Regular (Outpatient) RMT

Fever – Infants 0-90 days

See guideline Fever less than 90 days

Fever of Unknown Origin

children <5 should be sent to SRC or Bethel for UA

Viral URI

supportive care w/ reevaluation in ~ 2 days or sooner if any concerns

Stomatitis

• tx options are magic mouth wash, aggressive hydration with a sippy cup or syringe, cold fluids, Tylenol, Motrin and frequent reassessment for dehydration
• to Bethel or SRC if significant concerns. Usually worsens over 3 days and then gradually improves.

Group A Strep pharyngitis

Children under 3 do not suffer the adverse sequelae of GAS so don’t test / treat

• Rapid strep may remain + for up to 1 month of tx
• consider GAS eradication w/ Clindamycin or Augmentin for carriers w/ recurrent symptoms
• see ENT referral guidelines for recurrent GAS (Jane, I have these and will bring them next time for inclusion as a link)

Acute Otitis Media

See peds OM guideline

• recheck ears in children only if not improving or worse
• see ENT guidelines for recurrent AOM / perforation for PE tubes and tympanoplasty are covered in the referral orders for these on RAVEN

Sinusitis

• see peds sinusitis YKHC Guideline (usually requires Pediatric consult)
• For adults try to avoid antibiotics for at least 2.5 weeks. Use routine supportive measures; the villages have nasal saline, Sudafed, and Benadryl.

Community Acquired Pneumonia (Peds) or (Adults)

• Use routine clinical judgment in deciding to tx or not (i.e. fever, productive cough, pleuritic pain, duration of sxs) remembering that there is a large number of patients w/ bronchiectasis from recurrent respiratory infection
• look at problem list and have a lower threshold of using antibiotics in someone w/ recurrent CAP.
• Adults—Doxycycline, Augmentin, and Ceftriaxone are all available in the village
• Peds—see peds guideline. If abnormal respiratory exam, see recommendations as above.
• REMEMBER, fever and dehydration can affect respiratory rate and O2 sat, so treat these before deciding on disposition

Boils/cellulitis

see Skin and Soft Tissue guideline

• REMEMBER I&D is 1st line tx→many CHAs will perform I&Ds
• No running water in many villages so suprainfection is a common complication of many skin conditions (bug bites, scabies, eczema)→MRSA colonization is common so need to cover for MRSA
• Provide bleach bath education for recurrent MRSA / multiple boils (available in Patient Education Custom Templates)

UTI (Peds) or (Adults)

See UTI guidelines in children

• Adults: request cx. Use best clinical judgment to decide on empiric antibiotic
• Pregnant and suspected pyelonephritis→to Bethel for evaluation

Viral Gastroenteritis

• routine instructions.
• Close follow up for evaluation of dehydration

Abdominal pain

if nothing about exam or vitals is concerning, try empiric GERD / constipation tx w/ careful warning signs and next day recheck vs commercial flight for evaluation if dx is unclear and clinical concern

STD checks

• CHAs have standing orders for labs and medications
• tx if clinical concern warrants it; or wait for studies

Lacerations

• Some CHAs are comfortable placing sutures
• Hair tying and steri strips are other options for wound closure

Pregnancy Test

• Start PNVs, calcium, and iron
• have CHA schedule 1st Prenatal appt

Medication Refills

If the health aide requests that a patient needs med refills please do the following.

1. Review the documentation in the past few visits, problems, and the past labs that have been done.
2. If the patient needs labs drawn- please select those from the Future Lab order folder- in the Regular Lab folder on your home page.
3. If you feel comfortable giving the patient the refills -then go to the Medication tab- place the cursor on the med you want to refill and right click. You will get a variety of options. You can select one month with 1- refills or 1 month with no refills if they need labs done
4. Sign orders
5. If they need a new med refilled- do not add it to the Village Powerplan. Go to the Blue plus sign on the left hand side of the orders screen and select it- then ideally pick the Med out of the Med order folders in your home page and complete the order in the usual fashion.

WCCs

• Review RMT closely to make sure all safety, developmental screening, anticipatory guidance, fluoride varnish and immunizations are updated
• Also check growth curves for HC, weight and length and make sure CHAs know do this as well.
• Referral to dental, optometry and peds should be made as necessary.

Pediatric Dental Pre-op Travel Clearance RMTs

• must be forwarded to CPP RMT

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