Step 3 CCS Ordering

[SilentDoGood]

So I have a question, maybe you guys have more clarity on this than me. When it comes to ordering on the CCS cases, do you know if the test/giving of drugs is done as soon as you order them? Like for example, in suspected meningitis, it's important to start empiric vancomycin and ceftriaxone after you get blood cultures but before you get an LP. If I order blood cultures and the ABX on the same screen, is that the right move, or do you order blood cultures, advance by a min, and then order ABX?

I also had the same question when it came to doing emergent orders then doing a focused physical exam. Can I put in iv access, pulse ox, egg, etc and then click on my focused physical or do I need to advance the clock and get a result before doing any physical? Thanks for the responses.

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[chickensoupdr]

Based on UW CCS cases, you should order the blood cultures along with other initial labs that you want. Then see the results. Then order your antibiotics. But I'm not sure exactly what the real exam is looking for either.

 

[chickensoupdr]

What is considered routine vs stat? If you order labs for a patient in outpatient, is that considered routine?
Also at the last 2 minute mark, what do you type in order to change IV to PO and schedule follow ups?

 

[KSINGH]

What is considered routine vs stat? If you order labs for a patient in outpatient, is that considered routine?
Also at the last 2 minute mark, what do you type in order to change IV to PO and schedule follow ups?

Everything is stat on the new NBME software.

 

[chickensoupdr]

In a RCC case who needs a nephrectomy, do you consult oncology or surgery first?
If they have no recommendations, do you still go ahead and order a nephrectomy?
I've had very few cases where the consult actually recommends anything so what am I supposed to do after that?

 

[SilentDoGood]

You still need to order a consult. Even if they don’t give you any recommendations, it follows the “normal path” you would actually take in medicine. So yes, still order a consult.