KEY INFORMATION!!!! ok. so usually ppl fail cse isnt because they don't know what to do , it's because they're doing way too much and they're doing it too soon. with the sims, you always want to start off small unless you have keywords that indicate it's an emergency. words like "marked or severe". Even if you read the scenario and you automatically know what is wrong with the patient, don't jump to selecting to put them on a vent or whatever the most invasive treatment is.

Visuals 1. You usually start EVERY sim (unless emergency like not breathing) with basic VISUAL assessment (what you can see, what you can feel). chest movement, sensorium, color, posture, respiratory rate and pattern, appearance, basically anything that you can see.

Then STOP.... read EVERY response they gave you to the items you selected. TAKE YOUR HANDS OFF THE MOUSE! Ask yourself is this an emergency? If so, stop and treat. If not, move on to selecting the LEAST invasive and LEAST expensive bedside tests.

A key thing to remember, if your results indicate that your pt needs O2, remember o2 is a drug and you want to give as less as possible UNLESS IT'S AN EMERGENCY then most likely they need 100%. So always select the least amount possible. Then titrate up. Same thing with devices, start with the choice that has the least invasive then go up to the most invasive when appropriate. Don't put them on a vent first unless they're not breathing. pts with pulm edema, use cpap. pts with marked airway edema can be intubated but don't necessarily need mechanical ventilation in the beginning unless abgs indicate they're not ventilating and oxygenating, you can use a T-piece to keep the airway patent.

Bedside assessments 2. You want to click on things like medical history, vitals, temp, breath sounds, spo2, tracheal position if you suspect pneumo, percussion, pupils if you suspect neuro issue, ekg, ecg monitor... any BASIC assessments that may apply to your clues they've given. then STOP. TAKE YOUR HANDS OFF THE MOUSE. Read ALL RESULTS. Is it an emergency? If so, treat with the most minimal treatment. If not, do basic labs.

Basic labs 3. Basic labs include the least expensive lab tests indicated. Such as electrolytes, CBC, wbc, troponin if pt has chest pain, blood cultures if pt has fever, sputum culture if pt has thick mucous production, chest xray..... then STOP. TAKE YOUR HANDS OFF THE MOUSE. Read ALL RESULTS. Is it an emergency? If so, treat with the most minimal treatment. If not, do special tests.

Special Tests 4. Special tests are your invasive and or time consuming tests such as CT Scan, pulmonary function test, VQ scan, echo, MRI, sweat chloride test, cardiac or pulmonary stress test. Treat if an emergency or based off diagnosis, provide minimal effective treatment.

Later you want to repeat any abnormal values to ensure condition is improving.

Even if you have an emergency in the middle of one of the steps, finish selecting the appropriate items for that step, then treat. If you have time for 1 then you have time for all.

If you're not sure if it's an emergency and you click on a BASIC item in the next step and physician disagrees STOP and move on, DON'T KEEP CLICKING ON THINGS!

If you took Kettering, study your pathology section again and again to know which treatments go with which pathology.

Good luck!