Dr. Josyann Abisaab

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.

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.

The question of when to go to the emergency room hopefully does not come up too often, but when it does its good to know how to proceed.

Symptoms of heart attack and stroke certainly require immediate attention in the emergency room. Those symptoms include chest pain and/or shoulder pain which goes down the arm. Heartburn can also be a symptom. Other cardiac symptoms of hearth attack are shortness of breath, quick pulse, and palpitations.

Dr. Josyann Abisaab is an emergency room physician who frequently cares for patients in the emergency room experiencing heart attacks . Early intervention under such circumstances can often save a person’s life.

Third degree burns are the most severe. These burns involve all the skin’s layers and cause permanent damage to the tissues. Sometimes fat, muscle and even bone can be involved. If the burn is bad enough it could appear black and charred or look dry and white. There can be other toxic effects if smoke inhalation accompanied the burn and the patient might have trouble inhaling or exhaling.

Third degree burns are serious emergencies and require expert emergency care from emergency room doctors such as Josyann Abisaab. Call 911 as soon as possible, and while waiting for the ambulance be sure to:

1.    Not remove clothing, but make sure there is nothing smoldering or still burning touching the victim.

2.    Not immerse large and severe burns in cold water. Immersion in cool water could case the body temperature to drop, causing hypothermia, lowering of blood pressure, and poor circulation (shock.)

3.    Check for breathing and other signs of life such as coughing and movement. Start CPR if circulation seems to be curtailed.

4.    Try and keep the burned parts of the body elevated to a level above the heart, if possible.

5.    Cover the area where the burn is with a cool, moist and sterile bandage; clean moist cloth; or moist towels.

ER physicians like Dr. Josyann Abisaab know that a new visitor to the emergency room is sometimes confused as to why the department sometimes treats patients who arrived after him instead of providing treatment in the precise order in which patients arrived. That’s why it is important to learn the concept of triage. Triage is generally a patient’s first stop in the emergency department. It is the site where a member of the ER team, usually a nurse, evaluates the patient’s condition and assigns him to one of three categories:

1.       Imminently life threatening

2.       Urgent, but not imminently life threatening

3.       Less urgent

As a result of triage, someone who arrives with a life threatening condition can be seen immediately, even if he or she was not the first to arrive. Conversely, this means that patients with less time-oriented problems may need to wait a bit longer, while still being of receiving the correct level of treatment.

Having a child with asthma can be very stressful. It is hard to know when an ER visit is necessary. Emergency care doctors such as Dr. Josyann Abisaab recommend you prepare for such a visit in advance, and become familiar with the symptoms that need emergency care. Some of them are:

• If your child’s coloring changes; blue or gray lips and/or fingernails
• If your child has difficulty talking
• If your child’s peak flow reading drops below 50% and does not improve with medication
• If your child repeatedly uses rescue medications for severe flare-up symptoms which do not go away after five or ten minutes, or return quickly.
• If the areas between the ribs, below the ribs and in the neck pull in dramatically while your child inhales