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.
Winter weather can affect each person differently. For those of us with either lupus or rheumatoid arthritis, the cold weather which winter brings can be a real challenge.
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.
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.
Sometimes it’s necessary, and sometimes it’s not, but it is certainly true that almost all of us have been to the emergency at one time or another. Maybe it was a broken leg, or the fear of one. Perhaps it was a poisoning or a burn. Whatever it was, we are certainly glad for the existence and accessibility of the ER, and we all want them to run as efficiently as possible.
Unfortunately many times people just don’t know the difference between a good reason to go to the ER, and a “not such a good reason” to go. The more people can tell the difference, the better the emergency rooms can service their patients.
Here are the five most common reasons people go the ER, whether they are good reasons or not.
1. Stomach pain, cramps, and spasms- Severe stomach pain can be frightening. It is no wonder that this is the most common reason for visits to the ER. Stomach pain can also pose a more serious danger than simple food poisoning, so this is a reasonable reason to visit the ER.
2. Chest pain and related symptoms- Since chest pains can mean the possibility of having a heart attack most people rush to the ER if they have this symptom.
3. Fevers are the third most common reason for trips to the ER, but on the first day of a fever this is almost always not necessary. There are many reasons for people to exhibit a fever, from too much stress or even bad weather. However fever can be a sign of danger if it is already the third day of a fever which has not returned to normal, or if the fever is very high.
4. Cough-There are many reasons a person can develop a cough, but almost always the cough is harmless, meaning that it does not present a threat to life in and of itself. Although coughs should definitely be checked by a doctor, especially persistent coughs; there is almost never a reason to go to the ER to do this. Just make an appointment with your doctor. An exception is if the cough is combined with blood or other symptoms. Then off to the ER with you.
5. Headache- Head pain can be quite severe, and if it is people will go to the ER to get quick relief. But if your headache is not a recurrent symptom, it is most likely just a plain headache. Another thing to note; doctors can not treat a headache fast. If the only symptom is the headache, the doctor will want to run some tests to determine what is wrong.
Dr. Josyann Abisaab is an emergency room physician at the New York Presbyterian Hospital.
Sometimes it can be a difficult decision whether or not to visit the emergency room. No matter what you do end up deciding, remember that it is always a good idea to get your primary care doctor involved, the sooner the better. When your primary care doctor is kept informed he will be your guide and help direct you to the care of a specialist as well as insuring that your own personal history is considered before treatment is given. Your primary care physician will also help you decide whether a trip to the ER is needed, or to an urgent care center, or if it is something that can wait until a regular appointment can be made.
Here are some guidelines to help decide what to do in different cases requiring a decision about the next step in treatment.
In the case of a child who is injured over the weekend who was already brought to the emergency room for treatment:
• Contact your child’s pediatrician and tell him/her what the ER doctors said over the weekend. If your pediatrician agrees with the assessment, then have him make an appointment for you to see the specialist that the ER doctor recommended. It is very common to need a referral to see a specialist.
• Make the appointment yourself if your pediatrician can’t get an appointment for you soon enough. Call the specialist and tell him “My doctor (give his name) said that we need an appointment with you as soon possible.”
If you feel that you need a diagnosis of an illness or other similar situation urgently then it is best to proceed as follows:
• Ask your doctor if he agrees with the urgency of the matter. If you don’t have a primary care physician, you can call a nurse’s hot-line. This is a good way to find out just how urgent it is. Just as you should not stay home if you have bronchitis, you should also not wait for hours at the emergency room for just a cold.
• Before you leave for the ER, call a local urgent care center and find out how long the wait there is. Consider going to the urgent care center instead of the emergency room if the line there is not long. If it turns out the situation is a minor one, then you’ve saved yourself a trip to the ER, and if it is truly dire, then the urgent care referral will get you into to see an ER doctor sooner.
Josyann Abisaab is an emergency room doctor practicing medicine in New York City’s Presbyterian Hospital.
According to a new study which was published last February in the American Journal of Emergency Medicine, it is estimated that about 700,000 Americans visited emergency rooms due to poisoning related to the wrongful taking of prescription drugs in 2007. The estimated cost for this misuse of drugs was given as close to $1.4 billion, about 41% of which was paid for by either Medicare or Medicaid.
Aim of Study to Fight Drug Abuse
The study was produced out of Nationwide Children’s Hospital, at their Center for Injury Research and Policy in Columbus, Ohio, and was done as part of their efforts to more accurately quantify the problem of and focus in on trends that could help professionals to fight drug abuse in our society.
The director of the Center of Injury Research and Policy, Dr. Gary Smith, admitted being surprised by the size of the problem.
Rural Areas Hit Hardest
The study showed a large difference between urban and rural areas for overdoses among adults taking pain medications and psychotropic drugs. The most common age group for overdosing was the 35 to 54 range, with 3 times the number in rural areas.
Smith said that he could not explain why there was such a wide difference between urban and rural settings. It has been known, however, that at least in Ohio, “pill mills,” places where doctors prescribe large quantities of painkillers, have been of great concern in rural areas.
Children Also Victims
Among children, those five years old or younger had the largest number of accidental poisonings. In most of those cases it was found that children were playing with medicine which was prescribed for older relatives, or else taking too much of something that was meant for them or other children.
It was noted that syrups are especially problematic as far as children’s poisonings is concerned. Dr. Leslie Mihalov, the chief of emergency medicine at Children’s Hospital said that syrups which contain acetaminophen taste good to children, and they can easily drink down an entire bottle if no one is properly supervising them.
An easy way to prevent much of the inadvertent poisoning of children is to be vigilant in making sure that children do not have access to any medicines. As Dr. Mihalov said, prescription drugs should be kept out of reach and out of sight of children.
“I think the biggest problem is, elderly people or people who don’t have children in their home get those caps that are easier to open,” she said.
The problem is that children can often find medicines in Grandma’s purse, or they might fall out of Uncle’s pocket, to be swallowed by a child who does not know these things can be quite harmful.
The National Drug Abuse Warning Network believes that emergency visits due to prescription-drug abuse grew by twice from 2004 until 2008, from half a million visits to one million in 2008.
Dr. Josyann Abisaab is an emergency room physician practicing at New York’s Columbia-Presbyterian Hospital.
Wendy L. Bennett, MD, MPH and her colleagues wanted to know if the new types of medications that have been approved for the treatment of adult onset diabetes are any better than the standard treatment which has been on the market since winning approval from the FDA in 1995.
Dr. Bennet, who is an assistant professor in the Division of General Internal Medicine at the Johns Hopkins University School of Medicine, explained her investigation:
“Metformin works for most people. It’s cheaper, there’s a generic form ‘it’s tried and true.’ Our study shows that even though there are all these newer drugs, metformin works just as well and has fewer side effects. Diabetes is an enormous public health problem, and patients have difficult decisions to make about what medications they should be taking. Our study provides good information comparing drugs and can be used to inform those decisions.”
The use of metformin to reduce blood sugar levels has a long history, beginning in the 1920s when it was first synthesized. At that time diabetes was often treated with insulin and other drugs, until interest in metformin was rekindled in the ‘40s when reports showed that it was helpful in reducing blood sugar. French doctor Jean Sterne published the results of his clinical trial of the medication, the first such study, in 1957, and was consequently introduced into the United Kingdom in 1958. Canada began to treat diabetes with metformin in 1972, and the United States followed suit in 1995. Today metformin is probably the most widely prescribed medication for diabetes in the world, with over 42 million prescriptions for it filled in 2009 in the United States alone.
Type 2 diabetes, also known as adult onset diabetes, is a huge problem today in the US, with over 25 million Americans suffering from this serious illness. The annual price Americans pay for this epidemic is about $132 billion, and the figure is increasing, with most of the costs going to complications from this disease.
The research of Dr. Bennett showed that while most of the drugs available to treat diabetes do indeed lower blood sugar levels, metformin was consistently associated with fewer side effects. In addition, because the newer medications do not have generic alternatives for patients to purchase, metformin is considerably cheaper than its newer substitutes. For instance, in the case of Januvia 30 pills can cost almost $200, close to $7 per pill; metformin costs about $35 for 100 pills, or 35 cents each, a difference of a factor of 20.
Josyann Abisaab, MD is an emergency room physician in New York’s Presbyterian Hospital.
With Spring Break quickly approaching, it’s important to think about safety considerations for the family. The many ERs throughout the country, where doctors like Dr. Josyann Abisaab work, see frequent avoidable injuries and accidents at this time of year.
If you’re heading to the beach, make sure that all babies under six months of age are kept out of the direct sunlight. If the sun can’t be avoided completely, it is acceptable to apply a small amount of sunscreen to the baby. Whenever possible, dress babies in light weight clothing that covers their arms and legs and give them brimmed hats for protection.
As an emergency room specialist Dr. Josyann Abisaab sees many different types of injuries and illness during the course of her workday. The traffic seen in the emergency room also varies according to the season, and the time in the week. Weekends and holidays see more car accidents and other types of accidents are often due to alcohol consumption and in the case of car accidents, poor weather conditions. When someone arrives at the emergency room his condition is assessed by a triage nurse, assigning a level of relative emergency from one to five. One are things like sore throats, which are minor problems which probably shouldn’t be in the emergency room at all, while five are more serious, like a broken bone, which is a level five. Life threatening illnesses or trauma are beyond level five, and always get immediate attention.
Here is a list of the five most common reasons people come to the emergency room for care.
1. The top of the list people show up in the emergency room is due to falling. These are almost always preventable accidents.
2. Breathing problems are next. Most of the time upper respiratory problems are not an emergency and can be treated at home or by a family physician outside the emergency room. However, if the breathing is found to be quite difficult and is accompanied by chest pain, this is cause for concern as it could be a heart attack or stroke. Go directly to the emergency room.
3. Abdominal pain. This is a difficult symptom to decide if an emergency room visit is really needed. Most of the time the pain passes, but if you are just not sure, go to the ER.
4. Injuries due to weather such as a pulled muscle from shoveling snow, or falling on the ice. If you would prefer not to end up in the ER, don’t do any risky activity in bad weather.
5. People who are drunk and dizzy are the fifth most popular type of person to visit the ER.
Research has shown that more than half of all emergency room visits in the US are for non-emergencies. The trend to use the emergency room as if it were a doctor’s office is wasteful in several ways. First of all, it wastes money. The cost of seeing a doctor in the emergency room can be three times more than seeing a doctor in his office. Time is also wasted while the person who is ill waits his turn to be seen by a physician. Contrary to what many people seem to believe, patients are not seen on a ‘first come, first served’ basis. Not even close. An emergency room is designed to see the most critical patients first, and everyone that comes through the doors of the emergency room goes through ‘triage’, French for sorting. The less urgent the case, the longer patient will wait. According to statistics the average wait in an emergency room is about 2 hours.
Emergency room physicians like Josyann Abisaab urge people to only come to the emergency room if a real emergency arises which requires urgent care. Otherwise schedule an appointment with a primary care physician who will be glad to see you at a scheduled time and for a reasonable price.