Archer Online CCS Workshop - powerpoint slides. During the workshop, this live lecture is followed by interactive practice of various mock clinical cases in medicine. These powerpoint slides are samples of High-Yield concepts discussed during Archer Live Online CCS workshop and pay-Per-view

1. CCS Workshop A component of Archer Online USMLE Reviews WWW.CCSWORKSHOP.COM USMLE Galaxy, LLC All Rights reserved. “ Dr.Red CCS Workshop” and “Archer CCS Workshop” are the trademarks owned by USMLE Galaxy, LLC

14. Simple Guidelines for antibiotic management of Sepsis/ Infections on a CCS case Metronidazole p.o. If resistant, use vanco p.o ( do not use I.V vanco – not effective) c.difficle Pseudomembranous colitis/ C.Difficle Diarrhea Vanco+Ceftriaxone. If listeria suspected, add Ampicillin. Give Dexametasone prior to antibiotics S.pneumonia, H.influenzae, N.meningitidis, E.coli. In ages < 1month or > 50 years -Listeria Meningitis Quinolone, ceftriaxone, extended spectrum beta lactums, if enterococci is present  use ampicillin or vancomycin E.coli, proteus Enterococci Urinary tract infections Use good anerobic coverage : Cipro+flagyl, Pip/tazo, Ertapenem, Imipenem. Do not use cephalosporin alone ( add metronidazole if using it) Enteric gram –ve rods ( E.coli), Anerobes (B.fragilis) Intra abdominal infections ( diverticulitis) Use anti-pseudomonal drugs – PIP/TAZO + quinolone, Cefepime, Imipenem, Vancomycin (if MRSA suspected) Resistant gram –ves (ESBL), Pseudomonas, MRSA Late Hospital Acquired Pneumonia ( > 5days) PIP/TAZO, Unasyn, Cefepime or newer quinolone Gram negative rods – non resistant ( e.coli, proteus, klebsiella), S.pneumonia, H.influenzae, legionella Early Hospital Acquired Pneumonia ( < 5 days) Third generation cephalosporin + macrolide or Newer Quinolone S.pneumoniae, Legionella, mycoplasma, H.influenzae Community acquired pneumonia Emperical therapy Possible “Bugs” “ Presumed” or “Known” site of infection

15. ER Setting – A simple approach Address pain first and then come back to physical screen ( except in abdominal pain – do abdomen exam first and then address pain) “ “ Vitals” stable but History reveals severe “pain” Full physical and then go to “order” sheet “ Vitals” are “Stable” no “ Pain” Proceed to “Order sheet” and try to stabilize. Write “Stabilizing” orders, “Basic” orders, “Symptom” relieving orders. Write “Specific” diagnostic tests and “Specific” treatment since you already have a clue about the diagnosis from the history ( Some examples: Anaphylactic shock, Hypovolemic shock from MVA , strong clues of “PE” in the history ) “ Vitals” are “UNSTABLE” ( Shock or respiratory failure) + you have a clue about the diagnosis from the history Go to “physical screen “ – do a very focused physical ( 2 minutes – Chest and Cardiovascular. Consider “abdomen” only if history revealed abdominal pain or trauma)  Proceed to order sheet (Remember that when you have no clue from the history, a “Life” saving step for a severely unstable vital may not be identified until you do the “2-Minute” ( Chest, Cardiovascular) physical). Remember that if this step is done early ( less “Simulated” time), you will get maximum score Vitals” are very unstable + you, absolutely, have no clue about the diagnosis from the history Next Step on CCS Presenting Issue

48. Shock

49. Respiratory Failure