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* QS rearding CCS
  jellybean123 - 07/12/17 17:33
  I have some qs regarding ccs
1,What we order in PE for Diagnosis CT/VQ Scan. According to archer VQ Scan in stable and CT chest in unstable patient but U world use CT chest for diagnosis.
2,When we do colonoscopy in UC either on 1st visit or schedule patient for next visit .
3,how do we proceed in child with vaccination catch up at 5 years old case.

Plz answer.
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* Re:QS rearding CCS
  jellybean123 - 07/14/17 11:17
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* Re:QS rearding CCS
  lamonti - 07/14/17 11:48
  1- Go for spiral CT.
2- Due to timing issues in CCS, order "sigmoidoscopy" in the first visit. Avoid colonoscopy.
3- Please elaborate more. Do you mean a child came for a normal physical checkup or he came because of medical illness due to a late vaccine?
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* Re:QS rearding CCS
  jellybean123 - 07/14/17 13:20
  unvaccinated 5 years old child came for vaccination  
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* Re:QS rearding CCS
  lamonti - 07/14/17 14:55
  The vaccination status of an immigrant child depends on the child's age and country of origin. If no vaccination record is available or if the child had not received any vaccines before coming to the United States, the practitioner would likely treat the visit as a first vaccination visit of a 2-month-old infant.

At this visit, the child would require 1 dose each of DTaP, HBV vaccine, Hib, pneumococcal, HAV vaccine, and MMR vaccines; if he has not had varicella infection (chickenpox), he should also be given 1 dose of the varicella vaccine. Here is the expedited schedule.
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* Re:QS rearding CCS
  mansa - 07/19/17 23:39
  jellybean, good questions. I am doing Archer and according to it, V/Q only if patient can not get a contrast dye as in renal failure. In unstable patients, archer says to do a ct based on clinical score and bed side echo and give tPA and that's very good point. NO time for CT chest. Where did you hear unstable gets CT ?

2. Also, in Archer, should get sigmoidoiscopy in acute flare of ulcerative colitis. when whole thing is inflamed, you do not want to immediately do colonoscopy. risk of perforation is there. Also Archer CCS case mentions that doing flex sig is quick and can be accomplished immediately in office without rescheduling a patient for another appointment. This is the major thing about keeping simulated time low in CCS to score high
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