dka simulation scenario

Ziv A, Wolpe PR, Small SD, et al. A collection of data interpretation guides to help you learn how to interpret various laboratory and radiology investigations. The Pratcice It was developed for anesthesiology resident physicians with some background knowledge and experience caring for critically ill patients. Some error has occurred while processing your request. We ask the trainee why the blood pressure is so low or heart rate is so high, and how we should treat it. Available from: [. Clearlydocument your ABCDE assessment, including history, examination, observations, investigations, interventions, and the patients response. Inspect the urine currently in the catheter bag and note its appearance (e.g. 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. As with the animated lecture, the simulation is strongly dependent on a focused case study. 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. Search for Similar Articles A collection of anatomy notes covering the key anatomy concepts that medical students need to learn. Recognize the signs and symptoms of a patient presenting with diabetic ketoacidosis. 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. Trainee will increase knowledge of professional behaviors during the simulation. NPAs are typically better tolerated in patients who are partly or fully conscious compared to oropharyngeal airways. Many of the preclinical students have never seen a real life clinical monitor or even an intravenous (IV) setup. We now provide the students with handouts of the data to save time and provide consistency. *=NdL/c2XSJn8:I Jb8'.8>N*[L .hxw6afq40DX3c~>abt'Q,8y(BZu(vKBTufIR. They should introduce the student group to the environment, assign roles for each learner and guide the decision-making process. After initial insulin therapy has reduced plasma blood glucose levels (e.g. See ourintravenous cannulation guidefor more details. Trainee will improve their understanding of clinical practice through reflective assessment of actual cases during the prior PBL sessions. We have spent many hours debating whether the small group format was a waste of time. #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! From the Department of Anesthesiology, Pennsylvania State University College of Medicine, Hershey, PA. Dr. Murray is on the Speakers Bureau of METI, Sarasota, FL. % Review thepatients notes,chartsandrecent investigation results. 2017 May 29;9(5):e1286. Check the patency of the patients right nostril and if required (depending on the model of NPA) insert a safety pin through the flange of the NPA. 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.) Diabetic Ketoacidosis (DKA) | Acute Management | ABCDE Inspect for evidence of self-injection sites (e.g. If the patient is suspected to have sufferedsignificanttraumawith potential spinal involvement, perform ajaw-thrustrather than a head-tilt chin-lift manoeuvre: 2. SimMan Nursing Scenarios Software - laerdal.com We also show them IV bags containing saline and Ringers lactate, as well as show them IV infusion sets. CCA 175 Real Time Exam Scenario 17 | JOIN Multiple DataFrames | Save as This allows us to get in touch for more details if required. She does not take this regularly. Diabetic ketoacidosis; Simulation training; Medical students. In the context of DKA, a patients consciousness level may be reduced. If the patient is conscious, sit themuprightas this can also help with oxygenation. Medical Simulation Scenarios are text documents outlining the various details of a simulation - everything from patient simulator settings to debriefing notes. 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). The relationship between sleep, fatigue and patient and provider safety. Please write a single word answer in lowercase (this is an anti-spam measure). If the patient is confused you might be able to get a collateral history from staff or family members as appropriate. The students mentioned that they did not obtain the maximum value from the simulation session under these circumstances. Emergency medical services workLife characteristics contribute to clinically significant excessive daytime sleepiness. 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). The following scenarios are available for download and are designed to meet your multi-disciplinary nursing needs. Classroom Dynamics Re-assessthe patient using theABCDE approachto identify any changes in their clinical condition and assess the effectiveness of your previous interventions. - Associated symptoms 03:04 We have been presenting Simulation Laboratory sessions to our preclinical medical students (first and second years). A well-staged environment allows for greater student buy-in. <> The required potassium replacement varies greatly. Therefore, we have to emphasize the importance of airway, breathing, and circulation in the very sick patient in any clinical setting. <>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 595.32 841.92] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> This is particularly important for core cases and low-frequency, high-stakes procedures and encounters. Open the patients airwayusing ahead-tiltchin-lift manoeuvre: 1. 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). His Wife Gave Him 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. Section snippets . Scenarios thesimtech Circulating nurse in the emergency room (ER). #geekymedics #fyp #fypviral #studytok #medicalstudentuk #medtok #studytips #studytipsforstudents #medstudentuk #premed #medschoolfinals, Cardiovascular History Tips - DON'T FORGET these 3 things . - PSA Question Pack: https://geekymedics.com/psa-question-bank/ Conclusions This technical report describes the design and implementation of a simulation scenario on DKA for emergency medicine trainees. Endocrine - thesimbook.com Creating a Simulation Experience to Promote Clinical Judgment Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. The debriefing environment should be removed from the location where the simulation took place. The faculty member/course coordinator of Simulation Design Catheterisethe patient to closelymonitor urine outputto guide fluid resuscitation and need for escalation. Your message has been successfully sent to your colleague. If any obstruction is encountered, remove the tube and try the left nostril. Typically potassium levels should be maintained between 4.0 5.5 mmol/L and close monitoring is required. Scenarios. 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. A nasopharyngeal airway is a soft plastic tube with a bevel at one end and a flange at the other. Much time was wasted explaining why it did not matter. 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 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. tall tented T waves in hyperkalaemia). Physician working in the emergency department. doi: 10.7759/cureus.1286. Animated lectures, however, must work within the framework of a focused case study, which requires increased preparation time. 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. We believe it is important to have active, participatory learning by having conversations with the trainees in the form of questions and answers. 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. Prehosp Emerg Care. You may be asked to review a patient with DKA due to confusion, reduced level of consciousness, tachycardia, hypotension and/or vomiting. Ketones show 5.5. - Exacerbating & relieving factors 05:12 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. Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario General: Moaning, asking what has happening to her. Keywords: diabetic ketoacidosis, simulation, expertise, emergency medicine Introduction Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes mellitus, most . Lets discuss your options. Environment & Manikin There are several causes of DKA, which we remember by the "five I's". Pediatric Emergency Medicine Didactics and Simulation (PEMDAS 4. 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. In other words, they do not have clinical experience, but they have clinical knowledge. 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. A strong emphasis is placed on the focused, methodical examination of a specific medical problem and the decision-based treatment options available. We do not use passive visualizing materials such as videotapes or DVD other than vital signs shown on the monitors. A collection of interactive medical and surgical clinical case scenarios to put your diagnostic and management skills to the test. If the patient has COPD and a history of CO2retention you should switch to aventuri maskas soon as possible andtitrate oxygen appropriately. Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario An integral part of a PBL session is for trainees to be able to navigate through huge literature bases. If the patient loses consciousness and there are no signs of life on assessment, put out a crash call and commence CPR. 2011;15:108109. By joining Cureus, you agree to our Using your thumbs, slightly open the mouth by downward displacement of the chin. cloudy urine may indicate urinary tract infection). unilateral coarse crackles may be present if the patient has pneumonia which may have been the precipitant for DKA). The file explaining the session is sent to instructors 1 week before the sessions. For example, you could develop a diabetic scenario in which the prehospital provider encounters an altered patient with incomprehensible speech. %PDF-1.5 The main goal is to establish a safe learning environment for the learner [9, 13 . . See ourfluid prescribing guidefor more details onresuscitation fluids. DO NOT perform any examination or procedure on patients based purely on the content of these videos. 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. See Table 4 for a suggested standardized script. 1 0 obj and A debriefing section with pre-established questions allows the instructor to review the main focus and performance measures with the student group. (1), The assessment of a diabetic patient is best taught as a case-based simulation. dq-]gX4 `L'u7myx) rpjf0z,.y`VMyx-&Ju`U0 3. After entering the environment, the student doesnt have the option of leaving the simulation until the learning objectives and performance measures are achieved. 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. 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. Supplemental digital content is available for this article. Example: If the provider immediately evaluates blood glucose, then the reading will display 45 mg/dL. The use of case-based simulation, although more complicated and time consuming for the instructor, immerses the students in the subject matter. Capillary refill timemay be prolonged if the patient is hypovolaemic. Despite this increased calorie intake, she noticed an unexplained 20 lbs weight loss. On the basis of the feedback from the students, they indicated that they believed the small group sessions are better. This is an important period, as this is where the students see the theoretical concept (metabolic acidosis), come to life as for instance large tidal volumes. }HyEf,#$/JSRU9+CF6k\'/z+i`[ 5JudK*Zly^g%[jCK)H[)Y=Qp0/r9o9HW_zF}pTzI~'|q.~:=Y T 9w! confusion, coma), All critically unwell patients should have. Paediatric DKA | Simulation Education 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). 2. 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. your express consent. Use washable, non-toxic paints to imitate various body emissions. Medical simulation technology is a powerful tool for training physicians but papers dealing with DKA simulators are scarce. A pre-briefing session is conducted prior to the start of the simulation scenario. Animated Lecture 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. 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. Simulation-based medical education: An ethical imperative. Published August 2015. areas of lipohypertrophy) if it is unclear if the patient is diabetic. 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. 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). PDF Diabetic Ketoacidosis in the Obstetric Population: A Simulation - Severity 05:32 - 2500+ OSCE Flashcards: https://geekymedics.com/osce-flashcards/ Int J Evid Based Healthc. 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. In the meantime, you can perform some basic airway manoeuvres to help maintain the airway whilst awaiting senior input. Each performance measure is separated into cognitive, behavioral or technical categories. ABG, venepuncture). 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. vD0 x@FFJ{m[ 3//Oh|JR7! 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. 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 A traditional classroom lecture format allows for student participation but limits the instructors ability to create realistic situations. For similar reasons, we do not believe a videotaped session will keep the students attention as much as these live simulator sessions. A collection of surgery revision notes covering key surgical topics. An animated lecture may be described as a pseudo-simulation environment. The choice of fluid type, rate of administration and volume should be tailored to the individual patient based upon their vital signs and electrolytes. If an infection is suspected, IV antibioticsshould be administered as soon as possible. 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). PDF Medicine Simulation Scenario Diabetic Ketoacidosis: An Emergency - Cureus Virtual patient simulation (VPS) is an interactive computer simulation that recreates real-world scenarios with the objectives of training, education, and assessment for health care providers [].Virtual simulation has been used extensively to adapt nursing education to the COVID-19 pandemic context [], such as social distancing and/or confinement. "Never doubt that a small group of thoughtful, committed citizens can change the world. - Geeky Medics OSCE App: https://geekymedics.com/geeky-medics-app/ Schneider Sarver PA, Senczakowicz EA, Slovensky BM. 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. 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. 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. See our blood glucose measurement guide for more details. A chest X-ray should not delay the emergency management of DKA. Makeup may be used to depict gender, hollow eyes and cheeks, produce pallor or display bruises and scars. Using SOCRATES in History Taking | OSCE | Communication Skills, Diabetic Ketoacidosis (DKA) | Acute Management | ABCDE. Margolis GS, Romer GA, Fernandez AR, et al. The students have acquired all the applicable theoretical knowledge of the case during the previous multiday PBL sessions. With your index and other fingers placed behind the angle of the mandible, apply steady upwards and forward pressure to lift the mandible. 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. 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). oral fluids, intravenous fluids, urine output, drain output, stool output, vomiting) to inform resuscitation efforts. 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. 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. Diabetic Ketoacidosis (DKA) Clinical Pathway Emergency Department The lecture allows for understanding of concepts prior to action, and instructor feedback is immediate. Evenly balancing performance measures will ensure the student has the opportunity to critically think through patient treatment and to practice new or support previously learned behaviors and technical skills. The 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. (1) The assessment of a diabetic patient is best taught as a. 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. Inspect for evidence of infection on the skin (e.g. 1. Review the patients drug chart for medications which may cause a reduced level of consciousness (e.g. A number of key modifiers are described that allow for the adjustment of case . may email you for journal alerts and information, but is committed 4. 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. 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. Keyword Highlighting Wolters Kluwer Health Airway adjuncts are often helpful and in some cases essential to maintain a patients airway. Mosby:Philadelphia. Simulation Scenario. Using the arterial line, the scenario becomes much more dynamic. 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. KDCA for FSX - Fly Away Simulation Diabetic ketoacidosis (DKA) is a common, potentially lethal disease. 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. This guide provides an overview of the recognition and immediate management of diabetic ketoacidosis (DKA)using an ABCDE approach. - Site 01:12 The simulation experience serves to give substance to the theoretical words and concepts that the students encountered during the PBL sessions. Facebook: http://www.facebook.com/geekymedics DY{Qb"(EgN$QI*%XN1F""0a5 Each clinical case scenario allows you to work through history taking, investigations, diagnosis and management. Clearly communicate how often would you like the patients observations relayed to you by other staff members. Below is a collection of donated scenarios for you to use or modify. Simulation student Scenario- DKA-Peds.docx - DIABETIC Refer to your local guidelines for further details. 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. Outcomes Educating Nursing Students Using an Evolving, Simulated Case