dka simulation scenario dka simulation scenario

A blood glucose level may already be available from earlier investigations (e.g. Schneider Sarver PA, Senczakowicz EA, Slovensky BM. 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.) 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. insulin-dependent type 2 diabetes) Symptoms Typical symptoms of DKA include: Palpitations Nausea Vomiting Sweating Thirst Weight loss Leg cramps Clinical signs Typical clinical signs of DKA include: Tachycardia Hypotension COVID-19 Screening in the Pediatric Emergency Department. 2. 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)? The students have acquired all the applicable theoretical knowledge of the case during the previous multiday PBL sessions. Clearly communicate how often would you like the patients observations relayed to you by other staff members. An events progression section should include patient status changes, as well as a time/treatment continuum that incorporates if-then event progressions. In the meantime, you can perform some basic airway manoeuvres to help maintain the airway whilst awaiting senior input. This field is for validation purposes and should be left unchanged. (1), The assessment of a diabetic patient is best taught as a case-based simulation. They have had no clinical exposure or any clinical experience. NPAs are typically better tolerated in patients who are partly or fully conscious compared to oropharyngeal airways. *=NdL/c2XSJn8:I Jb8'.8>N*[L .hxw6afq40DX3c~>abt'Q,8y(BZu(vKBTufIR. % confusion, coma), All critically unwell patients should have. The students are in their first year. If the patient loses consciousness and there are no signs of life on assessment, put out a crash call and commence CPR. Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. The scenario would include an if-then algorithm. 3. Classroom Dynamics Acad Med. 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. 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. 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 . DKA can be caused by either: Absolute insulin deficiency (e.g. However, this turned out to be too slow, took too much time, and could not continuously demonstrate the direction of changes. 3. If the patient is conscious, sit themuprightas this can also help with oxygenation. Categories: Emergency Medicine, Medical Education Keywords: diabetic ketoacidosis, simulation, expertise, emergency medicine . Clearlydocument your ABCDE assessment, including history, examination, observations, investigations, interventions, and the patients response. Place one hand on the patients forehead and the other under the chin. Hypothermia may be present if the patient has been unconscious and exposed for some time. Manikin staging can provide strong cues. PBL was introduced at our institution in 1995. See ourCXR interpretation guidefor more details. Does the patient need a referral toHDU/ICU? In keeping with the case study, as a treatment marker is reached, the instructor should place emphasis on physiological, pharmacological, environmental and psychosocial issues. The addition of a fluid infusion containing some potassium allows insulin therapy to continue to suppress ketogenesis and normalise plasma pH whilst preventing the development of hypokalaemia. 2009;13:505511. See ourdocumentation guidesfor more details. We believe it is important to have active, participatory learning by having conversations with the trainees in the form of questions and answers. An oxygen mask is also demonstrated as an alternative device, as these early trainees had mostly not yet seen any of these devices. 1) Please read through this document as it will help you prepare for your upcoming simulation on DKA. A comprehensive collection of medical revision notes that cover a broad range of clinical topics. Consider active re-warming techniques in patients with severe hypothermia. 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. Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario If an infection is suspected, IV antibioticsshould be administered as soon as possible. From the Department of Anesthesiology, Pennsylvania State University College of Medicine, Hershey, PA. Dr. Murray is on the Speakers Bureau of METI, Sarasota, FL. <> Section snippets . 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. 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. Trainee will practice or observe good teamwork skills, both as a leader and a team player. Margolis GS, Romer GA, Fernandez AR, et al. Instagram: https://instagram.com/geekymedics <>>> Just place the BR2_KDCA file into your addons scenery folder: C:\\Program Files\\Microsoft Games\\Microsoft Flight Simulator X\\Addon Scenery\\Scenery. Airway adjuncts are often helpful and in some cases essential to maintain a patients airway. The student group is given a short introduction into a closed simulation environment. The students worked on the underlying physiology during a week long PBL session and are therefore familiar with the theoretical aspects of DKA. Seek senior helpif the patient shows no signs of improvement or if you have any concerns. The simulation session is also hosted as an interactive session. Each PBL case typically goes over 23 days, affording the students periods to find information for the case. Highlight selected keywords in the article text. Case-based education adds a real-world aspect to the learning environment. Given such a small group, the students indicated that they feel more involved than they would with a larger group (eg, the whole class.) Inspect theairwayfor obviousobstruction. We guide the group to suggest fluid. Lets discuss your options. Environment & Manikin It involves a facilitating instructor, a small learner group and conceptual aspects of environmental and manikin staging to provide sensory cues. cellulitis). Twitter: http://www.twitter.com/geekymedics However, this leads to confusion. This is a 25-year-old woman with a medical history of diabetes medicated with 40 units insulin per day. The teaching of diabetic assessment and management, like many other medical emergencies, lends itself well to case-based simulation. - 150+ PDF OSCE Checklists: https://geekymedics.com/pdf-osce-checklists/ Well done, youve now stabilised the patient and theyre doing much better. We then start the DKA state. See Appendix D, Supplemental Digital Content 4, https://links.lww.com/SIH/A4. See ourintravenous cannulation guidefor more details. Using SOCRATES in History Taking | OSCE | Communication Skills, Diabetic Ketoacidosis (DKA) | Acute Management | ABCDE. This allows us to get in touch for more details if required. She had developed nausea, extreme fatigue, mild disorientation, and blurred vision toward the end of the soccer match. TheABCDEapproach can be used to perform a systematic assessment of a critically unwell patient. 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. This video demonstrates how to use the SOCRATES acronym when taking a history of pain or other symptoms. 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! Refer to your local guidelines for further details. She tends to drink sugar containing fluids (soda) when she is thirsty, and she eats fast foods (cream-filled muffins) when she is hungry. The faculty member/course coordinator of Simulation Design Development of simulation scenarios for an adolescent patient with diabetic ketoacidosis. Urinary tract infections are a common DKA precipitant. Int J Evid Based Healthc. Extremities: mild cyanosis, no clubbing or edema (verbalized by instructors); pulses equal, and symmetrical (elucidated by trainees). Your message has been successfully sent to your colleague. The trainees have had background knowledge of biochemistry because they had completed the PBL case. stream As the name says, this screen is used to graph and plot any parameter. endobj 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. Measure the patients capillary blood glucose and ketone levels to confirm the diagnosis and guide the management of DKA. DY{Qb"(EgN$QI*%XN1F""0a5 1 Potassium losses occurring both before and during treatment of DKA must be replaced. A collection of interactive medical and surgical clinical case scenarios to put your diagnostic and management skills to the test. 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). 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. 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. Trigger 4, Pathway 1l of saline required over 1hour and insulin infusion need prescribing and making up in 50ml syringe. 2 The evaluation of potassium deficits is complicated by potassium exit from . Diabetic Ketoacidosis (DKA) Clinical Pathway Emergency Department | Children's Hospital of Philadelphia Adds true to life parking codes and extra parking for AI. The patient synopsis should include such standard aspects as age, sex, ethnicity, medical history, medications and allergies. Askhow the patient is feeling as this may provide some useful information about their current symptoms. - Associated symptoms 03:04 SimMan Nursing Scenarios Software. Given 6 to 8 back-to-back sessions, it is critical that every session starts and ends on time! Trainee will correlate the underlying pathophysiology with symptoms and signs as exhibited by the simulation session. Wolters Kluwer Health <>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 595.32 841.92] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> General: Moaning, asking what has happening to her. Supplemental digital content is available for this article. 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 . Inspect for evidence of self-injection sites (e.g. Many of the preclinical students have never seen a real life clinical monitor or even an intravenous (IV) setup. 6. 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. Research Watch Box:Sleep, Fatigue & SafetyBy David Page, MS, NREMT-P Standardized patient as the voice of the simulator (or the simulation operator may play this role). There are several causes of DKA, which we remember by the "five I's". type 1 diabetes), Complete insulin insensitivity (e.g. Physician working in the emergency department. 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). During an immersive simulation, its imperative the group uses critical-thinking skills and group collaboration independently. 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). modify the keyword list to augment your search. This is particularly important for core . For example, you could develop a diabetic scenario in which the prehospital provider encounters an altered patient with incomprehensible speech. A collection of free medical student quizzes to put your medical and surgical knowledge to the test! You might also be interested in our awesome bank of 700+ OSCE Stations. 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. Join the Geeky Medics community: We also show them IV bags containing saline and Ringers lactate, as well as show them IV infusion sets. endobj Therefore, the same file is also sent to the participants before the session. Simulation in Healthcare4(4):232-236, Winter 2009. After initial insulin therapy has reduced plasma blood glucose levels (e.g. Emergency medical services workLife characteristics contribute to clinically significant excessive daytime sleepiness. insulin-dependent type 2 diabetes), Altered consciousness (e.g. A debriefing section with pre-established questions allows the instructor to review the main focus and performance measures with the student group. Make sure tore-assessthe patient after anyintervention. The facilitator guides the group only when necessary. Tilt the forehead back whilst lifting the chin forwards to extend the neck. PA EMT Said COVID Patient Didnt Need to Go to the Hospital. Please try after some time. Diabetes UK with the Joint British Diabetes Societies Inpatient Care Group. Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. 4. 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 . The diabetes with DKA clinical pathway is a detailed plan of the course of care for pediatric patients seen in the emergency department with diabetic ketoacidosis. - Medical Finals Question Pack: https://geekymedics.com/medical-student-finals-questions/ Some error has occurred while processing your request. #geekymedics #fyp #fypviral #studytok #medicalstudentuk #medtok #studytips #studytipsforstudents #medstudentuk #premed #medschoolfinals, Cardiovascular History Tips - DON'T FORGET these 3 things . 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. doi: 10.7759/cureus.1286. 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. 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. At the end of the previous section, the trainee can make the diagnosis of DKA but has not confirmed it yet. . 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. 2. - Onset 01:48 As with the animated lecture, the simulation is strongly dependent on a focused case study. Interactive lecture/discussion with use of monitors that show the vital signs of the simulated patient on manikin. 2. - Over 3000 Free MCQs: https://geekyquiz.com/ His Heart Stopped On a Treadmill. We try to provide sufficient realism.. Ask for anotherclinicalmemberofstafftoassistyou if possible. Re-assessthe patient using theABCDE approachto identify any changes in their clinical condition and assess the effectiveness of your previous interventions. 2. DO NOT perform any examination or procedure on patients based purely on the content of these videos. Stage 3: Ongoing management and monitoring of DKA 1 hour after initiation of treatment. 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. Make sure to re-assess the patient after any intervention. In the final 10 minutes, we show how the patient has a good recovery after fluid replacement. 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. Privacy Policy Make sure thepatientsnotes,observationchartandprescriptionchartare easily accessible. The main goal is to establish a safe learning environment for the learner [9, 13 . Trainee will appropriately request assistance and use available resources. 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. Simulation Scenario. oral fluids, intravenous fluids, urine output, drain output, stool output, vomiting) to inform resuscitation efforts. can be reemphasized, and the effects of fluid therapy demonstrated. A comprehensive collection of OSCE guides to common clinical procedures, including step-by-step images of key steps, video demonstrations and PDF mark schemes. 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. Marx JA, Hockberger RS, Walls RM. 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.