How should I use the CCS Runner effectively?

CCS Runner Overview

The CCS Runner simulates Step 3 clinical patient cases. Your goal is to recognize life-threatening problems, order appropriate tests and treatments in a timely way, and manage the case through to a safe disposition (admit, observe, or discharge).

How to Use CCS Runner (Step-by-Step)

1. Rapid Assessment (0–1 min):
   • ABCs; check responsiveness and immediate threats (e.g., airway obstruction, severe respiratory distress, shock).
   • Place on pulse oximetry and cardiac monitor; obtain vital signs and IV access; consider supplemental O?.
   • Point-of-care glucose if altered or ill-appearing.
2. Focused H&P (1–3 min):
   • Brief targeted history, medication/allergy review, and focused exam to shape a working differential.
   • Identify red flags that mandate STAT interventions or imaging.
3. Initial Orders (3–6 min):
   • Monitoring (vitals q15–60 min as appropriate), IV fluids if needed, analgesia/antiemetics, NPO when relevant.
   • Core labs and first-line imaging based on presentation (see checklists below).
   • Begin empiric therapy when indicated (e.g., antibiotics for suspected sepsis, bronchodilators/steroids for severe asthma).
4. Advance Time & Reassess (6–10 min+):
   • Advance time to when “STAT” results would return or treatment effects can be assessed; then re-check vitals, exam, and labs.
   • Escalate care or refine the plan based on new data.
5. Disposition & Follow-up:
   • Admit (floor vs ICU), observe, or discharge with clear instructions and safety-netting.
   • Address DVT prophylaxis, diet, activity, consults, and follow-up testing as appropriate.

Core Orders Checklist (Consider Early)

• Monitoring: Vital signs (set frequency), pulse oximetry, cardiac monitor.
• Access/Support: IV access; O? if hypoxic or in distress; NPO if possible procedure or aspiration risk.
• Point-of-Care: Bedside glucose for altered/ill-appearing patients; urine pregnancy test if relevant.
• Symptom Control: Analgesia, antipyretics, antiemetics, bronchodilators as indicated.
• Prophylaxis: DVT prophylaxis for admitted, reduced-mobility patients unless contraindicated.

Common Early Labs

• CBC, BMP (or CMP), ± LFTs, coagulation panel when indicated.
• Urinalysis ± urine culture; blood cultures if febrile/septic; lactate for possible sepsis/shock.
• Cardiac enzymes (e.g., troponin) for chest pain/ischemia; BNP if heart failure suspected.
• ABG/VBG for significant respiratory issues or metabolic emergencies.

Common Early Imaging

• CXR for dyspnea, chest pain with pulmonary features, fever with cough.
• ECG for chest pain, dyspnea, syncope, toxicity, or abnormal vitals.
• CT/MRI as guided by presentation (e.g., non-contrast head CT for stroke within the appropriate window; CT abdomen/pelvis for acute abdomen if stable).

Time Management

• Order → Advance → Reassess loop: After placing STAT/urgent orders, advance 15–30 minutes (or until results available), then reassess vitals, symptoms, and data.
• Don’t over-advance: If unstable or awaiting critical results, advance in shorter increments and re-check frequently.
• Batch smartly: Group appropriate labs/imaging and start indicated therapy before advancing time.

High-Yield Scenarios & Starter Bundles

Chest Pain (r/o ACS)

• ABCs; O? if hypoxic; cardiac monitor; IV access; vitals q15–30 min; ECG STAT; troponin now and repeat per protocol.
• CXR; CBC, BMP, coag panel if anticoagulation or procedure is possible; consider aspirin if no contraindications.
• Risk stratify; admit/observe vs discharge with follow-up based on findings.

Sepsis / Septic Shock

• ABCs, O?, two large-bore IVs; fluids (e.g., isotonic bolus) if hypotensive or lactate elevated.
• Broad-spectrum antibiotics after obtaining cultures; CBC, CMP, lactate, UA/urine culture, blood cultures ×2, CXR ± focused imaging.
• Frequent vitals; consider vasopressors if hypotension persists despite fluids; admit (often ICU).

DKA / HHS

• ABCs; IV fluids; bedside glucose; BMP (with anion gap), serum/urine ketones, VBG/ABG, serum osmolality, β-hydroxybutyrate if available.
• Insulin protocol with electrolyte monitoring and potassium repletion as indicated; admit.

Stroke / TIA

• ABCs; neuro checks; glucose; non-contrast head CT STAT; ECG; troponin if indicated.
• Labs: CBC, BMP, coagulation studies; consider thrombolysis/thrombectomy pathways when eligible; admit.

Asthma / COPD Exacerbation

• ABCs; pulse ox; O? to target saturation; inhaled bronchodilators; steroids; consider CXR if focal findings/fever.
• ABG/VBG if severe; escalate (e.g., magnesium, NIV) if needed; disposition based on response.

GI Bleed

• ABCs; two large-bore IVs; type & screen; CBC, BMP, coagulation; consider PPI; antiemetics; NPO.
• Resuscitate as needed; risk-stratify; consult GI for endoscopy; admit.

Pregnancy Considerations

• Always obtain pregnancy test when applicable; prioritize maternal stabilization first.
• Use pregnancy-safe imaging/meds; involve OB early for concerning presentations.

Disposition & Supportive Care

• Admit: Clearly specify location (floor vs ICU), monitoring level, diet, activity, nursing parameters, and consults.
• Discharge: Provide diagnosis (or working dx), meds, return precautions, and close follow-up.
• Inpatient extras to remember: DVT prophylaxis, bowel regimen if opioids, glycemic control, vaccination status when relevant, and patient counseling.

Common Pitfalls

• Delaying lifesaving interventions while waiting for tests.
• Not reassessing after advancing time or after major interventions.
• Missing pregnancy testing in patients of childbearing potential.
• Forgetting monitoring orders, diet/NPO status, or DVT prophylaxis on admissions.
• Ordering contraindicated tests/medications in unstable patients.

Quick Reference: General Initial Orders

• Vitals (set frequency), pulse oximetry, cardiac monitor
• IV access, O? if indicated, NPO if appropriate
• Point-of-care glucose (if altered/ill-appearing)
• Labs: CBC, BMP/CMP ± LFTs, UA ± culture, lactate if ill/septic
• ECG (chest pain/syncope/dyspnea), CXR if pulmonary/infectious concern
• Symptom control (analgesic/antiemetic/antipyretic/bronchodilator)
• Admit vs observe vs discharge; DVT prophylaxis if admitted

Practice & Feedback

Use multiple cases to build pattern recognition and pacing. After each case, review the feedback to see which early actions you missed, which orders were unnecessary or harmful, and where delays occurred. Turn those insights into a short personal checklist and apply it on the next run.

Educational use only. This content is designed for exam simulation practice, not real-world patient care.