A Brief Review of Telemedicine in Critical Care
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Outcomes 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.
Notes from the Chair-Elect: EM/CCM Employment Task Force
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Winter 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.
Use of Point-Of-Care Ultrasound for the Diagnosis and Management of Hypertrophic Obstructive Cardiomyopathy
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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.
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.