dka simulation scenario

endobj They have had no clinical exposure or any clinical experience. reduced air entry, coarse crackles) to screen for evidence of pneumonia. 2011;15:108109. If fever is present, make sure to consider co-existing infection. - 150+ PDF OSCE Checklists: https://geekymedics.com/pdf-osce-checklists/ Measure the patients capillary blood glucose and ketone levels to confirm the diagnosis and guide the management of DKA. After the first voluntary session in 2006, feedback from the medical students indicated that they would like to receive this handout. We try to provide sufficient realism.. 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. 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. To read Pages full Research Review column, visit www.jems.com/patient-care. Glycosuria leads to urinary losses of potassium through osmotic diuresis. 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. Rosens Emergency Medicine: Concepts and Clinical Practice. Interactive lecture/discussion with use of monitors that show the vital signs of the simulated patient on manikin. At the end of the previous section, the trainee can make the diagnosis of DKA but has not confirmed it yet. The teaching of diabetic assessment and management, like many other medical emergencies, lends itself well to case-based simulation. A traditional classroom lecture format allows for student participation but limits the instructors ability to create realistic situations. In the final 10 minutes, we show how the patient has a good recovery after fluid replacement. Airway adjuncts are often helpful and in some cases essential to maintain a patients airway. Stage 3: Ongoing management and monitoring of DKA 1 hour after initiation of treatment. Trainee will be respectful to others and their views during the PBL session. The debriefing environment should be removed from the location where the simulation took place. A chest X-ray should not delay the emergency management of DKA. By joining Cureus, you agree to our Geeky Medics accepts no liability for loss of any kind incurred as a result of reliance upon the information provided in this video. Strategies of high-performing paramedic educational programs. In the meantime, you can perform some basic airway manoeuvres to help maintain the airway whilst awaiting senior input. Invasive monitors, including a left radial intraarterial and a right subclavian IV catheter, were placed. 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). 2 0 obj 1 0 obj A comprehensive collection of medical revision notes that cover a broad range of clinical topics. 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. 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Review thepatients notes,chartsandrecent investigation results. 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. Advance the airway until it lies within the pharynx. Available from: [. However, this leads to confusion. Therefore, we have to emphasize the importance of airway, breathing, and circulation in the very sick patient in any clinical setting. In some cases, normal saline with additional potassium is required to prevent overcorrection of serum potassium levels which would otherwise result in hypokalaemia. Each clinical case scenario allows you to work through history taking, investigations, diagnosis and management. 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 . The use of a simulated, evolving case scenario was an effective method of exposing nursing students to complex patient care. Simulation-based medical education: An ethical imperative. For more information, please refer to our Privacy Policy. Make sure tore-assessthe patient after anyintervention. Much time was wasted explaining why it did not matter. 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. 4. Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. In the meantime, you should re-assess and maintain the patients airway. The lecture allows for understanding of concepts prior to action, and instructor feedback is immediate. As individuals with uncontrolled type I . Prehosp Emerg Care. After initial insulin therapy has reduced plasma blood glucose levels (e.g. 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 . 4 0 obj We guide the group to suggest fluid. The 60 minutes training time consists of four 15-minute sections divided as follows. Re-assessthe patient using theABCDE approachto identify any changes in their clinical condition and assess the effectiveness of your previous interventions. 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Clearlydocument your ABCDE assessment, including history, examination, observations, investigations, interventions, and the patients response. Initially, we required the students to write down the vital signs. The immersive simulation is performed when the instructor feels comfortable with the acquired knowledge and skill base presented in the animated lecture or when the student group has sufficient practical experience to apply the cognitive, behavioral and technical skills outlined in the case scenario. endobj Each performance measure is separated into cognitive, behavioral or technical categories. - Medical Finals Question Pack: https://geekymedics.com/medical-student-finals-questions/ Target Learner Groups 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. Simulation provides a safe environment where learning is enhanced through the deliberate practice of skills and controlled management of a variety of clinical encounters. Debriefing 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. The main purpose of the simulation is to draw a line from the theoretical, boring biochemistry to the clinical manifestations. (1) According to Centers for Disease Control and Prevention (CDC), 223,619 deaths were attributed to diabetes in 2005. One of the key differences with the immersive simulation is that the instructor is absent from the simulation environment. Heart: S1 and S2 within normal limits; no S3/S4 or murmurs, normal rate and rhythm. 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 comprehensive collection of clinical examination OSCE guides that include step-by-step images of key steps, video demonstrations and PDF mark schemes. Healthcare Students' Psychological Well-Being in a Diabetic Ketoacidosis Simulation. Its best, however, to allow the student group to continue so theyre able to evaluate their decision-making processes during debriefing. Two abstracts related to sleepiness in the EMS workforce were presented at the National Association of EMS Physicians symposium in January. If an infection is suspected, IV antibioticsshould be administered as soon as possible. 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. As this is an interactive discussion session, any needed debriefing and/or explanation is given during the sessions. Perform urinalysis and send the urine for culture if urinary tract infection is suspected. It may be necessary toexposethe patient during your assessment: remember to prioritise patient dignity and conservation of body heat. Geeky Medics accepts no liability for loss of any kind incurred as a result of reliance upon the information provided in this video. As with the animated lecture, the simulation is strongly dependent on a focused case study. A fixed-rate intravenous insulin infusion should be commenced initially to suppress ketogenesis, reduce blood glucose levels and address electrolyte disturbances. Because of the early stage (first year) of their medical careers, they have not yet seen vital sign monitoring, or patients, so these clinical aspects are introduced and emphasized. We ask the trainee why the blood pressure is so low or heart rate is so high, and how we should treat it. DOWNLOAD Diabetic Ketoacidosis By the end of this scenario, the learner will be able to: 1. #geekymedics #fyp #fypviral #studytok #medicalstudentuk #medtok #studytips #studytipsforstudents #medstudentuk #premed #medschoolfinals, Cardiovascular History Tips - DON'T FORGET these 3 things . She began experiencing progressively worsening thirst, increased appetite, and excessively increased urination. Another example: At one minute into the scenario, the patient becomes unresponsive and their breathing becomes shallow. 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. Your message has been successfully sent to your colleague. Weight, Height: Not given, normal appearing (as per simulator) but has lost 20 lbs recently. *=NdL/c2XSJn8:I Jb8'.8>N*[L .hxw6afq40DX3c~>abt'Q,8y(BZu(vKBTufIR. Privacy Policy You might also be interested in our awesome bank of 700+ OSCE Stations. However, this turned out to be too slow, took too much time, and could not continuously demonstrate the direction of changes. 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. These simulation sessions seem to work because the medical students do have prior knowledge. 3. - Introduction 00:00 cloudy urine may indicate urinary tract infection). If foreign material is present, attempt removal using suction. 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). DOI 10.7759/cureus.1286. ABG, venepuncture). Calculate the patients current fluid balance using their fluid balance chart (e.g. His Heart Stopped On a Treadmill. 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. MassBay EMS Program Integrates Training for Dogs, Heat Waves Are Killing More LA Homeless People. She is lethargic and slightly confused but can intermittently respond to questions. The following scenarios are available for download and are designed to meet your multi-disciplinary nursing needs. This allows us to get in touch for more details if required. Mosby:Philadelphia. Adds true to life parking codes and extra parking for AI. 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. Consider any precipitating factors for the development of DKA and involve the diabetes team in the patients care. The students have acquired all the applicable theoretical knowledge of the case during the previous multiday PBL sessions. Conclusions This technical report describes the design and implementation of a simulation scenario on DKA for emergency medicine trainees. Development of simulation scenarios for an adolescent patient with diabetic ketoacidosis. We combined both to indicate the continuity of the curriculum, and the building on prior knowledge. 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. Scenario in a Nutshell Diabetic ketoacidosis (DKA) in pregnancy. 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. 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. This leads to hyperglycaemia, osmotic diuresis, and dehydration. NPAs are typically better tolerated in patients who are partly or fully conscious compared to oropharyngeal airways. 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. (1) The assessment of a diabetic patient is best taught as a. 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. The instructor should have visual access via one-way windows or cameras. TheABCDEapproach can be used to perform a systematic assessment of a critically unwell patient. Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario Cureus. <>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 595.32 841.92] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> Groups of more than seven may struggle with meeting objectives due to insufficient functional rolls. 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.. The Pratcice Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare, Get new journal Tables of Contents sent right to your email inbox, SIH_13_4_2018_08_03_KOBAYASHI_17-00153_SDC5.tif; [Other] (3.04 MB), SIH_4_4_2009_10_29_NANDATE_200199_SDC2.doc; [Word] (68 KB), SIH_4_4_2009_10_29_NANDATE_200199_SDC3.doc; [Word] (29 KB), SIH_4_4_2009_10_29_NANDATE_200199_SDC4.doc; [Word] (40 KB), Simulation of Diabetic Ketoacidosis for Cellular and Molecular Basics of Medical Practice, Articles in PubMed by Koichiro Nandate, MD, PhD, Articles in Google Scholar by Koichiro Nandate, MD, PhD, Other articles in this journal by Koichiro Nandate, MD, PhD, Privacy Policy (Updated December 15, 2022). We have 18 to 20 PBL groups for an hour each in the week after their PBL DKA session. 3 0 obj 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). Trainee will learn to collaborate with peers to decide on appropriate interventions, tests, and therapy. Works with Traffic 2005, but . Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. Extremities: mild cyanosis, no clubbing or edema (verbalized by instructors); pulses equal, and symmetrical (elucidated by trainees). DKA can develop within 24 hours and is potentially life threatening, requiring prompt recognition and therapeutic intervention. GRAPH. - PSA Question Pack: https://geekymedics.com/psa-question-bank/ 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. Seek senior helpif the patient shows no signs of improvement or if you have any concerns. tall tented T waves in hyperkalaemia). . Subscribe to our newsletter to be the first to know about our latest content: https://geekymedics.com/newsletter/ 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 . 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. See ourdocumentation guidesfor more details. Yes: if the patient can talk, their airway is patent and you can move on to the assessment of breathing. During an immersive simulation, its imperative the group uses critical-thinking skills and group collaboration independently. See Table 4 for a suggested standardized script. 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). 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. Physician working in the emergency department. Immersive Simulations insulin-dependent type 2 diabetes), Altered consciousness (e.g. In this case scenario, dehydration is one of the most serious immediate issues. When erroneous treatment is delivered, the instructor can end the simulation. The DKA simulation incorporates cue recognition, analysis of cues, generation of solutions, nursing interventions, and evaluation of outcomes, including effective communication and psychosocial concerns. Open the patients mouth to ensure there is no foreign material that may be pushed into the larynx. A comprehensive collection of OSCE guides to common clinical procedures, including step-by-step images of key steps, video demonstrations and PDF mark schemes. can be reemphasized, and the effects of fluid therapy demonstrated. As the name says, this screen is used to graph and plot any parameter. - Exacerbating & relieving factors 05:12 A GCS of 8 or below warrants urgent expert help from an anaesthetist. Stage 2: Emergency management of DKA and consideration of abnormal CTG. 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. You can check out our guide to using SOCRATES here: https://geekymedics.com/the-socrates-acronym-in-history-taking/ The instructors role is to facilitate active learning through a combination of learning styles. We do point out the blood pressure (BP) cuff, but these medical students in their first year do not really need to know how the BP values are generated, they need to understand the origin and therapy for the low blood pressure. 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). 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. 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. The patient was placed in the supine position and was a little confused as well as drowsy but at times had a good verbal response (Glasgow Coma Scale 15/15). The required potassium replacement varies greatly. 2008;6:278302. Administer oxygen to all critically unwell patients during yourinitialassessment. Inspect for evidence of self-injection sites (e.g. This guide provides an overview of the recognition and immediate management of diabetic ketoacidosis (DKA)using an ABCDE approach. Blood sugar issues in the Type II diabetic will have a gradual onset, with diagnosis generally resulting from routine laboratory exams.(1). A number of key modifiers are described that allow for the adjustment of case . Refer to your local guidelines which should provide a clear protocol for the management of DKA. The normal reference range for fasting plasma glucose is 4.0 5.8 mmol/l. 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. They have had no clinical exposure or any clinical experience. This session provides additional clinical support material for the theoretical PBL session. % 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. You could also ask a student to smear a small amount of acetone on a piece of glass to see how volatile it is, helping them understand why its being exhaled by the DKA patient. Should any changes be made to the current management of their underlying condition(s)? Its absolutely necessary to follow all immersive simulations with a positive, emotionally safe and nonjudgmental debriefing environment. DO NOT perform any examination or procedure on patients based purely on the content of these videos. Medical Simulation Scenarios are text documents outlining the various details of a simulation - everything from patient simulator settings to debriefing notes.Below is a collection of donated scenarios for you to use or modify. The faculty member/course coordinator of Simulation Design 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. This is particularly important for core . If any obstruction is encountered, remove the tube and try the left nostril. Trigger 4, Pathway 1l of saline required over 1hour and insulin infusion need prescribing and making up in 50ml syringe. Terms of Use. If the patient is suspected to have sufferedsignificanttraumawith potential spinal involvement, perform ajaw-thrustrather than a head-tilt chin-lift manoeuvre: 2. >> Patterson PD, Weaver M, Frank R, et al. Surgical dressings and imitation blood can support medical history. Recognize the signs and symptoms of a patient presenting with diabetic ketoacidosis. In other words, they do not have clinical experience, but they have clinical knowledge. 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). Diabetic ketoacidosis (DKA) is a common, potentially lethal disease. See ourhistory taking guidesfor more details. The use of case-based simulation, although more complicated and time consuming for the instructor, immerses the students in the subject matter. Hypothermia may be present if the patient has been unconscious and exposed for some time. vD0 x@FFJ{m[ 3//Oh|JR7! 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. Many of the preclinical students have never seen a real life clinical monitor or even an intravenous (IV) setup. 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. This is a combination of the modified traditional lecture within scenario-based learning. 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. The patient synopsis should include such standard aspects as age, sex, ethnicity, medical history, medications and allergies. Instead, instructors should combine case- and simulation-based techniques when teaching diabetic assessment. 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. - Geeky Medics OSCE App: https://geekymedics.com/geeky-medics-app/ The simulation experience serves to give substance to the theoretical words and concepts that the students encountered during the PBL sessions. Please try after some time. Instructors should write a case study for the simulation before the session. Causes: Any situation arising in a diabetic that requires increased insulin without that demand being met can result in DKA. The choice of fluid type, rate of administration and volume should be tailored to the individual patient based upon their vital signs and electrolytes. Urinary tract infections are a common DKA precipitant. - Radiation 02:45 2009;13:505511. may email you for journal alerts and information, but is committed Properly interpret a venous blood gas (VBG) and basic metabolic panel in a patient presenting with diabetic ketoacidosis. 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.