Archer CCS Strategies discussion - iara2

[ArchivalUser]

Thanks great points ib1983

[ArchivalUser]

i am back

strategy#4
CCS = DANCE LIKE THE MOVIE STARS
How the CCS cases are scored? It is, according to Archer,
Dance (Diagnosis) Like (Location) Movie (Monitoring) Stars (Sequencing).
There are some slides here http://www.slideshare.net/usmlegalaxy/ar...kshop-2012

[ArchivalUser]

thanq more tips please

[ArchivalUser]

order

changing orders is important. have to be careful when moving patient around. like sending patient home from inward/er. Make sure to cancel oxy, IV, nss. order npo before surgery but cancel post surgery. go back to regualr diet/ soft diet depending on the case.

Examples Asthma patient excerbation you may start IV steroids but than change to oral while discharging and cancel IV.

DKA case. Start IV insulin change to subcutaneous once anion gap closes. or Change NSS to D51/2 SALINE ONCE BLOOD SUGAR IS BELOW 260. keep an eye on potasium at same time..

Sequencing is very important these changes i believe are part of sequencing the cases and very difficult indeed.

[ArchivalUser]

thanks 1b1983...u are great

[ArchivalUser]

Strategy#4
CASES ending before the allotted time: is this bad or good? How do we know? How do we monitor response criteria to know whether case that ended went good or bad?

We should monitor the criteria for response after putting an order or a step. The criteria for response can be improvement in vitals or improvement in patient symptoms or improvement in labs.
Instead of advancing the clock too far , we should check the criteria for response to see if we are going in the right direction and if the patient is improving. Advancing the clock too far if the patient is unstable and doing so without knowing if things are improving, can end the case because the patient may crash if we go too far in simulated time.
Criteria for each case is different. In Archer CCS, Dr.Red tells how to check each criteria and intervals , these are different for office and ER cases. He groups them under broad categories of SHOCK, RESPIRATORY FAILURE, Encephalopathy in ER Cases and sets the follow-up criteria.......for example checking Neurochecks in a coma patient to see if things improve with our treatment. If Neurochecks are not improving and when it is deemed irreversible, he asks us to intubate immediately - like example : TCA toxicity case.
So, we should keep an eye on patient progress through out the case and change our management at each step depending on the case response. UW or usmleconsult does not explain this monitoring or does not give feedbacks because they are softwares. It is important to know these tricks and practice them on exam FRED exam software.
Source post : misshyd@ http://www.usmleforum.com/showthread.php?tid=547685

[ArchivalUser]

thanks for adding to the thread ib1983.
Above Stategy#4 will help us know how much to advance clock and when to do that and how far in the simulated time. Monitoring is everything

[ArchivalUser]

That is so true Iara. Monitoring is very important. we should not move clock ahead so much unless we are sure patient is improving. and parameters are different for each case.

Neurochecks for stroke/TIA/Dizziness/vertigo
PT/PTT/ Bleeding time for Hemophilia/vwd/heparin therapy
pulse ox for COPD/ASthma Excerbations,/Forgeing body Apsiration/pneumonia/pcp/PE
cardiac monitor for Cardiac cases there are so many
bp monitor for shock with perforation or any shock could be ruptured aortic aneurysm
vitals/cbc for septic shock or cbc for cellulitis/septic arthritis
Glucsoe/bmp for Diabteic ketoacidosis or hypersomalar

If i am not wrong most of these monitoring are for ER cases for Office cases monitoring is mostly with follow up visit.
OR
ESR/CRP for Tempral Arteritis/polymalygia rhemtica/rhematoid arteritis/ulcerative colitis
Hem/hematocirt for Anemia

Please add more if you know any. I have so far seen these in U world cases and with Archer



Also toward the Final orders sometimes long term monitoring parameters are also ordered.
Like LFTS after starting statin therapy YOU MAY ALSO ORDER LIPID PROFILE TO SEE IF THEY ARE IMPROVING
Colonscopy after acute ulcerative colitis episode
HBAIC in diabetic
pt/ptt in someone with start warfarin therapy
TSH with hypothrodis or hyperthyroidism

we order these in final window orders and set the date for later time like month or so. we will not see results of these orders obvisousily and case will end. But we will be expected to order these atleast.

Excuse my spelling I type fast and make mistakes.

[ArchivalUser]

ib1983 thanks for the thorough list

[ArchivalUser]

iara, ib1983....most valuable contributions, thank you