Critical Care Nurse Practitioner Lake Wales, Florida, United States
Disclosure(s):
Jennifer M. Steele, DNP, APRN, ACNP-BC, CPHQ: No financial relationships to disclose
Background: A community hospital uses a hybrid telehealth model pairing onsite APPs with centralized virtual physicians to provide continuous critical care coverage. This integration ensures uninterrupted monitoring, rapid decision-making, timely interventions, and specialist guidance across the healthcare system, improving responsiveness and outcomes regardless of time or location.
Methods: A 47-year-old man presented after heavy alcohol use with severe abdominal pain, nausea, and vomiting. Initial evaluation identified severe acute interstitial pancreatitis, a focal pancreatic tail lesion favoring a pseudocyst, and hepatic steatosis. Management included aggressive IV fluid resuscitation, broad‑spectrum antibiotics, electrolyte repletion, and close hemodynamic and laboratory monitoring. Respiratory support escalated from nasal cannula to noninvasive ventilation and then endotracheal intubation for refractory hypoxemia and hypercapnia. He was transferred to higher‑level centers for ARDS management and ultimately venovenous ECMO.
Outcome: During the course he developed acute kidney injury with hyperkalemia and worsening metabolic acidosis and progressed to acute hypoxemic and hypercapnic respiratory failure requiring high ventilator settings. A tracheostomy and PEG tube were placed for prolonged ventilatory support and enteral nutrition. After stabilization, rehabilitation with physical and respiratory therapy occurred; he was repatriated to the original facility and successfully discharged home.
Conclusion: Telehealth extends critical care to rural hospitals, standardizing protocols, accelerating decisions, and reducing transfers. Remote specialists enable early recognition of life‑threatening conditions—especially cardiogenic shock—facilitating rapid stabilization and timely referral for advanced therapies (mechanical circulatory support, ECMO, transplant), narrowing disparities and improving outcomes.
