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The links below provide feedback on diagnostic and management steps for the sample Step 3 Computer-Based Case Simulations. These also appear at the end of the practice cases. The computer-based case simulation database contains thousands of possible tests and treatments. Therefore, it is not feasible to list every action that might affect an examinee's score.
Program Toko Ipos 4 Keygen Idm on this page. The descriptions are meant to serve as examples of actions that would add to, subtract from, or have no effect on an examinee's score for each case. Orientation Feedback for Tension Pneumothorax In evaluating case performance, the domains of diagnosis (including physical examination and appropriate diagnostic tests), therapy, monitoring, timing, sequencing, and location are considered. In this case, a 65-year-old man is brought to the emergency department by ambulance because of acute chest pain and respiratory distress. Initially the presentation and reason for visit suggest a broad differential diagnosis, but the limited available history narrows the differential. The patient had an acute onset of right-sided chest pain 10 minutes before the ambulance arrived. He rates the pain as an 8 on a 10-point scale.
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The pain is excruciating, sharp, and increases with respiration. The patient appears pale and in marked respiratory distress. He is moaning and holding his hands over the right side of his chest.
Vital signs show tachypnea, tachycardia, and low blood pressure. Physical examination shows no breath sounds; there is tracheal deviation, jugular venous distention, hyperresonance to percussion on the right side of the chest, faint heart sounds, and weak peripheral pulses. The skin is pale, cool, and diaphoretic. The remainder of the physical examination is unremarkable. The patient's illness, at this point, seems most consistent with an intrathoracic process. The computer-based case simulation database contains thousands of possible tests and treatments. Therefore, it is not feasible to list every action that might affect an examinee's score.
The following descriptions are meant to serve as examples of actions that would add to, subtract from, or have no effect on an examinee's score for this case. Timely diagnosis and management are essential in this case. An optimal, efficient diagnostic approach would include quickly performing a targeted physical examination that includes chest/lung and cardiovascular examination, cardiac monitoring, and assessing oxygen saturation by pulse oximetry.
Treatment should be initiated immediately before the patient’s condition worsens. Ordering anything that might delay treatment (eg, a 12 lead ECG, arterial blood gases, or a portable chest x-ray) would be suboptimal in this case if ordered before the patient’s condition is stabilized. As soon as the absent breath sounds and exam findings consistent with tension pneumothorax are discovered, optimal treatment would include performing a needle thoracostomy for decompression followed by a chest tube insertion for lung reexpansion. A chest x-ray should be ordered to confirm appropriate tube placement and lung reexpansion. The patient’s blood pressure and respiratory rate should be closely monitored until the patient’s condition has stabilized. Examples of additional tests, treatments, or actions that could be ordered but would be neither useful nor harmful to the patient include: • Bronchodilators • Complete blood count • Electrolytes • Analgesics • Intravenous fluids Examples of suboptimal or poor management would include failure to examine the chest, admission before treatment, failure to order a chest x-ray after inserting the chest tube and/or needle thoracostomy, delay in treatment to reexpand the lung, or absence of treatment.