can be reemphasized, and the effects of fluid therapy demonstrated. Review the patientscurrent medicationsand check any regular medications areprescribed appropriately. 4. 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. Margolis GS, Romer GA, Fernandez AR, et al. Alert a senior immediately if you have any concerns about the consciousness level of a patient. cellulitis). DKA can develop within 24 hours and is potentially life threatening, requiring prompt recognition and therapeutic intervention. Its important to train and educate students of prehospital care on key indicators of a diabetic emergency. Make sure thepatientsnotes,observationchartandprescriptionchartare easily accessible. Initially, we required the students to write down the vital signs. Capillary refill timemay be prolonged if the patient is hypovolaemic. 3. "Never doubt that a small group of thoughtful, committed citizens can change the world. 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. 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. Open the patients airwayusing ahead-tiltchin-lift manoeuvre: 1. Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario Cureus. See ourhistory taking guidesfor more details. Example: If the provider immediately evaluates blood glucose, then the reading will display 45 mg/dL. 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. 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. stream Its absolutely necessary to follow all immersive simulations with a positive, emotionally safe and nonjudgmental debriefing environment. 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. Instructors should write a case study for the simulation before the session. Below is a collection of donated scenarios for you to use or modify. Instead, instructors should combine case- and simulation-based techniques when teaching diabetic assessment. A fixed-rate intravenous insulin infusion should be commenced initially to suppress ketogenesis, reduce blood glucose levels and address electrolyte disturbances. 2017 May 29;9(5):e1286. Using SOCRATES in History Taking | OSCE | Communication Skills, Diabetic Ketoacidosis (DKA) | Acute Management | ABCDE. Conclusion We are looking for declaration of DKA and request for pathway. Inspect the urine currently in the catheter bag and note its appearance (e.g. The Theory Available from: [, NICE guidelines. Stage 3: Ongoing management and monitoring of DKA 1 hour after initiation of treatment. Twitter: http://www.twitter.com/geekymedics We guide the group to suggest fluid. Over the years, some groups happened to have the simulation session before the completion of the theoretical PBL session. The lecture allows for understanding of concepts prior to action, and instructor feedback is immediate. Re-assessthe patient using theABCDE approachto identify any changes in their clinical condition and assess the effectiveness of your previous interventions. The main goal is to establish a safe learning environment for the learner [9, 13 . Performing an ECG should not delay the emergency management of DKA. Cureus 9(5): e1286. 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. See our blood glucose measurement guide for more details. The use of case-based simulation, although more complicated and time consuming for the instructor, immerses the students in the subject matter. A collection of anatomy notes covering the key anatomy concepts that medical students need to learn. The student group is given a short introduction into a closed simulation environment. 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). Simulation Scenario for Anesthesia Providers Clark Obr, MD*, Anthony Mueller, MD *Corresponding author: clark-obr@uiowa.edu Abstract Introduction: This simulation on diabetic ketoacidosis (DKA) in . Physician working in the emergency department. Typically potassium levels should be maintained between 4.0 5.5 mmol/L and close monitoring is required. Trainee will be respectful to others and their views during the PBL session. (1), The assessment of a diabetic patient is best taught as a case-based simulation. It should only be inserted in unconscious patients as it is otherwise poorly tolerated and may induce gagging and aspiration. Environment & Manikin - 2500+ OSCE Flashcards: https://geekymedics.com/osce-flashcards/ If the patient loses consciousness and there are no signs of life on assessment, put out a crash call and commence CPR. 3. % She had developed nausea, extreme fatigue, mild disorientation, and blurred vision toward the end of the soccer match. - Geeky Medics OSCE App: https://geekymedics.com/geeky-medics-app/ Manikin staging can provide strong cues. This allows the learner group to make a psychological break from the patient and environment while beginning the reflection process. Therefore, the same file is also sent to the participants before the session. A number of key modifiers are described that allow for the adjustment of case . However, this turned out to be too slow, took too much time, and could not continuously demonstrate the direction of changes. Some error has occurred while processing your request. Standardized patient as the voice of the simulator (or the simulation operator may play this role). See ourCXR interpretation guidefor more details. 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. DO NOT perform any examination or procedure on patients based purely on the content of these videos. Trigger 4, Pathway 1l of saline required over 1hour and insulin infusion need prescribing and making up in 50ml syringe. Animated Lecture The patient synopsis should include such standard aspects as age, sex, ethnicity, medical history, medications and allergies. 2. This session provides additional clinical support material for the theoretical PBL session. Using your thumbs, slightly open the mouth by downward displacement of the chin. your express consent. 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. Patients with DKA require fluid resuscitation to restore circulatory volume, clear ketones, correct electrolyte abnormalities and increase renal perfusion. Trainee will describe the changes in vital signs, the major metabolic, fluid, and electrolyte. Case-based simulation should include two to three broad-focus objectives, as well as 1020 specific performance measures that the student should accomplish. Its best, however, to allow the student group to continue so theyre able to evaluate their decision-making processes during debriefing. Use an effectiveSBARR handoverto communicate the key information effectively to other medical staff. It involves a facilitating instructor, a small learner group and conceptual aspects of environmental and manikin staging to provide sensory cues. - Severity 05:32 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. Properly interpret a venous blood gas (VBG) and basic metabolic panel in a patient presenting with diabetic ketoacidosis. 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). 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. 2 0 obj SimMan Nursing Scenarios Software. Check the patency of the patients right nostril and if required (depending on the model of NPA) insert a safety pin through the flange of the NPA. 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. The instructor can also gauge the direction the debriefing session should follow or be alerted to possible problems or conflicts in treatment opinions. 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]). See ourdocumentation guidesfor more details. We demonstrate to the trainees the significant changes on the monitors by asking them to point out any changes on the simulator (clinical examination) and the vital signs (monitor parameters). 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! If you have any scenarios you would be willing to share with the simulation community, please forward them to me. 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. Nandate, Koichiro MD, PhD; Abola, Ramon MD; Murray, W Bosseau MB; Whitfield, Carol PhD; Lang, Charles PhD; Sinz, Elizabeth MD. Please write a single word answer in lowercase (this is an anti-spam measure). The questionnaire for the assessment of the session is given in full in the web-based supplement (Appendix A, Supplemental Digital Content 1, https://links.lww.com/SIH/A1). Diabetes (type 1 and type 2) in children and young people: diagnosis and management. diagnosis of DKA Trigger 3, ABG show acidosis and high BM and normal potassium. Debriefing 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. Trainee will get to know how professionals behave during management of a critically ill patient. A strong emphasis is placed on the focused, methodical examination of a specific medical problem and the decision-based treatment options available. Causes: Any situation arising in a diabetic that requires increased insulin without that demand being met can result in DKA. This field is for validation purposes and should be left unchanged. 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). - Onset 01:48 endobj The instructor should have visual access via one-way windows or cameras. Catheterisethe patient to closelymonitor urine outputto guide fluid resuscitation and need for escalation. insulin-dependent type 2 diabetes), Altered consciousness (e.g. 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. The scenario would include an if-then algorithm. If the patient has COPD and a history of CO2retention you should switch to aventuri maskas soon as possible andtitrate oxygen appropriately. Mosby:Philadelphia. Therefore, we have to emphasize the importance of airway, breathing, and circulation in the very sick patient in any clinical setting. 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. . J Nurs Educ. 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. See ourfluid prescribing guidefor more details onresuscitation fluids. 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 . Please note that by doing so you agree to be added to our monthly email newsletter distribution list. 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. Reduced urine output (oliguria) is typically defined as less than 0.5ml/kg/hour in an adult. A patient with Type I diabetes will often have symptoms related to blood sugar imbalances that appear abruptly with polydipsia, polyuria, polyphagia and rapid weight loss. The DKA simulation incorporates cue recognition, analysis of cues, generation of solutions, nursing interventions, and evaluation of outcomes, including effective communication and psychosocial concerns. For similar reasons, we do not believe a videotaped session will keep the students attention as much as these live simulator sessions. If fever is present, make sure to consider co-existing infection. If the patient is suspected to have sufferedsignificanttraumawith potential spinal involvement, perform ajaw-thrustrather than a head-tilt chin-lift manoeuvre: 2. Your message has been successfully sent to your colleague. The researchers found that long shift hours (24hrs), working overtime and marital/relationship stress were strongly correlated. The Pratcice Trainee will improve their understanding of clinical practice through reflective assessment of actual cases during the prior PBL sessions. His Heart Stopped On a Treadmill. Airway adjuncts are often helpful and in some cases essential to maintain a patients airway. }HyEf,#$/JSRU9+CF6k\'/z+i`[ 5JudK*Zly^g%[jCK)H[)Y=Qp0/r9o9HW_zF}pTzI~'|q.~:=Y T 9w! Laschinger S, Medves J, Pulling C, et al. Extremities: mild cyanosis, no clubbing or edema (verbalized by instructors); pulses equal, and symmetrical (elucidated by trainees). Deteriorationshould be recognised quickly and acted upon immediately. Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario 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). Hypothermia may be present if the patient has been unconscious and exposed for some time. A comprehensive collection of medical revision notes that cover a broad range of clinical topics. Consider any precipitating factors for the development of DKA and involve the diabetes team in the patients care. reduced air entry, coarse crackles) to screen for evidence of pneumonia. A blood glucose level may already be available from earlier investigations (e.g. 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. We now provide the students with handouts of the data to save time and provide consistency. She tends to drink sugar containing fluids (soda) when she is thirsty, and she eats fast foods (cream-filled muffins) when she is hungry. We have spent many hours debating whether the small group format was a waste of time. 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 Search for Similar Articles Keyword Highlighting Groups of more than seven may struggle with meeting objectives due to insufficient functional rolls. It involves working through the following steps: Each stage of the ABCDE approach involvesclinicalassessment,investigationsandinterventions. Marx JA, Hockberger RS, Walls RM. (1) The assessment of a diabetic patient is best taught as a. Several environments may be suitable for your classroom. The choice of fluid type, rate of administration and volume should be tailored to the individual patient based upon their vital signs and electrolytes. Just place the BR2_KDCA file into your addons scenery folder: C:\\Program Files\\Microsoft Games\\Microsoft Flight Simulator X\\Addon Scenery\\Scenery. Please enable scripts and reload this page. Simulation Scenario for Anesthesia Providers Clark Obr, MD*, Anthony Mueller, MD . Clearly communicate how often would you like the patients observations relayed to you by other staff members. Acad Med. tall tented T waves in hyperkalaemia). The simulation session is also hosted as an interactive session. Despite this increased calorie intake, she noticed an unexplained 20 lbs weight loss. Introduceyourselfto whoever has requested a review of the patient andlistencarefullyto their handover. Stage 2: Emergency management of DKA and consideration of abnormal CTG. 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. 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. Subscribe to our newsletter to be the first to know about our latest content: https://geekymedics.com/newsletter/ 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 students are in their first year. 6. There are just a few more things to do. Assess the patients pulse and blood pressure: Inspect the patient from the end of the bed: they may appear drowsy, confused and/or clammy/pale. 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. You can check out our guide to using SOCRATES here: https://geekymedics.com/the-socrates-acronym-in-history-taking/ <>>> The main purpose of the simulation is to draw a line from the theoretical, boring biochemistry to the clinical manifestations. PBL was introduced at our institution in 1995. 1-6. The students are in their first year. Well done, youve now stabilised the patient and theyre doing much better. Please try again soon. Clearlydocument your ABCDE assessment, including history, examination, observations, investigations, interventions, and the patients response. Immersive simulations are mentally exhausting because they create an intense and stressful atmosphere requiring the learner to work outside their comfort zone. 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. 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. Urinary tract infections are a common DKA precipitant. Place one hand on the patients forehead and the other under the chin. During an immersive simulation, its imperative the group uses critical-thinking skills and group collaboration independently. In an animated lecture, its important that the student group have an instructor so they can ask direct questions. 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).

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