ePulse: Highlights of the week 10 – 17 April 2020

ePulse: Highlights of the week 10 – 17 April 2020

WRAP-UP

What a week! The current big medical condition that everyone is talking about is COVID-19, however we, as healthcare professionals are entering a new era of using technology to facilitate our encounters with patients. In the emergency room, things probably has not change much in terms of seeing patients face to face, but seeing and evaluating patients in the office is certainly not without its challenges. 

TOP CIRCULATING LINKS:

Core Ultrasound

Jacob Avila does lecture on Lung Ultrasound. Definitely worth a look.

Emergency Medicine Cases

COVID is primarily a lung disease, but don't forget the heart. Check out these cases and keep it in the back of your mind when you see a case of SOB, dyspnea and chest pain.

EMCrit

Josh Farkas is creating The Internet Book of Critical Care. Check out the COVID section.

The Royal Children's Hospital Melbourne

See the COVID section dedicated to our pediatric population.

Rebel EM

I personally really enjoy these posts and rate this as one of the best COVID resources for emergency physicians.

INTRODUCING INFOVENT

The good physician treats the disease; the great physician treats the patient who has the disease. William Osler

When I read this quote from Dr William Osler the first time, it made me think how I can help educate my patients better.  Each patient comes with their own framework (schooling, exposure to Dr Google, previous experiences, medical history, contact with specialists and other healthcare providers, goals of care etc) and our goal is to tap into that framework and explain medical issues to the best of our abilities in a language that is acceptable to our patients. It is an essential skill to help our patients understand the condition or treatment plan to succeed in maintaining their health.

As physicians, we are knowledgeable creatures and often take that for granted when communicating with our patients. I, myself, am often guilty of rushing through information that I think patient’s should know about, but having the ability to follow them up in an office setting, I realized that this is seldom the case. In fact, most information is lost or misinterpreted when expressed in the Emergency Room situation. This is likely due to fear, anxiety and the chaotic ambience created by the emergency setting.

Technology can help in managing our patients even better than before. Let’s create a scenario to explain this in more detail and explore options of where we could use technology to not only improve care towards our patient, but to build a trusting relationship even beyond the ER:

Ms T is a 65-year-old poorly controlled diabetic with hypertension and a vague history of having a MI 5 years ago. You are unable to find any documentation regarding this episode in the chart, but you acknowledge that in your notes. She is currently presenting with chest pain when she eats for the past 3 months. She only presented to the ER, because her neighbor read something online and advised her to see a doctor regarding angina pectoralis… 

The history is not concerning and on further inquiry it sounds like heartburn. You do a good job in working her up and all test are reassuring. While you are seeing her, the ambulance brings in a hypoxic elderly gentleman and you indicate to the nurse, that Ms T can be discharged while you gather your PPE to attend to the elderly gentleman gasping for air.

Your shift is nearly finished and you complete your notes on Ms T. She does not have family physician right now and fortunately the clerk entered her email into the EMR. As you formalize your notes, you think to yourself, ” I should probably do a stress ECG on her and I forgot to tell her when to return to the ED.” It is now 01:00 in the morning and you promised yourself that you would complete your work before leaving the hospital.

You turn to InfoVent and open the messenger to write Ms T a message that is sent from the Ventricle secure server. You quickly stipulate when she should return to the ER and that you are referring her for a stress ECG. You explain why you feel it is important and ask her to review the section on ANGINA in the database.

Ms T goes home, ” happy that they could not find anything.” She is unsure if she told the doctor everything, as it was so busy and loud in there. She wakes up and sees the email from you. She clicks on the link and it takes her to the user friendly interface on her mobile phone. She reads the section on Angina and realize that she forgot to tell you that it often comes on in the morning and she feels a but clammy when she gets it. She is also nauseous sometimes and forgot to tell you that it often happens when she is mad at someone. She is also a bit short of breath when she cleans her house and needs to sit down to rest, but thought it was just because she was unfit. 

She phones the emergency room and relays this information to the triage nurse, who is worried and ask her to return for another consultation. Ms T is found to have Wellen’s pattern on her ECG and cath lab is expedited for angiography that shows a 99% occlusion of the proximal LAD.

Communication is key in the Emergency Room and if no message was sent to her, she probably would have taken the PPI and had a poor outcome. Close the Loop: Use InfoVent.

  • Disclaimer: The views expressed in this post is my own and related to my experiences within the Emergency Department.

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