Alternate Common/Unique Diagnosis

Practicing Medicine in Bush Alaska—Some ABCs

Category:YKHC Guidelines

Emergency and Outpatient Departments

• Acute Myocardial Infarction
• Skin and Soft Tissue Infection
• UTI – Adult
• UTI – Children 3 Months–5 Years
• Seizures (Pediatric)
• Tuberculosis (Active and LTBI)
• Amoxicillin Allergy Trials

Emergency Department

• High-Flow Nasal Cannula
• Acute Ischemic Stroke
• Sepsis (Adult)
• Sepsis (Pediatric)
• Fever (0-90 days)
• Influenza
• Pneumonia (Adult)
• Procalcitonin (PCT) in Adult Lower Respiratory Tract Infections
• Pneumonia (Pediatric)
• Croup/Stridor
• Bronchiolitis/Wheezing
• Head Injury / Concussion Under 18 Years
• First Trimester Vaginal Bleeding
• Frostbite
• Burn Evaluation and Treatment
• Rabies
• Acetaminophen Overdose
• Alcohol Hangover/Withdrawal
• Title 47 Hold
• Botulism
• Fish Finger

Neonatal

• newborn Early-Onset Sepsis/GBS
• Neonatal Jaundice
• Neonatal Glucose Screening

Pediatric

• CPT1A Arctic Variant
• Congenital Adrenal Hyperplasia (CAH)
• Congenital Sucrase-Isomaltase Deficiency (CSID)
• Haemophilus influenza type a (Hia)
• Kuskokwim Syndrome (Arthrogryposis-like syndrome)
• Metachromatic Leukodystrophy (MLD)
• Micro-aspiration (in Apparently Neurologically Typical Children)
• Rickets and Vitamin D Deficiency
• Septo Optic Dysplasia
• Septic Joint

Obstetrics

• First Trimester Vaginal Bleeding
• Ectopic Pregnancy
• Preterm Labor
• Gestational Diabetes
• Group B Streptococcus (GBS) – Maternal
• Molar Pregnancy
• Anemia in Pregnancy
• Anti-D Immune Globulin
• Intrauterine Growth Restriction (IUGR)
• Oligohydramnios
• Intrahepatic Cholestatis of Pregnancy (IHCP)
• Chronic Hypertension in Pregnancy
• Gestational Hypertension
• Preterm Premature Rupture of Membranes
• Vaginal Birth After Cesarian

Outpatient

• Pharyngitis
• Peritonsillar Abscess
• Acute Cervical Lymphadenitis Evaluation & Treatment – Pediatrics
• Acute Otitis Media
• Sinusitis More Than 5 Years
• Chronic Cough/Bronchiectasis – Pediatrics
• Varicella
• Dyspepsia – H. Pylori
• Type 2 Diabetes
• Congestive Heart Failure
• Hypertension
• Osteoporosis Screening and Treatment
• Breast Cancer Screening
• Attention Deficit Hyperactivity Disorder in Children
• Blood Lead levels (Pediatric)
• Hepatitis B
• HLA-B27

Abdominal pain

• This is another very common reason for a visit to the ED. Most of our patients do not have access to fresh fruits and vegetables and reliable safe drinking water and therefore constipation is very common. The nursing staff has standard orders for triage for this problem. We do not have surgeons in Bethel (except for OB related issues) and so all appys need to travel to Anchorage if the surgeon wants to take out the appendix. They can often travel in on a commercial flight if they are stable. If unstable, or if pain can’t be controlled, they will need a medevac.

Injuries/Fractures

• Please send all x-rays with fractures diagnosed to ANMC orthopedic telerad. This is a paper form you must complete. That allows for non-urgent consultation to take place via the ambulatory clinic. If there is an urgent need, please call ANMC and speak to the on-call ortho doc. They can give you some advice over the phone and, during the day, look at your x-rays.
• If the patient is a trauma victim, call ANMC surgeon on call. They handle all calls related to trauma, even if the primary injury is orthopedic.

HLA-B27

This is frequent in this population with all of its associations (Reiters syndrome, Rheumatoid arthritis, and spondyloarthropathies are much more common here. We manage patients with rheumatic arthritis on Methotrexate with the assistance of ANMC specialist. Remember the labs that need to be done Q 1-2 months – kidney, liver, and blood count – CBC and Comp Chem.