oral fluids, intravenous fluids, urine output, drain output, stool output, vomiting) to inform resuscitation efforts. Animated Lecture Experience has shown that the more experienced the provider, the more detailed the environmental and manikin staging should be, because providers are trained to take in and interpret visual cues as indicators of patient status. Mosby:Philadelphia. >> Fernandez AR, Mac Crawford J, Pennell ML, et al. 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. For similar reasons, we do not believe a videotaped session will keep the students attention as much as these live simulator sessions. reduced air entry, coarse crackles) to screen for evidence of pneumonia. This guide provides an overview of the recognition and immediate management of diabetic ketoacidosis (DKA)using an ABCDE approach. See ourCXR interpretation guidefor more details. Glycosuria leads to urinary losses of potassium through osmotic diuresis. Privacy Policy Use washable, non-toxic paints to imitate various body emissions. Introduceyourselfto whoever has requested a review of the patient andlistencarefullyto their handover. - Onset 01:48 Trigger 4, Pathway 1l of saline required over 1hour and insulin infusion need prescribing and making up in 50ml syringe. (1) The assessment of a diabetic patient is best taught as a. - Examples 05:45 The addition of a fluid infusion containing some potassium allows insulin therapy to continue to suppress ketogenesis and normalise plasma pH whilst preventing the development of hypokalaemia. Depending on scenario complexity, team dynamic and treatment modalities, this simulation may take 1020 minutes. A fixed-rate intravenous insulin infusion should be commenced initially to suppress ketogenesis, reduce blood glucose levels and address electrolyte disturbances. Acad Med. These are not learning objectives in this program. 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. The choice of fluid type, rate of administration and volume should be tailored to the individual patient based upon their vital signs and electrolytes. 2008;6:278302. Forty percent of respondents reported excessive daytime sleepiness. <> If any obstruction is encountered, remove the tube and try the left nostril. Clinical Simulation in Nursing, Volume 39, 2020, pp. DOI 10.7759/cureus.1286. If fever is present, make sure to consider co-existing infection. SimMan Nursing Scenarios Software. 2. - Geeky Medics OSCE App: https://geekymedics.com/geeky-medics-app/ 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. You should have another member of the clinical team aiding you in your ABCDE assessment, such a nurse, who can perform observations, take samples to the lab and catheterise if appropriate. The consequences (low blood pressure, high heart rate, central nervous system status, etc.) 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. These simulation sessions seem to work because the medical students do have prior knowledge. A well-staged environment allows for greater student buy-in. An hour was . Another example: At one minute into the scenario, the patient becomes unresponsive and their breathing becomes shallow. Well done, youve now stabilised the patient and theyre doing much better. Strategies of high-performing paramedic educational programs. 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.) Trainee will get to know how professionals behave during management of a critically ill patient. Section snippets . - Introduction 00:00 Heart: S1 and S2 within normal limits; no S3/S4 or murmurs, normal rate and rhythm. 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. Using your thumbs, slightly open the mouth by downward displacement of the chin. 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.. Given 6 to 8 back-to-back sessions, it is critical that every session starts and ends on time! Trainee will correlate the underlying pathophysiology with symptoms and signs as exhibited by the simulation session. A collection of surgery revision notes covering key surgical topics. To read Pages full Research Review column, visit www.jems.com/patient-care. Environment & Manikin Simulation provides a safe environment where learning is enhanced through the deliberate practice of skills and controlled management of a variety of clinical encounters. Research Watch Box:Sleep, Fatigue & SafetyBy David Page, MS, NREMT-P The researchers found that long shift hours (24hrs), working overtime and marital/relationship stress were strongly correlated. Conclusions This technical report describes the design and implementation of a simulation scenario on DKA for emergency medicine trainees. Schneider Sarver PA, Senczakowicz EA, Slovensky BM. Diabetes UK with the Joint British Diabetes Societies Inpatient Care Group. 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]). 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). Place one hand on the patients forehead and the other under the chin. 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 student group should be encouraged to collaborate on management options and to perform skills. You may be trying to access this site from a secured browser on the server. Review thepatients notes,chartsandrecent investigation results. Lets discuss your options. 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. - Timing 03:23 DKA can develop within 24 hours and is potentially life threatening, requiring prompt recognition and therapeutic intervention. Over the years, some groups happened to have the simulation session before the completion of the theoretical PBL session. 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. The validity of the HFS-DKA scenario was verified by a certified diabetes nurse educator, a registered nurse, and a clinical nurse educator. Simulation provides a safe environment where learning is enhanced through the deliberate practice of skills and controlled management of a variety of clinical encounters. Before trainees arrival into the simulation area, the simulator is already preprogrammed for DKA. - 700+ OSCE Stations: https://geekymedics.com/osce-stations/ 1 0 obj This allows the learner group to make a psychological break from the patient and environment while beginning the reflection process. can be reemphasized, and the effects of fluid therapy demonstrated. We also show them IV bags containing saline and Ringers lactate, as well as show them IV infusion sets. 2 0 obj stream 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. Margolis GS, Romer GA, Fernandez AR, et al. A nasopharyngeal airway is a soft plastic tube with a bevel at one end and a flange at the other. - Over 3000 Free MCQs: https://geekyquiz.com/ a simulation training session designed to acquaint emergency medicine residents with the presentation and management of diabetic ketoacidosis (DKA) through the use of simulation. Emergency medical services workLife characteristics contribute to clinically significant excessive daytime sleepiness. The main purpose of the simulation is to draw a line from the theoretical, boring biochemistry to the clinical manifestations. 1. A pre-briefing session is conducted prior to the start of the simulation scenario. your express consent. Note that if-thens must also include negative patient outcomes for when the provider doesnt take appropriate action. A traditional classroom lecture format allows for student participation but limits the instructors ability to create realistic situations. Works with Traffic 2005, but . Medical simulation technology is a powerful tool for training physicians but papers dealing with DKA simulators are scarce. You may need further help or advice from a senior staff member and you shouldnot delay seeking help if you have concerns about your patient. (1), The assessment of a diabetic patient is best taught as a case-based simulation. 3. We used the Medical Education Technologies Inc. (METI) Human Patient Stimulator (HPS, METI Sarasoto, Fl). We have 18 to 20 PBL groups for an hour each in the week after their PBL DKA session. 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. Recognize the signs and symptoms of a patient presenting with diabetic ketoacidosis. We now provide the students with handouts of the data to save time and provide consistency. Using SOCRATES in History Taking | OSCE | Communication Skills, Diabetic Ketoacidosis (DKA) | Acute Management | ABCDE. Advance the airway until it lies within the pharynx. Target Learner Groups <>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 595.32 841.92] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> Typically potassium levels should be maintained between 4.0 5.5 mmol/L and close monitoring is required. 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 Geeky Medics accepts no liability for loss of any kind incurred as a result of reliance upon the information provided in this video. The teaching of diabetic assessment and management, like many other medical emergencies, lends itself well to case-based simulation. On the basis of the feedback from the students, they indicated that they believed the small group sessions are better. From the Department of Anesthesiology, Pennsylvania State University College of Medicine, Hershey, PA. Dr. Murray is on the Speakers Bureau of METI, Sarasota, FL. 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. Calculate the patients current fluid balance using their fluid balance chart (e.g. Search for Similar Articles Simulation-based medical education: An ethical imperative. Join the Geeky Medics community: Interactive lecture/discussion with use of monitors that show the vital signs of the simulated patient on manikin. A GCS of 8 or below warrants urgent expert help from an anaesthetist. Use blankets to re-warm patients who are mild to moderately hypothermic. If an obstruction is visible within the airway, use afingersweeporsuctionto remove it. It was developed for anesthesiology resident physicians with some background knowledge and experience caring for critically ill patients. Scenarios. The instructor can also gauge the direction the debriefing session should follow or be alerted to possible problems or conflicts in treatment opinions. Initially, we required the students to write down the vital signs. The following scenarios are available for download and are designed to meet your multi-disciplinary nursing needs. In this manner, the students have to apply their knowledge at the appropriate points during the progression of the scenario. We try to provide sufficient realism.. This may produce better retention of the subject matter and help students adapt to emergency scenes before going into the field. 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 . PBL was introduced at our institution in 1995. 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. Categories: Emergency Medicine, Medical Education Keywords: diabetic ketoacidosis, simulation, expertise, emergency medicine . See ourhistory taking guidesfor more details. Refer to your local guidelines which should provide a clear protocol for the management of DKA. 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 . 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. GRAPH. www.cdc.gov/diabetes/statistics/prev/national/. The use of a simulated, evolving case scenario was an effective method of exposing nursing students to complex patient care. Chapters: Much time was wasted explaining why it did not matter. Cureus 9(5): e1286. The simulation experience serves to give substance to the theoretical words and concepts that the students encountered during the PBL sessions. You might also be interested in our awesome bank of 700+ OSCE Stations. Ziv A, Wolpe PR, Small SD, et al. Physician working in the emergency department. See our blood glucose measurement guide for more details. Case-based education adds a real-world aspect to the learning environment. The Pratcice Her medical, social, and family histories are not clear at the time of admission to the emergency department. 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 . Trainee will increase knowledge of professional behaviors during the simulation. During an immersive simulation, its imperative the group uses critical-thinking skills and group collaboration independently. As individuals with uncontrolled type I . 2010;49:578586. They have had no clinical exposure or any clinical experience. Int J Evid Based Healthc. Keyword Highlighting Stage 1: Initial assessment of acutely unwell pregnant woman and diagnosis of DKA. Instructors should write a case study for the simulation before the session. She is lethargic and slightly confused but can intermittently respond to questions. Its absolutely necessary to follow all immersive simulations with a positive, emotionally safe and nonjudgmental debriefing environment. endobj Open the patients airwayusing ahead-tiltchin-lift manoeuvre: 1. modify the keyword list to augment your search. - Severity 05:32 Immersive simulations are mentally exhausting because they create an intense and stressful atmosphere requiring the learner to work outside their comfort zone. Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. }HyEf,#$/JSRU9+CF6k\'/z+i`[ 5JudK*Zly^g%[jCK)H[)Y=Qp0/r9o9HW_zF}pTzI~'|q.~:=Y T 9w! Make sure thepatientsnotes,observationchartandprescriptionchartare easily accessible. The student group is given a short introduction into a closed simulation environment. - Exacerbating & relieving factors 05:12 Makeup may be used to depict gender, hollow eyes and cheeks, produce pallor or display bruises and scars. 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. 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. 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. Groups of fewer than four students dont allow for optimal collaboration. After initial insulin therapy has reduced plasma blood glucose levels (e.g. DO NOT perform any examination or procedure on patients based purely on the content of these videos. 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. We combined both to indicate the continuity of the curriculum, and the building on prior knowledge. Does the patient need reviewing by a specialist? 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. Indeed, it is the only thing that ever has.". >> Patterson PD, Weaver M, Frank R, et al. 2017 May 29;9(5):e1286. 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. 4. 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. Diabetic Ketoacidosis (DKA) Clinical Pathway Emergency Department | Children's Hospital of Philadelphia Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario There are just a few more things to do. 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. The lecture allows for understanding of concepts prior to action, and instructor feedback is immediate. General: Moaning, asking what has happening to her. She tends to drink sugar containing fluids (soda) when she is thirsty, and she eats fast foods (cream-filled muffins) when she is hungry. - Associated symptoms 03:04 Several environments may be suitable for your classroom. In the final 10 minutes, we show how the patient has a good recovery after fluid replacement. - 2500+ OSCE Flashcards: https://geekymedics.com/osce-flashcards/ Deteriorationshould be recognised quickly and acted upon immediately. 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. DKA can be caused by either: Absolute insulin deficiency (e.g. Simulation Scenario for Anesthesia Providers Clark Obr, MD*, Anthony Mueller, MD . Alert a senior immediately if you have any concerns about the consciousness level of a patient. 4 0 obj After the first voluntary session in 2006, feedback from the medical students indicated that they would like to receive this handout. Could we not just do this as a large group session to all 160 students (versus 20 1-hour sessions to groups of eight students)? The debriefing environment should be removed from the location where the simulation took place. #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! 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. Performing an ECG should not delay the emergency management of DKA. Its important to train and educate students of prehospital care on key indicators of a diabetic emergency. Re-assessthe patient using theABCDE approachto identify any changes in their clinical condition and assess the effectiveness of your previous interventions. 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). In the meantime, you should re-assess and maintain the patients airway. Twitter: http://www.twitter.com/geekymedics 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 Facilitator to ask how often to measure BMs 2 The evaluation of potassium deficits is complicated by potassium exit from . Consider any precipitating factors for the development of DKA and involve the diabetes team in the patients care. 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). - 150+ PDF OSCE Checklists: https://geekymedics.com/pdf-osce-checklists/ 1 Potassium losses occurring both before and during treatment of DKA must be replaced. We then start the DKA state. See Appendix D, Supplemental Digital Content 4, https://links.lww.com/SIH/A4. If the patient is conscious, sit themuprightas this can also help with oxygenation. After entering the environment, the student doesnt have the option of leaving the simulation until the learning objectives and performance measures are achieved. Two abstracts related to sleepiness in the EMS workforce were presented at the National Association of EMS Physicians symposium in January.
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