How to order Blood cultures in CCS - USMLE Forums
USMLE Forums Logo
USMLE Forums         Your Reliable USMLE Online Community     Members     Posts
Home
USMLE Articles
USMLE News
USMLE Polls
USMLE Books
USMLE Apps
Go Back   USMLE Forums > USMLE Step 3 Forum

USMLE Step 3 Forum USMLE Step 3 Discussion Forum: Let's talk about anything related to USMLE Step 3 exam


Reply
 
Thread Tools Search this Thread Display Modes
  #1  
Old 08-27-2012
dr_mhm's Avatar
USMLE Forums Guru
 
Steps History: 1+CK+CS
Posts: 460
Threads: 100
Thanked 235 Times in 147 Posts
Reputation: 245
Syringe How to order Blood cultures in CCS

How do you order them?
I mean, you put in "blood cultures", advance a minute and start antibiotics if indicated. But usually you need a set of 2 or 3 cultures..., do you order them q 1hour and make sure you cancel the order after 2-3 hours?
Reply With Quote Quick reply to this message



  #2  
Old 08-27-2012
USMLE Forums Scout
 
Steps History: 1+CK+CS
Posts: 63
Threads: 8
Thanked 29 Times in 23 Posts
Reputation: 39
Default

I think this scenario arises in case of Infective endocarditis, in that case, yes we should order it every 1 hour for 3 samples before starting appropriate antibiotics and then cancel the order. Rest of the cases pretty much will suffice with one sample only.
Reply With Quote Quick reply to this message
  #3  
Old 08-27-2012
dr_mhm's Avatar
USMLE Forums Guru
 
Steps History: 1+CK+CS
Posts: 460
Threads: 100
Thanked 235 Times in 147 Posts
Reputation: 245
Default

Quote:
Originally Posted by Wisconsin View Post
I think this scenario arises in case of Infective endocarditis,in that case ,yes we should order it every 1 hour for 3 samples before starting appropriate antibiotics and then cancel the order.Rest of the cases pretty much will suffice with one sample only.
Mmh...., I'm not sure as you usually require multiple blood cultures in different settings, endocarditis is one, but sepsis would be another one....
I don't know if getting just one would be considered appropriate...
Reply With Quote Quick reply to this message
 
  #4  
Old 08-27-2012
DRFP's Avatar
USMLE Forums Veteran
 
Steps History: ---
Posts: 281
Threads: 35
Thanked 99 Times in 54 Posts
Reputation: 109
Default

Quote:
Originally Posted by Wisconsin View Post
I think this scenario arises in case of Infective endocarditis,in that case ,yes we should order it every 1 hour for 3 samples before starting appropriate antibiotics and then cancel the order.Rest of the cases pretty much will suffice with one sample only.
One set and start antibiotics broad spectrum, look at MTB step 3 Dr. Fischer covers this

Do not worry on what an ID doc would do or what is done elsewhere only what they want for the boards
Reply With Quote Quick reply to this message
  #5  
Old 08-28-2012
USMLE Forums Scout
 
Steps History: 1+CK+CS
Posts: 63
Threads: 8
Thanked 29 Times in 23 Posts
Reputation: 39
Default

Quote:
Originally Posted by dr_mhm View Post
Mmh...., I'm not sure as you usually require multiple blood cultures in different settings, endocarditis is one, but sepsis would be another one....
I don't know if getting just one would be considered appropriate...
For CCS only in Infective endocarditis, in rest of cases take blood culture and start antibiotic, but in IE you cannot start antibiotic before collecting 3 samples, that's the algorithm and CCS is scored based on algorithms and no human checks it.
Reply With Quote Quick reply to this message
  #6  
Old 08-28-2012
DRFP's Avatar
USMLE Forums Veteran
 
Steps History: ---
Posts: 281
Threads: 35
Thanked 99 Times in 54 Posts
Reputation: 109
Default

Quote:
Originally Posted by Wisconsin View Post
For CCS only in Infective endocarditis,in rest of cases take blood culture and start antibiotic,but in IE you cannot start antibiotic before collecting 3 samples,that's the algorithm and CCS is scored based on algorithms and no human checks it.
Yet USMLE WOrld cases for CCS is different
Blood culture
then ABX
then adjust
taking three samples are not choice on the test

I'm not sure I get what you are saying unless you are ordering 3 Blood cultures at one time

you would never wait till a blood culture to come back before Antibiotics since your patient would be DEAD

From Emedicine, " In the setting of acute IE, institute antibiotic therapy as soon as possible to minimize valvular damage. Three to 5 sets of blood cultures are obtained within 60-90 minutes, followed by the infusion of the appropriate antibiotic regimen. By necessity, the initial antibiotic choice is empiric in nature, determined by clinical history and physical examination findings." How do you do this? Order blood cultures Q 1 hour, other orders with it and then after 3 hours of the case order the ABX? REally the software is not sophisticated enough, I feel that this can be messed up because you need to start ABX ASAP

Last edited by DRFP; 08-28-2012 at 10:41 AM.
Reply With Quote Quick reply to this message
  #7  
Old 08-28-2012
DRFP's Avatar
USMLE Forums Veteran
 
Steps History: ---
Posts: 281
Threads: 35
Thanked 99 Times in 54 Posts
Reputation: 109
Default

So do this on CCS


Order bloodcultures every hour stat, order other things and per the day clock 3 hours later order the IV antibiotics and D/C the BC?

In the mean time stuff like labs and echo being done?

This is confusing per UW for CCS
Reply With Quote Quick reply to this message
  #8  
Old 08-28-2012
dr_mhm's Avatar
USMLE Forums Guru
 
Steps History: 1+CK+CS
Posts: 460
Threads: 100
Thanked 235 Times in 147 Posts
Reputation: 245
Default

Quote:
Originally Posted by DRFP View Post
So do this on CCS


Order bloodcultures every hour stat, order other things and per the day clock 3 hours later order the IV antibiotics and D/C the BC?

In the mean time stuff like labs and echo being done?

This is confusing per UW for CCS
I find UW CCS very confusing in many ways.
I would do: blood culture x 1, start abx, get another blood culture anyway an hour later (you took the first one without abx). not sure if that's correct...

And I agree, don't delay Abx for 3 hours just because of cultures!
Reply With Quote Quick reply to this message
  #9  
Old 08-28-2012
DRFP's Avatar
USMLE Forums Veteran
 
Steps History: ---
Posts: 281
Threads: 35
Thanked 99 Times in 54 Posts
Reputation: 109
Default

Quote:
Originally Posted by dr_mhm View Post
I find UW CCS very confusing in many ways.
I would do: blood culture x 1, start abx, get another blood culture anyway an hour later (you took the first one without abx). not sure if that's correct...

And I agree, don't delay Abx for 3 hours just because of cultures!
Well E medicine does say to delay 3 hours? I dunno it seems wrong to delay because I do not see why? Why not 3 at same time if worried
Reply With Quote Quick reply to this message
  #10  
Old 08-28-2012
USMLE Forums Scout
 
Steps History: 1+CK+CS
Posts: 63
Threads: 8
Thanked 29 Times in 23 Posts
Reputation: 39
Default

Guys I think we cannot start antibiotics before 3 BC samples.I had done Archers and in it Dr.Red has very nicely explained this fact and I agree on it personally.....but everyone can have their take on this issue. Whatever the fact is regarding timing might be confusing, but Antibiotics are not started before 3 blood cultures, that's for sure.
Reply With Quote Quick reply to this message
  #11  
Old 08-28-2012
USMLE Forums Scout
 
Steps History: 1+CK+CS
Posts: 63
Threads: 8
Thanked 29 Times in 23 Posts
Reputation: 39
Default

Quote:
Originally Posted by DRFP View Post
Well E medicine does say to delay 3 hours? I dunno it seems wrong to delay because I do not see why? Why not 3 at same time if worried
Please see the Major criteria for IE.We need 2 +ve cultures with certain organisms. Also one of minor criteria concerns +ve blood culture.
Reply With Quote Quick reply to this message
  #12  
Old 08-31-2012
DRFP's Avatar
USMLE Forums Veteran
 
Steps History: ---
Posts: 281
Threads: 35
Thanked 99 Times in 54 Posts
Reputation: 109
Default

Quote:
Originally Posted by Wisconsin View Post
Please see the Major criteria for IE.We need 2 +ve cultures with certain organisms.Also one of minor criteria concerns +ve blood culture.
Yes you need + blood cultures for IE true
but if you have a fever and suspect it you MUST start ABX that day, you can not wait days for BC to come back to Know.

Unless I misunderstand you
Reply With Quote Quick reply to this message
  #13  
Old 09-01-2012
USMLE Forums Scout
 
Steps History: 1+CK+CS
Posts: 63
Threads: 8
Thanked 29 Times in 23 Posts
Reputation: 39
Default

Quote:
Originally Posted by DRFP View Post
Yes you need + blood cultures for IE true
but if you have a fever and suspect it you MUST start ABX that day, you can not wait days for BC to come back to Know.

Unless I misunderstand you
I just meant that after collecting 3 Bc's then we start antibiotics and not before that. You are absolutely correct, we cannot wait days to start antibiotics
Reply With Quote Quick reply to this message
  #14  
Old 09-04-2012
dr_mhm's Avatar
USMLE Forums Guru
 
Steps History: 1+CK+CS
Posts: 460
Threads: 100
Thanked 235 Times in 147 Posts
Reputation: 245
Default

This just happened to me. If you order blood cultures q 1hour in UW you can't D/C them after 3 hours!!! If you do so, the whole order gets cancelled and you never get your initial results.
So, I would go just for blood cultures "stat" and that's it. I think in CCS case we can forget about times 3 or whatever simply because we can't d/c them afterwards and don't want blood cultures q 1 h indefinitely
Reply With Quote Quick reply to this message
The above post was thanked by:
doc.mav (09-04-2012)
  #15  
Old 09-04-2012
USMLE Forums Veteran
 
Steps History: 1+CK+CS+3
Posts: 236
Threads: 12
Thanked 194 Times in 98 Posts
Reputation: 206
Default

Quote:
Originally Posted by dr_mhm View Post
This just happened to me. If you order blood cultures q 1hour in UW you can't D/C them after 3 hours!!! If you do so, the whole order gets cancelled and you never get your initial results.
So, I would go just for blood cultures "stat" and that's it. I think in CCS case we can forget about times 3 or whatever simply because we can't d/c them afterwards and don't want blood cultures q 1 h indefinitely
I agree,on CCS software you have to act differently.In real life it is 3 BS and then Antibiotic,but on CCS you do BS and then Antibio.
Reply With Quote Quick reply to this message
The above post was thanked by:
DRFP (09-04-2012), Wisconsin (09-05-2012)






Reply

Tags
CCS-

Quick Reply
Message:
Options

Register Now

In order to be able to post messages on the USMLE Forums forums, you must first register.
Please enter your desired user name, your email address and other required details in the form below.
User Name:
Password
Please enter a password for your user account. Note that passwords are case-sensitive.
Password:
Confirm Password:
Email Address
Please enter a valid email address for yourself.
Email Address:
Medical School
Choose "---" if you don't want to tell. AMG for US & Canadian medical schools. IMG for all other medical schools.
USMLE Steps History
What steps finished! Example: 1+CK+CS+3 = Passed Step 1, Step 2 CK, Step 2 CS, and Step 3.

Choose "---" if you don't want to tell.

Favorite USMLE Books
What USMLE books you really think are useful. Leave blank if you don't want to tell.
Location
Where you live. Leave blank if you don't want to tell.

Log-in

Human Verification

In order to verify that you are a human and not a spam bot, please enter the answer into the following box below based on the instructions contained in the graphic.



Thread Tools Search this Thread
Search this Thread:

Advanced Search
Display Modes


Similar Threads
Thread Thread Starter Forum Replies Last Post
Order of LoRs in ERAS firstaid150 IMG Residency Match Forum 1 07-29-2012 08:25 PM
The order of doing NBMEs! ballers USMLE Step 1 Forum 2 07-02-2012 03:46 PM
EKG Stress Test; To Order or Not to Order tyagee USMLE Step 2 CK Forum 1 05-21-2012 07:33 PM
About to order Pathoma! :D Dr.NickRiviera USMLE Step 1 Forum 7 01-14-2012 10:11 PM
Blood Brain Blood CSF Barriers Difference Sabio USMLE Step 1 Bits & Pieces 0 09-25-2009 08:23 AM

RSS Feed
Find Us on Facebook
vBulletin Security provided by vBSecurity v2.2.2 (Pro) - vBulletin Mods & Addons Copyright © 2017 DragonByte Technologies Ltd.

USMLE® & other trade marks belong to their respective owners, read full disclaimer
USMLE Forums created under Creative Commons 3.0 License. (2009-2014)