TELEMEDICINE IS THE PREFERRED DIAGNOSTIC TOOL IN DIAGNOSING AND IN TREATING THE NEW CORONAVIRUS COVID-19, AS THERE IS NO INFECTION DANGER TO THE MEDICAL CONSULTANTS.
(BASED ON 14 YEARS EXPERIENCE OF OFFSITE CARE, A CALIFORNIA TELEMEDICINE COMPANY, AND 7 YEARS EXPERIENCE OF GLOBAL OFFSITE CARE, A NON-PROFIT CA CORP.)
- Telemedicine is the use of the Internet for physicians and other health professional to diagnose and to treat patients anywhere when requested.
- Telemedicine platforms are as follows: (as used by Offsite Care and Global Offsite Care) to connect the physician or other health professional with the patient by video picture and by voice.
- Smart phone (Android or iPhone)
- Android tablet or iPad
- Multidirectional holder to move the phone or tablet/pad “up and down and side to side”—making it an inexpensive Robot with the best of technology in an affordable package. Global Offsite Care favors this inexpensive “Robot.”
- Telemedicine platform with visual and audio and a stethoscope and/or ultrasound device.
- Advanced robot which has all the above features and the ability to be driven in the hospital or clinic setting to any bedside.
- With a computer with the Electronic Medical Record (EMR) of the Patient “on screen” & with a bedside RN or physician assistant in full Viral Protective Dress with appropriate Viral Protective Mask, the patient for COVID-19 consultation is examined as follows:
- History of Present Illness; Past Medical History; Allergies; Review of Systems; Current Medications; Occupation; Diet including unusual/wild species; Marital/Family Status; Travels—especially recent; Exposures to other in what kind of settings; Contacts with known or suspected Coronavirus Patents. Code status.
- Cat Scan without contrast of the chest is reviewed looking for multifocal pneumonia and/or ground glass findings of inflammation–THE ONLY TEST THAT WAS 100% PRESENT ON ALL 138 PATIENTS IN THE WUHAN CLINICAL STATISTICS REPORT leading to the changing of the diagnostic criteria in China for the diagnosis of COVID-19, as RNA studies were often not readily available and were not 100% reliable. Thus, given the availability of CT scanners, a 5-15 min.
- Vital Signs with sex, age, weight, height, O2 saturation on Room Air or on Supplemental Oxygen noting Nasal Prong delivery of oxygen in liters/min up to 8lmin; Mask Delivery of oxygen up to 15 l/min: High Flow Nasal Prong delivery of oxygen noting O2 liter/min and pressure; BiPap delivery of oxygen noting FIO2, Inspiratory Pressure, CPAP Pressure, and Respiratory Rate Setting, or Ventilatory Delivery of Oxygen noting Volume or Pressure Mode, % FIO2, Tidal Volume and Continuous Positive End Expiratory Pressure (PEEP).
- SYSTEMATIC EXAMINATION OF THE PATIENT DONE WITH THE ASSISTANCE OF FULLY PROTECTED RN or PHYSICIAN ASSISTANT:
- FACE; EYES INCLUDING PUPILS AND EYE MOTIONS
- MOVEMENT OF HEAD, EYES, NECK, ARMS AND LEGS; SKIN COLOR, RASHES, LESIONS; ANKLE EDEMA AND FOOT PULSES
- ABDOMEN AS TO DISTENSION, GUARDING, MASSES/ORGANOMEGALY
- BOWEL SOUNDS IF STETHOSCOPE AVAILABLE
- CHEST RESPIRATORY EXCURSIONS
- NON-MUSICAL CRACKLES OF LUNGS; MUSICAL WHEEZING OF LUNGS
- HEART MURMURS OR GALLOPS
- PATELLAR AND ACHILLES REFLEXES
- LOSS OF SENSATIONS OR MOVEMENTS. ORIENTATION TO PERSON, PLACE AND TIME. MINICOGNITIVE EXAM. PATIENT’S CODE PREFERENCE
- The Telemedicine Examination and Conclusions are dictated as part of the notes in the chart. The referring MD is called and the case is discussed
- Appropriate orders are written in the patient’s electronic medical record
- Consultations are requested if needed
- Patient is transferred if needed to another ward or facility
- Meeting with family/friends as appropriate and as requested
JK Gude MD, Intensivist and Pulmonologist,
Medical Director of OSC and of Global OSC
Clinical Professor of Medicine
University of San Francisco-California (UCSF)