Transcript - Donald Hudson Home

THE EXPANDED USE OF MEDICATIONS
(and who it affects)
Remote Sites
Patients
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Anchorage ER’s
by Don Hudson, D.O., FACEP/ACOEP
The expanded use of medications by the Remote
Site medical staff
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These rules will be pertinent only to
the medical staff supervised and
trained by Dr Hudson and Dr Dow
When in doubt as to what you
should do call Dr Hudson or Dr Dow.
The calls should be organized into
Emergent, Urgent and Routine.
These will be further defined later
Medication Use
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Because of the weather and other
factors beyond all of our control you
have medications on site that you
would not normally use. These are
to be used at the discretion of Dr
Dow &/or Dr Hudson only.
The next few slides explain about the various
medications you have on site
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Prescription Medication Guidelines
This document is to be used as a guide in the use of
common prescription medications. This is a living
document and subject to revision at the discretion of the
Medical sponsors.
Antibiotics:
Antibiotics are only to be utilized at the direction of the
physician for ill or septic patients. Any employee who
receives antibiotics must be re-evaluated at least with-in
24 hours of the first contact. Guidelines are to be
followed with common sense! All questions or
concerns are to be directed to the medical sponsors.
The Medical Director (s) or their designee must be
notified before starting any antibiotics. All patients who
receive antibiotics will be sent off site.
Distribution of meds
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You have PO and IV meds on site.
The IV meds will given only at the
discretion of the physician.
The patients are assumed to be
very sick, i.e. abscess, septic,
MRSA, suspected perforated bowel,
open fractures, etc. These are
patients who will be transferred to a
higher level of medical care.
Antibiotics
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AMOXICILLIN
Form: 500 mg capsules
Class: Semi-Synthetic form of Ampicillin (Penicillin group)
Dosing: 500 mg (3) three times daily for (7) seven to (10)
days
Uses: Upper Respiratory infections, severe dental infections,
sinus infections, Otitis Media.
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AZITHROMYCIN (Zithromax)
Form: 250 mg tablets
Class: Macrolide
Dosing: 500 mg on day one followed by 250 mg daily on days
2 through 5. This drug stays active in the system for 10 days.
Uses: Respiratory infections not responding to conservative
treatment (OTC meds), Otitis, Oral infections.
Antibiotics
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CEFAZOLIN (Ancef)
Form: 1 Gram vial
Class: Cephalosporin
Dosing: 1 Gram IV or IM every 6-8 hours
Uses: Trauma, complicated skin infections
ANY PERSON RECEIVING ANY IM OR IV INJECTION
MUST HAVE A MEDICAL SPONSOR CONSULTATION IN
ANTICIPATORY EVACUATION.
CEFTRIAXONE (Rocephin)
Form: 1 Gram vial
Class: Cephalosporin
Dosing: 1 Gram IM or IV every 24 hours.
Uses: Severe infections
ANY PERSON RECEIVING AN IM OR IV INJECTION
MUST HAVE A MEDICAL SPONSOR CONSULTATION AND
CONSIDERATION OF AN ANTICIPATORY EVACUATION
Antibiotics
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CEPHALEXIN (Keflex)
Form: 250 or 500 mg capsules
Class: Cephalosporin (first generation)
Dosing: 500 mg (4) four times daily. Length of course
varies by use.
Uses: Uncomplicated cellulitis, respiratory infections,
urinary tract infections, skin and oral infections.
CIPROFLOXIN (Cipro)
Form: 500 mg tablets
Class: Quinalones
Dosing: 500 mg (2) two times daily
Uses: Urinary tract infections, respiratory infections,
cellulitis of the feet, nail punctures through boots into
the feet, and gastrointestinal infections.
Cautions/Contraindications: DO NOT USE IN
PREGNANT PATIENTS
Antibiotics
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GENTAMYCIN OPHTHALMIC SOLUTION (Gentak
eye drops)
Form: 5-10 ml bottle
Class: Aminoglycoside
Dosing: 2 drops in the affected eye every (4) four
hours, while the patient is awake, for the first (2) two
days then (4) four times daily for the next (4) four
days.
Uses: Simple conjunctivitis.
PENICILLIN (Pen VK)
Form: 500 mg tablets
Class: Penicillin
Dosing: 500 mg (4) four times daily
Uses: Exudative pharyngitis (strep throat), oral
infections, rarely used for respiratory infections.
Antibiotics
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SILVER SULFADIAZINE (Silvadene)
Form: Cream
Class: Sulfa
Dosing: Varies by use, usually refresh with each
dressing change
Uses: First and second degree burns, wound care
treatments, rarely open blisters from frostbite injuries.
TRIMETHAPRIM/SULFAMEFOXAZOLE (Bactrim,
Septra)
Form: DS tablets
Class: Sulfa
Dosing: (1) one tablet (2) two times daily
Uses: Uncomplicated urinary tract infections. Simple
boils, cellulitis, respiratory infections, MRSA
Cautions/Contraindications: It will increase sun
sensitivity, DO NOT USE WITH PREGNANT
PATIENTS
Anti-Emetics
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DROPERIDOL (Inapsine)
Form: 5 mg/ 2 ml vial
Class: Phenothiazine
Dosing: Varies by use. IV administration is in 0.625 mg
increments (0.25 cc). IM administration is in 2.5 to 5.0 mg
doses
Uses: Vomiting, intractable nausea. May use for psychiatric
crisis. Always administer Diphenhydramine (Benadryl) with
the Doperidol to prevent dystonia.
Cautions/Contraindications: The drug will cause sedation; it
may cause dystonia which can be counteracted with
Diphenhydramine (Benadryl)
PROMETHAZINE (Phenergan)
Form: 25 or 50 mg suppository
Class: Phenothiazines
Dosing: 25 to 50 mg rectally every (6) six to (8) eight hours
for nausea and/or vomiting
Uses: Persistent nausea or vomiting because of pregnancy or
infection
Cautions/Contraindications: It may cause sedation and
infrequently may cause dystonia
Pain Medicines
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HYDROCODONE/APAP (Tylox, Vicodin)
Form: 5 mg Hydrocodxone + 500 mg Tylenol tablets
Class: Narcotic pain medicine
Dosing: (1-2) one to two tablets every (4) four to (6) six
hours for relief of pain
Uses: Moderate pain not relieved with Tylenol or antiinflammatory medications. Patient will be transported after
use of the medication.
Caution/Contraindication: Sedating
LIDOCAINE VISCOUS (Xylocaine)
Form: Viscous 4% solution
Class: Topical Local Anesthetic
Dosing: Varies with use. May mix with (20) twenty ml of
Maalox for relief of gastritis, may use as a topical pain
controller on a mucous membrane not to exceed (6) six
times daily, oral use not to exceed (2) two doses.
Cautions/Contraindications: Lidocaine toxicity is possible
through the mucous membranes, do not provide your
patient with more than (20) twenty cc of the solution
Pain medicines
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METHOCARBAMOL (Robaxin)
Form: 750 mg tablets
Class: Muscle Relaxant
Dosing: (1) one tablet (3) three times daily for up to
(5) five days
Uses: Mild to moderate muscle spasm
Cautions: Mildly sedation
PHENAZOPYRIDINE (Pyridium)
Form: 200 mg tablets
Class: Pain relievers for urinary tract
Uses: for relief of urinary tract pain and discomfort
Cautions/Contraindications: The medicine will turn all
secretions dark yellow or orange. WARN THE PATIENT!
It may stain skin or clothing on contact. DO NOT USE
IN PREGNANT PATIENTS.
Pain Medicines
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TETRACAINE EYE DROPS
Form: 15 cc bottle
Class: Topical anesthetic
Dosing: (1) one or (2) drops in the effected eye
(1) one time only.
Uses: Facilitation of eye exam.
Cautions/Contraindications: Do not use more
than once or at maximum twice during an
exam. DO NOT SEND HOME WITH THE
PATIENT BECAUSE IT CAN CAUSE
CORNEAL ULCERS WITH FREQUENT USE.
Steroids
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PREDNISONE
Form: 20 mg tablets
Class: Steroids
Dosing: Varies depending on use.
Uses: Respiratory illness (asthma, allergy) and
anti-inflammatory response. Call the medical
sponsor for dosing. You may always give (40)
forty to (60) sixty mg dose if contact not
possible.
Cautions/Contraindications: Patients requiring
steroids should be considered for evacuation.
When do you call for advice
&
who do you call
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Dr Dow and I expect you to use
common sense about your calls.
Before you call you should gather
enough information and be prepared to
answer a number of questions.
Make sure you have AMPLE information,
allergies, medications, past medical
history, last meal, any pertinent events
occurring before coming to see you.
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Be prepared for answering the
following:
Chief complaint
History of chief complaint, when,
where, has it ever happened before,
what makes it better or worse.
What have you done including a full
set of vital signs
What is your impression of the
problem
What do you want, transport,
medications, etc. that we can help you
with.
Definitions of urgency of calls
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Emergent- These patients obviously need to
go off site for further care. These are the
patients normally sent to the ER
These include patients with open Fx, chest
pains, abnormal EKG, shortness of breath with
low sats., unstable vital signs, altered mental
status, seizures, unconsciousness, active
bleeders difficult to control with pressure and
amputations.
This also includes other disease process that
need to get off site.
Emergent Calls
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These calls are usually directly to the
ER
These are patients who are being
transferred to the ER
You are asking for an accepting
physician before you sent them in
You may ask for directions; “is there
any thing else you want done before
they get to you?”
Urgent Calls
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These are more difficult to define. These
are the sick patients but with stable vital
signs who have in your opinion the
potential of getting sicker with out some
intervention.
The may include dehydration, continuing
diarrhea, alcohol withdrawal, Urinary
tract infections (+UA test strip), strep
throat (+strep screen)
Other sick patients as assessed by you
Urgent Calls
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These are calls that need to be
directed to Dr Dow or Dr Hudson
Call them several ways by cell,
home & the ER if Dr Dow is working
in the ER.
The universal # is 907-343-0333 to
reach the on-call doc.
The COMMON Phone # for the
ON-CALL DOC
343-0333
Phone numbers
Dr Hudson Hm 1-907-337-7990
Cell 1-907-748-7952
Fax 1907-333-3262
e-mail [email protected]
 Dr. Jennifer Dow
Hm 1-907-783-0186
Cell 1-907-227-2375
e-mail [email protected]
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Routine Calls
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These are the patients who would wait
until the next office appointment at their
doctors office.
They need a trial of OTC medications
They have normal vital signs and
essentially a normal examination
These patients, in your opinion, will not
get noticeably sicker in the next 24-48
hours
These patients are ones you call about
care Mon.-Fri. 9 am to 12noon
Calls
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It is a known fact that patients will
sometimes get sicker when you least
expect it. Any patient you consider
routine you should contact in the next 24
hours as well as advising them to return
to the clinic IF anything seems
worsening
Re-evaluation may cause you to reconsider their status. Respond
accordingly.
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All patients who are transferred
urgently I want a faxed or e-mailed
copy or the patient encounter as
soon as reasonably possible.
Send this to 1-907-333-3262
See the next page for responsible
actions for sick, deceased, or
transferred patients.
Medics Responsibilities
Medic
Responsibilities
Calls
Emergent
Follow up with patient
Urgent
Good records
Routine
Call the ER
Call Dr Dow or Dr Hudson
Medivac or transfer
Call Mon –Fri 9 am -12 am
E-mail copy or fax a copy of the
Report to Dr Dow & Dr Hudson
After contact
E-mail copy or fax of note to both
Dr Hudson & Dr Dow after
transfer
Fax copy of patient contacts
To Dr Hudson weekly
Why do all of this?
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Dr Dow & I are ultimately
responsible for you actions and the
effect they may have on the
patient.
We want to be sure you get enough
information to do your job and at
the same time assure the patient is
getting the best care we can
collectively can offer.
When in doubt
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Treat every patient as if they were a
member of your family.
Always consider several options
concerning the patients complaints
Always be a patient advocate and
believe their complaints. The
complaint may sometimes really be
about something else.
Listen carefully
If still in doubt
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is why you have
medical back up.
Call us.