Diplomate, Board Certification of Emergency Medicine
Chairman, Department of Emergency Medicine Ma'ayenei Hayeshua
Hospital
One of my correspondents requested I speak on the issue of
sugar intake in children.
Sugar is a high energy food which is actually not bad for you
if you are engaged in activities that require high energy.
Most of us are not, so this simple carbohydrate collects as
fat. That already is a serious problem.
Sugar in itself does not cause diabetes, but obesity can.
Furthermore, obesity can be a reason for heart disease and
stroke. A fat kid at age 8 will stay that way for life. Want
to give your kids a sweet treat? Try fruit. Candy, cake and
especially chocolate spread, have little nutritional value
and after the initial thrill of a great taste, they go
straight to fat. We all know what it is like trying to get
rid of fat. Do your children a favor -- cut sugary snacks
today!
We were speaking about the ambulance coming and starting an
IV to give medications. IVs can be difficult, sometimes the
neck or the leg must be used to find a vein. At this point, a
monitor may be attached -- it commonly beeps -- and shouldn't
scare you. It measures heart rate and rhythm. Blood pressure
is also checked -- this can be uncomfortable for a few
seconds, but one should be patient.
Should a patient be in cardiac arrest, meaning the heart is
not working, CPR will be started by ambulance staff. We have
discussed this in the past, and we strongly recommend that
this one-day course be taken by everyone, as a delay in
starting CPR can result in irreparable damage. If a rhythm
called VF is present, an electric shock must be given
immediately or the heart will stop working. Recently,
machines called AEDs have appeared, which give the shock
based on the rhythm. These machines are now in many airplanes
and police vehicles.
If breathing has stopped, then intubation is done. This will
also be done if breathing is very difficult or heavy. A
little anesthetic may be given, and then a tube is inserted
into the windpipe and air is pressed into the lungs that way.
Once the patient arrives in the hospital, the tube will be
hooked up to a respirator. While the tube is in the throat
the patient will generally be sedated, and even if he is not
sedated, he will not be able to talk.
On arrival at the hospital, the patient will be brought to a
special room. Often the ambulance will allow only one family
member to accompany the patient, and once in the hospital
that policy is generally continued. If a resuscitation is
occurring, in Israel they generally do not allow the family
to be present, but in other places in the world that is
changing. In any event, hysteria, screaming or interfering
with the report of the ambulance crew to the medical staff
impedes the ability to give the best care. Physicians are
trained to ask the right questions, and it is important to
answer the question being asked.
At the end of the interview is when to volunteer any
information that has not been asked. Bring all relevant
medical information and medication lists. Physicians do not
always know the color of pills, so saying he takes a green
pill for hypertension is not helpful.
Once a patient is stabilized, often a CT or an ECHO are
ordered. Sometimes this entails leaving the emergency
department. The emergency physician often calls for consults,
but remains the captain of the team so questions should be
addressed to him. Do not be demanding or ask that the patient
be seen by a cardiologist or other specialist. In Israel
there is no way of knowing whether the cardiology or other
specialist knows more than the Emergency Physician. We'll
finish next week. Write me in care of the Yated.
A message from Glaxo, sponsor of this column. I have a
headache now, so it's time once again to speak about the best
headache drugs -- Imitrex and Naramig. These drugs are now
the standard for migraines. I say to stick with the tried and
true. I know -- I've used them myself.
