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.
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.
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.
Its winter, a time of year when people are more susceptible to illness, and do seem to get sick more frequently. One of the more common illnesses which is seen by doctors, usually during regular office hours, but sometimes by emergency room doctors like Josyann Abisaab, is strep throat.
Strep throat is generally not an emergency and almost never requires a visit to the emergency room, but the development of a sudden and severe sore throat, especially in a young child, might drive a frantic parent to the emergency room anyway.
In most cases, even without treatment, strep throat will resolve on its own and go away within a few days. However, one of the dangers from step throat, aside from the pain, fever and lost time from work or school, is if it goes undiagnosed and/or untreated with antibiotics. Without antibiotics the infection can spread to other parts of the body, including the sinuses or the middle ear.
There is also a possibility that when the body’s immune system responds to the untreated strep it will attack healthy tissue which can cause rheumatic fever and some other illnesses. It has been shown that antibiotics given even nine days after the start of the infection will prevent rheumatic fever from developing.
Emergency room doctors, like Josyann Abisaab, MD, deal with an extraordinary range of medical issues on a regular basis. This makes them uniquely qualified to train army medics, who can be the difference between life and death for soldiers on the field, but who may not have the experience necessary to treat the issues with which they are confronted on the battlefield.
To that end, the British Royal Air Force has started its Trauma Inoculation Programme (TIP), in which RAF medics carry out a two-week placement at a hospital, receiving the ER training they need to be able to treat troops on the front lines. The results have been so successful that that the RAF hopes to put all of its trainee medics through similar training.
People often make the mistake of going to the ER when their condition is not an emergency. Not only is this a waste of time and money, it also causes stress and unnecessary disorder in the emergency room. Doctors such as Dr. Josyann Abisaab recommend that you think objectively about the condition you encounter, before making that decision. Here is a general list of symptoms which may need to be dealt with in an ER:
Loss of consciousness
Signs of a stroke such as numbness or sudden weakness in one side of the body such as in the face, an arm or a leg; sudden loss of vision, especially in one eye; loss of speech, trouble talking or understanding; sudden memory loss; unexplained dizziness or sudden falls
Serious traumatic injury (to the head, for example)
Instant, severe, inexplicable pain
Bleeding which does not cease after ten minutes of direct pressure
Signs of a heart attack such as a feeling of pressure, squeezing, fullness or tightness in the chest for over two minutes; burning or aching under the breast bone; chest pain accompanied by lightheadedness
ER doctors such as Dr. Josyann Abisaab often encounter unpleasant, remarkably painful and slow-healing injuries. One of the most common is a wrist or elbow fracture. People occasionally lose their balance or are knocked over while participating in a physical activity like skiing or mountain biking. Instinctually, they put out a hand or two to break their fall. This can easily result in a major gash or fracture which could take weeks or even months to heal properly. Occasionally physical therapy is needed, too. Sometimes the hand goes behind the body to break a backwards fall, which can result in an elbow injury as well.
There are a few things that can be done in advance to prevent such injuries:
1. Train your instincts. Practice falling on a safer surface, and train yourself to react by tucking in your chin and rolling with the initial impact. If you can, try to fall on the back of your shoulder as this is a strong area of your body.
2. Practice regaining your balance in a quick manner. Use a bike, or think of other ways to flex your balance muscles.
3. It is important to wear a helmet and wrist guards. They may seem foolish, but they really can make a significant difference in a fall.
Halloween is approaching, and already people can feel the excitement as they choose their costumes, make plans with trick-or-treat companions, and select pumpkins for their jack-o lanterns. Everyone is anticipating this fun, candy-filled night. Many ER doctors such as Dr. Josyann Abisaab and others have seen Halloween accidents first-hand, and, while Halloween night is certainly an exciting experience, parents are encouraged to be aware of the possible accidents that can occur.
The careful behavior should begin at home; children should not be allowed to carve pumpkins on their own. Pumpkin carvers, adults as well, should make sure to use a carving knife instead of a regular kitchen knife, so that their movements can be smoother and more controlled, even while cutting through the pumpkin’s thick skin. Also, make sure the handle of the knife is dry before it is used, to avoid slipping. If a cut on a finger or hand does occur, raise the area above the heart and apply direct pressure to the wound with a clean cloth. If the bleeding persists, a visit to the ER might be necessary.
A new study published recently in Pediatrics highlights that more children and teenagers are suffering traumatic brain injuries while playing basketball. Taking a ten year range from 1997 to 2007, researchers looked at visits to emergency rooms like the one where Dr. Josyann Abisaab works. They found that, for people under the age of 20 treated for basketball related injuries, the number of traumatic brain injuries had shot up by 70%.
Overall, the traumatic brain injury proportions doubled for boys and tripled for girls during this time, said senior study author Dr. Laura B. McKenzie.
Certainly, doctors like Josyann Abisaab, researchers and centers like the Brain Trauma Foundation encourage coaches, athletes and parents to understand what causes traumatic brain injuries and to recognize the signs of a possible concussion.
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:
A nebulizer machine with bronchodilators. These work to relax muscles around the bronchial tissue to help with better breathing.
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.
An intravenous injection of corticosteroids may be given to reduce the inflammatory processes.
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.
According to AHRQ News and Numbers which is based on data inEmergency 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.