Trigger 4, Pathway 1l of saline required over 1hour and insulin infusion need prescribing and making up in 50ml syringe. Please try again soon. 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.) See ourCXR interpretation guidefor more details. 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. A collection of free medical student quizzes to put your medical and surgical knowledge to the test! Laschinger S, Medves J, Pulling C, et al. The Theory 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. - 2500+ OSCE Flashcards: https://geekymedics.com/osce-flashcards/ The Theory Geeky Medics accepts no liability for loss of any kind incurred as a result of reliance upon the information provided in this video. - Radiation 02:45 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. 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). 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. Trainee will recognize and interpret the clinical signs and symptoms and the typical history of a patient with DKA, as well as understand the major causative factors of DKA. 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). 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. 1. #geekymedics #fyp #fypviral #studytok #medicalstudentuk #medtok #studytips #studytipsforstudents #medstudentuk #premed #medschoolfinals, Cardiovascular History Tips - DON'T FORGET these 3 things . It may be necessary toexposethe patient during your assessment: remember to prioritise patient dignity and conservation of body heat. 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 . 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 DKA simulation incorporates cue recognition, analysis of cues, generation of solutions, nursing interventions, and evaluation of outcomes, including effective communication and psychosocial concerns. If fever is present, make sure to consider co-existing infection. The normal reference range for fasting plasma glucose is 4.0 5.8 mmol/l. confusion, coma), All critically unwell patients should have. Each clinical case scenario allows you to work through history taking, investigations, diagnosis and management. There are just a few more things to do. SimMan Nursing Scenarios Software. a simulation training session designed to acquaint emergency medicine residents with the presentation and management of diabetic ketoacidosis (DKA) through the use of simulation. You may need further help or advice from a senior staff member and you shouldnot delay seeking help if you have concerns about your patient. 2009;13:505511. She was taken to the Emergency Department from her soccer game because she complained of nausea, extreme fatigue, mild disorientation, and blurred vision toward the end of the soccer match. 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. Capillary refill timemay be prolonged if the patient is hypovolaemic. Terms of Use. - Over 3000 Free MCQs: https://geekyquiz.com/ For similar reasons, we do not believe a videotaped session will keep the students attention as much as these live simulator sessions. 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. A collection of interactive medical and surgical clinical case scenarios to put your diagnostic and management skills to the test. Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario Introduceyourselfto whoever has requested a review of the patient andlistencarefullyto their handover. See ourdocumentation guidesfor more details. If the patient is suspected to have sufferedsignificanttraumawith potential spinal involvement, perform ajaw-thrustrather than a head-tilt chin-lift manoeuvre: 2. This allows the learner group to make a psychological break from the patient and environment while beginning the reflection process. To read Pages full Research Review column, visit www.jems.com/patient-care. 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. 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. If the patient has clinical signs ofanaphylaxis(e.g. Initially, we had a white board available, but the temptation (and habits) were just too strong, and the simulator sessions tended to become one way lectures, rather than an interactive, 2 way discussion.. You may be trying to access this site from a secured browser on the server. Re-assessthe patient using theABCDE approachto identify any changes in their clinical condition and assess the effectiveness of your previous interventions. LYqC+pJ&6X4onfBT#?=R}.p8N3+Dk,P4tIgWB}-L'=8;_G >,K#.e89XnG'B~NtR Refer to your local guidelines for further details. Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario. - PDF areas of lipohypertrophy) if it is unclear if the patient is diabetic. - Medical Finals Question Pack: https://geekymedics.com/medical-student-finals-questions/ DY{Qb"(EgN$QI*%XN1F""0a5 tall tented T waves in hyperkalaemia). Trainee will improve their understanding of clinical practice through reflective assessment of actual cases during the prior PBL sessions. PDF Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario 1) Please read through this document as it will help you prepare for your upcoming simulation on DKA. Insert the airway bevel-end first, vertically along the floor of the nose with a slight twisting action. 1. www.cdc.gov/diabetes/statistics/prev/national/. - Onset 01:48 2003;78:783788. Keywords: diabetic ketoacidosis, simulation, expertise, emergency medicine Introduction Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes mellitus, most . Emergency medical services workLife characteristics contribute to clinically significant excessive daytime sleepiness. PDF Medicine Simulation Scenario Diabetic Ketoacidosis: An Emergency - Cureus Each PBL case typically goes over 23 days, affording the students periods to find information for the case. The teaching of diabetic assessment and management, like many other medical emergencies, lends itself well to case-based simulation. - Character 02:14 You might also be interested in our awesome bank of 700+ OSCE Stations. Two abstracts related to sleepiness in the EMS workforce were presented at the National Association of EMS Physicians symposium in January. 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. - Timing 03:23 However, this turned out to be too slow, took too much time, and could not continuously demonstrate the direction of changes. Simulation Scenario. 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. Review the patients drug chart for medications which may cause a reduced level of consciousness (e.g. The students worked on the underlying physiology during a week long PBL session and are therefore familiar with the theoretical aspects of DKA. We also show them IV bags containing saline and Ringers lactate, as well as show them IV infusion sets. doi: 10.7759/cureus.1286. This guide provides an overview of the recognition and immediate management of diabetic ketoacidosis (DKA)using an ABCDE approach. PA EMT Said COVID Patient Didnt Need to Go to the Hospital. 6. Case-based simulation should include two to three broad-focus objectives, as well as 1020 specific performance measures that the student should accomplish. KDCA, Ronald Reagan Washington National Airport, DC. Some error has occurred while processing your request. 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].. Physician working in the emergency department. COVID-19 Screening in the Pediatric Emergency Department. <> Trainee will learn to collaborate with peers to decide on appropriate interventions, tests, and therapy. For example, you could develop a diabetic scenario in which the prehospital provider encounters an altered patient with incomprehensible speech. A comprehensive collection of OSCE guides to common clinical procedures, including step-by-step images of key steps, video demonstrations and PDF mark schemes. The impetus for creating and implementing the high-fidelity diabetic ketoacidosis (DKA) simulation was based on a needs assessment and reviewing of undergraduate nursing students' examination statistics in a second semester medical-surgical course. The main purpose of the simulation is to draw a line from the theoretical, boring biochemistry to the clinical manifestations. The students have acquired all the applicable theoretical knowledge of the case during the previous multiday PBL sessions. A collection of data interpretation guides to help you learn how to interpret various laboratory and radiology investigations. Review the patientsoxygen saturation(SpO2): Auscultate the chest to screen for evidence of respiratory pathology (e.g. Search for Similar Articles Classroom Dynamics Trainee will get to know how professionals behave during management of a critically ill patient. Available from: [. PDF Diabetic Ketoacidosis in the Obstetric Population: A Simulation This is particularly important for core cases and low-frequency, high-stakes procedures and encounters. Pediatric Emergency Medicine Didactics and Simulation (PEMDAS Note that if-thens must also include negative patient outcomes for when the provider doesnt take appropriate action. Please note that by doing so you agree to be added to our monthly email newsletter distribution list. 4 0 obj Facilitator to ask how often to measure BMs Initially, we used a blood pressure cuff to generate the blood pressure values. We are looking for declaration of DKA and request for pathway. This may produce better retention of the subject matter and help students adapt to emergency scenes before going into the field. Both external and internal potassium balances are disturbed during the development and treatment of DKA. In the context of DKA, a patients consciousness level may be reduced. % Teaching nursing management of diabetic ketoacidosis: a description of We do point out the blood pressure (BP) cuff, but these medical students in their first year do not really need to know how the BP values are generated, they need to understand the origin and therapy for the low blood pressure. A pre-briefing session is conducted prior to the start of the simulation scenario. Extremities: mild cyanosis, no clubbing or edema (verbalized by instructors); pulses equal, and symmetrical (elucidated by trainees). There are several causes of DKA, which we remember by the "five I's". MassBay EMS Program Integrates Training for Dogs, Heat Waves Are Killing More LA Homeless People. J Nurs Educ. Furthermore, we demonstrate and explain the basic parameters (ECG, SpO2, BP, capnography), using an interactive format of questions and answers, and encourage the group to observe the normal values. Performing an ECG should not delay the emergency management of DKA. >> Patterson PD, Weaver M, Frank R, et al. . 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. Open the patients airwayusing ahead-tiltchin-lift manoeuvre: 1. Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario Cureus. Similar to a ward round, where the instructor would say: Come and listen to this patient with an aortic stenosis. Endocrine - thesimbook.com Creating a Simulation Experience to Promote Clinical Judgment Diabetic Ketoacidosis in the Obstetric Population: A Simulation endobj 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. 1-6. Respiratory Failure in the Course of Treatment of Diabetic Ketoacidosis GRAPH. 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 increase knowledge of professional behaviors during the simulation. 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. 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. Scenarios thesimtech Simulation-based medical education: An ethical imperative. to maintaining your privacy and will not share your personal information without 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. From the Department of Anesthesiology, Pennsylvania State University College of Medicine, Hershey, PA. Dr. Murray is on the Speakers Bureau of METI, Sarasota, FL. General: Moaning, asking what has happening to her. - Examples 05:45 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. Make sure thepatientsnotes,observationchartandprescriptionchartare easily accessible. 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. Inspect for evidence of self-injection sites (e.g. She tends to drink sugar containing fluids (soda) when she is thirsty, and she eats fast foods (cream-filled muffins) when she is hungry. Calculate the patients current fluid balance using their fluid balance chart (e.g. A traditional classroom lecture format allows for student participation but limits the instructors ability to create realistic situations. Diabetic Ketoacidosis in the Obstetric Population: A Simulation Pediatric Emergency Medicine Didactics and Simulation (PEMDAS 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). Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario *=NdL/c2XSJn8:I Jb8'.8>N*[L .hxw6afq40DX3c~>abt'Q,8y(BZu(vKBTufIR. Review the patientscurrent medicationsand check any regular medications areprescribed appropriately. Geeky Medics accepts no liability for loss of any kind incurred as a result of reliance upon the information provided in this video. You may search for similar articles that contain these same keywords or you may - Severity 05:32 Diabetic ketoacidosis simulator: a new learning tool for a life 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. Her medical, social, and family histories are not clear at the time of admission to the emergency department. 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. This is a 25-year-old woman with a medical history of diabetes medicated with 40 units insulin per day. 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). An individual student can get an immediate answer to a question, the facilitator can see puzzled expressions on faces, and the PBL group could get answers that they could not get during their prior PBL group discussions. DO NOT perform any examination or procedure on patients based purely on the content of these videos. We now provide the students with handouts of the data to save time and provide consistency. #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! 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.