Master Emergency Orders & The "First 2 Minutes"

The First 2 Minutes Rule

In every acute CCS simulation, the real-world clock starts immediately. Before you begin typing exotic diagnostics, stabilize the patient with the universal emergent order set.

CCS Simulation Drill Universal Emergent Order Sequence

Primum Non Nocere: Interactive Master Order Sheet

Search, filter, and place orders in sequence. Practice the golden rule of Step 3 CCS: Stabilize first, diagnose systematically, treat specifically, and always counsel before discharge.

Search orders

Category: All Orders (25) Emergent (6)Diagnostic (10)Treatment (5)Counseling (4)

Matching: 25 of 25 orders

Order Catalog

• Pulse oximetry continuous Essential
  + Order
• Continuous cardiac monitoring Essential
  + Order
• IV access Essential
  + Order
• Normal saline 0.9% IV bolus/infusion Essential
  + Order
• Oxygen via nasal cannula Essential
  + Order
• NPO diet High Yield
  + Order
• ECG 12-lead stat Essential
  + Order
• Chest X-ray portable AP Essential
  + Order
• Complete blood count (CBC) Essential
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• Basic metabolic panel (BMP) Essential
  + Order
• Hepatic function panel (LFT) Routine
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• PT / INR and aPTT Routine
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• Troponin I / T stat & serial High Yield
  + Order
• Urinalysis with microscopy Routine
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• Blood cultures × 2 sets Essential
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• Arterial blood gas (ABG) Essential
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• Aspirin 325 mg chewed Essential
  + Order
• Nitroglycerin sublingual Essential
  + Order
• Heparin IV bolus and infusion Essential
  + Order
• Ceftriaxone 1g IV stat Essential
  + Order
• Vancomycin IV stat Essential
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• Counsel patient: Smoking cessation High Yield
  + Order
• Counsel patient: Medication adherence High Yield
  + Order
• Counsel patient: Safe sexual practices High Yield
  + Order
• Schedule outpatient follow-up in 1-2 weeks High Yield
  + Order

Active Placed Orders (0)

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Simulated case clock: T+0 min

Cost per order: Emergent +1, Diagnostic +5, Treatment +2, Counseling +3 min.

• No orders placed yet. Select items from the catalog.

CCS Master Verification Checklist

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Universal Initial Orders Routine (The “O-M-N-I” Mnemonic)

flowchart LR
    O["O: Oxygen\n(Pulse oximetry continuous +\nO2 via cannula if SpO2 < 94%)"]
    M["M: Monitor\n(Continuous cardiac monitoring +\nBlood pressure q15min)"]
    N["N: Needles & Fluids\n(IV access 18-gauge +\nNormal saline 0.9% IV bolus/maintenance)"]
    I["I: Initial Labs & ECG\n(ECG 12-lead stat +\nCBC, BMP, PT/INR, PTT, UA)"]

    O --> M --> N --> I

The 5 Essential Phases of Every CCS Case

Phase	Time Window	Actions
Phase 1: Emergent Stabilization	Case Min 0–1	Place vital monitoring orders: Pulse ox, Cardiac monitor, IV access, O2, normal saline. If in clinic and unstable $\rightarrow$ Transfer to Emergency Department immediately.
Phase 2: Targeted Physical Exam	Case Min 1–2	Perform focused physical examination (e.g. Chest/Lungs, Heart, Abdomen, Neuro). Avoid full head-to-toe exam on unstable patients as it wastes simulation time.
Phase 3: Diagnostic Workup	Case Min 2–4	Order targeted imaging (CXR portable, CT, Ultrasound) and laboratory evaluations. Advance clock to when results are ready.
Phase 4: Disease-Specific Therapy	Case Min 4–15	Administer disease-specific medications (e.g., Aspirin/Heparin for ACS, Antibiotics for Sepsis, Insulin for DKA). Transfer to ICU or Inpatient Ward.
Phase 5: Preventive Counseling & Close	Final 2-Minute Warning	The 2-minute warning pop-up appears. Immediately place all preventive counseling orders and schedule outpatient follow-up.

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Critical Orders by Chief Complaint

Acute Chest Pain

• Emergent: Pulse ox, cardiac monitor, IV access, normal saline, oxygen.
• Diagnostics: ECG 12-lead stat, CXR portable AP, Troponin I stat & serial q3h, CBC, BMP, PT/INR, PTT, lipid panel.
• Treatment: Aspirin 325 mg chewed stat, Nitroglycerin sublingual, Morphine IV if pain persists, Heparin IV bolus and infusion, Metoprolol PO (if no bradycardia/CHF).
• Consults: Cardiology consult for urgent cardiac catheterization.

Acute Shortness of Breath (Suspected Asthma / COPD Exacerbation)

• Emergent: Pulse ox, continuous cardiac monitor, IV access, oxygen (titrate SpO2 88-92% for COPD).
• Diagnostics: ABG stat, CXR portable, CBC, BMP, peak expiratory flow rate (PEFR).
• Treatment: Albuterol + Ipratropium nebulized stat, Methylprednisolone IV or Prednisone PO stat. If COPD: Azithromycin or Ceftriaxone.