dka simulation scenario

DKA can develop within 24 hours and is potentially life threatening, requiring prompt recognition and therapeutic intervention. Airway adjuncts are often helpful and in some cases essential to maintain a patients airway. As with the animated lecture, the simulation is strongly dependent on a focused case study. Stage 1: Initial assessment of acutely unwell pregnant woman and diagnosis of DKA. and Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario Cureus. The instructor should have visual access via one-way windows or cameras. 4. A collection of data interpretation guides to help you learn how to interpret various laboratory and radiology investigations. Revisit history taking to explore relevant medical history and identify any precipitating factors for DKA. Please try again soon. - Character 02:14 TheABCDEapproach can be used to perform a systematic assessment of a critically unwell patient. A blood glucose level may already be available from earlier investigations (e.g. 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. 4. 3. Effectiveness of simulation on health profession students knowledge, skills, confidence and satisfaction. Askhow the patient is feeling as this may provide some useful information about their current symptoms. Antibiotics should be prescribed in keeping with local guidelines. We ask the trainee why the blood pressure is so low or heart rate is so high, and how we should treat it. When erroneous treatment is delivered, the instructor can end the simulation. A comprehensive collection of medical revision notes that cover a broad range of clinical topics. As this is a PBL session, the trainees are not given any references. Just place the BR2_KDCA file into your addons scenery folder: C:\\Program Files\\Microsoft Games\\Microsoft Flight Simulator X\\Addon Scenery\\Scenery. Urinary tract infections are a common DKA precipitant. We have 18 to 20 PBL groups for an hour each in the week after their PBL DKA session. LYqC+pJ&6X4onfBT#?=R}.p8N3+Dk,P4tIgWB}-L'=8;_G >,K#.e89XnG'B~NtR An animated lecture may be described as a pseudo-simulation environment. endobj The main goal is to establish a safe learning environment for the learner [9, 13 . The teaching of diabetic assessment and management, like many other medical emergencies, lends itself well to case-based simulation. 1. your express consent. Please write a single word answer in lowercase (this is an anti-spam measure). If you have any scenarios you would be willing to share with the simulation community, please forward them . Simulation provides a safe environment where learning is enhanced through the deliberate practice of skills and controlled management of a variety of clinical encounters. - Exacerbating & relieving factors 05:12 stream Please try after some time. In the meantime, you can perform some basic airway manoeuvres to help maintain the airway whilst awaiting senior input. 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. 3. Standardized patient as the voice of the simulator (or the simulation operator may play this role). The student group should be encouraged to collaborate on management options and to perform skills. Trainee will correlate the underlying pathophysiology with symptoms and signs as exhibited by the simulation session. Twitter: http://www.twitter.com/geekymedics Using your thumbs, slightly open the mouth by downward displacement of the chin. Discuss the patients current clinical condition with aseniorclinicianusing anSBARR style handover. 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. Healthcare Students' Psychological Well-Being in a Diabetic Ketoacidosis Simulation. From the Department of Anesthesiology, Pennsylvania State University College of Medicine, Hershey, PA. Dr. Murray is on the Speakers Bureau of METI, Sarasota, FL. 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. }HyEf,#$/JSRU9+CF6k\'/z+i`[ 5JudK*Zly^g%[jCK)H[)Y=Qp0/r9o9HW_zF}pTzI~'|q.~:=Y T 9w! In this case scenario, dehydration is one of the most serious immediate issues. You can check out our guide to using SOCRATES here: https://geekymedics.com/the-socrates-acronym-in-history-taking/ DO NOT perform any examination or procedure on patients based purely on the content of these videos. I assigned true to life parking codes, and added some extra parking for the superfluous US Express AI. We used the Medical Education Technologies Inc. (METI) Human Patient Stimulator (HPS, METI Sarasoto, Fl). 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. Hypothermia may be present if the patient has been unconscious and exposed for some time. We believe it is important to have active, participatory learning by having conversations with the trainees in the form of questions and answers. JEMS. Observe and discuss the effects of therapy in a mathematically modeled physiological simulator. An events progression section should include patient status changes, as well as a time/treatment continuum that incorporates if-then event progressions. . This typically involves the use of anon-rebreathe maskwith an oxygen flow rate of15L. 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 provides a safe environment where learning is enhanced through the deliberate practice of skills and controlled management of a variety of clinical encounters. %PDF-1.5 dq-]gX4 `L'u7myx) rpjf0z,.y`VMyx-&Ju`U0 1. An integral part of a PBL session is for trainees to be able to navigate through huge literature bases. However, this turned out to be too slow, took too much time, and could not continuously demonstrate the direction of changes. A GCS of 8 or below warrants urgent expert help from an anaesthetist. If the patientloses consciousnessand there areno signs of lifeon assessment, put out acrash callandcommence CPR. Initially, we used a blood pressure cuff to generate the blood pressure values. 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. Prehosp Emerg Care. Administer oxygen to all critically unwell patients during yourinitialassessment. 3. Ask for anotherclinicalmemberofstafftoassistyou if possible. Each clinical case scenario allows you to work through history taking, investigations, diagnosis and management. endobj Strategies of high-performing paramedic educational programs. Properly interpret a venous blood gas (VBG) and basic metabolic panel in a patient presenting with diabetic ketoacidosis. Typically potassium levels should be maintained between 4.0 5.5 mmol/L and close monitoring is required. Animated Lecture A number of key modifiers are described that allow for the adjustment of case . Weight, Height: Not given, normal appearing (as per simulator) but has lost 20 lbs recently. We guide the group to suggest fluid. (1) The assessment of a diabetic patient is best taught as a. Trainee will be respectful to others and their views during the PBL session. This session provides additional clinical support material for the theoretical PBL session. 2003;78:783788. 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. Insert the airway bevel-end first, vertically along the floor of the nose with a slight twisting action. Much time was wasted explaining why it did not matter. 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 - 150+ PDF OSCE Checklists: https://geekymedics.com/pdf-osce-checklists/ 1. J Nurs Educ. Depending on scenario complexity, team dynamic and treatment modalities, this simulation may take 1020 minutes. Invasive monitors, including a left radial intraarterial and a right subclavian IV catheter, were placed. Intubation lubricants can mimic drooling. Instagram: https://instagram.com/geekymedics There are several causes of DKA, which we remember by the "five I's". 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. If fever is present, make sure to consider co-existing infection. After the first voluntary session in 2006, feedback from the medical students indicated that they would like to receive this handout. 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. Published August 2015. This allows the learner group to make a psychological break from the patient and environment while beginning the reflection process. See ourintravenous cannulation guidefor more details. 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. This is a 25-year-old woman with a medical history of diabetes medicated with 40 units insulin per day. DO NOT perform any examination or procedure on patients based purely on the content of these videos. Trainee will improve their understanding of clinical practice through reflective assessment of actual cases during the prior PBL sessions. 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 . 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). In some cases, normal saline with additional potassium is required to prevent overcorrection of serum potassium levels which would otherwise result in hypokalaemia. Research Watch Box:Sleep, Fatigue & SafetyBy David Page, MS, NREMT-P Some error has occurred while processing your request. (1) According to Centers for Disease Control and Prevention (CDC), 223,619 deaths were attributed to diabetes in 2005. The optimal number of simulation participants is four to seven individuals, depending on the case study objectives. 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. Questionswhich may need to be considered include: The next team of doctors on shift should bemade awareof any patient in their department who hasrecently deteriorated. Therefore, we have to emphasize the importance of airway, breathing, and circulation in the very sick patient in any clinical setting. Categories: Emergency Medicine, Medical Education Keywords: diabetic ketoacidosis, simulation, expertise, emergency medicine . Many of the preclinical students have never seen a real life clinical monitor or even an intravenous (IV) setup. Data is temporarily unavailable. 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. The Theory See our blood glucose measurement guide for more details. 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. At the end of the previous section, the trainee can make the diagnosis of DKA but has not confirmed it yet. Introduceyourselfto thepatientincluding yournameandrole. A collection of free medical student quizzes to put your medical and surgical knowledge to the test! 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. Facilitator to ask how often to measure BMs Animated lectures, however, must work within the framework of a focused case study, which requires increased preparation time. Each performance measure is separated into cognitive, behavioral or technical categories. 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. 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. Problems are addressed as they are identified and the patient is re-assessed regularly to monitor their response to treatment. 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.. 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). Centers for Disease Control and Prevention. Your message has been successfully sent to your colleague. His Wife Gave Him CPR. Consider any precipitating factors for the development of DKA and involve the diabetes team in the patients care. Trainee will appropriately request assistance and use available resources. 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. 6. Rosens Emergency Medicine: Concepts and Clinical Practice. - Severity 05:32 The use of case-based simulation, although more complicated and time consuming for the instructor, immerses the students in the subject matter. A strong emphasis is placed on the focused, methodical examination of a specific medical problem and the decision-based treatment options available. The files are given in full in the web supplement (Appendix B, Supplemental Digital Content 2, https://links.lww.com/SIH/A2). The student group is given a short introduction into a closed simulation environment. Initially, we required the students to write down the vital signs. confusion, coma), All critically unwell patients should have. Available from: [. In the meantime, you should re-assess and maintain the patients airway. 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. Simulation Scenario for Anesthesia Providers Clark Obr, MD*, Anthony Mueller, MD . Margolis GS, Romer GA, Fernandez AR, et al. DO NOT perform any examination or procedure on patients based purely on the content of these videos. If foreign material is present, attempt removal using suction. <>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 595.32 841.92] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> Finally, we summarize the course and give them time for questions. Please enable scripts and reload this page. Place one hand on the patients forehead and the other under the chin. A pre-briefing session is conducted prior to the start of the simulation scenario. 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. 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. 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. Scenarios. 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). 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. Groups of more than seven may struggle with meeting objectives due to insufficient functional rolls. Makeup may be used to depict gender, hollow eyes and cheeks, produce pallor or display bruises and scars. Terms of Use. 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. 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 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. 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. A chest X-ray should not delay the emergency management of DKA. Its important to train and educate students of prehospital care on key indicators of a diabetic emergency. Advance the airway until it lies within the pharynx. The objective is to give as many visual and tactile cues concerning the patient condition and background as possible. - Timing 03:23 She is lethargic and slightly confused but can intermittently respond to questions. You may be trying to access this site from a secured browser on the server. Before trainees arrival into the simulation area, the simulator is already preprogrammed for DKA. 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). Diabetes (type 1 and type 2) in children and young people: diagnosis and management. Immersive Simulations The patient synopsis should include such standard aspects as age, sex, ethnicity, medical history, medications and allergies. The use of a simulated, evolving case scenario was an effective method of exposing nursing students to complex patient care. - Introduction 00:00 The immersive simulation is performed when the instructor feels comfortable with the acquired knowledge and skill base presented in the animated lecture or when the student group has sufficient practical experience to apply the cognitive, behavioral and technical skills outlined in the case scenario. It was Review thepatients notes,chartsandrecent investigation results. During an immersive simulation, its imperative the group uses critical-thinking skills and group collaboration independently. Geeky Medics accepts no liability for loss of any kind incurred as a result of reliance upon the information provided in this video. Using SOCRATES in History Taking | OSCE | Communication Skills, Diabetic Ketoacidosis (DKA) | Acute Management | ABCDE. 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. We also show them IV bags containing saline and Ringers lactate, as well as show them IV infusion sets. Join the Geeky Medics community: - Over 3000 Free MCQs: https://geekyquiz.com/ 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.) If the patient loses consciousness and there are no signs of life on assessment, put out a crash call and commence CPR. Geeky Medics accepts no liability for loss of any kind incurred as a result of reliance upon the information provided in this video. The simulation session is also hosted as an interactive session. DOWNLOAD Diabetic Ketoacidosis By the end of this scenario, the learner will be able to: 1. - Examples 05:45 Ziv A, Wolpe PR, Small SD, et al. 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. Clearlydocument your ABCDE assessment, including history, examination, observations, investigations, interventions, and the patients response. If you have any scenarios you would be willing to share with the simulation community, please forward them to me. Both external and internal potassium balances are disturbed during the development and treatment of DKA. 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. A debriefing section with pre-established questions allows the instructor to review the main focus and performance measures with the student group. 3 0 obj Diabetes mellitus affects nearly 7.8% of the U.S. population, with approximately 510% of this group affected by Type I and 9095% by Type II.1 Diabetes is the most common type of endocrine disease and was the seventh leading underlying cause of death listed on death certificates in 2006.