dka simulation scenario dka simulation scenario

Clearly communicate how often would you like the patients observations relayed to you by other staff members. It should only be inserted in unconscious patients as it is otherwise poorly tolerated and may induce gagging and aspiration. 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. This is an important period, as this is where the students see the theoretical concept (metabolic acidosis), come to life as for instance large tidal volumes. Data is temporarily unavailable. Environment & Manikin Capillary refill timemay be prolonged if the patient is hypovolaemic. The researchers found that long shift hours (24hrs), working overtime and marital/relationship stress were strongly correlated. Please note that by doing so you agree to be added to our monthly email newsletter distribution list. areas of lipohypertrophy) if it is unclear if the patient is diabetic. The faculty member/course coordinator of Simulation Design 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). Marx JA, Hockberger RS, Walls RM. The main purpose of the simulation is to draw a line from the theoretical, boring biochemistry to the clinical manifestations. If the patient is conscious, sit themuprightas this can also help with oxygenation. Research Watch Box:Sleep, Fatigue & SafetyBy David Page, MS, NREMT-P (1) The assessment of a diabetic patient is best taught as a. This is particularly important for core . Adds true to life parking codes and extra parking for AI. <>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 595.32 841.92] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> Available from: [. Section snippets . 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 Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario Recognize the signs and symptoms of a patient presenting with diabetic ketoacidosis. Similar to a ward round, where the instructor would say: Come and listen to this patient with an aortic stenosis. 3. Depending on scenario complexity, team dynamic and treatment modalities, this simulation may take 1020 minutes. 1. Trigger 4, Pathway 1l of saline required over 1hour and insulin infusion need prescribing and making up in 50ml syringe. Make sure thepatientsnotes,observationchartandprescriptionchartare easily accessible. There are several causes of DKA, which we remember by the "five I's". Please try again soon. In keeping with the case study, as a treatment marker is reached, the instructor should place emphasis on physiological, pharmacological, environmental and psychosocial issues. The 60 minutes training time consists of four 15-minute sections divided as follows. 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"Never doubt that a small group of thoughtful, committed citizens can change the world. 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. 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She began experiencing progressively worsening thirst, increased appetite, and excessively increased urination. Open the patients mouth to ensure there is no foreign material that may be pushed into the larynx. Review the patients drug chart for medications which may cause a reduced level of consciousness (e.g. Seek senior helpif the patient shows no signs of improvement or if you have any concerns. Performing an ECG should not delay the emergency management of DKA. dq-]gX4 `L'u7myx) rpjf0z,.y`VMyx-&Ju`U0 type 1 diabetes) Complete insulin insensitivity (e.g. Hypothermia may be present if the patient has been unconscious and exposed for some time. See our blood glucose measurement guide for more details. You can check out our guide to using SOCRATES here: https://geekymedics.com/the-socrates-acronym-in-history-taking/ This video demonstrates how to use the SOCRATES acronym when taking a history of pain or other symptoms. Make sure tore-assessthe patient after anyintervention. Open the patients airwayusing ahead-tiltchin-lift manoeuvre: 1. 2003;78:783788. Using SOCRATES in History Taking | OSCE | Communication Skills, Diabetic Ketoacidosis (DKA) | Acute Management | ABCDE. She Died the Next Day. 4. DY{Qb"(EgN$QI*%XN1F""0a5 Therefore, the same file is also sent to the participants before the session. Are any further assessments or interventions required? Privacy Policy Centers for Disease Control and Prevention. Simulation Scenario. Use washable, non-toxic paints to imitate various body emissions. Scenarios thesimtech Consider active re-warming techniques in patients with severe hypothermia. Diabetic Ketoacidosis (DKA) Clinical Pathway Emergency Department | Children's Hospital of Philadelphia Much time was wasted explaining why it did not matter. A comprehensive collection of medical revision notes that cover a broad range of clinical topics. 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. 1-6. - Severity 05:32 This style also doesnt mimic an actual scene, and a student may feel that treatment modalities and skills are performed at a slower rate than real-world applications. 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. The students are in their first year. For diabetic assessment involving DKA, staging may include the use of a container with a small amount of acetone placed near the manikin because many students may not know what acetone smells like but will expect to smell something. - Associated symptoms 03:04 3. Refer to your local guidelines for further details. opioids, sedatives, anxiolytics, insulin, oral hypoglycaemic medications). These are not learning objectives in this program. Trainee will get to know how professionals behave during management of a critically ill patient. Diabetic Ketoacidosis (DKA) Clinical Pathway Emergency Department As with the animated lecture, the simulation is strongly dependent on a focused case study. *=NdL/c2XSJn8:I Jb8'.8>N*[L .hxw6afq40DX3c~>abt'Q,8y(BZu(vKBTufIR. 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. The DKA simulation incorporates cue recognition, analysis of cues, generation of solutions, nursing interventions, and evaluation of outcomes, including effective communication and psychosocial concerns. Facilitator to ask how often to measure BMs 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. Diabetic ketoacidosis; Simulation training; Medical students. Simulation Training Ideal for Diabetic Patients - JEMS This allows us to get in touch for more details if required. 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. 3. 2009;13:505511. confusion, coma), All critically unwell patients should have. Patients with DKA require fluid resuscitation to restore circulatory volume, clear ketones, correct electrolyte abnormalities and increase renal perfusion. 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. PA EMT Said COVID Patient Didnt Need to Go to the Hospital. JEMS. 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. 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. Well done, youve now stabilised the patient and theyre doing much better. modify the keyword list to augment your search. If the patient loses consciousness and there are no signs of life on assessment, put out a crash call and commence CPR. 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. This session provides additional clinical support material for the theoretical PBL session. Healthcare Students' Psychological Well-Being in a Diabetic Ketoacidosis Simulation. Management of diabetic ketoacidosis in adults. Diabetic Ketoacidosis in the Obstetric Population: A Simulation A number of key modifiers are described that allow for the adjustment of case . Groups of fewer than four students dont allow for optimal collaboration. The debriefing environment should be removed from the location where the simulation took place. PDF Adult Type I Diabetic Ketoacidosis Pre-simulation Preparation Student Simulation provides a safe environment where learning is enhanced through the deliberate practice of skills and controlled management of a variety of clinical encounters. 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. Twitter: http://www.twitter.com/geekymedics The simulation session is also hosted as an interactive session. Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario %PDF-1.5 The teaching of diabetic assessment and management, like many other medical emergencies, lends itself well to case-based simulation. 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. 6. Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. 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. The normal reference range for fasting plasma glucose is 4.0 5.8 mmol/l. 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. Inspect theairwayfor obviousobstruction. Each clinical case scenario allows you to work through history taking, investigations, diagnosis and management. We guide the group to suggest fluid. Trainee will increase knowledge of professional behaviors during the simulation. Alert a senior immediately if you have any concerns about the consciousness level of a patient. Should any changes be made to the current management of their underlying condition(s)? The Theory 2008;6:278302. Askhow the patient is feeling as this may provide some useful information about their current symptoms. This may produce better retention of the subject matter and help students adapt to emergency scenes before going into the field. 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. 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. For example, if a student is to run a diabetic emergency in an extended living facility, the room should be staged with the appropriate bed, linens and medical equipment, and include personal artifacts and memorabilia normally found in such environments. Just place the BR2_KDCA file into your addons scenery folder: C:\\Program Files\\Microsoft Games\\Microsoft Flight Simulator X\\Addon Scenery\\Scenery. DKA can develop within 24 hours and is potentially life threatening, requiring prompt recognition and therapeutic intervention. - 2500+ OSCE Flashcards: https://geekymedics.com/osce-flashcards/ 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]). Chapters: Conclusions This technical report describes the design and implementation of a simulation scenario on DKA for emergency medicine trainees. 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! Reduced urine output (oliguria) is typically defined as less than 0.5ml/kg/hour in an adult. Catheterisethe patient to closelymonitor urine outputto guide fluid resuscitation and need for escalation. Both external and internal potassium balances are disturbed during the development and treatment of DKA. Wolters Kluwer Health 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. 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). Clearlydocument your ABCDE assessment, including history, examination, observations, investigations, interventions, and the patients response. 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. Some manikin models support a variety of human functions, such as capillary and facial cyanosis, facial sweating, foley catheter and IV placement, blood pressure generation, cardiac rhythms and abnormalities, defibrillation, cardioversion, external pacing and vital sign generation. The choice of fluid type, rate of administration and volume should be tailored to the individual patient based upon their vital signs and electrolytes. Diabetic ketoacidosis simulator: a new learning tool for a life 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 . Note that if-thens must also include negative patient outcomes for when the provider doesnt take appropriate action. MassBay EMS Program Integrates Training for Dogs, Heat Waves Are Killing More LA Homeless People. Initially, we used a blood pressure cuff to generate the blood pressure values. vD0 x@FFJ{m[ 3//Oh|JR7! An oxygen mask is also demonstrated as an alternative device, as these early trainees had mostly not yet seen any of these devices. An integral part of a PBL session is for trainees to be able to navigate through huge literature bases. 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.) stream Indeed, it is the only thing that ever has.". Immersive simulations are mentally exhausting because they create an intense and stressful atmosphere requiring the learner to work outside their comfort zone. unilateral coarse crackles may be present if the patient has pneumonia which may have been the precipitant for DKA). As this is a PBL session, the trainees are not given any references. We have 18 to 20 PBL groups for an hour each in the week after their PBL DKA session. 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. - Radiation 02:45 You may be trying to access this site from a secured browser on the server. Simulation provides a safe environment where learning is enhanced through the deliberate practice of skills and controlled management of a variety of clinical encounters. 1. 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. Another example: At one minute into the scenario, the patient becomes unresponsive and their breathing becomes shallow. The instructors role is to facilitate active learning through a combination of learning styles. They have had no clinical exposure or any clinical experience. Simulation student Scenario- DKA-Peds.docx - DIABETIC Simulation Scenario for Anesthesia Providers Clark Obr, MD*, Anthony Mueller, MD . Administer oxygen to all critically unwell patients during yourinitialassessment. Margolis GS, Romer GA, Fernandez AR, et al. 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. Cureus 9(5): e1286. However, this turned out to be too slow, took too much time, and could not continuously demonstrate the direction of changes. An animated lecture may be described as a pseudo-simulation environment. Diabetic Ketoacidosis (DKA) | Acute Management | ABCDE DIABETIC KETOACIDOSIS MODULE: ENDOCRINOLOGY / METABOLIC TARGET: ALL PAEDIATRIC TRAINEES;NURSING STAFF BACKGROUND: DKA occurs when a relative or absolute lack of insulin leads to the inability to metabolise glucose. At the end of the previous section, the trainee can make the diagnosis of DKA but has not confirmed it yet. 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 . See ourCXR interpretation guidefor more details. Therefore, we have to emphasize the importance of airway, breathing, and circulation in the very sick patient in any clinical setting. Simulation in Healthcare4(4):232-236, Winter 2009. 2 The evaluation of potassium deficits is complicated by potassium exit from . - Introduction 00:00 LYqC+pJ&6X4onfBT#?=R}.p8N3+Dk,P4tIgWB}-L'=8;_G >,K#.e89XnG'B~NtR Laschinger S, Medves J, Pulling C, et al. 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. Introduceyourselfto thepatientincluding yournameandrole. 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. Inspect for evidence of infection on the skin (e.g. In this section, we have to guide them as to what they should do first for the patient in this critical condition (ie, treat the A, B, Cs of airway, breathing, and circulation) before we can confirm the diagnosis. Use blankets to re-warm patients who are mild to moderately hypothermic. The simulation experience serves to give substance to the theoretical words and concepts that the students encountered during the PBL sessions. Medical Simulation Scenarios are text documents outlining the various details of a simulation - everything from patient simulator settings to debriefing notes. DO NOT perform any examination or procedure on patients based purely on the content of these videos. If the patient isunconsciousorunresponsive, start thebasic life support(BLS)algorithmas per resuscitation guidelines. DOWNLOAD Diabetic Ketoacidosis By the end of this scenario, the learner will be able to: 1. 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. A nasopharyngeal airway is a soft plastic tube with a bevel at one end and a flange at the other. Glycosuria leads to urinary losses of potassium through osmotic diuresis. Extremities: mild cyanosis, no clubbing or edema (verbalized by instructors); pulses equal, and symmetrical (elucidated by trainees). There are actually two sets of educational objectives: the first set is for the theoretical PBL sessions, and the 2nd set is for the Simulation Session. diagnosis of DKA Trigger 3, ABG show acidosis and high BM and normal potassium. Rosens Emergency Medicine: Concepts and Clinical Practice. Advance the airway until it lies within the pharynx. SimMan Nursing Scenarios Software. 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 . Lets discuss your options. Deteriorationshould be recognised quickly and acted upon immediately. The patient synopsis should include such standard aspects as age, sex, ethnicity, medical history, medications and allergies. 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 . The validity of the HFS-DKA scenario was verified by a certified diabetes nurse educator, a registered nurse, and a clinical nurse educator. 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. 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). 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). They have had no clinical exposure or any clinical experience. Endocrine - thesimbook.com You may be asked to review a patient with DKA due to confusion, reduced level of consciousness, tachycardia, hypotension and/or vomiting. 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. 2. 2 0 obj angioedema, rash) commence appropriate treatment as discussed in ouranaphylaxis guide. Animated lectures, however, must work within the framework of a focused case study, which requires increased preparation time. 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 accepts no liability for loss of any kind incurred as a result of reliance upon the information provided in this video. Creating a Simulation Experience to Promote Clinical Judgment In the meantime, you should re-assess and maintain the patients airway. This is particularly important for core cases and low-frequency, high-stakes procedures and encounters. See ourfluid prescribing guidefor more details onresuscitation fluids. Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario 2017 May 29;9(5):e1286. x]o ]?9kgq~:)?hE )R6!up}\<8||\]}Y~;xp~yQ$#4~djX&{n_m-]^K1/~/AD Hv 99evs,;8}8zwnhFxV.kf-V^? may email you for journal alerts and information, but is committed The students are in their basic science course. 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. Invasive monitors, including a left radial intraarterial and a right subclavian IV catheter, were placed. The students worked on the underlying physiology during a week long PBL session and are therefore familiar with the theoretical aspects of DKA. This is a combination of the modified traditional lecture within scenario-based learning. A strong emphasis is placed on the focused, methodical examination of a specific medical problem and the decision-based treatment options available.