August 28, 2006 (REVISED 06/29/2011) Dear CHAM User:

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1 Alaska Native Tribal Health Consortium Community Health Aide Program 4000 Ambassador Drive, 4th Floor Anchorage, Alaska Telephone: /3642 Facsimile: August 28, 2006 (REVISED 06/29/2011) Dear CHAM User: Welcome to your 2006 Alaska Community Health Aide/Practitioner Manual (CHAM)! We are excited to bring you this edition-an integrated 4-volume set with CD-ROM. In the past several months we have provided orientation to the CHAM for many Community Health Aides, Community Health Practitioners, training center staff, field staff, pharmacists, referral physicians, and others. Feedback has been extremely positive. However, the CHAM Revision Team has identified a few areas that require revision or correction at this time. Enclosed you will find a packet that contains 14 corrections or additions to place in your CHAM. You must cut the new information out and tape it in your CHAM in the right place. For each change, we have provided a copy of the CHAM page to help you put the revision in exactly the right place. An option is for you to download this packet from and print the revisions to sticker paper; cut and paste as instructed. As you are making changes, if you find any missing and duplicate pages, please contact us so we can send you a replacement book. Please make these changes immediately. If you have any questions, please contact the CHAP Statewide Services Office at for assistance. Thank you for taking the time to make these revisions and get to know your CHAM. If you have any other questions or concerns that have not been identified, you may contact this office (see staff list above) or go to and find the 2006 CHAM User Comment Sheet to provide feedback. In the next few months we will be evaluating the changes in the immunization schedule and how those changes will be made in the CHAM. We also anticipate changes in national emergency standards and procedures that the CHAM Revision Team will evaluate and make recommendations. We value your input and hope you will enjoy using this new tool in the provision of health care. Sincerely, Victorie Heart, MS, RN Director, CHAP/Rural Health Enclosure: Revisions to 2006 CHAM-August 2006 Packet

2 CHAM Patient Care Visit Book Correction: Page 96. CHANGE 0.8 mg to 8 mg. CUT on the lines around this box and place over text as shown on Xerox copy of page 96, attached. Morphine, IM shot. How supplied: 10 mg/ml for injection. Give 8 mg (0.8 ml) IM shot every 4 hours, as needed, for as long as doctor orders it. Revision 8/06 ADDITION: Page 159. Under Social History, question #7 added. CUT on the lines around this box and place over text as shown on Xerox copy of page 159, attached. Social History Note: Look for signs of neglect or abuse that might go along with family problems. See Information for CHA/P Child Abuse or Neglect, p Who lives in your home? 2. How are you doing with the child? 3. How do brothers and sisters get along with child? 4. How does child get along with rest of family? 5. Does anyone else care for the child regularly? 6. Are there people living in the house who drink alcohol, use street drugs or sniff? 7. Are there people living in the house who smoke? [If yes:] Do they smoke inside or outside of the house? 8. Is there enough money for food? [If no:] Are you on WIC? Revision 8/06 Correction: Page 237. CHANGE in History box for Otitis Media with Effusion. CUT on the lines around this box and place over text as shown on Xerox copy of page 237, attached. May have: Mild earache. Trouble hearing. Feeling that ear is full, plugged up. Revisions to 2006 CHAM - August 2006 Revision 8/06 1

3 Correction: Page 239. CHANGE definition of Otitis Media with Effusion. CUT on the lines around this box and place over text as shown on Xerox copy of page 239, attached. Ear 2: Otitis Media with Effusion (OME) (Serous Otitis, Glue Ear, Fluid in Middle Ear) Build up of non-infected fluid behind eardrum. Can cause decreased hearing because of decreased movement of eardrum (tympanic membrane, TM). [Standing Order possible] Revision 8/06 Correction: Page 241. CHANGE in Patient Education box. CUT on the lines around this box and place over text as shown on Xerox copy of page 241, attached. If your child is in group childcare, be aware that infections can be spread from child to child. Good handwashing will help prevent your child from getting an infection. Revision 8/06 Correction: Page 247. CHANGE in Definition box for Otitis Media with Effusion. CUT on the lines around this box and place over text as shown on Xerox copy of page 247, attached. Fluid in the middle ear. NOT an infection. Often caused by Eustachian tube not working. May be painful. Revision 8/06 ADDITION: Inside Back Cover - Recheck Visit. CUT on the lines around this box and place under #4 as shown on Xerox copy of Inside Back Cover - Recheck Visit, attached. 5. [If child younger than 3 years] Is child: Eating normally? Drinking normally? Urinating (peeing) as much as usual? 0 When was the last wet diaper? Having normal bowel movements? Active and playful, or acting tired or fussy? Revision 8/06 2

4 CHAM Medicine Handbook Correction: page M-52. CHANGE Pneumococcal conjugate vaccine abbreviation to PCV7. CUT on the lines around this box and place over text as shown on Xerox copy of page M-52, attached. Pneumococcal conjugate (PCV7 Pneum-conj) Disregard this correction. See updated information in the June 2011 Revision Packet Prevnar Revision 8/06 NOTE: Page M-55 CHANGE Pneumococcal conjugate vaccine abbreviation to PCV7 in ALL 4 boxes. Correction: page M-106. CHANGE dose for 75 to 84 lb 7 ml (1,875) to (1,750 mg). CUT on the lines around this box and place over text as shown on Xerox copy of page M-106, attached. Ceftriaxone (Rocephin ), IM Schedule 1 (Meningitis/Severe Infection) Strength: See preparation section (p. M-27) for mixing instructions. When mixed the concentration is 250 mg/ml Weight (lbs) Dose Revision 8/06 less than 15 lbs Consult doctor. 15 to 19 lbs 1.5 ml (375 mg) 20 to 24 lbs 2 ml (500 mg) 25 to 29 lbs 2.5 ml (625 mg) 30 to 34 lbs 3 ml (750 mg) 35 to 39 lbs 3.5 ml (875 mg) 40 to 44 lbs 4 ml (1,000 mg) 45 to 54 lbs 4.5 ml (1,125 mg) 55 to 64 lbs 5.5 ml (1,375 mg) 65 to 74 lbs 6.5 ml (1,625 mg) 75 to 84 lbs 7 ml (1,750 mg) > 85 lbs & Adult 8 ml (2,000 mg) 3

5 Correction: Page M-109. CHANGE in Ceftriaxone preparation. CUT on the lines around this box and place over text as shown on Xerox copy of page M-109, attached. Ceftriaxone (continued) 4 Preparation: You may have 2 different size vials of Ceftriaxone. 0 Call your referral doctor or pharmacist if you are NOT sure how to mix or measure this medicine. Use one of the instructions below for either a 250 mg OR 1,000 mg (1 Gm) vial. See Mixing Powdered Medicine or Vaccine for Injection, p. M-27. Do not inject more than one ml in one site in an infant; or more than 3 ml in one site in an adult or older child. After an injection, patient may have a severe allergic reaction, which can quickly cause death (anaphylaxis, p. 77). 0 When you give a shot, always have Epinephrine nearby (p. M-73). Revision 8/06 Correction: Page M-149. CHANGE (600 mg/800 mg) to (160 mg/800 mg). CUT on the lines around this box and place over text as shown on Xerox copy of page M-149, attached. For all other adult patients: 0 Give Trimethoprim/Sulfamethoxazole 2 tablets (160 mg/800 mg), by mouth (po) 2 times a day, for 3 days. Revision 8/06 Correction: Page M-231, Top of Page. CHANGE strength 50 mg to 500 mg. CUT on the lines around this box and place over text as shown on Xerox copy of page M-231, attached. Fosphenytoin (FOS fen i toyn) Strength: 500 mg PE/10 ml for IM injection Revision 8/06 Correction: Page M-330. CHANGE Take a shower to Do NOT take a shower. CUT on the lines around this box and place over text as shown on Xerox copy of page M-330, attached. 4 If you are treating scabies: Revision 8/06 Do NOT take a shower or bath before using this medicine. Apply Elimite from neck down with special attention to genitals and skin creases. Rub in completely. 0 Use enough medicine to cover skin head to toe. Leave on for 8 to 14 hours. Then rinse or bathe using soap and water. Use a clean towel. Put on clean clothes. Put clean sheets and blankets on bed. Launder used clothes, towels, and bedding in the hottest water possible and dry with a high heat setting. Use the medicine only once, unless Health Aide tells you to repeat. 4

6 CHAM Reference and Procedure Correction: Page R-179. CHANGE (swap) labels for Frontal and Sphenoid sinuses. CUT on the lines around these 2 text boxes and place over text as shown on Xerox copy of page R-179, attached. Frontal Sinus Revision 8/06 Sphenoid Sinus Revision 8/06 5

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