First 5 minutes for the critical patient
›Immediate stabilization
›Cardiac monitoring when unstable or conduction concern
›Two large bore IV if sepsis concern
›Oxygen for hypoxemia
›Point of care glucose if altered mental status
›Early antibiotics for suspected rickettsial disease
›Testing plan
›CBC and CMP when systemic symptoms
›ECG when cardiac symptoms or bradycardia
›Targeted tick borne testing based on syndrome
›Lumbar puncture when meningitis or encephalitis concern
Empiric and directed therapy
›Antibiotic strategy
›Lyme post exposure prophylaxis when high risk bite
›Doxycycline 200 mg orally once
›Children doxycycline 4.4 mg per kg orally once
›Maximum 200 mg once
›Within 72 hours of tick removal
›Not for low risk bites
›Suspected RMSF
›Doxycycline 100 mg orally or IV every 12 hours
›Children doxycycline 2.2 mg per kg every 12 hours
›Minimum 5 days
›Continue at least 3 days after fever resolves
›Early localized Lyme erythema migrans
›Doxycycline 100 mg orally every 12 hours
›Typical duration 10 days local protocol dependent
›Alternative amoxicillin when doxycycline unsuitable
›Lyme carditis severe
›Hospitalization and IV ceftriaxone
›Ceftriaxone 2 g IV daily
›Switch to oral when improving per guideline
›Babesiosis suspected or confirmed
›ID consult recommended
›Severe disease admission criteria low threshold
Symptom control and supportive care
›Supportive management
›Antipyretics
›IV fluids for dehydration
›Antiemetics if vomiting
›Reassessment triggers
›Repeat vitals within 60 minutes if febrile or tachycardic
›Repeat neuro exam if headache or weakness
›Repeat ECG if palpitations or presyncope
›Escalate level of care for worsening rash or hypotension
›Specialty involvement
›Infectious diseases for severe or atypical presentations
›Cardiology for high grade atrioventricular block or PR 300 ms or longer
›Neurology for encephalitis or progressive weakness
›Public health notification local protocol dependent