Diplomate, Board Certification of Emergency Medicine
Chairman, Department of Emergency Medicine Ma'ayenei
Hayeshua Hospital
Before we continue to speak about the lungs, two safety tips
must be mentioned. We have been seeing a sharp upsurge in
corkonet (scooter) injuries. Children are suffering serious
head injuries and broken arms from falls from these riding
toys. A helmet is necessary, and scooters are not designed
for small children or for going down big hills. Falling on
one's shoulder and rolling may prevent more injuries than on
an outstretched arm. Parents: please buy your children
helmets or have your local council consider subsidizing
them.
Another safety issue is people who drive with children on
their laps. Children need to be in safety belts or baby
seats; anything less is very, and I mean very, dangerous.
Don't be foolish.
Infections can happen to the lungs despite all their defense
mechanisms. You only need five small bacteria or viruses to
get an infection, and the average sick person coughs out
millions in a single cough. Sick people who are careless
about covering their mouths when they cough or who wipe
their face or hands on communal towels are spreading
disease.
Viruses are by far the most common cause of lung infections.
Fever or green sputum do not mean that the cause is not
viral. There is no treatment for most viruses, with the
exception of the flu virus, and antibiotics will certainly
not help. Antihistamines are also not a good idea as they
dry up secretions and make them harder to get out.
Bacteria do cause lung infections, most commonly pneumonia.
An x-ray is the easiest way to tell if there is pneumonia,
but it can take some time to show on the x-ray especially if
the patient is dehydrated. Even in the absence of a positive
x-ray I would probably treat very young or very old patients
with fever and cough and shortness of breath. In these high
risk groups, Zinnat, a drug made Glaxo, by our sponsor, is
an excellent idea, as it covers most bacteria that go to the
lung. Many of these patients need to be admitted to the
hospital. In lower risk patients, drugs of the erythromycin
class are the first line, and there are now four in that
class.
Cough gets out secretions and bacteria. It is extremely hard
to suppress cough and I'm not sure you should try, but
dextromthorphan containing medications probably work the
best, even though they don't work that well. Vaporizers may
help, but there is no evidence that forcing fluids does
anything.
Before we say good bye for the week, I try to answer all our
mail, and one of our readers asks why doctors have such
terrible handwriting. This has never been studied and maybe
it should be, but doctors tend to be very busy and also
people whose minds work a lot faster than their hands, so
they often write fast and sloppily. Good penmanship takes
time to do and that is why I believe we have such bad
handwriting. The editors of Yated make me (and every
regular contributor) type my column--I wonder why? Write me
in care of the Yated.
