Dei'ah veDibur - Information & Insight

A Window into the Chareidi World

3 Cheshvan 5763 - October 9, 2002 | Mordecai Plaut, director Published Weekly









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Shema Yisrael Torah Network











Home and Family
Your Medical Questions Answered!
by Joseph B. Leibman, MD

Diplomate, Board Certification of Emergency Medicine

Chairman, Department of Emergency Medicine Ma'ayenei Hayeshua Hospital

Shabbos is something precious to all of us, and I want to give you a guide on how to approach the medical aspects. I am not here to discuss halacha, although should one of my readers desire to respond to this column or ask questions on the medical aspects I would be very elated.

The problem, especially in Israel, is that often the physicians staffing Shabbos clinics are inferior physicians and since they are not sure, they often unnecessarily send patients to the emergency department.

Lacerations should generally be closed within six hours, but facial lacerations have 24 hours. Obviously cleaner lacerations do better and all wounds should be cleansed immediately with running water. Polydine is not necessary. If a wound is not closed within six hours, it can be closed again in four days through a simple procedure called delayed primary closure.

Fractures of the neck, pelvis, spine, and skull can be major, but most other closed fractures are not. With the exception of fractures that are open, grossly deformed, and in the elbow area, most fractures can wait until after Shabbos. Head injuries without loss of consciousness generally do well. Older people, especially those taking blood thinners, must be watched closely. I am not one who believes that every elderly person who falls needs a CAT-soan, but close watching for confusion, decreased mentation, or persistent vomiting is always indicated.

Fever in kids can be tricky. A stiff neck, vomiting and fever can indicate meningitis. However, a child with fever who looks basically good and is eating well can be watched at home. On the other extreme, if there is lethargy or shortness of breath, or a sick-looking kid, he must be seen immediately.

Most dehydration in young adults can be treated orally with medications to stop vomiting and diarrhea.

Chest pain is a reason to go to the hospital, although in a younger-than-thirty person who does not smoke, sometimes it suffices to have a good physical exam and a normal EKG.

Bee stings in a non-allergic person do not need to go to the hospital. Bleeding in pregnancy depends: if it is painless and very little, and we aren't speaking of the third trimester, we may not need to go to the hospital. Usually however that is not the case.

Fainting in a young person, hypoglycemia that has resolved, and a seizure in a known seizure patient don't necessarily need a hospital on Shabbos.

These are only the first things that came to my mind. If you have other questions let me hear from you.

This much I would like to say. It is absolutely imperative to make sure you have a rov in town who is well versed in medical halacha, and as well that you have a physician for Shabbos who is well trained. Most, but not all, Arabs are not. If they completed a residency here in Israel or did their medical school here, then they can be depended on. You should not consider yourself a doctor based on this column but you should at least be an educated consumer. Write me in care of the Yated.

A message from Glaxo, sponsor of this column. I saw the Imitrex representative this week, and was surprised to learn that almost all the competitors to Imitrex were invented in Glaxo's lab. This is a compliment to this excellent medication which is the standard in migraine therapy.


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