quick Q about CCS

[Femtochemistry]

hey guys

In the ER when you have an acute case (ie, chest pain, panic attack, etc), I understand you have to order a number of things prior to examination of the patient (such as iv access, oxygen, pulse ox, cardiac monitoring, etc), should you move the clock so you get results of EKG, vitals, pulse ox, glucose etc BEFORE you do the exam or can you order that stuff and then just examin the pt?

Cheers

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[Femtochemistry]

oh and what does interval/follow up mean and when do you order it??

thanks a mill!

 

[ayanjoe]

When you order I.V. access, O2, and other therapeutic/monitoring stuff, they will be done right away... but other diagnostic tests (CXR, EKG, Chem 8...) take more time (at least 5 to 15 minutes if ordered STAT). Interval/follow sets up when you want to see the patient again or get updated regarding the results. I mainly used "when next update/result is available".

Good luck!

 

[Old_Mil]

When you order I.V. access, O2, and other therapeutic/monitoring stuff, they will be done right away... but other diagnostic tests (CXR, EKG, Chem 8...) take more time (at least 5 to 15 minutes if ordered STAT). Interval/follow sets up when you want to see the patient again or get updated regarding the results. I mainly used "when next update/result is available".

Good luck!

That's what I've been using for the CCS, and it seems to be working OK. When the patient is admitted to the ward, I do "re-evaluate in 1 day" when I'm waiting for a therapy to take effect.

The question I have regards labwork...do you get dinged for ordering all the stuff while the patient is in the ER "stat"? Otherwise, they seem to take forever to come back...

 

[mickey1t]

I just got my score back, and I did pretty well. As far as the interval checkup, I feel that is used when the patient is inpt as a way jump to checkup on them. It will give u a brief summary, saying, patient feels better, or pt feels the same. It gives u a brief hint as to wether ur going in the right direction. As for getting test back, I would always use advance time to next result comes back.

As for ordering stuff STAT, I basically did that for everything in the ER. The only time I wouldnt is if I was ordering screening test for an outpt in the clininc, and i would just have them come back. I would also order things routine, if the pt was admitted and I wanted daily measures.

I dont know if it right, but it worked well for me.

 

[BillyRubinstein]

How long do you have to complete each CCS case? Is there a set limit, like eg. 25 minutes of real time for each case, or do they all difffer?

When I'm doing UW CCS cases and they tell me the case is over, I don't know if it's because I hit most of the relevant things, or because I just ran out of time.

 

[mickey1t]

Billy, u have 25 minutes.....but from my experience, when u pretty much do everything right it ends early....if u wanna check, go back and do a UW CCS u already did, and see how quickly it ends when u do it properly

on the real exam, all the time u dont use for the CCS is added to the break, so be aware that u have alot of break time on day 2....i wish i would have know that, since it is the second str8 day and u r obviously gonna be tired.

 

[BillyRubinstein]

So on UWorld, if the case automatically ends at the ie. 12 minute mark, and says you now have 5 minutes to review the chart...etc, does that mean I "completed the requirements" for the case, or "passed" the case?

That seems to be happening quite a bit, where the case will end well before the 25 minute mark. On review of the case, there are things I miss, although I suppose I'm hitting the points needed to pass the case.

Do you know of there is a specific scoring criteria for each case, or is a pass/fail on a case by case basis?

 

[ohio FMG]

So on UWorld, if the case automatically ends at the ie. 12 minute mark, and says you now have 5 minutes to review the chart...etc, does that mean I "completed the requirements" for the case, or "passed" the case?

That seems to be happening quite a bit, where the case will end well before the 25 minute mark. On review of the case, there are things I miss, although I suppose I'm hitting the points needed to pass the case.

Do you know of there is a specific scoring criteria for each case, or is a pass/fail on a case by case basis?

Good question. That's happening to me too. Is it a positive sign when the UW CCS practice cases end early? Conversely, will the case just drone on for the entire 25 minutes if you're completely off the mark? Thanks.

 

[QuinnB]

It is not necessarily a positive thing. Like if you try to get a brain biopsy on a migraine patient or something outrageous like that the case may end early.

That being said, typically, if you've completed the required therapy for a given presentation the case can end early. I don't think this means that you necessarily ordered all of the right tests to get there, but ordering the tests after treating something that you thought was there rarely makes sense (save examples like temporal arteritis).

If you feel like you're on the right track and don't do anything grossly abnormal, the case ending early is probably okay but it doesn't mean you totally rocked it.