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]). Intubation lubricants can mimic drooling. 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. 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 fixed-rate intravenous insulin infusion should be commenced initially to suppress ketogenesis, reduce blood glucose levels and address electrolyte disturbances. 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. Refer to your local guidelines for further details. Scenarios. Using the arterial line, the scenario becomes much more dynamic. A collection of free medical student quizzes to put your medical and surgical knowledge to the test! 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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). Urinary tract infections are a common DKA precipitant. DO NOT perform any examination or procedure on patients based purely on the content of these videos. Causes: Any situation arising in a diabetic that requires increased insulin without that demand being met can result in DKA. PA EMT Said COVID Patient Didnt Need to Go to the Hospital. We are looking for declaration of DKA and request for pathway. Finally, we summarize the course and give them time for questions. Discuss the patients current clinical condition with aseniorclinicianusing anSBARR style handover. Note that if-thens must also include negative patient outcomes for when the provider doesnt take appropriate action. Its important to train and educate students of prehospital care on key indicators of a diabetic emergency. Clearly communicate how often would you like the patients observations relayed to you by other staff members. Clearlydocument your ABCDE assessment, including history, examination, observations, investigations, interventions, and the patients response. We do not use passive visualizing materials such as videotapes or DVD other than vital signs shown on the monitors. 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. unilateral coarse crackles may be present if the patient has pneumonia which may have been the precipitant for DKA). The patient synopsis should include such standard aspects as age, sex, ethnicity, medical history, medications and allergies. Inspect theairwayfor obviousobstruction. Indeed, it is the only thing that ever has.". After initial insulin therapy has reduced plasma blood glucose levels (e.g. endobj Int J Evid Based Healthc. Askhow the patient is feeling as this may provide some useful information about their current symptoms. A pre-briefing session is conducted prior to the start of the simulation scenario. Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. His Heart Stopped On a Treadmill. If you have any scenarios you would be willing to share with the simulation community, please forward them . 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. Heart: S1 and S2 within normal limits; no S3/S4 or murmurs, normal rate and rhythm. 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. Extremities: mild cyanosis, no clubbing or edema (verbalized by instructors); pulses equal, and symmetrical (elucidated by trainees). Diabetes (type 1 and type 2) in children and young people: diagnosis and management. PBL was introduced at our institution in 1995. Tilt the forehead back whilst lifting the chin forwards to extend the neck. >> Fernandez AR, Mac Crawford J, Pennell ML, et al. There are several causes of DKA, which we remember by the "five I's". 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). Margolis GS, Romer GA, Fernandez AR, et al. The main purpose of the simulation is to draw a line from the theoretical, boring biochemistry to the clinical manifestations. It was developed for anesthesiology resident physicians with some background knowledge and experience caring for critically ill patients. - Onset 01:48 If the patient loses consciousness and there are no signs of life on assessment, put out a crash call and commence CPR. 3. Published August 2015. 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. Could we not just do this as a large group session to all 160 students (versus 20 1-hour sessions to groups of eight students)? Because of the early stage (first year) of their medical careers, they have not yet seen vital sign monitoring, or patients, so these clinical aspects are introduced and emphasized. You may be asked to review a patient with DKA due to confusion, reduced level of consciousness, tachycardia, hypotension and/or vomiting. It was 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. % Emergency medical services workLife characteristics contribute to clinically significant excessive daytime sleepiness. Refer to your local guidelines which should provide a clear protocol for the management of DKA. Trainee will appropriately request assistance and use available resources. 3. YouTube Video VVVram5yRUhROGJRUW1sZk5kQVFDXzV3LjMxakdNallNcng0, YouTube Video VVVram5yRUhROGJRUW1sZk5kQVFDXzV3LkJPVjVZMzBKczY4, YouTube Video VVVram5yRUhROGJRUW1sZk5kQVFDXzV3LkxEM2VkQzB2NTBr, Start typing to see results or hit ESC to close, Deep Vein Thrombosis (DVT) Examination OSCE Guide, Pre-hospital Advanced Life Support (ALS) OSCE Guide, Adult Choking (Basic Life Support) OSCE Guide, Paediatric Intravenous Cannulation OSCE Guide, Intrauterine System (Mirena) Counselling OSCE guide, Geeky Medics OSCE Book | Clinical Examination, Paediatric Gastro-oesophageal Reflux Disease, A Career as a GP with Special Interest with Dr Fiona Mosgrove, Absolute insulin deficiency (e.g. A collection of surgery revision notes covering key surgical topics. Manikin staging can provide strong cues. 3. If the patient is conscious, sit themuprightas this can also help with oxygenation. The instructor can also gauge the direction the debriefing session should follow or be alerted to possible problems or conflicts in treatment opinions. Simulation Scenario for Anesthesia Providers Clark Obr, MD*, Anthony Mueller, MD . Case-based education adds a real-world aspect to the learning environment. Alert a senior immediately if you have any concerns about the consciousness level of a patient. During an immersive simulation, its imperative the group uses critical-thinking skills and group collaboration independently. Just place the BR2_KDCA file into your addons scenery folder: C:\\Program Files\\Microsoft Games\\Microsoft Flight Simulator X\\Addon Scenery\\Scenery. TikTok: https://www.tiktok.com/@geekymedics >> Patterson PD, Weaver M, Frank R, et al. Make sure to re-assess the patient after any intervention. It involves working through the following steps: Each stage of the ABCDE approach involvesclinicalassessment,investigationsandinterventions. We used the Medical Education Technologies Inc. (METI) Human Patient Stimulator (HPS, METI Sarasoto, Fl). The students mentioned that they did not obtain the maximum value from the simulation session under these circumstances. www.cdc.gov/diabetes/statistics/prev/national/. 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. 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. If the patient isunconsciousorunresponsive, start thebasic life support(BLS)algorithmas per resuscitation guidelines. 1. - Over 3000 Free MCQs: https://geekyquiz.com/ #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! 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. Trainee will practice or observe good teamwork skills, both as a leader and a team player. 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. Chapters: This video demonstrates how to use the SOCRATES acronym when taking a history of pain or other symptoms. 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! modify the keyword list to augment your search. The researchers found that long shift hours (24hrs), working overtime and marital/relationship stress were strongly correlated. Insert at least onewide-bore intravenous cannula(14G or 16G) and take blood tests as discussed below. Section snippets . DO NOT perform any examination or procedure on patients based purely on the content of these videos. 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. Review the patientscurrent medicationsand check any regular medications areprescribed appropriately. Open the patients mouth to ensure there is no foreign material that may be pushed into the larynx. 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. DO NOT perform any examination or procedure on patients based purely on the content of these videos. See ourintravenous cannulation guidefor more details. 1 Potassium losses occurring both before and during treatment of DKA must be replaced. . Properly interpret a venous blood gas (VBG) and basic metabolic panel in a patient presenting with diabetic ketoacidosis. Because of this consciousness status, it is very difficult to obtain information of cardiovascular, pulmonary, renal, hepatic, endocrine, hematology, or coagulation status other than uncontrolled diabetes. However, this leads to confusion. The lecture allows for understanding of concepts prior to action, and instructor feedback is immediate. Search for Similar Articles This allows us to get in touch for more details if required. 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 . Consider active re-warming techniques in patients with severe hypothermia. vD0 x@FFJ{m[ 3//Oh|JR7! 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. 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. 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 . By joining Cureus, you agree to our An hour was . 2. 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. 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. Given such a small group, the students indicated that they feel more involved than they would with a larger group (eg, the whole class.) She Died the Next Day. Recognize the signs and symptoms of a patient presenting with diabetic ketoacidosis. This guide provides an overview of the recognition and immediate management of diabetic ketoacidosis (DKA)using an ABCDE approach. Invasive monitors, including a left radial intraarterial and a right subclavian IV catheter, were placed. Supplemental digital content is available for this article. 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. TheABCDEapproach can be used to perform a systematic assessment of a critically unwell patient. Review the patientsoxygen saturation(SpO2): Auscultate the chest to screen for evidence of respiratory pathology (e.g. Airway adjuncts are often helpful and in some cases essential to maintain a patients airway. 2010;49:578586. Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario Cureus. This may produce better retention of the subject matter and help students adapt to emergency scenes before going into the field. 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. This typically involves the use of anon-rebreathe maskwith an oxygen flow rate of15L. 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.. Rosens Emergency Medicine: Concepts and Clinical Practice. Privacy Policy Her medical, social, and family histories are not clear at the time of admission to the emergency department. The student group should be encouraged to collaborate on management options and to perform skills. Strategies of high-performing paramedic educational programs. 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 See Table 4 for a suggested standardized script. The Theory The validity of the HFS-DKA scenario was verified by a certified diabetes nurse educator, a registered nurse, and a clinical nurse educator. If the patient has COPD and a history of CO2retention you should switch to aventuri maskas soon as possible andtitrate oxygen appropriately. A collection of interactive medical and surgical clinical case scenarios to put your diagnostic and management skills to the test. Over the years, some groups happened to have the simulation session before the completion of the theoretical PBL session. It involves a facilitating instructor, a small learner group and conceptual aspects of environmental and manikin staging to provide sensory cues. Trainee will be respectful to others and their views during the PBL session. His Wife Gave Him CPR. 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. x]o ]?9kgq~:)?hE )R6!up}\<8||\]}Y~;xp~yQ$#4~djX&{n_m-]^K1/~/AD Hv 99evs,;8}8zwnhFxV.kf-V^? In an animated lecture, its important that the student group have an instructor so they can ask direct questions. Nandate, Koichiro MD, PhD; Abola, Ramon MD; Murray, W Bosseau MB; Whitfield, Carol PhD; Lang, Charles PhD; Sinz, Elizabeth MD. 4. 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. SimMan Nursing Scenarios Software. To read Pages full Research Review column, visit www.jems.com/patient-care. Keywords: diabetic ketoacidosis, simulation, expertise, emergency medicine Introduction Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes mellitus, most . The required potassium replacement varies greatly. 2011;15:108109. Medical Simulation Scenarios are text documents outlining the various details of a simulation - everything from patient simulator settings to debriefing notes. 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 | Children's Hospital of Philadelphia 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). We also show them IV bags containing saline and Ringers lactate, as well as show them IV infusion sets. This is a 25-year-old woman with a medical history of diabetes medicated with 40 units insulin per day. You may be trying to access this site from a secured browser on the server. Each PBL case typically goes over 23 days, affording the students periods to find information for the case. Despite this increased calorie intake, she noticed an unexplained 20 lbs weight loss. We now provide the students with handouts of the data to save time and provide consistency. Trainee will learn to collaborate with peers to decide on appropriate interventions, tests, and therapy. At the end of the previous section, the trainee can make the diagnosis of DKA but has not confirmed it yet. type 1 diabetes), Complete insulin insensitivity (e.g. Introduceyourselfto thepatientincluding yournameandrole. Hypothermia may be present if the patient has been unconscious and exposed for some time. KDCA, Ronald Reagan Washington National Airport, DC. Use washable, non-toxic paints to imitate various body emissions. Initially, we used a blood pressure cuff to generate the blood pressure values. A list of the requirements (monitors, props, and others) is given in Tables 2 and 3, as well as in the web supplement (Appendix C, Supplemental Digital Content 3, https://links.lww.com/SIH/A3). - Geeky Medics OSCE App: https://geekymedics.com/geeky-medics-app/ 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. After entering the environment, the student doesnt have the option of leaving the simulation until the learning objectives and performance measures are achieved. Inspect for evidence of infection on the skin (e.g. Development of simulation scenarios for an adolescent patient with diabetic ketoacidosis. 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