dka simulation scenario

dka simulation scenario

If an infection is suspected, IV antibioticsshould be administered as soon as possible. Stage 2: Emergency management of DKA and consideration of abnormal CTG. Reduced urine output (oliguria) is typically defined as less than 0.5ml/kg/hour in an adult. 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.) PBL was introduced at our institution in 1995. The instructor should have visual access via one-way windows or cameras. 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. Open the patients mouth to ensure there is no foreign material that may be pushed into the larynx. These are not learning objectives in this program. After the first voluntary session in 2006, feedback from the medical students indicated that they would like to receive this handout. It should only be inserted in unconscious patients as it is otherwise poorly tolerated and may induce gagging and aspiration. If the patient is confused you might be able to get a collateral history from staff or family members as appropriate. Extremities: mild cyanosis, no clubbing or edema (verbalized by instructors); pulses equal, and symmetrical (elucidated by trainees). Another example: At one minute into the scenario, the patient becomes unresponsive and their breathing becomes shallow. It involves working through the following steps: Each stage of the ABCDE approach involvesclinicalassessment,investigationsandinterventions. 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. - Character 02:14 Use an effectiveSBARR handoverto communicate the key information effectively to other medical staff. Review the patientscurrent medicationsand check any regular medications areprescribed appropriately. 2. Consider any precipitating factors for the development of DKA and involve the diabetes team in the patients care. There are several causes of DKA, which we remember by the "five I's". A chest X-ray should not delay the emergency management of DKA. Please note that by doing so you agree to be added to our monthly email newsletter distribution list. Terms of Use. Prehosp Emerg Care. Note that if-thens must also include negative patient outcomes for when the provider doesnt take appropriate action. PA EMT Said COVID Patient Didnt Need to Go to the NYC Unions Demand Reinstatement, Back Pay for Workers Fired for Refusing President Biden to End COVID-19 Emergencies on May 11. >> Fernandez AR, Mac Crawford J, Pennell ML, et al. "Never doubt that a small group of thoughtful, committed citizens can change the world. 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). Advance the airway until it lies within the pharynx. Assessment & Treatment of Five Diabetic Emergencies - JEMS Categories: Emergency Medicine, Medical Education Keywords: diabetic ketoacidosis, simulation, expertise, emergency medicine . Diabetic Ketoacidosis (DKA) Clinical Pathway Emergency Department Instagram: https://instagram.com/geekymedics Several environments may be suitable for your classroom. Marx JA, Hockberger RS, Walls RM. The relationship between sleep, fatigue and patient and provider safety. >> Patterson PD, Weaver M, Frank R, et al. One advantage to the animated lecture style is the ability to introduce treatment options in a methodically guided approach thats in conjunction with simultaneous environmental stimulus. Two abstracts related to sleepiness in the EMS workforce were presented at the National Association of EMS Physicians symposium in January. endobj Centers for Disease Control and Prevention. If the patient is suspected to have sufferedsignificanttraumawith potential spinal involvement, perform ajaw-thrustrather than a head-tilt chin-lift manoeuvre: 2. 1. Teaching nursing management of diabetic ketoacidosis: a description of Using the arterial line, the scenario becomes much more dynamic. By joining Cureus, you agree to our Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. Trainee will appropriately request assistance and use available resources. (1) According to Centers for Disease Control and Prevention (CDC), 223,619 deaths were attributed to diabetes in 2005. This is particularly important for core cases and low-frequency, high-stakes procedures and encounters. His Heart Stopped On a Treadmill. 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. This may produce better retention of the subject matter and help students adapt to emergency scenes before going into the field. Trainee will practice or observe good teamwork skills, both as a leader and a team player. NPAs are typically better tolerated in patients who are partly or fully conscious compared to oropharyngeal airways. Alert a senior immediately if you have any concerns about the consciousness level of a patient. Conclusions This technical report describes the design and implementation of a simulation scenario on DKA for emergency medicine trainees. The students worked on the underlying physiology during a week long PBL session and are therefore familiar with the theoretical aspects of DKA. Urinary tract infections are a common DKA precipitant. 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. Each clinical case scenario allows you to work through history taking, investigations, diagnosis and management. Should any changes be made to the current management of their underlying condition(s)? 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. Glycosuria leads to urinary losses of potassium through osmotic diuresis. 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. - Over 3000 Free MCQs: https://geekyquiz.com/ If the patient loses consciousness and there are no signs of life on assessment, put out a crash call and commence CPR. Management of diabetic ketoacidosis in adults. GRAPH. - PSA Question Pack: https://geekymedics.com/psa-question-bank/ 1 Potassium losses occurring both before and during treatment of DKA must be replaced. A collection of anatomy notes covering the key anatomy concepts that medical students need to learn. Your message has been successfully sent to your colleague. Review the patients drug chart for medications which may cause a reduced level of consciousness (e.g. <> Diabetes UK with the Joint British Diabetes Societies Inpatient Care Group. Animated Lecture 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. Refer to your local guidelines for further details. 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. Simulation Scenario. 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. SimMan Nursing Scenarios Software. The student group is given a short introduction into a closed simulation environment. 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. It was developed for anesthesiology resident physicians with some background knowledge and experience caring for critically ill patients. As this is a PBL session, the trainees are not given any references. See ourdocumentation guidesfor more details. The normal reference range for fasting plasma glucose is 4.0 5.8 mmol/l. At the end of the previous section, the trainee can make the diagnosis of DKA but has not confirmed it yet. Similar to a ward round, where the instructor would say: Come and listen to this patient with an aortic stenosis. 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. Animated lectures, however, must work within the framework of a focused case study, which requires increased preparation time. Facebook: http://www.facebook.com/geekymedics 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. Trainee will recognize the need for therapy and suggest an appropriate therapy in a simulated environment. Instructors should write a case study for the simulation before the session. In other words, they do not have clinical experience, but they have clinical knowledge. The instructors never expect the trainees to exhibit full understanding of pathophysiology and skills in the treatment but do give them a few important points to understand the diagnosis and initial treatment of the patients with DKA. We give the history of the patient to the trainees. This allows the learner group to make a psychological break from the patient and environment while beginning the reflection process. This typically involves the use of anon-rebreathe maskwith an oxygen flow rate of15L. - 2500+ OSCE Flashcards: https://geekymedics.com/osce-flashcards/ Check out our other awesome clinical skills resources including: CCA 175 Real Time Exam Scenario 17 | JOIN Multiple DataFrames | Save as DOI 10.7759/cureus.1286. We ask the trainee why the blood pressure is so low or heart rate is so high, and how we should treat it. 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. This leads to hyperglycaemia, osmotic diuresis, and dehydration. Use blankets to re-warm patients who are mild to moderately hypothermic. - Geeky Medics OSCE App: https://geekymedics.com/geeky-medics-app/ Could we not just do this as a large group session to all 160 students (versus 20 1-hour sessions to groups of eight students)? We used the Medical Education Technologies Inc. (METI) Human Patient Stimulator (HPS, METI Sarasoto, Fl). Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. As the name says, this screen is used to graph and plot any parameter. Therefore, the same file is also sent to the participants before the session. oral fluids, intravenous fluids, urine output, drain output, stool output, vomiting) to inform resuscitation efforts. Many of the preclinical students have never seen a real life clinical monitor or even an intravenous (IV) setup. The simulation experience serves to give substance to the theoretical words and concepts that the students encountered during the PBL sessions. KDCA for FSX - Fly Away Simulation DKA can develop within 24 hours and is potentially life threatening, requiring prompt recognition and therapeutic intervention. Heart: S1 and S2 within normal limits; no S3/S4 or murmurs, normal rate and rhythm. The student group should be encouraged to collaborate on management options and to perform skills. 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. may email you for journal alerts and information, but is committed Trainee will increase knowledge of professional behaviors during the simulation. We combined both to indicate the continuity of the curriculum, and the building on prior knowledge. A collection of interactive medical and surgical clinical case scenarios to put your diagnostic and management skills to the test. Chapters: 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. 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. Adds true to life parking codes and extra parking for AI. Diabetic ketoacidosis (DKA) is a common, potentially lethal disease. A fixed-rate intravenous insulin infusion should be commenced initially to suppress ketogenesis, reduce blood glucose levels and address electrolyte disturbances. Target Learner Groups The following scenarios are available for download and are designed to meet your multi-disciplinary nursing needs. PDF Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario A collection of data interpretation guides to help you learn how to interpret various laboratory and radiology investigations. After entering the environment, the student doesnt have the option of leaving the simulation until the learning objectives and performance measures are achieved. The instructor can also gauge the direction the debriefing session should follow or be alerted to possible problems or conflicts in treatment opinions. 3 0 obj Supplemental digital content is available for this article. Margolis GS, Romer GA, Fernandez AR, et al. This is a combination of the modified traditional lecture within scenario-based learning. Blood sugar issues in the Type II diabetic will have a gradual onset, with diagnosis generally resulting from routine laboratory exams.(1). #geekymedics #fyp #fypviral #studytok #medicalstudentuk #medtok #studytips #studytipsforstudents #medstudentuk #premed #medschoolfinals, Cardiovascular History Tips - DON'T FORGET these 3 things . If any obstruction is encountered, remove the tube and try the left nostril. Refer to your local guidelines for further details. Creating a Simulation Experience to Promote Clinical Judgment 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. We have spent many hours debating whether the small group format was a waste of time. A blood glucose level may already be available from earlier investigations (e.g. Tilt the forehead back whilst lifting the chin forwards to extend the neck. Rosens Emergency Medicine: Concepts and Clinical Practice. Classroom Dynamics They have had no clinical exposure or any clinical experience. 3. 1. #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! 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. Cureus is on a mission to change the long-standing paradigm of medical publishing, where submitting research can be costly, complex and time-consuming. 3. 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. Simulation student Scenario- DKA-Peds.docx - DIABETIC 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. Ask for anotherclinicalmemberofstafftoassistyou if possible. Calculate the patients current fluid balance using their fluid balance chart (e.g. Healthcare Students' Psychological Well-Being in a Diabetic Ketoacidosis Simulation. It involves a facilitating instructor, a small learner group and conceptual aspects of environmental and manikin staging to provide sensory cues. The teaching of diabetic assessment and management, like many other medical emergencies, lends itself well to case-based simulation. 2007. The file explaining the session is sent to instructors 1 week before the sessions. Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. This is a 25-year-old woman with a medical history of diabetes medicated with 40 units insulin per day. Competency-based medical education has seen widespread adoption in the field along with ongoing work in the areas of . 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. Make sure tore-assessthe patient after anyintervention. and Development of simulation scenarios for an adolescent patient with diabetic ketoacidosis. Simulation provides a safe environment where learning is enhanced through the deliberate practice of skills and controlled management of a variety of clinical encounters. Causes: Any situation arising in a diabetic that requires increased insulin without that demand being met can result in DKA. If the patientloses consciousnessand there areno signs of lifeon assessment, put out acrash callandcommence CPR. 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). insulin-dependent type 2 diabetes), Altered consciousness (e.g. Airway adjuncts are often helpful and in some cases essential to maintain a patients airway. We have been presenting Simulation Laboratory sessions to our preclinical medical students (first and second years). 3. Twitter: http://www.twitter.com/geekymedics 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. <> Inspect for evidence of infection on the skin (e.g. Groups of fewer than four students dont allow for optimal collaboration. A nasopharyngeal airway is a soft plastic tube with a bevel at one end and a flange at the other. Are any further assessments or interventions required? Trainee will correlate the underlying pathophysiology with symptoms and signs as exhibited by the simulation session. PDF DKA Sim Scenario - ABCD (Diabetes Care) Ltd The Theory Available from: [, NICE guidelines. Works with Traffic 2005, but . 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. Antibiotics should be prescribed in keeping with local guidelines. Conclusion Data is temporarily unavailable. 1 0 obj Discuss the patients current clinical condition with aseniorclinicianusing anSBARR style handover. . Example: If the provider immediately evaluates blood glucose, then the reading will display 45 mg/dL. to maintaining your privacy and will not share your personal information without Introduceyourselfto thepatientincluding yournameandrole. This guide provides an overview of the recognition and immediate management of diabetic ketoacidosis (DKA)using an ABCDE approach. COVID-19 Screening in the Pediatric Emergency Department. %PDF-1.5 Environment & Manikin 2010;49:578586. Hypothermia may be present if the patient has been unconscious and exposed for some time. - Site 01:12 Makeup may be used to depict gender, hollow eyes and cheeks, produce pallor or display bruises and scars. 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. An oxygen mask is also demonstrated as an alternative device, as these early trainees had mostly not yet seen any of these devices. The trainees have had background knowledge of biochemistry because they had completed the PBL case. Pediatric Emergency Medicine Didactics and Simulation (PEMDAS Perform urinalysis and send the urine for culture if urinary tract infection is suspected. Cureus 9(5): e1286. If the provider starts an IV and gives dextrose, then the patients alertness will increase, respirations will normalize and repeated blood glucose will read 210 mg/dL over a two-minute interval. If the patient has clinical signs ofanaphylaxis(e.g. vD0 x@FFJ{m[ 3//Oh|JR7! The choice of fluid type, rate of administration and volume should be tailored to the individual patient based upon their vital signs and electrolytes. In some cases, normal saline with additional potassium is required to prevent overcorrection of serum potassium levels which would otherwise result in hypokalaemia. Diabetes (type 1 and type 2) in children and young people: diagnosis and management. 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. As this is an interactive discussion session, any needed debriefing and/or explanation is given during the sessions. A traditional classroom lecture format allows for student participation but limits the instructors ability to create realistic situations. - Medical Finals Question Pack: https://geekymedics.com/medical-student-finals-questions/ 4. Trainee will get to know how professionals behave during management of a critically ill patient. You might also be interested in our awesome bank of 700+ OSCE Stations. Scenarios thesimtech 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].. 5. Geeky Medics accepts no liability for loss of any kind incurred as a result of reliance upon the information provided in this video. Capillary refill timemay be prolonged if the patient is hypovolaemic. The patient synopsis should include such standard aspects as age, sex, ethnicity, medical history, medications and allergies. We do not use passive visualizing materials such as videotapes or DVD other than vital signs shown on the monitors. Each PBL case typically goes over 23 days, affording the students periods to find information for the case. 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. Place one hand on the patients forehead and the other under the chin. 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. In this manner, the students have to apply their knowledge at the appropriate points during the progression of the scenario. Mosby:Philadelphia. An events progression section should include patient status changes, as well as a time/treatment continuum that incorporates if-then event progressions. Simulation Scenario for Anesthesia Providers Clark Obr, MD*, Anthony Mueller, MD . However, this leads to confusion. These simulation sessions seem to work because the medical students do have prior knowledge. There are just a few more things to do. 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