dka simulation scenario

The choice of fluid type, rate of administration and volume should be tailored to the individual patient based upon their vital signs and electrolytes. 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. Stage 3: Ongoing management and monitoring of DKA 1 hour after initiation of treatment. Subscribe to our newsletter to be the first to know about our latest content: https://geekymedics.com/newsletter/ Acad Med. It may be necessary toexposethe patient during your assessment: remember to prioritise patient dignity and conservation of body heat. cloudy urine may indicate urinary tract infection). Trainee will practice or observe good teamwork skills, both as a leader and a team player. Diabetic Ketoacidosis (DKA) | Acute Management | ABCDE Effectiveness of simulation on health profession students knowledge, skills, confidence and satisfaction. 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. 3. JEMS. DO NOT perform any examination or procedure on patients based purely on the content of these videos. diagnosis of DKA Trigger 3, ABG show acidosis and high BM and normal potassium. 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. Re-assessthe patient using theABCDE approachto identify any changes in their clinical condition and assess the effectiveness of your previous interventions. 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). In an animated lecture, its important that the student group have an instructor so they can ask direct questions. The students are in their basic science course. Tilt the forehead back whilst lifting the chin forwards to extend the neck. DKA can be caused by either: Absolute insulin deficiency (e.g. Scenarios thesimtech <> The students worked on the underlying physiology during a week long PBL session and are therefore familiar with the theoretical aspects of DKA. Groups of more than seven may struggle with meeting objectives due to insufficient functional rolls. type 1 diabetes), Complete insulin insensitivity (e.g. She had developed nausea, extreme fatigue, mild disorientation, and blurred vision toward the end of the soccer match. Conclusion 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. You might also be interested in our awesome bank of 700+ OSCE Stations. If the patient is suspected to have sufferedsignificanttraumawith potential spinal involvement, perform ajaw-thrustrather than a head-tilt chin-lift manoeuvre: 2. 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 allows the learner group to make a psychological break from the patient and environment while beginning the reflection process. In this case scenario, dehydration is one of the most serious immediate issues. <>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 595.32 841.92] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> DY{Qb"(EgN$QI*%XN1F""0a5 Download: http://teamworkmatters.ocbmedia.com/media/DKA-Simulation-Scenario.docx Categories: 5th Year MBChB paeds scenario, Emergency Department, Human Factors, Interprofessional / multidisciplinary, Non-technical skills, Paediatrics, Postgraduate / newly qualified, Undergraduate / pre-registration Rating Consider active re-warming techniques in patients with severe hypothermia. We have spent many hours debating whether the small group format was a waste of time. 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. Facebook: http://www.facebook.com/geekymedics For similar reasons, we do not believe a videotaped session will keep the students attention as much as these live simulator sessions. Clinical Simulation in Nursing, Volume 39, 2020, pp. Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario. - PDF 1. - Associated symptoms 03:04 As individuals with uncontrolled type I . Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario - Introduction 00:00 Rosens Emergency Medicine: Concepts and Clinical Practice. Both external and internal potassium balances are disturbed during the development and treatment of DKA. 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. 3. A collection of communication skills guides, for common OSCE scenarios, including history taking and information giving. 4. Indeed, it is the only thing that ever has.". 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. can be reemphasized, and the effects of fluid therapy demonstrated. The instructor should have visual access via one-way windows or cameras. Instructors should write a case study for the simulation before the session. 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. - Severity 05:32 You can check out our guide to using SOCRATES here: https://geekymedics.com/the-socrates-acronym-in-history-taking/ Creating a Simulation Experience to Promote Clinical Judgment To read Pages full Research Review column, visit www.jems.com/patient-care. Immersive simulations are mentally exhausting because they create an intense and stressful atmosphere requiring the learner to work outside their comfort zone. - Medical Finals Question Pack: https://geekymedics.com/medical-student-finals-questions/ His Heart Stopped On a Treadmill. Case-based simulation should include two to three broad-focus objectives, as well as 1020 specific performance measures that the student should accomplish. Similar to a ward round, where the instructor would say: Come and listen to this patient with an aortic stenosis. Trainee will describe the changes in vital signs, the major metabolic, fluid, and electrolyte. These are not learning objectives in this program. reduced air entry, coarse crackles) to screen for evidence of pneumonia. 2011;15:108109. Refer to your local guidelines which should provide a clear protocol for the management of DKA. Trainee will learn to collaborate with peers to decide on appropriate interventions, tests, and therapy. If fever is present, make sure to consider co-existing infection. The students are in their first year. At the end of the previous section, the trainee can make the diagnosis of DKA but has not confirmed it yet. Example: If the provider immediately evaluates blood glucose, then the reading will display 45 mg/dL. The 60 minutes training time consists of four 15-minute sections divided as follows. 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. 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). Management of diabetic ketoacidosis in adults. cellulitis). This allows us to get in touch for more details if required. Geeky Medics accepts no liability for loss of any kind incurred as a result of reliance upon the information provided in this video. Competency-based medical education has seen widespread adoption in the field along with ongoing work in the areas of . 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). The normal reference range for fasting plasma glucose is 4.0 5.8 mmol/l. Highlight selected keywords in the article text. Two abstracts related to sleepiness in the EMS workforce were presented at the National Association of EMS Physicians symposium in January. Works with Traffic 2005, but . vD0 x@FFJ{m[ 3//Oh|JR7! Make sure tore-assessthe patient after anyintervention. By joining Cureus, you agree to our Inspect theairwayfor obviousobstruction. You may search for similar articles that contain these same keywords or you may 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. opioids, sedatives, anxiolytics, insulin, oral hypoglycaemic medications). 2. Respiratory Failure in the Course of Treatment of Diabetic Ketoacidosis Laschinger S, Medves J, Pulling C, et al. Does the patient need a referral toHDU/ICU? If foreign material is present, attempt removal using suction. areas of lipohypertrophy) if it is unclear if the patient is diabetic. Trainee will recognize the need for therapy and suggest an appropriate therapy in a simulated environment. Trainee will recognize and interpret the clinical signs and symptoms and the typical history of a patient with DKA, as well as understand the major causative factors of DKA. For more information, please refer to our Privacy Policy. Nandate, Koichiro MD, PhD; Abola, Ramon MD; Murray, W Bosseau MB; Whitfield, Carol PhD; Lang, Charles PhD; Sinz, Elizabeth MD. 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. Alert a senior immediately if you have any concerns about the consciousness level of a patient. Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. 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. The authors of the second study reported that poor sleep quality (60% of respondents) and extreme fatigue (55% of respondents) are independently associated with safety risks on the job. Many of the preclinical students have never seen a real life clinical monitor or even an intravenous (IV) setup. The Pratcice Ketones show 5.5. GRAPH. type 1 diabetes) Complete insulin insensitivity (e.g. 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. You may be asked to review a patient with DKA due to confusion, reduced level of consciousness, tachycardia, hypotension and/or vomiting. Refer to your local guidelines for further details. This is particularly important for core cases and low-frequency, high-stakes procedures and encounters. LYqC+pJ&6X4onfBT#?=R}.p8N3+Dk,P4tIgWB}-L'=8;_G >,K#.e89XnG'B~NtR Advance the airway until it lies within the pharynx. Typically potassium levels should be maintained between 4.0 5.5 mmol/L and close monitoring is required. Supplemental digital content is available for this article. %PDF-1.5 A fixed-rate intravenous insulin infusion should be commenced initially to suppress ketogenesis, reduce blood glucose levels and address electrolyte disturbances. Diabetic Ketoacidosis (DKA) Clinical Pathway Emergency Department | Children's Hospital of Philadelphia The researchers found that long shift hours (24hrs), working overtime and marital/relationship stress were strongly correlated. Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. 2010;49:578586. 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. DOI 10.7759/cureus.1286. Several environments may be suitable for your classroom. Diabetic Ketoacidosis in the Obstetric Population: A Simulation Animated lectures, however, must work within the framework of a focused case study, which requires increased preparation time. PBL was introduced at our institution in 1995. The main goal is to establish a safe learning environment for the learner [9, 13 . 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. We do not use passive visualizing materials such as videotapes or DVD other than vital signs shown on the monitors. Therefore, the same file is also sent to the participants before the session. The instructors role is to facilitate active learning through a combination of learning styles. Intubation lubricants can mimic drooling. x]o ]?9kgq~:)?hE )R6!up}\<8||\]}Y~;xp~yQ$#4~djX&{n_m-]^K1/~/AD Hv 99evs,;8}8zwnhFxV.kf-V^? In this manner, the students have to apply their knowledge at the appropriate points during the progression of the scenario. oral fluids, intravenous fluids, urine output, drain output, stool output, vomiting) to inform resuscitation efforts. PDF Medicine Simulation Scenario Diabetic Ketoacidosis: An Emergency - Cureus Make sure to re-assess the patient after any intervention. dq-]gX4 `L'u7myx) rpjf0z,.y`VMyx-&Ju`U0 Margolis GS, Romer GA, Fernandez AR, et al. 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. Introduceyourselfto thepatientincluding yournameandrole. Animated Lecture Lets discuss your options. Geeky Medics accepts no liability for loss of any kind incurred as a result of reliance upon the information provided in this video. 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. your express consent. 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 . 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.. This is particularly important for core . Healthcare Students' Psychological Well-Being in a Diabetic Ketoacidosis Simulation. 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. 3 0 obj Classroom Dynamics We try to provide sufficient realism.. 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. Problems are addressed as they are identified and the patient is re-assessed regularly to monitor their response to treatment. - Site 01:12 This leads to hyperglycaemia, osmotic diuresis, and dehydration. TheABCDEapproach can be used to perform a systematic assessment of a critically unwell patient. Pediatric Emergency Medicine Didactics and Simulation (PEMDAS Privacy Policy 2. PA EMT Said COVID Patient Didnt Need to Go to the Hospital. Extremities: mild cyanosis, no clubbing or edema (verbalized by instructors); pulses equal, and symmetrical (elucidated by trainees). 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 nasopharyngeal airway is a soft plastic tube with a bevel at one end and a flange at the other. Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario A GCS of 8 or below warrants urgent expert help from an anaesthetist. Consider any precipitating factors for the development of DKA and involve the diabetes team in the patients care. Anesthetic Management Using the Oxygen Reserve Index for Tracheal Resection and Tracheal End-to-E A Scoping Review of the Impact of COVID-19 on Kidney Transplant Patients in the United States, Alabama College of Osteopathic Medicine Research, Baylor Scott & White Medical Center Department of Neurosurgery, California Institute of Behavioral Neurosciences & Psychology, Contemporary Reviews in Neurology and Neurosurgery, DMIMS School of Epidemiology and Public Health, Simulation, Biodesign, & Innovation In Medical Education, The Florida Medical Student Research Publications, University of Florida-Jacksonville Neurosurgery, VCOM Clinical, Biomedical, and Educational Research, American Red Cross Scientific Advisory Council, Canadian Association of Radiation Oncology, International Liaison Committee on Resuscitation, International Pediatric Simulation Society, Medical Society of Delaware Academic Channel, Society for Healthcare & Research Development, Surgically Targeted Radiation Therapy for Brain Tumors: Clinical Case Review, Clinical and Economic Benefits of Autologous Epidermal Grafting, Defining Health in the Era of Value-Based Care, Optimization Strategies for Organ Donation and Utilization, MR-Guided Radiation Therapy: Clinical Applications & Experiences, Multiple Brain Metastases: Exceptional Outcomes from Stereotactic Radiosurgery, Proton Therapy: Advanced Applications for the Most Challenging Cases, Radiation Therapy as a Modality to Create Abscopal Effects: Current and Future Practices, Clinical Applications and Benefits Using Closed-Incision Negative Pressure Therapy for Incision and Surrounding Soft Tissue Management, Negative Pressure Wound Therapy with Instillation, NPWT with Instillation and Dwell: Clinical Results in Cleansing and Removal of Infectious Material with Novel Dressings. The use of a simulated, evolving case scenario was an effective method of exposing nursing students to complex patient care. 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. 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. This is a combination of the modified traditional lecture within scenario-based learning. Simulation student Scenario- DKA-Peds.docx - DIABETIC 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. The Theory 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. 3. - Character 02:14 2011;15:108109. An integral part of a PBL session is for trainees to be able to navigate through huge literature bases. and 2003;78:783788. 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. Wolters Kluwer Health may email you for journal alerts and information, but is committed 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. Simulation of Diabetic Ketoacidosis for Cellular and Molecul A pre-briefing session is conducted prior to the start of the simulation scenario. Before trainees arrival into the simulation area, the simulator is already preprogrammed for DKA. Causes: Any situation arising in a diabetic that requires increased insulin without that demand being met can result in DKA. 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. We are looking for declaration of DKA and request for pathway. 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. Review thepatients notes,chartsandrecent investigation results. Trigger 4, Pathway 1l of saline required over 1hour and insulin infusion need prescribing and making up in 50ml syringe. Diabetic ketoacidosis simulator: a new learning tool for a life Mosby:Philadelphia. Case-based education adds a real-world aspect to the learning environment. . The students are in their first year. "Never doubt that a small group of thoughtful, committed citizens can change the world. 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. 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. KDCA, Ronald Reagan Washington National Airport, DC. KDCA for FSX - Fly Away Simulation Surgical dressings and imitation blood can support medical history. >> Fernandez AR, Mac Crawford J, Pennell ML, et al. 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). Urinary tract infections are a common DKA precipitant. You may be trying to access this site from a secured browser on the server. Heart: S1 and S2 within normal limits; no S3/S4 or murmurs, normal rate and rhythm. Just place the BR2_KDCA file into your addons scenery folder: C:\\Program Files\\Microsoft Games\\Microsoft Flight Simulator X\\Addon Scenery\\Scenery. Patients with DKA require fluid resuscitation to restore circulatory volume, clear ketones, correct electrolyte abnormalities and increase renal perfusion. 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 . confusion, coma), All critically unwell patients should have. The instructor can also gauge the direction the debriefing session should follow or be alerted to possible problems or conflicts in treatment opinions. If the patient has COPD and a history of CO2retention you should switch to aventuri maskas soon as possible andtitrate oxygen appropriately. 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. Trainee will be respectful to others and their views during the PBL session. This may produce better retention of the subject matter and help students adapt to emergency scenes before going into the field. Reprints: Koichiro Nandate, MD, PhD, Department of Anesthesiology, Milton S. Hershey Medical Center, Pennsylvania State University College of Medicine, 500 University Drive Box 850, Hershey, PA 17033 (e-mail: [emailprotected]). This 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. unilateral coarse crackles may be present if the patient has pneumonia which may have been the precipitant for DKA). An animated lecture may be described as a pseudo-simulation environment. 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. *=NdL/c2XSJn8:I Jb8'.8>N*[L .hxw6afq40DX3c~>abt'Q,8y(BZu(vKBTufIR. A collection of data interpretation guides to help you learn how to interpret various laboratory and radiology investigations. 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). 34 - Diabetic Ketoacidosis in Pregnancy | Obgyn Key The file explaining the session is sent to instructors 1 week before the sessions. 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). Keywords: diabetic ketoacidosis, simulation, expertise, emergency medicine Introduction Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes mellitus, most . There are several causes of DKA, which we remember by the "five I's". 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. 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.

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