<> Another example: At one minute into the scenario, the patient becomes unresponsive and their breathing becomes shallow. Open the patients mouth to ensure there is no foreign material that may be pushed into the larynx. The required potassium replacement varies greatly. We introduce the Simulation Laboratory and the Simulator, and demonstrate: pulses, eyes blinking, pupil constriction, gas moves in and out of mouth (place hand over mouth), chest moves up and down. A nasopharyngeal airway is a soft plastic tube with a bevel at one end and a flange at the other. 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. In some cases, normal saline with additional potassium is required to prevent overcorrection of serum potassium levels which would otherwise result in hypokalaemia. The relationship between sleep, fatigue and patient and provider safety. 1) Please read through this document as it will help you prepare for your upcoming simulation on DKA. DKA can be caused by either: Absolute insulin deficiency (e.g. DKA can develop within 24 hours and is potentially life threatening, requiring prompt recognition and therapeutic intervention. Insert the airway bevel-end first, vertically along the floor of the nose with a slight twisting action. See ourdocumentation guidesfor more details. DOWNLOAD Diabetic Ketoacidosis By the end of this scenario, the learner will be able to: 1. His Heart Stopped On a Treadmill. Diabetes (type 1 and type 2) in children and young people: diagnosis and management. They should introduce the student group to the environment, assign roles for each learner and guide the decision-making process. The students are in their basic science course. Deteriorationshould be recognised quickly and acted upon immediately. Emergency medical services workLife characteristics contribute to clinically significant excessive daytime sleepiness. insulin-dependent type 2 diabetes), Altered consciousness (e.g. 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].. cloudy urine may indicate urinary tract infection). As the name says, this screen is used to graph and plot any parameter. His Wife Gave Him CPR. In the context of DKA, a patients consciousness level may be reduced. If the patient is confused you might be able to get a collateral history from staff or family members as appropriate. 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. modify the keyword list to augment your search. Several environments may be suitable for your classroom. reduced air entry, coarse crackles) to screen for evidence of pneumonia. Prehosp Emerg Care. 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. This allows us to get in touch for more details if required. Trainee will describe the changes in vital signs, the major metabolic, fluid, and electrolyte. Check out our other awesome clinical skills resources including: In keeping with the case study, as a treatment marker is reached, the instructor should place emphasis on physiological, pharmacological, environmental and psychosocial issues. 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. Make sure tore-assessthe patient after anyintervention. }HyEf,#$/JSRU9+CF6k\'/z+i`[ 5JudK*Zly^g%[jCK)H[)Y=Qp0/r9o9HW_zF}pTzI~'|q.~:=Y T 9w! We believe it is important to have active, participatory learning by having conversations with the trainees in the form of questions and answers. By joining Cureus, you agree to our 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. Consider active re-warming techniques in patients with severe hypothermia. We do not use passive visualizing materials such as videotapes or DVD other than vital signs shown on the monitors. There are just a few more things to do. After initial insulin therapy has reduced plasma blood glucose levels (e.g. The students mentioned that they did not obtain the maximum value from the simulation session under these circumstances. A debriefing section with pre-established questions allows the instructor to review the main focus and performance measures with the student group. Note that if-thens must also include negative patient outcomes for when the provider doesnt take appropriate action. Strategies of high-performing paramedic educational programs. 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. This guide has been created to assist students in preparing for emergencysimulationsessionsas part of their training,it is not intended to be relied upon for patient care. They have had no clinical exposure or any clinical experience. Makeup may be used to depict gender, hollow eyes and cheeks, produce pallor or display bruises and scars. The simulation session is also hosted as an interactive session. 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. It involves working through the following steps: Each stage of the ABCDE approach involvesclinicalassessment,investigationsandinterventions. Insert at least onewide-bore intravenous cannula(14G or 16G) and take blood tests as discussed below. MassBay EMS Program Integrates Training for Dogs, Heat Waves Are Killing More LA Homeless People. 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. Twitter: http://www.twitter.com/geekymedics Facebook: http://www.facebook.com/geekymedics can be reemphasized, and the effects of fluid therapy demonstrated. Laschinger S, Medves J, Pulling C, et al. 2. Geeky Medics accepts no liability for loss of any kind incurred as a result of reliance upon the information provided in this video. 1 Potassium losses occurring both before and during treatment of DKA must be replaced. >> Fernandez AR, Mac Crawford J, Pennell ML, et al. Two abstracts related to sleepiness in the EMS workforce were presented at the National Association of EMS Physicians symposium in January. A collection of communication skills guides, for common OSCE scenarios, including history taking and information giving. 2011;15:108109. Blood sugar issues in the Type II diabetic will have a gradual onset, with diagnosis generally resulting from routine laboratory exams.(1). 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. 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. 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. Given such a small group, the students indicated that they feel more involved than they would with a larger group (eg, the whole class.) Case-based education adds a real-world aspect to the learning environment. endobj Please enable scripts and reload this page. Glycosuria leads to urinary losses of potassium through osmotic diuresis. #geekymedics #fyp #fypviral #studytok #medicalstudentuk #medtok #studytips #studytipsforstudents #medstudentuk #premed #medschoolfinals, Cardiovascular History Tips - DON'T FORGET these 3 things . Example: If the provider immediately evaluates blood glucose, then the reading will display 45 mg/dL. 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. Just place the BR2_KDCA file into your addons scenery folder: C:\\Program Files\\Microsoft Games\\Microsoft Flight Simulator X\\Addon Scenery\\Scenery. Conclusion The use of simulation-based instruction enables a student to learn at their own pace and allows them to repeat sequential steps to gain confidence and proficiency. 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. 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. We have been presenting Simulation Laboratory sessions to our preclinical medical students (first and second years). Effectiveness of simulation on health profession students knowledge, skills, confidence and satisfaction. Before trainees arrival into the simulation area, the simulator is already preprogrammed for DKA. The following scenarios are available for download and are designed to meet your multi-disciplinary nursing needs. We guide the group to suggest fluid. 2017 May 29;9(5):e1286. We combined both to indicate the continuity of the curriculum, and the building on prior knowledge. Stage 1: Initial assessment of acutely unwell pregnant woman and diagnosis of DKA. An events progression section should include patient status changes, as well as a time/treatment continuum that incorporates if-then event progressions. . A collection of surgery revision notes covering key surgical topics. 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 files are given in full in the web supplement (Appendix B, Supplemental Digital Content 2, https://links.lww.com/SIH/A2). We also show them IV bags containing saline and Ringers lactate, as well as show them IV infusion sets. Properly interpret a venous blood gas (VBG) and basic metabolic panel in a patient presenting with diabetic ketoacidosis. 2010;49:578586. Invasive monitors, including a left radial intraarterial and a right subclavian IV catheter, were placed. General: Moaning, asking what has happening to her. Both external and internal potassium balances are disturbed during the development and treatment of DKA. DO NOT perform any examination or procedure on patients based purely on the content of these videos. 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. As this is a PBL session, the trainees are not given any references. You may be trying to access this site from a secured browser on the server. Subscribe to our newsletter to be the first to know about our latest content: https://geekymedics.com/newsletter/ In the meantime, you should re-assess and maintain the patients airway. 3 0 obj 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. Circulating nurse in the emergency room (ER). Observe and discuss the effects of therapy in a mathematically modeled physiological simulator. A comprehensive collection of medical revision notes that cover a broad range of clinical topics. 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). Target Learner Groups See our blood glucose measurement guide for more details. The main goal is to establish a safe learning environment for the learner [9, 13 . opioids, sedatives, anxiolytics, insulin, oral hypoglycaemic medications). Intubation lubricants can mimic drooling. NPAs should not be used in patients who may have sustained a skull base fracture, due to the small but life-threatening risk of entering the cranial vault with the NPA. 3. 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. Does the patient need a referral toHDU/ICU? Simulation provides a safe environment where learning is enhanced through the deliberate practice of skills and controlled management of a variety of clinical encounters. Development of simulation scenarios for an adolescent patient with diabetic ketoacidosis. Please try again soon. 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). 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. Discuss the patients current clinical condition with aseniorclinicianusing anSBARR style handover. A collection of interactive medical and surgical clinical case scenarios to put your diagnostic and management skills to the test. A comprehensive collection of clinical examination OSCE guides that include step-by-step images of key steps, video demonstrations and PDF mark schemes. She is lethargic and slightly confused but can intermittently respond to questions. Please note that by doing so you agree to be added to our monthly email newsletter distribution list. Classroom Dynamics 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). 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. 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. Use washable, non-toxic paints to imitate various body emissions. Available from: [. Diabetes UK with the Joint British Diabetes Societies Inpatient Care Group. 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. 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. If the patientloses consciousnessand there areno signs of lifeon assessment, put out acrash callandcommence CPR. A collection of free medical student quizzes to put your medical and surgical knowledge to the test! If any obstruction is encountered, remove the tube and try the left nostril. Much time was wasted explaining why it did not matter. Simulation Scenario for Anesthesia Providers Clark Obr, MD*, Anthony Mueller, MD . In other words, they do not have clinical experience, but they have clinical knowledge. Case-based simulation should include two to three broad-focus objectives, as well as 1020 specific performance measures that the student should accomplish. Medical Simulation Scenarios are text documents outlining the various details of a simulation - everything from patient simulator settings to debriefing notes. - 2500+ OSCE Flashcards: https://geekymedics.com/osce-flashcards/ 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). 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. 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. If the patient isunconsciousorunresponsive, start thebasic life support(BLS)algorithmas per resuscitation guidelines. We used the Medical Education Technologies Inc. (METI) Human Patient Stimulator (HPS, METI Sarasoto, Fl). Interactive lecture/discussion with use of monitors that show the vital signs of the simulated patient on manikin. If fever is present, make sure to consider co-existing infection. Review thepatients notes,chartsandrecent investigation results. 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 . Trainee will increase knowledge of professional behaviors during the simulation. 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). 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. 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. 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 Many of the preclinical students have never seen a real life clinical monitor or even an intravenous (IV) setup. 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. Int J Evid Based Healthc. Animated Lecture Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. Heart: S1 and S2 within normal limits; no S3/S4 or murmurs, normal rate and rhythm. The normal reference range for fasting plasma glucose is 4.0 5.8 mmol/l. Chapters: Trainee will improve their understanding of clinical practice through reflective assessment of actual cases during the prior PBL sessions. Re-assessthe patient using theABCDE approachto identify any changes in their clinical condition and assess the effectiveness of your previous interventions. 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. confusion, coma), All critically unwell patients should have. Diabetic ketoacidosis (DKA) is a common, potentially lethal disease. We give the history of the patient to the trainees. An oxygen mask is also demonstrated as an alternative device, as these early trainees had mostly not yet seen any of these devices. Lets discuss your options. 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. On the basis of the feedback from the students, they indicated that they believed the small group sessions are better. The faculty member/course coordinator of Simulation Design Advance the airway until it lies within the pharynx. (1) The assessment of a diabetic patient is best taught as a. The students have acquired all the applicable theoretical knowledge of the case during the previous multiday PBL sessions. Conclusions This technical report describes the design and implementation of a simulation scenario on DKA for emergency medicine trainees. Use an effectiveSBARR handoverto communicate the key information effectively to other medical staff. The instructors role is to facilitate active learning through a combination of learning styles. This allows the learner group to make a psychological break from the patient and environment while beginning the reflection process. She tends to drink sugar containing fluids (soda) when she is thirsty, and she eats fast foods (cream-filled muffins) when she is hungry. Facilitator to ask how often to measure BMs Does the patient need reviewing by a specialist? You can check out our guide to using SOCRATES here: https://geekymedics.com/the-socrates-acronym-in-history-taking/ Ask for anotherclinicalmemberofstafftoassistyou if possible. A collection of anatomy notes covering the key anatomy concepts that medical students need to learn. In this manner, the students have to apply their knowledge at the appropriate points during the progression of the scenario. We are looking for declaration of DKA and request for pathway. Trainee will get to know how professionals behave during management of a critically ill patient. The Theory Using SOCRATES in History Taking | OSCE | Communication Skills, Diabetic Ketoacidosis (DKA) | Acute Management | ABCDE. The debriefing environment should be removed from the location where the simulation took place. Its important to train and educate students of prehospital care on key indicators of a diabetic emergency. Mosby:Philadelphia. To read Pages full Research Review column, visit www.jems.com/patient-care. Prehosp Emerg Care. 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 Airway adjuncts are often helpful and in some cases essential to maintain a patients airway. 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! endobj 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.. The choice of fluid type, rate of administration and volume should be tailored to the individual patient based upon their vital signs and electrolytes. 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. Each PBL case typically goes over 23 days, affording the students periods to find information for the case. Your message has been successfully sent to your colleague. Calculate the patients current fluid balance using their fluid balance chart (e.g. Its best, however, to allow the student group to continue so theyre able to evaluate their decision-making processes during debriefing. We now provide the students with handouts of the data to save time and provide consistency. Are any further assessments or interventions required? Urinary tract infections are a common DKA precipitant. - Site 01:12 - Associated symptoms 03:04 Margolis GS, Romer GA, Fernandez AR, et al. Acad Med. 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. It was developed for anesthesiology resident physicians with some background knowledge and experience caring for critically ill patients. PBL was introduced at our institution in 1995. Manikin staging can provide strong cues. From the Department of Anesthesiology, Pennsylvania State University College of Medicine, Hershey, PA. Dr. Murray is on the Speakers Bureau of METI, Sarasota, FL. Trainee will appropriately request assistance and use available resources. Environment & Manikin COVID-19 Screening in the Pediatric Emergency Department. Depending on scenario complexity, team dynamic and treatment modalities, this simulation may take 1020 minutes. Tilt the forehead back whilst lifting the chin forwards to extend the neck. Diabetic Ketoacidosis (DKA) Clinical Pathway Emergency Department | Children's Hospital of Philadelphia - Examples 05:45 Open the patients airwayusing ahead-tiltchin-lift manoeuvre: 1. 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. 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. Competency-based medical education has seen widespread adoption in the field along with ongoing work in the areas of . Consider any precipitating factors for the development of DKA and involve the diabetes team in the patients care. 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. We try to provide sufficient realism.. may email you for journal alerts and information, but is committed KDCA, Ronald Reagan Washington National Airport, DC. This session provides additional clinical support material for the theoretical PBL session. 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. Despite this increased calorie intake, she noticed an unexplained 20 lbs weight loss. www.cdc.gov/diabetes/statistics/prev/national/. 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. Review the patientscurrent medicationsand check any regular medications areprescribed appropriately. doi: 10.7759/cureus.1286. Available from: [, NICE guidelines. It may be necessary toexposethe patient during your assessment: remember to prioritise patient dignity and conservation of body heat. endobj Data is temporarily unavailable. Supplemental digital content is available for this article. PBL in our institution is implemented as a small group (n 68 students) self study session with a facilitator, who incrementally discloses further information about the patient. Please write a single word answer in lowercase (this is an anti-spam measure). Works with Traffic 2005, but . A traditional classroom lecture format allows for student participation but limits the instructors ability to create realistic situations. 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]). your express consent. The learning objectives follow the American College of Graduate Medical Education (ACGME) Core Compentencies. Cureus 9(5): e1286. Instagram: https://instagram.com/geekymedics 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 . 1. Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. Stage 2: Emergency management of DKA and consideration of abnormal CTG. ABG, venepuncture). Ziv A, Wolpe PR, Small SD, et al. angioedema, rash) commence appropriate treatment as discussed in ouranaphylaxis guide. Simulation in Healthcare4(4):232-236, Winter 2009. These are not learning objectives in this program. Trainee will be respectful to others and their views during the PBL session. % Similar to a ward round, where the instructor would say: Come and listen to this patient with an aortic stenosis. Indeed, it is the only thing that ever has.". 1. 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.