dka simulation scenario

Inspect the urine currently in the catheter bag and note its appearance (e.g. We do point out the blood pressure (BP) cuff, but these medical students in their first year do not really need to know how the BP values are generated, they need to understand the origin and therapy for the low blood pressure. This is particularly important for core cases and low-frequency, high-stakes procedures and encounters. Trainee will correlate the underlying pathophysiology with symptoms and signs as exhibited by the simulation session. Each performance measure is separated into cognitive, behavioral or technical categories. 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. If you have any scenarios you would be willing to share with the simulation community, please forward them . 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. On the basis of the feedback from the students, they indicated that they believed the small group sessions are better. Animated Lecture KDCA, Ronald Reagan Washington National Airport, DC. TikTok: https://www.tiktok.com/@geekymedics We guide the group to suggest fluid. As this is a PBL session, the trainees are not given any references. 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. In an animated lecture, its important that the student group have an instructor so they can ask direct questions. Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. 4 0 obj An oropharyngeal airway is a curved plastic tube with a flange on one end that sits between the tongue and hard palate to relieve soft palate obstruction. Heart: S1 and S2 within normal limits; no S3/S4 or murmurs, normal rate and rhythm. 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. 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. Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario Cureus. Diabetic Ketoacidosis (DKA) Clinical Pathway Emergency Department | Children's Hospital of Philadelphia She does not take this regularly. Observe and discuss the effects of therapy in a mathematically modeled physiological simulator. Using the arterial line, the scenario becomes much more dynamic. A strong emphasis is placed on the focused, methodical examination of a specific medical problem and the decision-based treatment options available. 1. Physician working in the emergency department. 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). Catheterisethe patient to closelymonitor urine outputto guide fluid resuscitation and need for escalation. DKA can develop within 24 hours and is potentially life threatening, requiring prompt recognition and therapeutic intervention. 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. 1 0 obj 3. Cureus 9(5): e1286. I assigned true to life parking codes, and added some extra parking for the superfluous US Express AI. Research Watch Box:Sleep, Fatigue & SafetyBy David Page, MS, NREMT-P angioedema, rash) commence appropriate treatment as discussed in ouranaphylaxis guide. Available from: [. Medical simulation technology is a powerful tool for training physicians but papers dealing with DKA simulators are scarce. Emergency medical services workLife characteristics contribute to clinically significant excessive daytime sleepiness. It should only be inserted in unconscious patients as it is otherwise poorly tolerated and may induce gagging and aspiration. His Wife Gave Him CPR. unilateral coarse crackles may be present if the patient has pneumonia which may have been the precipitant for DKA). During an immersive simulation, its imperative the group uses critical-thinking skills and group collaboration independently. Groups of fewer than four students dont allow for optimal collaboration. The following scenarios are available for download and are designed to meet your multi-disciplinary nursing needs. 1. Published August 2015. Indeed, it is the only thing that ever has.". DY{Qb"(EgN$QI*%XN1F""0a5 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. The student group is given a short introduction into a closed simulation environment. Administer oxygen to all critically unwell patients during yourinitialassessment. Each PBL case typically goes over 23 days, affording the students periods to find information for the case. After initial insulin therapy has reduced plasma blood glucose levels (e.g. It involves working through the following steps: Each stage of the ABCDE approach involvesclinicalassessment,investigationsandinterventions. A nasopharyngeal airway is a soft plastic tube with a bevel at one end and a flange at the other. This session provides additional clinical support material for the theoretical PBL session. The objective is to give as many visual and tactile cues concerning the patient condition and background as possible. Its best, however, to allow the student group to continue so theyre able to evaluate their decision-making processes during debriefing. 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. 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. Assess the patients pulse and blood pressure: Inspect the patient from the end of the bed: they may appear drowsy, confused and/or clammy/pale. Given 6 to 8 back-to-back sessions, it is critical that every session starts and ends on time! Askhow the patient is feeling as this may provide some useful information about their current symptoms. For example, you could develop a diabetic scenario in which the prehospital provider encounters an altered patient with incomprehensible speech. PA EMT Said COVID Patient Didnt Need to Go to the Hospital. A comprehensive collection of OSCE guides to common clinical procedures, including step-by-step images of key steps, video demonstrations and PDF mark schemes. Surgical dressings and imitation blood can support medical history. We combined both to indicate the continuity of the curriculum, and the building on prior knowledge. 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].. Lets discuss your options. The main purpose of the simulation is to draw a line from the theoretical, boring biochemistry to the clinical manifestations. - Over 3000 Free MCQs: https://geekyquiz.com/ Before trainees arrival into the simulation area, the simulator is already preprogrammed for DKA. The simulation session is also hosted as an interactive session. (1) The assessment of a diabetic patient is best taught as a. Antibiotics should be prescribed in keeping with local guidelines. diagnosis of DKA Trigger 3, ABG show acidosis and high BM and normal potassium. To read Pages full Research Review column, visit www.jems.com/patient-care. www.cdc.gov/diabetes/statistics/prev/national/. 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. Make sure thepatientsnotes,observationchartandprescriptionchartare easily accessible. Insert at least onewide-bore intravenous cannula(14G or 16G) and take blood tests as discussed below. insulin-dependent type 2 diabetes), Altered consciousness (e.g. 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. 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 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). 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. 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. 1) Please read through this document as it will help you prepare for your upcoming simulation on DKA. Weight, Height: Not given, normal appearing (as per simulator) but has lost 20 lbs recently. vD0 x@FFJ{m[ 3//Oh|JR7! The Pratcice 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 . We then start the DKA state. See Appendix D, Supplemental Digital Content 4, https://links.lww.com/SIH/A4. Recognize the signs and symptoms of a patient presenting with diabetic ketoacidosis. Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. She tends to drink sugar containing fluids (soda) when she is thirsty, and she eats fast foods (cream-filled muffins) when she is hungry. This allows the learner group to make a psychological break from the patient and environment while beginning the reflection process. COVID-19 Screening in the Pediatric Emergency Department. Subscribe to our newsletter to be the first to know about our latest content: https://geekymedics.com/newsletter/ 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. Should any changes be made to the current management of their underlying condition(s)? If foreign material is present, attempt removal using suction. Circulating nurse in the emergency room (ER). Margolis GS, Romer GA, Fernandez AR, et al. #geekymedics #fyp #fypviral #studytok #medicalstudentuk #medtok #studytips #studytipsforstudents #medstudentuk #premed #medschoolfinals, Cardiovascular History Tips - DON'T FORGET these 3 things . In some cases, normal saline with additional potassium is required to prevent overcorrection of serum potassium levels which would otherwise result in hypokalaemia. Immersive Simulations 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! The 60 minutes training time consists of four 15-minute sections divided as follows. Below is a collection of donated scenarios for you to use or modify. In this manner, the students have to apply their knowledge at the appropriate points during the progression of the scenario. Manikin staging can provide strong cues. 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. 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. 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. The researchers found that long shift hours (24hrs), working overtime and marital/relationship stress were strongly correlated. See ourfluid prescribing guidefor more details onresuscitation fluids. Standardized patient as the voice of the simulator (or the simulation operator may play this role). PBL was introduced at our institution in 1995. DO NOT perform any examination or procedure on patients based purely on the content of these videos. See ourintravenous cannulation guidefor more details. - Site 01:12 Keywords: diabetic ketoacidosis, simulation, expertise, emergency medicine Introduction Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes mellitus, most . Works with Traffic 2005, but . Inspect theairwayfor obviousobstruction. confusion, coma), All critically unwell patients should have. As individuals with uncontrolled type I . - Exacerbating & relieving factors 05:12 2 The evaluation of potassium deficits is complicated by potassium exit from . A blood glucose level may already be available from earlier investigations (e.g. 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. In the meantime, you should re-assess and maintain the patients airway. Diabetes (type 1 and type 2) in children and young people: diagnosis and management. Measure the patients capillary blood glucose and ketone levels to confirm the diagnosis and guide the management of DKA. The students are in their first year. Its absolutely necessary to follow all immersive simulations with a positive, emotionally safe and nonjudgmental debriefing environment. The students are in their basic science course. Extremities: mild cyanosis, no clubbing or edema (verbalized by instructors); pulses equal, and symmetrical (elucidated by trainees). cloudy urine may indicate urinary tract infection). A debriefing section with pre-established questions allows the instructor to review the main focus and performance measures with the student group. Supplemental digital content is available for this article.