Hi friends,
I am doing ccs cases in uworld since 2 days. I have a doubt regarding referring cases to other specialties. Whenever I refer a case to a specialist, I always get the same message that the consultant has no explicit management at this time. What does this mean? Does it mean that I should not refer?
For eg I wanted to refer a case of abd trauma to a surgeon and I got back this message. This is a case of sub capsular splenic haematoma which doesn't require any surgery. Will we get this message just because it is not necessary or will we get this message even if it is necessary. Like for eg if it was a case of splenic rupture, then if I refer this case to surgeon then will I get the same message or do we get anything new?
Can anybody please clarify this doubt?
come on guys nobody to help me out!!!
If you think that you still need to order some procedure, go ahead order it, the software let you got! It means that you can do it on your own. You can also give supportive care only.
I am confused too. like, when an acute appendicitis pt needs surgery, the consult came back:no explicit management at this time. then you order appendectomy yourself, it worked. then why need surgeon consult?
after 20 cases in uw, I have not got any suggestion form consult, it is always no explicit..., is it supposed to be this way in uw?
I like to know about it too.
My friends CCS is confusing in first few test.
in CCS consultant will never suggest procedure. It test our ability to refer them at right time.
Just refer them and every time they will come with same suggestions.
But if you think pt need surgery like appendicectomy please write an order for that surgery and surgery will be planned and done. Do not expect consult to suggest any treatment. It is you who order all Rx including surgery and post op order.
For surgery do not forget to NPO, IV saline, pt/inr, PTT order. If you expect blood loss in surgery always order blood group and cross match
CCS is confusing but I suggest to do same case twice consequently so you will improve your ability to manage.
Hope it is help ful to all of you.
many people are confused about this. dr.red addressed this in his workshop as many people were asking him this question. This was his writing in his "questions panel sheet" during the live workshop
"THIS WILL NOT HAPPEN TO YOU ON THE REAL EXAM SOFTWARE. This is critical mistake in USMLEWorld software where the software was not properly designed to accept the patient when an appropriate surgery is ordered. This error can misguide you to think as if there is no need for surgery and this can cost you the entire case on the exam. Do not get misguided. When there is an indication for surgery, the surgeon will accept the patient and a window pops up saying " patient will be scheduled for surgery. Continue with medical management". You should then type the Name of the Surgery itself along with pre-op orders such as NPO, Type-crossmatch, obtain consent, PT, PTT. "
"This error should not also make you think you should order the name of procedure such as appendicectomy when a surgeon clearly rejected the patient for surgery. Please remember this is an error on UW software and it will not occur on your exam. You can try case # 5 on your USMLE Sample CD and the surgeon will say patient will be scheduled for surgery if you consulted him after getting a CT Chest. As long as you meet the indication for surgery, surgeon must accept on your exam. In case # 5 on your USMLE Sample CD, indication for surgery can only be met after looking at some diagnostic test such as CT Chest which revealed that there is ascending aorta dissection. The information that the dissection is in "ascending" but not just "desecnding" is critical because surgery is the treatment of choice in ascending aorta dissection where as descending dissections are mainly treated medically. So, a sugery consult must be requested after looking at the CT Scan result on the software. If you call the surgeon before you looked at the CT scan result , the surgeon will deny the surgery in this same case#5. Try this example of calling the surgeon before the CT and after the CT in case 5 on USMLE CD. So, it is important to meet the INDICATION FOR SURGERY before you call the surgeon. If you meet such an indication, surgeon must and will always accept the patient on your real exam software. "
This is very clear.so we must only order the name of surgical procedure after surgeon accepts. The error on "surgeon not accepting" is confined to UW software and this confusion does not happen on the real exam as per the above explaination. I did test this on USMLE CD and when i called thoracic surgery consult for aortic dissection case after getting CT chest, it says "patient will be scheduled for surgery". So no worries guys.
thanks thyrogen, so the right sequence is as follows
surgery consult------>preop orders------->and the procedure itself
welcome zilbil
the right sequence is
meet the indication for surgery in that case ( clinical or imaging) ---> surgery consult ---> advance clock so as surgery sees the patient ---> pop up says patient "accepted" ---> preop orders + name of procedure itself
preop orders include : obtain consent, NPO, Type and cross, PT, PTT and name of the surgical procedure itself.
Hi thyrogen
good to know.
always ordered the procedure along.
I had the doubt but settled for this sequence, but will try the new one which u said.
thanks.