I took my day 2 yday. I bombed 2 cases. One case I dunno what it was and had to eventually intubate coz the pt was deteriorating and tuning blue. Similarly another case was also presenting acutely and it was throwing negative updates and I had no option but to intubate coz I was losing the pt. Both the cases got better and the case ended. How screwed am I?
Devastated
- Thread starter grakg
- Start date
So I had a diabetes patient that I gave dietary counseling and exercise counseling to but the case ended before I gave therapy. Also didn’t check platelets or inr in any heparin warfarin patients. Gosh I just need to pass!!!!
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If time permits, advancing the case to get back INR results will guide you on timing of heparin discontinuation. This alone should not cost you lot of points. But this is one reason why it is better to choose "Rivaroxaban" rather than warfarin in managing DVT/ PE cases on exam. UWorld has not updated their software but exam software has Rivaroxaban as an option to Rx VTE. Choosing this reduces the burden of INR monitoring, heparin bridge and navigating the clock and will obviously get you good score.
USMLE - DOACs on CCS
I'm currently doing the Uworld CCS cases and I've just come across two cases in which DVT/PE is treated with warfarin and heparin bridging. Now where I practice, uncomplicated DVT/PE is just treated with apixaban/rivaroxaban/whichever right off the bat, sometimes with prior LMWH/UFH if there is...
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If time permits, advancing the case to get back INR results will guide you on timing of heparin discontinuation. This alone should not cost you lot of points. But this is one reason why it is better to choose "Rivaroxaban" rather than warfarin in managing DVT/ PE cases on exam. UWorld has not updated their software but exam software has Rivaroxaban as an option to Rx VTE. Choosing this reduces the burden of INR monitoring, heparin bridge and navigating the clock and will obviously get you good score.
Best wishes!USMLE - DOACs on CCS
I'm currently doing the Uworld CCS cases and I've just come across two cases in which DVT/PE is treated with warfarin and heparin bridging. Now where I practice, uncomplicated DVT/PE is just treated with apixaban/rivaroxaban/whichever right off the bat, sometimes with prior LMWH/UFH if there is...
Any idea about my situation? This wait sucks!If time permits, advancing the case to get back INR results will guide you on timing of heparin discontinuation. This alone should not cost you lot of points. But this is one reason why it is better to choose "Rivaroxaban" rather than warfarin in managing DVT/ PE cases on exam. UWorld has not updated their software but exam software has Rivaroxaban as an option to Rx VTE. Choosing this reduces the burden of INR monitoring, heparin bridge and navigating the clock and will obviously get you good score.
Best wishes!USMLE - DOACs on CCS
I'm currently doing the Uworld CCS cases and I've just come across two cases in which DVT/PE is treated with warfarin and heparin bridging. Now where I practice, uncomplicated DVT/PE is just treated with apixaban/rivaroxaban/whichever right off the bat, sometimes with prior LMWH/UFH if there is...
- Joined
- Sep 22, 2017
- Messages
- 93
- Reaction score
- 75
@grakg; we almost never get to intubate on CCS cases. The reason is that intubation needs to be followed by Vent management which is complex - software is not designed for that. Step 3 tests us at FP level and not at critical care fellow level. Having said that, we must certainly understand the role of non-invasive ventilation in stabilizing the respiratory compromise patients. Such methods include NPPV such as BiPap, CPAP. Invasive intubation is only needed if the non-invasive methods do not work or are contraindicated.
But it appears like you did the case fairly well. And you are saying "intubating" made the patient better and you got that positive feedback from the software --- as long as you have made a diagnosis, stabilized the patient and have monitoring orders in place, you will capture most of the score. All the best!