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careful guys!!! - legionella
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07-05-2007, 06:13 AM
Recently in ccs cases at least three of them has dual diagnosis so u may see even after treating the initial problem the patient is not getting better so look for secondary problem eg I had UTI with new onset Diabetes Mellitus. For most of us it had been the first 3 cases but it may be different for you.
07-05-2007, 06:30 AM
it does not matter if the patient has triple, quadruple dx. The board does not grade you on Dx (remember that). So, you have to Rx the patient base on their presentation. You cant get paranoid and go searching for CCS case w/more than 1 dx.
07-05-2007, 06:41 AM
I agree with you but many of my friends became really anxious as the patient was not getting better which effected there next cases. So the reason I mentioned it that if you know about that you will be less anxious and do the right thing if at all there is another diagnosis. Board may not grade you on diagnosis but they will grade low you if treat UTI only but don't address diabetes as in my case.
07-05-2007, 06:57 AM
Sorry Legionella I have to disagree with you. The CCS cases are programmed in a very simple way. If patient is not getting better means you missed some important clues in the begingining itself either in history or physical. They are not programmed in complexway.
07-05-2007, 07:02 AM
but I agree you have to treat the associated conditions also if they are not controlled.Copd patient with pneumothorax .Offcourse you have to treat pneumothorax first and make sure you get ABG and give albuterol nebs etc .Same thing for Diabetic patient with divertiulitis or cellulitis .Yes you have to see how his diabetes also. As primary physician you have to treat the main problem and see what are all the associated problems and do the screening vaccinations etc , but concentrate on mainthing there asking us
07-05-2007, 07:06 AM
My intention was to help not create any panic or confusion. I just wanted to inform everyone that for most of people had three complex cases. You are right rest of the cases were straight forward. Now here is what happened with one of my friends- by the time he figured out that patient may have another problem 19 minutes was over thus did not have enough time do anything. You are right we may miss something in the history, so we may go back and review the history or physical exam again.
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