One of the most requested resources on r/step3 is a comprehensive list of CCS order sets organized by condition. Instead of memorizing thousands of individual orders, you can learn standardized order sets for the most common presentations and then modify them based on the specific case. This article is that database.
Each order set below is organized into four phases: Initial Orders, Diagnostic Workup, Treatment, and Disposition/Follow-Up. Memorize these frameworks, and you will have a strong foundation for any CCS case.
How to Use This Database
1. Study phase: Read through each order set and understand why each order is included
2. Memorization phase: Focus on the conditions most likely to appear (high-yield cases)
3. Practice phase: Use these order sets during practice CCS cases and modify as needed
4. Exam day: Write the universal ER/clinic sets on your scratch paper for quick reference
Universal Order Sets
Universal ER Opening
• IV access
• Cardiac monitor
• Pulse oximetry
• Vital signs
• CBC, BMP, UA
• EKG (12-lead)
Universal 2-Minute Screen Checklist
• Follow-up appointment
• Influenza vaccine
• Tdap vaccine
• Colonoscopy referral (age ≥ 45)
• Mammogram referral (female ≥ 40)
• Smoking cessation counseling (if smoker)
• Diet counseling
• Exercise counseling
• Condition-specific follow-up labs
Cardiac Conditions
Acute Coronary Syndrome (STEMI/NSTEMI)
Initial: IV access, cardiac monitor, pulse ox, O2 if SpO2 < 94%
Diagnostic: EKG, troponin (serial x 3), CBC, BMP, coagulation panel, lipid panel, BNP, CXR, echocardiogram
Treatment: Aspirin 325 mg, heparin, clopidogrel (or ticagrelor), nitroglycerin, morphine (refractory pain), beta-blocker, ACE inhibitor, high-intensity statin, cardiology consult, PCI for STEMI
Location: ICU/CCU
Disposition: Step down to floor when stable → discharge with cardiac rehab referral, smoking cessation, diet counseling, follow-up in 1–2 weeks
Congestive Heart Failure Exacerbation
Initial: IV access, cardiac monitor, pulse ox, O2
Diagnostic: BNP, CBC, BMP, troponin, CXR, EKG, echocardiogram
Treatment: Furosemide IV, nitroglycerin (if hypertensive), ACE inhibitor, beta-blocker (continue if already on; do not start acutely if decompensated), sodium and fluid restriction, daily weights, strict I&Os
Monitoring: Daily BMP (K+ and creatinine), daily weights, repeat CXR
Disposition: Floor → discharge when euvolemic. Follow-up in 1 week. Cardiology referral. Diet counseling (low sodium). Medication adherence counseling.
Atrial Fibrillation (New Onset)
Initial: Cardiac monitor, EKG, IV access
Diagnostic: CBC, BMP, TSH, magnesium, CXR, echocardiogram
Treatment: Rate control: metoprolol IV (or diltiazem). Anticoagulation assessment: CHA2DS2-VASc score → apixaban or warfarin if score ≥ 2. Cardioversion if hemodynamically unstable.
Disposition: Floor or observation → discharge with oral rate control. Anticoagulation follow-up. Cardiology referral.
Pulmonary Conditions
Pulmonary Embolism
Initial: IV access, cardiac monitor, pulse ox, O2
Diagnostic: D-dimer (low/mod risk), CT pulmonary angiography, troponin, BNP, lower extremity doppler ultrasound, echocardiogram (right heart strain), CBC, BMP, coagulation panel
Treatment: Heparin drip → transition to oral anticoagulation (rivaroxaban, apixaban, or warfarin). Massive PE with shock: tPA (alteplase) + ICU.
Location: Floor for stable PE, ICU for massive/submassive
Disposition: Discharge on oral anticoagulation (minimum 3 months). Hematology referral if unprovoked. Anticoagulation clinic. Follow-up in 1–2 weeks.
COPD Exacerbation
Initial: Pulse ox, O2 (target 88–92%), IV access
Diagnostic: ABG, CBC, BMP, CXR, sputum culture
Treatment: Albuterol + ipratropium nebulizers, systemic steroids (prednisone or methylprednisolone), antibiotics (azithromycin or levofloxacin), BiPAP if worsening. Intubation if BiPAP fails.
Monitoring: Repeat ABG, continuous pulse ox
Disposition: Floor → discharge with oral steroids (5-day course), inhalers (LAMA + LABA + ICS), smoking cessation, pulmonary rehab referral, influenza + pneumococcal vaccines. Follow-up in 1–2 weeks.
Community-Acquired Pneumonia
Initial: IV access, pulse ox, O2
Diagnostic: Blood cultures x 2, sputum culture, CBC, BMP, lactate, procalcitonin, CXR, Legionella urine antigen, pneumococcal urine antigen, UA
Treatment: Ceftriaxone + azithromycin (inpatient). Advance clock 1 min between cultures and antibiotics. IV fluids if dehydrated. Antipyretics.
Monitoring: Repeat CXR at 48–72 hours, follow fever curve, WBC trend
Disposition: Floor → discharge when afebrile 48 hours and tolerating PO. Transition to oral antibiotics. Influenza + pneumococcal vaccines. Follow-up in 1–2 weeks.
Infectious Disease
Sepsis / Septic Shock
Initial: IV access x 2, cardiac monitor, pulse ox, O2, Foley catheter
Diagnostic: Lactate (STAT), blood cultures x 2, CBC, BMP, LFTs, coagulation panel, procalcitonin, ABG, UA + urine culture, CXR
Treatment: Blood cultures → advance 1 min → broad-spectrum IV antibiotics (vancomycin + piperacillin-tazobactam), NS 30 mL/kg bolus. Vasopressors (norepinephrine) if MAP < 65 after fluids. Stress-dose hydrocortisone if refractory shock.
Location: ICU for septic shock; floor for sepsis without shock
Monitoring: Repeat lactate at 3–6 hours, urine output, serial vitals
Disposition: ICU → floor when off vasopressors. Narrow antibiotics based on cultures. Follow-up in 1 week.
Meningitis
Initial: IV access, cardiac monitor
Diagnostic: Blood cultures x 2, CT head without contrast (before LP), lumbar puncture → CSF: cell count, glucose, protein, gram stain, culture, HSV PCR
Treatment: Empiric antibiotics immediately (vancomycin + ceftriaxone + dexamethasone). Add ampicillin if age > 50 or immunocompromised. Add acyclovir if HSV suspected.
Location: ICU
Monitoring: Serial neuro checks, repeat LP if not improving
Disposition: Complete antibiotic course. Follow-up with infectious disease. Hearing test after bacterial meningitis.
Endocrine Conditions
Diabetic Ketoacidosis (DKA)
Initial: IV access x 2, cardiac monitor, pulse ox, Foley catheter
Diagnostic: Fingerstick glucose, CBC, BMP (with anion gap), ABG or VBG, serum ketones, UA, phosphate, magnesium, HbA1c, blood cultures if febrile
Treatment: Insulin drip (regular insulin), aggressive IV NS (1–2 L in first hour), potassium replacement (if K < 5.3, add to fluids BEFORE insulin; if K < 3.3, hold insulin until K repleted), phosphate and magnesium replacement as needed, transition to subcutaneous insulin when anion gap closes and patient is eating
Location: ICU
Monitoring: Hourly fingerstick glucose, BMP every 2–4 hours (K+, bicarb, anion gap), ABG every 4–6 hours
Disposition: Floor when stable → discharge with diabetes education, insulin teaching, endocrinology follow-up. Diet counseling. Medication adherence counseling. Follow-up HbA1c in 3 months.
Hyperthyroidism / Thyroid Storm
Initial: IV access, cardiac monitor, cooling measures if febrile
Diagnostic: TSH, free T4, free T3, CBC, BMP, LFTs
Treatment: Beta-blocker (propranolol), PTU or methimazole, hydrocortisone (blocks T4→T3 conversion), iodine (give 1 hour AFTER PTU)
Location: ICU for thyroid storm; floor for uncomplicated hyperthyroidism
Disposition: Endocrinology referral. Follow-up TFTs in 4–6 weeks.
Neurological Conditions
Acute Ischemic Stroke
Initial: IV access, cardiac monitor, pulse ox, fingerstick glucose
Diagnostic: CT head without contrast (STAT), CT angiography, CBC, BMP, coagulation panel, troponin, EKG, glucose
Treatment: tPA (alteplase) if within time window and no contraindications. BP management (permissive hypertension unless > 220/120, or > 185/110 if giving tPA). Neurology consult STAT. Aspirin (after 24 hours if tPA given). Statin.
Location: Stroke unit / ICU
Monitoring: Serial NIH Stroke Scale, neuro checks every 1–2 hours, BP monitoring
Disposition: Floor when stable → discharge with aspirin + statin, PT/OT/speech therapy, neurology follow-up. Fall prevention, diet counseling, smoking cessation.
Seizure / Status Epilepticus
Initial: Protect airway, IV access, cardiac monitor, pulse ox, fingerstick glucose
Diagnostic: CBC, BMP, magnesium, calcium, glucose, toxicology screen, antiepileptic drug levels, CT head, EEG
Treatment: Lorazepam IV (first-line for active seizure), levetiracetam or fosphenytoin (second-line), intubation if status epilepticus not breaking. Neurology consult.
Location: ICU for status epilepticus; floor for resolved seizure with workup
Disposition: Neurology follow-up. Driving restrictions counseling. Antiepileptic medication. Follow-up EEG if indicated.
GI Conditions
Upper GI Bleed
Initial: IV access x 2, cardiac monitor, type and crossmatch, NPO
Diagnostic: CBC (serial), BMP, LFTs, coagulation panel, blood type and crossmatch
Treatment: IV PPI (pantoprazole drip), transfuse pRBCs if Hgb < 7 (or < 9 if symptomatic/cardiac), IV fluids, GI consult for endoscopy, octreotide if variceal bleed suspected. Hold anticoagulation.
Location: ICU if hemodynamically unstable or active bleeding; floor if stable
Monitoring: Serial CBC (every 6–8 hours), vitals, I&Os
Disposition: Continue PPI. H. pylori testing. GI follow-up. Avoid NSAIDs. Alcohol counseling if applicable.
Acute Pancreatitis
Initial: IV access, NPO, pain management (morphine or hydromorphone)
Diagnostic: Lipase, CBC, BMP, LFTs, calcium, triglycerides, CXR, abdominal ultrasound (gallstones), CT abdomen (if uncertain diagnosis or assess severity after 48–72 hours)
Treatment: Aggressive IV fluid resuscitation (lactated Ringer's), pain control, antiemetics, advance diet as tolerated (early feeding when pain improves — clear liquids then low-fat). No antibiotics unless infected necrosis.
Monitoring: Daily BMP, lipase trend, vital signs. Ranson's or BISAP severity scoring.
Disposition: Floor → discharge when tolerating PO, pain controlled. GI follow-up. If gallstone pancreatitis: cholecystectomy before discharge (if mild) or surgical follow-up. Alcohol counseling if alcohol-related.
How to Memorize These Order Sets
1. Group by system: Cardiac, pulmonary, infectious, endocrine, neuro, GI
2. Learn the framework, not every order: Initial → Diagnostic → Treatment → Disposition
3. Practice with a simulator: Use these order sets as your starting template, then adjust for each case
4. Focus on high-yield conditions first: ACS, CHF, sepsis, PE, DKA, stroke, pneumonia — these appear most frequently
5. Write the universal sets on your scratch paper on exam day
Related Articles:
• Ultimate Guide to CCS Section of Step 3 (2026)
• CCS Hacks: Time Management, Copy-Paste Orders & Clock Tricks
• CCS Preventive Care & Discharge Cheat Sheet