Blood sugar issues in the Type II diabetic will have a gradual onset, with diagnosis generally resulting from routine laboratory exams.(1). A pre-briefing session is conducted prior to the start of the simulation scenario. Twitter: http://www.twitter.com/geekymedics Using the arterial line, the scenario becomes much more dynamic. Diabetes UK with the Joint British Diabetes Societies Inpatient Care Group. Instructors should write a case study for the simulation before the session. This is a 25-year-old woman with a medical history of diabetes medicated with 40 units insulin per day. Debriefing
Antibiotics should be prescribed in keeping with local guidelines. Trainee will recognize the need for therapy and suggest an appropriate therapy in a simulated environment. We give the history of the patient to the trainees. (1) The assessment of a diabetic patient is best taught as a. Section snippets . Schneider Sarver PA, Senczakowicz EA, Slovensky BM. 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. 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. See ourintravenous cannulation guidefor more details. Does the patient need a referral toHDU/ICU? Prehosp Emerg Care. We guide the group to suggest fluid. A comprehensive collection of OSCE guides to common clinical procedures, including step-by-step images of key steps, video demonstrations and PDF mark schemes. - Severity 05:32 Indeed, it is the only thing that ever has.". Makeup may be used to depict gender, hollow eyes and cheeks, produce pallor or display bruises and scars. - 150+ PDF OSCE Checklists: https://geekymedics.com/pdf-osce-checklists/ Simulation Scenario for Anesthesia Providers Clark Obr, MD*, Anthony Mueller, MD . PDF Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. dq-]gX4
`L'u7myx) rpjf0z,.y`VMyx-&Ju`U0 The objective is to give as many visual and tactile cues concerning the patient condition and background as possible. Facebook: http://www.facebook.com/geekymedics If the patient has COPD and a history of CO2retention you should switch to aventuri maskas soon as possible andtitrate oxygen appropriately. - Introduction 00:00 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. a simulation training session designed to acquaint emergency medicine residents with the presentation and management of diabetic ketoacidosis (DKA) through the use of simulation. The choice of fluid type, rate of administration and volume should be tailored to the individual patient based upon their vital signs and electrolytes. This is particularly important for core . 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). cellulitis). 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. Consider active re-warming techniques in patients with severe hypothermia. 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). You may be trying to access this site from a secured browser on the server. 3. 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].. JEMS. On the basis of the feedback from the students, they indicated that they believed the small group sessions are better. Groups of more than seven may struggle with meeting objectives due to insufficient functional rolls. Re-assessthe patient using theABCDE approachto identify any changes in their clinical condition and assess the effectiveness of your previous interventions. 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. 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. LYqC+pJ&6X4onfBT#?=R}.p8N3+Dk,P4tIgWB}-L'=8;_G >,K#.e89XnG'B~NtR An oxygen mask is also demonstrated as an alternative device, as these early trainees had mostly not yet seen any of these devices. 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 . She Died the Next Day. 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. SimMan Nursing Scenarios Software - laerdal.com Marx JA, Hockberger RS, Walls RM. A chest X-ray should not delay the emergency management of DKA. Published August 2015. Diabetic Ketoacidosis (DKA) | Acute Management | ABCDE Creating a Simulation Experience to Promote Clinical Judgment Diabetic Ketoacidosis in the Obstetric Population: A Simulation Data is temporarily unavailable. In the meantime, you can perform some basic airway manoeuvres to help maintain the airway whilst awaiting senior input. A traditional classroom lecture format allows for student participation but limits the instructors ability to create realistic situations. 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). When erroneous treatment is delivered, the instructor can end the simulation. cloudy urine may indicate urinary tract infection). Refer to your local guidelines which should provide a clear protocol for the management of DKA. There are several causes of DKA, which we remember by the "five I's". Cureus 9(5): e1286. Trainee will get to know how professionals behave during management of a critically ill patient. - Site 01:12 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). Given such a small group, the students indicated that they feel more involved than they would with a larger group (eg, the whole class.) Adds true to life parking codes and extra parking for AI. This is a combination of the modified traditional lecture within scenario-based learning. Experience has shown that the more experienced the provider, the more detailed the environmental and manikin staging should be, because providers are trained to take in and interpret visual cues as indicators of patient status. Centers for Disease Control and Prevention. 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. Before trainees arrival into the simulation area, the simulator is already preprogrammed for DKA. If the patientloses consciousnessand there areno signs of lifeon assessment, put out acrash callandcommence CPR. 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. We believe it is important to have active, participatory learning by having conversations with the trainees in the form of questions and answers. Depending on scenario complexity, team dynamic and treatment modalities, this simulation may take 1020 minutes. See Table 4 for a suggested standardized script. 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. Keyword Highlighting
Stage 2: Emergency management of DKA and consideration of abnormal CTG. Available if the trainee asks: arterial blood gas, glucose, electrolytes, BUN and plasma osmolality (please see last section of Appendix B, Supplemental Digital Content 2, https://links.lww.com/SIH/A2, for values). Diabetic Ketoacidosis (DKA) Clinical Pathway Emergency Department | Children's Hospital of Philadelphia Refer to your local guidelines for further details. Ketones show 5.5. The file explaining the session is sent to instructors 1 week before the sessions. In this section, we have to help the trainee to institute definitive therapy based on the underlying biochemical abnormalities. It involves a facilitating instructor, a small learner group and conceptual aspects of environmental and manikin staging to provide sensory cues. Healthcare Students' Psychological Well-Being in a Diabetic Ketoacidosis Simulation. *=NdL/c2XSJn8:I Jb8'.8>N*[L .hxw6afq40DX3c~>abt'Q,8y(BZu(vKBTufIR. It may be necessary toexposethe patient during your assessment: remember to prioritise patient dignity and conservation of body heat. 2007. www.cdc.gov/diabetes/statistics/prev/national/. 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]). Medical Simulation Scenarios are text documents outlining the various details of a simulation - everything from patient simulator settings to debriefing notes. areas of lipohypertrophy) if it is unclear if the patient is diabetic. endobj
Open the patients airwayusing ahead-tiltchin-lift manoeuvre: 1. Animated Lecture
Discuss the patients current clinical condition with aseniorclinicianusing anSBARR style handover. If you have any scenarios you would be willing to share with the simulation community, please forward them . 2011;15:108109. They should introduce the student group to the environment, assign roles for each learner and guide the decision-making process. Advance the airway until it lies within the pharynx. DO NOT perform any examination or procedure on patients based purely on the content of these videos. Clearlydocument your ABCDE assessment, including history, examination, observations, investigations, interventions, and the patients response. - PSA Question Pack: https://geekymedics.com/psa-question-bank/ The student group should be encouraged to collaborate on management options and to perform skills. DKA can develop within 24 hours and is potentially life threatening, requiring prompt recognition and therapeutic intervention. 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. For diabetic assessment involving DKA, staging may include the use of a container with a small amount of acetone placed near the manikin because many students may not know what acetone smells like but will expect to smell something. Emergency medical services workLife characteristics contribute to clinically significant excessive daytime sleepiness. In an animated lecture, its important that the student group have an instructor so they can ask direct questions. 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. Both external and internal potassium balances are disturbed during the development and treatment of DKA. 2008;6:278302. Case-based education adds a real-world aspect to the learning environment. 3 0 obj
In some cases, normal saline with additional potassium is required to prevent overcorrection of serum potassium levels which would otherwise result in hypokalaemia. Catheterisethe patient to closelymonitor urine outputto guide fluid resuscitation and need for escalation. Competency-based medical education has seen widespread adoption in the field along with ongoing work in the areas of . DO NOT perform any examination or procedure on patients based purely on the content of these videos. 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. If the patient isunconsciousorunresponsive, start thebasic life support(BLS)algorithmas per resuscitation guidelines. 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. - Associated symptoms 03:04 The consequences (low blood pressure, high heart rate, central nervous system status, etc.) A well-staged environment allows for greater student buy-in. Clearly communicate how often would you like the patients observations relayed to you by other staff members. - Timing 03:23 Observe and discuss the effects of therapy in a mathematically modeled physiological simulator. For more information, please refer to our Privacy Policy. Seek senior helpif the patient shows no signs of improvement or if you have any concerns. Problems are addressed as they are identified and the patient is re-assessed regularly to monitor their response to treatment. Strategies of high-performing paramedic educational programs. PBL was introduced at our institution in 1995. The faculty member/course coordinator of Simulation Design We have been presenting Simulation Laboratory sessions to our preclinical medical students (first and second years). Example: If the provider immediately evaluates blood glucose, then the reading will display 45 mg/dL. KDCA, Ronald Reagan Washington National Airport, DC. A comprehensive collection of clinical examination OSCE guides that include step-by-step images of key steps, video demonstrations and PDF mark schemes. Inspect for evidence of infection on the skin (e.g. 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). Simulation Scenario. GRAPH. stream
DO NOT perform any examination or procedure on patients based purely on the content of these videos. Causes: Any situation arising in a diabetic that requires increased insulin without that demand being met can result in DKA. Please try after some time. The students have acquired all the applicable theoretical knowledge of the case during the previous multiday PBL sessions. For similar reasons, we do not believe a videotaped session will keep the students attention as much as these live simulator sessions. The researchers found that long shift hours (24hrs), working overtime and marital/relationship stress were strongly correlated. 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. A number of key modifiers are described that allow for the adjustment of case . We have 18 to 20 PBL groups for an hour each in the week after their PBL DKA session. 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. The main purpose of the simulation is to draw a line from the theoretical, boring biochemistry to the clinical manifestations. DOI 10.7759/cureus.1286. The relationship between sleep, fatigue and patient and provider safety. Use an effectiveSBARR handoverto communicate the key information effectively to other medical staff. Does the patient need reviewing by a specialist? The student group is given a short introduction into a closed simulation environment. 6. The reason for inserting the airway upside down initially is to reduce the risk of pushing the tongue backwards and worsening airway obstruction. 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. 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. Scenarios thesimtech . 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. TheABCDEapproach can be used to perform a systematic assessment of a critically unwell patient. Hypothermia may be present if the patient has been unconscious and exposed for some time. If the patient is conscious, sit themuprightas this can also help with oxygenation. #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! Simulation provides a safe environment where learning is enhanced through the deliberate practice of skills and controlled management of a variety of clinical encounters. As individuals with uncontrolled type I . The facilitator guides the group only when necessary. Introduceyourselfto thepatientincluding yournameandrole. 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. . Properly interpret a venous blood gas (VBG) and basic metabolic panel in a patient presenting with diabetic ketoacidosis. Introduceyourselfto whoever has requested a review of the patient andlistencarefullyto their handover. If the patient is confused you might be able to get a collateral history from staff or family members as appropriate. Using your thumbs, slightly open the mouth by downward displacement of the chin. Chapters: Your message has been successfully sent to your colleague. Initially, we required the students to write down the vital signs. 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. An animated lecture may be described as a pseudo-simulation environment. Use blankets to re-warm patients who are mild to moderately hypothermic. These are not learning objectives in this program. 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. 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. 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 As this is an interactive discussion session, any needed debriefing and/or explanation is given during the sessions. 2. If any obstruction is encountered, remove the tube and try the left nostril. Please write a single word answer in lowercase (this is an anti-spam measure). 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. Simulation of Diabetic Ketoacidosis for Cellular and Molecul Manikin staging can provide strong cues. 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. The files are given in full in the web supplement (Appendix B, Supplemental Digital Content 2, https://links.lww.com/SIH/A2). Diabetic ketoacidosis; Simulation training; Medical students. Diabetic Ketoacidosis in the Obstetric Population: A Simulation 34 - Diabetic Ketoacidosis in Pregnancy | Obgyn Key As this is a PBL session, the trainees are not given any references. 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). In this manner, the students have to apply their knowledge at the appropriate points during the progression of the scenario. 4. 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. As the name says, this screen is used to graph and plot any parameter. Stage 1: Initial assessment of acutely unwell pregnant woman and diagnosis of DKA. In other words, they do not have clinical experience, but they have clinical knowledge. The simulation session is also hosted as an interactive session. She tends to drink sugar containing fluids (soda) when she is thirsty, and she eats fast foods (cream-filled muffins) when she is hungry. Place one hand on the patients forehead and the other under the chin. However, we should not spend too much time on (not become distracted with) explaining unfamiliar monitors for the present trainees, such as central venous pressure or ETCO2 concentration. 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. - Radiation 02:45 Prehosp Emerg Care. - 2500+ OSCE Flashcards: https://geekymedics.com/osce-flashcards/ can be reemphasized, and the effects of fluid therapy demonstrated. 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.