Seek senior helpif the patient shows no signs of improvement or if you have any concerns. 3. Measure the patients capillary blood glucose and ketone levels to confirm the diagnosis and guide the management of DKA. Its absolutely necessary to follow all immersive simulations with a positive, emotionally safe and nonjudgmental debriefing environment. 2. Trainee will practice or observe good teamwork skills, both as a leader and a team player. The students are in their basic science course. Trainee will appropriately request assistance and use available resources. In the meantime, you should re-assess and maintain the patients airway. Each clinical case scenario allows you to work through history taking, investigations, diagnosis and management. www.cdc.gov/diabetes/statistics/prev/national/. This typically involves the use of anon-rebreathe maskwith an oxygen flow rate of15L. If the patient is suspected to have sufferedsignificanttraumawith potential spinal involvement, perform ajaw-thrustrather than a head-tilt chin-lift manoeuvre: 2. Initially, we used a blood pressure cuff to generate the blood pressure values. Prehosp Emerg Care. 2009;13:505511. NPAs are typically better tolerated in patients who are partly or fully conscious compared to oropharyngeal airways. A comprehensive collection of medical revision notes that cover a broad range of clinical topics. Conclusions This technical report describes the design and implementation of a simulation scenario on DKA for emergency medicine trainees. . Simulation provides a safe environment where learning is enhanced through the deliberate practice of skills and controlled management of a variety of clinical encounters. 2. cloudy urine may indicate urinary tract infection). Keyword Highlighting
An events progression section should include patient status changes, as well as a time/treatment continuum that incorporates if-then event progressions. We are looking for declaration of DKA and request for pathway. Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. Similar to a ward round, where the instructor would say: Come and listen to this patient with an aortic stenosis. We guide the group to suggest fluid. In the meantime, you can perform some basic airway manoeuvres to help maintain the airway whilst awaiting senior input. The debriefing environment should be removed from the location where the simulation took place. The file explaining the session is sent to instructors 1 week before the sessions. Simulation in Healthcare4(4):232-236, Winter 2009. Introduceyourselfto thepatientincluding yournameandrole. I assigned true to life parking codes, and added some extra parking for the superfluous US Express AI. 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 . Alert a senior immediately if you have any concerns about the consciousness level of a patient. Trainee will improve their understanding of clinical practice through reflective assessment of actual cases during the prior PBL sessions. If foreign material is present, attempt removal using suction. *=NdL/c2XSJn8:I Jb8'.8>N*[L .hxw6afq40DX3c~>abt'Q,8y(BZu(vKBTufIR. The choice of fluid type, rate of administration and volume should be tailored to the individual patient based upon their vital signs and electrolytes. Scenario in a Nutshell Diabetic ketoacidosis (DKA) in pregnancy. Clinical Simulation in Nursing, Volume 39, 2020, pp. If the patient is confused you might be able to get a collateral history from staff or family members as appropriate. Please enable scripts and reload this page. 34 - Diabetic Ketoacidosis in Pregnancy | Obgyn Key endobj
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. Problems are addressed as they are identified and the patient is re-assessed regularly to monitor their response to treatment. Note that if-thens must also include negative patient outcomes for when the provider doesnt take appropriate action. Facilitator to ask how often to measure BMs She had developed nausea, extreme fatigue, mild disorientation, and blurred vision toward the end of the soccer match. modify the keyword list to augment your search. 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: 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. Use washable, non-toxic paints to imitate various body emissions. Urinary tract infections are a common DKA precipitant. Geeky Medics accepts no liability for loss of any kind incurred as a result of reliance upon the information provided in this video. ABG, venepuncture). Indeed, it is the only thing that ever has.". 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. Trigger 4, Pathway 1l of saline required over 1hour and insulin infusion need prescribing and making up in 50ml syringe. DKA can be caused by either: Absolute insulin deficiency (e.g. dq-]gX4
`L'u7myx) rpjf0z,.y`VMyx-&Ju`U0 endobj
The Pratcice
Causes: Any situation arising in a diabetic that requires increased insulin without that demand being met can result in DKA. 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. Administer oxygen to all critically unwell patients during yourinitialassessment. 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). reduced air entry, coarse crackles) to screen for evidence of pneumonia. Use blankets to re-warm patients who are mild to moderately hypothermic. Finally, we summarize the course and give them time for questions. His Wife Gave Him CPR. The use of case-based simulation, although more complicated and time consuming for the instructor, immerses the students in the subject matter. Vital Signs: BP, 90/30 mm Hg (ECG shows normal sinus rhythm); central venous pressure, 0 to 2 cm H. Lungs: All lung fields are clear to auscultation without wheeze or rhonchi, and the respiratory pattern is typical of Kussmaul breathing, ie, large deep tidal volumes and increased respiratory rate. Discuss the patients current clinical condition with aseniorclinicianusing anSBARR style handover. Management of diabetic ketoacidosis in adults. NPAs should not be used in patients who may have sustained a skull base fracture, due to the small but life-threatening risk of entering the cranial vault with the NPA. 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. During an immersive simulation, its imperative the group uses critical-thinking skills and group collaboration independently. Please note that by doing so you agree to be added to our monthly email newsletter distribution list. Regardless of the underlying cause of airway obstruction, seekimmediate expert supportfrom an anaesthetist and the emergency medical team (often referred to as the crash team). Anesthetic Management Using the Oxygen Reserve Index for Tracheal Resection and Tracheal End-to-E A Scoping Review of the Impact of COVID-19 on Kidney Transplant Patients in the United States, Alabama College of Osteopathic Medicine Research, Baylor Scott & White Medical Center Department of Neurosurgery, California Institute of Behavioral Neurosciences & Psychology, Contemporary Reviews in Neurology and Neurosurgery, DMIMS School of Epidemiology and Public Health, Simulation, Biodesign, & Innovation In Medical Education, The Florida Medical Student Research Publications, University of Florida-Jacksonville Neurosurgery, VCOM Clinical, Biomedical, and Educational Research, American Red Cross Scientific Advisory Council, Canadian Association of Radiation Oncology, International Liaison Committee on Resuscitation, International Pediatric Simulation Society, Medical Society of Delaware Academic Channel, Society for Healthcare & Research Development, Surgically Targeted Radiation Therapy for Brain Tumors: Clinical Case Review, Clinical and Economic Benefits of Autologous Epidermal Grafting, Defining Health in the Era of Value-Based Care, Optimization Strategies for Organ Donation and Utilization, MR-Guided Radiation Therapy: Clinical Applications & Experiences, Multiple Brain Metastases: Exceptional Outcomes from Stereotactic Radiosurgery, Proton Therapy: Advanced Applications for the Most Challenging Cases, Radiation Therapy as a Modality to Create Abscopal Effects: Current and Future Practices, Clinical Applications and Benefits Using Closed-Incision Negative Pressure Therapy for Incision and Surrounding Soft Tissue Management, Negative Pressure Wound Therapy with Instillation, NPWT with Instillation and Dwell: Clinical Results in Cleansing and Removal of Infectious Material with Novel Dressings. The instructors role is to facilitate active learning through a combination of learning styles. A strong emphasis is placed on the focused, methodical examination of a specific medical problem and the decision-based treatment options available. Askhow the patient is feeling as this may provide some useful information about their current symptoms. Physician working in the emergency department. CCA 175 Real Time Exam Scenario 17 | JOIN Multiple DataFrames | Save as Trainee will correlate the underlying pathophysiology with symptoms and signs as exhibited by the simulation session. In an animated lecture, its important that the student group have an instructor so they can ask direct questions. 3. 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. endobj
If an obstruction is visible within the airway, use afingersweeporsuctionto remove it. She Died the Next Day. DOWNLOAD Diabetic Ketoacidosis By the end of this scenario, the learner will be able to: 1. If you have any scenarios you would be willing to share with the simulation community, please forward them . This may produce better retention of the subject matter and help students adapt to emergency scenes before going into the field. The relationship between sleep, fatigue and patient and provider safety. - Site 01:12 Both external and internal potassium balances are disturbed during the development and treatment of DKA. Diabetes mellitus affects nearly 7.8% of the U.S. population, with approximately 510% of this group affected by Type I and 9095% by Type II.1 Diabetes is the most common type of endocrine disease and was the seventh leading underlying cause of death listed on death certificates in 2006. Development of simulation scenarios for an adolescent patient with diabetic ketoacidosis. Clearlydocument your ABCDE assessment, including history, examination, observations, investigations, interventions, and the patients response. We ask the trainee why the blood pressure is so low or heart rate is so high, and how we should treat it. your express consent. An hour was . Ask for anotherclinicalmemberofstafftoassistyou if possible. Schneider Sarver PA, Senczakowicz EA, Slovensky BM. 4 0 obj
- Examples 05:45 3. The validity of the HFS-DKA scenario was verified by a certified diabetes nurse educator, a registered nurse, and a clinical nurse educator. Works with Traffic 2005, but . 2. A well-staged environment allows for greater student buy-in. Diabetic ketoacidosis simulator: a new learning tool for a life Each performance measure is separated into cognitive, behavioral or technical categories. There are several causes of DKA, which we remember by the "five I's". Wolters Kluwer Health
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). 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. Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes mellitus, most common in patients with type 1 diabetes in particular due to a deficiency or absence of insulin [1].. She began experiencing progressively worsening thirst, increased appetite, and excessively increased urination. Make sure tore-assessthe patient after anyintervention. Healthcare Students' Psychological Well-Being in a Diabetic Ketoacidosis Simulation. Simulation student Scenario- DKA-Peds.docx - DIABETIC The lecture allows for understanding of concepts prior to action, and instructor feedback is immediate. 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. and Use an effectiveSBARR handoverto communicate the key information effectively to other medical staff. Animated Lecture
PDF Medicine Simulation Scenario Diabetic Ketoacidosis: An Emergency Glycosuria leads to urinary losses of potassium through osmotic diuresis. By joining Cureus, you agree to our Paediatric DKA | Simulation Education Review the patientscurrent medicationsand check any regular medications areprescribed appropriately. It was Patients with DKA require fluid resuscitation to restore circulatory volume, clear ketones, correct electrolyte abnormalities and increase renal perfusion. Generaltipsfor applying anABCDEapproachin an emergency setting include: Acute scenarios typically begin with abriefhandoverfrom a member of thenursing staffincluding thepatients name,age,backgroundand thereasonthereviewhas been requested. As this is an interactive discussion session, any needed debriefing and/or explanation is given during the sessions. Conclusion
4. 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. Catheterisethe patient to closelymonitor urine outputto guide fluid resuscitation and need for escalation. >> Fernandez AR, Mac Crawford J, Pennell ML, et al. 1. From the Department of Anesthesiology, Pennsylvania State University College of Medicine, Hershey, PA. Dr. Murray is on the Speakers Bureau of METI, Sarasota, FL. Clearly communicate how often would you like the patients observations relayed to you by other staff members. We have spent many hours debating whether the small group format was a waste of time. Intubation lubricants can mimic drooling. Invasive monitors, including a left radial intraarterial and a right subclavian IV catheter, were placed. - Geeky Medics OSCE App: https://geekymedics.com/geeky-medics-app/ a simulation training session designed to acquaint emergency medicine residents with the presentation and management of diabetic ketoacidosis (DKA) through the use of simulation. 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. The students worked on the underlying physiology during a week long PBL session and are therefore familiar with the theoretical aspects of DKA. 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. (1), The assessment of a diabetic patient is best taught as a case-based simulation. It involves working through the following steps: Each stage of the ABCDE approach involvesclinicalassessment,investigationsandinterventions. can be reemphasized, and the effects of fluid therapy demonstrated. You might also be interested in our awesome bank of 700+ OSCE Stations. <>>>
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. A list of the requirements (monitors, props, and others) is given in Tables 2 and 3, as well as in the web supplement (Appendix C, Supplemental Digital Content 3, https://links.lww.com/SIH/A3). Respiratory Failure in the Course of Treatment of Diabetic Ketoacidosis 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 . A collection of data interpretation guides to help you learn how to interpret various laboratory and radiology investigations. 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). - Radiation 02:45 PDF Medicine Simulation Scenario Diabetic Ketoacidosis: An Emergency - Cureus Diabetes (type 1 and type 2) in children and young people: diagnosis and management. 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. Keywords: diabetic ketoacidosis, simulation, expertise, emergency medicine Introduction Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes mellitus, most . Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario In the context of DKA, a patients consciousness level may be reduced. Research Watch Box:Sleep, Fatigue & SafetyBy David Page, MS, NREMT-P
As individuals with uncontrolled type I . One of the key differences with the immersive simulation is that the instructor is absent from the simulation environment. 2 The evaluation of potassium deficits is complicated by potassium exit from . Insert at least onewide-bore intravenous cannula(14G or 16G) and take blood tests as discussed below. 1. Case-based education adds a real-world aspect to the learning environment. 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. DKA can develop within 24 hours and is potentially life threatening, requiring prompt recognition and therapeutic intervention. This allows the learner group to make a psychological break from the patient and environment while beginning the reflection process. - Severity 05:32 Two abstracts related to sleepiness in the EMS workforce were presented at the National Association of EMS Physicians symposium in January. Yes: if the patient can talk, their airway is patent and you can move on to the assessment of breathing. Groups of fewer than four students dont allow for optimal collaboration. 1) Please read through this document as it will help you prepare for your upcoming simulation on DKA. This leads to hyperglycaemia, osmotic diuresis, and dehydration. 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. A GCS of 8 or below warrants urgent expert help from an anaesthetist. Re-assessthe patient using theABCDE approachto identify any changes in their clinical condition and assess the effectiveness of your previous interventions. Each PBL case typically goes over 23 days, affording the students periods to find information for the case. Rosens Emergency Medicine: Concepts and Clinical Practice. Extremities: mild cyanosis, no clubbing or edema (verbalized by instructors); pulses equal, and symmetrical (elucidated by trainees). The normal reference range for fasting plasma glucose is 4.0 5.8 mmol/l. - Onset 01:48 Much time was wasted explaining why it did not matter. As the name says, this screen is used to graph and plot any parameter. Circulating nurse in the emergency room (ER). Instagram: https://instagram.com/geekymedics 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. Int J Evid Based Healthc. Lets discuss your options. Diabetic Ketoacidosis (DKA) | Acute Management | ABCDE An animated lecture may be described as a pseudo-simulation environment. Insert the airway bevel-end first, vertically along the floor of the nose with a slight twisting action. General: Moaning, asking what has happening to her. insulin-dependent type 2 diabetes), Altered consciousness (e.g. Classroom Dynamics
Creating a Simulation Experience to Promote Clinical Judgment #geekymedics #fyp #fypviral #studytok #medicalstudentuk #medtok #studytips #studytipsforstudents #medstudentuk #premed #medschoolfinals, Cardiovascular History Tips - DON'T FORGET these 3 things . We also show them IV bags containing saline and Ringers lactate, as well as show them IV infusion sets. Surgical dressings and imitation blood can support medical history. Using the arterial line, the scenario becomes much more dynamic. TikTok: https://www.tiktok.com/@geekymedics Your message has been successfully sent to your colleague. If the patient is conscious, sit themuprightas this can also help with oxygenation. Several environments may be suitable for your classroom. Strategies of high-performing paramedic educational programs. If the patient has COPD and a history of CO2retention you should switch to aventuri maskas soon as possible andtitrate oxygen appropriately. The patient synopsis should include such standard aspects as age, sex, ethnicity, medical history, medications and allergies. This is a combination of the modified traditional lecture within scenario-based learning. 5. Calculate the patients current fluid balance using their fluid balance chart (e.g. PA EMT Said COVID Patient Didnt Need to Go to the Hospital. Effectiveness of simulation on health profession students knowledge, skills, confidence and satisfaction. stream
This is particularly important for core . - 2500+ OSCE Flashcards: https://geekymedics.com/osce-flashcards/ 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. 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. Does the patient need reviewing by a specialist? Refer to your local guidelines for further details. We then start the DKA state. See Appendix D, Supplemental Digital Content 4, https://links.lww.com/SIH/A4. See ourintravenous cannulation guidefor more details. An integral part of a PBL session is for trainees to be able to navigate through huge literature bases. Terms of Use. Inspect for evidence of infection on the skin (e.g. 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. A patient presenting with altered level of consciousness and a blood sugar level below 80 mg/dL should be considered hypoglycemic, and treatment modalities should be consistent with those for a diabetic patient. On arrival to the ER, standard monitors (electrocardiogram [ECG] and pulse oximetry [SpO2]) and end-tidal carbon dioxide (ETCO2) concentration were placed, and the patient was given oxygen by nasal cannulae. Evenly balancing performance measures will ensure the student has the opportunity to critically think through patient treatment and to practice new or support previously learned behaviors and technical skills. Trainee will describe the changes in vital signs, the major metabolic, fluid, and electrolyte. Simulation-based medical education: An ethical imperative. These are not learning objectives in this program. Other details are also important, including descriptions regarding patient language skill, social history, socioeconomic history, family history, religious practices or beliefs pertinent to treatment, and descriptive signs and symptoms. The students are in their first year. 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. 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. See Table 4 for a suggested standardized script. Simulation Scenario. 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 simulation experience serves to give substance to the theoretical words and concepts that the students encountered during the PBL sessions. DO NOT perform any examination or procedure on patients based purely on the content of these videos. Teaching nursing management of diabetic ketoacidosis: a description of Should any changes be made to the current management of their underlying condition(s)? Centers for Disease Control and Prevention. A traditional classroom lecture format allows for student participation but limits the instructors ability to create realistic situations. 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.