<> Initially, we used a blood pressure cuff to generate the blood pressure values. Each clinical case scenario allows you to work through history taking, investigations, diagnosis and management. Simulation Scenario. In the context of DKA, a patients consciousness level may be reduced. A collection of anatomy notes covering the key anatomy concepts that medical students need to learn. Prehosp Emerg Care. The files are given in full in the web supplement (Appendix B, Supplemental Digital Content 2, https://links.lww.com/SIH/A2). If the patientloses consciousnessand there areno signs of lifeon assessment, put out acrash callandcommence CPR. #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! Environment & Manikin We then start the DKA state. See Appendix D, Supplemental Digital Content 4, https://links.lww.com/SIH/A4. Insert at least onewide-bore intravenous cannula(14G or 16G) and take blood tests as discussed below. Published August 2015. Using SOCRATES in History Taking | OSCE | Communication Skills, Diabetic Ketoacidosis (DKA) | Acute Management | ABCDE. 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. The use of case-based simulation, although more complicated and time consuming for the instructor, immerses the students in the subject matter. . Your message has been successfully sent to your colleague. DKA can develop within 24 hours and is potentially life threatening, requiring prompt recognition and therapeutic intervention. A hyperglycemic patient may present with tachypnea, which often presents as Kussmauls respirations, tachycardia, orthostatic blood pressure changes and other signs of dehydration and diabetic ketoacidosis (DKA). 1. The required potassium replacement varies greatly. A debriefing section with pre-established questions allows the instructor to review the main focus and performance measures with the student group. 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. may email you for journal alerts and information, but is committed 3. Medical Simulation Scenarios are text documents outlining the various details of a simulation - everything from patient simulator settings to debriefing notes. 2 0 obj 3. Wolters Kluwer Health 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].. The debriefing environment should be removed from the location where the simulation took place. 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. 2 The evaluation of potassium deficits is complicated by potassium exit from . Refer to your local guidelines for further details. As this is an interactive discussion session, any needed debriefing and/or explanation is given during the sessions. Ketones show 5.5. The scenario would include an if-then algorithm. One of the key differences with the immersive simulation is that the instructor is absent from the simulation environment. Privacy Policy Effectiveness of simulation on health profession students knowledge, skills, confidence and satisfaction. An integral part of a PBL session is for trainees to be able to navigate through huge literature bases. 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. type 1 diabetes) Complete insulin insensitivity (e.g. Competency-based medical education has seen widespread adoption in the field along with ongoing work in the areas of . Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. Using your thumbs, slightly open the mouth by downward displacement of the chin. Insert the airway bevel-end first, vertically along the floor of the nose with a slight twisting action. Ask for anotherclinicalmemberofstafftoassistyou if possible. Rosens Emergency Medicine: Concepts and Clinical Practice. Surgical dressings and imitation blood can support medical history. PA EMT Said COVID Patient Didnt Need to Go to the Hospital. In the meantime, you should re-assess and maintain the patients airway. The faculty member/course coordinator of Simulation Design Glycosuria leads to urinary losses of potassium through osmotic diuresis. See ourintravenous cannulation guidefor more details. Simulation-based medical education: An ethical imperative. The normal reference range for fasting plasma glucose is 4.0 5.8 mmol/l. After the first voluntary session in 2006, feedback from the medical students indicated that they would like to receive this handout. 1 0 obj Problems are addressed as they are identified and the patient is re-assessed regularly to monitor their response to treatment. 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. Review thepatients notes,chartsandrecent investigation results. Trainee will recognize the need for therapy and suggest an appropriate therapy in a simulated environment. can be reemphasized, and the effects of fluid therapy demonstrated. We now provide the students with handouts of the data to save time and provide consistency. - Character 02:14 This video demonstrates how to use the SOCRATES acronym when taking a history of pain or other symptoms. DKA can be caused by either: Absolute insulin deficiency (e.g. In an animated lecture, its important that the student group have an instructor so they can ask direct questions. 5. Subscribe to our newsletter to be the first to know about our latest content: https://geekymedics.com/newsletter/ The addition of a fluid infusion containing some potassium allows insulin therapy to continue to suppress ketogenesis and normalise plasma pH whilst preventing the development of hypokalaemia. General: Moaning, asking what has happening to her. 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. We guide the group to suggest fluid. Please try after some time. Available from: [. Inspect for evidence of infection on the skin (e.g. If foreign material is present, attempt removal using suction. The students are in their first year. Medical Simulation Scenarios are text documents outlining the various details of a simulation - everything from patient simulator settings to debriefing notes.Below is a collection of donated scenarios for you to use or modify. Development of simulation scenarios for an adolescent patient with diabetic ketoacidosis. 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]). Capillary refill timemay be prolonged if the patient is hypovolaemic. Cureus is on a mission to change the long-standing paradigm of medical publishing, where submitting research can be costly, complex and time-consuming. Typically potassium levels should be maintained between 4.0 5.5 mmol/L and close monitoring is required. Much time was wasted explaining why it did not matter. 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). 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). The objective is to give as many visual and tactile cues concerning the patient condition and background as possible. If an obstruction is visible within the airway, use afingersweeporsuctionto remove it. x]o ]?9kgq~:)?hE )R6!up}\<8||\]}Y~;xp~yQ$#4~djX&{n_m-]^K1/~/AD Hv 99evs,;8}8zwnhFxV.kf-V^? 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. In other words, they do not have clinical experience, but they have clinical knowledge. If you have any scenarios you would be willing to share with the simulation community, please forward them . - Examples 05:45 The following scenarios are available for download and are designed to meet your multi-disciplinary nursing needs. An oropharyngeal airway is a curved plastic tube with a flange on one end that sits between the tongue and hard palate to relieve soft palate obstruction. Both external and internal potassium balances are disturbed during the development and treatment of DKA. The Theory Conclusion: Our DKA simulator is a new tool whose objective is the training in a severe, frequent and complex situation, and can be used to improve the approach made by the junior physicians to the real diabetic . We have 18 to 20 PBL groups for an hour each in the week after their PBL DKA session. 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. Diabetes (type 1 and type 2) in children and young people: diagnosis and management. 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. Emergency medical services workLife characteristics contribute to clinically significant excessive daytime sleepiness. endobj 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). Laschinger S, Medves J, Pulling C, et al. Inspect theairwayfor obviousobstruction. Trainee will practice or observe good teamwork skills, both as a leader and a team player. The optimal number of simulation participants is four to seven individuals, depending on the case study objectives. Int J Evid Based Healthc. angioedema, rash) commence appropriate treatment as discussed in ouranaphylaxis guide. 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. 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. 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. It was 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. The instructors role is to facilitate active learning through a combination of learning styles. After entering the environment, the student doesnt have the option of leaving the simulation until the learning objectives and performance measures are achieved. The DKA simulation incorporates cue recognition, analysis of cues, generation of solutions, nursing interventions, and evaluation of outcomes, including effective communication and psychosocial concerns. unilateral coarse crackles may be present if the patient has pneumonia which may have been the precipitant for DKA). ABG, venepuncture). Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. Geeky Medics accepts no liability for loss of any kind incurred as a result of reliance upon the information provided in this video. In this case scenario, dehydration is one of the most serious immediate issues. Note that if-thens must also include negative patient outcomes for when the provider doesnt take appropriate action. If fever is present, make sure to consider co-existing infection. Instead, instructors should combine case- and simulation-based techniques when teaching diabetic assessment. A fixed-rate intravenous insulin infusion should be commenced initially to suppress ketogenesis, reduce blood glucose levels and address electrolyte disturbances. Urinary tract infections are a common DKA precipitant. Lets discuss your options. Diabetes UK with the Joint British Diabetes Societies Inpatient Care Group. Cureus 9(5): e1286. This is a 25-year-old woman with a medical history of diabetes medicated with 40 units insulin per day. <> <>>> 3. You might also be interested in our awesome bank of 700+ OSCE Stations. modify the keyword list to augment your search. Supplemental digital content is available for this article. TheABCDEapproach can be used to perform a systematic assessment of a critically unwell patient. The students mentioned that they did not obtain the maximum value from the simulation session under these circumstances. Use washable, non-toxic paints to imitate various body emissions. Ziv A, Wolpe PR, Small SD, et al. Properly interpret a venous blood gas (VBG) and basic metabolic panel in a patient presenting with diabetic ketoacidosis. This is particularly important for core cases and low-frequency, high-stakes procedures and encounters. GRAPH. Immersive simulations are mentally exhausting because they create an intense and stressful atmosphere requiring the learner to work outside their comfort zone. Target Learner Groups The simulation experience serves to give substance to the theoretical words and concepts that the students encountered during the PBL sessions. The 60 minutes training time consists of four 15-minute sections divided as follows. Prehosp Emerg Care. Nandate, Koichiro MD, PhD; Abola, Ramon MD; Murray, W Bosseau MB; Whitfield, Carol PhD; Lang, Charles PhD; Sinz, Elizabeth MD. 2009;13:505511. 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. Immersive Simulations 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. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journals Web site (www.simulationinhealthcare.com). You may search for similar articles that contain these same keywords or you may Research Watch Box:Sleep, Fatigue & SafetyBy David Page, MS, NREMT-P LYqC+pJ&6X4onfBT#?=R}.p8N3+Dk,P4tIgWB}-L'=8;_G >,K#.e89XnG'B~NtR A traditional classroom lecture format allows for student participation but limits the instructors ability to create realistic situations. 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. Schneider Sarver PA, Senczakowicz EA, Slovensky BM. 4. Makeup may be used to depict gender, hollow eyes and cheeks, produce pallor or display bruises and scars. DKA can develop within 24 hours and is potentially life threatening, requiring prompt recognition and therapeutic intervention. 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. This may produce better retention of the subject matter and help students adapt to emergency scenes before going into the field. A collection of surgery revision notes covering key surgical topics. Calculate the patients current fluid balance using their fluid balance chart (e.g. Trainee will learn to collaborate with peers to decide on appropriate interventions, tests, and therapy. Consider any precipitating factors for the development of DKA and involve the diabetes team in the patients care. 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. Clearlydocument your ABCDE assessment, including history, examination, observations, investigations, interventions, and the patients response. Yes: if the patient can talk, their airway is patent and you can move on to the assessment of breathing. 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. Tilt the forehead back whilst lifting the chin forwards to extend the neck. Performing an ECG should not delay the emergency management of DKA. If the patient has clinical signs ofanaphylaxis(e.g. A nasopharyngeal airway is a soft plastic tube with a bevel at one end and a flange at the other. In keeping with the case study, as a treatment marker is reached, the instructor should place emphasis on physiological, pharmacological, environmental and psychosocial issues. A number of key modifiers are described that allow for the adjustment of case . Use blankets to re-warm patients who are mild to moderately hypothermic. Alert a senior immediately if you have any concerns about the consciousness level of a patient. Groups of fewer than four students dont allow for optimal collaboration. DO NOT perform any examination or procedure on patients based purely on the content of these videos. Stage 3: Ongoing management and monitoring of DKA 1 hour after initiation of treatment. We used the Medical Education Technologies Inc. (METI) Human Patient Stimulator (HPS, METI Sarasoto, Fl). 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. VbQuX#R M21 Each PBL case typically goes over 23 days, affording the students periods to find information for the case. 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. 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. If the provider starts an IV and gives dextrose, then the patients alertness will increase, respirations will normalize and repeated blood glucose will read 210 mg/dL over a two-minute interval. If the patient loses consciousness and there are no signs of life on assessment, put out a crash call and commence CPR. Instructors should write a case study for the simulation before the session. She had developed nausea, extreme fatigue, mild disorientation, and blurred vision toward the end of the soccer match. This field is for validation purposes and should be left unchanged. Margolis GS, Romer GA, Fernandez AR, et al. Scenarios. Trainee will improve their understanding of clinical practice through reflective assessment of actual cases during the prior PBL sessions. A GCS of 8 or below warrants urgent expert help from an anaesthetist. 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 Open the patients airwayusing ahead-tiltchin-lift manoeuvre: 1. - 150+ PDF OSCE Checklists: https://geekymedics.com/pdf-osce-checklists/ 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. Revisit history taking to explore relevant medical history and identify any precipitating factors for DKA. 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. Simulation in Healthcare4(4):232-236, Winter 2009. A chest X-ray should not delay the emergency management of DKA. 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. Trigger 4, Pathway 1l of saline required over 1hour and insulin infusion need prescribing and making up in 50ml syringe. - Site 01:12 Case-based simulation should include two to three broad-focus objectives, as well as 1020 specific performance measures that the student should accomplish. This guide provides an overview of the recognition and immediate management of diabetic ketoacidosis (DKA)using an ABCDE approach. Advance the airway until it lies within the pharynx. Weight, Height: Not given, normal appearing (as per simulator) but has lost 20 lbs recently. Please enable scripts and reload this page. Therefore, we have to emphasize the importance of airway, breathing, and circulation in the very sick patient in any clinical setting. Invasive monitors, including a left radial intraarterial and a right subclavian IV catheter, were placed. 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. Deteriorationshould be recognised quickly and acted upon immediately. Circulating nurse in the emergency room (ER). 2. 2017 May 29;9(5):e1286. 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. You can check out our guide to using SOCRATES here: https://geekymedics.com/the-socrates-acronym-in-history-taking/ Administer oxygen to all critically unwell patients during yourinitialassessment. Intubation lubricants can mimic drooling. 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). Given such a small group, the students indicated that they feel more involved than they would with a larger group (eg, the whole class.) Moses Lake (WA) Fire Department Gets $3.3M Grant for more Firefighters, Woman Who Crashed into Responders, Killing PA Firefighter, Gets Prison, Three Apparent Gas Explosions at San Bernardino (CA) Mountain Homes, Enid (OK) Fire Department Begins SWAT Medic Program to Assist Police, FDNY EMS Providers Win COVID-19-Linked Free Speech Lawsuit, Coronavirus Origins Still a Mystery Three Years into Pandemic. Review the patientscurrent medicationsand check any regular medications areprescribed appropriately. It involves working through the following steps: Each stage of the ABCDE approach involvesclinicalassessment,investigationsandinterventions. Review the patientsoxygen saturation(SpO2): Auscultate the chest to screen for evidence of respiratory pathology (e.g. 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). 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. By joining Cureus, you agree to our An events progression section should include patient status changes, as well as a time/treatment continuum that incorporates if-then event progressions. - Severity 05:32 DOWNLOAD Diabetic Ketoacidosis By the end of this scenario, the learner will be able to: 1. 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 correlate the underlying pathophysiology with symptoms and signs as exhibited by the simulation session. Prior to starting the scenario, the instructor should introduce a short summary of the case study and ask open-ended questions regarding the management direction. 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. 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. This allows the learner group to make a psychological break from the patient and environment while beginning the reflection process. The learning environment should closely mimic real-world applications. See our blood glucose measurement guide for more details. Search for Similar Articles Make sure thepatientsnotes,observationchartandprescriptionchartare easily accessible. 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. Inspect the urine currently in the catheter bag and note its appearance (e.g. Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario Cureus. - Medical Finals Question Pack: https://geekymedics.com/medical-student-finals-questions/ We have been presenting Simulation Laboratory sessions to our preclinical medical students (first and second years). 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. Section snippets . Discuss the patients current clinical condition with aseniorclinicianusing anSBARR style handover. 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.. This environment doesnt allow the student to identify presentation cues, be active in their own learning or apply their skills without endangering the lives of patients.(2). Example: If the provider immediately evaluates blood glucose, then the reading will display 45 mg/dL. 3. Many of the preclinical students have never seen a real life clinical monitor or even an intravenous (IV) setup. Clinical Simulation in Nursing, Volume 39, 2020, pp.
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