@nataliamullins6919

Key points:
1. Timing (1:01)
Real time = the actual time/real world time, which is 10-20 min.
Simulated time = hypothetical time, which can last from hours to days to weeks.

2. What to look for in case's introduction (2:18)
Age
Gender
Allergies
Main HPI points
Screening (vaccinations, pap smear, colonoscopy, etc)

3. Physical exam (3:45)
Complete physical exam --> if patient is stable or in the office
Focused physical exam --> if patient is unstable or in the ED; you can always do a complete PE later in the case after putting in emergency orders!

4. Disposition (4:35)
Where do you want the patient to be? Options: home, ED, admit to inpatient, admit to ICU. 

5. Emergency orders (5:55)
MAVOCCF, which stands for:
Morphine
Acc (gives you IV access and glucose accucheck)
Vitals check
Oxygen/oximeter
Cardiac monitor
C-spine
Fluids (normal saline)

6. Routine orders (6:51)
CCCMP
CUAEH
LLUSCENT 
stands for:

CBC, CMP, Creatine phosphokinase, Magnesium, Phosphate
Chest x-ray/other x-rays, Ultrasounds, Abg, Ecg/other cardiac tests, Hcg
Lactate,  Lft/pt/ptt/inr, Urinalysis/culture/toxicology, Stool culture/pH/ova/etc, Culture (blood), Esr/crp, Neuro checks, Tsh

7. You should land on a diagnosis by this point and thus, a treament (9:09)

8. Case might finish early if you have managed the patient correctly (9:27)

9. Once the case finishes, you have 2 minutes at the end to put in last minute- orders (10:00). 
These can be pap smears, colonoscopies, vaccinations, counseling the patient on various topics. 
SITPM (vaccines)
CPM (screening tests)
ISSSAD (counseling)

Shingles
Influenza
Tetanus
Pneumococcal
Meningococcal

Colonoscopy (50-75 yrs, every 10 years)
Pap smear (21-65 yrs, every 3 years)
Mammography (50-75 yrs, every 2 years)

Instruct
Smoking cessation
Safe sex
Seatbelt
Alcohol abstention
Disease specific (diabetes, medication side effects, etc)

@ethankeller961

Here is a summary of the entire first part of the video (some of this is abbreviated so hopefully it makes sense, but you can watch and read along)

CCS Cases

Things to look for initially (brief skim of H&P) - write these on scratch sheet
1. Age
2. Gender
3. Allergies
4. Brief skim of hx
5. Screening/vaccines/social hx (smoke, drink, drugs, sexual hx)
**skimming hx - buzzwords (they don’t want to trick you, dx is sometimes very very obvious)
ex: RUQ pain exacerbated by fatty foods - gallstones
They want to see if you can put in orders correctly, in correct order, and rule out other scary things (i.e ACS, pancreatitis etc)

VS

Exam:
1. If pt stable (i.e. in clinic and HDS) - complete physical (especially hitting the things they present with)
2. If pt unstable - not doing complete PE, wastes “simulated” time, need to “act fast” and do a focused PE

Disposition - Where do you want the patient to be?
1. Home
2. ED
3. Admit
4. ICU
STAT orders - Do you want to place any emergency orders?
Mnemonic - MAVOCC + F (not all needed, but reminder of some HY examples)
1. Morphine
2. ACC (gives you IV access and glucose accuchecks)
3. Vitals check
4. Oxygen/oximeter
5. Cardiac monitor
6. C-spine
7. Fluids (NS)

Orders (mnemonic) - tailor these tests to your ddx, don’t order all every time for every patient
CCCMP
CUAEH
LLUSCENT
1. CBC
2. CMP
3. Creatine phosphokinase (CPK/CK)
4. Magnesium
5. Phosphate

1. CXR (or any XR)
2. US
3. ABG
4. ECG (other cardiac tests - echo, troponins)
5. B-HCG (repro age like <45-50 yo)

1. Lactate
2. LFT/PT/PTT/INR
3. UA/cx/UDS (or toxicology)
4. Stool cx/pH/Ova etc
5. Culture (blood, sputum etc)
6. ESR/CRP
7. Neuro checks
8. TSH

Ex: 20 minute case (real-world time)
- Takes you 10 minutes to complete (real time)
- You treat pt perfectly
- Case will end early
- If you get major big things, haven’t done anything super wrong, and pt is improving —> case will end early and you have 2 minutes at the end to put in extra orders
**refer back to scratch paper for quick reference for these below
1. Screening tests - i.e. colonoscopy, Pap smear, mammography
2. Vaccines - shingles, tetanus, pneumococcal
3. Counseling patient - i.e. smoking/drinking/drug cessation, medications, compliance, side effects, safe sex (if STI case), seat belt

SITPM
CPM
ISSSAD

SITPM
Vax - based on case, age, gender etc
1. Shingles - zoster max - >50 yo, 2 dose series, now then in 2-6 mo
2. Influenza/COVID - fall/winter season (RSV >60 yo)
3. Tetanus - q10years
4. Pneumococcal >65 (or susceptible to encapsulated organisms)
5. Meningococcal - 2-dose at 11-12 yo and 16 yo

CPM
Screening
1. Colonoscopy - 45-75 yo (q10years if no abn)
2. Pap smear - (21-29 yo) q3yr w/ cervical cyto alone
			  - (30-65) q3yr w/ cervical cyto alone, q5yr w/ high-risk HPV testing alone, or q5yr w/ hrHPV w/ cyto (co-testing)
- Chlamydia/gonorrhea - all sexually active women <24 yo and >25 yo at increased risk for infection 
3. Mammography - 50-74 yo - biennial screening

ISSSAD
Instructing patient - when you type “instruct” into order search, gives you lots of options
1. Instruct
2. Smoking
3. Safe sex
4. Seatbelt
5. Alcohol abstention 
6. Disease specific instructions

@salamalvi3690

This was a phenomenal video bro. I used all your ccs mnemonics and tips and passed with ease. Thank You !

@sarahhmaidan6754

By far the best video on this content. Thank you so much for taking the time to make this!

@lesc1234

my test is on Monday and this was great!!! you gave me some ideas on how to optimize my time. thanks doc!!

@namratasethi5420

Very helpful. Makes CCS feel less overwhelming. Thank you!

@anmolsaggar9525

Extremely thorough yet succinct. Thank you for this gem.

@AB-xd8ft

one of the most informative videos of my lifetime really really thank you

@alejandrolopez1868

Where are u located? 
That lemon tree looks stunning !

@VallousseB

This was extremely helpful.  Thanks so much for putting this together.

@EdwinSaji

Thank you, found this video the day before my exam, and it helped a ton!

@muhammadhamzashahab1704

You are an absolute legend.

@MalikKhan_925

Wonderful! Really helpful. I can finally open my CCS and start solving the cases with confidence!

@abbeyerwin2097

Wow, this was so incredibly helpful!!

@mb5101

I really needed this video. Thank you so much

@uth-psy

Super Helpful. Instead of trying to memorize those terrible acronyms, I changed a few. 
Emergent orders : FAV-MOCCA 
Workup orders: LUNCHMEATS 4CLUE-P
Admit/Treatment orders: CICADA FLAB
Closing orders: STIMP shots and CP SADISMS
The admit/treatment one I made up: Consult, Insulin, Counsel meds, Abx, Diet, Acid, Fever/pain, Laxative, Activity, Blood (T/S/Transfuse)

@leyrezubiri6584

Thank you so much for the video. It's really helpful!  I don't think you need prophylactic cefazolin on the cholecystitis case as you already started therapeutic piperacillin-tazobactam. Thanks again!

@samimazizi90

This is amazing, thanks buddy

@GypsyZoya

Amazing, so helpful!! you should be paid by the CCS cases :D

@anishalewis7958

SO helpful! Thank you!