Clinical Information

Opioid Resources and Recommendations for Practitioners and Printable Reference Materials for Patients and Families

  • Listing of Resouces for Epic, PMG guides, and materials from CDC, Snohomish Health District, and SAMHSA

 2018 Cumulative Sensitivity Reports

  • Inpatient
  • Outpatient - (not yet posted)
  • Long Term Care - (not yet posted)

2017 Cumulative Sensitivity Reports

Antimicrobial Selection Guideline for Adults - November 2017

Mumps

Alert from 2019-6-20

Action requested: Submit appropriate specimens when mumps suspected

Recommendations

  • Contact the Health District (425-339-5278) for testing guidance when mumps is suspected.  Polymerase chain reaction (PCR) testing (done at the Washington State Public Health Laboratory) depends on timing:
    • On days 0-3 after onset of parotitis (date of onset is day 0), collect a buccal swab only
    • On days 4 – 10 after onset of parotitis (date of onset is day 0), collect both a buccal swab & urine
    • Contact the Health District before testing if more than 10 days has elapsed since onset of parotitis
  • If serologic testing is desired, serum can generally be sent commercially; both IgM and IgG results should be requested.  Note: Follow up to determine IgG results will be important for patients with unknown vaccination status, since a negative PCR cannot rule out mumps on a person previously exposed to mumps antigen, either by vaccination or previous infection.

Zika

Action requested: Be aware of updated guidance about Zika virus transmission & testing of pregnant women & infants.

Background: Florida Dept. of Health continues to investigate Zika virus transmission in Miami-Dade County and information about areas of Zika transmission is rapidly evolving. A new area of active transmission in a 1.5-square-mile section of Miami Beach has been identified in addition to the previously reported area of active transmission in the Wynwood neighborhood of Miami (http://www.cdc.gov/zika/intheus/florida-update.html). It is possible that other neighborhoods in Miami-Dade County have active Zika virus transmission that is not yet apparent, but other areas with active Zika virus transmission are likely to emerge.

The Centers for Disease Control & Prevention (CDC) has issued updated guidance for evaluation and management of infants with possible congenital Zika virus infection. See resources below for more details.

Recommendations:

  • Advise pregnant patients to avoid non-essential travel to all areas with active Zika virus transmission, including the specified areas of Miami-Dade County. Pregnant women and their partners who are concerned about being exposed to Zika should consider postponing nonessential travel to all parts of Miami-Dade County.
  • Assess all pregnant patients for possible Zika virus exposure during each prenatal care visit, including for signs and symptoms of Zika virus disease, a travel history, and their sexual partner’s potential exposure to Zika virus, to determine whether Zika virus testing is indicated.
  • Test infants born to mothers with laboratory evidence of Zika virus infection during pregnancy and infants who have abnormal clinical or neuroimaging findings suggestive of congenital Zika syndrome (microcephaly, intracranial calcifications or other brain anomalies, or eye anomalies, among others) and a maternal epidemiologic link suggesting possible transmission, regardless of maternal Zika virus test results.
  • Collect serum and urine from infants in the first two days of life, if possible, for PCR and IgM testing; testing of cord blood is no longer recommended. A positive infant serum or urine rRT-PCR test result confirms congenital Zika virus infection. Positive Zika virus IgM testing, with a negative rRT-PCR result, indicates probable congenital Zika virus infection.
  • Report suspected cases by calling the Health District at 425-339-5278. Staff are available for consultation about testing of suspected Zika cases. A completed Zika intake form is required prior to approval of testing through Public Health.

Resources:

You can find my recent health alerts posted on the Provider pages of our website.

Project Access: Snohomish County Alliance for Health Access

Most physicians already see charity patients. However, since there is no system for providing support services for these patients, the physician often feels frustrated and the process is often inefficient and ineffective.

The Snohomish County Alliance for Health Access is designed to change that. Patients are screened for appropriate lab work, x-rays, and medications before the patient is scheduled with a specialty physician.

Referrals are carefully managed to ensure that caring for charity patients is shared fairly throughout the community. Physicians are recognized for their contribution, and most of them choose to continue year after year.