In this manner, the students have to apply their knowledge at the appropriate points during the progression of the scenario. 2. Blood sugar issues in the Type II diabetic will have a gradual onset, with diagnosis generally resulting from routine laboratory exams.(1). This is an important period, as this is where the students see the theoretical concept (metabolic acidosis), come to life as for instance large tidal volumes. Should any changes be made to the current management of their underlying condition(s)? Lets discuss your options. Competency-based medical education has seen widespread adoption in the field along with ongoing work in the areas of . Groups of fewer than four students dont allow for optimal collaboration. Open the patients airwayusing ahead-tiltchin-lift manoeuvre: 1. During the debriefing process that follows the simulation, well-balanced performance measures will guide feedback toward accomplished tasks and may illustrate existing decision-making, behavioral or technical skill deficits. Works with Traffic 2005, but . Abstract Introduction: This simulation on diabetic ketoacidosis (DKA) in the obstetric population presents learners with one of the more commonly encountered etiologies of critical illness in the pregnant patient. If the patient loses consciousness and there are no signs of life on assessment, put out a crash call and commence CPR. endobj The students worked on the underlying physiology during a week long PBL session and are therefore familiar with the theoretical aspects of DKA. Another example: At one minute into the scenario, the patient becomes unresponsive and their breathing becomes shallow. Given such a small group, the students indicated that they feel more involved than they would with a larger group (eg, the whole class.) This session provides additional clinical support material for the theoretical PBL session. (1) The assessment of a diabetic patient is best taught as a. Trainee will appropriately request assistance and use available resources. Available if the trainee asks: arterial blood gas, glucose, electrolytes, BUN and plasma osmolality (please see last section of Appendix B, Supplemental Digital Content 2, https://links.lww.com/SIH/A2, for values). Keywords: diabetic ketoacidosis, simulation, expertise, emergency medicine Introduction Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes mellitus, most commonly occurring in patients with type I diabetes. DO NOT perform any examination or procedure on patients based purely on the content of these videos. A collection of surgery revision notes covering key surgical topics. Initially, we required the students to write down the vital signs. Simulation Scenario. Environment & Manikin - Examples 05:45 Does the patient need a referral toHDU/ICU? The patient was placed in the supine position and was a little confused as well as drowsy but at times had a good verbal response (Glasgow Coma Scale 15/15). Nandate, Koichiro MD, PhD; Abola, Ramon MD; Murray, W Bosseau MB; Whitfield, Carol PhD; Lang, Charles PhD; Sinz, Elizabeth MD. After the first voluntary session in 2006, feedback from the medical students indicated that they would like to receive this handout. Trigger 4, Pathway 1l of saline required over 1hour and insulin infusion need prescribing and making up in 50ml syringe. A collection of data interpretation guides to help you learn how to interpret various laboratory and radiology investigations. For example, you could develop a diabetic scenario in which the prehospital provider encounters an altered patient with incomprehensible speech. It should only be inserted in unconscious patients as it is otherwise poorly tolerated and may induce gagging and aspiration. - Severity 05:32 Given 6 to 8 back-to-back sessions, it is critical that every session starts and ends on time! As the name says, this screen is used to graph and plot any parameter. a simulation training session designed to acquaint emergency medicine residents with the presentation and management of diabetic ketoacidosis (DKA) through the use of simulation. Conclusion: Our DKA simulator is a new tool whose objective is the training in a severe, frequent and complex situation, and can be used to improve the approach made by the junior physicians to the real diabetic . 5. Trainee will correlate the underlying pathophysiology with symptoms and signs as exhibited by the simulation session. Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. For instance, one of the questions is: Why is Tiffany dehydrated? There are several possible reasons and mechanisms (as outlined in Appendix B, fourth 15 minutes, Supplemental Digital Content 2, https://links.lww.com/SIH/A2), which the students can mention. 1-6. areas of lipohypertrophy) if it is unclear if the patient is diabetic. A chest X-ray should not delay the emergency management of DKA. She Died the Next Day. - Over 3000 Free MCQs: https://geekyquiz.com/ Much time was wasted explaining why it did not matter. The reason for inserting the airway upside down initially is to reduce the risk of pushing the tongue backwards and worsening airway obstruction. Questionswhich may need to be considered include: The next team of doctors on shift should bemade awareof any patient in their department who hasrecently deteriorated. However, we should not spend too much time on (not become distracted with) explaining unfamiliar monitors for the present trainees, such as central venous pressure or ETCO2 concentration. Both external and internal potassium balances are disturbed during the development and treatment of DKA. Trainee will practice or observe good teamwork skills, both as a leader and a team player. - Medical Finals Question Pack: https://geekymedics.com/medical-student-finals-questions/ Our simulated patient is a 25-year-old woman, Tiffany, who has been taken to the Emergency Department from her soccer game by her boyfriend, Adam. This guide has been created to assist students in preparing for emergencysimulationsessionsas part of their training,it is not intended to be relied upon for patient care. Because of the early stage (first year) of their medical careers, they have not yet seen vital sign monitoring, or patients, so these clinical aspects are introduced and emphasized. Abdomen: The abdominal examination reveals diffuse mild epigastric tenderness to deep palpitation but neither rebound tenderness nor guarding (result of examination given by patient or by instructor). A debriefing section with pre-established questions allows the instructor to review the main focus and performance measures with the student group. The researchers found that long shift hours (24hrs), working overtime and marital/relationship stress were strongly correlated. Groups of more than seven may struggle with meeting objectives due to insufficient functional rolls. Urinary tract infections are a common DKA precipitant. The objective is to give as many visual and tactile cues concerning the patient condition and background as possible. A comprehensive collection of medical revision notes that cover a broad range of clinical topics. insulin-dependent type 2 diabetes), Altered consciousness (e.g. The Pratcice Available from: [. The instructor can also gauge the direction the debriefing session should follow or be alerted to possible problems or conflicts in treatment opinions. In this case scenario, dehydration is one of the most serious immediate issues. Circulating nurse in the emergency room (ER). Subscribe to our newsletter to be the first to know about our latest content: https://geekymedics.com/newsletter/ The authors of the second study reported that poor sleep quality (60% of respondents) and extreme fatigue (55% of respondents) are independently associated with safety risks on the job. Open the patients mouth to ensure there is no foreign material that may be pushed into the larynx. See ourhistory taking guidesfor more details. SimMan offers you the ability to provide simulation education to challenge and test your students clinical and decision-making skills during realistic patient care scenarios. A blood glucose level may already be available from earlier investigations (e.g. - Onset 01:48 Your message has been successfully sent to your colleague. 2003;78:783788. After the initial treatment is initiated, by showing a simulated urine and blood, and by getting them to smell ketones, we can enable the trainee to confirm the diagnosis of DKA. Insert the airway bevel-end first, vertically along the floor of the nose with a slight twisting action. doi: 10.7759/cureus.1286. Assess the patients level of consciousness using the AVPU scale: If a more detailed assessment of the patients level of consciousness is required, use the Glasgow Coma Scale (GCS). }HyEf,#$/JSRU9+CF6k\'/z+i`[ 5JudK*Zly^g%[jCK)H[)Y=Qp0/r9o9HW_zF}pTzI~'|q.~:=Y T 9w! Several environments may be suitable for your classroom. Example: If the provider immediately evaluates blood glucose, then the reading will display 45 mg/dL. Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario Cureus. The students are in their basic science course. We are looking for declaration of DKA and request for pathway. Simulation Scenario for Anesthesia Providers Clark Obr, MD*, Anthony Mueller, MD . PBL in our institution is implemented as a small group (n 68 students) self study session with a facilitator, who incrementally discloses further information about the patient. Moses Lake (WA) Fire Department Gets $3.3M Grant for more Firefighters, Woman Who Crashed into Responders, Killing PA Firefighter, Gets Prison, Three Apparent Gas Explosions at San Bernardino (CA) Mountain Homes, Enid (OK) Fire Department Begins SWAT Medic Program to Assist Police, FDNY EMS Providers Win COVID-19-Linked Free Speech Lawsuit, Coronavirus Origins Still a Mystery Three Years into Pandemic. reduced air entry, coarse crackles) to screen for evidence of pneumonia. The students are in their first year. During an immersive simulation, its imperative the group uses critical-thinking skills and group collaboration independently. Are any further assessments or interventions required? We introduce the Simulation Laboratory and the Simulator, and demonstrate: pulses, eyes blinking, pupil constriction, gas moves in and out of mouth (place hand over mouth), chest moves up and down. An arterial blood gas (ABG) can provide lots of useful information to guide management including: A chest X-ray may be indicated if abnormalities are noted on auscultation (e.g. This simulation session therefore aims to make the case come alive, and show this known case in a clinical context. Revisit history taking to explore relevant medical history and identify any precipitating factors for DKA. Cureus is on a mission to change the long-standing paradigm of medical publishing, where submitting research can be costly, complex and time-consuming. angioedema, rash) commence appropriate treatment as discussed in ouranaphylaxis guide. Search for Similar Articles The simulators do not have rock steady vital sign values, and the students were unsure as to write down 121 or 122 mm Hg as the systolic blood pressure. An oropharyngeal airway is a curved plastic tube with a flange on one end that sits between the tongue and hard palate to relieve soft palate obstruction. A traditional classroom lecture format allows for student participation but limits the instructors ability to create realistic situations. . The use of a simulated, evolving case scenario was an effective method of exposing nursing students to complex patient care. This is particularly important for core . Typically potassium levels should be maintained between 4.0 5.5 mmol/L and close monitoring is required. Cureus 9(5): e1286. One of the key differences with the immersive simulation is that the instructor is absent from the simulation environment. Clearly communicate how often would you like the patients observations relayed to you by other staff members. LYqC+pJ&6X4onfBT#?=R}.p8N3+Dk,P4tIgWB}-L'=8;_G >,K#.e89XnG'B~NtR Trainee will recognize and interpret the clinical signs and symptoms and the typical history of a patient with DKA, as well as understand the major causative factors of DKA. The choice of fluid type, rate of administration and volume should be tailored to the individual patient based upon their vital signs and electrolytes. For more information, please refer to our Privacy Policy. The validity of the HFS-DKA scenario was verified by a certified diabetes nurse educator, a registered nurse, and a clinical nurse educator. Airway adjuncts are often helpful and in some cases essential to maintain a patients airway. Antibiotics should be prescribed in keeping with local guidelines. Geeky Medics accepts no liability for loss of any kind incurred as a result of reliance upon the information provided in this video. Prehosp Emerg Care. Review the patientscurrent medicationsand check any regular medications areprescribed appropriately. 1 0 obj diagnosis of DKA Trigger 3, ABG show acidosis and high BM and normal potassium. COVID-19 Screening in the Pediatric Emergency Department. Keywords: diabetic ketoacidosis, simulation, expertise, emergency medicine Introduction Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes mellitus, most . Privacy Policy #geekymedics #fyp #fypviral #studytok #medicalstudentuk #medtok #studytips #studytipsforstudents #medstudentuk #premed #medschoolfinals #shorts, Cardiovascular Exam Tips - DON'T FORGET these 3 things , Watch this video to find out the most COMMONLY FORGOTTEN components of the cardiovascular history! Save this video to help prepare for your upcoming OSCEs and dont forget to follow Geeky Medics! (1) According to Centers for Disease Control and Prevention (CDC), 223,619 deaths were attributed to diabetes in 2005. Does the patient need reviewing by a specialist? The Simulation Laboratory session follows after a completed PBL session, and is aimed at making the case come alive, while providing a clinical perspective to preclinical students. The patient synopsis should include such standard aspects as age, sex, ethnicity, medical history, medications and allergies. In the meantime, you should re-assess and maintain the patients airway. Instagram: https://instagram.com/geekymedics <>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 595.32 841.92] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> As with the animated lecture, the simulation is strongly dependent on a focused case study. Check the patency of the patients right nostril and if required (depending on the model of NPA) insert a safety pin through the flange of the NPA. There are several causes of DKA, which we remember by the "five I's". Interactive lecture/discussion with use of monitors that show the vital signs of the simulated patient on manikin. Medical Simulation Scenarios are text documents outlining the various details of a simulation - everything from patient simulator settings to debriefing notes. You can check out our guide to using SOCRATES here: https://geekymedics.com/the-socrates-acronym-in-history-taking/ Marx JA, Hockberger RS, Walls RM. Well done, youve now stabilised the patient and theyre doing much better. The students are in their first year. Observe and discuss the effects of therapy in a mathematically modeled physiological simulator. You may search for similar articles that contain these same keywords or you may This may produce better retention of the subject matter and help students adapt to emergency scenes before going into the field. Using SOCRATES in History Taking | OSCE | Communication Skills, Diabetic Ketoacidosis (DKA) | Acute Management | ABCDE. Debriefing A fixed-rate intravenous insulin infusion should be commenced initially to suppress ketogenesis, reduce blood glucose levels and address electrolyte disturbances. The simulation session is also hosted as an interactive session. The optimal number of simulation participants is four to seven individuals, depending on the case study objectives. dq-]gX4 `L'u7myx) rpjf0z,.y`VMyx-&Ju`U0 She is lethargic and slightly confused but can intermittently respond to questions. If an obstruction is visible within the airway, use afingersweeporsuctionto remove it. Scenarios. Causes: Any situation arising in a diabetic that requires increased insulin without that demand being met can result in DKA. There are just a few more things to do. Use an effectiveSBARR handoverto communicate the key information effectively to other medical staff. Standardized patient as the voice of the simulator (or the simulation operator may play this role). Advance the airway until it lies within the pharynx. The file explaining the session is sent to instructors 1 week before the sessions. Patients with DKA require fluid resuscitation to restore circulatory volume, clear ketones, correct electrolyte abnormalities and increase renal perfusion. Stage 2: Emergency management of DKA and consideration of abnormal CTG. 3. The students have acquired all the applicable theoretical knowledge of the case during the previous multiday PBL sessions. Recognize the signs and symptoms of a patient presenting with diabetic ketoacidosis. Performing an ECG should not delay the emergency management of DKA. This leads to hyperglycaemia, osmotic diuresis, and dehydration. Because of this consciousness status, it is very difficult to obtain information of cardiovascular, pulmonary, renal, hepatic, endocrine, hematology, or coagulation status other than uncontrolled diabetes. YouTube Video VVVram5yRUhROGJRUW1sZk5kQVFDXzV3LjMxakdNallNcng0, YouTube Video VVVram5yRUhROGJRUW1sZk5kQVFDXzV3LkJPVjVZMzBKczY4, YouTube Video VVVram5yRUhROGJRUW1sZk5kQVFDXzV3LkxEM2VkQzB2NTBr, Start typing to see results or hit ESC to close, Deep Vein Thrombosis (DVT) Examination OSCE Guide, Pre-hospital Advanced Life Support (ALS) OSCE Guide, Adult Choking (Basic Life Support) OSCE Guide, Paediatric Intravenous Cannulation OSCE Guide, Intrauterine System (Mirena) Counselling OSCE guide, Geeky Medics OSCE Book | Clinical Examination, Paediatric Gastro-oesophageal Reflux Disease, A Career as a GP with Special Interest with Dr Fiona Mosgrove, Absolute insulin deficiency (e.g. and DKA can be caused by either: Absolute insulin deficiency (e.g. A collection of interactive medical and surgical clinical case scenarios to put your diagnostic and management skills to the test. An animated lecture may be described as a pseudo-simulation environment. Properly interpret a venous blood gas (VBG) and basic metabolic panel in a patient presenting with diabetic ketoacidosis. As individuals with uncontrolled type I . We also show them IV bags containing saline and Ringers lactate, as well as show them IV infusion sets. Please try again soon. Please enable scripts and reload this page. You may be asked to review a patient with DKA due to confusion, reduced level of consciousness, tachycardia, hypotension and/or vomiting. Yes: if the patient can talk, their airway is patent and you can move on to the assessment of breathing. Trainee will recognize the need for therapy and suggest an appropriate therapy in a simulated environment. However, this turned out to be too slow, took too much time, and could not continuously demonstrate the direction of changes. Calculate the patients current fluid balance using their fluid balance chart (e.g. Collectblood testsafter cannulating the patient including: An ECG should be performed to screen for cardiac pathology such as arrhythmias which may be precipitated by electrolyte abnormalities (e.g. We do not use passive visualizing materials such as videotapes or DVD other than vital signs shown on the monitors. DO NOT perform any examination or procedure on patients based purely on the content of these videos. (1), The assessment of a diabetic patient is best taught as a case-based simulation. Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario They have had no clinical exposure or any clinical experience. It involves working through the following steps: Each stage of the ABCDE approach involvesclinicalassessment,investigationsandinterventions. In the context of DKA, a patients consciousness level may be reduced. Refer to your local guidelines for further details. The learning objectives follow the American College of Graduate Medical Education (ACGME) Core Compentencies. I assigned true to life parking codes, and added some extra parking for the superfluous US Express AI. Instead, instructors should combine case- and simulation-based techniques when teaching diabetic assessment. DO NOT perform any examination or procedure on patients based purely on the content of these videos. Glycosuria leads to urinary losses of potassium through osmotic diuresis. The following scenarios are available for download and are designed to meet your multi-disciplinary nursing needs. Reduced urine output (oliguria) is typically defined as less than 0.5ml/kg/hour in an adult. Using your thumbs, slightly open the mouth by downward displacement of the chin. Just place the BR2_KDCA file into your addons scenery folder: C:\\Program Files\\Microsoft Games\\Microsoft Flight Simulator X\\Addon Scenery\\Scenery. If the patient has clinical signs ofanaphylaxis(e.g. Physician working in the emergency department. Re-assessthe patient using theABCDE approachto identify any changes in their clinical condition and assess the effectiveness of your previous interventions. Strategies of high-performing paramedic educational programs. These are not learning objectives in this program. The students mentioned that they did not obtain the maximum value from the simulation session under these circumstances. Clinical Simulation in Nursing, Volume 39, 2020, pp. Acad Med. Check out our NEW & IMPROVED quiz platform at geekyquiz.com, To be the first to know about our latest videos, subscribe to our YouTube channel . Use blankets to re-warm patients who are mild to moderately hypothermic. This is particularly important for core cases and low-frequency, high-stakes procedures and encounters. By joining Cureus, you agree to our In this section, we have to help the trainee to institute definitive therapy based on the underlying biochemical abnormalities. We have been presenting Simulation Laboratory sessions to our preclinical medical students (first and second years). tall tented T waves in hyperkalaemia). Askhow the patient is feeling as this may provide some useful information about their current symptoms. Each clinical case scenario allows you to work through history taking, investigations, diagnosis and management. can be reemphasized, and the effects of fluid therapy demonstrated. JEMS. Medical Simulation Scenarios are text documents outlining the various details of a simulation - everything from patient simulator settings to debriefing notes.Below is a collection of donated scenarios for you to use or modify. The immersive simulation is performed when the instructor feels comfortable with the acquired knowledge and skill base presented in the animated lecture or when the student group has sufficient practical experience to apply the cognitive, behavioral and technical skills outlined in the case scenario. 2007. The facilitator guides the group only when necessary. At the end of the previous section, the trainee can make the diagnosis of DKA but has not confirmed it yet. Laschinger S, Medves J, Pulling C, et al. Her medical, social, and family histories are not clear at the time of admission to the emergency department. - 150+ PDF OSCE Checklists: https://geekymedics.com/pdf-osce-checklists/ PBL was introduced at our institution in 1995. TikTok: https://www.tiktok.com/@geekymedics Introduceyourselfto thepatientincluding yournameandrole. Wolters Kluwer Health We now provide the students with handouts of the data to save time and provide consistency. Forty percent of respondents reported excessive daytime sleepiness. Mosby:Philadelphia. 1) Please read through this document as it will help you prepare for your upcoming simulation on DKA. Therefore, we have to emphasize the importance of airway, breathing, and circulation in the very sick patient in any clinical setting. opioids, sedatives, anxiolytics, insulin, oral hypoglycaemic medications). insulin-dependent type 2 diabetes) Symptoms Typical symptoms of DKA include: Palpitations Nausea Vomiting Sweating Thirst Weight loss Leg cramps Clinical signs Typical clinical signs of DKA include: Tachycardia Hypotension Intubation lubricants can mimic drooling. x]o ]?9kgq~:)?hE )R6!up}\<8||\]}Y~;xp~yQ$#4~djX&{n_m-]^K1/~/AD Hv 99evs,;8}8zwnhFxV.kf-V^? In the simulated environment, trainees will ask questions on how to interpret the data that they observe on the monitors and interpretation of clinical signs and symptoms on the manikin. 4. Despite this increased calorie intake, she noticed an unexplained 20 lbs weight loss. 2. In other words, they do not have clinical experience, but they have clinical knowledge. 2010;49:578586. Twitter: http://www.twitter.com/geekymedics If the patient isunconsciousorunresponsive, start thebasic life support(BLS)algorithmas per resuscitation guidelines. The required potassium replacement varies greatly. Surgical dressings and imitation blood can support medical history. Similar to a ward round, where the instructor would say: Come and listen to this patient with an aortic stenosis. A collection of free medical student quizzes to put your medical and surgical knowledge to the test! The diabetes with DKA clinical pathway is a detailed plan of the course of care for pediatric patients seen in the emergency department with diabetic ketoacidosis. >> Patterson PD, Weaver M, Frank R, et al. When a group treatment decision is made that would be contraindicated or harmful to the patient, the instructor can redirect the learner group while maintaining an atmosphere inclined toward independent thinking. We try to provide sufficient realism.. 2. See Table 4 for a suggested standardized script. When erroneous treatment is delivered, the instructor can end the simulation. 2 0 obj Conclusions This technical report describes the design and implementation of a simulation scenario on DKA for emergency medicine trainees.
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