Josyann Abisaab

Dr. Josyann Abisaab – ER Physician

Symptoms of a Heart Attack

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.

Josyann Abisaab:Keep Meds Away From Children

Josyann Abisaab:Keep Meds Away From Children

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.

ER Dr. Josyann AbisaabAs 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.

Josyann Abisaab

Emergency Room

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.

Often children with asthma sometimes find themselves in the emergency room where an emergency room doctor, such as Dr. Josyann Abisaab will treat them for the difficult breathing asthma sufferers experience.

Although the underlying cause of asthma is unknown it often runs in families. What happens is that certain substances which the person with asthma is sensitive to, such as dust, smoke, or animal fur irritate the lining of the bronchial tubes causing the production of phlegm, which blocks the air passageway. The increased level of mucus (phlegm) makes breathing difficult, causing the main symptom of asthma.

View this video to learn a bit about how asthma is often treated and which inhaler is right for children.

Dr. Josyann Abisaab

Baby with Croup Coughing

Many parents of young children have had to deal with the illness known as croup at some time. Also known as laryngotracheobronchitis, croup is a respiratory illness which is often caused by a viral infection in the upper airway. The infection causes swelling inside the throat causing an impediment to normal breathing. The interference to the child’s breathing is what causes the barking cough and hoarseness. Symptoms can be mild, moderate or severe, and often send parents to the emergency room with their sick child. In the emergency room the doctor will first rule out other more serious causes of the symptoms, such as epiglottitis or some foreign object blocking the airway, and then treat if necessary. Treatment usually involves one dose of oral steroids and sometimes epinephrine in more severe incidents. Rarely is hospitalization needed.

Croup is a relatively common illness which affects about 15% of all children between 6 months old and 5-6 years old at some time, but it is extremely rare in teens and adults.

As an emergency room physician, Dr. Josyann Abisaab treats children with croup when they arrive in the emergency room seeking care for their distressing and sometimes frightening illness.

Statistics show that most people that come to the emergency room are not in need of emergency care. Here are some things that  you need to know so that you do not become part of this statistic.

•    First of all, use good judgment. Become knowledgeable about the signs of serious illnesses which need immediate attention such as heart attacks and strokes, and trust your instincts.

•    Call your family doctor and describe to him/her your symptoms. If your doctor feels it’s warranted, then he/she will recommend a trip to the emergency room. If the problem is not urgent enough for a trip to the emergency room, but nevertheless urgent, your doctor will make room in his schedule to see you. Also, a good primary care physician should ideally be available 24/7 or else he/she takes turns covering after-hours on-call responsibilities with other doctors. In other words there are alternatives to getting off-hour or last-minute care instead of going  to the emergency room.

•    Keep a booklet in your home which is easily accessible which describes the types of symptoms which need emergency room treatment.

Dr. Josyann Abisaab is an emergency room physician practicing in New York City at New York Presbyterian Hospital.

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.

There is no exact number which determines that someone with high blood pressure should go to the emergency room or dial 911. However, if there are other symptoms accompanying the high blood pressure reading, including severe headache with no known cause, back-pain, severe chest pain or impaired or blurry vision, or any other type of symptom connected to brain function, it is probably a good idea to go the emergency room or call 911.

Normal blood pressure readings are around 120/80. If you experience blood pressure where the systolic (first) number is at or above 180, or the diastolic (second) number is above 110, you should probably have it checked by a physician. If your instincts have a bad feeling about it, or its accompanied by any other symptoms, it is probably a good idea to go to the emergency room where a qualified emergency room doctor like Josyann Abisaab can check you and make a proper diagnosis.

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.

An informed ER patient is one who has a basic understanding of the workings of the emergency room, and so can better appreciate the complex and wide range of medical care that is provided. ER physicians, like Dr. Josyann Abisaab, explain that a visit to the ER frequently involves one or more blood tests, which helps the ER team to accurately diagnose the source of the patient’s symptoms.

When a blood test is performed, the patient’s blood is placed into different colored tubes, each with a specific additive that relates to the test in question. A CBC (complete blood count) test uses a purple-top tube. The CBC measures the numbers of each of the three types of bloods cells: red blood cells, white blood cells, and platelets, in order to help diagnose specific illnesses and health conditions. A serum (the liquid/non-cellular part of the blood) test uses a tube with a red top, while a blue-top tube is used to test blood clotting.

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
  • Poisoning
  • 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
  • Sudden severe/ persistent vomiting