drgeorgie
Forum Senior
Topics: 22
Posts: 149
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How should I approach a CCS case? Till what "level" should I manage the case? What I mean is how do I know it's time to stop? Should I wait till the patient is discharged to home?
For eg..the case of Tension pneumothorax how do we proceed?
This is how I will proceed
step 1 vitals, chest and CVS exam
so diagnosis is tension pneumothorax
Step 2.. needle decompression, vitals
pt. is a little better
step 3 Put in chest tube after taking consent, vitals
step 4 Check XRAY to confirm tube placement
step 5 admit the patient(pt is shifted to room from the ER)
step 5 detailed history, physical exam
now what? the patient is better.......how do i proceed?
when should i advance time?
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"The army saw Goliath as too big to hit. David saw him as too big to miss!"
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| smal
Forum Guru
Topics: 140
Posts: 727
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time will be advanced in PE so dont worry
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remedy for weakness is not brooding over it ,but thinking of strength.
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| move along
Forum Senior
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Posts: 188
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oh there are lots of things to be done after that
all the basic labs.....along with a repeat chest xray....
then keep advancing the clock to the next most important test result,,,,,,
like the chest xray........here.......
then you gotta start meds as well rite?
painkillers, antibiotics depending on other symptoms.....
the point is to add something or advance to next most important result,,,,,
mostly if you ve done the required the ccs case will end in real exam,,,so don t worry.......
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| drgeorgie
Forum Senior
Topics: 22
Posts: 149
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so did i do it right?
when do we stop and go on to the next case?
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"The army saw Goliath as too big to hit. David saw him as too big to miss!"
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| move along
Forum Senior
Topics: 11
Posts: 188
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oh well
there will be a screen saying 5 minutes left, with an end case option
you just type in the final orders like discontinuing stuff or counselling or adding things and then u can end it by clickin on end case screen
and then you type in diagnosis and you are done,,,,,,,,
is this what you wanted to know?
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| drgeorgie
Forum Senior
Topics: 22
Posts: 149
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hmm i'm begining to understand..
do they expect a complete management? meaning from ER till home?
for eg if the case is pneumothorax...should we just manage the pneumothorax...or should we treat him till he can go home?
it's tough to decide when to send patient home isn't it?
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"The army saw Goliath as too big to hit. David saw him as too big to miss!"
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| arlete
Intern in 2009!!!!!
Topics: 30
Posts: 2,229
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Yes, it is. Tougher during the test than in real life, for sure.
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When men make the rules, God decides the exceptions.
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| ea
Forum Senior
Topics: 15
Posts: 142
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Hi drgeorgie,
I don't think the exam is testing us the whole management. If I'm not wrong, not just internists but also other specialists need to take this exam. In that scenario, how can a psychiatrist know in such debts???
It is just about your approach; like how you are managing an emergency case, whether or not you are asking for a right referral, are you doing the basic ABCD's and are you thinking of the right diagnosis.
Like, if you get an Obese Type 2 DM pt with RBS of 350mg/dl, what they want us to do is: give him NS and regular insulin and when glucose levels return to normal keep him on metformin. It is not about will you manage him in ICU or Inpatient floors or when will you shift him? Those things probably won't affect our score.
I worked as a tutor in Kaplan USMLE Clinical Skills exam and I use to grade people who come for training. I learnt an easy way to pass exam, i.e., getting the basics right.
For CCS, according to me the golden rule will be.... getting the basic things right... IV access, pulse oximeter, Oxygen, cardiac monitoring, CXR, CBC, BMP, referrals,... and right diagnosis. If you give the right basic treatment, patient will definitely improve irrespective of whether he is in ED/ ICU/ Inpatient !!
If we can get these right... we should pass !!
I hope I'm right. I took my exam on Oct16 and 17, still did not get my result but I'm sure my approach is right.
Good luck.
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| drgeorgie
Forum Senior
Topics: 22
Posts: 149
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ya i think sol...
coz sometimes the follow up treatment is not in our hands.
Example: i diagnose a/c abdomen as appendicitis...get the surgery consult, they schdule him for a surgery..so all i can do is keep the pt on NPO, do cbc, bmp, PT,BT abd CT and may be pmol for fever, abiotics 3rd gen cephalosporin...
everything else is decided by surgeon isn't it
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"The army saw Goliath as too big to hit. David saw him as too big to miss!"
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| ea
Forum Senior
Topics: 15
Posts: 142
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yeah that is all we are expected to do !! If we can write orders for all of those preoperative investigations, we will comfortably pass the exam.
Try to practice all cases once through the CD. Don't worry a lot about moving him and other minor things. Frame few things in your brain for every case and follow those rules. Like, I made a point to order follow up h/o at least two times in every case !
Good luck.
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| IModicaMD
Forum Newbie
Topics: 1
Posts: 6
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Believe me guys...after the hundreds of MCQ's along the course of two days...when you finally do get to the CCS part, consisting of nine cases I can assure you 100% you will not be worrying when to stop your treatment or if you did enough....you WILL be concerned to do the right things...make sure you covered all the issues...you reviewed the stats...when everything is done right..the case will end for you automatically. You will never have a case where you concern is.."ok when do i stop"...if the case is continuing it means you need to do further..whether following up with treatment and diagnostics...if its a chronic issue...or you are missing something..etc. Trust me..if you do everything you need to do...the case will end.
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