The real CCS cases can end abruptly when the criteria as per CCS algorithm on the exam is fulfilled. Here are some useful points I collected and I think this will help you :
" Case ending can be good or bad. Most times it is good, only way we can know is by checking if our patient symptoms improved or not before the case ended.
In pneumothorax case 1, on demo usmle software - try to advance clock by 12 hours with out putting chest tube. The case ends in 5 minutes of real time. Here, case ended because patient crashed and we get zero for that case. In case 5, try to send patient home after some initial treatment and schedule follow up in 3 days, the case ends in just 5 mins of real time. So case can end even when we completely mess up the case. The only way to know if we messed up or if we did well is by checking on our patient progress after treating them. We can check the patient progress by interval history, checking vitals for many cases.
In some cases like DKA, follow up labs like BMP every 2 hours will give us patient's progress. In cases ike hypothyroidism, following TSH 6 weeks later will give us the adequacy of treatment and patient's progress. As long as you did these follow ups and you confirmed that your patient or patient's labs were improving prior to the case ending notification, you will be fine and will get a great score. But the idea that many people have "that case ending soon is always good" is not always true as mentioned in above examples.
Also, we need to be clear about simulated time vs. real time. You can go very far in simulated time in just 5 minutes of real time and that can end the case. Simulated time is the time in patient's life, real time is the time given to us to complete the case.
If you take a pneumothorax case, allowed simulated time for the patient is less than 1 hour. You can reach to the end of that one hour time in 5 minutes of real time by advancing the clock once the patient presents to you - that will kill the patient and the case ends in 2minutes of real time. So, it is important to get the clarity of the concept of simulated time versus real time and how you are supposed to manage with in a designated simulated time for urgent ER cases irrespective of what real time is.
The case ends based on whether you met the requirements with in certain designated simulated time ( patient time). If you met the requirements, the case will end and it is good ending. If you do not meet the requirements, the case will let you advance the clock until simulated time reaches a dangerous point where even when you put correct treatment it is considered as a life threatening treatment delay. So at that dangerous point in simulated time the case will end - If no life-saving treatment was administered by that point simulated time - case is a fail. If treatment was delayed until that point, case is average. If the treatment is done early much before this danger simulated time as done in a good ER , case is excellent.
For example, a pneumotorax case, if you put chest tube at 45 minutes of simulated time, you delayed it - your case performance is average and after that case ends when simulated time hits that point
If you put chest tube in 5 minutes, case will let you go on until 45 minutes and it will, end there. You get excellent score
If you let the case go until 45 mins with out putting chest tube and does not put it at all, patients vitals will crash ( so 45 minutes is considered as a critical point in the life of this patient with tension pneumothorax) . This case will be failure"
_/-
