Rural Videoconference

ABOUT THIS SERIES

This course currently offers a series of weekly COVID 19 sessions focused on providing up-to-date, evidence-based, patient-focused clinical pearls that change day-to-day practice and to help participants adapt this knowledge to their local rural and remote contexts in primary care and hospital environments. For upcoming events and registration, see the University of Calgary Office of CME&PD main website.

Help us provide COVID-19 education, training and resources for health care professionals by donating to CME&PD.

Webinars

Managing Anxiety and Stress Virtually During COVID-19: Rural Patients and Practitioners

LEARNING OBJECTIVES
  • Address virtual support and consultation to patients with anxiety and stress during isolation in COVID 19
  • Apply strategies for managing healthcare providers mental wellness issues in the time of a pandemic
  • Identify resources available for rural healthcare practitioners for both patients and themselves
WEBINAR RECORDING
Presentation and Q&A

Handout

Q&A

Time Question
44:19 Do the heart math workshops need the app for heart math and the heart monitor
44:53 Are these resources available to non-albertans (the Covid workbook etc)?
45:49 The Amy Tan she recommends following is it Dr Amy Tan?

Comment: www.amytanmd.ucalgaryblogs.ca
46:42 Do you think that it would be better for patients to be trained how to make a balance in their hygienic practice to prevent obsessive regarding health safety in Covid pandemic?
48:32 What are your thoughts on Zoom security issues in the context of psychiatric practice?
55:53 What platform does Babylon use?

RESOURCES

Rural ER Patient Management and Disaster Planning

LEARNING OBJECTIVES
  • Apply the principles of disaster planning to develop and implement a disaster plan for your rural emergency department or health center
  • Apply different strategies managing adult and geriatric patients in rural ER during COVID 19 time
WEBINAR RECORDING
Presentation and Q&A

Handout

Q&A

Time Question
48:03 Are there any lessons learned from the two largest outbreaks in our province, both in rural towns from disaster planning or pandemic point of view that either of our speakers are aware of?
50:13 How often do you recommend to carry out dry runs for preparedness? What are you experiences until now?
51:32 Is the physician order sheet you mentioned in your presentation an AHS form? If so, can you please share the form number with us?

Comment: Form 100725
52:01 There is a sense that we are past the worst and preparing for disaster is probably not necessary, yet if we get a second wave, this may all become very necessary. Is there a concern about compliance from the public/patients if we do see a second wave? Will it become a logistical challenge: the non-compliant/disbelieving patient?

Rural ER Management in the Time of COVID-19

LEARNING OBJECTIVES
  • Identify an approach to COVID-19 preparation and management in a rural community.
  • Identify an approach to COVID-19 preparation and management in a remote community.
  • Describe an approach to mitigation of a COVID-19 outbreak in a rural community.
  • Articulate the role of virtual technologies in the COVID-19 era for rural and remote communities.
WEBINAR RECORDING
Presentation and Q&A

Handout

Q&A

Time Question
43:11 Have you considered Helmet based NIV?
45:34 Is ultrasound preferable to portable x rays in COVID 19 patients?Do we use ultrasound just to avoid more people ( from radiology)getting exposed?

Is CXR useless at early stages of Covid pneumonia,so why to do it at all?
47:16 We all observe potential vectors in our community, was the local medical professionals able to address infection control issues with Cargill before the outbreak? If so, how and where do you think improvements could have been made. If not, how do you think it could have been done?
49:23 Should these patients with COVID+ ,have a pulse oxymeter at home when being followed remotely ?
52:49 I see in one slide we used Zithromax? What is the rational?
53:51 Any case experiences on Happy Hypoxemic?
56:47 How did High River arrange isolation in multigenerational housing, did you use isolation centres or hotels?

Rural OBGYN Management in the Time of COVID-19

LEARNING OBJECTIVES
  • Effectively apply PPE for deliveries and keep practitioners and parents safe during deliveries
  • Manage and transport COVID positive/suspected patients for safe delivery to a regional hospital
  • Apply virtual care strategies to manage gynecology issues such as pelvic masses, lab work, etc, during COVID-19

 

WEBINAR RECORDING
Presentation and Q&A

Handout

Q&A

Time Question
36:17 How important is it to COMPLETELY segregate OB pts from CoVID patients-eg is it ok to house OB pts on the same physical floor, separated by a temporary partition with potential for airborne spread, possible use of same elevator for both, and possibly overlapping support staff?
37:51 Do you have any recommendations for pregnant health care workers, ie: working in ER covid vs. non covid patients; recommendation to go off in third trimester?
40:26 Rural doctors do the delivery and also neonatal rescuitation, which can be CPAP and AGMP. Should they be using N95 .AHS guidance is confusing
41:49 Assuming vertical transmission is not possible, what are the current recommendations on managing COVID discordant mother-baby patients postpartum?
42:55 Wash abdomen with what? Soap and water? or something stronger?
43:43 Are we recommending self-isolation for two weeks before booked sections?
44:44 What about repeat pap smear with ASCUS/LSIL etc? can we wait on those or should we repeat on time?
45:35 What is the recommendation for patients/couples who are interested in trying to get pregnant? Do you suggest waiting?
47:05 Should mom get a mask even if asymptomatic? Or only if symptoms? Are you only wearing full contact/droplet PPE for positive/probable COVID women in labour? And only masks if healthy?
48:54 Are the current COVID ideas/recommendations based on what we know about well-known respiratory illnesses and pregnancy (i.e. influenza and pregnancy)
50:08 Are we testing babes for COVID?
Comment (45:22) I believe the CFPC has published suggestions for prenatal schedule (altered schedule) @ https://www.cfp.ca/news/2020/03/25/3-24

RESOURCES

AHS COVID19 Podcast - Labour and Delivery with Dr. Colin Birch

Safe Intubation and Ventilation in the Time of COVID

LEARNING OBJECTIVES
  • Identify strategies to ensure safe intubation in very ill patients when resources are limited
  • Perform effective post intubation care to patients in rural areas in the time of COVID
  • Apply ventilation strategies in rural areas in the time of COVID

 

WEBINAR RECORDING
Presentation and Q&A

Handout

Q&A

Time Question
35:40 We do not have a vent at our site. Any suggestions on bagging the tubed patient while we wait for EMS/transport?
39:30 How long have these patients remained "happy Hypooxemic", and do they decompensate?
41:42 Good morning. Should we be treating any intubation as possible COVID, might be asymptomatic spreader? ie. If a trauma comes in, no history, can you use bvm to bag or should this be avoided until everyone in room in N95
44:54 Any change required to the dosing in RSI meds if the patient is hemodynamically unstable? (ie. “shock dose” meds) - or does that not apply to these patients?
48:37 What is the percentage of ICU staff that were positive COVID-19?
49:16 As the current recommendations call for delaying intubating the COVID patient (ie: having them self prone, Wiengart's Poor Man's CPAP using a NIV mask), do you recommend this same practice for the rural setting or should our threshold for intubation bve a lower?
53:09 Could you comment on secretions during intubation? Is this dealt with any differently? Heard that there is much more when trying to visualize chords than in non-COVID intubations
54:40 What are the recommendations on optiflow to temporize patients if transfer to a large center is delayed?
56:06 Did the intubation recommendation specify 4-8 0r 6-8ml/kg of ideal body weight vs. total body weight? Should be ideal body weight, sorry if I missed it.
59:13 Can you comment on EtCO2 values when bagging patients?

Alcohol and Substance Use in the Time of COVID-19

LEARNING OBJECTIVES
  • Apply virtual care strategies to care for patients with alcohol and substance use in the time of COVID in rural areas
  • Determine when face to face care or acute care is necessary for patients and take appropriate steps to refer
  • Determine what resources are available virtually for patient support and advice during COVID

 

WEBINAR RECORDING
Presentation

Handout

Q&A

Question Time
On one of your slides you mentioned that people taking stimulants are also at increased risk: does that include people on prescription stimulants (Concerta etc) ? 31:42
Are there online programs for family members to take the place of Al-Anon etc? 32:47
Can you comment more on the psychosis related to meth withdrawal. Very difficult to get Psych referrals in rural. 33:25
Is there a protocol you would suggest for the switch from methadone to buprenorphine. It can be tricky. 35:25
(For referenced slides see 53:37)
Verbal consent vs written consent from patients these days while starting withdrawal program? 37:45
Is there any talk of safe supply with the decrease in illicit supply? BC has sent out a document with suggestions form BCCSU 39:00
For supplying clients with “safe supply”: is this a cost the client will have to be responsible for or is there government financial support for prescriptions? 41:02
How is the daily dose delivered to a COVID+ patient? 41:50
Some psychologists will not see our clients with SUD until several months sober, even if psychosis, any words to relay when advocating for our clients in this situation? 43:02
Why we’re using clonazepam as the benzo of choice? 44:45
Why does the virtual buddy system check in every 2 minutes? 47:52
Can you explain differences between Landers and other programs? 48:53
At one point you mentioned 60 or even 90 day prescriptions for select patients. How do you determine who would be safe with that (low risk of diversion)? And pharmacies here are only dispensing 30 days at a time (for everyone) 50:20
Given the aim of long acting benzos is there are a reason you're not using Chlordiazepoxide (librium) instead of clonazepam given Chlordiazepoxide has a much longer half life including the active metabolites? 52:30

COVID-19: Rural Management Updates

LEARNING OBJECTIVES
  • Summarize the spread in rural communities and identify rural hotspots
  • Describe effective prevention methods and necessary preparation in rural communities for a potential outbreak
  • Advise patients on the implication of symptomatic, asymptomatic, transmission and management measures
  • Articulate management strategies for COVID-19 patients and non-COVID patients in rural communities with limited resource

 

WEBINAR RECORDING
Presentation and Q&A

Handouts

COVID-19 Rural Update

LEARNING OBJECTIVES
  • Describe AHS protocols for COVID-19 pandemic
  • Describe AHS treatment protocol or recommendation, and well as healthcare providers self-care including PPE
  • Recognize COVID-19 symptoms and differentiate it from other flu
  • Explain proper testing procedure
  • Advise patients on prevention practice

 

WEBINAR RECORDING
Presentation

Handout

Q&A