Street; and at the Allen Hospital at 5141 Broadway at 220th Street.
New York-Presbyterian Hospital prides itself on its goal to provide the highest quality care possible, using the most modern and cutting edge techniques and equipment available, to all New Yorkers no matter their background. The emergency medical facility also offers quaternary referral centers for those arriving at the emergency room with complicated medical or surgical issues from all over the globe.
Josyann Abisaab, MD, is an emergency room physician at New York-Presbyterian, as well as an Assistant Professor of Clinical Medicine at the Weill Cornell Medical College. In her capacity as a physician working in the front lines of emergency care, Dr. Josyann Abisaab is able to bring back to the classroom the lessons of the emergency room. This is just one part of the uniqueness and strength that makes New York-Presbyterian Emergency Medicine strategically positioned, in both the academic and clinical realms, to advance successfully into the future of state-of-the art emergency care.
Many people have the misconception that they’ll get treated faster in the emergency room if they arrive in an ambulance. While people with serious problems, who are brought to an emergency room like New York Presbyterian Hospital Dr. Josyann Abisaab, may get put at the front of the line, others won’t necessarily.
As Michelle Dressman, a pediatric ER nurse at Johns Hopkins Hospital in Baltimore, Maryland explains, patients get evaluated upon arrival. The length of time that you have to wait will depend on your symptoms and history, not whether or not you arrived with blinking lights.
If you do decide that you need an ambulance, make sure to find out which hospital they plan to take you to. Some hospitals may be better suited to help with you with the specific type of issues that you have. A major medical center, for instance, may be more suited for your needs than is a community hospital. This is particularly true if you have neuromuscular disease or other tricky issues.
The summer is certainly the hottest time of the year. Most people don’t want their children sitting inside all summer, but they need to be aware of the safety tips that can keep their children safe while exercising during the hottest months. Emergency room doctors like Dr. Josyann Abisaab treat children each summer for heat stroke and dehydration; and these situations can easily be avoided with a bit of preparation and knowledge.
If there is a high heat or humidity warning in your area, children should only participate in intense physical activities for 15 minutes or less. Before they participate in prolonged physical activities, children need to be well-hydrated.
During the first hour of exercise, children should then be given plenty of water to drink and they should continue drinking either water or a sports drink every 20 minutes for as long as they are exercising.
During strenuous activities in the heat, children should have on light-colored and lightweight clothing and should only be wearing one layer.
If children start to feel lightheaded, too hot, or fatigued, they should get to a cooler, shaded environment and should drink plenty of water or carbohydrate-electrolyte beverages.
These tips will help to reduce the number of visits to the E.R. where physicians like Josyann Abisaab treat heat-induced sicknesses each summer.
Certainly, the summer is the time when children enjoy being outside, getting fresh air and plenty of exercise. It’s also the time when emergency room doctors like Dr. Josyann Abisaab see more accidents and injuries in children.
There is virtually no end to accidents that may occur during the summer months, with children enjoying swimming, boating, outdoor playing and sun exposure. Accidents can be avoided, however, and it’s important for parents to know these safety tips.
Emergency room doctors like Josyann Abisaab see boating accidents each summer that could easily be avoided with the proper care. Children should always wear life jackets when they are in a boat, or when they are going to be near bodies of water.
The life jacket needs to actually be the right size for the child. The jacket should fit tightly and it should be worn exactly as instructed with all of the straps belted.
Adults who are taking a boat ride with a child should also wear life jackets. This is both to protect them in the water, and to set a good example for the children on board. Blow-up water toys like air mattresses, wings and toys should never be used as life jackets or as personal flotation devices.
Keeping these boating tips in mind will help to keep everyone safe and secure while enjoying the warm, summer months and the water activities that abound.
Due to increased need for all aspects of health care to cut costs, emergency rooms are relying more and more on the services of what are called physician’s assistants, (PAs.) PAs can diagnose and treat patients, and their lower cost can help keep the price of running an emergency room down while helping to speed up the turnaround time for patients.
Until recently most PAs worked in family practice medicine. However, between 1996 and 2008 the percentage of PAs working in this area decreased substantially from almost 40% to only 26%. The decrease is attributed to the move of PAs from family practice to emergency room practice as their presence in the emergency room became more accepted while patient use of emergency rooms went up during the same period by 32%.
Patients should always be aware who is treating them, and whatever diagnosis that is made should be verified with a staff physician.
Josyann Abisaab, MD is an emergency room physician practicing in the Columbia Presbyterian Medical Center in New York City.
With the advent of summer the possibility of suffering from heat stroke increases. Over exertion in hot, humid weather when not staying properly hydrated can lead to heat stroke, which is a medical emergency.
Heat stroke is a kind of hyperthermia, when the body temperature becomes elevated. This happens when the body is not able to regulate its temperature properly, either because the cooling mechanism of evaporation of sweat is hampered, due to extreme heat and humidity causing the body temperature to rise dangerously, sometimes to as much as 106 degrees Fahrenheit.
Another contributing factor to heat stroke is dehydration, so it is important to drink plenty of fluids, especially water, when exercising or otherwise exerting yourself outside on hot, humid days.
Some signs and symptoms of heat stroke are:
• Muscle Cramps
Sometimes individuals can get heat stroke without warning and without showing signs in advance.
Other things to look for in someone who you suspect may have heat stroke:
• high body temperature
• the absence of sweating, with hot red or flushed dry skin
• rapid pulse
• difficulty breathing
• strange behavior
Heatstroke is a true medical emergency, and should be dealt with immediately. If you suspect someone is suffering from heatstroke do the following:
• Take steps to cool the victim: Take him into the shade, take off clothing, place cool or lukewarm water on the skin, you can use a garden hose to gently spray the victim, fan the sufferer to encourage evaporation, and place ice into the armpits and on the groin.
• Encourage the intake of cool liquids such as water or other drinks which do not contain caffeine or alcohol.
• Observe body temperature and continue the cooling steps until the temperature drops down to 101 or 102 Fahrenheit. (38.3 – 38.8 Celsius)
• Call 911 as soon as the heat stroke is detected. If they will be delayed they can help you with instructions for how to help the victim further.
Emergency room doctors such as Josyann Abisaab, MD see many victims of heat stroke all summer long. Keep cool, drink a lot, and you will hopefully be able to avoid such an emergency.