This table cannot be relied upon in the absence of: PA Medical Directive #4 Otolaryngology
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1 Title and Number f Directive: Order Table PA-4: Otlarynglgy This table cannt be relied upn in the absence f: PA Medical Directive #4 Otlarynglgy 1. OVERALL CONDITIONS - The PA may evaluate and prvide care fr patients presenting with the fllwing new r nging cnditins: Ear Hearing impairment Cerumen impactin Otitis externa Otitis media Serus titis Eustachian tube dysfunctin Tympanic membrane rupture Vertig Labyrinthitis Freign bdy in ear Nse Epistaxis Nasal plyps Freign bdy in nse Muth Oral thrush/candidiasis Apthus stmatitis Herpes labialis Peridntal abscess Upper respiratry tract Sinusitis Acute Chrnic Rhinitis Viral Allergic 1
2 Vasmtr Rhinitis medicamentsa Pharyngitis/tnsillitis Viral (including mnnuclesis) Streptcccal Laryngitis Symptms invlving ears, nse, thrat r sinuses - Directives fr Peridic Health Exam apply, with adaptatins as identified in this rder table. - PA will discuss patient status and care with the physician n an nging basis as identified in the Practice Outline, and as necessary. Guidelines: - Anti-infective Guidelines fr Cmmunity-acquired Infectins, 2012 editin. - Cmpendium f Pharmaceuticals and Specialties, Orders Indicatins and Cntraindicatins. 2. HISTORY AND PHYSICAL EXAMINATION - The PA may cmplete a fcused histry based n presenting cnditin. Histry f present illness. Pertinent past medical histry. - Fcused physical exam may include: Vital signs. Grwth in children. ENT. Respiratry system. Cardivascular system. Abdminal exam. 2
3 3. COUNSELING - Smking cessatin if applicable. - Envirnmental factrs if cntributry. - Supprtive therapy as apprpriate. 4. LABS AND INVESTIGATIONS - CBC Indicatins: - Aphthus ulcers. - Suspected mnnuclesis. - Recurrent epistaxis. - Mnspt. - Liver functin tests. Indicatins: - Suspected mnnuclesis. - HSV serlgy. Indicatins: - Suspected herpes labialis. - Quick-vue rapid strep test. Indicatins: - Suspected strep pharyngitis. - Swab fr C&S. Indicatins: - Ear canal swab in titis externa. - Thrat swab fr suspected strep pharyngitis. 3
4 5. IMMUNIZATIONS - In accrdance with PA Medical Directive #1 Peridic Health Exam. Guidelines: - Canadian Immunizatin Guide Seventh Editin THERAPEUTICS Otic slutins: - The PA may prescribes the fllwing tic slutins: Bur-sl tic slutin Crtisprin tic slutin. Ciprdex tic slutin. Indicatins: - Otitis externa. - Otitis media with perfrated tympanic membrane (Ciprdex nly). Cntraindicatins: - Cnsult supervising physician if: Invasive infectin f external auditry canal suspicius fr necrtizing titis externa. Antibitics: - The PA may prescribe the fllwing antibitics: Amxicillin. Amxicillin/clavulanate. Azithrmycin. Cephalexin. Clarithrmycin. Dxycycline. Erythrmycin Pencillin V. Trimethprim/sulfamethxazle. Indicatins: - Otitis media - Pharyngitis/tnsillitis (bacterial) - Sinusitis (bacterial) - Peridntal abscess Cntraindicatins: - Cnsult supervising physician if: Suspected chrnic suppurative titis media r chlesteatma. 4
5 Prbitics - The PA may recmmend the use f OTC prbitics. Indicatins: - Patients taking antibitics. Analgesics/anti-pyretics: - The PA may recmmend the fllwing OTC medicatins: Acetaminphen. Ibuprfen. Naprxen. Indicatins: - Pain. - Fever. Cntraindicatins: - Naprxen: nt recmmended in children less than 12 years ld. Oral analgesics: - The PA may recmmend the fllwing ral analgesics: Benzcaine. Viscus lidcaine. OTC preparatins. Indicatins: - Apthus ulcers. - Herpes simplex ulcers. Oral anesthetics - The PA may prescribe the fllwing ral anesthetic: Benzydamine. Indicatins: - Acute pharyngitis. Cntraindicatins: - Nt recmmended in children. 5
6 Decngestants: - The PA may recmmend the fllwing decngestants: Pseudephedrine. Phenylephrine. OTC cmbinatin agents cntaining abve decngestants. Indicatins: - Nasal cngestin. - Eustachian tube dysfunctin. - Sinusitis. Cntraindicatins: - Nt recmmended in children less than 4 years ld. Nasal crticsterids: - The PA may prescribe the fllwing nasal crticsterids: Mmetasne. Ciclesnide. Fluticasne. Indicatins: - Acute rhinitis. - Acute sinusitis. - Allergic rhinitis. - Eustachian tube dysfunctin. Cntraindicatins: - Cnsult with supervising physician if: Patient less than 12 years ld. Beta-2 Agnists: - The PA may prescribe the fllwing beta-2 agnists: Albuterl Terbutaline. Indicatins: - Brnchspasm related t upper respiratry infectin. Cntraindicatins: - Cnsult with supervising physician if: Patient less than 6 years ld. Saline therapy - The PA may recmmend the fllwing saline therapy: Saline spray. Saline drps. Saline rinses. Saline gargles. Indicatins: - Nasal cngestin. - Pst-nasal drip. - Sre thrat (saline gargles nly). 6
7 Antihistamines - The PA may prescribe the fllwing antihistamines: First generatin: Cyclizine. Dimenhydrinate. Meclizine. Secnd generatin: Cetirizine. Deslratadine. Fexfenadine. Lratadine. Indicatins: - First generatin antihistamines: Vertig. Labyrinthitis. - Secnd generatin antihistamines: Allergic rhinitis. Eustachian tube dysfunctin. Antifungals - The PA may prescribe the fllwing antifungals: Cltrimazle. Flucnazle. Micnazle. Nystatin. Indicatins: - Oral candidiasis. Antivirals: - The PA may prescribe the fllwing antivirals: Acyclvir. Famciclvir. Valacyclvir. Indicatins: - Herpes labialis.. 7
8 Tpical vascnstrictrs: - The PA may prescribe/apply the fllwing tpical vascnstrictrs: Phenylephrine Oxymetazline. Indicatins - Epistaxis with identifiable bleeding site. - The PA may perfrm the fllwing: Dix-Hallpike maneuver. Indicatins: - Patients with vertig. 7. PROCEDURES - The PA may perfrm cauterizatin using silver nitrate. Indicatins - Epistaxis with identifiable bleeding site. - The PA may remve r rder remval f cerumen using mechanical means r irrigatin. Indicatins - Cerumen impactin. - Cerumen bstructing visualizatin f TM. - The PA may remve freign bdies lcated in the ear canal r naris using mechanical means. Indicatins - Freign bdy in ear canal r naris. 8. REFERRALS - Smking cessatin cunselr. Indicatins: - On patient request. 8
9 - Allergy testing. Indicatins: - Patients with allergic rhinitis whse symptms are nt cntrlled by medicatin and allergen avidance. - Audimetry. Indicatins: - Patients with decreased hearing n exam r by histry. - ENT specialists in cnsultatin with supervising physician. Indicatins: - Patients requiring cnsultatin with specialist. 9. ABSENTEE NOTES The PA may write absentee ntes as apprpriate. 9
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