Nội dung text ONECARE DRS GUIDE NOTES WIKI
OneCare Clinic Guide / Wiki and Short Notes on Common Presenting Issues Contents General Principles 3 URTI / Respiratory 4 URTI 4 Acute Bronchitis / CAP 4 Chronic cough 5 Asthma / COPD / GINA Guidelines 5 Tonsillitis / Pharyngitis 5 Cardiovascular / Gastrointestinal / Urinary Tract / Neurology 7 GE 7 Gastritis / H Pylori Ix 7 Piles 9 Reflux 9 Abdo pain DDx 9 Acute Chest pain DDx 9 UTI 9 Calculi 9 STDs 9 Headaches 10 Ortho / Rheumatology 10 General principles 10 Shoulder Exam 10 Gout 11 OA 12 Plantar Fasciitis 12 Ankle Sprains 12 Other Trauma / Injuries / Tendinopathy 12 ENT / Eye 13 Chronic Sore Throat 13 Chronic Rhinitis 13 Otitis media / externa 14 Ear wax / Syringing 14 Vertiginous giddiness 14 Epistaxis 15 Foreign bodies 15 Conjunctivitis / Styes / Chalazion / Blepharitis 15
Dermatology 15 Eczema 15 Cellulitis / Folliculitis 16 Wound management 16 T&S / I&D 16 Warts 16 Acne 16 Psoriasis 17 Seborrhoeic Dermatitis 17 Hair loss 17 O&G / Paeds 18 Menstrual Issues 18 Pap smears 18 Emergency Contraception 18 Regular Contraception 19 Fungal infections 19 Chickenpox / HFMD 19 NCIS Vaccinations / DA 20 Other Infections / Misc 21 Dengue 21 Helminthic infections 21 NAIS Vaccinations 21 Travel advice / Malaria prophylaxis / Altitude sickness 21 Needlestick injuries 21 Foreign Domestic Worker (FDW) Exams 21 Dependant pass / EP / S-pass / Work Permit 22 Insurance checkups 22 Pre-employment Checkups 23 Police reports / Medical reports 23 Health screening advice / reviews 23 Disability Assessments 23 Other Chronic Conditions 24 HTN 24 HLD 24 DM 24 Hypo / Hyperthyroidism 25 Hep B Carriers 25 ==============================================
1. General Principles a. Review Consultation / Waiver ■ Generally same or related problem, within +/- 1 week. Can use your discretion- we are fairly liberal if reasons for return are reasonable - Tell staff verbally / “CONREVIEW” code when typing in meds / Add comment under ‘instructions’ ■ If feel visit doesn’t warrant a charge for patient, eg bad laceration sent to ED stat without much done / unable to address the patients’ concerns due to language/beyond your capabilities - Inform the staff to waive (or “CONWAIVE code) b. Lab Tests ■ Private patients - default lab is INNOQUEST. List of common tests up on the wall, otherwise use the lab book and the price patients pay is list price in book + GST. ■ Corporate patients - use the guide on the wall to determine which lab to send ■ Urgent labs - please fill in the urgent result HOTO form to hand over to the evening Dr, which may be a different OC clinic if your clinic is closed. c. Radiology ■ Private pts - Check with staff where the nearest facility is/patient preference ■ Send to Radoc Imaging in Raffles Place if no preference, esp for Ultrasounds where waiting time is short (usually next day) ■ Company insurance pts may have specific radiology centers patients need to be send to, check with staff d. Checking of results ■ Please assist to vet thru the lab/x-ray results ■ For results needing an urgent review, please indicate and hand to the CA separately from the rest of the stack; if appropriate, you can call the patient to verbally inform results and discuss the plan; document in the EMR as usual ■ Tick ‘Call for review’ for non urgent reviews ■ TIck ‘No follow-up required’ for normal work permit etc checkups e. Specialist referrals ■ CHAS/MG/PG card holders can be sent directly to Govt subsidized SOC (there is a separate form to fill in). Routine vs fast-track appointments available. ■ We have a Referral Coordinator to check for insurance eligibility and arrange appointments. Generally, inform patients that a coordinator will be contacting them within 3 working days, and if no one contacts them, they can call the referral centre directly (number on envelope)
2. URTI / Respiratory a. URTI ■ Differentiate acute vs chronic symptoms ■ Contact and occupational history ■ Check if fits swab criteria ■ Preempt questions about antibiotics ■ Kids - Kids under 2 usually require minimal medication and more explanation (on risks of sedation, self limiting nature etc) ■ Pts may ask about Danzen / Serratiopeptidase / Leftose - anti-inflammatory enzyme - Not HSA registered as a prescription medication anymore. ■ Typical drug types used for such patients- ● Paracetamol/NSAID ● Lozenges (‘Purple type’ usually refers to MAC) ● Antihistamine (eg non sedating OM + sedating ON) +/- Decongestant ● Mucolytic (Fluimucil / Bromhexine) ● Expectorant / Cough suppressant (Bena / DMP / Sedilix / Cophadyl [beware of addicts]) [Guidelines on Opioids] ● Antibiotic ■ Drowsiness at work / Side effects ● Can prescribe a non-drowsy drug for the morning (eg Clarytyne/Telfast +/- decongestant version) and a drowsy one for the evening (eg Piriton). Also cough medications - can use Ivy leaf syrup morning/noon and dhasedyl-like syrups at night ● Some find the side effects of decongestants quite troubling - palpitations, feeling ‘jumpy’, insomnia ● Use Pseudoephedrine containing medications with great caution in patients with or at risk of ischaemic heart disease/arrhythmias or stroke. b. Acute Bronchitis / CAP ■ If CXR needed, order as urgent report/film ■ COVID - using dry nebs with spacer (Salbutamol 10 puff, Atrovent 4 puff if > 10kg; Salbutamol 5 puff, Atrovent 2 puff if <10kg) ■ Spacers available for sale in clinic ■ Give a fixed review date ■ Parents usually question if salbutamol inhaler use will lead to dependance or if kids have ‘asthma’ c. Chronic cough ■ Assess for red flags that may suggest sinister causes e.g. cancer, TB, heart failure