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Telemedicine Using Stationary Hard-Wire Audiovisual Equipment or Robotic Systems in Critical Care: A Brief Review

By: Nikhanj NS, Raschke RA, Groves R, Cavallazzi R, Ramos KS

Abstract: No abstract available. Article truncated after 150 words. A shortage of critical care physicians in the United States has been widely recognized and reported (1). Most intensive care units (ICUs) do no not have a formally-trained intensivist in their staff despite compelling evidence that high-intensity intensivist staffing leads to better patient outcomes (1,2). Critical care telemedicine is one potential solution that has expanded rapidly since its inception in 2000 (3). In its simplest form, telemedicine leverages audiovisual technology and the electronic medical record to provide remote two-way communication between a physician and a patient. Current telemedicine models differ by the type of hardware facilitating remote audiovisual interaction, the location of the provider, and the type of patient-care service provided. We collectively have experience with several of these models and feel that future telemedicine programs will likely integrate the most advantageous aspects of each with an increasing role for telemedicine robotics. The dominant current model for providing Critical Care …



Medical Image of the Week: Coral Reef Aorta

By: Eberson L, Ghazala S

Abstract: No abstract available. Article truncated at 150 words. A 52-year-old woman with no past medical history presented to the emergency department with signs and symptoms concerning for pneumonia. Chest x-ray showed incidental findings of a calcified aortic mass. Subsequently, a follow up computed tomography scan (CT) was obtained which showed coral reef aorta (Figure 1). On physical examination, vital signs were only significant for mildly elevated blood pressure to 146/62 mmHg. She also had normal and equal pulses and pressures throughout all 4 extremities. In retrospect, patient had complaints of bilateral lower extremity claudication on strenuous exercise. Coral reef aorta, a rare condition that was first described in 1984 by Qvarfordt et al. (1) is characterized by an eccentric, heavily calcified polypoid lesion and stenosis of the juxtarenal and suprarenal aorta. The rock-hard, irregular, gritty, whitish surface of the calcification strongly resembled a coral reef. The most common presentation is severe hypertension and intermittent claudication. Magnetic resonance angiogram …



Medical Image of the Week: Hematopneumatoceles from Pulmonary Lacerations

By: Chaddha U, Maehara D, Puscas I, Prosper A, Mahdavi R

Abstract: No abstract available. Article truncated after 150 words. A 17-year-old man was brought to the emergency room after a fall from a 50-foot bridge. He was hypoxemic on presentation, requiring endotracheal intubation. Chest computed tomography (CT) revealed bilateral airspace opacities consistent with pulmonary contusions, and multiple air-fluid levels diagnostic of pulmonary lacerations (Figures 1-3). Pulmonary lacerations are rare complications of blunt chest trauma (1). They can be contained within the lung parenchyma or may extend through the visceral pleura causing a pneumothorax. Due to its elastic recoil, the surrounding lung tissue pulls back from the laceration resulting in a round or oval cavity that may fill with air (pneumatocele), blood (hematocele) or both (hematopneumatocele). Lacerations are often obscured on chest x-ray as they are usually surrounded by contusion, requiring a CT for detection (2). They are classified into four types according to the mechanism of injury: Type 1 (compression rupture injury, most common type, usually centrally located), Type …



Senate Health Bill Lacks 50 Votes Needed to Proceed

By: Moore NS

Abstract: No abstract available. Article truncated at 150 words. Yesterday (7/17), two additional Senators – Sen. Roberts (R-KS) and Sen. Lee (R-NE) joined Senators Paul (R-KY) and Collins (R-ME) in announcing their intention to vote “no” on the motion to proceed on considering the Senate ACA repeal and replace legislation – effectively blocking Senate consideration of the current Senate Republican health care bill. Senators Paul, Lee and Roberts opposed the bill for not going far enough, while Senator Collins expressed her concern the bill goes too far. With the 4 publicly announced NO votes – Senator Majority Leader Mitch McConnell does not have the 50 votes needed to begin debate on the bill, let alone assure final passage. Speculation now turns to what happens next. President Trump has tweeted his preference to let Obamacare fail as a way to force Democrats to negotiate new legislation. Senator McConnell has suggested a series of symbolic votes on full repeal with multi-year delay to work …



Medi-Cal Blamed for Poor Care in Lawsuit

By: Robbins RA

Abstract: No abstract available. Article truncated at 150 words. Several sources are reporting a lawsuit filed in California alleging poor care in the state’s Medicaid program, Medi-Cal (1). The suit alleges that Medi-Cal failed to pay doctors enough to provide proper care. The suit was filed by five Latino residents on behalf of California’s 13 million lower-income residents, more than half of them Latinos. The suit alleges that "…California has created a separate and unequal system of health care, one for the insurance program with the largest proportion of Latinos (Medi-Cal), and one for the other principal insurance plans, whose recipients are disproportionately white.” The state budget includes $107 billion in state and federal funding for Medi-Cal this year, but the spending is not enough to restore reimbursement cuts made during the Great Recession of 2008. A proposal in the U.S. Senate to repeal the Affordable Health Care law (ACA, Obamacare) could drastically reduce funding for Medicare and the …