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ccs - put all orders at once? (urgent.. taking CCS tomorrow!)

docbonez

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    Taking the CCS tomorrow.. an urgent question..

    For the CCS, should I just put all orders i can think of at the very beginning of the encounter?

    Im an ED resident so I have no idea how things work in the office.. say you are suspecting lung cancer, should i just go ahead and put all the orders at the very beginning? ie: sputum cytology, chest xray, chest/abd/pelvis ct.. or should i go stepwise.. like get a chest xray first.. if it shows a mass, then get cytology.. and if thats positive then get the CTs for staging?

    thanks
     

    Law2Doc

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    1. Attending Physician
      Taking the CCS tomorrow.. an urgent question..

      For the CCS, should I just put all orders i can think of at the very beginning of the encounter?

      Im an ED resident so I have no idea how things work in the office.. say you are suspecting lung cancer, should i just go ahead and put all the orders at the very beginning? ie: sputum cytology, chest xray, chest/abd/pelvis ct.. or should i go stepwise.. like get a chest xray first.. if it shows a mass, then get cytology.. and if thats positive then get the CTs for staging?

      thanks

      A little of both. You want to put in emergency orders first if the patient is unstable. Then do your exam. Then do targeted orders and appropriate imaging. Then depending on what those show, do more orders. So you may be ordering things in batches, not one at a time, but there will be multiple batches based on what various studies show you.
      The UW CCS cases have nice suggested time management explanations that I found very helpful in knowing how best to group orders.
       

      ilovepath

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        So let's say pt is deficient in something-- b12, iron, folate etc...you would do a batch to check their serum levels and the next batch to tx the deficiency? In some of the examples I saw they did both in the same batch which really didn't make sense since the tx can influence serum level.
        I guess the other case I can think of is you may want to do cxs prior to empiric abx?
         
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