Regular (Outpatient) RMT
- 1 Fever - Infants 0-90 days
- 2 FUO
- 3 Viral URI
- 4 Stomatitis
- 5 Group A Strep pharyngitis
- 6 AOM
- 7 Sinusitis
- 8 Community Acquired Pneumonia
- 9 Boils/cellulitis
- 10 UTI
- 11 Viral Gastroenteritis
- 12 Abdominal pain
- 13 STD checks
- 14 Lacerations
- 15 Pregnancy Test
- 16 Medication Refills
- 17 Prenatals
- 18 WCCs
- 19 Pediatric Dental Pre-op Travel Clearance RMTs
Fever - Infants 0-90 days
See guideline Fever less than 90 days
children <5 should be sent to SRC or Bethel for UA
supportive care w/ reevaluation in ~ 2 days or sooner if any concerns
- 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)
- 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
- 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
- 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
- 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)
- Adults: request cx. Use best clinical judgment to decide on empiric antibiotic
- Pregnant and suspected pyelonephritis→to Bethel for evaluation
- routine instructions.
- Close follow up for evaluation of dehydration
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
- CHAs have standing orders for labs and medications
- tx if clinical concern warrants it; or wait for studies
- Some CHAs are comfortable placing sutures
- Hair tying and steri strips are other options for wound closure
- Start PNVs, calcium, and iron
- have CHA schedule 1st Prenatal appt
If the health aide requests that a patient needs med refills please do the following.
- Review the documentation in the past few visits, problems, and the past labs that have been done.
- If the patient needs labs drawn- please select those from the Future Lab order folder- in the Regular Lab folder on your home page.
- 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
- Sign orders
- 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.
- 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