dka simulation scenario

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. The instructor should have visual access via one-way windows or cameras. 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].. These are not learning objectives in this program. Emergency medical services workLife characteristics contribute to clinically significant excessive daytime sleepiness. A nasopharyngeal airway is a soft plastic tube with a bevel at one end and a flange at the other. (1) The assessment of a diabetic patient is best taught as a. and PDF Adult Type I Diabetic Ketoacidosis Pre-simulation Preparation Student Clearly communicate how often would you like the patients observations relayed to you by other staff members. She began experiencing progressively worsening thirst, increased appetite, and excessively increased urination. www.cdc.gov/diabetes/statistics/prev/national/. A collection of anatomy notes covering the key anatomy concepts that medical students need to learn. Simulation of Diabetic Ketoacidosis for Cellular and Molecul She does not take this regularly. - Exacerbating & relieving factors 05:12 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. A comprehensive collection of medical revision notes that cover a broad range of clinical topics. Lets discuss your options. Please enable scripts and reload this page. Simulation Scenario for Anesthesia Providers Clark Obr, MD*, Anthony Mueller, MD . The 60 minutes training time consists of four 15-minute sections divided as follows. - Medical Finals Question Pack: https://geekymedics.com/medical-student-finals-questions/ opioids, sedatives, anxiolytics, insulin, oral hypoglycaemic medications). Outcomes Educating Nursing Students Using an Evolving, Simulated Case Several environments may be suitable for your classroom. Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. 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. This guide provides an overview of the recognition and immediate management of diabetic ketoacidosis (DKA)using an ABCDE approach. Each PBL case typically goes over 23 days, affording the students periods to find information for the case. Make sure tore-assessthe patient after anyintervention. Pediatric Emergency Medicine Didactics and Simulation (PEMDAS 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 . DO NOT perform any examination or procedure on patients based purely on the content of these videos. Initially, we required the students to write down the vital signs. It involves working through the following steps: Each stage of the ABCDE approach involvesclinicalassessment,investigationsandinterventions. Interactive lecture/discussion with use of monitors that show the vital signs of the simulated patient on manikin. 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! To read Pages full Research Review column, visit www.jems.com/patient-care. Insert at least onewide-bore intravenous cannula(14G or 16G) and take blood tests as discussed below. 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. Measure the patients capillary blood glucose and ketone levels to confirm the diagnosis and guide the management of DKA. Case-based education adds a real-world aspect to the learning environment. Urinary tract infections are a common DKA precipitant. TheABCDEapproach can be used to perform a systematic assessment of a critically unwell patient. Review the patientscurrent medicationsand check any regular medications areprescribed appropriately. Please try after some time. Observe and discuss the effects of therapy in a mathematically modeled physiological simulator. The students have acquired all the applicable theoretical knowledge of the case during the previous multiday PBL sessions. Available from: [. #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! 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. may email you for journal alerts and information, but is committed 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. The student group should be encouraged to collaborate on management options and to perform skills. PBL was introduced at our institution in 1995. The researchers found that long shift hours (24hrs), working overtime and marital/relationship stress were strongly correlated. DKA can develop within 24 hours and is potentially life threatening, requiring prompt recognition and therapeutic intervention. Recognize the signs and symptoms of a patient presenting with diabetic ketoacidosis. We now provide the students with handouts of the data to save time and provide consistency. 1. If the patient isunconsciousorunresponsive, start thebasic life support(BLS)algorithmas per resuscitation guidelines. It should only be inserted in unconscious patients as it is otherwise poorly tolerated and may induce gagging and aspiration. Use washable, non-toxic paints to imitate various body emissions. We believe it is important to have active, participatory learning by having conversations with the trainees in the form of questions and answers. See ourCXR interpretation guidefor more details. The Theory Supplemental digital content is available for this article. areas of lipohypertrophy) if it is unclear if the patient is diabetic. DKA can be caused by either: Absolute insulin deficiency (e.g. TikTok: https://www.tiktok.com/@geekymedics Clearlydocument your ABCDE assessment, including history, examination, observations, investigations, interventions, and the patients response. The instructor can also gauge the direction the debriefing session should follow or be alerted to possible problems or conflicts in treatment opinions. Simulation student Scenario- DKA-Peds.docx - DIABETIC Published August 2015. There are several causes of DKA, which we remember by the "five I's". Manikin staging can provide strong cues. Search for Similar Articles A collection of interactive medical and surgical clinical case scenarios to put your diagnostic and management skills to the test. 2011;15:108109. Typically potassium levels should be maintained between 4.0 5.5 mmol/L and close monitoring is required. Prehosp Emerg Care. PDF Diabetic Ketoacidosis in the Obstetric Population: A Simulation Below is a collection of donated scenarios for you to use or modify. Consider any precipitating factors for the development of DKA and involve the diabetes team in the patients care. An hour was . 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. See ourfluid prescribing guidefor more details onresuscitation fluids. Before trainees arrival into the simulation area, the simulator is already preprogrammed for DKA. A number of key modifiers are described that allow for the adjustment of case . 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. 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. diagnosis of DKA Trigger 3, ABG show acidosis and high BM and normal potassium. Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario This simulation session therefore aims to make the case come alive, and show this known case in a clinical context. A traditional classroom lecture format allows for student participation but limits the instructors ability to create realistic situations. }HyEf,#$/JSRU9+CF6k\'/z+i`[ 5JudK*Zly^g%[jCK)H[)Y=Qp0/r9o9HW_zF}pTzI~'|q.~:=Y T 9w! If you'd like to support us and get something great in return, check out our awesome products: You don't need to tell us which article this feedback relates to, as we automatically capture that information for you. The reason for inserting the airway upside down initially is to reduce the risk of pushing the tongue backwards and worsening airway obstruction. Trainee will recognize the need for therapy and suggest an appropriate therapy in a simulated environment. Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario Cureus. After entering the environment, the student doesnt have the option of leaving the simulation until the learning objectives and performance measures are achieved. oral fluids, intravenous fluids, urine output, drain output, stool output, vomiting) to inform resuscitation efforts. 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. If the patientloses consciousnessand there areno signs of lifeon assessment, put out acrash callandcommence CPR. 1 0 obj Creating a Simulation Experience to Promote Clinical Judgment This is particularly important for core cases and low-frequency, high-stakes procedures and encounters. If the patient has COPD and a history of CO2retention you should switch to aventuri maskas soon as possible andtitrate oxygen appropriately. Target Learner Groups You may search for similar articles that contain these same keywords or you may The students are in their first year. A collection of free medical student quizzes to put your medical and surgical knowledge to the test! Teaching nursing management of diabetic ketoacidosis: a description of Reduced urine output (oliguria) is typically defined as less than 0.5ml/kg/hour in an adult. MassBay EMS Program Integrates Training for Dogs, Heat Waves Are Killing More LA Homeless People. In keeping with the case study, as a treatment marker is reached, the instructor should place emphasis on physiological, pharmacological, environmental and psychosocial issues. When erroneous treatment is delivered, the instructor can end the simulation. Does the patient need a referral toHDU/ICU? For instance, one of the questions is: Why is Tiffany dehydrated? There are several possible reasons and mechanisms (as outlined in Appendix B, fourth 15 minutes, Supplemental Digital Content 2, https://links.lww.com/SIH/A2), which the students can mention. 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. The students mentioned that they did not obtain the maximum value from the simulation session under these circumstances. Geeky Medics accepts no liability for loss of any kind incurred as a result of reliance upon the information provided in this video. Debriefing An animated lecture may be described as a pseudo-simulation environment. 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. - Introduction 00:00 Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario 2010;49:578586. DKA can develop within 24 hours and is potentially life threatening, requiring prompt recognition and therapeutic intervention. A simulation training session is described designed to acquaint emergency medicine residents with the presentation and management of diabetic ketoacidosis through the use of simulation. Experience has shown that the more experienced the provider, the more detailed the environmental and manikin staging should be, because providers are trained to take in and interpret visual cues as indicators of patient status. There are just a few more things to do. 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). 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. We ask the trainee why the blood pressure is so low or heart rate is so high, and how we should treat it. Perform urinalysis and send the urine for culture if urinary tract infection is suspected. Prehosp Emerg Care. <>>> A collection of data interpretation guides to help you learn how to interpret various laboratory and radiology investigations. Finally, we summarize the course and give them time for questions. Clinical Simulation in Nursing, Volume 39, 2020, pp. 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 Categories: Emergency Medicine, Medical Education Keywords: diabetic ketoacidosis, simulation, expertise, emergency medicine . If the patient loses consciousness and there are no signs of life on assessment, put out a crash call and commence CPR. 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 is confused you might be able to get a collateral history from staff or family members as appropriate. Strategies of high-performing paramedic educational programs. Creating a Simulation Experience to Promote Clinical Judgment As this is an interactive discussion session, any needed debriefing and/or explanation is given during the sessions. type 1 diabetes), Complete insulin insensitivity (e.g. Invasive monitors, including a left radial intraarterial and a right subclavian IV catheter, were placed. 2017 May 29;9(5):e1286. JEMS. Int J Evid Based Healthc. 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. A GCS of 8 or below warrants urgent expert help from an anaesthetist. An oxygen mask is also demonstrated as an alternative device, as these early trainees had mostly not yet seen any of these devices. She is lethargic and slightly confused but can intermittently respond to questions. 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. 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. 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. In the final 10 minutes, we show how the patient has a good recovery after fluid replacement. Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. Some error has occurred while processing your request. Are any further assessments or interventions required? Please write a single word answer in lowercase (this is an anti-spam measure). Diabetic ketoacidosis simulator: a new learning tool for a life cloudy urine may indicate urinary tract infection). 3. PDF Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario Please try again soon. I assigned true to life parking codes, and added some extra parking for the superfluous US Express AI. NPAs are typically better tolerated in patients who are partly or fully conscious compared to oropharyngeal airways. can be reemphasized, and the effects of fluid therapy demonstrated. Glycosuria leads to urinary losses of potassium through osmotic diuresis. 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. 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. Conclusions This technical report describes the design and implementation of a simulation scenario on DKA for emergency medicine trainees. In other words, they do not have clinical experience, but they have clinical knowledge. 2. unilateral coarse crackles may be present if the patient has pneumonia which may have been the precipitant for DKA). - PSA Question Pack: https://geekymedics.com/psa-question-bank/ Hypothermia may be present if the patient has been unconscious and exposed for some time. Should any changes be made to the current management of their underlying condition(s)? Facilitator to ask how often to measure BMs Groups of fewer than four students dont allow for optimal collaboration. Inspect theairwayfor obviousobstruction. By joining Cureus, you agree to our You might also be interested in our awesome bank of 700+ OSCE Stations. 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. Surgical dressings and imitation blood can support medical history. 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 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 . - 700+ OSCE Stations: https://geekymedics.com/osce-stations/ See ourintravenous cannulation guidefor more details. The use of case-based simulation, although more complicated and time consuming for the instructor, immerses the students in the subject matter. 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. Healthcare Students' Psychological Well-Being in a Diabetic Ketoacidosis Simulation. The learning environment should closely mimic real-world applications. Cureus 9(5): e1286. If the patient is suspected to have sufferedsignificanttraumawith potential spinal involvement, perform ajaw-thrustrather than a head-tilt chin-lift manoeuvre: 2. 1. In an animated lecture, its important that the student group have an instructor so they can ask direct questions. 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. 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). The normal reference range for fasting plasma glucose is 4.0 5.8 mmol/l. Pediatric Emergency Medicine Didactics and Simulation (PEMDAS Trainee will practice or observe good teamwork skills, both as a leader and a team player. Stage 3: Ongoing management and monitoring of DKA 1 hour after initiation of treatment. DOI 10.7759/cureus.1286. endobj Trainee will describe the changes in vital signs, the major metabolic, fluid, and electrolyte. Revisit history taking to explore relevant medical history and identify any precipitating factors for DKA. Ketones show 5.5. However, this turned out to be too slow, took too much time, and could not continuously demonstrate the direction of changes. It was developed for anesthesiology resident physicians with some background knowledge and experience caring for critically ill patients. 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.