Diplomate, Board Certification of Emergency Medicine
Chairman, Department of Emergency Medicine Ma'ayenei Hayeshua
Hospital
Before we start our next series, I would like to say a word
about commercialization. The point of this column from its
beginning has been to improve the medical knowledge of the
readers, and make them into educated consumers of the health
care system. In an ideal sense this may even save lives. I
want you to be a partner with your doctor to help make
decisions that affect your health together.
As such, this column is not and will never be a personal
advertisement and you will notice that the column never
states how one can become a personal patient of mine.
Furthermore, the column is not copyrighted. While I would not
like you to use my column to make money, I have no objections
whatsoever that you copy my column or use it to advance the
medical knowledge of anyone you choose. I have one reader who
objects to our sponsor and I invite anyone who wishes to
sponsor the column instead of Glaxo to come forward.
We have never really discussed pregnancy and two particular
issues about pregnancy are the subject of our next series:
Emergencies in pregnancy, and tetratogens in pregnancy.
Tetratogens are things that can cause fetal malformations or
demise, lo oleinu.
Pregnancy induces a very unique state in a human's life. A
women's normal blood pressure lowers, her normal pulse
increases, she has a much higher circulating volume of
fluids, her blood count drops, her normal white count
increases, and many hormone secreting organs such as the
thyroid secrete differently in pregnancy. Oddly enough, a
perfectly healthy pregnant female can develop a usually
dangerous disease like diabetes or high blood pressure, only
to see it disappear once she gives birth.
These changes are very important from many physical and
mental standpoints (post partum depression probably has a
hormonal basis). As an emergency physician, one of the most
dangerous scenarios is a pregnant woman involved in a trauma
such as a road accident. Aside from having to treat two
people, in pregnancy a woman remains remarkably stable until
the last minute. That is, blood pressure and pulse will
remain stable despite what could be massive internal
bleeding. Furthermore, abdominal organs are displaced by
pregnancy, and this is where the most common site of bleeding
is. To make matters more complicated, a small separation of
the placenta from the uterus can be devastating, a problem
called abruptio. A small amount of maternal bleeding can
cause Rh problems.
We'll go into some more detail on this subject in subsequent
weeks, but I hope you can already appreciate a bit of what is
involved in trauma, and why a pregnant lady that feels well
often gets fully investigated before being allowed to go
home. Write me in care of the Yated.
A message from Glaxo, sponsor of this column. Valtrex
is a very important medicine. Herpes infections can be
devastating in a newborn and are often overlooked. Valtrex
works well against this virus as well as the one--a related
one--that causes chicken pox. Cold sores also respond
well.
