Headache or ER visit?

How can you distinguish between a headache and something more serious? When should you head out to the ER and when should you just take a pain medication and head off to bed? Various analyses have been taken, and there was one study conducted by the University of Southern California-Neurology, Los Angeles, CA a couple of years ago. It looked at: “the demographics, diagnosis, and treatment patterns in patients with headache-seeking treatment in one of the busiest emergency rooms (ER) of an academic medical center in the USA. The question one wants to ask is it really a good idea to go to the ER or can one find more appropriate and efficient care elsewhere? One has to ask if they are just panicking (due to the understandable severity of the pain) or really need to see an ER doctor. The ER really should be used for just that – emergency medicine. If a headache can be taken care of by avoiding the ER, that should be done. Remember: being in the ER can be very loud and stressful; two factors that are not good for people suffering from very bad headaches. But if nothing eases the pain and your local physician is not available then a trip to the ER would be advised. Take care to analyze the specifics of your situation before heading for the ER.

Learn Basic Cardiopulmonary Resuscitation (CPR)

Of course, it isn’t something one wants to have to do ever need to know, but having the know-how when it comes to CPR, is something one definitely should try and learn. There isn’t always the time needed to get to the ER. One can begin these lessons by studying the subject online.

3 Common Summer Dangers: Dr. Josyann Abisaab

During the summer, doctors in emergency rooms see an increased rise in visits. This is particularly true in the pediatric emergency rooms, and often involves a number of repeat issues. Certainly, if emergency room doctors like Josyann Abisaab can make parents aware of these dangers, it may help to decrease emergency room visits.

“In the summer, we see a much higher incidence of injuries caused by accidents and sports,” says Dr Scalzo, who is a SLUCare pediatrician at SSM Cardinal Glennon Children’s Medical Center. “Kids are going to be kids and they are going to get hurt. But many of these accidents could be prevented by proper parental supervision.”
Three areas that create many accidents include trampolines, all-terrain vehicles and bikes/skates/skateboards.

Parents need to be very careful when allowing their children to use any of these items, and children need to do so under adult supervision. Obviously, these items are used during other times of the year as well, but children have more time for these activities during the summer and they tend to be less supervised than they are during the school year.

Kids, Parents and Drugs

What do you do if your child asks you a direct question like “have you ever used drugs?” and your truthful answer is “yes”? Pediatrician Dr. Perri Klass recently addressed this issue. Honesty is important for our children even if we still want to prevent them from taking their own risks. As a pediatric resident, Klass was asked this question herself so knows it is likely to arise. One way of dealing with this is that we know much more about substance abuse now than we did then. So we can explain that we had no way of knowing what the damage would be back then. Things are different now, for our children. For example, today, scientists understand way more about the neurobiology of the brain of a teenager and the impact of drug and alcohol abuse this has on it. We now know that it is not until 20 that the brain ceases development so such experiments at 16 for example, could be extremely detrimental. The best way to stay healthy is to maintain health through preventive measures. In addition, one never knows what they are going to be negatively affected by before trying it so the education we should be giving to our children is that the risk is just too high.

Advances in US Health Care Reform and New York-Presbyterian Hospital

There have been some tremendous advances in America’s health care reform which have led to the country’s 70 million children receiving coverage to meet their specific needs. Timely access is what will often save lives. This has resulted in “two patients from NewYork-Presbyterian/Phyllis and David Komansky Center for Children's Health and NewYork-Presbyterian/Morgan Stanley Children's Hospital and their families went to Washington, D.C., to discuss their personal health care stories with lawmakers who are carefully monitoring how health reform implementation rolls out.” These families are Castro and McKiever (along with 30 other families from America). The obstacles that still remain include: inadequate amount of pediatric doctors; insufficient reimbursement from Medicaid for pediatric care; lack of consistency for quality measures and incentives across states; threat of more state-level Medicaid cuts.

Beware of Outdoor Accidents This Summer

The sun is shining, your kids are desperate to go out and you love sitting outdoors. But you should be aware that there are many little mishaps that could potentially ruin your carefree summer activity. While there is no doubt (and studies have proven this) that kids do better in the classroom when they’ve had time outdoors, one should always remember to take special care when kids are outdoors. Ensure that you take a few tips into consideration as a preventive measure of going to the ER. Let your kids have a great summer, but make sure they do it safely and if something does happen untoward, be in the know about the best and fastest way to react. If necessary, don’t hesitate, just go straight to the ER.

Josyann Abisaab and the American University of Beirut

Josyann Abisaab studied at the American University of Beirut, from where she graduated with a BS (Distinction) in 1984. Recent news from the university is that Dr. Fuad N. Ziyadeh (chair of the Department of Internal Medicine) was appointed a member of the International Foundations of Medicine (IFOM) Oversight Committee. For the university this appointment means that it is now part of “an international assessment of medical students.” For Ziyadeh, this is quite an honor since he is the only individual on this committee selected from outside North America and Europe. And for the university it’s great, as, according to AUB Faculty of Medicine’s Dean, Dr. Mohamed H. Sayegh, Raja N. Khuri, it “makes AUB a key player in international medical education.”

Staying Motivated for Morning Workouts

It's never easy to get out of bed in the morning, but it's often even harder if you plan to exercise first thing in the morning. This blog offers some great tips for staying motivated with your morning workout and keeping yourself to your routine.

Reduction of ER Visits at NY Presbyterian Hospital

A report in May 2010 showed that there has been a significant reduction in emergency room visits and hospitalizations – up to 50 percent – at the NY Presbyterian Hospital. Much effort has been undertaken to achieve this result, with a partnership forming between the Ambulatory Care Network at New York-Presbyterian Hospital and the Washington Heights/Inwood community, to form the Washington-Heights Inwood Network (aptly known as WIN) for Asthma program. This spells good news for all those associated with the hospital, especially those working in the ER department like Josyann Abisaab, Assistant Attending Physician.

“The program began in May 2006 to improve outcomes for children with poorly controlled asthma by providing culturally relevant asthma education. To date, Community Health Workers have enrolled 400 families. Families who completed the one-year program reported a greater than 50 percent drop in emergency room visits, a greater than 50 percent drop in hospitalization and a 30 percent drop in school absenteeism. Caregivers also reported that they were significantly more confident in caring and controlling their child's asthma after participating in the program.” For more information on this venture, visit: http://nyp.org/news/hospital/win-asthma-program.html

Josyann Abisaab and New York Hospital

The New York-Presbyterian Hospital where Josyann Abisaab serves as an ER doctor, was named to the America’s Best Hospitals Honor Roll. This is not the first time the hospital has been honored in this way. The hospital last year boasted “strong scores in many specialty rankings.” The hospital houses 2,192 beds and in 2007 undertook 10,4924 surgeries.

Josyann Abisaab and New York ER

Josyann Abisaab, a doctor at the hospital’s ER, can take pride in how well the new York-Presbyterian serves its public. For example, in 2007 her department dealt with a staggering 24,0331visits, suggesting it has the resources to take care of a tremendous amount of work. As well, it serves as a teaching hospital and accredited by the CARF and Joint Commission. So of course no one ever wants to have to go to a hospital, but if a visit has to be made, the New York Presbyterian Hospital certainly has a pretty good reputation.

Protect Your Child's Feet: Josyann Abisaab

Many parents would be surprised to know how often children are brought to the ER as a result of barefoot accidents. Emergency room doctors like Josyann Abisaab end up stitching feet that have been cut by glass, metal or jagged rocks as a result of children running around barefoot.

While it’s fun to run around barefoot, especially in the summer months, it’s very important for parents to keep their children wearing shoes when outside. Have a first-aid kit in the house, as well, so that you can take care of cuts and scrapes when they occur. Make sure to always keep your child’s tetanus shots up to date to prevent even worse consequences.

These simple instructions can cut down on unnecessary stitches and injuries and can keep your child’s feet safe and healthy all year round.

Keeping Burns at Bay with Josyann Abisaab

When children show up to the E.R. for burns, they are usually a result of hot liquids from the home. As doctors such as Josyann Abisaab and many others know only too well, most of these burns could have been prevented. Here are some important tips for keeping hot liquids away from little ones.

1. Never drink anything hot when you have a baby in your lap in nearby.

2. Keep containers of hot liquids away from tables and counter edges, and keep the cords out of reach as well. This will prevent children from pulling hot containers down from a ledge.

3. Make the stove a no-kid zone. Don’t cook with children nearby or let them sit on the counter to watch you.

4. Cook on back burners whenever possible and turn pot handles to the rear, not towards the room.

5. Make sure your water heater is set below 120 degrees Fahrenheit. If you can’t control the heater, install an anti-scald device. This ingenuous device reduces the water flow to a trickle when the temperature reaches 120 degrees Fahrenheit.

6. Always test the bath water before a child steps into it.

Josyann Abisaab on Head Safety Advice

This is a scary and dramatic statistic: 75% of bicycle related fatalities in children could actually be prevented by using bike helmets. When riding a bike or a skateboard, wearing a helmet can prevent everything from a concussion, head trauma and even death.

This should be a hard and fast rule in every home from the time that kids are very little. If children are used to wearing helmets from a very early age, it will become second nature to them and they won’t challenge this requirement.

In addition to wearing a helmet for bike riding, doctors like Josyann Abisaab explain that they need to be worn for roller-skating, in-line skating, skiing, skateboarding, street hockey, horseback riding and more.

Make sure that the strap under the chin is buckled correctly so that the helmet can’t move around on the child’s head or slip over his eyes.

Twenty Years Service Citation Awarded to Dr. Josyann Abisaab

After twenty years of dedicated service in emergency medicine Doctor Josyann Abisaab was awarded a citation in recognition of this service by Dean Gotto, the Dean of the Weill Cornell Medical College. Along with the citation Dean Gotto also offered warm congratulations, as seen above, in November 2009.

5 Medical Options with a Sickness or Accident

In times of a potential emergency, you have five main options. You can treat the issue at home, particularly if it is a cut, bruise, or other minor rash or cough. You can call your physician and speak either to the doctor of the nurse. This is a good idea since they can help you to discuss the issues and to figure out if you need further care.

You can go to one of the overnight emergency care centers. This is particularly useful if you think you have a broken bone after hours, or if you need stitches or if you have a minor issue that needs medical attention but isn't life threatening.

Your two final options are to go to the emergency room to be seen by an ER doctor like Josyann Abisaab or to call an ambulance. An ambulance should only be called if you feel that you need immediate assistance and that you'll need assistance on the way to the hospital.

Hopefully, with these options in mind, you'll be able to make the right decision when the time comes and someone needs attention in your house.

Visiting the Hospital with a Child

The hospital can be a very scary place for a child. One way to reduce the stress for your child and for you is to be prepared and to prepare your child for what is coming. Research actually shows that children heal and recuperate better from illnesses and injuries when they are prepared. When they can predict what will happen during their treatment, it builds a sense of trust and eases their stress.

Remember that you are an important part of the team. Working with the health care staff helps to make the process go more smoothly. This includes remaining calm and projecting a positive attitude to comfort your child. If the health care professional isn’t explaining things enough to your child, ask for clarification and explain to your child what he can expect. Obviously, if the situation is life threatening, this is irrelevant – but in a more contained situation it can be very helpful.

Warning - Texting May Be Dangerous for Your Health

Ergonomics researchers are taking a look at college students to evaluate what texting could mean for their health. Most adults between the ages of 18-21 prefer texting on their phone to e-mail or phone calls. Judith Gold, an assistant professor of Epidemiology at the College of Health Professions and Social Work, thinks that they may be jeopardizing their health.

At the annual meeting of the American Public Health Association, she presented her preliminary findings showing that college students who texted more had more pain in their neck and shoulders than did those who texted less. This is quite a new area of research, since texting is a new phenomenon. However, she says that, "Given the similarities in body position, findings from research on overuse injuries from computers could be applicable here.”

Office workers who experience on-the-job injuries often show carpal tunnel syndrome, bursitis and tendonitis. These are issues that emergency room physicians like Josyann Abisaab will then see, or that a family physician will need to examine.

Common conditions which do not require a visit to the emergency room include, but are not limited to:

• Earaches

• Cuts where the bleeding is under control

• An animal bite which is no longer bleeding; However please note you should contact a doctor to clarify whether or not a rabies shot is needed.

• A broken bone does not require an ER visit. Rather, call your doctor. If it is not possible to call your doctor, or the fracture/break is self-evident, then yes go to the ER.

• Sprains, rashes, sunburns and other burns do not need an ER visit.

• Insect sting, unless there are signs of breathing difficulties. If this is the case, rush to the ER or else call 911 immediately.

• Fever does not need a visit to the ER unless it is accompanied by convulsions.

• Colds, flu symptoms, a cough or a sore throat is not a reason to go to the emergency room.

• STDs do not require an ER visit.

Reasons to Visit the Emergency Room

The following is a list of symptoms which require a visit to the emergency room:

• Loss of consciousness.

• The following signs of a heart attack which last longer than two minutes: Pressure, fullness, squeezing or pain in the center of the chest; tightness, burning or aching under the breastbone; chest pain with lightheadedness.

• The following signs of a stroke: sudden weakness or numbness of the face, arm or leg on one side of the body; loss of vision or dimness suddenly, especially if it’s in one eye; inability to talk, or trouble talking, or understanding someone else talking; a severe and sudden headache with no explainable cause; dizziness, unsteadiness, sudden falling which are unexplained, particularly if they occur with other symptoms of stroke.

• More than normal shortness of breath.

• Bleeding which continues even after the application of direct pressure for ten minutes.

• Sudden, instantaneous and severe pain.

• Poisoning- however it is important to note that if it is at all possible to contact a poison control center first, it is better to get immediate advice. There are some poisons that need to vomited-up immediately, and others which need to be diluted with water immediately. Quick action in this regard can save a life.

• If there is an allergic reaction to an insect bite, sting or medication, particularly if it becomes difficult to breath. The symptoms become worse over time.

• Traumatic and serious head injury.

• Disorientation, sleepiness, or stupor which is unexplained.

• Coughing or vomiting up blood.

• Sever vomiting which is unabated.

• Feelings of a suicidal or homicidal nature.

Handle with Care: Emergency Room Care

There is a growing trend today to go to the emergency room even when there is no indication of a real emergency. In many cases people are refraining from scheduling a visit with their doctor in favor of an expensive and uncomfortable emergency room visit.

Non-emergency patients may find that they have to wait upwards of 2 hours or more to be seen by a physician in the emergency room. This is due to the fact that the ER practices triage, a system which assures that the most urgent cases, the real emergencies, get the immediate care that they need without having to wait on line. In many cases in real emergencies having to wait for care could mean the difference between life and death.

But what about the in-between cases in which one is not sure whether they are experiencing a “real” emergency or it is something better seen by your doctor in his office after scheduling an appointment.

The first rule is that if you believe you are experiencing a medical emergency, then you should not hesitate to go to the ER. Short of that, it might be prudent to first call your regular doctor, describe your symptoms, and have your doctor help you decide what you should do. It is possible that your doctor will tell you to come to his office to check you, and squeeze you in between his regularly scheduled patients to be sure you either do or do not need to go to the ER.
Most primary care doctors are available 24 hours a day, or else are part of a practice with a group of doctors in which there is always someone on call.

It is a good idea to become familiar with the kind of symptoms requiring an ER visit. The American College of Emergency Physicians (ACEP) published a booklet describing the signs and symptoms of illnesses and injuries which need immediate medical attention in an emergency room. To receive a free copy you can call the ACEP at 800-446-9776.

Helping to Create a Smooth Emergency Room Visit

Certainly, when you go the emergency room, there are many things that you can’t control. You can’t control how long you’ll have to be there, how many people need more urgent care than you do, or what the doctors will find. There are, however, certain things that you can control and the more that you take advantage of these items, the more smooth your process may be.

1. Id and insurance: If you have insurance, make sure to bring it with you to the emergency room. Bring the identification materials for the patient as well. If you bring your child for care, for instance, it’s not enough to bring your insurance materials. Bring the child’s materials.

2. Don’t bring a crowd: There are enough people in the emergency room – they don’t need extra people around. If you bring your child for care, don’t bring along the grandparents, both parents and siblings. One caregiver, or two at the most, is enough company for the patient.

3. Health record: If the patient has pre-existing conditions or medicines, make sure to bring materials on these issues. If they take medications, for instance, make sure you’ve got the name of each medicine and the dose. The emergency room doctors aren’t clairvoyant. They can only work with the materials that they have in front of them, and the more that you provide them with information, the better off they will be in creating good care.

4. Provide information: Along these lines, make sure to be upfront with the doctors. If you’ve brought your elderly father for care and he had two alcoholic drinks earlier in the evening, don’t hide this fact. If you noticed a bull’s eye on your son’s skin, but you assume it’s nothing, don’t blow it off! This small detail might be the difference between diagnosing Lyme’s Disease and missing it entirely.

Emergency Care Tips

As Benjamin Franklin said, “An ounce of prevention is worth a pound of cure.” This is certainly true when it comes to emergency room care. The more that you plan for an emergency, as ironic as that sounds, the more smooth the situation will be when there is really a crisis. For this reason, here are a number of tips for emergency room trip preparation.

Before anyone in the house needs to go to the emergency room, here are the things that should be done:

1. Keep all emergency numbers by the phone. These should include the police, the fire department, the poison control center, the name and number for your primary care doctor, and your insurance carrier. In time of a crisis, people often forget things and having them right by the phone will be very helpful. In addition, if you have a babysitter in the house or someone else, they’ll know how to get in touch with the help they need.

2. Know what your insurance policy covers. Before anyone needs emergency care, find out what to do in case of an emergency. Do you have to call your primary care physician first and get permission to go to the emergency room? Are certain emergencies covered by your insurance, while others aren’t? Do your homework now so that you don’t pay out of pocket later.

3. Have a list of all medications that you take and allergies that you have. This list should be in an easily accessible place, either with your health insurance card or on your Blackberry in an obvious place. Someone else should know where you keep this information, in case you can’t tell anyone about it when you need emergency care.

These preventative steps can make a big difference when an emergency strikes.

Show Patience as a Patient in the Emergency Room

If you end up in the emergency room for any reason, you’ll certainly want to know what to expect. Some people have the misconception that they will show up, be seen immediately, and be treated without any wait. This is simply not the case in most of the emergency rooms in the country, and here’s why.

When you first enter the emergency room, you’ll probably undergo a triage process. This is the process by which patients are seen and evaluated. The nurses and doctors need to look at each patient, decide how quickly the patient needs care, and then decide where the patient should go next. Obviously, people with the most urgent needs will be seen first. While you may get annoyed that others are going in front of you, the emergency room isn’t a place that waits on people on a first come, first serve basis.

You will probably have to wait for awhile to be seen, and then wait for awhile to be evaluated. Don’t think that you’ve been ignored or that the medical staff doesn’t care about you. They are working their way through the patients as quickly – and professionally – as they can. They do want to treat you – they just have to do so in order of need. They also might be waiting for lab results or x-rays to return; they may be waiting for a bed to open up for you; or they might been dealing with other patients.

Keep these ideas in mind as you enter the emergency room, and know that you will be treated by a professional staff that wants you to get back home as soon as possible.

Emergency Room - Be Prepared

Sure it seems ironic to plan for an emergency room visit. However, when you’re having trouble breathing or you’ve hurt yourself, you’re not going to take the time to get organized. If you are organized when you’re not hurt and not under pressure, it will help you to have a much smoother experience, should you need to visit the emergency room at some point.

You should always have your identification materials and your insurance materials together – and with you. If something happens to you when you aren’t home, and you’re taken to the emergency room in an ambulance, you’ll certainly want to have a way for them to identify you and to check your coverage. How many of us have run out of the house “just for a second” to buy something carrying only a $20 in our pocket? Or, who hasn’t gone jogging, carrying nothing but the iPod? It’s really quite important to make sure that you always have your identification on you.

You should also check with your health insurance company to know exactly what is covered in your plan. If you have an emergency that you think needs immediate care, will they cover it? What about if you have broken a limb? Have a terribly sore throat? Have a reaction to a rash? Finding out exactly what is covered and what isn’t with your emergency room care can save you hours of headaches – and bills – later.

Josyann Abisaab

Doctor Josyann Abisaab started her academic career at the American University in Beirut, Lebanon where she received her B.S. degree with Distinction.  She continued her education at the University of Rochester School of Medicine where she completed her medical degree in 1989.

She spent her residency and internship in Internal Medicine at the New York Hospital/ Cornell University Medical College.  Since 1992, she has been an Assistant Attending Physician in the Emergency Department of New York Presbyterian Hospital and has been an Assistant Professor of Clinical Medicine in the Department of Internal Medicine at Weill Cornell Medical College.

Dr. Abisaab published an article called "Emergency department presentation of bilateral carotid artery dissections in a postpartum patient", that she co-wrote with N. Nevadunsky and N. Flomenbaum.  It is published in the November, 2004 edition of Annals of Emergency Medicine.