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Please enter your name here. You have entered an incorrect email address! Leave this field empty. If you still feel your copyrights have been violated, then you may contact us immediately: Contact us: admin cmecde. Components that are scoredComponents that are scored Several of your approaches may be scored.
YourSeveral of your approaches may be scored. Unstable cases should be sent to ER asLocation of your treatment and evaluation. Unstable cases should be sent to ER as soon as possible after initial therapy in office. Doing tests in office takes longer than doing testssoon as possible after initial therapy in office.
Doing tests in office takes longer than doing tests in ER. If not met, send to ward. For example, stabilizing a patient Sequencing your orders. For example, stabilizing a patient firstfirst andand thenthen orderingordering an imaging study in aortic dissectionan imaging study in aortic dissection beforebefore obtaining a surgery consult. This is just an example! Sequencing will be demonstrated more in our practice cases. Monitoring parameters!. Define Shock or Respiratory failure.
Tachycardia per se, is not usually an unstable vital unless it isTachycardia per se, is not usually an unstable vital unless it is associated with irregular rhythm you will know on physical or Shock. A high temperature may not always becan also have fever. DoingDo not waste time doing complete physical. Fast treatment — first stabilize. After stabilizing and afterAfter stabilizing and after treating adequatelytreating adequately, you can proceed with, you can proceed with completecomplete physical do not forget it!
If raleschest is clear. IfIV Fluids. Order other MIcath. Order other MI managementmanagement By doing a 2pulmonary edema, MI with pulmonary edema, PE.
Start presumptive therapy with antibiotics but you should have a rationale regarding theWAIT! P monitoringContinuos B. If your patient isIf BP does not improve, add a pressor. If your patient is tachycardic, choose Nor-epinephrine. If your patient has atachycardic, choose Nor-epinephrine. If your patient has a low output state, use Dopamine. Do not use cephalosporinImipenem. Do not use cephalosporin alone add metronidazole if using it alone add metronidazole if using it Urinary tract infectionsUrinary tract infections E.
If listeria suspected, add Ampicillin. Give Dexametasone prioradd Ampicillin. Difficle DiarrheaDiarrhea c. If resistant, use vancoMetronidazole p. If resistant, use vanco p. V vanco — notp. Considerminutes — Chest and Cardiovascular.
ER settingER setting In most ER cases, you can proceed to the orderIn most ER cases, you can proceed to the order sheet to stabilize your patient or to treat thesheet to stabilize your patient or to treat the severe symptoms. But sometimes you do notsevere symptoms. General ApproachGeneral Approach Stabilization ordersStabilization orders Basic TestsBasic Tests Symptomatic treatment address signsSymptomatic treatment address signs also also Specific diagnostic tests if you have aSpecific diagnostic tests if you have a clue from the history.
If not please doclue from the history. If not please do focused physical before ordering disease-focused physical before ordering disease- specific tests specific tests Specific Treatment if you are pretty sure Specific Treatment if you are pretty sure Blood cx first, advance clock by 1 min and then antibiotics. This iscx first, advance clock by 1 min and then antibiotics.
This is very important in case of Infective Endocarditis wherevery important in case of Infective Endocarditis where blood cultures x 3 must be obtained 30 minutes apartblood cultures x 3 must be obtained 30 minutes apart before starting antibiotics —before starting antibiotics — cultures here dictatecultures here dictate management decisions further in that casemanagement decisions further in that case TEE in aortic dissection both take sameCT chest vs.
TEE in aortic dissection both take same time. Angiogram for PAD Look and exclude rapidly reversibleright away after giving dextrose. Look and exclude rapidly reversible causes of coma by using history, physical and lab testscauses of coma by using history, physical and lab tests hypoglycemia, opiod overdose, BZD overdose, hepatic hypoglycemia, opiod overdose, BZD overdose, hepatic encephalopathy etc before you prophylactically intubate for airwayencephalopathy etc before you prophylactically intubate for airway protection in comaprotection in coma - fingerstick glucose stat Accucheck ,- fingerstick glucose stat Accucheck , - naloxone given if opiates are suspected Pupils - naloxone given if opiates are suspected Pupils - thiamine added to IV fluids if alcoholic.
Not all comatose patients need this cocktail. Check theCheck the history — you may find clueshistory — you may find clues heat stroke, fever with heat stroke, fever with delirium, motor weakness with delirium, finger stickdelirium, motor weakness with delirium, finger stick glucose very high with delirium as in DKA or HONK glucose very high with delirium as in DKA or HONK If you are obtaining a surgical consult, get the consult first.
Then,If you are obtaining a surgical consult, get the consult first. If the surgeon did not accept, check carefully if yousurgery are met. If the surgeon did not accept, check carefully if you have met the criteria. If you have not, order necessary tests to meet thehave met the criteria. If you have not, order necessary tests to meet the criteria for surgery if surgery is indicated.
If you feel surgeon is notcriteria for surgery if surgery is indicated. Advancing clockAdvancing clock Advance only after putting appropriateAdvance only after putting appropriate ordersorders If you do not advance you will use up yourIf you do not advance you will use up your real time without nothing happening withreal time without nothing happening with the patientthe patient If you do not advance , it means you haveIf you do not advance , it means you have not implemented the orders you wrotenot implemented the orders you wrote Advance clock to get results when neededAdvance clock to get results when needed Before advancing clock!
Think twice is there anything else that needs toThink twice is there anything else that needs to be done, Esply true for ER Casesbe done, Esply true for ER Cases If you already stabilized the patient but had doneIf you already stabilized the patient but had done only focused physical at presentation in ER, youonly focused physical at presentation in ER, you may use this waiting time to complete your othermay use this waiting time to complete your other relevant physical - this is the time to do it — whilerelevant physical - this is the time to do it — while awaiting the lab results, imaging studies etc — doawaiting the lab results, imaging studies etc — do not advance the clock just to get results unlessnot advance the clock just to get results unless you have nothing else left to do.
Eg: you order a CBC — Let us say order time isEg: you order a CBC — Let us say order time is and report time is — do an interval hx and report time is — do an interval hx or a previously unfinished physical in the meanor a previously unfinished physical in the mean time that will automatically advance the clocktime that will automatically advance the clock further. Stop the clock function is a critical step. When you start advancing the clock to a future time, several results of the tests youWhen you start advancing the clock to a future time, several results of the tests you ordered or patient updates start to pop up.
Each result or patient update may give youordered or patient updates start to pop up. Each result or patient update may give you information that is important to accurately proceed with the case. If the result needs to be addressed immediately, stop the clock and put the immediate necessary treatment orders or diagnostic orders to addressclock and put the immediate necessary treatment orders or diagnostic orders to address that important result. If the result is trivial or if it can be addressed at a later time, you canthat important result.
If the result is trivial or if it can be addressed at a later time, you can choose to "continue" the clock until you reach the time you want. When the patient is atStop the clock" after the result is very important in office cases scenarios as well. When the patient is at "Home", the results still keep coming up before the patient's next appointment. You should look at the results"Home", the results still keep coming up before the patient's next appointment.
You should look at the results and if any result needs to be addressed immediately, you must "Stop the clock" and put in further tests orand if any result needs to be addressed immediately, you must "Stop the clock" and put in further tests or common oral treatments on the order sheet even though patient's location is showing at "HOME". If the resultscommon oral treatments on the order sheet even though patient's location is showing at "HOME". If the results are dangerous like a potassium of 2.
The software will regardwould advance the simulated time and will adversely affect your score on that case. The software will regard this as failure to address critical findings in a timely manner which may be life threatening to the patient. You mustIn office cases, when you press "Stop the clock" button previous appointment will be cancelled. You must reschedule the appointment after each time you stop the clock.
This memory of previously scheduledreschedule the appointment after each time you stop the clock. This memory of previously scheduled appointment is lost on the software because when you stop the clock you stop it because you saw anappointment is lost on the software because when you stop the clock you stop it because you saw an important result and such a decision may lead you to pre-pone or post-pone the appointment.
So, you mustimportant result and such a decision may lead you to pre-pone or post-pone the appointment. So, you must In some cases new firmware cannot support a backup file of the older firmware.
If this is the case, you will need to reconfigure the router manually. Go to download center for your Region on the TP-Link website. Then, select the appropriate drop downs for your TP-Link product. Choose the corresponding hardware version, click on Firmware. A list of available firmware will be displayed. Click the Upgrade button.
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