dka simulation scenario

Join the Geeky Medics community: Stage 1: Initial assessment of acutely unwell pregnant woman and diagnosis of DKA. A blood glucose level may already be available from earlier investigations (e.g. Simulation Scenario for Anesthesia Providers Clark Obr, MD*, Anthony Mueller, MD . 2 0 obj Effectiveness of simulation on health profession students knowledge, skills, confidence and satisfaction. One of the key differences with the immersive simulation is that the instructor is absent from the simulation environment. The use of case-based simulation, although more complicated and time consuming for the instructor, immerses the students in the subject matter. The DKA simulation incorporates cue recognition, analysis of cues, generation of solutions, nursing interventions, and evaluation of outcomes, including effective communication and psychosocial concerns. 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. Works with Traffic 2005, but . 3. Available from: [. Prehosp Emerg Care. Geeky Medics accepts no liability for loss of any kind incurred as a result of reliance upon the information provided in this video. In this section, we have to help the trainee to institute definitive therapy based on the underlying biochemical abnormalities. A collection of free medical student quizzes to put your medical and surgical knowledge to the test! Introduceyourselfto whoever has requested a review of the patient andlistencarefullyto their handover. This is particularly important for core . may email you for journal alerts and information, but is committed The trainees have had background knowledge of biochemistry because they had completed the PBL case. 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. - Associated symptoms 03:04 DKA can be caused by either: Absolute insulin deficiency (e.g. Many of the preclinical students have never seen a real life clinical monitor or even an intravenous (IV) setup. 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). An integral part of a PBL session is for trainees to be able to navigate through huge literature bases. Extremities: mild cyanosis, no clubbing or edema (verbalized by instructors); pulses equal, and symmetrical (elucidated by trainees). Animated lectures, however, must work within the framework of a focused case study, which requires increased preparation time. Centers for Disease Control and Prevention. Conclusion An hour was . Acad Med. Over the years, some groups happened to have the simulation session before the completion of the theoretical PBL session. 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. The Pratcice 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. 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.) By joining Cureus, you agree to our Well done, youve now stabilised the patient and theyre doing much better. Much time was wasted explaining why it did not matter. We do not use passive visualizing materials such as videotapes or DVD other than vital signs shown on the monitors. The Theory The file explaining the session is sent to instructors 1 week before the sessions. Maintain head-tilt chin-lift or jaw thrust and assess the patency of the patients airway by looking, listening and feeling for signs of breathing. It involves working through the following steps: Each stage of the ABCDE approach involvesclinicalassessment,investigationsandinterventions. 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. General: Moaning, asking what has happening to her. Scenarios. If the patient loses consciousness and there are no signs of life on assessment, put out a crash call and commence CPR. If you have any scenarios you would be willing to share with the simulation community, please forward them . - 150+ PDF OSCE Checklists: https://geekymedics.com/pdf-osce-checklists/ 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. Measure the patients capillary blood glucose and ketone levels to confirm the diagnosis and guide the management of DKA. Facebook: http://www.facebook.com/geekymedics Classroom Dynamics - Over 3000 Free MCQs: https://geekyquiz.com/ We have 18 to 20 PBL groups for an hour each in the week after their PBL DKA session. See ourCXR interpretation guidefor more details. Please note that by doing so you agree to be added to our monthly email newsletter distribution list. Open the patients mouth to ensure there is no foreign material that may be pushed into the larynx. A collection of anatomy notes covering the key anatomy concepts that medical students need to learn. A chest X-ray should not delay the emergency management of DKA. The choice of fluid type, rate of administration and volume should be tailored to the individual patient based upon their vital signs and electrolytes. 3. 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. www.cdc.gov/diabetes/statistics/prev/national/. 2011;15:108109. 2 The evaluation of potassium deficits is complicated by potassium exit from . 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 An oxygen mask is also demonstrated as an alternative device, as these early trainees had mostly not yet seen any of these devices. Instagram: https://instagram.com/geekymedics oral fluids, intravenous fluids, urine output, drain output, stool output, vomiting) to inform resuscitation efforts. You may search for similar articles that contain these same keywords or you may After the first voluntary session in 2006, feedback from the medical students indicated that they would like to receive this handout. VbQuX#R M21 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. Diabetic ketoacidosis (DKA) is a common, potentially lethal disease. A GCS of 8 or below warrants urgent expert help from an anaesthetist. Review the patients drug chart for medications which may cause a reduced level of consciousness (e.g. Several environments may be suitable for your classroom. These simulation sessions seem to work because the medical students do have prior knowledge. They have had no clinical exposure or any clinical experience. Example: If the provider immediately evaluates blood glucose, then the reading will display 45 mg/dL. 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). Deteriorationshould be recognised quickly and acted upon immediately. An animated lecture may be described as a pseudo-simulation environment. For example, you could develop a diabetic scenario in which the prehospital provider encounters an altered patient with incomprehensible speech. Conclusions This technical report describes the design and implementation of a simulation scenario on DKA for emergency medicine trainees. 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. dq-]gX4 `L'u7myx) rpjf0z,.y`VMyx-&Ju`U0 NPAs are typically better tolerated in patients who are partly or fully conscious compared to oropharyngeal airways. Reduced urine output (oliguria) is typically defined as less than 0.5ml/kg/hour in an adult. Medical simulation technology is a powerful tool for training physicians but papers dealing with DKA simulators are scarce. 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. Using your thumbs, slightly open the mouth by downward displacement of the chin. Section snippets . . Trainee will appropriately request assistance and use available resources. Glycosuria leads to urinary losses of potassium through osmotic diuresis. She does not take this regularly. 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 . Immersive Simulations Your message has been successfully sent to your colleague. Review the patientsoxygen saturation(SpO2): Auscultate the chest to screen for evidence of respiratory pathology (e.g. In other words, they do not have clinical experience, but they have clinical knowledge. We have spent many hours debating whether the small group format was a waste of time. There are just a few more things to do. The consequences (low blood pressure, high heart rate, central nervous system status, etc.) A fixed-rate intravenous insulin infusion should be commenced initially to suppress ketogenesis, reduce blood glucose levels and address electrolyte disturbances. Mosby:Philadelphia. We are looking for declaration of DKA and request for pathway. 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. 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. Review thepatients notes,chartsandrecent investigation results. Competency-based medical education has seen widespread adoption in the field along with ongoing work in the areas of . Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario For similar reasons, we do not believe a videotaped session will keep the students attention as much as these live simulator sessions. Geeky Medics accepts no liability for loss of any kind incurred as a result of reliance upon the information provided in this video. On the basis of the feedback from the students, they indicated that they believed the small group sessions are better. When erroneous treatment is delivered, the instructor can end the simulation. We introduce the Simulation Laboratory and the Simulator, and demonstrate: pulses, eyes blinking, pupil constriction, gas moves in and out of mouth (place hand over mouth), chest moves up and down. Her medical, social, and family histories are not clear at the time of admission to the emergency department. 1. 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. Emergency medical services workLife characteristics contribute to clinically significant excessive daytime sleepiness. The main goal is to establish a safe learning environment for the learner [9, 13 . 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. - 700+ OSCE Stations: https://geekymedics.com/osce-stations/ 3. 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. Clearly communicate how often would you like the patients observations relayed to you by other staff members. It involves a facilitating instructor, a small learner group and conceptual aspects of environmental and manikin staging to provide sensory cues. Advance the airway until it lies within the pharynx. This guide provides an overview of the recognition and immediate management of diabetic ketoacidosis (DKA)using an ABCDE approach. endobj These are not learning objectives in this program. LYqC+pJ&6X4onfBT#?=R}.p8N3+Dk,P4tIgWB}-L'=8;_G >,K#.e89XnG'B~NtR Groups of more than seven may struggle with meeting objectives due to insufficient functional rolls. Please try after some time. Clearlydocument your ABCDE assessment, including history, examination, observations, investigations, interventions, and the patients response. We ask the trainee why the blood pressure is so low or heart rate is so high, and how we should treat it. Using SOCRATES in History Taking | OSCE | Communication Skills, Diabetic Ketoacidosis (DKA) | Acute Management | ABCDE. 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]). Trainee will be respectful to others and their views during the PBL session. SimMan offers you the ability to provide simulation education to challenge and test your students clinical and decision-making skills during realistic patient care scenarios. The students mentioned that they did not obtain the maximum value from the simulation session under these circumstances. 3 0 obj Please enable scripts and reload this page. A collection of interactive medical and surgical clinical case scenarios to put your diagnostic and management skills to the test. Below is a collection of donated scenarios for you to use or modify. 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. 4 0 obj GRAPH. 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. 2010;49:578586. Make sure tore-assessthe patient after anyintervention. The instructors role is to facilitate active learning through a combination of learning styles. We combined both to indicate the continuity of the curriculum, and the building on prior knowledge. Airway adjuncts are often helpful and in some cases essential to maintain a patients airway. 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. Insert at least onewide-bore intravenous cannula(14G or 16G) and take blood tests as discussed below. PA EMT Said COVID Patient Didnt Need to Go to the Hospital. Therefore, we have to emphasize the importance of airway, breathing, and circulation in the very sick patient in any clinical setting. Data is temporarily unavailable. 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). Discuss the patients current clinical condition with aseniorclinicianusing anSBARR style handover. A hyperglycemic patient may present with tachypnea, which often presents as Kussmauls respirations, tachycardia, orthostatic blood pressure changes and other signs of dehydration and diabetic ketoacidosis (DKA). 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). We used the Medical Education Technologies Inc. (METI) Human Patient Stimulator (HPS, METI Sarasoto, Fl). Urinary tract infections are a common DKA precipitant. Its important to train and educate students of prehospital care on key indicators of a diabetic emergency. Schneider Sarver PA, Senczakowicz EA, Slovensky BM. 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. areas of lipohypertrophy) if it is unclear if the patient is diabetic. As this is a PBL session, the trainees are not given any references. 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. If fever is present, make sure to consider co-existing infection. The student group is given a short introduction into a closed simulation environment. Regardless of the underlying cause of airway obstruction, seekimmediate expert supportfrom an anaesthetist and the emergency medical team (often referred to as the crash team). Makeup may be used to depict gender, hollow eyes and cheeks, produce pallor or display bruises and scars. In the simulated environment, trainees will ask questions on how to interpret the data that they observe on the monitors and interpretation of clinical signs and symptoms on the manikin. 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. (1) According to Centers for Disease Control and Prevention (CDC), 223,619 deaths were attributed to diabetes in 2005. We guide the group to suggest fluid. (1) The assessment of a diabetic patient is best taught as a. His Heart Stopped On a Treadmill. Consider any precipitating factors for the development of DKA and involve the diabetes team in the patients care. The files are given in full in the web supplement (Appendix B, Supplemental Digital Content 2, https://links.lww.com/SIH/A2). In the meantime, you can perform some basic airway manoeuvres to help maintain the airway whilst awaiting senior input. An events progression section should include patient status changes, as well as a time/treatment continuum that incorporates if-then event progressions. If the patient is suspected to have sufferedsignificanttraumawith potential spinal involvement, perform ajaw-thrustrather than a head-tilt chin-lift manoeuvre: 2. As with the animated lecture, the simulation is strongly dependent on a focused case study. Environment & Manikin We then start the DKA state. See Appendix D, Supplemental Digital Content 4, https://links.lww.com/SIH/A4. A collection of data interpretation guides to help you learn how to interpret various laboratory and radiology investigations. tall tented T waves in hyperkalaemia). type 1 diabetes), Complete insulin insensitivity (e.g. 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. 2011;15:108109. Properly interpret a venous blood gas (VBG) and basic metabolic panel in a patient presenting with diabetic ketoacidosis. to maintaining your privacy and will not share your personal information without 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. 4. 1 Potassium losses occurring both before and during treatment of DKA must be replaced. A comprehensive collection of OSCE guides to common clinical procedures, including step-by-step images of key steps, video demonstrations and PDF mark schemes. A strong emphasis is placed on the focused, methodical examination of a specific medical problem and the decision-based treatment options available. In the first, the authors expanded the National Registrys Longitudinal EMT Attributes and Demographic (LEADS) study by resurveying 1,600 EMS workers about their sleepiness while at work. Observe and discuss the effects of therapy in a mathematically modeled physiological simulator. Place one hand on the patients forehead and the other under the chin. I assigned true to life parking codes, and added some extra parking for the superfluous US Express AI. This is particularly important for core cases and low-frequency, high-stakes procedures and encounters. A comprehensive collection of medical revision notes that cover a broad range of clinical topics. If you have any scenarios you would be willing to share with the simulation community, please forward them to me. Should any changes be made to the current management of their underlying condition(s)? 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)? A number of key modifiers are described that allow for the adjustment of case . This allows the learner group to make a psychological break from the patient and environment while beginning the reflection process. Does the patient need reviewing by a specialist? *=NdL/c2XSJn8:I Jb8'.8>N*[L .hxw6afq40DX3c~>abt'Q,8y(BZu(vKBTufIR. <>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 595.32 841.92] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> The student group should be encouraged to collaborate on management options and to perform skills. Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. Please write a single word answer in lowercase (this is an anti-spam measure). vD0 x@FFJ{m[ 3//Oh|JR7! Therefore, the same file is also sent to the participants before the session. Make sure thepatientsnotes,observationchartandprescriptionchartare easily accessible. 2008;6:278302. The students are in their basic science course. 2003;78:783788. If an obstruction is visible within the airway, use afingersweeporsuctionto remove it. A collection of communication skills guides, for common OSCE scenarios, including history taking and information giving. Calculate the patients current fluid balance using their fluid balance chart (e.g. 1. It may be necessary toexposethe patient during your assessment: remember to prioritise patient dignity and conservation of body heat. 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. 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. If the patient is conscious, sit themuprightas this can also help with oxygenation. Animated Lecture Target Learner Groups 2. The relationship between sleep, fatigue and patient and provider safety. 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. As the name says, this screen is used to graph and plot any parameter. This allows us to get in touch for more details if required. Wolters Kluwer Health 6. Antibiotics should be prescribed in keeping with local guidelines. confusion, coma), All critically unwell patients should have. 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. 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. MassBay EMS Program Integrates Training for Dogs, Heat Waves Are Killing More LA Homeless People. The students are in their first year. Just place the BR2_KDCA file into your addons scenery folder: C:\\Program Files\\Microsoft Games\\Microsoft Flight Simulator X\\Addon Scenery\\Scenery. Its best, however, to allow the student group to continue so theyre able to evaluate their decision-making processes during debriefing. modify the keyword list to augment your search. Groups of fewer than four students dont allow for optimal collaboration. After entering the environment, the student doesnt have the option of leaving the simulation until the learning objectives and performance measures are achieved. Before trainees arrival into the simulation area, the simulator is already preprogrammed for DKA. 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. This may produce better retention of the subject matter and help students adapt to emergency scenes before going into the field. 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].. Consider active re-warming techniques in patients with severe hypothermia. 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. Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. 1. The debriefing environment should be removed from the location where the simulation took place. The reason for inserting the airway upside down initially is to reduce the risk of pushing the tongue backwards and worsening airway obstruction. If the patientloses consciousnessand there areno signs of lifeon assessment, put out acrash callandcommence CPR. Physician working in the emergency department. Surgical dressings and imitation blood can support medical history. Published August 2015. 1 0 obj Despite this increased calorie intake, she noticed an unexplained 20 lbs weight loss. Diabetes (type 1 and type 2) in children and young people: diagnosis and management. 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. Healthcare Students' Psychological Well-Being in a Diabetic Ketoacidosis Simulation. 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. Keyword Highlighting In the meantime, you should re-assess and maintain the patients airway. 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. Its absolutely necessary to follow all immersive simulations with a positive, emotionally safe and nonjudgmental debriefing environment. >> Patterson PD, Weaver M, Frank R, et al. 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.