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THE UNIT: The Official Newsletter of the ACEP Critical Care Medicine Section - Spring 2017

ICU Telemedicine, The LOV-ED Study with Brian Fuller, MD, Updates from the Chair-Elect, and Critical Care Documentation and Billing


A Brief Review of Telemedicine in Critical Care

RaghuSeethala2015Tele-ICUOutcomes are improved when ICU’s are staffed primarily by intensivists. Medical societies (ie, SCCM) and organizations (ie, Leapfrog) recommend that ICU patients be cared for by intensivists 24 hours a day/7 days a week. Despite these findings and recommendations, there is a shortage of intensivists in the U.S. Only 15 - 20% of ICU’s are staffed by intensivists full time. With the aging population, this shortage is expected to increase over the next few decades. One of the strategies to deal with this shortage is to employ telemedicine in ICU’s, or tele-ICU’s. 

Telemedicine is not a novel technology or concept - it has been around for over 25 years in some form or other. Medicaid defines telemedicine as follows: “telemedicine seeks to improve a patient's health by permitting two-way, real time interactive communication between the patient and the physician or practitioner at the distant site. This electronic communication means the use of interactive telecommunications equipment that includes, at a minimum, audio and video equipment.” Many different medical specialties have ventured into telemedicine. In this article, we will explore and review the applications of telemedicine in critical care and the concept of the tele-ICU.

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Notes from the Chair-Elect: EM/CCM Employment Task Force

NickMohrWinter is a good time to be thinking about searching for jobs. It’s cold outside, our fellows are in the midst of their job searches, and we are all looking toward the new beginnings that spring will bring. This winter, members of the EM/CCM Employment Task Force have been hard at work discussing employment issues and starting to develop resources for critical care employment within the section.

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Use of Point-Of-Care Ultrasound for the Diagnosis and Management of Hypertrophic Obstructive Cardiomyopathy

Previously published in the December 2016 newsletter of the Emergency Ultrasound Section. 

Hypertrophic obstructive cardiomyopathy (HOCM) is an occasionally encountered and under-recognized clinical entity in the critical and emergency care environment. Point-of-Care Ultrasound (POCUS) can be utilized to better recognize HOCM and tailor resuscitation.

Case Description
A 49-year-old man with a history of decompensated cirrhosis secondary to alcoholic liver disease, complicated by hepatic encephalopathy, hepatorenal syndrome, recurrent pleural effusions, and ascites was admitted to the medical intensive care unit (ICU) for septic shock. The patient eventually required mechanical ventilation, blood transfusions, IR embolization, multiple vasopressor support and broad-spectrum antibiotics. Physical exam was notable for a systolic murmur, prompting further investigation. POCUS findings were consistent with HOCM.

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The Importance of Mechanical Ventilation in the Emergency Department: An Interview with Brian Fuller, MD

Susan Wilcox 2016Brian Fuller, MD, is an associate professor of anesthesiology and emergency medicine at Washington University School of Medicine in St. Louis and an emergency physician at Barnes Jewish Hospital.  


He and his colleagues recently published the LOV-ED study regarding mechanical ventilation in the ED in Annals of Emergency Medicine, and he presented their findings at the Society of Critical Care Medicine Annual Congress in January 2017. 

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A Primer on Critical Care Documentation and Billing for the Emergency Intensivist

Joseph Tonna 2016One of the factors that distinguish intensivists from other physician providers is the routine provision of critical care. While critical care can also be performed by emergency medicine and other physicians, critically ill patients in the ICU, or in the ED/ICU, are more likely to receive critical care. Accordingly, a thorough understanding of the documentation associated with the provision of critical care, and the billing resulting from it, should be germane to our profession. Here, The Unit discusses some of the common questions pertaining to the documentation and billing associated with critically ill patients.

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UCSD Anesthesiology (Emergency Medicine) Critical Care Medicine Fellowship

Specialty certification pathway: Anesthesiology (of note, there is a separate IM-CCM pathway that UCSD offers for EM graduates - for details, click on the web link at the bottom)

Length of fellowship: 2 years

Number of fellows: 1-2 (4 total, including Anesthesia. 1 dedicated EM spot. Willing to take more depending on match ranking)

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