S.S.Patel Select Start Case to begin Maximum allotted case time 20 minutes + 5 minutes for case end orders Warning: Select anything on the screen other.

Slides:



Advertisements
Similar presentations
NEXTGEN VITAL SIGNS DEMONSTRATION
Advertisements

Agenda Sean add whatever you want Next phase of scenario prep
+ HEALTH INSURANCE: UNDERSTANDING YOUR COVERAGE Navigator Name Blank County Extension UGA Health Navigators.
April  Advanced Functions in AxiUm  Chart Audits.
1 STEMI PROTOCOL UNION HOSPITAL EMERGENCY DEPT.. 2 Presentation of Patient Patient presenting to ER with acute chest pain suspicious of cardiac origin.
GOING TO THE DOCTOR Prof. Teresita Rojas González.
Case present By Intern 劉一璋. Patient data Name: 陳 ○ 富 Sex: 男 Age: 71 歲 Date of admission: 96/08/09 Chart No:
Huda Al-Owairdy Clinical Pharmacy Dept.
History and Physical Examination Mike Clark, M.D..
Sickle Cell Disease: Core Concepts for the Emergency Physician and Nurse Acute Chest Syndrome Case Study David M. Cline, MD Wake Forest School of Medicine.
Medication Reconciliation
STROKE: 911 Emergency Learning Objectives for Stroke: 911 Emergency When you finish this course you will be able to answer the following questions: Where.
McKesson Upgrade - ER 11/12 What is ER 11/12? ER is “Enterprise Release” and 11/12 is the software version. This release will upgrade many parts of the.
Chest Pain and Cardiac Emergencies Chest Pain and Cardiac Emergencies WelcomeChest PainCertaintySimulation.
Case Discussion: Cell Injury At the end of the Case Discussion, the involved group is requested to submit a report of answers to all the questions asked.
Hospital Documentation
NEXTGEN VITAL SIGNS DEMONSTRATION This demonstration reviews the documentation of vital signs in NextGen. This is similar across all specialties. This.
The History and Physical Exam. The History Welcome the patient - ensure comfort and privacy Know and use the patient's name - introduce and identify yourself.
PROGRESS NOTE (SOAP Notes)
Central Sleep Apnea Problem Based Learning Module Vidya Krishnan, and Sutapa Mukherjee for the Sleep Education for Pulmonary Fellows and Practitioners,
Fundamentals I: Case studies Unit 1: checking the chart Go here for help with this unit: re/chart_%20interview.doc.
Sepsis Case study. A 78 year old female comes from the nursing home by ambulance. The nursing home said she seems weak and more tired than usual. She.
EMR Work Flow KNIGHTS Clinic at Grace Medical Home.
Acute Coronary Syndrome. Acute Coronary Syndrome (ACS) Definition of ACS Signs and symptoms of ACS Gender and age related difference in ACS Pathophysiology.
Angina and MI.
PROBLEM BASED LEARNING
A Case Study. The background You admitted MB after a LIMA-LAD, SVG x2, initial vital signs were stable – HR 75, BP 114/73, CVP of 5, Cardiac index was.
Brought to you by: TRANSITION OF CARE SUMMIT JULY 10, 2014.
RADIOLOGY ORDER ENTRY (ROE) WITH DECISION SUPPORT
HOME AND AMBULATORY BLOOD PRESSURE MONITORING
Perioperative Testing
Preparing Patients for the Operating Room Sugong Chen June 22, 2015.
E and M Audit Forms M. Cremers NOTE: Doctor must have asked / noted at least one of the above listed 10 components in the patient’s chart note.
NYU Medical Grand Rounds Clinical Vignette Karyn Singer, PGY3 September 22, 2010 U NITED S TATES D EPARTMENT OF V ETERANS A FFAIRS.
APPROACH TO CHEST PAIN. OBJECTIVES  1. Establish a differential diagnosis for chest pain  2. Know what clues to obtain on history to rule-in or out.
Example: Improving Care by Design of an EHR Lecture by Farrokh Alemi, Ph.D. Narrated by Jonathan Duxbury.
ICU Conference Teaser Age/Sex CC Brief Hx The idea is to have this slide up while folks are getting settled. It tells them you’re ready to go, so “sit.
Rhythm Strips Jessica Wagner UMSON. EKG Grid.
Computerized Physician Documentation Emergency Department September 2012.
NYU Medical Grand Rounds Clinical Vignette Maryann Kwa, MD PGY-3 March 20, 2012 U NITED S TATES D EPARTMENT OF V ETERANS A FFAIRS.
Case Study: Scope and Purpose This Case Study was developed to demonstrate the use of IMI telemedicine technology in a “real life” ophthalmic clinical.
Cardiovascular Pathology I. Cardiovascular Pathology I Case 1.
Unit 8 Case Study. Case Study The wife of a 67-year-old man called the office and reported that her husband awoke this morning with weakness and numbness.
What are the rest of his vital signs? What is his usual BP? How does he feel? Was this found on routine vital sign check or is something wrong?
GASTROINTESTINAL PATHOLOGY LAB #1 January 10, 2013.
Cardiac Emergencies and CPR
MedLifeCard in real-life scenarios Cost Saving Improved Patient Care.
PATIENT ASSESSMENT. Patient assessment in emergency medicine as performed by First Responders & EMS providers consists of 7 parts: 1._________________________________________________.
Chapter 5 Cardiac Emergencies.
Section VII. Home BP Measurement 2015 Canadian Hypertension Education Program Recommendations.
Case 60 F with PMH HTN, DM, CVA presented to UNC ED CC: seizure. Per the daughter the pt was walking and all of a sudden fell and her whole body started.
MYOCARDIAL INFARCTION. CASE 1 Mr. A: 38 years old He smokes 1 pack of cigarettes per day He has no other past medical history 8 hours ago, he gets sharp.
{ Challenging Case Presentations From South Texas Methodist Hospital REGIONAL SYSTEMS OF CARE DEMONSTRATION PROJECT: MISSION: LIFELINE™ STEMI SYSTEMS ACCELERATOR.
!. You are on call…. You get the page… West is calling--- Nurse: – “Mr. Jones in 3201 has chest pain” – “What should I do student doctor?”
Health Care terms and language (Health care records)
Objectives Review chest pain Define ACS
Medication Reconciliation using Web OMR
Background Information
Chapter 19 Vital Signs.
Health Care terms and language (Health care records)
Pulmonary Pathology November 27, 2017
HYPERTENSIVE CRISES Mini-Lecture.
Harper University Hospital Orientation
Assessment of the Medical Patient
Six Microskills for Clinical Teaching
Using the Software ProtoMED Practice Management and Electronic Medical Records software enables users to … View schedules View patient information View.
ProtoMED Practice Management and Electronic Medical Records Software
Respiratory Simulation
Harper University Hospital Orientation
Presentation transcript:

S.S.Patel Select Start Case to begin Maximum allotted case time 20 minutes + 5 minutes for case end orders Warning: Select anything on the screen other than start case may result in unrecoverable data and time loss This case may take 3 minutes to load Do not select “Next” unless instructed Next

Day 1: 10:00 am A 60-years old male comes to your office for refilling of his hypertension medicine OK Click here

Day 1: 10:00 am A 60-years old male comes to your office for refilling of his medication for hypertension. In your office, he suddenly develop severe chest pain. Patient describes pain as tearing chest pain. 9/10 in severity. He has not been taking his medicine for HTN regularly. Physical examination revealed unequal blood pressure in both arms. PMH: h/o HTN for last ten years Social History: smoking one pack of cigarette for last 20 years OK Click here There may be more information on the real exam usually but I’ve written only relevant points here. On the exam, you must have formulated your differential diagnosis by this time. Most of the cases are straight forward and usually less than three differential diagnosis if not straight forward.

Vitals: Temp – F Pulse – 115 RR – 19 BP – 190/110 OK Click here Up to this, you just click OK on the real exam. Once you click OK here, you are on your own. You need to take decision from here what you want to do with this patient

PE or Interval History Order Obtain lab results or see the patient later Patient Location Select an option above Click here This exam gives score according to the step you are taking in the patient’s care. It is not necessary to do physical examination first all the time. Atleast for this exam! So depending upon patient’s condition, you can write order first or start examination first. We all have nearly similar knowledge but software is the way to check how we apply our knowledge when it comes to patient’s care. If you follow standard protocol, you won’t have any problem on the real exam.

PE or Interval History Order Obtain lab results or see the patient later Patient Location Order Input: Confirm OrderCancel O-SAT IVA Oxygen EKG Transfer to ER (you can do that by clicking on patient location so do not need to write here in order) You can write everything at the same time or enter the order individually. When you click “Confirm Order”, It will ask you to verify your order by giving all available options for your order. For example: If you have written EKG, it may show you following options. EKG, 12 lead EKG, ambulatory EKG, monitor EKG, rhythm EKG, stress test USMLE software give all available option from first 3 letters you have entered Click here Once you click on “confirm order” it will follow the same way as you have already seen in other cases before. So I haven’t gone through all orders as I did before

PE or Interval History Order Obtain lab results or see the patient later Patient Location Order Verification: Confirm OrderCancel Oxygen Saturation Click here

PE or Interval History Order Obtain lab results or see the patient later Patient Location Order Qualifier: Confirm OrderCancel Oxygen saturation Urgency Stat Frequency Every: Hour Click here

PE or Interval History Order Obtain lab results or see the patient later Patient Location Order Verification: Confirm OrderCancel Oxygen Click here

PE or Interval History Order Obtain lab results or see the patient later Patient Location Order Qualifier: Confirm OrderCancel Oxygen Route Inhalation Click here Frequency One time/Bolus: Continuous:

PE or Interval History Order Obtain lab results or see the patient later Patient Location Order Verification: Confirm OrderCancel IV Access Click here

PE or Interval History Order Obtain lab results or see the patient later Patient Location Order Qualifier: Confirm OrderCancel IV Access Urgency Stat Frequency Every: Hour Click here

PE or Interval History Order Obtain lab results or see the patient later Patient Location Order Verification: Confirm OrderCancel EKG EKG, 12 lead EKG, ambulatory EKG, monitor EKG, rhythm EKG, stress test Click here

PE or Interval History Order Obtain lab results or see the patient later Patient Location Order Qualifier: Confirm OrderCancel EKG, 12 leads Urgency Stat Frequency Every: Hour Click here

PE or Interval History Order Obtain lab results or see the patient later Patient Location Order sheet Progress note Vital signs Lab report Imaging Other tests Tx Records Order Route/Urgency Frequency Time Order Time Report After you complete Ordering process (order input, order verification & order qualifier), you will see summary of your orders here with reporting time which will help you to advance the clock to see available lab results Click here

PE or Interval History Order Obtain lab results or see the patient later Patient Location Emergency Room ICU Ward Office Home Close Click here

PE or Interval History Order Obtain lab results or see the patient later Patient Location Order Review: Confirm MoveCancel You will see all orders that are pending. When you click “Confirm Move” It will show you the vitals for that time. Now patient is in the ward so to move on this case, you need to enter new orders Click here

PE or Interval History Order Obtain lab results or see the patient later Patient Location Order Input: Confirm OrderCancel Propranolol ASPIRIN Morphine Cardiac monitor Cardiac enzymes Vitals CBC BMP CXR You can write everything at the same time or enter the order individually. When you click “Confirm Order”, It will ask you to verify your order by giving all available options for your order. For example: If you have written EKG, it may show you following options. EKG, 12 lead EKG, ambulatory EKG, monitor EKG, rhythm EKG, stress test USMLE software give all available option from first 3 letters you have entered Click here Once you click on “confirm order” it will follow the same way as you have already seen in other cases before. So I haven’t gone through all orders as I did before

PE or Interval History Order Obtain lab results or see the patient later Patient Location Order Verification: Confirm OrderCancel Propranolol Click here

PE or Interval History Order Obtain lab results or see the patient later Patient Location Order Qualifier: Confirm OrderCancel Propranolol Route IV Oral Click here One time/Bolus: Continuous: Frequency

PE or Interval History Order Obtain lab results or see the patient later Patient Location Order Verification: Confirm OrderCancel Monitor, cardiac There will be a list of many things under monitor like monitor, fetal external; monitor, EKG, etc. Click here

PE or Interval History Order Obtain lab results or see the patient later Patient Location Order Qualifier: Confirm OrderCancel Monitor, cardiac Urgency Stat Frequency Every: Hour Click here

PE or Interval History Order Obtain lab results or see the patient later Patient Location Order Verification: Confirm OrderCancel Aspirin Click here

PE or Interval History Order Obtain lab results or see the patient later Patient Location Order Qualifier: Confirm OrderCancel Aspirin Route IV Oral Click here Frequency One time/Bolus: Continuous:

PE or Interval History Order Obtain lab results or see the patient later Patient Location Order sheet Progress note Vital signs Lab report Imaging Other tests Tx Records Order Route/Urgency Frequency Time Order Time Report After you complete Ordering process (order input, order verification & order qualifier), you will see summary of your orders here with reporting time which will help you to advance the clock to see available lab results Click here

PE or Interval History Order Obtain lab results or see the patient later Patient Location History Interval / Follow up Physical Examination Complete (order vitals from order sheet) Skin Lymphnode Cardiovascular Chest / Lung Head & Neck General appearance Abdomen Rectal Neuro exam Genitalia Extremities & Spine Breast OkCancel Click OK after you’ve selected the exam you want

Confirm H&P Choices: OkCancel PE or Interval History Order Obtain lab results or see the patient later Patient Location Physical Examinations General appearance………………………………1 min Head & Neck……………………………………… 2 mins Chest / Lung……………………………………… 1 min CVS………...……………………………………… 1 min Abdomen..………………………………………… 1 min Total minutes: 6 mins This will advance your clock to: Day am Click OK will advance your clock and will give you result of examination you have selected

History & Physical: OkCancel PE or Interval History Order Obtain lab results or see the patient later Patient Location You will see physical exam findings here. Signs are usually straight forward according to case. I have written only relevant information here. For this Case findings will be as follow: General Appearance: patient in severe pain CVS: murmur of aortic regurgitation Lung: CTA B/L HEENT: no JVD ABD: BS (+), spleen & liver not enlarged Click here

PE or Interval History Order Obtain lab results or see the patient later Patient Location Order sheet Progress note Vital signs Lab report Imaging Other tests Tx Records Order Route/Urgency Frequency Time Order Time Report After you complete Ordering process (order input, order verification & order qualifier), you will see summary of your orders here with reporting time which will help you to advance the clock to see available lab results Click here

Schedule Appointment On In With next available result Call/see me as needed PE or Interval History Order Obtain lab results or see the patient later Patient Location SonMonTueWedThuFriSat DaysHoursMins OkCancel Click here Add 15 mins

PE or Interval History Order Obtain lab results or see the patient later Patient Location Order sheet Progress note Vital signs Lab report Imaging Other tests Tx Records Order Route/Urgency Frequency Time Order Time Report By advancing clock to 10 mins, you will see the result of test that will be available in 10 mins. Once you see all result, you need to write order again as you did before. For this case, you will get result of cardiac monitor, vitals, CBC, BMP and CXR. So after you look at the results, you need to click on order to write new order. Click here

PE or Interval History Order Obtain lab results or see the patient later Patient Location Order Input: Confirm OrderCancel Chest CT scan Bed rest Click here Once you click on “confirm order” it will follow the same way as you have already seen in other cases before. So I haven’t gone through all orders as I did before

PE or Interval History Order Obtain lab results or see the patient later Patient Location Order Verification: Confirm OrderCancel Chest CT scan Click here

PE or Interval History Order Obtain lab results or see the patient later Patient Location Order Qualifier: Confirm OrderCancel Chest CT scan Urgency Stat Frequency Every: Hour Click here

PE or Interval History Order Obtain lab results or see the patient later Patient Location Order sheet Progress note Vital signs Lab report Imaging Other tests Tx Records Order Route/Urgency Frequency Time Order Time Report After you complete Ordering process (order input, order verification & order qualifier), you will see summary of your orders here with reporting time which will help you to advance the clock to see available lab results Click here

Schedule Appointment On In With next available result Call/see me as needed PE or Interval History Order Obtain lab results or see the patient later Patient Location SonMonTueWedThuFriSat DaysHoursMins OkCancel Click here Add mins to get CT scan result

PE or Interval History Order Obtain lab results or see the patient later Patient Location Order sheet Progress note Vital signs Lab report Imaging Other tests Tx Records Order Route/Urgency Frequency Time Order Time Report By advancing clock, you will see the result of test that will be available. Once you see all result, you need to write order again as you did before. For this case, you will get result of chest CT scan. So after you look at the results, you need to click on order to write new order. Click here

PE or Interval History Order Obtain lab results or see the patient later Patient Location Order Input: Confirm OrderCancel Consult surgery Click here Once you click on “confirm order” it will follow the same way as you have already seen in other cases before. So I haven’t gone through all orders as I did before

PE or Interval History Order Obtain lab results or see the patient later Patient Location Order Verification: Confirm OrderCancel Consult, surgery Click here

PE or Interval History Order Obtain lab results or see the patient later Patient Location Order Qualifier: Confirm OrderCancel Surgery consult Urgency Stat Frequency Every: Hour Click here

PE or Interval History Order Obtain lab results or see the patient later Patient Location Reason: Confirm OrderCancel Aortic Dissection needs emergency surgery Click here

PE or Interval History Order Obtain lab results or see the patient later Patient Location Surgery Consult: Confirm OrderCancel An emergency surgery has been schedule for this patient. If you think any additional tests or therapies are needed, order them Click here

PE or Interval History Order Obtain lab results or see the patient later Patient Location Order sheet Progress note Vital signs Lab report Imaging Other tests Tx Records Order Route/Urgency Frequency Time Order Time Report For this case, an emergency surgery has been schedule so Now it is time to ask the patient how he is feeling. Click here

PE or Interval History Order Obtain lab results or see the patient later Patient Location History Interval / Follow up Physical Examination Complete (order vitals from order sheet) Skin Lymphnode Cardiovascular Chest / Lung Head & Neck General appearance Abdomen Rectal Neuro exam Genitalia Extremities & Spine Breast OkCancel Click here

Confirm H&P Choices: OkCancel PE or Interval History Order Obtain lab results or see the patient later Patient Location Interval Follow-up………………………………2 mins Total minutes: 2 mins This will advance your clock to: Day am Click OK will advance your clock and will give you result of examination you have selected

Interval Follow-up: OkCancel PE or Interval History Order Obtain lab results or see the patient later Patient Location No change in patient’s condition

Case-end Instruction: OK PE or Interval History Order Obtain lab results or see the patient later Patient Location This case will end in 5 mins “Real Time” On the next screen finalize the order (adding / deleting) according to patient’s current condition then confirm your order and enter your diagnosis Click here

PE or Interval History Order Obtain lab results or see the patient later Patient Location Order Review : Write new OrderExit Case You will see all orders here. You can delete orders (just by click on it. It will ask you stop or cancel) which you don’t want to continue or you can write new orders by clicking on “Write new Orders” Click here Review Chart

PE or Interval History Order Obtain lab results or see the patient later Patient Location Order Input: Confirm OrderCancel Stop smoking Safe sex Educate patient Low salt diet Click here Follow ordering process as you have already gone through before

PE or Interval History Order Obtain lab results or see the patient later Patient Location Order Review : Write new OrderExit Case You will see all orders here. Now you can exit the case by click on “Exit Case”. Click here Review Chart

PE or Interval History Order Obtain lab results or see the patient later Patient Location Enter your final diagnosis : OK Aortic Dissection Click here