Shotgun order lists that worked for me on the most common CCS chief complaints
Sharing what I used for CCS prep in case it helps. These are not gospel, just the defaults I built up over ~50 practice cases so I was not thinking from scratch in the first 60 seconds. Drop your additions/corrections in the comments and I will edit them in.
Universal first-minute orders (most cases):
- IV access, pulse ox, continuous cardiac monitoring
- CBC, CMP/BMP, UA
- ECG if any chest, syncope, dyspnea, or age > 50
- Pregnancy test for any female of reproductive age
Chest pain:
- High-sensitivity troponin (serial), CXR, ECG (within 10 min)
- ASA 325 chewed, sublingual nitro, heparin if ACS
- Statin (atorva 80), beta-blocker if no contraindication
- Cardiology consult once trop comes back
- (Morphine is no longer first-line in NSTEMI per recent guidelines - only if refractory pain on nitro)
Shortness of breath:
- CXR, ABG, BNP, D-dimer if PE suspected (CT-PA if positive)
- Supplemental O2 to keep sat > 92
- Nebs + steroids if wheezing
Abdominal pain:
- Lipase, LFTs, lactate
- Upright + supine abdominal x-ray
- US (RUQ) or CT abd/pelvis depending on age and exam
- NPO, IV fluids, antiemetic, analgesic
Altered mental status:
- Glucose first, always
- CBC, CMP, urine tox, blood alcohol
- CT head non-contrast
- LP if febrile or meningismus
- (Ammonia, B12, TSH only if the history actually points there)
GI bleed:
- Type and screen, coags, lactate
- 2 large bore IVs, IV fluids, PPI drip
- GI consult for endoscopy
Sepsis-looking:
- 2 sets blood cultures BEFORE antibiotics
- Lactate (repeat at 2-4h if elevated)
- Broad spectrum within 1 hour
- 30 mL/kg crystalloid bolus
Things I personally kept forgetting on practice cases: prophylaxis (DVT, GI), counseling/education, smoking cessation, and follow-up labs. Setting those as end of case defaults helped me a lot.
u/Key-Improvement-9729 — 6 hours ago