Dr. Josyann Abisaab

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.

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.

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.

The Worst Has Been Averted

The catastrophe taking place now in Japan has brought the world’s attention to what could happen when there is a leak, or worse, at a nuclear power plant and radiation is released into the environment. Thankfully it looks like there will not be a major nuclear disaster in Japan as experts continue to bring the situation under control. Nevertheless there has been acknowledgment that a certain amount of radioactivity was released into the water supply and atmosphere. What does that mean for the health of the people affected by their proximity to the power plants and to those further away?

Nuclear Plant Workers Exposed

It has been reported that some of the workers who are struggling to prevent a meltdown have already suffered radiation sickness and other injuries from hydrogen buildup explosions inside the reactor’s buildings.

“The scariest outcome from such releases of radiation are the immediate effects, which are going to be only felt by personnel who have to go into the building and shut it down,” radiation biologist Jacqueline P. Williams, PhD, said. Williams is a researcher in the department of radiation oncology at the University of Rochester, N.Y.,  Dr. Josyann Abisaab’s alma mater.

Dr. Williams continued to explain that the long term effects of exposure to high levels of radiation are primarily the development of a variety of cancers, most commonly leukemia and thyroid, lung and breast cancer.

Danger So Far Minimal

Another expert on radiation adds that it is easy to overestimate the danger of exposure to radiation. Henry D. Royal, MD was a co-leader of the international team that studied the effects on health caused by the nuclear disaster at Chernobyl. Dr. Royal is currently the do-director of the Mallinckrodt Institute of Radiology at Washington University in St. Louis.
“In Chernobyl, people living within 1 to 2 kilometers of the plant, who stayed indoors, received about 50 millisieverts of radiation — equivalent to about five CT scans,” Royal explained. “And in Fukushima, we are not talking about Chernobyl. This may be worse than Three Mile Island, but nothing like Chernobyl.”

“The Chernobyl cloud technically covered a huge area. It did follow the jet stream and everything else,” Williams says. “But radioactive particles have substance, they have weight. The bigger the particle, the quicker it falls out of the cloud. So the contamination area where you have risks from contamination are relatively close to the disaster site. As far as I am aware, the cancers from Chernobyl radiation occurred in and around Chernobyl itself.”

US Not at Risk

People in the United States are concerned that radiation from Japan could possible reach their shores. Radiation experts at Oregon State University department of radiation and physics have state that no radiation from Japan is expected to arrive in the US.

“Any radioactive contaminants released will end up raining out of the atmosphere into the Pacific Ocean, where they will be diluted and absorbed, or in the very near vicinity of the plants,” Kathryn Higley, PhD, says in a news release. “This is not Chernobyl.”

COPD stands for Chronic Obstructive Pulmonary Disease. This illness is composed mainly of three separate chronic illnesses; chronic bronchitis, chronic asthma and emphysema. The main cause of COPD in the United States today is smoking, which accounts for about 90% of the cases. And although not every smoker will get COPD, it is estimated that about 15% of smokers will. It is not completely understood yet if passive smoking (inhaling cigarette smoke from a nearby smoker) can contribute to the development of COPD; it is known that children living with people that smoke are more likely to develop respiratory infections and the symptoms of asthma.

Emergency room physicians such as Dr. Josyann Abisaab urge smokers to try and reduce the amount they smoke, or even better, quit smoking altogether. Evidence shows that if a patient with COPD stops smoking, their decline in respiratory function slows down to the same level as a non-smoker, showing that it is “never too late to quit.”

Emergency room doctor Josyann Abisaab MD, frequently sees parents bring their children to the emergency room for what seems like a serious illness, but in reality it is just a cold or flu and the visit was unnecessary.

Here is a video to help parents decide whether their child is ill enough to warrant a trip to the emergency room, or if you can treat your child’s illness and symptoms at home, knowing that they will pass and your child will get better with help from you and your family doctor.

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.

The Centers for Disease Control’s Advisory Committee on Immunization Practices recommends that every person over 6 months old should be vaccinated against the influenza virus. They voted for this policy last winter, on February 24, 2010. Their recommendation was that there should be “universal” flu vaccination in the United States and that the  program at that time should be expanded to meet this goal, which was done.

The groups most ‘at risk’ should be especially careful to get their flu shots early in the season which begins in September, but it is not too late even now, in January. If you fall into any of the following groups and are still not vaccinated, it is wise to heed the advice of the CDC and do so at once. As of January 1st, 2011 those with Medicare coverage are entitled to free flu vaccines, so now there is no reason to delay taking this important step to protecting your health.

1. Pregnant women
2. Anyone over 50 years old
3. Children who are younger than 5 years old, but there is a special urgency for those between 6 months and 2 years old
4. Anyone of any age with some chronic medical conditions. Check with your doctor.
5. Those who live in nursing homes or other care facilities long-term.
6. People who come into frequent contact or live with others who are at high risk for the complications of the flu, which includes but is not limited to:

a.    Those who work or live with young children, especially if the children are less than 6 months old and are too young to be vaccinated themselves.
b.    Those who come in contact with persons at high risk for the complications the flu can cause.
c.    Any health care workers.

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.