PDF Medicine Simulation Scenario Diabetic Ketoacidosis: An Emergency >> Fernandez AR, Mac Crawford J, Pennell ML, et al. They should be used in conjunction with the maneuvres mentioned above as the position of the head and neck need to be maintained to keep the airway aligned. The required potassium replacement varies greatly. Research Watch Box:Sleep, Fatigue & SafetyBy David Page, MS, NREMT-P 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. Check out our other awesome clinical skills resources including: DIABETIC KETOACIDOSIS MODULE: ENDOCRINOLOGY / METABOLIC TARGET: ALL PAEDIATRIC TRAINEES;NURSING STAFF BACKGROUND: DKA occurs when a relative or absolute lack of insulin leads to the inability to metabolise glucose. If the patient is suspected to have sufferedsignificanttraumawith potential spinal involvement, perform ajaw-thrustrather than a head-tilt chin-lift manoeuvre: 2. 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. The purpose of this simulation is to demonstrate the specific clinical signs of the patients with DKA, and the keys by which we recognize DKA in the early stages. Another example: At one minute into the scenario, the patient becomes unresponsive and their breathing becomes shallow. Please try after some time. As with the animated lecture, the simulation is strongly dependent on a focused case study. In the first, the authors expanded the National Registrys Longitudinal EMT Attributes and Demographic (LEADS) study by resurveying 1,600 EMS workers about their sleepiness while at work. 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. The HFS-DKA simulation teaching consisted of pre-briefing (an hour), running simulation (30 minutes) and debriefing (an hour) for the high-fidelity simulator using the Lardeal SIM man . A pre-briefing session is conducted prior to the start of the simulation scenario. Highlight selected keywords in the article text. Stage 1: Initial assessment of acutely unwell pregnant woman and diagnosis of DKA. Surgical dressings and imitation blood can support medical history. The simulation session is also hosted as an interactive session. 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. The relationship between sleep, fatigue and patient and provider safety. Revisit history taking to explore relevant medical history and identify any precipitating factors for DKA. Causes: Any situation arising in a diabetic that requires increased insulin without that demand being met can result in DKA. We are looking for declaration of DKA and request for pathway. Therefore, the same file is also sent to the participants before the session. This session provides additional clinical support material for the theoretical PBL session. Subscribe to our newsletter to be the first to know about our latest content: https://geekymedics.com/newsletter/ 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. Diabetic ketoacidosis simulator: a new learning tool for a life Debriefing and vD0 x@FFJ{m[ 3//Oh|JR7! This allows us to get in touch for more details if required. Geeky Medics accepts no liability for loss of any kind incurred as a result of reliance upon the information provided in this video. On the basis of the feedback from the students, they indicated that they believed the small group sessions are better. As the name says, this screen is used to graph and plot any parameter. These are not learning objectives in this program. Yes: if the patient can talk, their airway is patent and you can move on to the assessment of breathing. Its best, however, to allow the student group to continue so theyre able to evaluate their decision-making processes during debriefing. General: Moaning, asking what has happening to her. Trainee will practice or observe good teamwork skills, both as a leader and a team player. You might also be interested in our awesome bank of 700+ OSCE Stations. They should introduce the student group to the environment, assign roles for each learner and guide the decision-making process. Maintain head-tilt chin-lift or jaw thrust and assess the patency of the patients airway by looking, listening and feeling for signs of breathing. CCA 175 Real Time Exam Scenario 17 | JOIN Multiple DataFrames | Save as KDCA, Ronald Reagan Washington National Airport, DC. Initially, we used a blood pressure cuff to generate the blood pressure values. The students are in their first year. Simulation provides a safe environment where learning is enhanced through the deliberate practice of skills and controlled management of a variety of clinical encounters. 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. Each PBL case typically goes over 23 days, affording the students periods to find information for the case. Reprints: Koichiro Nandate, MD, PhD, Department of Anesthesiology, Milton S. Hershey Medical Center, Pennsylvania State University College of Medicine, 500 University Drive Box 850, Hershey, PA 17033 (e-mail: [emailprotected]). 2 0 obj The validity of the HFS-DKA scenario was verified by a certified diabetes nurse educator, a registered nurse, and a clinical nurse educator. Please note that by doing so you agree to be added to our monthly email newsletter distribution list. As a next step, we will let one of the trainees talk to the patient, and prompt to ask medical questions such as previous medical issues or recent drug use for them to practice asking questions to generate a differential diagnosis (in this case, other causes for confusion). A number of key modifiers are described that allow for the adjustment of case . Pediatric Emergency Medicine Didactics and Simulation (PEMDAS Creating a Simulation Experience to Promote Clinical Judgment However, this leads to confusion. <>>> A collection of data interpretation guides to help you learn how to interpret various laboratory and radiology investigations. Typically potassium levels should be maintained between 4.0 5.5 mmol/L and close monitoring is required. Join the Geeky Medics community: Search for Similar Articles As this is a PBL session, the trainees are not given any references. . The instructor should have visual access via one-way windows or cameras. insulin-dependent type 2 diabetes), Altered consciousness (e.g. Prior to starting the scenario, the instructor should introduce a short summary of the case study and ask open-ended questions regarding the management direction. type 1 diabetes) Complete insulin insensitivity (e.g. In keeping with the case study, as a treatment marker is reached, the instructor should place emphasis on physiological, pharmacological, environmental and psychosocial issues. In this manner, the students have to apply their knowledge at the appropriate points during the progression of the scenario. confusion, coma), All critically unwell patients should have. This is particularly important for core cases and low-frequency, high-stakes procedures and encounters. Medical Simulation Scenarios are text documents outlining the various details of a simulation - everything from patient simulator settings to debriefing notes. Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario Cureus. 1 0 obj unilateral coarse crackles may be present if the patient has pneumonia which may have been the precipitant for DKA). Assessment & Treatment of Five Diabetic Emergencies - JEMS Centers for Disease Control and Prevention. A GCS of 8 or below warrants urgent expert help from an anaesthetist. dq-]gX4 `L'u7myx) rpjf0z,.y`VMyx-&Ju`U0 Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario. - PDF endobj Each performance measure is separated into cognitive, behavioral or technical categories. During an immersive simulation, its imperative the group uses critical-thinking skills and group collaboration independently. Available from: [. See Table 4 for a suggested standardized script. Introduction: Diabetic ketoacidosis (DKA) is a life-threatening illness which classically presents with polyuria, polydipsia, and polyphagia that can rapidly progress to severe dehydration and altered mental status from cerebral edema. . Askhow the patient is feeling as this may provide some useful information about their current symptoms. - Site 01:12 Wolters Kluwer Health Over the years, some groups happened to have the simulation session before the completion of the theoretical PBL session. 2009;13:505511. These simulation sessions seem to work because the medical students do have prior knowledge. 3. Invasive monitors, including a left radial intraarterial and a right subclavian IV catheter, were placed. Finally, we summarize the course and give them time for questions. Case-based simulation should include two to three broad-focus objectives, as well as 1020 specific performance measures that the student should accomplish. This article originally appeared in March 2011 JEMS as Diabetes Demonstration: Simulation-based learning works best., Simulation Training Ideal for Diabetic Patients, CMS Begins Reprocessing Retroactive Payments, Documents Detail EMTs Failure to Aid Tyre Nichols, New Course Lets Bystanders Be the Help Until Help Arrives, All Paramedic Recruits in New Castle County (DE) Obtain NRP Certification, International Prehospital Medicine Institute Literature Review, March 2023. If the provider starts an IV and gives dextrose, then the patients alertness will increase, respirations will normalize and repeated blood glucose will read 210 mg/dL over a two-minute interval. Often, the learner group will be unaware of these behaviors, but the instructor can key into the first few comments made during the transition between rooms. Initially, we had a white board available, but the temptation (and habits) were just too strong, and the simulator sessions tended to become one way lectures, rather than an interactive, 2 way discussion.. Some error has occurred while processing your request. The students worked on the underlying physiology during a week long PBL session and are therefore familiar with the theoretical aspects of DKA. If the patient has clinical signs ofanaphylaxis(e.g. Keyword Highlighting Its important to train and educate students of prehospital care on key indicators of a diabetic emergency. We also show them IV bags containing saline and Ringers lactate, as well as show them IV infusion sets. From the Department of Anesthesiology, Pennsylvania State University College of Medicine, Hershey, PA. Dr. Murray is on the Speakers Bureau of METI, Sarasota, FL. Trainee will learn to collaborate with peers to decide on appropriate interventions, tests, and therapy. Diabetes UK with the Joint British Diabetes Societies Inpatient Care Group. Circulating nurse in the emergency room (ER). Please enable scripts and reload this page. COVID-19 Screening in the Pediatric Emergency Department. Paediatric DKA | Simulation Education 2008;6:278302. 3. 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). - Onset 01:48 It should only be inserted in unconscious patients as it is otherwise poorly tolerated and may induce gagging and aspiration. Simulation Scenario for Anesthesia Providers Clark Obr, MD*, Anthony Mueller, MD *Corresponding author: clark-obr@uiowa.edu Abstract Introduction: This simulation on diabetic ketoacidosis (DKA) in . Target Learner Groups Medical simulation technology is a powerful tool for training physicians but papers dealing with DKA simulators are scarce. This environment doesnt allow the student to identify presentation cues, be active in their own learning or apply their skills without endangering the lives of patients.(2). A collection of anatomy notes covering the key anatomy concepts that medical students need to learn. The impetus for creating and implementing the high-fidelity diabetic ketoacidosis (DKA) simulation was based on a needs assessment and reviewing of undergraduate nursing students' examination statistics in a second semester medical-surgical course. Virtual patient simulation (VPS) is an interactive computer simulation that recreates real-world scenarios with the objectives of training, education, and assessment for health care providers [].Virtual simulation has been used extensively to adapt nursing education to the COVID-19 pandemic context [], such as social distancing and/or confinement. Review thepatients notes,chartsandrecent investigation results. A debriefing section with pre-established questions allows the instructor to review the main focus and performance measures with the student group. Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario The learning objectives follow the American College of Graduate Medical Education (ACGME) Core Compentencies. With your index and other fingers placed behind the angle of the mandible, apply steady upwards and forward pressure to lift the mandible. Advance the airway until it lies within the pharynx. The students have acquired all the applicable theoretical knowledge of the case during the previous multiday PBL sessions. As this is a value-added session that demonstrates new concepts, such as the vital signs on a clinical monitor, there are no assessment instruments to measure gaining of understanding. 1) Please read through this document as it will help you prepare for your upcoming simulation on DKA. 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). To read Pages full Research Review column, visit www.jems.com/patient-care. Download: http://teamworkmatters.ocbmedia.com/media/DKA-Simulation-Scenario.docx Categories: 5th Year MBChB paeds scenario, Emergency Department, Human Factors, Interprofessional / multidisciplinary, Non-technical skills, Paediatrics, Postgraduate / newly qualified, Undergraduate / pre-registration Rating - 150+ PDF OSCE Checklists: https://geekymedics.com/pdf-osce-checklists/ (1), The assessment of a diabetic patient is best taught as a case-based simulation. opioids, sedatives, anxiolytics, insulin, oral hypoglycaemic medications). The instructor can also gauge the direction the debriefing session should follow or be alerted to possible problems or conflicts in treatment opinions. 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. #geekymedics #fyp #fypviral #studytok #medicalstudentuk #medtok #studytips #studytipsforstudents #medstudentuk #premed #medschoolfinals, Cardiovascular History Tips - DON'T FORGET these 3 things . Trainee will get to know how professionals behave during management of a critically ill patient. Mosby:Philadelphia. Both external and internal potassium balances are disturbed during the development and treatment of DKA. She began experiencing progressively worsening thirst, increased appetite, and excessively increased urination. Insert at least onewide-bore intravenous cannula(14G or 16G) and take blood tests as discussed below. 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. The trainees have had background knowledge of biochemistry because they had completed the PBL case. The use of simulation-based instruction enables a student to learn at their own pace and allows them to repeat sequential steps to gain confidence and proficiency. cellulitis). 3. Extremities: mild cyanosis, no clubbing or edema (verbalized by instructors); pulses equal, and symmetrical (elucidated by trainees). Adds true to life parking codes and extra parking for AI. Glycosuria leads to urinary losses of potassium through osmotic diuresis. Groups of fewer than four students dont allow for optimal collaboration. Healthcare Students' Psychological Well-Being in a Diabetic Ketoacidosis Simulation. Environment & Manikin The researchers found that long shift hours (24hrs), working overtime and marital/relationship stress were strongly correlated. If the patient has COPD and a history of CO2retention you should switch to aventuri maskas soon as possible andtitrate oxygen appropriately. 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. At the end of the previous section, the trainee can make the diagnosis of DKA but has not confirmed it yet. Consider any precipitating factors for the development of DKA and involve the diabetes team in the patients care. areas of lipohypertrophy) if it is unclear if the patient is diabetic. An hour was . Furthermore, we demonstrate and explain the basic parameters (ECG, SpO2, BP, capnography), using an interactive format of questions and answers, and encourage the group to observe the normal values. PDF Adult Type I Diabetic Ketoacidosis Pre-simulation Preparation Student Given 6 to 8 back-to-back sessions, it is critical that every session starts and ends on time! Marx JA, Hockberger RS, Walls RM. The following scenarios are available for download and are designed to meet your multi-disciplinary nursing needs. Does the patient need a referral toHDU/ICU? One advantage to the animated lecture style is the ability to introduce treatment options in a methodically guided approach thats in conjunction with simultaneous environmental stimulus. This leads to hyperglycaemia, osmotic diuresis, and dehydration. We do have a wig that we place on the patient, but we do not try for full realism. For instance, if we mimicked the noise and traffic of a real emergency department, this would constitute excessive realism, and become a distraction to beginner medical students. The Theory A collection of communication skills guides, for common OSCE scenarios, including history taking and information giving. 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 PDF Diabetic Ketoacidosis in the Obstetric Population: A Simulation We have been presenting Simulation Laboratory sessions to our preclinical medical students (first and second years). She was taken to the Emergency Department from her soccer game because she complained of nausea, extreme fatigue, mild disorientation, and blurred vision toward the end of the soccer match. 1 Potassium losses occurring both before and during treatment of DKA must be replaced. The patient synopsis should include such standard aspects as age, sex, ethnicity, medical history, medications and allergies. You can plot as many parameters as you want and can choose to display either Historical data or have the graphs update as often as new data comes in and view them in Real-time. You may search for similar articles that contain these same keywords or you may Open the patients mouth to ensure there is no foreign material that may be pushed into the larynx. 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. <> ABG, venepuncture). Several environments may be suitable for your classroom. 2. Given such a small group, the students indicated that they feel more involved than they would with a larger group (eg, the whole class.) - Associated symptoms 03:04 A fixed-rate intravenous insulin infusion should be commenced initially to suppress ketogenesis, reduce blood glucose levels and address electrolyte disturbances. 2007. Well done, youve now stabilised the patient and theyre doing much better. DY{Qb"(EgN$QI*%XN1F""0a5 diagnosis of DKA Trigger 3, ABG show acidosis and high BM and normal potassium. Diabetic Ketoacidosis in the Obstetric Population: A Simulation An oxygen mask is also demonstrated as an alternative device, as these early trainees had mostly not yet seen any of these devices. A collection of interactive medical and surgical clinical case scenarios to put your diagnostic and management skills to the test. If the patient loses consciousness and there are no signs of life on assessment, put out a crash call and commence CPR. The file explaining the session is sent to instructors 1 week before the sessions. If the patient is conscious, sit themuprightas this can also help with oxygenation. 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