See Table 4 for a suggested standardized script. Ketones show 5.5. When erroneous treatment is delivered, the instructor can end the simulation. If you have any scenarios you would be willing to share with the simulation community, please forward them to me. Interactive lecture/discussion with use of monitors that show the vital signs of the simulated patient on manikin. 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. We give the history of the patient to the trainees. TheABCDEapproach can be used to perform a systematic assessment of a critically unwell patient. JEMS. Observe and discuss the effects of therapy in a mathematically modeled physiological simulator. 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). 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). Revisit history taking to explore relevant medical history and identify any precipitating factors for DKA. Open the patients airwayusing ahead-tiltchin-lift manoeuvre: 1. These simulation sessions seem to work because the medical students do have prior knowledge. A number of key modifiers are described that allow for the adjustment of case . 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. Antibiotics should be prescribed in keeping with local guidelines. Administer oxygen to all critically unwell patients during yourinitialassessment. A comprehensive collection of medical revision notes that cover a broad range of clinical topics. (1), The assessment of a diabetic patient is best taught as a case-based simulation. 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. As the name says, this screen is used to graph and plot any parameter. (1) According to Centers for Disease Control and Prevention (CDC), 223,619 deaths were attributed to diabetes in 2005. GRAPH. Research Watch Box:Sleep, Fatigue & SafetyBy David Page, MS, NREMT-P The simulation experience serves to give substance to the theoretical words and concepts that the students encountered during the PBL sessions. 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. Cureus 9(5): e1286. Works with Traffic 2005, but . 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. A debriefing section with pre-established questions allows the instructor to review the main focus and performance measures with the student group. Inspect for evidence of infection on the skin (e.g. 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. 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. cloudy urine may indicate urinary tract infection). 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). SimMan Nursing Scenarios Software. Its important to train and educate students of prehospital care on key indicators of a diabetic emergency. Make sure thepatientsnotes,observationchartandprescriptionchartare easily accessible. The DKA simulation incorporates cue recognition, analysis of cues, generation of solutions, nursing interventions, and evaluation of outcomes, including effective communication and psychosocial concerns. Trainee will correlate the underlying pathophysiology with symptoms and signs as exhibited by the simulation session. 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. Weight, Height: Not given, normal appearing (as per simulator) but has lost 20 lbs recently. Review the patientscurrent medicationsand check any regular medications areprescribed appropriately. 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). In the meantime, you should re-assess and maintain the patients airway. It involves working through the following steps: Each stage of the ABCDE approach involvesclinicalassessment,investigationsandinterventions. Keywords: diabetic ketoacidosis, simulation, expertise, emergency medicine Introduction Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes mellitus, most . Properly interpret a venous blood gas (VBG) and basic metabolic panel in a patient presenting with diabetic ketoacidosis. We do not use passive visualizing materials such as videotapes or DVD other than vital signs shown on the monitors. Check out our NEW & IMPROVED quiz platform at geekyquiz.com, To be the first to know about our latest videos, subscribe to our YouTube channel . Example: If the provider immediately evaluates blood glucose, then the reading will display 45 mg/dL. Trainee will appropriately request assistance and use available resources. Diabetic Ketoacidosis (DKA) Clinical Pathway Emergency Department | Children's Hospital of Philadelphia 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. If any obstruction is encountered, remove the tube and try the left nostril. 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. Both external and internal potassium balances are disturbed during the development and treatment of DKA. - Over 3000 Free MCQs: https://geekyquiz.com/ Review the patients drug chart for medications which may cause a reduced level of consciousness (e.g. See ourintravenous cannulation guidefor more details. We also show them IV bags containing saline and Ringers lactate, as well as show them IV infusion sets. 3. 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). The learning objectives follow the American College of Graduate Medical Education (ACGME) Core Compentencies. The choice of fluid type, rate of administration and volume should be tailored to the individual patient based upon their vital signs and electrolytes. 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). A chest X-ray should not delay the emergency management of DKA. Development of simulation scenarios for an adolescent patient with diabetic ketoacidosis. 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. - 2500+ OSCE Flashcards: https://geekymedics.com/osce-flashcards/ Many of the preclinical students have never seen a real life clinical monitor or even an intravenous (IV) setup. >> Patterson PD, Weaver M, Frank R, et al. This is particularly important for core cases and low-frequency, high-stakes procedures and encounters. Conclusions This technical report describes the design and implementation of a simulation scenario on DKA for emergency medicine trainees. An events progression section should include patient status changes, as well as a time/treatment continuum that incorporates if-then event progressions. Management of diabetic ketoacidosis in adults. Ziv A, Wolpe PR, Small SD, et al. This simulation session therefore aims to make the case come alive, and show this known case in a clinical context. Wolters Kluwer Health #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! She is lethargic and slightly confused but can intermittently respond to questions. A collection of interactive medical and surgical clinical case scenarios to put your diagnostic and management skills to the test. - Examples 05:45 The trainees have had background knowledge of biochemistry because they had completed the PBL case. Acad Med. Urinary tract infections are a common DKA precipitant. Its best, however, to allow the student group to continue so theyre able to evaluate their decision-making processes during debriefing. Margolis GS, Romer GA, Fernandez AR, et al. 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)? 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. This guide provides an overview of the recognition and immediate management of diabetic ketoacidosis (DKA)using an ABCDE approach. The authors of the second study reported that poor sleep quality (60% of respondents) and extreme fatigue (55% of respondents) are independently associated with safety risks on the job. Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario Cureus. Given such a small group, the students indicated that they feel more involved than they would with a larger group (eg, the whole class.) may email you for journal alerts and information, but is committed Prehosp Emerg Care. This field is for validation purposes and should be left unchanged. There are several causes of DKA, which we remember by the "five I's". Inspect the urine currently in the catheter bag and note its appearance (e.g. cellulitis). to maintaining your privacy and will not share your personal information without The students are in their basic science course. 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. Therefore, we should not have to take much time on this issue, but we have to focus on the relationship between the biochemistry and clinical signs and symptoms by asking why the patient is dehydrated, why acidosis develops, why respiration is rapid and deep (Kussmaul) respirations, and what the rationale for inpatient treatment is. The normal reference range for fasting plasma glucose is 4.0 5.8 mmol/l. angioedema, rash) commence appropriate treatment as discussed in ouranaphylaxis guide. PA EMT Said COVID Patient Didnt Need to Go to the Hospital. The 60 minutes training time consists of four 15-minute sections divided as follows. COVID-19 Screening in the Pediatric Emergency Department. 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. Refer to your local guidelines for further details. Below is a collection of donated scenarios for you to use or modify. Trainee will be able to apply skills of communication with the simulated patient in a semiacute crisis to get sufficient important information for a final diagnosis. The Theory The following scenarios are available for download and are designed to meet your multi-disciplinary nursing needs. 1) Please read through this document as it will help you prepare for your upcoming simulation on DKA. 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. We used the Medical Education Technologies Inc. (METI) Human Patient Stimulator (HPS, METI Sarasoto, Fl). DKA can develop within 24 hours and is potentially life threatening, requiring prompt recognition and therapeutic intervention. % Initially, we used a blood pressure cuff to generate the blood pressure values. Because of the early stage (first year) of their medical careers, they have not yet seen vital sign monitoring, or patients, so these clinical aspects are introduced and emphasized. 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].. 2003;78:783788. 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. 2 The evaluation of potassium deficits is complicated by potassium exit from . By joining Cureus, you agree to our 3. 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. - Onset 01:48 Simulation in Healthcare4(4):232-236, Winter 2009. A comprehensive collection of clinical examination OSCE guides that include step-by-step images of key steps, video demonstrations and PDF mark schemes. DONT FORGET these 3 key components of the cardiovascular exam for your upcoming OSCEs Save this video to watch later and dont forget to follow Geeky Medics! His Wife Gave Him CPR. DKA can develop within 24 hours and is potentially life threatening, requiring prompt recognition and therapeutic intervention. As this is a PBL session, the trainees are not given any references. Finally, we summarize the course and give them time for questions. After initial insulin therapy has reduced plasma blood glucose levels (e.g. Trainee will describe the changes in vital signs, the major metabolic, fluid, and electrolyte. Therefore, we have to emphasize the importance of airway, breathing, and circulation in the very sick patient in any clinical setting. Please enable scripts and reload this page. Immersive simulations are mentally exhausting because they create an intense and stressful atmosphere requiring the learner to work outside their comfort zone. This typically involves the use of anon-rebreathe maskwith an oxygen flow rate of15L. If an obstruction is visible within the airway, use afingersweeporsuctionto remove it. 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.
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