ABSTRACT
Daniel Slack Charlotte NC1, Paul Colavita Charlotte NC1, Abdelrahman Nimeri Charlotte NC1 Carolinas Medical Center, Atrium Health1 We present a 55-year-old female with class II obesity and a previous history of sleeve gastrectomy who developed significant gastroesophageal reflux disease refractory to medical management. After a covid infection in fall of 2020 she began to report new symptoms of dysphagia that progressed from solids to liquids. She underwent extensive workup including upper endoscopy, upper GI barium swallow, manometry, pH impedence and EndoFlip leading to a diagnosis of Achalasia type II as well as a paraesophageal hernia. Given these findings she underwent a combined paraesophageal hernia repair with conversion of sleeve gastrectomy to Roux-en-Y gastric diversion and an intra-operative Peroral Endoscopic Myotomy. Intra-operatively she was noted to have significant lower abdominal adhesions leading to performing the Roux-en-Y reconstruction through a supramesocolic defect in a retrocolic fashion. The patient tolerated the procedure well and recovered with improvement of both her reflux and achalasia.
ABSTRACT
INTRODUCTION: The National Emergency Tele-Critical Care Network (NETCCN) was developed to address limited and geographically unevenly distributed critical care (CC) providers during COVID-19 pandemic surges. Although designed for on-demand access to CC experts, for pandemic response, NETCCN continues to evolve and must be flexible and adaptable to future mass casualty/disasters. We report a pilot using tele-critical care (TCC) through NETCCN in emergency medical services (EMS). METHODS: We deployed a mobile device enabled cloud based, easy to use and learn, secure, HIPAA compliant TCC app developed for NETCCN in an emergency medical services (EMS) pilot designed to facilitate rapid communication via text, voice, video and file sharing between paramedics in the field, and emergency medicine specialists. A 30-minute session trained participants on the app, including account creation, login, and functions. EMS providers were encouraged to replace existing telephone communication triage protocols with the NETCCN mobile app. We collected the number/nature of consults, and narrative feedback. RESULTS: The pilot ran for 30 days and was used on average 3 times/week. No patient data was entered into the system, and the app was solely used for its communication features. The most common use case was terminating resuscitation. Debrief and feedback confirmed that the app was easy to use, not significantly affected by connectivity issues, and elicited several barriers to adoption by EMS providers: 1) manual input of patient data 2) perception of being micromanaged. Overall impression of the app and its utility was positive by both remote and EMS providers, and discussion elicited strategies to improve adoption: 1) incorporate TCC into protocols for interfacility critical care transport 2) automate patient data entry (e.g. scan driver's license)). CONCLUSIONS: We demonstrated that the NETCCN TCC app is quickly and easily usable in the EMS setting, but that further optimization is required to promote adoption. Novel non-disaster use cases like this can provide means to stabilize and sustain a system designed primarily for infrequent “as needed” response. Additionally, feedback and problem solving for these novel use cases can be an effective way to enhance system flexibility with dividends for future disaster use.