dka simulation scenario
A well-staged environment allows for greater student buy-in. Much time was wasted explaining why it did not matter. Use blankets to re-warm patients who are mild to moderately hypothermic. An hour was . The reason for inserting the airway upside down initially is to reduce the risk of pushing the tongue backwards and worsening airway obstruction. Seek senior helpif the patient shows no signs of improvement or if you have any concerns. Classroom Dynamics 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). Problems are addressed as they are identified and the patient is re-assessed regularly to monitor their response to treatment. Trainee will correlate the underlying pathophysiology with symptoms and signs as exhibited by the simulation session. As with the animated lecture, the simulation is strongly dependent on a focused case study. - 150+ PDF OSCE Checklists: https://geekymedics.com/pdf-osce-checklists/ tall tented T waves in hyperkalaemia). Respiratory Failure in the Course of Treatment of Diabetic Ketoacidosis 1. Antibiotics should be prescribed in keeping with local guidelines. Trainee will describe the changes in vital signs, the major metabolic, fluid, and electrolyte. Keyword Highlighting DO NOT perform any examination or procedure on patients based purely on the content of these videos. Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario Cureus. 3. endobj Diabetes (type 1 and type 2) in children and young people: diagnosis and management. CCA 175 Real Time Exam Scenario 17 | JOIN Multiple DataFrames | Save as See ourintravenous cannulation guidefor more details. You may search for similar articles that contain these same keywords or you may 1. . DKA can be caused by either: Absolute insulin deficiency (e.g. Using the arterial line, the scenario becomes much more dynamic. Groups of fewer than four students dont allow for optimal collaboration. Simulation Scenario for Anesthesia Providers Clark Obr, MD*, Anthony Mueller, MD . 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. When erroneous treatment is delivered, the instructor can end the simulation. Each performance measure is separated into cognitive, behavioral or technical categories. After the first voluntary session in 2006, feedback from the medical students indicated that they would like to receive this handout. Effectiveness of simulation on health profession students knowledge, skills, confidence and satisfaction. Introduceyourselfto thepatientincluding yournameandrole. 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. Below is a collection of donated scenarios for you to use or modify. Makeup may be used to depict gender, hollow eyes and cheeks, produce pallor or display bruises and scars. 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. Clinical Simulation in Nursing, Volume 39, 2020, pp. PDF Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario They should introduce the student group to the environment, assign roles for each learner and guide the decision-making process. Note that if-thens must also include negative patient outcomes for when the provider doesnt take appropriate action. 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. 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. - Onset 01:48 Supplemental digital content is available for this article. Diabetes UK with the Joint British Diabetes Societies Inpatient Care Group. 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. Wolters Kluwer Health 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. However, this leads to confusion. - Radiation 02:45 Perform urinalysis and send the urine for culture if urinary tract infection is suspected. 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.) Simulation provides a safe environment where learning is enhanced through the deliberate practice of skills and controlled management of a variety of clinical encounters. Each PBL case typically goes over 23 days, affording the students periods to find information for the case. Rosens Emergency Medicine: Concepts and Clinical Practice. COVID-19 Screening in the Pediatric Emergency Department. The Theory The teaching of diabetic assessment and management, like many other medical emergencies, lends itself well to case-based simulation. Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. PBL was introduced at our institution in 1995. Ask for anotherclinicalmemberofstafftoassistyou if possible. Conclusion See Table 4 for a suggested standardized script. The required potassium replacement varies greatly. Animated Lecture dq-]gX4 `L'u7myx) rpjf0z,.y`VMyx-&Ju`U0 Generaltipsfor applying anABCDEapproachin an emergency setting include: Acute scenarios typically begin with abriefhandoverfrom a member of thenursing staffincluding thepatients name,age,backgroundand thereasonthereviewhas been requested. 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. The trainees have had background knowledge of biochemistry because they had completed the PBL case. If the patient isunconsciousorunresponsive, start thebasic life support(BLS)algorithmas per resuscitation guidelines. - Geeky Medics OSCE App: https://geekymedics.com/geeky-medics-app/ 4 0 obj These are not learning objectives in this program. A collection of interactive medical and surgical clinical case scenarios to put your diagnostic and management skills to the test. Instead, instructors should combine case- and simulation-based techniques when teaching diabetic assessment. 2008;6:278302. This may produce better retention of the subject matter and help students adapt to emergency scenes before going into the field. Highlight selected keywords in the article text. Development of simulation scenarios for an adolescent patient with diabetic ketoacidosis. 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. JEMS. 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. This leads to hyperglycaemia, osmotic diuresis, and dehydration. Schneider Sarver PA, Senczakowicz EA, Slovensky BM. Review the patients drug chart for medications which may cause a reduced level of consciousness (e.g. 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. doi: 10.7759/cureus.1286. MassBay EMS Program Integrates Training for Dogs, Heat Waves Are Killing More LA Homeless People. 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. Please write a single word answer in lowercase (this is an anti-spam measure). The simulation session is also hosted as an interactive session. - 2500+ OSCE Flashcards: https://geekymedics.com/osce-flashcards/ TheABCDEapproach can be used to perform a systematic assessment of a critically unwell patient. 34 - Diabetic Ketoacidosis in Pregnancy | Obgyn Key We combined both to indicate the continuity of the curriculum, and the building on prior knowledge. The students mentioned that they did not obtain the maximum value from the simulation session under these circumstances. Research Watch Box:Sleep, Fatigue & SafetyBy David Page, MS, NREMT-P 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. Indeed, it is the only thing that ever has.". 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. 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. Marx JA, Hockberger RS, Walls RM. unilateral coarse crackles may be present if the patient has pneumonia which may have been the precipitant for DKA). Diabetic Ketoacidosis (DKA) | Acute Management | ABCDE Available from: [. Her medical, social, and family histories are not clear at the time of admission to the emergency department. Make sure to re-assess the patient after any intervention. Simulation of Diabetic Ketoacidosis for Cellular and Molecul DOI 10.7759/cureus.1286. The objective is to give as many visual and tactile cues concerning the patient condition and background as possible. 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. Please note that by doing so you agree to be added to our monthly email newsletter distribution list. The scenario would include an if-then algorithm. 2010;49:578586. This simulation session therefore aims to make the case come alive, and show this known case in a clinical context. From the Department of Anesthesiology, Pennsylvania State University College of Medicine, Hershey, PA. Dr. Murray is on the Speakers Bureau of METI, Sarasota, FL. 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 Inspect for evidence of infection on the skin (e.g. The validity of the HFS-DKA scenario was verified by a certified diabetes nurse educator, a registered nurse, and a clinical nurse educator. If the patient loses consciousness and there are no signs of life on assessment, put out a crash call and commence CPR. Simulation-based medical education: An ethical imperative. This is a combination of the modified traditional lecture within scenario-based learning. It involves a facilitating instructor, a small learner group and conceptual aspects of environmental and manikin staging to provide sensory cues. Tilt the forehead back whilst lifting the chin forwards to extend the neck. 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. See ourhistory taking guidesfor more details. However, we should not spend too much time on (not become distracted with) explaining unfamiliar monitors for the present trainees, such as central venous pressure or ETCO2 concentration. She tends to drink sugar containing fluids (soda) when she is thirsty, and she eats fast foods (cream-filled muffins) when she is hungry. The student group is given a short introduction into a closed simulation environment. LYqC+pJ&6X4onfBT#?=R}.p8N3+Dk,P4tIgWB}-L'=8;_G >,K#.e89XnG'B~NtR If the patientloses consciousnessand there areno signs of lifeon assessment, put out acrash callandcommence CPR. 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. This guide provides an overview of the recognition and immediate management of diabetic ketoacidosis (DKA)using an ABCDE approach. 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. Refer to your local guidelines which should provide a clear protocol for the management of DKA. Centers for Disease Control and Prevention. If foreign material is present, attempt removal using suction. Ketones show 5.5. - Associated symptoms 03:04 . This video demonstrates how to use the SOCRATES acronym when taking a history of pain or other symptoms. I assigned true to life parking codes, and added some extra parking for the superfluous US Express AI. Instagram: https://instagram.com/geekymedics Example: If the provider immediately evaluates blood glucose, then the reading will display 45 mg/dL. The researchers found that long shift hours (24hrs), working overtime and marital/relationship stress were strongly correlated. >> Patterson PD, Weaver M, Frank R, et al. KDCA for FSX - Fly Away Simulation Trainee will appropriately request assistance and use available resources. A number of key modifiers are described that allow for the adjustment of case . Subscribe to our newsletter to be the first to know about our latest content: https://geekymedics.com/newsletter/ 2003;78:783788. 3. - Character 02:14 Scenarios thesimtech We do have a wig that we place on the patient, but we do not try for full realism. For instance, if we mimicked the noise and traffic of a real emergency department, this would constitute excessive realism, and become a distraction to beginner medical students. 6. Simulation Training Ideal for Diabetic Patients - JEMS Scenario in a Nutshell Diabetic ketoacidosis (DKA) in pregnancy. In the final 10 minutes, we show how the patient has a good recovery after fluid replacement. 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. The use of case-based simulation, although more complicated and time consuming for the instructor, immerses the students in the subject matter. If the patient is confused you might be able to get a collateral history from staff or family members as appropriate. Teaching nursing management of diabetic ketoacidosis: a description of Catheterisethe patient to closelymonitor urine outputto guide fluid resuscitation and need for escalation. #geekymedics #fyp #fypviral #studytok #medicalstudentuk #medtok #studytips #studytipsforstudents #medstudentuk #premed #medschoolfinals, Cardiovascular History Tips - DON'T FORGET these 3 things . A blood glucose level may already be available from earlier investigations (e.g. 2. Yes: if the patient can talk, their airway is patent and you can move on to the assessment of breathing. 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). If any obstruction is encountered, remove the tube and try the left nostril. The debriefing environment should be removed from the location where the simulation took place. His Heart Stopped On a Treadmill. 1 Potassium losses occurring both before and during treatment of DKA must be replaced. Case-based simulation should include two to three broad-focus objectives, as well as 1020 specific performance measures that the student should accomplish. Simulation Scenario. Pediatric Emergency Medicine Didactics and Simulation (PEMDAS to maintaining your privacy and will not share your personal information without In some cases, normal saline with additional potassium is required to prevent overcorrection of serum potassium levels which would otherwise result in hypokalaemia. You might also be interested in our awesome bank of 700+ OSCE Stations. can be reemphasized, and the effects of fluid therapy demonstrated. Healthcare Students' Psychological Well-Being in a Diabetic Ketoacidosis Simulation. 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 students are in their basic science course. It was developed for anesthesiology resident physicians with some background knowledge and experience caring for critically ill patients. Data is temporarily unavailable. To read Pages full Research Review column, visit www.jems.com/patient-care. We now provide the students with handouts of the data to save time and provide consistency. 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. Inspect theairwayfor obviousobstruction. Deteriorationshould be recognised quickly and acted upon immediately. your express consent. At the end of the previous section, the trainee can make the diagnosis of DKA but has not confirmed it yet. 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. 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. x]o ]?9kgq~:)?hE )R6!up}\<8||\]}Y~;xp~yQ$#4~djX&{n_m-]^K1/~/AD Hv 99evs,;8}8zwnhFxV.kf-V^? 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. Groups of more than seven may struggle with meeting objectives due to insufficient functional rolls. 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. As this is a PBL session, the trainees are not given any references. Review the patientscurrent medicationsand check any regular medications areprescribed appropriately. A strong emphasis is placed on the focused, methodical examination of a specific medical problem and the decision-based treatment options available. 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. % 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. 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. Acad Med. Diabetic ketoacidosis simulator: a new learning tool for a life Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. VbQuX#R M21 4. Section snippets . Strategies of high-performing paramedic educational programs. Instructors should write a case study for the simulation before the session. The facilitator guides the group only when necessary. 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). As individuals with uncontrolled type I . Int J Evid Based Healthc. Two abstracts related to sleepiness in the EMS workforce were presented at the National Association of EMS Physicians symposium in January. We do not use passive visualizing materials such as videotapes or DVD other than vital signs shown on the monitors. 2 0 obj 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. See ourfluid prescribing guidefor more details onresuscitation fluids. Invasive monitors, including a left radial intraarterial and a right subclavian IV catheter, were placed. Urinary tract infections are a common DKA precipitant. Introduceyourselfto whoever has requested a review of the patient andlistencarefullyto their handover. #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! 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. 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. Before trainees arrival into the simulation area, the simulator is already preprogrammed for DKA. This guide has been created to assist students in preparing for emergencysimulationsessionsas part of their training,it is not intended to be relied upon for patient care. Its important to train and educate students of prehospital care on key indicators of a diabetic emergency. Trainee will get to know how professionals behave during management of a critically ill patient. Initially, we required the students to write down the vital signs. See ourdocumentation guidesfor more details. Geeky Medics accepts no liability for loss of any kind incurred as a result of reliance upon the information provided in this video. Margolis GS, Romer GA, Fernandez AR, et al. Its best, however, to allow the student group to continue so theyre able to evaluate their decision-making processes during debriefing. GRAPH. Manikin staging can provide strong cues. 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). - Exacerbating & relieving factors 05:12 PDF Diabetic Ketoacidosis in the Obstetric Population: A Simulation