dka simulation scenario

An hour was . Typically potassium levels should be maintained between 4.0 5.5 mmol/L and close monitoring is required. Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario Before trainees arrival into the simulation area, the simulator is already preprogrammed for DKA. 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. The simulation session is also hosted as an interactive session. 4 0 obj DOI 10.7759/cureus.1286. - Character 02:14 The 60 minutes training time consists of four 15-minute sections divided as follows. 2009;13:505511. Emergency medical services workLife characteristics contribute to clinically significant excessive daytime sleepiness. If you have any scenarios you would be willing to share with the simulation community, please forward them . Open the patients mouth to ensure there is no foreign material that may be pushed into the larynx. See Table 4 for a suggested standardized script. The instructors role is to facilitate active learning through a combination of learning styles. See ourhistory taking guidesfor more details. Instructors should write a case study for the simulation before the session. We have been presenting Simulation Laboratory sessions to our preclinical medical students (first and second years). - Examples 05:45 Lets discuss your options. An animated lecture may be described as a pseudo-simulation environment. Simulation provides a safe environment where learning is enhanced through the deliberate practice of skills and controlled management of a variety of clinical encounters. Geeky Medics accepts no liability for loss of any kind incurred as a result of reliance upon the information provided in this video. The files are given in full in the web supplement (Appendix B, Supplemental Digital Content 2, https://links.lww.com/SIH/A2). 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. Development of simulation scenarios for an adolescent patient with diabetic ketoacidosis. (1), The assessment of a diabetic patient is best taught as a case-based simulation. (1) The assessment of a diabetic patient is best taught as a. 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. A pre-briefing session is conducted prior to the start of the simulation scenario. 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. 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. 1. Using your thumbs, slightly open the mouth by downward displacement of the chin. If an obstruction is visible within the airway, use afingersweeporsuctionto remove it. <> Data is temporarily unavailable. Cureus is on a mission to change the long-standing paradigm of medical publishing, where submitting research can be costly, complex and time-consuming. Therefore, we have to emphasize the importance of airway, breathing, and circulation in the very sick patient in any clinical setting. 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 . 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. Marx JA, Hockberger RS, Walls RM. Case-based education adds a real-world aspect to the learning environment. 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). Urinary tract infections are a common DKA precipitant. Given such a small group, the students indicated that they feel more involved than they would with a larger group (eg, the whole class.) COVID-19 Screening in the Pediatric Emergency Department. Well done, youve now stabilised the patient and theyre doing much better. They have had no clinical exposure or any clinical experience. For diabetic assessment involving DKA, staging may include the use of a container with a small amount of acetone placed near the manikin because many students may not know what acetone smells like but will expect to smell something. 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.. 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. Abstract 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. opioids, sedatives, anxiolytics, insulin, oral hypoglycaemic medications). Deteriorationshould be recognised quickly and acted upon immediately. Please enable scripts and reload this page. Its absolutely necessary to follow all immersive simulations with a positive, emotionally safe and nonjudgmental debriefing environment. A comprehensive collection of clinical examination OSCE guides that include step-by-step images of key steps, video demonstrations and PDF mark schemes. Each performance measure is separated into cognitive, behavioral or technical categories. Effectiveness of simulation on health profession students knowledge, skills, confidence and satisfaction. 1-6. Note that if-thens must also include negative patient outcomes for when the provider doesnt take appropriate action. - Severity 05:32 A fixed-rate intravenous insulin infusion should be commenced initially to suppress ketogenesis, reduce blood glucose levels and address electrolyte disturbances. Please try after some time. His Wife Gave Him CPR. Please try again soon. Forty percent of respondents reported excessive daytime sleepiness. We combined both to indicate the continuity of the curriculum, and the building on prior knowledge. A collection of communication skills guides, for common OSCE scenarios, including history taking and information giving. 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. To read Pages full Research Review column, visit www.jems.com/patient-care. Each clinical case scenario allows you to work through history taking, investigations, diagnosis and management. Consider active re-warming techniques in patients with severe hypothermia. Given 6 to 8 back-to-back sessions, it is critical that every session starts and ends on time! 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. DO NOT perform any examination or procedure on patients based purely on the content of these videos. She began experiencing progressively worsening thirst, increased appetite, and excessively increased urination. Recognize the signs and symptoms of a patient presenting with diabetic ketoacidosis. Another example: At one minute into the scenario, the patient becomes unresponsive and their breathing becomes shallow. The students are in their basic science course. See ourdocumentation guidesfor more details. A collection of interactive medical and surgical clinical case scenarios to put your diagnostic and management skills to the test. Inspect for evidence of infection on the skin (e.g. DO NOT perform any examination or procedure on patients based purely on the content of these videos. Trainee will appropriately request assistance and use available resources. They should introduce the student group to the environment, assign roles for each learner and guide the decision-making process. As the name says, this screen is used to graph and plot any parameter. Hypothermia may be present if the patient has been unconscious and exposed for some time. 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. 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). Measure the patients capillary blood glucose and ketone levels to confirm the diagnosis and guide the management of DKA. Simulation provides a safe environment where learning is enhanced through the deliberate practice of skills and controlled management of a variety of clinical encounters. 2. a simulation training session designed to acquaint emergency medicine residents with the presentation and management of diabetic ketoacidosis (DKA) through the use of simulation. Stage 1: Initial assessment of acutely unwell pregnant woman and diagnosis of DKA. In this case scenario, dehydration is one of the most serious immediate issues. Join the Geeky Medics community: 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. 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). DKA can be caused by either: Absolute insulin deficiency (e.g. Re-assessthe patient using theABCDE approachto identify any changes in their clinical condition and assess the effectiveness of your previous interventions. Strategies of high-performing paramedic educational programs. 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. If the patient loses consciousness and there are no signs of life on assessment, put out a crash call and commence CPR. Scenario in a Nutshell Diabetic ketoacidosis (DKA) in pregnancy. This is particularly important for core cases and low-frequency, high-stakes procedures and encounters. 2. Yes: if the patient can talk, their airway is patent and you can move on to the assessment of breathing. Indeed, it is the only thing that ever has.". 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. reduced air entry, coarse crackles) to screen for evidence of pneumonia. In keeping with the case study, as a treatment marker is reached, the instructor should place emphasis on physiological, pharmacological, environmental and psychosocial issues. Margolis GS, Romer GA, Fernandez AR, et al. DOWNLOAD Diabetic Ketoacidosis By the end of this scenario, the learner will be able to: 1. Example: If the provider immediately evaluates blood glucose, then the reading will display 45 mg/dL. VbQuX#R M21 stream A collection of anatomy notes covering the key anatomy concepts that medical students need to learn. With your index and other fingers placed behind the angle of the mandible, apply steady upwards and forward pressure to lift the mandible. Inspect for evidence of self-injection sites (e.g. Prehosp Emerg Care. Immersive Simulations >> Patterson PD, Weaver M, Frank R, et al. Use washable, non-toxic paints to imitate various body emissions. 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. 2007. 3. Place one hand on the patients forehead and the other under the chin. The validity of the HFS-DKA scenario was verified by a certified diabetes nurse educator, a registered nurse, and a clinical nurse educator. 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. Many of the preclinical students have never seen a real life clinical monitor or even an intravenous (IV) setup. Initially, we used a blood pressure cuff to generate the blood pressure values. 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. Using SOCRATES in History Taking | OSCE | Communication Skills, Diabetic Ketoacidosis (DKA) | Acute Management | ABCDE. We used the Medical Education Technologies Inc. (METI) Human Patient Stimulator (HPS, METI Sarasoto, Fl). Insert the airway bevel-end first, vertically along the floor of the nose with a slight twisting action. - Medical Finals Question Pack: https://geekymedics.com/medical-student-finals-questions/ 5. type 1 diabetes) Complete insulin insensitivity (e.g. 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). Refer to your local guidelines for further details. See ourCXR interpretation guidefor more details. endobj and These are not learning objectives in this program. Scenarios. Does the patient need reviewing by a specialist? This typically involves the use of anon-rebreathe maskwith an oxygen flow rate of15L. - Introduction 00:00 After the initial treatment is initiated, by showing a simulated urine and blood, and by getting them to smell ketones, we can enable the trainee to confirm the diagnosis of DKA. 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). Consider any precipitating factors for the development of DKA and involve the diabetes team in the patients care. A well-staged environment allows for greater student buy-in. In some cases, normal saline with additional potassium is required to prevent overcorrection of serum potassium levels which would otherwise result in hypokalaemia. 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. See ourfluid prescribing guidefor more details onresuscitation fluids. Below is a collection of donated scenarios for you to use or modify. 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. The optimal number of simulation participants is four to seven individuals, depending on the case study objectives. The use of case-based simulation, although more complicated and time consuming for the instructor, immerses the students in the subject matter. It may be necessary toexposethe patient during your assessment: remember to prioritise patient dignity and conservation of body heat. A collection of free medical student quizzes to put your medical and surgical knowledge to the test! The instructor can also gauge the direction the debriefing session should follow or be alerted to possible problems or conflicts in treatment opinions. If the patient has COPD and a history of CO2retention you should switch to aventuri maskas soon as possible andtitrate oxygen appropriately. . 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). endobj It should only be inserted in unconscious patients as it is otherwise poorly tolerated and may induce gagging and aspiration. 6. Laschinger S, Medves J, Pulling C, et al. You may be trying to access this site from a secured browser on the server. We now provide the students with handouts of the data to save time and provide consistency. Inspect theairwayfor obviousobstruction. TheABCDEapproach can be used to perform a systematic assessment of a critically unwell patient. You may be asked to review a patient with DKA due to confusion, reduced level of consciousness, tachycardia, hypotension and/or vomiting. Her medical, social, and family histories are not clear at the time of admission to the emergency department. Capillary refill timemay be prolonged if the patient is hypovolaemic. Trainee will recognize the need for therapy and suggest an appropriate therapy in a simulated environment. We believe it is important to have active, participatory learning by having conversations with the trainees in the form of questions and answers. Antibiotics should be prescribed in keeping with local guidelines. 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). The trainees have had background knowledge of biochemistry because they had completed the PBL case. Animated lectures, however, must work within the framework of a focused case study, which requires increased preparation time. - Over 3000 Free MCQs: https://geekyquiz.com/ Patients with DKA require fluid resuscitation to restore circulatory volume, clear ketones, correct electrolyte abnormalities and increase renal perfusion. Twitter: http://www.twitter.com/geekymedics - PSA Question Pack: https://geekymedics.com/psa-question-bank/ Insert the oropharyngeal airway in the upside-down position until you reach the junction of the hard and soft palate, at which point you should rotate it 180. Stage 2: Emergency management of DKA and consideration of abnormal CTG. Trainee will practice or observe good teamwork skills, both as a leader and a team player. Interactive lecture/discussion with use of monitors that show the vital signs of the simulated patient on manikin. 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. We have spent many hours debating whether the small group format was a waste of time. Circulating nurse in the emergency room (ER). His Heart Stopped On a Treadmill. - Onset 01:48 She Died the Next Day. She is lethargic and slightly confused but can intermittently respond to questions. If you have any scenarios you would be willing to share with the simulation community, please forward them to me. A number of key modifiers are described that allow for the adjustment of case . 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. Animated Lecture The following scenarios are available for download and are designed to meet your multi-disciplinary nursing needs. dq-]gX4 `L'u7myx) rpjf0z,.y`VMyx-&Ju`U0 Should any changes be made to the current management of their underlying condition(s)? 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.

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