Dr. Josyann Abisaab

While staycations are great fun and a relaxing way to enjoy the summer, they can also be a recipe for disaster.  As emergency room doctors like Dr. Josyann Abisaab can attest, children are constantly brought to the emergency room with accidents that could have been avoided.

The home swimming pool can be just as dangerous as the vast ocean. As the Insurance Information Institute reports, each year about 43,000 people are injured in or near a pool and more than 600 people drown at their home pools or at public pool locations.

You should make sure that anyone who swims in the family pool knows how to swim well before being allowed to enter. No one should swim alone and there would be adequate lifesaving equipment near the pool.

In addition, all electrical devices need to be on dry surfaces and far away from the pool and other water sources.

One of the more common reasons for emergency room visits is head trauma. A new study published in November’s issue of the official journal of the Congress of Neurological Surgeons, Neurosurgery, has shown that low oxygen supply, or hypoxia, to vulnerable brain tissue is a crucial factor in the risk of death or severe disability after serious traumatic brain injury (TBI.)

The study showed that the larger the decrease in brain oxygenation, then the higher was the risk of severe disability or death later on. The study strongly suggests that patients with prolonged periods of brain hypoxia have an increased likelihood of having poor prognosis separate from the results of intracranial pressure, brain blood flow and other risk factors.

The results of the study support the recommendation of including brain oxygen monitoring as a part of an integrated monitoring policy after severe TBI. Results are not yet in of whether treatment adjustments in response to the brain oxygenation monitoring lead to improved outcome in patients with severe TBI.

Joanne Abisaab, MD, practices emergency room medicine at New York Presbyterian Hospital.

After Triage

If your child’s problem does not require immediate attention, then you will need to wait. Luckily you have some books, toys and/or crayons (see part 1) to help pass the time with your child.

Your child might need an x-ray or other tests, and you might be told that your child should not eat or drink until after the tests are completed.

Your Turn Arrives

Finally you and your child will be called into the examination room. You may have to wait a bit longer until a doctor arrives, and when she does arrive she will ask you about your child’s medical issue, and decide what additional tests are needed in addition to any that have already been done.

When the doctor decides what treatment is needed, most of the time the patient is sent home. On occasion the doctor might decide that your child needs to stay in the hospital, either overnight for observation, or longer for proper treatment, depending on the medical issue.

If you do go home the ER doctor might tell you that your child should be examined by your regular doctor at a later date; to make sure the treatment is working and recovery is progressing properly.

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

If you ever need to bring a child to the emergency room, it’s a good idea to prepare her/him in advance. If he knows what to expect, the trauma of the visit will be reduced to a minimum.

On the Way to the ER

Although it is certainly possible to drive to the emergency room yourself, if you need to get your child there quickly, consider calling 911 for an ambulance. Not only is an ambulance the fastest way to get to the ER, but there are trained professionals in the ambulance who can administer whatever care that is immediately necessary. If you have time, bring some of your child’s belongings that can comfort and calm him while he is there, like a stuffed animal, small toy, crayons or books.

What to Expect

Explain to your child that the first thing you do when you get to the ER is sign-up at the front desk. In this way the doctors know you are there and that your child needs attention. If it is a problem requiring immediate care your child will probably be seen right away. After the initial signing-in a nurse will perform triage, which is how the nurse decides who needs to be seen first by the ER doctors.

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

Today is the 10th anniversary of what has become known as “9-11,” the attack by terrorists in two airplanes, each of which crashed into one of the two twin towers of the World Trade Center in lower Manhattan, causing them both to collapse within two hours. 2801 people were killed in that horrific event, 147 of which were passengers on the two planes.

As one might imagine, New York’s emergency services were sorely taxed by this catastrophe, including the City’s public health, health care and social service systems.

On this day of memorial and commemoration it is important to take note of the heroic efforts of the dedicated people that helped their fellow citizens on that fateful day ten years ago. Of utmost importance was the role that the Department of Health played in helping people and saving lives, focusing their efforts into three categories, surveillance, maintenance of routine, and communications.

Four surveillance systems were established; a fast evaluation of injuries caused by the attack; a hospital requirements assessment; a way to report injuries which occurred to the rescue workers themselves; and a surveillance system which monitored any symptoms which could have been caused by biological or similar agents which might have been released during the attack. This last system was staffed by 15 specialized epidemic intelligence agents from the Centers for Disease Control who were assigned to hospital emergency rooms throughout the city.

The final outcome was that an electronic system for reporting was created at 30 local New York City Hospitals.

Many lives were saved due to the fast response and previously rehearsed exercises conducted by the DOH, which allowed them to respond quickly and efficiently to the needs of the day. The tragedy of 9-11 taught us to appreciate the dedicated men and women that populate emergency rooms and other emergency health services around New York and the rest of the country.

Water safety is incredibly important, especially during the summer months.  Doctors like Josyann Abisaab will explain that they see many tragedies every summer, as parents come to the emergency room with their children who have had pool accidents.

Drowning is actually the second most common cause of death from injuries for children under 14.  Here are some key tips to keep kids safe around the water in the summer.

Children should never dive off of the side of a pool unless an adult says that the water is deep enough.  They should look at the depth markers and pay attention to them.

Make sure to test the water’s temperature before jumping in, as the water can shock the body and make both blood pressure and heart rate increase.

And adult should always be present when children are in the pool and all pool rules should be obeyed.  Make sure children don’t run around the pool, since they can slip and hurt themselves on the ground or fall into the water.

Children who are just learning to swim should stay in the shallow end, and children should be taught not to push or jump on others in the water.

One of the most common injuries seen in the ER is the ankle injury. Ankle sprains, breaks and fractures are most often a result of activities which require quick stops and starts, as well as abrupt changes in direction. Improper footwear is also a common cause of such injuries.
Emergency care doctors like Dr. Josyann Abisaab understand that it is important to:

• Do daily exercises to strengthen the ankles, as well as to increase their flexibility
• Strengthen and support old ankle injuries
• Wear the correct shoes for an activity such as hiking or soccer
• Avoid running on uneven surfaces.

The pain of a broken bone usually sends the victim straight to the emergency room, whether or not there is certainty that a bone is actually broken. A careful examination including an x-ray, by an emergency room doctor such as Dr. Josyann Abisaab can usually determine with a great deal of certainty whether a bone was indeed broken.

A bone will break if there is more pressure placed on the bone than what the bone can handle. The bone can either split or break, and in either case this break, no matter how large, is called a fracture. If the broken edge of the bone breaks through the skin, then the fracture is called either an open fracture or a compound fracture.

A stress fracture is caused by repetitive or prolonged forces acting against the bone, resulting in a hairline fracture within the bone.

It is easy to mistake a dislocated bone from a broken bone, but since both situations require immediate attention as emergencies, and the immediate treatment for both is the same, there is no reason do differentiate them before you get to the emergency room.

Some causes of a broken bone:

Broken Bone in Forearm

• Falling
• Accident
• Direct blow to the bone
• Repetitive actions like running can cause a stress fracture to develop in the foot, ankle, tibia and even the hip

Symptoms of a broken bone:

• Conspicuous looking out-of-place or misshapen limb or joint
• Swelling, bleeding, bruising
• Significant and intense painful sensations
• Numbness, tingling
• Skin is broken and bone is sticking out
• Limb cannot be moved, or its mobility is limited

The Knee

When all the parts of the body are working together well, it is easy to forget how each and every muscle, bone, and organ are essential for a painless, well-functioning body.

A good example of this is when someone has a knee injury. In just a moment the person goes from painless walking, bending, climbing stairs, crouching and stretching, to a person who experiences pain with every bend of the leg at the knee.

The knee is the largest joint in the body. Joints are the places where two bones come together. The knees provide the body with stability, flexibility and allow your legs to straighten up, bend and swivel. The knee is made up of bones, cartilage, ligaments and tendons. A damaged knee can be damaged in any one, or several of these parts.

It is important to seek the care of a physician, and if the injury is severe, and emergency room physician such as Dr. Josyann Abisaab would be able to diagnose and advise the patient about what treatment is required, and if a specialist is needed such as an orthopedist or a physical therapist.

It seems that CT scans on kids in Emergency Rooms might be being over-used somewhat according to a recent study in ‘Radiology.’ Indeed, figures show that the number has increased a staggering fivefold since 1995 and this has to “raise concerns about radiation exposure.”  The huge escalation can probably be explained by advancements in CT technology, but may not justify it.  The problem also becomes when some radiology departments not “consistently tailor[ing] the CT technique to the child’s size.”  Physicians need to “ensure appropriate scanning indications to minimize pediatric radiation exposure.”

Dr. Josyann Abisaab is an emergency room physician practicing at New York’s Columbia-Presbyterian Hospital.