A

ABREVIATIONS:

SPM: STATE PRACTICE MANGERS
CPM: CLINICAL PRACTICE MANAGER

ACLS:
- Vtach and V - fib - Dfib, or synch cardiovert, Amniodarone firts time 300 mg, second time 150 mg
- Pulseless electrical activity - normal electrical activity - but no pusle: TX compression and epi, 1 Liter Fluids if decreased volume, consider potasium low or high and treat it known, consider Acidotic - treat if acidotic with sodium bicarb

Acne: acutane (Absorica)
Sprionlactone
Ortho tri, ortho cyclen, Enskyce, Yasmin)

Acutes Cornary Syndrome
- for year after stent need aspirin aand clpidgrel (300 - 600 mg)
- Prasugrel 70 mng
- Ticagrelor 60- 90 mg can also be considered

- usually Atorvastatin 80 mg daily
- Or Rosuvastin (Crestor) 20 mg
- usually bebablocker - after 24 hours (during first 24 hours may not want to slow down or decrease heart pressure)
- usually ACE inhibitior irrgardless of BP

- above meds usually for at least one year

Antibiotics to use:

Cellulitis (cause strep pyogenes (GAS) or Stphylococcus Aureus
- Augmentin
_ Cephalexin
- clindamycin
- Doxycycline
- Bactro,m
Impetigo - (Cause: Staphylococcus Aureus)
- Mupirocin
- Augmentin
- Cephalexin
- Bactrim

Acute Otitis Media (Cause Streptococcus Pnemonia, Haemophilus Influenza, Moraxella catarrhalits)
- Amoxicillin
- Azithromycin (probably 500 mg q day x 3 days)
- Augmentinc (if resistant or suspected resistant: bilateral conjunctivitis and bilateral otitis media)

Phayrngitis (strep, Mycoplasm Pneumonia, Chlamydia Pneumonia, Nisseria gonorrhea, cornebacterium deiphtheria
- Penicillin VK
- Amoxicillin
- Azithromycin - Z-pal
- Clindamycin
- Cephalexin

Acute Bacteiral Sinusitis ( Strep Pneumonia (normal flora), Haemophilus influenza (noraml floar in children <2, and Moraxella catrrahalis, which is NEVER normal flora and must be treated Augmentin or Clarythromycin ( I think)
- Amoxicillin
- Augmentin
- Doxycyline
- Levofloxacin
Pneumonia (community Acquired)- CAUSES:
TYPICAL CAUSES:
- strep pneumoina
- Haemophilus Influenza
- MOraxella catarrhalie
- Staphylococcus Ausreus
- Streptococcus Pysogenes
Atypical organism:
- chlamydia pneumoina
- Legionella
- M. Pneumonia (Atypical)
Adult (Low Risks) Treatments: (Typical)
- Azithromycin
- Doxycycline
Adult (High Risk)
- Augmentin
- Levofloxacin
Children treatement:
- Amoxicillin
- Augmentin
- Clindamycin
- Doxycycline (if greater than 7 years)CAUSES: Ecoli, Proteus Mirabili
- Azithromycin (for Atipical)

Cystitis: CAUSES: E-coli, Proteus Mirabilis (can treat with Amoxicillin and Keflex), Pseudomonas, Klebielaa pneumonia, Enterobacter specied, Candida Species
- Macrobid (dont give if positive for Nitrites)
- Bactrim - give if positive for Nitrites
- Cipro - 2nd line - if positive for Nitrites -
- Levofloxacin
- Cephalexin - (3rd line) (if positive for Nitrates)
- Add Fosfomycin 3 gram once for women (must have creatine clearance greater than 60)
- for men with UTI: Fosfomycin 3 gm every 2-3 days for 3 doses (must have creatine clearance greater than 60)
- Dissovle acket in in 3-4 ounces of water

- lactobacillus might help - Allign (bifidus-gut) or Florastor (lacobacillus and bifidus (gut))
Otitis Externa (Psudemdomonas aeraginosa and Staphylococcus Aureus--or Fungal)
- for fungal use - RX clotimaxole 1% drops
- if perforation use Ciprodex -
- by mouth - keflex
- by mouth - amoxicillin
- Flouroquinolones (but be careful of side effects)


B

BLS: Bsic life Support

For choking: 4 back blows or slaps - 4 chest compressions

Peiatric: CPR: one persion is 30 compression to 2 respirations

Pediatric: CPR: Two person infant 15 compression to 2 respiration--for pediatric patient under 8 years of age

ADULT: CPR: Two persson 30 compression to 2 respiration

C

Collaboration Meeting:
Every Wednesday Night at 8 PM
1. call (712) 770 - 4010
2. Access code 732722
3. Host 1498

 

Controls Monthly:
- hba1c
- hc urine pregnancy
- urinalysi
- BD veritor device testing - flu testing???
- (not certin about urine microablcuimn)

CME events
1. April 28,29,30 Anaheim Primed TOTAL: CME 14.66 -- PHARMACY 2.570
2. ACLS MAY 20 PASADENA 7 CEU
2. June 14 LB Long Beach Primed
3. Long Beach Nov 9,10,11,12 ER/URGENT CARE

Consent to treat Minors: get it under 18 years; 16 years and older can be seen without parent but still need a chaperone, store or Contrceptives:
-
responsible adult who is 18 or more or a chaperone must be present with a minor
- a minor can no use their parents Credit Card - they must bpay in cash

Contraceptive: Birth Control
Monophasic: Apri, Enskyce, yasmin (3rd generation, Beyaz
Biphasic: kariva, necon 10/11
Triphasic: may decreased Side effects (but probably not), ortho tricycle, otho tri8 Lo, Otho Novum 7/7/7, Estrstep, most "Tro"
- Srintec may be the cheapest one st about $8 per month

BREAST FEEDING PATIENT AND PREVIOUS CANCER PATIENTS: may want mini pill or prgesterone alone, THESE MAY INCREASE THE RISK OF BLOOD CLOTS
Examples of mini pills: Camila, Jolivette, Orth Mirconor - norethrindone

Contraception: BE CAREFUL, there

Contraindications: Prgenant, over 35 and smoking, previous DVT or PE, BReast CA

They all work approximately the same. The price may vary a lot. Sprintec (I think is also tricyclen lo is only about $8.00)--so will often be my first choice

Mini Pill = progesterone only (Camila, Jolivette) - Mini pill is not as effective during Breast Feeding

MINI PILL: MICRONOR-NORETHRINDRONE

Ortho tri, ortho cyclen, Enskyce, Yasmin)
If Sptting: try higher dose estrogen/ or higher dose progesterone, or lower androgen (Ortho Cept, Yasmin, Estrostep PE)
If depsression: lower progestin (orth tri, Ovcon 35, Triphasil, Trivora)
If Endometriosis: lower estrogen, higher progesterone, higher androgen (Levora, loestrin, loOvral) can skip placebo or just 4 of placebo

If headache this it menstrual related/ no menstrual: low estrogen/ lower progesting: Aless, necon, Orth Cuyclen, Ortho Tri

Moodiness/irritability: lower progestin: Alesse, loestrin 1/20 fe, Yasmin, Yaz, Beyaz

Menstrual crams;: higher progestin: Desogen, Enskyce, yasim, Ortho Cept

Weight gain: lower estrogen, lower progestin (Alesse, Loestrin 1/20 fe, yasmin, Yaz, Beyaz)

Nuva Rgin (Etongestrel (3rd generation and ethinyl estradiol

Transdermermal-ortho Evra (Don use if greater than 198 pounds)
Norelgestromin and ethinyl estradiol

IUD: short term Mirena, Liletta, and Skyla ( all cvontain progesterone)

Paragard is made of copper and can last for 10 years

Implant/subdermal: nexplan - 3 years, etonogestrel

3 month RX - Sesonique or seaonal


D

DEA renewal:

http://www.deadiversion.usdoj.gov/schedules/organgebook/c cs alpha.pdf

DOT
for question write to: DOTCoach@minuteclinic.com
*REMEBER to MONTHlY complete a form on the FMCSA weib site:
*You can also find a new DOT form and certificate there.

*To find more information about DOT EXAM you can also look on the INTRANET, SPECIAL OFFERS, DOT, Training Tools and TIPS
*Supposedly, NP are now able to imput there own information to FMSCA
* New form: FMSCA 5875 http://www.oswegohealth.org/media/1479/fmcsa-medical-exam.pdf

* CERTIFICATE: CERTIFICATE https://www.fmcsa.dot.gov/sites/fmcsa.dot.gov/files/docs/Medical-Examiners-Certificate-%28MEC%29-Form-MCSA-5876.pdf
* Dont do the physical in EPIC
* Do Scan The H&P into Epic
* do not say whether ther person till the end
* once started the patient will be charged the complete fee
* If follow up is needed it is best to have the same NP; give them the 866 389 2727 number to help determine the day the NP is working
* Dont give the Driver whole H&P unless he request it
*
There is a SPECIFIC MINUTE CLINIC FOLLOW UP SHEET--that needed to Printed--filled out, scanned and then given to the driver

E

Expiration: See Month-End-Inventory

F

Flu
- only 65 years are old get high doses - probably more for 75 years and older
- Probably 65-75 years are best getting quadrivalent
- hihg dose is 25% more effective for 75 years and older
- new rapid flu test 99% accurate

G

GEHA program: 1/1/16 - 12/31/16
- must ahve voucher
- price will be $49
- click "visit info"
-. chief complaitn sport or camp
- special offer: 1016 GEHA sports physical discount or camp "
- scan a nd keep vouch and submit a the end of the day

H.

 

Hand Injuries:

Ulner Nerve effects 1.5 fingers of 4th and 5th fingers
Medial Nerve effects 3.75 PALNAR (or volar) fingers 1st, 2nd, 3rd, 4th, and distal DORSAL (TOP) finger tips of 2nd and 3rd fingers

-Snuff Box Pain with pressure indicates scaffoid fracture.
-Lister tubercle: dorsal wrist, a high point at the distal part of the radial bone. If there is pain here it may indicate a colles fracture or scafoid lunate ligament tear. Colles fracture is a fruacture about 1.5 inch from the end of the radius.
-Lister tubercle pain: may also occure if there is Scafoid -Lunate ligament tear: this is small but very important ligment that hold the scafoid bone and lunate bone together- if this is torn the bones can become diplaced. There may also be pain when the person squeezes there hand. (It requires an MRI to see)
- Distal Ulnar Pain - may mean fracture to the distal ulnar bone
- Distal Ulnar Pain - may also mean: ECU Extensive Carpi TENDENITIS or TFCC Triangular Fibrocartilage Complex ( a mixture of cartilage and small ligaments on at teh Distal Ulnar area.

Test:
- Two point discrimination two determine if nerves are intact
- Medial nerve damage:
- Tinnel Test - tap hard between THENAR and HYPOTHENAR region--not between the ulnar and radial region to see if induces numbness and tingling
- Dirkin Test- press hard for about 20 second between THENAR and HYPOTHENAR region to see if induces numbness and tingling

- Phalyn's test - Plamar flex
- Is there Thenar waiting - usually occurs from carpal tunnel syndrome

History:
- ask about night pain: this is caused by a reduced blood pressure and therefore decrease blood to the area of the hand: causing numbness and tingling
- Hurts with movement - increased change of tendeon or ligament injury

Treatment
- thumb spica splint
- wrist splint
- cortisone injection
- IF NOT BETTER IN 30 DAYS SEND TO ORTHOPEDIC SURGEON



HYPERTENSIVE CRISIS - either the sytolic is greater than 180 or the diastolic is greater than 120 PLUS there is evidence of END ORGAN Failure: edmea, Crackles, encepaholpathy: decreased concentraction, lethargy

I

LA Care is accepted but you call it "Synermed"

Convenient Care Plus (CCP) is a memberships program
- on the inusrnace tab select "Add Special Offer" - and select "Convenient Care Plus"
- proceed wiuth the visit
- do not collect any monthy

IT Self-help tool
Got the InTRANET and find the "communication tab:
On the right lower colum look for "IT self-help tool"

J

K

L

M

Myocradial Infarction:
- both ST elevation and Non-ST elevation may need cath lab - to try to immediately releive clot

Month End Inventory

Check all products and remove if within 30 days of expiration:
- vaccines especially
- clinic kits
- general supplies (gloves, synringes, probe covers, hand sanitizers)
SOME GENERAL SUPPLIES CAN BE THROWN OUT
- vaccines can go to Genco: log into MC Intranet/ "Expirable and Excursion"
- also update teh Inventory Management System to reflect ththe romoval

-

My HR

go to web site: http://www.myHR.cvs.com

or call 888-694-7287

open seven days a week

MSB - MEDICAL SERVICES BENEFITS

Basically money paid via pharmayc benefits

Organization participatin Chemtura, CBS Corporation, Heating and Piping and Refrigeration, Aetna

There are still copays determined by EPIC

Where to find Information: MinuteClinic Intranet / clinical operations / programs / special offers/ flu / Medical Services Benefits / Clients "heating and Piping and Regri" etc.

 

 

N

O

P

Q

R

Refer Out:
Abdominal pain

Dizziness - when it is a part of the another diagnosis --like the flu-- NOT by itself
Diarrhea: If it is not improving or getting worse or if there is blood - or dehydration requiring IV.
Diarrhea May be treated If a traveler can suspect bacterial infection and treat with Bactrim or Cipro: I think. IF SEVERE, consider referral to urgent care for IV rehydration. -- Another common treatment is Flagyl - for most parasites. (First Choice--if not allergic--should be Bactrim because it can treat both Infection and parasites.

 

S

Supplies

Questions can be directed to MCOperationsSupport@cvscaremark.com

SCHEDULE 360
- Must sign up for on call, 2 per six weeks
- mcregion3.com master scheduler: christine
- How to Swap Shifts
--- click post
--- providers elligible provider to switch with
--- then click on the shift you want to take from there
--- the hit submit
- on call " you should see yello at top--
- -- oull down the on call

T

Tricare:

1. Most importantly, if is an active duty military person try to make certain that they have authorization for the visit. If not, suggest they get it.

2. All Active and family members must sign a paper that says that they are aware that Tricae might not pay for everything.

This paper is can be found on the internet in the Intranet part of the Intranet - with the other tricare information.

TREATMENTS to add to treatments at a later date:

Croup - dexamethasone? If respiration fast or labored to ER, may need admitted and entubated

hypertension: Is being piloted--But not in LA, And the person needs to follow up with blood tests for K+ and Na that might become inballanced due to the diuretic effect of some medications. maximum RX if 1 month.

Injection service; called "Patient supplied Medication for Injection". The patient must have an order from a physician--not just the medication.

Onetime Medication Remewal:
* Make sure that patient has not renewed that medication for 15 months at AT MINUTE CLINIC
* check the list of possible medications that can be renewed and the number of days: usually 30 - 90 days
* no narcotics are amphetmines are renewable
* Patient must have seen their provider within the last 15 months (verbally reports)
* Do not refill if they have NOT used in the last 45 days

 

U

 

UTI:
- see antibiotics
- Add Fosfomycin 3 gram once for women
- for men with UTI: Fosfomycin 3 gm every 2-3 days for 3 doses
- Dissovle acket in in 3-4 ounces of water

V.

 

Varicose Veins:
- Stripping is no longer done
- Duplex Scan is what to order determine damage to veins
- TREATMENTS
- usually done by Dermatolgist or Vascular surgeon
- weight loss
- exercise
- Laser Endo
- clara vein
- - schlera therapy (probalby the most treatment)
- compression stock as long as pulses pressure to feet is adequate (there is a test using simultaneous blood pressure in the arm and ankle, ankle brachial index - index)
- ABI less than 0.90-this is most likely due to Peripheral vascular disease-but this number is not 100% relaible
- If peripheral vascular disease is possible due not suggest compression stockings
- endo veno therapy: this treatment heats the vein until it closes
- Compresion stocking hurts at the beginning but feels better at the end of the days


W

Work Brain - correction of missing punches:

You must go to the Intranet:

Find the tab called "Scheduling"

I don't have the rest of the direction in front ot me but the following is what I remember.

You must look for something in the right lower quadrant of the page in small print ( a link).

Whisper Vocie Test According to Minute Clinic
- stand behind the patient
- put your finger in the patient's one ear
- extend your arm and staand as far away fro the patient as possible
- after exhaling completly, say three letters or numbe in a whisper and have the patient repeat them "4 k 2" or "5 B 6" or "22 z 8"
- if the patient can not hear out of one ear it is ok--but if he can not hear out o the other he must pass an adiology exam and return and shows those passing scores.

 

 

Y

Z