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If the patientloses consciousnessand there areno signs of lifeon assessment, put out acrash callandcommence CPR. A collection of data interpretation guides to help you learn how to interpret various laboratory and radiology investigations. Some error has occurred while processing your request. The teaching of diabetic assessment and management, like many other medical emergencies, lends itself well to case-based simulation. Facebook: http://www.facebook.com/geekymedics 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. Airway adjuncts are often helpful and in some cases essential to maintain a patients airway. type 1 diabetes), Complete insulin insensitivity (e.g. Advance the airway until it lies within the pharynx. Search for Similar Articles The students are in their first year. 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. Environment & Manikin A GCS of 8 or below warrants urgent expert help from an anaesthetist. Emergency medical services workLife characteristics contribute to clinically significant excessive daytime sleepiness. DKA can develop within 24 hours and is potentially life threatening, requiring prompt recognition and therapeutic intervention. 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. As this is a PBL session, the trainees are not given any references. Many of the preclinical students have never seen a real life clinical monitor or even an intravenous (IV) setup. A number of key modifiers are described that allow for the adjustment of case . 2011;15:108109. This is particularly important for core cases and low-frequency, high-stakes procedures and encounters. During an immersive simulation, its imperative the group uses critical-thinking skills and group collaboration independently. Much time was wasted explaining why it did not matter. After entering the environment, the student doesnt have the option of leaving the simulation until the learning objectives and performance measures are achieved. We believe it is important to have active, participatory learning by having conversations with the trainees in the form of questions and answers. Open the patients airwayusing ahead-tiltchin-lift manoeuvre: 1. 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. 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. 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. 1. Acad Med. x]o ]?9kgq~:)?hE )R6!up}\<8||\]}Y~;xp~yQ$#4~djX&{n_m-]^K1/~/AD Hv 99evs,;8}8zwnhFxV.kf-V^? Clinical Simulation in Nursing, Volume 39, 2020, pp. Glycosuria leads to urinary losses of potassium through osmotic diuresis. Diabetes (type 1 and type 2) in children and young people: diagnosis and management. J Nurs Educ. 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. The students are in their basic science course. See ourfluid prescribing guidefor more details onresuscitation fluids. If the patient loses consciousness and there are no signs of life on assessment, put out a crash call and commence CPR. 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. 2. A nasopharyngeal airway is a soft plastic tube with a bevel at one end and a flange at the other. This guide provides an overview of the recognition and immediate management of diabetic ketoacidosis (DKA)using an ABCDE approach. We have been presenting Simulation Laboratory sessions to our preclinical medical students (first and second years). 3. Review the patientscurrent medicationsand check any regular medications areprescribed appropriately. Stage 3: Ongoing management and monitoring of DKA 1 hour after initiation of treatment. 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. From the Department of Anesthesiology, Pennsylvania State University College of Medicine, Hershey, PA. Dr. Murray is on the Speakers Bureau of METI, Sarasota, FL. Groups of fewer than four students dont allow for optimal collaboration. As a next step, we will let one of the trainees talk to the patient, and prompt to ask medical questions such as previous medical issues or recent drug use for them to practice asking questions to generate a differential diagnosis (in this case, other causes for confusion). Typically potassium levels should be maintained between 4.0 5.5 mmol/L and close monitoring is required. areas of lipohypertrophy) if it is unclear if the patient is diabetic. If the patient has clinical signs ofanaphylaxis(e.g. Use washable, non-toxic paints to imitate various body emissions. It involves a facilitating instructor, a small learner group and conceptual aspects of environmental and manikin staging to provide sensory cues. 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). Research Watch Box:Sleep, Fatigue & SafetyBy David Page, MS, NREMT-P A collection of free medical student quizzes to put your medical and surgical knowledge to the test! His Heart Stopped On a Treadmill. 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 file explaining the session is sent to instructors 1 week before the sessions. 2010;49:578586. 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 . Prehosp Emerg Care. Initially, we required the students to write down the vital signs. Refer to your local guidelines for further details. 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. Well done, youve now stabilised the patient and theyre doing much better. 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). Medical Simulation Scenarios are text documents outlining the various details of a simulation - everything from patient simulator settings to debriefing notes. In other words, they do not have clinical experience, but they have clinical knowledge. For example, you could develop a diabetic scenario in which the prehospital provider encounters an altered patient with incomprehensible speech. The students have acquired all the applicable theoretical knowledge of the case during the previous multiday PBL sessions. A fixed-rate intravenous insulin infusion should be commenced initially to suppress ketogenesis, reduce blood glucose levels and address electrolyte disturbances. vD0 x@FFJ{m[ 3//Oh|JR7! 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. In this section, we have to help the trainee to institute definitive therapy based on the underlying biochemical abnormalities. Inspect the urine currently in the catheter bag and note its appearance (e.g. Deteriorationshould be recognised quickly and acted upon immediately. Yes: if the patient can talk, their airway is patent and you can move on to the assessment of breathing. In this case scenario, dehydration is one of the most serious immediate issues. These are not learning objectives in this program. *=NdL/c2XSJn8:I Jb8'.8>N*[L .hxw6afq40DX3c~>abt'Q,8y(BZu(vKBTufIR. 4. 2008;6:278302. Using the arterial line, the scenario becomes much more dynamic. 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. The relationship between sleep, fatigue and patient and provider safety. In keeping with the case study, as a treatment marker is reached, the instructor should place emphasis on physiological, pharmacological, environmental and psychosocial issues. Centers for Disease Control and Prevention. Schneider Sarver PA, Senczakowicz EA, Slovensky BM. For instance, one of the questions is: Why is Tiffany dehydrated? There are several possible reasons and mechanisms (as outlined in Appendix B, fourth 15 minutes, Supplemental Digital Content 2, https://links.lww.com/SIH/A2), which the students can mention. Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario Cureus. This session provides additional clinical support material for the theoretical PBL session. The consequences (low blood pressure, high heart rate, central nervous system status, etc.) - 700+ OSCE Stations: https://geekymedics.com/osce-stations/ 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. GRAPH. - PSA Question Pack: https://geekymedics.com/psa-question-bank/ Example: If the provider immediately evaluates blood glucose, then the reading will display 45 mg/dL. Trainee will learn to collaborate with peers to decide on appropriate interventions, tests, and therapy. It involves working through the following steps: Each stage of the ABCDE approach involvesclinicalassessment,investigationsandinterventions. However, this turned out to be too slow, took too much time, and could not continuously demonstrate the direction of changes. >> Patterson PD, Weaver M, Frank R, et al. Administer oxygen to all critically unwell patients during yourinitialassessment. Geeky Medics accepts no liability for loss of any kind incurred as a result of reliance upon the information provided in this video. In the meantime, you should re-assess and maintain the patients airway. Measure the patients capillary blood glucose and ketone levels to confirm the diagnosis and guide the management of DKA. Manikin staging can provide strong cues. 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. LYqC+pJ&6X4onfBT#?=R}.p8N3+Dk,P4tIgWB}-L'=8;_G >,K#.e89XnG'B~NtR 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. 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. Terms of Use. 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). Trainee will increase knowledge of professional behaviors during the simulation. Please try after some time. 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. 5. Seek senior helpif the patient shows no signs of improvement or if you have any concerns. Trainee will get to know how professionals behave during management of a critically ill patient. This is particularly important for core . The trainees have had background knowledge of biochemistry because they had completed the PBL case. Note that if-thens must also include negative patient outcomes for when the provider doesnt take appropriate action. The reason for inserting the airway upside down initially is to reduce the risk of pushing the tongue backwards and worsening airway obstruction. Keywords: diabetic ketoacidosis, simulation, expertise, emergency medicine Introduction Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes mellitus, most . 2. Feel the slow and tardy pulse, we consider these PBL sessions as an example of a Look here, see this use of a full human simulator in the hierarchy of learning strategies with a full human simulator (Table 1). 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. cloudy urine may indicate urinary tract infection). A traditional classroom lecture format allows for student participation but limits the instructors ability to create realistic situations. The instructor should have visual access via one-way windows or cameras. General: Moaning, asking what has happening to her. The lecture allows for understanding of concepts prior to action, and instructor feedback is immediate. Consider active re-warming techniques in patients with severe hypothermia. Use an effectiveSBARR handoverto communicate the key information effectively to other medical staff. 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)? If any obstruction is encountered, remove the tube and try the left nostril. 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. Diabetic ketoacidosis; Simulation training; Medical students. Instead, instructors should combine case- and simulation-based techniques when teaching diabetic assessment. The required potassium replacement varies greatly. Healthcare Students' Psychological Well-Being in a Diabetic Ketoacidosis Simulation. Clearlydocument your ABCDE assessment, including history, examination, observations, investigations, interventions, and the patients response. Antibiotics should be prescribed in keeping with local guidelines. DOWNLOAD Diabetic Ketoacidosis By the end of this scenario, the learner will be able to: 1. One of the key differences with the immersive simulation is that the instructor is absent from the simulation environment. 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. Stage 1: Initial assessment of acutely unwell pregnant woman and diagnosis of DKA. These simulation sessions seem to work because the medical students do have prior knowledge. In the final 10 minutes, we show how the patient has a good recovery after fluid replacement. They have had no clinical exposure or any clinical experience. We also show them IV bags containing saline and Ringers lactate, as well as show them IV infusion sets. Chapters: 4 0 obj His Wife Gave Him CPR. 1-6. - Onset 01:48 Rosens Emergency Medicine: Concepts and Clinical Practice. We give the history of the patient to the trainees. 6. 3 0 obj Join the Geeky Medics community: and Makeup may be used to depict gender, hollow eyes and cheeks, produce pallor or display bruises and scars. 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. Subscribe to our newsletter to be the first to know about our latest content: https://geekymedics.com/newsletter/ She had developed nausea, extreme fatigue, mild disorientation, and blurred vision toward the end of the soccer match. 2011;15:108109. 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. Trainee will improve their understanding of clinical practice through reflective assessment of actual cases during the prior PBL sessions. The faculty member/course coordinator of Simulation Design This environment doesnt allow the student to identify presentation cues, be active in their own learning or apply their skills without endangering the lives of patients.(2). Immersive simulations are mentally exhausting because they create an intense and stressful atmosphere requiring the learner to work outside their comfort zone. stream If the patient has COPD and a history of CO2retention you should switch to aventuri maskas soon as possible andtitrate oxygen appropriately. - Timing 03:23 An animated lecture may be described as a pseudo-simulation environment. Please note that by doing so you agree to be added to our monthly email newsletter distribution list. You can check out our guide to using SOCRATES here: https://geekymedics.com/the-socrates-acronym-in-history-taking/ On the basis of the feedback from the students, they indicated that they believed the small group sessions are better. Lets discuss your options. If fever is present, make sure to consider co-existing infection. Stage 2: Emergency management of DKA and consideration of abnormal CTG. tall tented T waves in hyperkalaemia). unilateral coarse crackles may be present if the patient has pneumonia which may have been the precipitant for DKA). An integral part of a PBL session is for trainees to be able to navigate through huge literature bases. Should any changes be made to the current management of their underlying condition(s)? After the first voluntary session in 2006, feedback from the medical students indicated that they would like to receive this handout. Nandate, Koichiro MD, PhD; Abola, Ramon MD; Murray, W Bosseau MB; Whitfield, Carol PhD; Lang, Charles PhD; Sinz, Elizabeth MD. cellulitis). can be reemphasized, and the effects of fluid therapy demonstrated. 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. . The files are given in full in the web supplement (Appendix B, Supplemental Digital Content 2, https://links.lww.com/SIH/A2). (1) According to Centers for Disease Control and Prevention (CDC), 223,619 deaths were attributed to diabetes in 2005. - 150+ PDF OSCE Checklists: https://geekymedics.com/pdf-osce-checklists/ The instructors role is to facilitate active learning through a combination of learning styles. Conclusions This technical report describes the design and implementation of a simulation scenario on DKA for emergency medicine trainees. Given 6 to 8 back-to-back sessions, it is critical that every session starts and ends on time! An hour was . Animated Lecture Trainee will describe the changes in vital signs, the major metabolic, fluid, and electrolyte. 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 Two abstracts related to sleepiness in the EMS workforce were presented at the National Association of EMS Physicians symposium in January. 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.) Open the patients mouth to ensure there is no foreign material that may be pushed into the larynx. 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. Does the patient need reviewing by a specialist? 3. Recognize the signs and symptoms of a patient presenting with diabetic ketoacidosis. Ketones show 5.5. See ourintravenous cannulation guidefor more details. 2. DKA can be caused by either: Absolute insulin deficiency (e.g. Geeky Medics accepts no liability for loss of any kind incurred as a result of reliance upon the information provided in this video. Instagram: https://instagram.com/geekymedics Over the years, some groups happened to have the simulation session before the completion of the theoretical PBL session. 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