1 / 24

Changing Your Frame of Reference

Changing Your Frame of Reference. Standards of Care in HA Operations. “Two Standards of Care”. Understand “Two Standards of Care” Empiricism - relying on hunches more than hard data Medical Supplies WHO Emergency Health Kit. The Non-U.S. Standard of Care.

brit
Download Presentation

Changing Your Frame of Reference

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Changing Your Frame of Reference Standards of Care in HA Operations

  2. “Two Standards of Care” • Understand “Two Standards of Care” • Empiricism - relying on hunches more than hard data • Medical Supplies • WHO Emergency Health Kit

  3. The Non-U.S. Standard of Care • Other people have the same values, morals, ethics • They lack the same resources • $8 per person per year

  4. Who Provides Health Care? • Nurses and community health workers • Little to no supervision by a physician • In an HA op, there will not be the HM/MO to patient ratio we are used to: • train refugees/IDPs as community health workers • train Marines, soldiers

  5. The Best Thing for Medical • Training Others to perform medical tasks is the most valuable use of our time • Oral rehydration • Health education • Disease surveillance

  6. Who is Treated? • No extraordinary measures • Don’t do something if it cannot be sustained • why resuscitate a heart attack victim if there’s no ICU for the patient to recuperate? • Why resuscitate a premature infant if you cannot support him afterwards?

  7. How do you treat? • IV therapy is extraordinary treatment • expensive (man-hours, sterile supplies) • Greater reliance on oral and intramuscular medications • Convenience and ease of administration are forsaken for cost and durability of medicines • No lab or X-ray; no time for in-depth diagnosis (up to 60-100 patients per day per doc)

  8. What is Used to Treat? • No comfort meds (cold and cough remedies) • Low cost, low glamor antibiotics

  9. Strive Hard to Maintain the Two Standards of Care • Do not stir up ethnic strife by inadvertant favoritism • Do not make the refugees more unwelcome than they already are by exceeding the standard of care of the host country • Don’t set a standard you can’t sustain • Set a policy for civilians/refugees injured by USMC activities

  10. The WHO Emergency Health Kit • Developed by UNHCR, London School of Tropical Medicine, UNICEF, Doctors without Borders, International Red Cross) • Driven by prior failures • Reliable, standardized, proven, durable, inexpensive, appropriate • Packaged for durability (can be air-dropped) • Inventory used as model for whole nations’ drug supplies

  11. WHO Kit Set-up • Designed to support 10,000 patients for 3 months • 10 Basic Units: oral and topical medicines • 1 Supplementary Unit: injectables 1000 1000 1000 1000 1000 1000 1000 1000 1000 1000 10,000

  12. Specialized Kits • Measles Vaccination Cold-Chain Kit • 5000 immunizations

  13. Supplies in the WHO Kit(selected list) • Antibiotics (very basic) • Oral Rehydration Salts • Pressure Sterilizer • Kerosene Stove • Weight / Height Charts • Clinical Guidelines

  14. The Antibiotics • Penicillin V • Penicillin G IM • Penicillin G IV • Ampicillin • Septra • Chloramphenicol • Tetracycline

  15. Penicillin V • 250 mg tabs (4000) • child 25 - 50 mg / kg / d divided q 6-8 h • adult: 1 tab po qid • Indications • Minor respiratory • head and neck infecitons • oral anaerobes, group A strep

  16. Penicillin G and Bicillin IM • Procaine IM only (1000 doses) • child: 25-50 k units / kg / d divided q 12 h • adult: 300 - 600 k units q 12 h • Bicillin (50 doses) • depot shot q 15-30 days • Indications • Mild-moderate versions of: • respiratory infections • head & neck infections • oral anaerobes, strep

  17. Ampicillin PO / IM / IV • Ampicillin PO (2000 tabs) • child: 50 - 100 mg / kg / d divided q6h • adult: 2 - 4 g / d divided q6h • Ampicllin IM / IV (200 doses) • child: 100 - 400 mg / kg / d divided q4-6h • adult: 6 - 12 g / d divided q4-6h • Indications • moderate-severe respiratory infections • neonatal sepsis / meningitis • better gram-negative coverage than PCN

  18. Septa • 80 TMP / 400 SMX tabs ORAL (20,000 doses) • child: 8 - 12 mg TMP /kg/d divided BID • adult: 1 - 2 tabs PO bid • Indications: • mild-moderate respiratory conditions • skin infections • UTI • cholera and dysentery • Watch out for sulfa allergy and bone marrow suppression

  19. Chloramphenicol • Oral: 250 mg tabs (2000 doses) • IM / IV 1 g injections (500 doses) • Doses: • < 1 wk: 25 mg/kg/day • > 1 wk: 50 mg/kg/day div q12h • > 4 wk: 50 mg/kg/day div q6h • child/adult: 100 mg/kg/day divided q6h

  20. Chloramphenicol continued • Indications • Excellent penetration of all body fluids • Use for all serious infections • sepsis • meningitis • respiratory infections • bone / joint infections • typhoid, cholera, dysentery

  21. Excellent Bioavailability of Chloramphenicol

  22. Toxicity of Chloramphenicol • Reversible dose-dependent bone marrow suppression • Aplastic anemia (1:40,000 recipients) • occurs weeks to months later • not dose related • Gray Baby Syndrome • overdosing in infants --> flaccidity, cyanosis • Hemolytic anemia in G6PD deficiency

  23. Tetracyline • PO: 250 mg (2000 doses) • child: 25 - 50 mg/kg/day div q6h • adult: 250-500 mg q6h • Indications: • mild-moderate respiratory infections • cholera, dysentery, malaria • Toxicity • stains young teeth: don’t give to pregnants or kids < 8 yrs/ old

More Related