CCS questions

[link2swim06]

CCS's interface and scoring seem pretty confusing.

1. Do you have to order the test in the priority of importance or can you just order then in a big batch like you would in real life? I ask because the uworld ccs thing seems to give them back to me one at a time and I don't want to lose points because it gave the bmp before the abd US, when the pt obviously had a AAA.

2. Do the consultants on the real test actually do something? The uworld consultants say nothing helpful. I just had two cases where there was colon ca and then cholecystitis. My surgical consult said there was nothing for them to do. I don't see laparatomy as an order...wtf am I suppose to do with them as they chill in the hospital for days? Maybe keep running them through the CT scanner just hoping that it might irradiate their adenocarcinoma?

3. Are we expected to do counseling on every pt? If so, what's the order we are suppose to be selecting for that?

---

Members don't see this ad.

 

[Puff-of-Snow Sign]

1. I don't think the order matters so much when you're ordering as a big batch. However, if you ordered a CT of the chest and waited for the results before ordering a US abd for a suspected AAA, you might get docked for that.

2. First, laparotomy (or at least "exploratory laparotomy") should be a choice in the UW software. The consultants will do something for you on the test, if it's appropriate based on the info you've gathered up to that point. However, I don't ever remember anything useful coming from the consultants on the UW cases.

3. Yes. I'd play it safe and counsel patients when you're sending them home to follow-up and at the end of every case in the "Final Orders", if you haven't just counseled them moments earlier in real or simulated time.

 

[jakeislove]

My thought process is going to be: Address urgent things urgently, and in their proper setting. For example; give a patient with shortness of breath and hypotension O2 and IV fluids, advance the clock one minute, and then order labs.

I don't believe we're supposed to throw the kitchen sink at every case.

 

[thehundredthone]

You do have to order in order of priority to the extent that you would order all your necessary stat/inital labs at once, and order the follow up labs after the necessary results.

In a case that requires immediate initial measures, you'll instate them on the first screen before doing your focussed physical examination. The physical exam will advance your clock by a few minutes before you order any further labs and measures.

E.g. someone with ACS/MI like history: Pulse ox, cardiac monitor, BP monitor, O2, IV access, aspirin -> focussed physical -> ECG, enzymes, CBC, BMP, PT/PTT/INR, CXR, morphine -> cath and angioplasty, statin, beta blocker (all in the ED, then move the patient to the ICU after the procedure). Obviously this is not a comprehensive list of things to be done in this case but it gives you the gist of the process you should follow.

All surgical procedures exist in the order list. Laparotomy, laparoscopy as general procedures, hemicolectomy, nephrectomy etc. as specific therapeutic measures in certain cases. You consult to prove that you know when to get the team on board, but you must order the actual intervention yourself because you have to prove you know what needs to be done for the patient.

Counsel them whenever, and as many times as you feel like, there is no inappropriate time. Only a few things are time sensitive, e.g cancer diagnosis, CPS, safety plan etc.

Quick tip: If someone comes in with >5/10 pain give them their morphine (+ phenergan) fix or they're going to cry about it throughout their case. Apparently ketorolac is not good enough.