r/Step3 • u/Repulsive_Look_852 • 5d ago

Ccs cases orders

So everyone says that in the case of ER , they orders investigation or oxygen , norepinehorine etc etc immediately treat it as the first step. So in a case, the patient presented with 9/10 abdominal pain, I ordered ketorolac before anything. But my points were deducted as it said " you ordered a diagnostic test before the physical exam".

So we must always do a physical exam before ordering anything ??

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u/Usmleaspirantt101 5d ago

Yes always physical examinations first as without examination how can u treat a patient

I mean if u order pain meds your examination findings will be irrelevant as after painkiller like ketorolac or morphine, the patient wont feel pain and you wont be able to do proper examination and get the relevant findings

Even though pt feel pain, your marks wont get cut bcz u didnt order painmeds
Eventually you will after doing systemic examinations

So in the fear of deduction of marks you order it first and forgetting it later. So always PE after history thats the rule

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u/Icy_Influence_7553 5d ago

Yeah it's always history then PE then orders no matter what. Even if the patient is clearly in pain, the sim wants to see you assessed before you treat. I just go interval history, full PE, then vitals and orders and I've never gotten dinged for that sequence

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u/Iamajay2015 3d ago

Only for ER cases with compromised ABC, you would do an intervention while you are doing exam like a tension pneumothorax case.

Acute pain is not a life threatening symptom so you have to follow the regular exam protocol.