3. Using SOCRATES in History Taking | OSCE | Communication Skills, Diabetic Ketoacidosis (DKA) | Acute Management | ABCDE. 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. 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. They have had no clinical exposure or any clinical experience. His Wife Gave Him CPR. to maintaining your privacy and will not share your personal information without Insert at least onewide-bore intravenous cannula(14G or 16G) and take blood tests as discussed below. type 1 diabetes) Complete insulin insensitivity (e.g. If the patient has COPD and a history of CO2retention you should switch to aventuri maskas soon as possible andtitrate oxygen appropriately. We believe it is important to have active, participatory learning by having conversations with the trainees in the form of questions and answers. 2010;49:578586. NPAs are typically better tolerated in patients who are partly or fully conscious compared to oropharyngeal airways. Stage 2: Emergency management of DKA and consideration of abnormal CTG. cloudy urine may indicate urinary tract infection). Check out our other awesome clinical skills resources including: - Examples 05:45 If fever is present, make sure to consider co-existing infection. <>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 595.32 841.92] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> Please write a single word answer in lowercase (this is an anti-spam measure). See ourfluid prescribing guidefor more details onresuscitation fluids. 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 . This allows us to get in touch for more details if required. endobj 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). This field is for validation purposes and should be left unchanged. Consider active re-warming techniques in patients with severe hypothermia. vD0 x@FFJ{m[ 3//Oh|JR7! If the patient has clinical signs ofanaphylaxis(e.g. Are any further assessments or interventions required? Prehosp Emerg Care. Consider any precipitating factors for the development of DKA and involve the diabetes team in the patients care. These simulation sessions seem to work because the medical students do have prior knowledge. 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. Discuss the patients current clinical condition with aseniorclinicianusing anSBARR style handover. Inspect the urine currently in the catheter bag and note its appearance (e.g. 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. Simulation Scenario. If you'd like to support us and get something great in return, check out our awesome products: You don't need to tell us which article this feedback relates to, as we automatically capture that information for you. Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario Cureus. The instructor can also gauge the direction the debriefing session should follow or be alerted to possible problems or conflicts in treatment opinions. Observe and discuss the effects of therapy in a mathematically modeled physiological simulator. See Table 4 for a suggested standardized script. Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario Therefore, we have to emphasize the importance of airway, breathing, and circulation in the very sick patient in any clinical setting. Interactive lecture/discussion with use of monitors that show the vital signs of the simulated patient on manikin. We used the Medical Education Technologies Inc. (METI) Human Patient Stimulator (HPS, METI Sarasoto, Fl). The 60 minutes training time consists of four 15-minute sections divided as follows. LYqC+pJ&6X4onfBT#?=R}.p8N3+Dk,P4tIgWB}-L'=8;_G >,K#.e89XnG'B~NtR Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. Ask for anotherclinicalmemberofstafftoassistyou if possible. DKA can develop within 24 hours and is potentially life threatening, requiring prompt recognition and therapeutic intervention. 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. 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. 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. Circulating nurse in the emergency room (ER). a simulation training session designed to acquaint emergency medicine residents with the presentation and management of diabetic ketoacidosis (DKA) through the use of simulation. PBL was introduced at our institution in 1995. The following scenarios are available for download and are designed to meet your multi-disciplinary nursing needs. . Forty percent of respondents reported excessive daytime sleepiness. Centers for Disease Control and Prevention. Standardized patient as the voice of the simulator (or the simulation operator may play this role). Management of diabetic ketoacidosis in adults. Keywords: diabetic ketoacidosis, simulation, expertise, emergency medicine Introduction Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes mellitus, most . Please try again soon. 2 0 obj endobj Inspect for evidence of self-injection sites (e.g. 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].. If an obstruction is visible within the airway, use afingersweeporsuctionto remove it. type 1 diabetes), Complete insulin insensitivity (e.g. Respiratory Failure in the Course of Treatment of Diabetic Ketoacidosis Alert a senior immediately if you have any concerns about the consciousness level of a patient. 3. your express consent. A chest X-ray should not delay the emergency management of DKA. Diabetic Ketoacidosis in the Obstetric Population: A Simulation 2. 2009;13:505511. stream She began experiencing progressively worsening thirst, increased appetite, and excessively increased urination. 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. We now provide the students with handouts of the data to save time and provide consistency. DONT FORGET these 3 key components of the cardiovascular exam for your upcoming OSCEs Save this video to watch later and dont forget to follow Geeky Medics! In some cases, normal saline with additional potassium is required to prevent overcorrection of serum potassium levels which would otherwise result in hypokalaemia. The optimal number of simulation participants is four to seven individuals, depending on the case study objectives. In this case scenario, dehydration is one of the most serious immediate issues. *=NdL/c2XSJn8:I Jb8'.8>N*[L .hxw6afq40DX3c~>abt'Q,8y(BZu(vKBTufIR. >> Fernandez AR, Mac Crawford J, Pennell ML, et al. doi: 10.7759/cureus.1286. Schneider Sarver PA, Senczakowicz EA, Slovensky BM. Prehosp Emerg Care. Categories: Emergency Medicine, Medical Education Keywords: diabetic ketoacidosis, simulation, expertise, emergency medicine . 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. Her medical, social, and family histories are not clear at the time of admission to the emergency department. Trainee will correlate the underlying pathophysiology with symptoms and signs as exhibited by the simulation session. 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). A pre-briefing session is conducted prior to the start of the simulation scenario. With your index and other fingers placed behind the angle of the mandible, apply steady upwards and forward pressure to lift the mandible. The researchers found that long shift hours (24hrs), working overtime and marital/relationship stress were strongly correlated. 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 may be necessary toexposethe patient during your assessment: remember to prioritise patient dignity and conservation of body heat. <> Development of simulation scenarios for an adolescent patient with diabetic ketoacidosis. The students are in their first year. Chapters: #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! Just place the BR2_KDCA file into your addons scenery folder: C:\\Program Files\\Microsoft Games\\Microsoft Flight Simulator X\\Addon Scenery\\Scenery. 2011;15:108109. For similar reasons, we do not believe a videotaped session will keep the students attention as much as these live simulator sessions. Capillary refill timemay be prolonged if the patient is hypovolaemic. Depending on scenario complexity, team dynamic and treatment modalities, this simulation may take 1020 minutes. . See ourhistory taking guidesfor more details. 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. 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. 5. 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 . - 2500+ OSCE Flashcards: https://geekymedics.com/osce-flashcards/ Initially, we used a blood pressure cuff to generate the blood pressure values. Conclusions This technical report describes the design and implementation of a simulation scenario on DKA for emergency medicine trainees. Facilitator to ask how often to measure BMs The patient synopsis should include such standard aspects as age, sex, ethnicity, medical history, medications and allergies. A strong emphasis is placed on the focused, methodical examination of a specific medical problem and the decision-based treatment options available. <> PDF Diabetic Ketoacidosis in the Obstetric Population: A Simulation The students are in their basic science course. 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. Makeup may be used to depict gender, hollow eyes and cheeks, produce pallor or display bruises and scars. Problems are addressed as they are identified and the patient is re-assessed regularly to monitor their response to treatment. Blood sugar issues in the Type II diabetic will have a gradual onset, with diagnosis generally resulting from routine laboratory exams.(1). 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. 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. We give the history of the patient to the trainees. - Timing 03:23 Airway adjuncts are often helpful and in some cases essential to maintain a patients airway. Environment & Manikin Trainee will get to know how professionals behave during management of a critically ill patient. Endocrine - thesimbook.com Several environments may be suitable for your classroom. modify the keyword list to augment your search. There are just a few more things to do. The simulation experience serves to give substance to the theoretical words and concepts that the students encountered during the PBL sessions. Manikin staging can provide strong cues. 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. Trainee will be respectful to others and their views during the PBL session. Competency-based medical education has seen widespread adoption in the field along with ongoing work in the areas of . 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 . Weight, Height: Not given, normal appearing (as per simulator) but has lost 20 lbs recently. They should introduce the student group to the environment, assign roles for each learner and guide the decision-making process. x]o ]?9kgq~:)?hE )R6!up}\<8||\]}Y~;xp~yQ$#4~djX&{n_m-]^K1/~/AD Hv 99evs,;8}8zwnhFxV.kf-V^? Simulation provides a safe environment where learning is enhanced through the deliberate practice of skills and controlled management of a variety of clinical encounters. 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. 2. Askhow the patient is feeling as this may provide some useful information about their current symptoms. CCA 175 Real Time Exam Scenario 17 | JOIN Multiple DataFrames | Save as 3. Antibiotics should be prescribed in keeping with local guidelines. Geeky Medics accepts no liability for loss of any kind incurred as a result of reliance upon the information provided in this video. 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). In this manner, the students have to apply their knowledge at the appropriate points during the progression of the scenario. Stage 3: Ongoing management and monitoring of DKA 1 hour after initiation of treatment. Medical simulation technology is a powerful tool for training physicians but papers dealing with DKA simulators are scarce. The instructor should have visual access via one-way windows or cameras. The Theory 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. Twitter: http://www.twitter.com/geekymedics Review the patientscurrent medicationsand check any regular medications areprescribed appropriately. 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. In this section, we have to help the trainee to institute definitive therapy based on the underlying biochemical abnormalities. Does the patient need a referral toHDU/ICU? diagnosis of DKA Trigger 3, ABG show acidosis and high BM and normal potassium. Performing an ECG should not delay the emergency management of DKA. 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. Diabetes UK with the Joint British Diabetes Societies Inpatient Care Group. 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. Assessment & Treatment of Five Diabetic Emergencies - JEMS KDCA, Ronald Reagan Washington National Airport, DC. Introduceyourselfto whoever has requested a review of the patient andlistencarefullyto their handover. Mosby:Philadelphia. The choice of fluid type, rate of administration and volume should be tailored to the individual patient based upon their vital signs and electrolytes. SimMan Nursing Scenarios Software - laerdal.com Trainee will increase knowledge of professional behaviors during the simulation. 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. Groups of more than seven may struggle with meeting objectives due to insufficient functional rolls. Medical Simulation Scenarios are text documents outlining the various details of a simulation - everything from patient simulator settings to debriefing notes. 2003;78:783788. DOI 10.7759/cureus.1286. Pediatric Emergency Medicine Didactics and Simulation (PEMDAS reduced air entry, coarse crackles) to screen for evidence of pneumonia. 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. Its best, however, to allow the student group to continue so theyre able to evaluate their decision-making processes during debriefing. 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. DOWNLOAD Diabetic Ketoacidosis By the end of this scenario, the learner will be able to: 1. In the context of DKA, a patients consciousness level may be reduced. Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario 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. - Associated symptoms 03:04 DKA can be caused by either: Absolute insulin deficiency (e.g. Please enable scripts and reload this page. % Intubation lubricants can mimic drooling. Before trainees arrival into the simulation area, the simulator is already preprogrammed for DKA. 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. 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. Acad Med. 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. A traditional classroom lecture format allows for student participation but limits the instructors ability to create realistic situations. Healthcare Students' Psychological Well-Being in a Diabetic Ketoacidosis Simulation. Typically potassium levels should be maintained between 4.0 5.5 mmol/L and close monitoring is required. 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. - Over 3000 Free MCQs: https://geekyquiz.com/ A debriefing section with pre-established questions allows the instructor to review the main focus and performance measures with the student group. GRAPH. If you have any scenarios you would be willing to share with the simulation community, please forward them . 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. We try to provide sufficient realism.. TheABCDEapproach can be used to perform a systematic assessment of a critically unwell patient. Terms of Use. If the patient is conscious, sit themuprightas this can also help with oxygenation. Heart: S1 and S2 within normal limits; no S3/S4 or murmurs, normal rate and rhythm. KDCA for FSX - Fly Away Simulation One of the key differences with the immersive simulation is that the instructor is absent from the simulation environment. DKA can develop within 24 hours and is potentially life threatening, requiring prompt recognition and therapeutic intervention. 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.) A collection of communication skills guides, for common OSCE scenarios, including history taking and information giving. Revisit history taking to explore relevant medical history and identify any precipitating factors for DKA. Inspect for evidence of infection on the skin (e.g. If an infection is suspected, IV antibioticsshould be administered as soon as possible. You might also be interested in our awesome bank of 700+ OSCE Stations. 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. Another example: At one minute into the scenario, the patient becomes unresponsive and their breathing becomes shallow. 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). PDF DKA Sim Scenario - ABCD (Diabetes Care) Ltd 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. Measure the patients capillary blood glucose and ketone levels to confirm the diagnosis and guide the management of DKA. (1), The assessment of a diabetic patient is best taught as a case-based simulation. One advantage to the animated lecture style is the ability to introduce treatment options in a methodically guided approach thats in conjunction with simultaneous environmental stimulus. For example, you could develop a diabetic scenario in which the prehospital provider encounters an altered patient with incomprehensible speech.
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dka simulation scenario