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.
