RO­BOT TO THE RES­CUE

PressReader - LStep Channel - RO­BOT TO THE RES­CUE
On a chilly af­ter­noon at the end of Novem­ber, Quentel Merasty was at home in the north­ern com­mu­nity of Pel­i­can Nar­rows when she re­al­ized her four-month old son, Guentzel, was hav­ing a seizure.Pel­i­can Nar­rows, pop­u­la­tion 2,000, is more than an hour’s drive from the near­est hospi­tal in Flin Flon, on the Saskatchewan-man­i­toba bor­der. The near­est airstrip to mede­vac some­one out of the com­mu­nity is a bumpy 45-minute drive away, in Sandy Bay.The Pel­i­can Nar­rows nurs­ing sta­tion is served by fly-in doc­tors on one- or two-week ro­ta­tions. Some days there are no physi­cians in the com­mu­nity.Nov. 19 — when Quentel rushed in with her seiz­ing in­fant — was one of those days. Quentel Merasty, mother of Guentzel Merasty: He started twitch­ing his one hand and then we called an am­bu­lance right away. The am­bu­lance took long and then we got a ride there. He was still twitch­ing. La­toya Pat­ter­son, a nurse prac­ti­tioner at the Pel­i­can Nar­rows nurs­ing sta­tion: On pre­sen­ta­tion he was com­pletely ashen, so his colour was very poor. He was un­re­spon­sive. And all his limbs were twitch­ing … I knew that there were cir­cu­la­tion is­sues and, be­cause he was hav­ing gen­er­al­ized twitch­ing at four months old, that was a seizure sit­u­a­tion. Ivar Men­dez, Uni­fied Head of the Depart­ment of Surgery at the Univer­sity of Saskatchewan: There is ac­tu­ally a rat­ing scale of how ur­gent a case is; we score pa­tients from one to four. So when you are a score of one that means that your life is threat­ened … If you don’t have the ap­pro­pri­ate care, you either will die or have a per­ma­nent in­jury … This was a No. 1.Pat­ter­son: It was a nor­mally healthy child who was all of a sud­den hav­ing seizures and mom said it was go­ing on for the five min­utes be­fore she got here and usu­ally a seizure over two min­utes is con­cern­ing. So a sit­u­a­tion like that, you start wor­ry­ing about the brain, you start wor­ry­ing about his wel­fare and his abil­ity to ac­tu­ally live. And so it was what we call a re­sus­ci­ta­tion sit­u­a­tion, which is why I called for help.In 2014, Pel­i­can Nar­rows be­came the first site in Canada to of­fer health-care ser­vices through re­mote pres­ence tech­nol­ogy. There is a ro­bot at the nurs­ing sta­tion and when staff re­quire ex­pert help, they phone a spe­cial­ist physi­cian in Saska­toon, more than 500 kilo­me­tres away. The spe­cial­ist logs onto a com­puter sys­tem, re­motely drives the ro­bot to the emer­gency room, ob­serves what is hap­pen­ing and speaks through the ro­bot to ad­vise nurs­ing staff on how to pro­ceed.There are now 12 com­mu­ni­ties in north­ern Saskatchewan equipped with re­mote pres­ence tech­nol­ogy. Physi­cians in Saska­toon re­spond to two or three re­mote calls a week.Tanya Holt, head of Saskatchewan’s Pe­di­atric In­ten­sive CareUnit: We’ve de­vel­oped a ro­bot call sched­ule so I was on-call for re­mote pres­ence and I got a call from Pel­i­can Nar­rows. One of the nurse prac­ti­tion­ers had a very sick baby that had been brought in and they were alarmed by how ill the child was and phoned and asked me to see the pa­tient im­me­di­ately and so I logged on to my lap­top, which was at my desk, and I was there within min­utes to sup­port their team.Pat­ter­son: Of­ten (the sys­tem) will ask for de­mo­graphic in­for­ma­tion, who’s this per­son, what’s their regis­tra­tion num­ber, how old are they, what are their symp­toms. In a sit­u­a­tion like that, I just told them that this was a code and I needed help right now. So it took maybe about two min­utes for her to be avail­able.Holt: The ro­bot is docked some­where else and I au­tonomously drive to the emer­gency lo­ca­tion in the Pel­i­can Nar­rows clinic and then I see the en­tire team sur­round­ing the bed of this crit­i­cally ill baby … Ba­bies are usu­ally awake. The baby was un­con­scious. And ba­bies usu­ally don’t work hard to breathe and the baby was work­ing very hard to breathe and I could see that im­me­di­ately … The baby was ac­tu­ally ac­tively hav­ing a seizure and I could also see that im­me­di­ately.The nor­mal heart rate for a four­month-old is be­tween 100 and 110 beats per minute. Holt could see on the heart rate mon­i­tor that Guentzel’s heart was beat­ing at 207 beats per minute.Holt: The very first thing you need to in­ter­vene with a crit­i­cally ill baby is to rec­og­nize the ur­gency of the sit­u­a­tion and vi­tal signs help that a lot. The child was on a mon­i­tor and I was able to as­sess his vi­tal signs and de­ter­mine whether they were ab­nor­mal or nor­mal and they were cer­tainly ab­nor­mal … The very ob­jec­tive find­ing in the vi­tal signs that told you that this baby was in a life-threat­en­ing sit­u­a­tion was the heart rate. That heart rate tells you that he’s in shock and, what we know about shock and liv­ing in re­mote com­mu­ni­ties, is that if you re­verse shock within 75 min­utes, there’s a 96 per cent chance of sur­vival in ba­bies. But with every hour that passes that you don’t re­verse shock, there’s a two-fold in­crease in mor­tal­ity. So time­li­ness in treat­ing shock can­not be un­der­stated.Merasty: I was so scared. I was so scared that I would lose my baby. But I prayed and prayed and told the nurses, ‘Please help my baby,’ and they told me ‘We’re try­ing, we’re try­ing our best, don’t cry Quentel.’ So I’m hold­ing his hand and telling him ‘Baby, wake up, I still need you.’Holt: When a baby is seizur­ing, that can be dan­ger­ous for the brain and their over­all out­come so we needed to get that seizure stopped and so that was the No. 1 thing on my list and then the best way to do that is to use a med­i­ca­tion to stop the seizure and there’s sev­eral that we have on our list and if they don’t work then we move on to the next.Even­tu­ally the med­i­ca­tion worked and the seizures stopped, but Guentzel was still un­con­scious.Holt: We rec­og­nized that the baby essen­tially was in shock and our work­ing di­ag­no­sis at that point was the baby had sep­tic shock. Sep­tic shock is a fancy term for a se­vere in­fec­tion that’s putting the child in a life-threat­en­ing sit­u­a­tion be­cause of low blood pres­sure and we call it per­fu­sion so, at that point then, we have the seizures stopped, we con­tinue to mon­i­tor the neu­ro­logic sta­tus and we give flu­ids, we give sup­port with med­i­ca­tions for the heart.Merasty: All the nurses, they’re all on him, there’s stuff on him.Un­der Holt’s guid­ance, nurses and nurse prac­ti­tion­ers in Pel­i­can Nar­rows used in­tra­venous lines to ad­min­is­ter med­i­ca­tions, flu­ids and an­tibi­otics.Roughly 30 min­utes af­ter Guentzel was brought into the hospi­tal, he be­gan to wake up.Holt: We started to see the baby be­gin to rouse and this, of course, for the team is the most amaz­ing feel­ing be­cause they have this baby that presents un­con­scious, seizur­ing, in shock, and, all of a sud­den, the baby’s start­ing to wake up and do nor­mal baby things like look around and make nor­mal baby noises and move ap­pro­pri­ately and th­ese are things that, then, the team starts to feel re­as­sured and calm down and the en­tire room starts to set­tle and then we re­group and we get an­other set of vi­tal signs.Pat­ter­son: It’s a re­lief, right? Be­cause now you’re not won­der­ing if he’s go­ing to pass away or not, won­der­ing if you’re go­ing to lose him. You can ac­tu­ally see a re­sponse and see that we in­ter­vened quickly and well.Merasty: I was so happy when they told me that he was go­ing to be OK.Guentzel was still not out of the woods. As soon as Holt saw the ashen, seiz­ing in­fant on her lap­top screen she knew he would need fur­ther in­ten­sive treat­ment that wasn’t avail­able in Pel­i­can Nar­rows. While she was work­ing with the nurses re­motely, she dis­patched a pe­di­atric crit­i­cal-care trans­port team to pick up Guentzel and bring him to the in­ten­sive-care unit at Royal Univer­sity Hospi­tal in Saska­toon. She stayed con­nected with staff in Pel­i­can Nar­rows while the team was en route, mak­ing sure the baby re­mained in sta­ble con­di­tion.Men­dez: The run­way in Pel­i­can Nar­rows is not func­tional. When we go to Pel­i­can Nar­rows we have to land in Sandy Bay, which is about a half-hour away.Holt: This time they took a fixed wing plane to La Ronge and a Twin Ot­ter into Pel­i­can Nar­rows and then they Twin-ot­tered back to La Ronge and fix-winged back to Saska­toon.Men­dez: It took two and a half hours to get there with Tanya im­me­di­ately mo­bi­liz­ing it, so if she hadn’t been there, it could have taken four hours.Guentzel spent less than a week in ICU be­fore be­ing dis­charged. He is now back home in Pel­i­can Nar­rows and does not ap­pear to have suf­fered any ad­verse ef­fects from his seizures. Holt be­lieves the shock was caused by a bac­te­rial in­fec­tion.Merasty: He’s bet­ter. He smiles. He gig­gles. It’s not clear what Guentzel’s out­come would have been if Holt hadn’t been able to re­motely as­sist in his re­sus­ci­ta­tion via the ro­bot.Holt: Over the last four years, since we’ve been us­ing this tech­nol­ogy, what’s struck me is how present I feel as a part of the team there and that, out­side of be­ing able to feel the baby my­self, I feel like I’m there and help­ing ma­noeu­vre care and sup­port the team … I’m a lot more ag­gres­sive with ther­apy when I’m there in per­son … I can’t say for sure (what would have hap­pened with­out this tech­nol­ogy), but what I do know is that he was in a life-threat­en­ing sit­u­a­tion there and we were able to get him quite sta­ble within 30 min­utes to an hour.I think the more im­por­tant ques­tion is: What would his out­come have been?He may have sur­vived, but would there have been any mor­bid­ity? And mor­bid­ity means: Would there have been a de­crease in func­tion long-term? And that’s what we gen­er­ally see is that if they sur­vive the im­pact of a pe­riod of time where care hasn’t been op­ti­mized it can lead to kind of sub­se­quent dys­func­tions in the fu­ture. Now, what we saw is this lit­tle baby who was thriv­ing essen­tially and this is a mom away from a crit­i­cal sce­nario.Men­dez: What you’re see­ing here, is — I think — a win­dow into what the fu­ture would look like. We need to go where the pa­tient is. We need to go in real time.The pa­tients that need ex­pert care should ac­tu­ally be able to get it in real time. And that’s where tech­nol­ogy’s go­ing.I was so scared. I was so scared that I would lose my baby. But I prayed and prayed and told the nurses, ‘Please help my baby.’

When the call came in from Pel­i­can Nar­rows that a four-month-old baby was hav­ing a life-threat­en­ing seizure, Tanya Holt, a pe­di­atric crit­i­cal-care doc­tor at the Health Sci­ences Depart­ment of Surgery in Saska­toon, sprang into ac­tion. Us­ing a re­mote-con­trolled ro­bot, she was able to help a team of nurses sta­bi­lize the pa­tient for trans­port.

Dr. Tanya Holt speaks through a com­puter and re­mote ro­bot to Quentel Merasty, her in­fant son, Guentzel, and Nurse Prac­ti­tioner La­toya Pat­ter­son in Pel­i­can Nar­rows hospi­tal.

© PressReader. All rights reserved.