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Antibiotics should be prescribed in keeping with local guidelines. Kymera Systems Inc | SCADA Online Demo Ignition Chapters: 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. This video demonstrates how to use the SOCRATES acronym when taking a history of pain or other symptoms. Catheterisethe patient to closelymonitor urine outputto guide fluid resuscitation and need for escalation. Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario Before trainees arrival into the simulation area, the simulator is already preprogrammed for DKA. Trainee will practice or observe good teamwork skills, both as a leader and a team player. 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: An Emergency Medicine Simulation Scenario 2. Diabetic ketoacidosis (DKA) is a common, potentially lethal disease. She had developed nausea, extreme fatigue, mild disorientation, and blurred vision toward the end of the soccer match. www.cdc.gov/diabetes/statistics/prev/national/. Make sure tore-assessthe patient after anyintervention. 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 . 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. A well-staged environment allows for greater student buy-in. Despite this increased calorie intake, she noticed an unexplained 20 lbs weight loss. Pediatric Emergency Medicine Didactics and Simulation (PEMDAS In keeping with the case study, as a treatment marker is reached, the instructor should place emphasis on physiological, pharmacological, environmental and psychosocial issues. 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.. 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. Geeky Medics accepts no liability for loss of any kind incurred as a result of reliance upon the information provided in this video. A comprehensive collection of clinical examination OSCE guides that include step-by-step images of key steps, video demonstrations and PDF mark schemes. Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario. - PDF We do not use passive visualizing materials such as videotapes or DVD other than vital signs shown on the monitors. to below 12 mmol/L) an infusion containing normal saline and 5% dextrose is typically commenced to prevent the development of hypoglycaemia, whilst allowing insulin therapy to continue to suppress ketogenesis and reduce serum electrolyte concentrations. A blood glucose level may already be available from earlier investigations (e.g. Instead, instructors should combine case- and simulation-based techniques when teaching diabetic assessment. diagnosis of DKA Trigger 3, ABG show acidosis and high BM and normal potassium. This is a 25-year-old woman with a medical history of diabetes medicated with 40 units insulin per day. Typically potassium levels should be maintained between 4.0 5.5 mmol/L and close monitoring is required. 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. Nandate, Koichiro MD, PhD; Abola, Ramon MD; Murray, W Bosseau MB; Whitfield, Carol PhD; Lang, Charles PhD; Sinz, Elizabeth MD. }HyEf,#$/JSRU9+CF6k\'/z+i`[ 5JudK*Zly^g%[jCK)H[)Y=Qp0/r9o9HW_zF}pTzI~'|q.~:=Y T 9w! Does the patient need reviewing by a specialist? Diabetes UK with the Joint British Diabetes Societies Inpatient Care Group. If fever is present, make sure to consider co-existing infection. 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. Simulation Scenario. We then start the DKA state. See Appendix D, Supplemental Digital Content 4, https://links.lww.com/SIH/A4. If the patient loses consciousness and there are no signs of life on assessment, put out a crash call and commence CPR. DO NOT perform any examination or procedure on patients based purely on the content of these videos. An individual student can get an immediate answer to a question, the facilitator can see puzzled expressions on faces, and the PBL group could get answers that they could not get during their prior PBL group discussions. Ketones show 5.5. Using your thumbs, slightly open the mouth by downward displacement of the chin. After entering the environment, the student doesnt have the option of leaving the simulation until the learning objectives and performance measures are achieved. Trainee will increase knowledge of professional behaviors during the simulation. Does the patient need a referral toHDU/ICU? - 700+ OSCE Stations: https://geekymedics.com/osce-stations/ Assess the patients pulse and blood pressure: Inspect the patient from the end of the bed: they may appear drowsy, confused and/or clammy/pale. - Introduction 00:00 opioids, sedatives, anxiolytics, insulin, oral hypoglycaemic medications). Trainee will be respectful to others and their views during the PBL session. Data is temporarily unavailable. KDCA for FSX - Fly Away Simulation Its best, however, to allow the student group to continue so theyre able to evaluate their decision-making processes during debriefing. The students mentioned that they did not obtain the maximum value from the simulation session under these circumstances. Clearly communicate how often would you like the patients observations relayed to you by other staff members. The students are in their basic science course. 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. In this case scenario, dehydration is one of the most serious immediate issues. This typically involves the use of anon-rebreathe maskwith an oxygen flow rate of15L. Stage 2: Emergency management of DKA and consideration of abnormal CTG. Refer to your local guidelines which should provide a clear protocol for the management of DKA. Depending on scenario complexity, team dynamic and treatment modalities, this simulation may take 1020 minutes. endobj You may be asked to review a patient with DKA due to confusion, reduced level of consciousness, tachycardia, hypotension and/or vomiting. Geeky Medics accepts no liability for loss of any kind incurred as a result of reliance upon the information provided in this video. If the patient is conscious, sit themuprightas this can also help with oxygenation. One of the key differences with the immersive simulation is that the instructor is absent from the simulation environment. (1), The assessment of a diabetic patient is best taught as a case-based simulation. Feel the slow and tardy pulse, we consider these PBL sessions as an example of a Look here, see this use of a full human simulator in the hierarchy of learning strategies with a full human simulator (Table 1). Cureus 9(5): e1286. A pre-briefing session is conducted prior to the start of the simulation scenario. Deteriorationshould be recognised quickly and acted upon immediately. As this is a PBL session, the trainees are not given any references. An oxygen mask is also demonstrated as an alternative device, as these early trainees had mostly not yet seen any of these devices. 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 . Keywords: diabetic ketoacidosis, simulation, expertise, emergency medicine Introduction Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes mellitus, most . Consider active re-warming techniques in patients with severe hypothermia. We combined both to indicate the continuity of the curriculum, and the building on prior knowledge. Section snippets . 5. Check out our other awesome clinical skills resources including: 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 We used the Medical Education Technologies Inc. (METI) Human Patient Stimulator (HPS, METI Sarasoto, Fl). The students have acquired all the applicable theoretical knowledge of the case during the previous multiday PBL sessions. Refer to your local guidelines for further details. The use of a simulated, evolving case scenario was an effective method of exposing nursing students to complex patient care. The instructor should have visual access via one-way windows or cameras. Prehosp Emerg Care. - 150+ PDF OSCE Checklists: https://geekymedics.com/pdf-osce-checklists/ Glycosuria leads to urinary losses of potassium through osmotic diuresis. Patients with DKA require fluid resuscitation to restore circulatory volume, clear ketones, correct electrolyte abnormalities and increase renal perfusion. 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. Hypothermia may be present if the patient has been unconscious and exposed for some time. There are actually two sets of educational objectives: the first set is for the theoretical PBL sessions, and the 2nd set is for the Simulation Session. Respiratory Failure in the Course of Treatment of Diabetic Ketoacidosis Join the Geeky Medics community: Ask for anotherclinicalmemberofstafftoassistyou if possible. An hour was . Medical Simulation Scenarios are text documents outlining the various details of a simulation - everything from patient simulator settings to debriefing notes. reduced air entry, coarse crackles) to screen for evidence of pneumonia. We ask the trainee why the blood pressure is so low or heart rate is so high, and how we should treat it. PDF Medicine Simulation Scenario Diabetic Ketoacidosis: An Emergency 4 0 obj Published August 2015. As the name says, this screen is used to graph and plot any parameter. 3. Causes: Any situation arising in a diabetic that requires increased insulin without that demand being met can result in DKA. Prehosp Emerg Care. Twitter: http://www.twitter.com/geekymedics Please try after some time. 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. Insert at least onewide-bore intravenous cannula(14G or 16G) and take blood tests as discussed below. We give the history of the patient to the trainees. 2. A patient with Type I diabetes will often have symptoms related to blood sugar imbalances that appear abruptly with polydipsia, polyuria, polyphagia and rapid weight loss. Intubation lubricants can mimic drooling. Diabetic ketoacidosis; Simulation training; Medical students. 1. Therefore, the session is divided into four sections of 15 minutes each, so that the facilitator is constantly aware of being on time (or not), even after the first 15 minutes period. 2) Complete the assigned suggested readings 3) Complete the presimulation preparation virtual simulation game (Instructor will provide link) 4) Once you have completed reading this document and prepared for your simulation, please: a. - PSA Question Pack: https://geekymedics.com/psa-question-bank/ 2003;78:783788. 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. We try to provide sufficient realism.. Highlight selected keywords in the article text. She began experiencing progressively worsening thirst, increased appetite, and excessively increased urination. A debriefing section with pre-established questions allows the instructor to review the main focus and performance measures with the student group. For similar reasons, we do not believe a videotaped session will keep the students attention as much as these live simulator sessions. Ziv A, Wolpe PR, Small SD, et al. Perform urinalysis and send the urine for culture if urinary tract infection is suspected. A hyperglycemic patient may present with tachypnea, which often presents as Kussmauls respirations, tachycardia, orthostatic blood pressure changes and other signs of dehydration and diabetic ketoacidosis (DKA). 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. Open the patients airwayusing ahead-tiltchin-lift manoeuvre: 1. 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. Laschinger S, Medves J, Pulling C, et al. Advance the airway until it lies within the pharynx. Scenarios. Development of simulation scenarios for an adolescent patient with diabetic ketoacidosis. - Geeky Medics OSCE App: https://geekymedics.com/geeky-medics-app/ 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. 3. Therefore, we should not have to take much time on this issue, but we have to focus on the relationship between the biochemistry and clinical signs and symptoms by asking why the patient is dehydrated, why acidosis develops, why respiration is rapid and deep (Kussmaul) respirations, and what the rationale for inpatient treatment is. Trainee will be able to apply skills of communication with the simulated patient in a semiacute crisis to get sufficient important information for a final diagnosis. Problems are addressed as they are identified and the patient is re-assessed regularly to monitor their response to treatment. Review the patientscurrent medicationsand check any regular medications areprescribed appropriately. As individuals with uncontrolled type I . Insert the oropharyngeal airway in the upside-down position until you reach the junction of the hard and soft palate, at which point you should rotate it 180. Animated Lecture 3. The faculty member/course coordinator of Simulation Design The students are in their first year. Simulation Training Ideal for Diabetic Patients - JEMS Over the years, some groups happened to have the simulation session before the completion of the theoretical PBL session. We are looking for declaration of DKA and request for pathway. cloudy urine may indicate urinary tract infection). After the first voluntary session in 2006, feedback from the medical students indicated that they would like to receive this handout. The instructions to the facilitators suggest a series of structured, sequential questions to the students (starting at one end, involving each student in turn, and repeatedly cycling around the group.) Diabetic ketoacidosis simulator: a new learning tool for a life Research Watch Box:Sleep, Fatigue & SafetyBy David Page, MS, NREMT-P Clinical Simulation in Nursing, Volume 39, 2020, pp. Simulation provides a safe environment where learning is enhanced through the deliberate practice of skills and controlled management of a variety of clinical encounters. We found it more important to have the students full attention so that they could concentrate on concepts and not on menial tasks such as recording data. Case-based education adds a real-world aspect to the learning environment. Simulation in Healthcare4(4):232-236, Winter 2009. You can check out our guide to using SOCRATES here: https://geekymedics.com/the-socrates-acronym-in-history-taking/ Animated lectures, however, must work within the framework of a focused case study, which requires increased preparation time. They have had no clinical exposure or any clinical experience. See ourhistory taking guidesfor more details. We are adding to their theoretical knowledge by introducing them to physical objects, dynamic moving vital sign signals, and a moving, breathing simulated patient to make the case come alive. endobj 4. The student group should be encouraged to collaborate on management options and to perform skills. Available from: [. However, this turned out to be too slow, took too much time, and could not continuously demonstrate the direction of changes. If foreign material is present, attempt removal using suction. They should introduce the student group to the environment, assign roles for each learner and guide the decision-making process. For more information, please refer to our Privacy Policy. A collection of communication skills guides, for common OSCE scenarios, including history taking and information giving. Review the patients drug chart for medications which may cause a reduced level of consciousness (e.g. 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. unilateral coarse crackles may be present if the patient has pneumonia which may have been the precipitant for DKA). This field is for validation purposes and should be left unchanged. Use blankets to re-warm patients who are mild to moderately hypothermic. Consider any precipitating factors for the development of DKA and involve the diabetes team in the patients care. If any obstruction is encountered, remove the tube and try the left nostril. Endocrine - thesimbook.com 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. PDF Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario Some error has occurred while processing your request. The DKA simulation incorporates cue recognition, analysis of cues, generation of solutions, nursing interventions, and evaluation of outcomes, including effective communication and psychosocial concerns. If you have any scenarios you would be willing to share with the simulation community, please forward them to me. Askhow the patient is feeling as this may provide some useful information about their current symptoms. In some cases, normal saline with additional potassium is required to prevent overcorrection of serum potassium levels which would otherwise result in hypokalaemia. The students are in their first year. We have 18 to 20 PBL groups for an hour each in the week after their PBL DKA session. This allows the learner group to make a psychological break from the patient and environment while beginning the reflection process. Centers for Disease Control and Prevention. - Medical Finals Question Pack: https://geekymedics.com/medical-student-finals-questions/ The choice of fluid type, rate of administration and volume should be tailored to the individual patient based upon their vital signs and electrolytes. The reason for inserting the airway upside down initially is to reduce the risk of pushing the tongue backwards and worsening airway obstruction. vD0 x@FFJ{m[ 3//Oh|JR7! Insert the airway bevel-end first, vertically along the floor of the nose with a slight twisting action. Inspect theairwayfor obviousobstruction. Invasive monitors, including a left radial intraarterial and a right subclavian IV catheter, were placed. These simulation sessions seem to work because the medical students do have prior knowledge. - Onset 01:48 The main goal is to establish a safe learning environment for the learner [9, 13 . Scenario in a Nutshell Diabetic ketoacidosis (DKA) in pregnancy. Healthcare Students' Psychological Well-Being in a Diabetic Ketoacidosis Simulation. Pediatric Emergency Medicine Didactics and Simulation (PEMDAS From the Department of Anesthesiology, Pennsylvania State University College of Medicine, Hershey, PA. Dr. Murray is on the Speakers Bureau of METI, Sarasota, FL. 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. Revisit history taking to explore relevant medical history and identify any precipitating factors for DKA. A collection of data interpretation guides to help you learn how to interpret various laboratory and radiology investigations. Its important to train and educate students of prehospital care on key indicators of a diabetic emergency. With your index and other fingers placed behind the angle of the mandible, apply steady upwards and forward pressure to lift the mandible. As this is an interactive discussion session, any needed debriefing and/or explanation is given during the sessions. Forty percent of respondents reported excessive daytime sleepiness. It involves a facilitating instructor, a small learner group and conceptual aspects of environmental and manikin staging to provide sensory cues. Extremities: mild cyanosis, no clubbing or edema (verbalized by instructors); pulses equal, and symmetrical (elucidated by trainees). 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. <> 2011;15:108109. endobj In the meantime, you can perform some basic airway manoeuvres to help maintain the airway whilst awaiting senior input. 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. Int J Evid Based Healthc. Privacy Policy Testing a diabetes keotacidosis simulation in critical care nursing: A Strategies of high-performing paramedic educational programs. Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario Cureus. The instructors have to appreciate that the trainees participating in this simulation have not seen a diabetic patient in either a ward or ER, but that they have knowledge of the underlying physiology. An integral part of a PBL session is for trainees to be able to navigate through huge literature bases. See ourfluid prescribing guidefor more details onresuscitation fluids. Similar to a ward round, where the instructor would say: Come and listen to this patient with an aortic stenosis. In the context of DKA, a patients consciousness level may be reduced. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journals Web site (www.simulationinhealthcare.com). 2007. Data Description All the product records are stored at /user/spark/dataset/retail_db/products All the category records are stored at /user/spark/dataset /ret. Wolters Kluwer Health PDF Medicine Simulation Scenario Diabetic Ketoacidosis: An Emergency - Cureus J Nurs Educ. doi: 10.7759/cureus.1286. 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. your express consent. This simulation session therefore aims to make the case come alive, and show this known case in a clinical context. Using SOCRATES in History Taking | OSCE | Communication Skills, Diabetic Ketoacidosis (DKA) | Acute Management | ABCDE. The simulation session is also hosted as an interactive session. DO NOT perform any examination or procedure on patients based purely on the content of these videos. oral fluids, intravenous fluids, urine output, drain output, stool output, vomiting) to inform resuscitation efforts. The questionnaire for the assessment of the session is given in full in the web-based supplement (Appendix A, Supplemental Digital Content 1, https://links.lww.com/SIH/A1). Diabetic Ketoacidosis (DKA) Clinical Pathway Emergency Department Therefore, we have to emphasize the importance of airway, breathing, and circulation in the very sick patient in any clinical setting. 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. SimMan Nursing Scenarios Software. As with the animated lecture, the simulation is strongly dependent on a focused case study. Groups of fewer than four students dont allow for optimal collaboration. - Examples 05:45 In other words, they do not have clinical experience, but they have clinical knowledge. 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. Target Learner Groups By joining Cureus, you agree to our Diabetic Ketoacidosis in the Obstetric Population: A Simulation Classroom Dynamics The file explaining the session is sent to instructors 1 week before the sessions. - Site 01:12 PBL was introduced at our institution in 1995. Example: If the provider immediately evaluates blood glucose, then the reading will display 45 mg/dL. A simulation training session is described designed to acquaint emergency medicine residents with the presentation and management of diabetic ketoacidosis through the use of simulation. 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]). Subscribe to our newsletter to be the first to know about our latest content: https://geekymedics.com/newsletter/ 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. A collection of free medical student quizzes to put your medical and surgical knowledge to the test! Acad Med. A traditional classroom lecture format allows for student participation but limits the instructors ability to create realistic situations. Works with Traffic 2005, but . - Timing 03:23 In this manner, the students have to apply their knowledge at the appropriate points during the progression of the scenario. PA EMT Said COVID Patient Didnt Need to Go to the NYC Unions Demand Reinstatement, Back Pay for Workers Fired for Refusing President Biden to End COVID-19 Emergencies on May 11. It should only be inserted in unconscious patients as it is otherwise poorly tolerated and may induce gagging and aspiration.