Archer CCS Strategies discussion - iara2

[ArchivalUser]

criteria for intubation in a CCS case, anyone?

[ArchivalUser]

Archer CCS Strategy 9:
Intubation in AMS cases:

Not all cases need to be intubated. One need to set up follow up monitoring right on the initial screen in cases of AMS. Monitoring is in form of NEUROCHECKS Q2h.
Some cases of AMS are rapidly reversible eg: hypoglycemia, Hepatic encephalopathy and opiod overdose. If your intervention worked and patient's neurochecks showed improvement in few minutes and gag reflex on physical exam is preserved, no need to intubate.
Intubation is invasive and some lose score for unnecessarily intubating patients in AMS cases that have rapidly reversible etiologies.
These AMS cases and sequencing of orders are very well well shown in archer workshops and we can see that as we move clock to get follow-up neurochecks,case gets better with interventions. So do not get invasive with intubation right away, get your monitoring orders in place right from beginning so you know if patient's mental status is getting better.

[ArchivalUser]

50 year old with purpuric rash and Thrombocytopenia in clinic , case work - up anyone?

[ArchivalUser]

Archer CCS strategy 10.

Monitoring blood pressure via, arterial line.
Arterial lines are indicated when you want to accurately measure the mean arterial pressure to titrate the rate of continuous infusions of vasopressors or antihypertensives. This is more accurate than non-invasive BP measurements. This is invasive procedure so should only be ordered when indicated. A-line is also done when you want frequent blood gas analysis (ABG) in acidosis or respiratory failure patients.

Placing A-line is scored on exam when indicated. This is a crucial step to titrate vasoactive drugs
Place an order for "arterial catheter" in cases of
1. Shock requiring vasopressors to sustain Blood Pressure and maintain MAP > 65. Eg: Septic shock not responding to IV hydration alone and is on pressors like norepinephrine or dopamine. You need to place A-line to adjust the flow rate of these drugs to target accurate MAP.
2. Hypertensive emergencies requiring continuous infusions of antihypertensive drugs eg: Sodium nitroprusside in hypertensive emergency/ stroke from hypertensive emergency where it is critical to maintain a target BP accurately

[ArchivalUser]

good one on the A-line indications, thanks

[ArchivalUser]

Encephalopathy cases on CCS, different scenarios - approaches --anyone?

[ArchivalUser]

Under encephalopathy, often asked are
1. Hepatic encepalopathy case
2. TCA overdose
3. Hypoglycemia
4. Sepsis - metabolic encephalopathy
...

[ArchivalUser]

it's clear why CCS matters so much https://archerusmleblog.com/usmle-step3-...rformance/

[ArchivalUser]

Thank you iara2.

[ArchivalUser]

Any updates to Archer's workshops: http://www.usmleforum.com/showthread.php?tid=723751