March 15, 2020

Offsite Care providing Telemedicine Total Care & Consultation for PVH Covid-19 Patients

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.)

  1. Telemedicine is the use of the Internet for physicians and other health professional to diagnose and to treat patients anywhere when requested.
  2. 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.
    1. Smart phone (Android or iPhone)
    2. Android tablet or iPad
    3. 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.”
    4. Telemedicine platform with visual and audio and a stethoscope and/or ultrasound device.
    5. Advanced robot which has all the above features and the ability to be driven in the hospital or clinic setting to any bedside.

  1. 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:
     
    1. 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.
    2. 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.
    3. 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).
    4. SYSTEMATIC EXAMINATION OF THE PATIENT DONE WITH THE ASSISTANCE OF FULLY PROTECTED RN or PHYSICIAN ASSISTANT:
      1. FACE; EYES INCLUDING PUPILS AND EYE MOTIONS
      2. MOVEMENT OF HEAD, EYES, NECK, ARMS AND LEGS; SKIN COLOR, RASHES, LESIONS; ANKLE EDEMA AND FOOT PULSES
      3. CALVES/THIGHS
      4. ABDOMEN AS TO DISTENSION, GUARDING, MASSES/ORGANOMEGALY
      5. BOWEL SOUNDS IF STETHOSCOPE AVAILABLE
      6. CHEST RESPIRATORY EXCURSIONS
      7. NON-MUSICAL CRACKLES OF LUNGS; MUSICAL WHEEZING OF LUNGS
      8. HEART MURMURS OR GALLOPS
      9. PATELLAR AND ACHILLES REFLEXES
      10. LOSS OF SENSATIONS OR MOVEMENTS. ORIENTATION TO PERSON, PLACE AND TIME. MINICOGNITIVE EXAM. PATIENT’S CODE PREFERENCE
  1. 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
  2. Appropriate orders are written in the patient’s electronic medical record
  3. Consultations are requested if needed
  4. Patient is transferred if needed to another ward or facility
  5. 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)