dka simulation scenario

Use blankets to re-warm patients who are mild to moderately hypothermic. 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. Re-assessthe patient using theABCDE approachto identify any changes in their clinical condition and assess the effectiveness of your previous interventions. LYqC+pJ&6X4onfBT#?=R}.p8N3+Dk,P4tIgWB}-L'=8;_G >,K#.e89XnG'B~NtR In this case scenario, dehydration is one of the most serious immediate issues. 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. Join the Geeky Medics community: 3. #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! 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. 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. Her medical, social, and family histories are not clear at the time of admission to the emergency department. The patient synopsis should include such standard aspects as age, sex, ethnicity, medical history, medications and allergies. may email you for journal alerts and information, but is committed A comprehensive collection of medical revision notes that cover a broad range of clinical topics. Medical Simulation Scenarios are text documents outlining the various details of a simulation - everything from patient simulator settings to debriefing notes. She began experiencing progressively worsening thirst, increased appetite, and excessively increased urination. See ourhistory taking guidesfor more details. Hypothermia may be present if the patient has been unconscious and exposed for some time. Instructors should write a case study for the simulation before the session. DY{Qb"(EgN$QI*%XN1F""0a5 Immersive simulations are mentally exhausting because they create an intense and stressful atmosphere requiring the learner to work outside their comfort zone. Intubation lubricants can mimic drooling. 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. They have had no clinical exposure or any clinical experience. 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. Forty percent of respondents reported excessive daytime sleepiness. Surgical dressings and imitation blood can support medical history. This video demonstrates how to use the SOCRATES acronym when taking a history of pain or other symptoms. Trainee will increase knowledge of professional behaviors during the simulation. As individuals with uncontrolled type I . Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario Cureus. 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. Schneider Sarver PA, Senczakowicz EA, Slovensky BM. This typically involves the use of anon-rebreathe maskwith an oxygen flow rate of15L. A list of the requirements (monitors, props, and others) is given in Tables 2 and 3, as well as in the web supplement (Appendix C, Supplemental Digital Content 3, https://links.lww.com/SIH/A3). 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. Refer to your local guidelines for further details. Virtual patient simulation (VPS) is an interactive computer simulation that recreates real-world scenarios with the objectives of training, education, and assessment for health care providers [].Virtual simulation has been used extensively to adapt nursing education to the COVID-19 pandemic context [], such as social distancing and/or confinement. Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario 2009;13:505511. Observe and discuss the effects of therapy in a mathematically modeled physiological simulator. Each PBL case typically goes over 23 days, affording the students periods to find information for the case. <>>> 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. 2007. 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. Using your thumbs, slightly open the mouth by downward displacement of the chin. 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. - Exacerbating & relieving factors 05:12 PBL was introduced at our institution in 1995. 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. Twitter: http://www.twitter.com/geekymedics Case-based education adds a real-world aspect to the learning environment. Below is a collection of donated scenarios for you to use or modify. We are looking for declaration of DKA and request for pathway. We give the history of the patient to the trainees. We now provide the students with handouts of the data to save time and provide consistency. As with the animated lecture, the simulation is strongly dependent on a focused case study. If an obstruction is visible within the airway, use afingersweeporsuctionto remove it. To read Pages full Research Review column, visit www.jems.com/patient-care. Invasive monitors, including a left radial intraarterial and a right subclavian IV catheter, were placed. Therefore, we have to emphasize the importance of airway, breathing, and circulation in the very sick patient in any clinical setting. Terms of Use. Many of the preclinical students have never seen a real life clinical monitor or even an intravenous (IV) setup. The files are given in full in the web supplement (Appendix B, Supplemental Digital Content 2, https://links.lww.com/SIH/A2). Marx JA, Hockberger RS, Walls RM. NPAs are typically better tolerated in patients who are partly or fully conscious compared to oropharyngeal airways. TheABCDEapproach can be used to perform a systematic assessment of a critically unwell patient. Section snippets . A blood glucose level may already be available from earlier investigations (e.g. Inspect for evidence of infection on the skin (e.g. The Theory In the meantime, you can perform some basic airway manoeuvres to help maintain the airway whilst awaiting senior input. Acad Med. An events progression section should include patient status changes, as well as a time/treatment continuum that incorporates if-then event progressions. Trainee will appropriately request assistance and use available resources. 2003;78:783788. TikTok: https://www.tiktok.com/@geekymedics 3. If an infection is suspected, IV antibioticsshould be administered as soon as possible. The normal reference range for fasting plasma glucose is 4.0 5.8 mmol/l. doi: 10.7759/cureus.1286. Facilitator to ask how often to measure BMs Diabetic Ketoacidosis (DKA) Clinical Pathway Emergency Department | Children's Hospital of Philadelphia 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). In an animated lecture, its important that the student group have an instructor so they can ask direct questions. 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. 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. 1) Please read through this document as it will help you prepare for your upcoming simulation on DKA. Make sure tore-assessthe patient after anyintervention. A nasopharyngeal airway is a soft plastic tube with a bevel at one end and a flange at the other. Using the arterial line, the scenario becomes much more dynamic. Conclusions This technical report describes the design and implementation of a simulation scenario on DKA for emergency medicine trainees. Patients with DKA require fluid resuscitation to restore circulatory volume, clear ketones, correct electrolyte abnormalities and increase renal perfusion. The use of a simulated, evolving case scenario was an effective method of exposing nursing students to complex patient care. Ask for anotherclinicalmemberofstafftoassistyou if possible. This session provides additional clinical support material for the theoretical PBL session. After initial insulin therapy has reduced plasma blood glucose levels (e.g. Indeed, it is the only thing that ever has.". confusion, coma), All critically unwell patients should have. Should any changes be made to the current management of their underlying condition(s)? 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. - Site 01:12 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). JEMS. You may be asked to review a patient with DKA due to confusion, reduced level of consciousness, tachycardia, hypotension and/or vomiting. 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. There are several causes of DKA, which we remember by the "five I's". Search for Similar Articles cellulitis). 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. - Radiation 02:45 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. See ourdocumentation guidesfor more details. }HyEf,#$/JSRU9+CF6k\'/z+i`[ 5JudK*Zly^g%[jCK)H[)Y=Qp0/r9o9HW_zF}pTzI~'|q.~:=Y T 9w! 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. Trainee will practice or observe good teamwork skills, both as a leader and a team player. If foreign material is present, attempt removal using suction. Debriefing 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. - Introduction 00:00 DKA can be caused by either: Absolute insulin deficiency (e.g. 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. The 60 minutes training time consists of four 15-minute sections divided as follows. Published August 2015. your express consent. The trainees have had background knowledge of biochemistry because they had completed the PBL case. The validity of the HFS-DKA scenario was verified by a certified diabetes nurse educator, a registered nurse, and a clinical nurse educator. The debriefing environment should be removed from the location where the simulation took place. For similar reasons, we do not believe a videotaped session will keep the students attention as much as these live simulator sessions. You may search for similar articles that contain these same keywords or you may A collection of communication skills guides, for common OSCE scenarios, including history taking and information giving. 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. The reason for inserting the airway upside down initially is to reduce the risk of pushing the tongue backwards and worsening airway obstruction. Trainee will learn to collaborate with peers to decide on appropriate interventions, tests, and therapy. An integral part of a PBL session is for trainees to be able to navigate through huge literature bases. 2011;15:108109. stream 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. Finally, we summarize the course and give them time for questions. Instagram: https://instagram.com/geekymedics This guide provides an overview of the recognition and immediate management of diabetic ketoacidosis (DKA)using an ABCDE approach. Causes: Any situation arising in a diabetic that requires increased insulin without that demand being met can result in DKA. 2008;6:278302. 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. The instructor can also gauge the direction the debriefing session should follow or be alerted to possible problems or conflicts in treatment opinions. Simulation Scenario. Initially, we used a blood pressure cuff to generate the blood pressure values. Urinary tract infections are a common DKA precipitant. cloudy urine may indicate urinary tract infection). Case-based simulation should include two to three broad-focus objectives, as well as 1020 specific performance measures that the student should accomplish. angioedema, rash) commence appropriate treatment as discussed in ouranaphylaxis guide. Some error has occurred while processing your request. The choice of fluid type, rate of administration and volume should be tailored to the individual patient based upon their vital signs and electrolytes. The students mentioned that they did not obtain the maximum value from the simulation session under these circumstances. 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. 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. 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). VbQuX#R M21 Please enable scripts and reload this page. Both external and internal potassium balances are disturbed during the development and treatment of DKA. We then start the DKA state. See Appendix D, Supplemental Digital Content 4, https://links.lww.com/SIH/A4. - Severity 05:32 Well done, youve now stabilised the patient and theyre doing much better. Open the patients airwayusing ahead-tiltchin-lift manoeuvre: 1. You should have another member of the clinical team aiding you in your ABCDE assessment, such a nurse, who can perform observations, take samples to the lab and catheterise if appropriate. 3. Trainee will recognize the need for therapy and suggest an appropriate therapy in a simulated environment. A pre-briefing session is conducted prior to the start of the simulation scenario. See ourCXR interpretation guidefor more details. The optimal number of simulation participants is four to seven individuals, depending on the case study objectives. Ketones show 5.5. 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 This is a combination of the modified traditional lecture within scenario-based learning. We have been presenting Simulation Laboratory sessions to our preclinical medical students (first and second years). With your index and other fingers placed behind the angle of the mandible, apply steady upwards and forward pressure to lift the mandible. In this section, we have to help the trainee to institute definitive therapy based on the underlying biochemical abnormalities. 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. - 700+ OSCE Stations: https://geekymedics.com/osce-stations/ These are not learning objectives in this program. For example, you could develop a diabetic scenario in which the prehospital provider encounters an altered patient with incomprehensible speech. 4 0 obj to maintaining your privacy and will not share your personal information without % 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. Using SOCRATES in History Taking | OSCE | Communication Skills, Diabetic Ketoacidosis (DKA) | Acute Management | ABCDE. Laschinger S, Medves J, Pulling C, et al. 2 0 obj Its important to train and educate students of prehospital care on key indicators of a diabetic emergency. This leads to hyperglycaemia, osmotic diuresis, and dehydration. - Geeky Medics OSCE App: https://geekymedics.com/geeky-medics-app/ . Example: If the provider immediately evaluates blood glucose, then the reading will display 45 mg/dL. <> DO NOT perform any examination or procedure on patients based purely on the content of these videos. 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 . "Never doubt that a small group of thoughtful, committed citizens can change the world. Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. A comprehensive collection of OSCE guides to common clinical procedures, including step-by-step images of key steps, video demonstrations and PDF mark schemes. Please try again soon. Simulation provides a safe environment where learning is enhanced through the deliberate practice of skills and controlled management of a variety of clinical encounters. The relationship between sleep, fatigue and patient and provider safety. Instead, instructors should combine case- and simulation-based techniques when teaching diabetic assessment. Emergency medical services workLife characteristics contribute to clinically significant excessive daytime sleepiness. It may be necessary toexposethe patient during your assessment: remember to prioritise patient dignity and conservation of body heat. We ask the trainee why the blood pressure is so low or heart rate is so high, and how we should treat it. Available from: [. If any obstruction is encountered, remove the tube and try the left nostril. (1), The assessment of a diabetic patient is best taught as a case-based simulation. We combined both to indicate the continuity of the curriculum, and the building on prior knowledge. Alert a senior immediately if you have any concerns about the consciousness level of a patient. 3. As this is an interactive discussion session, any needed debriefing and/or explanation is given during the sessions. A number of key modifiers are described that allow for the adjustment of case . 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. Diabetes UK with the Joint British Diabetes Societies Inpatient Care Group. 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. 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. Makeup may be used to depict gender, hollow eyes and cheeks, produce pallor or display bruises and scars. Keyword Highlighting Stage 2: Emergency management of DKA and consideration of abnormal CTG. The Theory Airway adjuncts are often helpful and in some cases essential to maintain a patients airway. They have had no clinical exposure or any clinical experience. 2. 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].. Make sure to re-assess the patient after any intervention. DO NOT perform any examination or procedure on patients based purely on the content of these videos. 2. endobj - Over 3000 Free MCQs: https://geekyquiz.com/ The learning environment should closely mimic real-world applications. Measure the patients capillary blood glucose and ketone levels to confirm the diagnosis and guide the management of DKA. If the patient is suspected to have sufferedsignificanttraumawith potential spinal involvement, perform ajaw-thrustrather than a head-tilt chin-lift manoeuvre: 2. Scenario in a Nutshell Diabetic ketoacidosis (DKA) in pregnancy. Adds true to life parking codes and extra parking for AI. A collection of free medical student quizzes to put your medical and surgical knowledge to the test! When erroneous treatment is delivered, the instructor can end the simulation. We believe it is important to have active, participatory learning by having conversations with the trainees in the form of questions and answers. 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.