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.
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.
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.
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.
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.
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 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.
New research and training could mean that there is an increase in the survival rate of cardiac arrest patients as well as a reduction in brain damage of these same individuals. The new treatment – cooling therapy – is being taught to New York City paramedics. This is definitely welcome news for those working in the ER, such as Josyann Abisaab MD, Assistant Attending Physician at New York Presbyterian Hospital.
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.