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PULMONARY

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					                SIERRA NEVADA MEDICAL ASSOCIATES, INC. (IPA)
                          UTILIZATION GUIDELINES

                    PRIMARY CARE MANAGEMENT GUIDELINES


PULMONARY


The Primary Care Physician should:

1.    Diagnose and treat asthma, acute bronchitis and pneumonia.

2.    Diagnose and treat chronic bronchitis and chronic obstructive pulmonary disease
      with periodic antibiotics, inhaled or oral bronchodilators and/or steroids. Obtain
      the results of peak-flow rates, pulmonary function, arterial blood gas and
      theophylline levels as appropriate.
      a)     Refer patients for respiratory failure or poor response to their regimen.

3.    Manage home aerosol medications and oxygen as needed.

4.    Work up possible tuberculosis or fungus infections with skin tests, sputum tests,
      and serological tests.

5.    Order chest x-rays, special views (e.g., decubitus views) and CT scans as
      appropriate.

6.    In general, refer for:

      a)     percutaneous lung biopsies, pleural biopsies, supraclavicular node
             biopsies, or bronchoscopy.
      b)     pleural effusions not due to heart failure or acute pneumonia.
      c)     unresolved pneumonia, hemoptysis, lung masses, interstitial disease,
             sarcoidosis, tuberculosis, or unusual infections.




PC MGMT - PULMONARY                                                   PAGE 1 of 1

				
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