Josyann Abisaab

Asthma, according to The American Academy of Allergy, Asthma and Immunology, affects nearly 34 million Americans.  Each year, over 200,000 emergency room visits are due to allergy attacks, as are 300 deaths.  Serious asthma attacks may warrant a visit to the emergency room where doctors like Dr. Josyann Abisaab will assess the situation and treat the patient accordingly.

Once in the emergency room, there are a number of treatment techniques that doctors may use. These include:

1. A nebulizer machine with bronchodilators.  These work to relax muscles around the bronchial tissue to help with better breathing.
2. Iptratropium combined with nebulized albuterol is often used for acute asthma attacks in the E.R.  This helps to stop spasms of the muscles surrounding lung tissue.
3. An intravenous injection of corticosteroids may be given to reduce the inflammatory processes.
4. In severe situations, patients may be treated with an injection of adrenergic medications including epinephrine or terbutaline.

Oxygen may be administered through a breathing mask and a pulse oxymeter will most likely be placed on a finger or earlobe to evaluate blood oxygen concentration levels.  While the administration of oxygen won’t stop the attack, it will provide more oxygen to the blood and may help to prevent death.

An upcoming conference on the new American Heart Association guidelines, is due to take place on November 12, 2010 at McCormick Place, Chicago, IL.  At this conference, participants will be given the opportunity to learn about resuscitation science, education and training.  Cardiopulmonary resuscitation (CPR) combines the teaching of rescue breathing and chest compressions for individuals who appear to be in cardiac arrest.  Cardiac arrest occurs when the heart stops pumping blood.  Even if you don’t have the capacities of an ER doctor, having CPR knowledge can bridge the gap between an attack and the arrival of an ambulance which definitely makes life easier for ER doctors such as Josyann Abisaab MD, Assistant Attending Physician at New York-Presbyterian Hospital.

Summer is a time when children have more time off and more time to explore and to enjoy.  At the same time, emergency room doctors like Josyann Abisaab see a great deal of avoidable injuries in the summer.  Keep these tips in mind as you enjoy your summer with your children.

Drowning is one of the leading causes of accidental death among young children.  Children shouldn’t be left unattended while in a bath, pool, lake or other body of water and home swimming pools should be protected and securely locked.

Since people drive more during the summer, there is an increased rate of car accidents.  Make sure that children are always buckled and that they are always in the age-appropriate car seats while traveling.  Heat and dehydration also cause a great deal of E.R. visits.  Never leave a child in the car and keep kids well hydrated during the summer.

Dr. Josyann Abisaab was recently presented with an award “for devoting 20 years to helping establish and nurture Emergency Medicine as a clinical and academic specialty.”  This is not the first time the MD has received an award for her dedication and services.  In 2009 Abisaab was likewise awarded a citation for two decades of service in medicine.  This was connected to her work at Weill Cornell Medical College and at that time, the college’s dean, Dean Gotto, was pictured with her at the ceremony.  In June 2010 however, the award was presented at the New York Presbyterian Residency Graduation Ceremony.

Chest Pains: A Leading Cause of Er Visits

According to AHRQ News and Numbers which is based on data in Emergency Department Visits for Adults in Community Hospitals from Selected States, 2005, chest pains are one of the leading reason that people visit the emergency room.  Chest pains that did not appear to be a heart attack upon examination accounted for 1.6 million visits in 23 states in 2005.

The top four reasons to visit the emergency room, as reported by this study were: sprains and strains (2.4 million visits), bruises and superficial injuries (2 million), abdominal pain (1.7 million), and then chest pains at 1.6 million.  In less than 5% of the cases, the patient was actually admitted to the hospital.

Five additional conditions that were seen a great deal by the emergency room were: back problems (1.4 million), leg and arm open wounds (1.3 million), headaches (1.2 million), nose and throat infections (1.1 million), and skin infections/urinary tract infections (1 million).

The more prepared you are before you have to visit the hospital, the more smoothly the experience should go when you actually have an emergency.  If you are elderly and living alone, there are a number of precautions that you should take before an emergency room visit is necessary.

Make sure that you know which emergency room you’ll want to go to.  Plan out how you will get there and have the phone numbers for your friends, your taxi service or your other ideas easily accessible and by the phone.

Going to the hospital for a visit isn’t a bad idea, particularly if you’ve never been to this particular hospital.  Find out when you are there where you check in, where you wait and how the system works.  Obviously, if you are brought in by an ambulance, this information won’t be relevant.  But, it’s certainly possible that you will be coming on your own with a driver who has brought you.

When someone has been in the emergency room for care, they often don’t bother to follow through afterwards.  They might be happy to be feeling better the next day, or they are exhausted from their ordeal and don’t have the energy to follow through.  The follow through, however, is as important as is the emergency room care itself.  What does this mean?

Usually, when you are discharged from the emergency room you’ll be given follow-up instructions from the doctor.  You’ll often receive a written summary of how you should continue your care, when you should visit your primary care physician, what you should do if symptoms return, and more.  Before you leave the emergency room, make sure that you understand all instructions that the doctors and nurses give to you.  Don’t leave feeling that you still have questions that haven’t been answered!

Then, make sure to follow through.  Go and see your primary care physician the next day to give them the paperwork from the emergency room and to have them follow your care.  Get your prescriptions filled and take the medicine that the emergency room has recommended.  Pay attention for recurring symptoms, and more.  Just because you’ve left the emergency room, and the emergency doctor’s care, doesn’t mean that you shouldn’t continue to be careful about your treatment and your follow-up care at home.

The question of when a visit to the emergency room is warranted and when to just go to the doctor or wait it out is sometimes a difficult one, especially with children. According to Elda Ramirez, PhD, RN, you should bring your child in after an injury if you feel at all uncomfortable. She believes in trusting the parents’ instincts about their children’s health.

“You know your kid, how they respond, how they behave. Better to be sent home from the ER than to have wished you had made the trip,” says Ramirez, an associate professor of clinical nursing for emergency nurse practitioners at The University of Texas School of Nursing at Houston.

The types of injuries or illnesses that can happen are many and each one must be assessed with care. These emergencies include, but are not limited to:

1.    Head injuries- any loss of consciousness, vomiting, sleepiness is a sign of a concussion and should be checked. Lacerations with head injuries indicate a hard impact and should also be attended to. But even without loss of consciousness, if your child just doesn’t seem to be “herself” could be a good enough reason for a visit to the emergency room.

2.    Bone and spine injuries- injuries of the spine, especially the neck should be examined by a doctor. Numbness, tingling or lingering pain is suspicious. Broken bones which are obvious, such as legs bent backwards or bones sticking up out through the skin not only require the emergency room, but transport there in an ambulance. If the tips of the fingers or toes or blue or whitish, this can indicate a break and needs immediate attention.

3.    Stomach ailments- don’t let a “mere stomach-ache” catch you off guard. Yes, usually it is just a tummy ache, but if there is severe vomiting or diarrhea in which fluids are not retained by the body, it is crucial that children or older people be seen within 24 hours. Dehydration can be life threatening, and can happen with lightning speed.

Josyann Abisaab is an Assistant Attending Physician at New York Presbyterian Hospital, where all these injuries and illnesses, and a lot more, are treated by her and the expert staff of doctors found there. The bottom line is to be cautious and alert to the signs of illness or serious injury, and respond responsibly and promptly.

We all hope to never have to visit an emergency room, but if you ever do find that you need to visit it is better to come there prepared than not, so that your time there is as productive and pleasant as possible. We hope these tips will also make your visit as safe as possible and help save you money, too.

Prepare in advance a folder with all your medical information such as past doctor visits, tests you have taken, medicine you use, allergies you may have, any vitamins or other nutritional supplements you may be taking, and all other relevant information that could help a doctor know about you and your state of health without having to discuss it with you. You may be in pain or be nervous, and you might forget to tell the doctor something, or not want to talk at all.

Find out from your health insurance company which hospitals your insurance will pay for and keep this list in a handy place so you don’t have to search for it when the emergency arises.

When you go to the ER be sure to bring with you the folder you prepared in advance, and come expecting to have to wait. Many emergency rooms are extremely busy places. The ER at New York Presbyterian Hospital where Josyann Abisaab is on staff is one of the country’s busiest and best. Although you can expect excellent care in such a place, you may have to wait for it. Therefore it is a good idea to come prepared for such an eventuality with comfort items like  water, hand sanitizer, coins for vending machines and pay phones (if you don’t have a cell phone), tissues, snacks, something to read.

There are many reasons people visit emergency rooms- such as the ER at New York Presbyterian Hospital where Josyann Abisaab is an emergency room physician. Often young children are brought in due to fever, pain, runny nose, which could very likely be caused by an ear infection, also called acute otitis media. This illness happens to be the most common reason doctors prescribe antibiotics for children in the United States. It is estimated that more than 15 million prescriptions for antibiotics are written each year to treat ear infections at a cost of millions of dollars.

About two thirds of cases of AOM are caused by bacteria, with the remaining due to viral infection. AOM is an illness that affects mostly young children, with very few cases in children over five years old. According to an article published in the American College of Emergency Physicians’ Newsletter, if AOM goes untreated, 80% of the cases will resolve on their own, with no medical intervention needed.

Therefore it is relevant to ask the question if it is good medical practice to prescribe antibiotics every time a child presents with a runny nose, a slight fever and a tympanic membrane only slightly erythematous. Of increasing concern is the growing worldwide problem that overprescribing of antibiotics has led to an increase in the prevalence of antibiotic-resistant bacteria, making many illnesses that used to be easily treatable more dangerous, and even deadly in some cases.

In the Netherlands physicians have been treating AOM with a different strategy for the past 20 years. Instead of immediately prescribing antibiotics to children with AOM, they instead treat the symptoms of pain and fever with analgesics and antipyretics such as ibuprofen or acetaminophen and observe the patient for 2-3 days. Only in the few cases in which the child does not improve or gets worse during those 2-3 days, are antibiotics prescribed.

Due to this practice the number of patients prescribed antibiotics is much reduced, amounting to only 31% of the cases and the occurrence of the resistant strain of S. pneumonia is only 1%. This is an important achievement and worth emulating in the United States.