Dr. Josyann Abisaab

Josyann Abisaab: Emergency Room Treatment of Snakebites

Perhaps not in New York specifically, but as a general problem snakebites are significant in the United States. There are about 7 to 8 thousand bites reported each year, but because of the high quality and readily available medical care in the US, there are only about six deaths per year from snakebites.

The successful rate of treating snakebites is due to a quick medical evaluation, a methodical clinical assessment, and the prompt administration of antivenom to selected patients. According to a study on the management of Crotalinae (rattlesnake, water moccasin or copperhead) bites in the United States, it is highly recommended that a medical toxicologist or other doctor experienced in treating poisonous snakebites be consulted before giving the antivenom. A medical toxicologist is available by phone through a US regional poison control center at 1-800-222-1222.

Some analysts believe that due to the recent earthquake and hurricane on the east coast poisonous snakes are present in greater numbers among people than normal, posing a greater threat than usual. In one county in Maryland there have been three snakebites in the past few weeks, the same number that the county usually has in an entire year.

Josyann Abisaab, MD is an emergency room physician at New York-Presbyterian Hospital.

New York-Presbyterian Center for Emergency Medicine

The department of emergency medicine at the New York-Presbyterian Hospital in Manhattan is one of the busiest emergency rooms in the country. Giving highly expert care to almost a quarter of a million people each year, the department has a reputation for excellence and professionalism.

Of those 250,000, about one fifth are consequently admitted into the hospital for the full treatment that they need.

Josyann Abisaab, as a physician in the emergency room at New York-Presbyterian, she sees the full gamut of issues commonly seen in emergency room settings, the most common of which are: chest pain, abdominal pain, infectious diseases, head trauma and gastrointestinal bleeding.

The emergency room at New York-Presbyterian is an officially designated 911 Ambulance-Receiving Center, offering Level I adult trauma services to patients arriving there.

Josyann Abisaab:Symptoms of Reyes Syndrome

Reyes Syndrome is an illness that can be difficult to diagnose, but unless Reyes is treated early, it can prove to be deadly. As of now, the cause of Reyes Syndrome is not known, but research has deduced a link between Reyes and aspirin and other medications containing salicylate, whether they are prescription, over the counter or topical ointments.

Children Most at Risk

Reyes Syndrome can affect anyone at any age but is most common in children under the age of 18, and particularly dangerous for infants and babies. The illness attacks all the body’s organs, with an especially devastating effect on the liver and brain. Reyes is frequently misdiagnosed and is often mistaken as encephalitis, meningitis, diabetes, drug overdose, poisoning, Sudden Infant Death Syndrome, or a psychiatric disorder.

Prevalent in Winter

The most common months for Reyes to appear are January through March, the months when the flu is most frequent. This is because Reyes is also associated with the patient just recovering from a previous infection, like a cold, the flu or chicken pox. When the flu or chicken pox strikes in epidemic numbers, there is also a spike in the number of cases of Reyes syndrome. Because there is also a connection between Reyes and treatment with aspirin, aspirin should always be avoided during viral infections, and a substitute pain and fever reducer should be used instead.

Early Diagnoses Crucial

When Reyes syndrome is diagnosed early and treated quickly, the chances of a complete recovery are high. It is important therefore, to be diligent when recovering from a viral illness and be on the lookout for symptoms of Reyes Syndrome. If you believe there is a chance of the patient having Reyes, then go to the emergency room, where physicians such as Dr. Josyann Abisaab will diagnose and treat the illness.

Symptoms in the Stages of Reyes Syndrome:

Stage I

•    Persistent or continuous vomiting
•    Signs of brain dysfunction:
•    Listlessness
•    Loss of pep and energy
•    Drowsiness

Stage II

•    Personality changes:
•    Irritability
•    Aggressive behavior
•    Disorientation:
•    Confusion
•    Irrational behavior
•    Combative
•    Delirium, convulsions, coma

Abdominal Pain and Emergency Room Visits

As an emergency room physician, Dr. Josyann Abisaab treats many people for abdominal pain. About 5% of all visits to the emergency room are due to abdominal pain. The emergency room doctor discharges the vast majority of these patients after examination. In about 10% of cases is emergency surgery required for patients complaining of abdominal pain who visit the emergency room.

Head Injuries and the ER

Many people are not sure when a visit to the ER is necessary. Some people are more inclined to play it safe and go regardless of the severity of the condition, while others prefer to wait things out. ER doctors such as Dr. Josyann Abisaab stress that it is important for people to be familiar with different levels of emergency, to avoid unnecessary visits or lack of necessary care.

Head injuries are common in sports. Parents often see their children take a blow to the head, and then get up and continue playing. They may even sit out for a few minutes. It is important to understand that concussions are a type of brain trauma, and they do not always result in unconsciousness. While an ER visit is not always necessary, it is important that you take the hit seriously and pay attention to any changes in the child’s demeanor. Sudden drowsiness, vomiting, uneven pupil dilation and even a split second of unconsciousness are probably signs of a concussion. Consult a doctor before making the trip, if you’d like, but don’t brush the occurrence off. Also, if a laceration occurred at the time of the blow, the child should definitely be examined.

Emergency Care Visits

When you go to the emergency room, you should be doing so because of a life threatening condition.  Many people use the emergency room as their primary care facility, going there with headaches, fevers, rashes and more.  This overtaxes the emergency room and isn’t the correct use of the emergency doctor’s time or energy.  Here, we discuss a number of reasons that you would go to the emergency room.

Certainly, if you’ve lost consciousness or have a broken bone, you should get to the emergency room for care.  If you are having chest pains or you are vomiting blood, go for emergency care.  Similarly, for very deep cuts, for head injuries, for seizures, for difficulty breathing, and for acute asthma you need to visit the emergency room.

The emergency room is not supposed to be the first location that you visit for routine care.  It is intended for emergency situations that require immediate care by trained emergency room physicians and nurses.

Emergency Room Care Advice

You’ve had an accident in the house and need to get to the emergency room.  Are you prepared?  Do you have all of the materials that you need to take with you? Do you know how you are getting there?

Here, we offer recommendations for things that you should know before this situation happens.  Hopefully, by reading this information now, you’ll be ready should a real accident occur. 

First, find out what urgent care facilities are in your area.  You might actually find that a 24-hour walk-in clinic or a minor emergency center is a better option for your injury.  You may find this option to be less expensive and faster than the actual emergency room of a hospital.  Check on your insurance coverage for these issues as well.  These facilities are often a good option when you want someone to see your sick child in the middle of the night.

Make sure that you know whether or not you need prior approval from your general care doctor to go to the hospital. Have the number of your doctor easily accessible and have someone who is not in pain call for you.

Know which hospital is associated with your insurance plan.  You want to go to the right place, and not get sent to another location when your time matters.  You should designate someone that you’ll want to come with you to the emergency room, as well.  Ask someone ahead of time if they will be willing to accompany you; it’s very helpful to have someone to navigate the system for you who isn’t in pain.