EM:RAP doctors Mel Herbert and Jess Mason provide you with the latest COVID-19 updates to the Corependium online reference. We will continue to post updates here as more developments are made.
Love the constant updates! Thank you. We are about to start a tent screening area but our dilemma is: what constitutes a medical screening exam? An eyeball test plus interview should be sufficient for ER docs but is it enough for MSE and if so, how do you write up chart that reflects the MSE? I would be happy if others could share (or Jess /Fresno) what they are doing.
Also if no contact occurs is there a full donn/doff between patients ? We are rapidly burning through our PPE and need to manage this appropriately.
How are people documenting on patients that they do a "virtual screening visit" like using an iPad or facetime. I totally agree that this is the safest way to evaluate these sick patients but how are you handling physical exam documentation? Are you billing these visits as level 1 visits? I know not the most important issues right now just wanted some guidance on this. You guys are awesome thanks for all the hard work and advice!
With regard to CPAP and High Flow nasal oxygen for pneumonia in the article :Expired air dispersion during high flow cannula therapy versus CPAP via different masks -Hui DS European Respiratory Journal April 2019 the team did tests marking expired air with pulmonary “smoke “for visualization and revelation by a laser light sheet . It was in normal lungs not pneumonic lungs . They claimed expired air leakage from an intranasal high flow mask was Minimal as long as high flow nasal cannula and interface tube was correct not loose . In Italy Dr Robert Consentini on EM rap March 2020 reported for CPAP a helmet type delivery was used with CPAP and the health care infection rates with PPE was 5% . This Expired Air Tests could be repeated in some iteration .
The CAVEAT to Aerosol Generating procedures is strongly argued by Dr Jonathan Chun Hei - Chung eg al in Lancet Feb24 2020 - “Staff Safety during emergency management of Covid 19 “ where it was stated NOT to use oxygen above 6L/min in NON -airborne isolation room .
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brendan c. - March 17, 2020 6:26 AM
Love the constant updates! Thank you. We are about to start a tent screening area but our dilemma is: what constitutes a medical screening exam? An eyeball test plus interview should be sufficient for ER docs but is it enough for MSE and if so, how do you write up chart that reflects the MSE? I would be happy if others could share (or Jess /Fresno) what they are doing.
Also if no contact occurs is there a full donn/doff between patients ? We are rapidly burning through our PPE and need to manage this appropriately.
Keep it up Jess and Mel!! We need you!!
Adam H. - March 17, 2020 8:41 AM
How are people documenting on patients that they do a "virtual screening visit" like using an iPad or facetime. I totally agree that this is the safest way to evaluate these sick patients but how are you handling physical exam documentation? Are you billing these visits as level 1 visits? I know not the most important issues right now just wanted some guidance on this. You guys are awesome thanks for all the hard work and advice!
Ian L. - March 17, 2020 3:39 PM
With regard to CPAP and High Flow nasal oxygen for pneumonia in the article :Expired air dispersion during high flow cannula therapy versus CPAP via different masks -Hui DS European Respiratory Journal April 2019 the team did tests marking expired air with pulmonary “smoke “for visualization and revelation by a laser light sheet .
It was in normal lungs not pneumonic lungs .
They claimed expired air leakage from an intranasal high flow mask was Minimal as long as high flow nasal cannula and interface tube was correct not loose .
In Italy Dr Robert Consentini on EM rap March 2020 reported for CPAP a helmet type delivery was used with CPAP and the health care infection rates with PPE was 5% .
This Expired Air Tests could be repeated in some iteration .
Ian L. - March 21, 2020 7:35 PM
The CAVEAT to Aerosol Generating procedures is strongly argued by Dr Jonathan Chun Hei - Chung eg al in Lancet Feb24 2020 - “Staff Safety during emergency management of Covid 19 “ where it was stated NOT to use oxygen above 6L/min in NON -airborne isolation room .