CCS questions

[Bazinga1983]

Hey guys,

Got couple of questions.

1) Do i need to re do physical exam each time i move the patient? For example: saw him at the office and then transferred to the ER, redo PE? Complete or just focused?


2) Generally speaking, when is it a good time or cut off to move the patient from ER to the ward? After ordering consult and getting their recommendation. And then move the patient to the floor and order npo, iv access, pt ptt, blood type and procedure? for example uw ccs case about PUD. They ordered pre op labs, npo, bedrest, surg consult AND then moved the patient to the ward/ICU. Advanced the clock after patient has been moved to get consult results...Not sure which is better..

archer says " only move the er patient to the ward once patient is stable and when the ordered procedure has been completed and the report is back. So if you ordered pericardiocentesis then order this and wait to have this done and then move the patient if need to"

3) Lets say patient has epigastric pain but hemodynamically stable. Okay to order pain meds (morphine etc) as the very first thing. Kind of like stabilizng orders but only morphine instead of iv access, pulse ox, cardiac/ bp monitor?



Thanks

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[ICUatUCI]

Hey guys,

Got couple of questions.

1) Do i need to re do physical exam each time i move the patient? For example: saw him at the office and then transferred to the ER, redo PE? Complete or just focused?


2) Generally speaking, when is it a good time or cut off to move the patient from ER to the ward? After ordering consult and getting their recommendation. And then move the patient to the floor and order npo, iv access, pt ptt, blood type and procedure? for example uw ccs case about PUD. They ordered pre op labs, npo, bedrest, surg consult AND then moved the patient to the ward/ICU. Advanced the clock after patient has been moved to get consult results...Not sure which is better..

archer says " only move the er patient to the ward once patient is stable and when the ordered procedure has been completed and the report is back. So if you ordered pericardiocentesis then order this and wait to have this done and then move the patient if need to"

3) Lets say patient has epigastric pain but hemodynamically stable. Okay to order pain meds (morphine etc) as the very first thing. Kind of like stabilizng orders but only morphine instead of iv access, pulse ox, cardiac/ bp monitor?



Thanks

1. I don't think you need to do physical each time after you move the patient. But if is an unstable patient, then I would do physical let say q4hr or something along that line and not just at another day.

2. That doesn't really matter. I would like UWORLD, just put in the orders then get the recommendation, then move the pt. or you can move the patient then get the consults recommendations.

3. So this shouldn't matter that much because this is what i would do, I would just put all of them at once at the order screen in whichever order you prefer because in the end, the "simulation time" and "real time" in this case be about the same and I don't think they will take off points. I'd do the usual stuff in the beginning in the same order like IV access, pulse ox monitoring, cardiac monitoring, order cardiac monitoring, oxygen. Those are free points.

For CCS portion, most of my dots were on the right side but didn't get the asterisk; just one was on the borderline; so I did pretty ok. Most of the cases ended pretty early like for 20min cases, i finished within 5-6 min.

Also note that on the test, every order is a stat order, there is no "normal vs stat" so makes things easier.

 

[Bazinga1983]

1. I don't think you need to do physical each time after you move the patient. But if is an unstable patient, then I would do physical let say q4hr or something along that line and not just at another day.

2. That doesn't really matter. I would like UWORLD, just put in the orders then get the recommendation, then move the pt. or you can move the patient then get the consults recommendations.

3. So this shouldn't matter that much because this is what i would do, I would just put all of them at once at the order screen in whichever order you prefer because in the end, the "simulation time" and "real time" in this case be about the same and I don't think they will take off points. I'd do the usual stuff in the beginning in the same order like IV access, pulse ox monitoring, cardiac monitoring, order cardiac monitoring, oxygen. Those are free points.

For CCS portion, most of my dots were on the right side but didn't get the asterisk; just one was on the borderline; so I did pretty ok. Most of the cases ended pretty early like for 20min cases, i finished within 5-6 min.

Also note that on the test, every order is a stat order, there is no "normal vs stat" so makes things easier.

Thank you very much for taking the time to reply.

 

[chemistryguy]

Is there any drawback to ordering most tests up front? Will ordering unnecesary non invasive tests lead to a worse score?