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. A collection of interactive medical and surgical clinical case scenarios to put your diagnostic and management skills to the test. Available from: [, NICE guidelines. In the meantime, you can perform some basic airway manoeuvres to help maintain the airway whilst awaiting senior input. A number of key modifiers are described that allow for the adjustment of case . They have had no clinical exposure or any clinical experience. If you have any scenarios you would be willing to share with the simulation community, please forward them . They should introduce the student group to the environment, assign roles for each learner and guide the decision-making process. Schneider Sarver PA, Senczakowicz EA, Slovensky BM. - Over 3000 Free MCQs: https://geekyquiz.com/ www.cdc.gov/diabetes/statistics/prev/national/. She does not take this regularly. The DKA simulation incorporates cue recognition, analysis of cues, generation of solutions, nursing interventions, and evaluation of outcomes, including effective communication and psychosocial concerns. In the final 10 minutes, we show how the patient has a good recovery after fluid replacement. DKA can be caused by either: Absolute insulin deficiency (e.g. DY{Qb"(EgN$QI*%XN1F""0a5 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. A debriefing section with pre-established questions allows the instructor to review the main focus and performance measures with the student group. and Introduceyourselfto whoever has requested a review of the patient andlistencarefullyto their handover. Join the Geeky Medics community: 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. Your message has been successfully sent to your colleague. I assigned true to life parking codes, and added some extra parking for the superfluous US Express AI. - Character 02:14 See ourCXR interpretation guidefor more details. In an animated lecture, its important that the student group have an instructor so they can ask direct questions. Insert the airway bevel-end first, vertically along the floor of the nose with a slight twisting action. We give the history of the patient to the trainees. Development of simulation scenarios for an adolescent patient with diabetic ketoacidosis. The questionnaire for the assessment of the session is given in full in the web-based supplement (Appendix A, Supplemental Digital Content 1, https://links.lww.com/SIH/A1). The validity of the HFS-DKA scenario was verified by a certified diabetes nurse educator, a registered nurse, and a clinical nurse educator. You can check out our guide to using SOCRATES here: https://geekymedics.com/the-socrates-acronym-in-history-taking/ Assess the patients level of consciousness using the AVPU scale: If a more detailed assessment of the patients level of consciousness is required, use the Glasgow Coma Scale (GCS). The instructors role is to facilitate active learning through a combination of learning styles. The students are in their first year. 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. The Pratcice Trigger 4, Pathway 1l of saline required over 1hour and insulin infusion need prescribing and making up in 50ml syringe. 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. 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. Finally, we summarize the course and give them time for questions. We have 18 to 20 PBL groups for an hour each in the week after their PBL DKA session. Initially, we required the students to write down the vital signs. The objective is to give as many visual and tactile cues concerning the patient condition and background as possible. It involves working through the following steps: Each stage of the ABCDE approach involvesclinicalassessment,investigationsandinterventions. 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. Deteriorationshould be recognised quickly and acted upon immediately. His Heart Stopped On a Treadmill. type 1 diabetes), Complete insulin insensitivity (e.g. The use of simulation-based instruction enables a student to learn at their own pace and allows them to repeat sequential steps to gain confidence and proficiency. During an immersive simulation, its imperative the group uses critical-thinking skills and group collaboration independently. Both external and internal potassium balances are disturbed during the development and treatment of DKA. Int J Evid Based Healthc. - Timing 03:23 Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario Cureus. Review the patients drug chart for medications which may cause a reduced level of consciousness (e.g. Initially, we used a blood pressure cuff to generate the blood pressure values. Discuss the patients current clinical condition with aseniorclinicianusing anSBARR style handover. 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 x]o ]?9kgq~:)?hE )R6!up}\<8||\]}Y~;xp~yQ$#4~djX&{n_m-]^K1/~/AD Hv 99evs,;8}8zwnhFxV.kf-V^? Re-assessthe patient using theABCDE approachto identify any changes in their clinical condition and assess the effectiveness of your previous interventions. Conclusions This technical report describes the design and implementation of a simulation scenario on DKA for emergency medicine trainees. It involves a facilitating instructor, a small learner group and conceptual aspects of environmental and manikin staging to provide sensory cues. 2010;49:578586. - Introduction 00:00 cloudy urine may indicate urinary tract infection). Invasive monitors, including a left radial intraarterial and a right subclavian IV catheter, were placed. . You may be asked to review a patient with DKA due to confusion, reduced level of consciousness, tachycardia, hypotension and/or vomiting. Askhow the patient is feeling as this may provide some useful information about their current symptoms. You may search for similar articles that contain these same keywords or you may The optimal number of simulation participants is four to seven individuals, depending on the case study objectives. Note that if-thens must also include negative patient outcomes for when the provider doesnt take appropriate action. - 700+ OSCE Stations: https://geekymedics.com/osce-stations/ Management of diabetic ketoacidosis in adults. 4 0 obj Consider active re-warming techniques in patients with severe hypothermia. PA EMT Said COVID Patient Didnt Need to Go to the Hospital. Diabetic ketoacidosis (DKA) is a common, potentially lethal disease. ABG, venepuncture). The instructor should have visual access via one-way windows or cameras. We ask the trainee why the blood pressure is so low or heart rate is so high, and how we should treat it. vD0 x@FFJ{m[ 3//Oh|JR7! Many of the preclinical students have never seen a real life clinical monitor or even an intravenous (IV) setup. 1. Performing an ECG should not delay the emergency management of 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. Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. Intubation lubricants can mimic drooling. Trainee will appropriately request assistance and use available resources. TheABCDEapproach can be used to perform a systematic assessment of a critically unwell patient. 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 relationship between sleep, fatigue and patient and provider safety. Centers for Disease Control and Prevention. Over the years, some groups happened to have the simulation session before the completion of the theoretical PBL session. Scenario in a Nutshell Diabetic ketoacidosis (DKA) in pregnancy. 4. The patient synopsis should include such standard aspects as age, sex, ethnicity, medical history, medications and allergies. - PSA Question Pack: https://geekymedics.com/psa-question-bank/ 3. 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. Supplemental digital content is available for this article. - Medical Finals Question Pack: https://geekymedics.com/medical-student-finals-questions/ - Examples 05:45 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. Use washable, non-toxic paints to imitate various body emissions. The students have acquired all the applicable theoretical knowledge of the case during the previous multiday PBL sessions. Trainee will increase knowledge of professional behaviors during the simulation. The teaching of diabetic assessment and management, like many other medical emergencies, lends itself well to case-based simulation. Chapters: See Table 4 for a suggested standardized script. Research Watch Box:Sleep, Fatigue & SafetyBy David Page, MS, NREMT-P COVID-19 Screening in the Pediatric Emergency Department. 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). See ourintravenous cannulation guidefor more details. 1) Please read through this document as it will help you prepare for your upcoming simulation on DKA. There are several causes of DKA, which we remember by the "five I's". As the name says, this screen is used to graph and plot any parameter. Perform urinalysis and send the urine for culture if urinary tract infection is suspected. Margolis GS, Romer GA, Fernandez AR, et al. Wolters Kluwer Health 1. KDCA, Ronald Reagan Washington National Airport, DC. A GCS of 8 or below warrants urgent expert help from an anaesthetist. cellulitis). 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.. GRAPH. Should any changes be made to the current management of their underlying condition(s)? 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. The normal reference range for fasting plasma glucose is 4.0 5.8 mmol/l. Facilitator to ask how often to measure BMs 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. The reason for inserting the airway upside down initially is to reduce the risk of pushing the tongue backwards and worsening airway obstruction. 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. DKA can develop within 24 hours and is potentially life threatening, requiring prompt recognition and therapeutic intervention. 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. Several environments may be suitable for your classroom. tall tented T waves in hyperkalaemia). A well-staged environment allows for greater student buy-in. Each performance measure is separated into cognitive, behavioral or technical categories. 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. This is a combination of the modified traditional lecture within scenario-based learning. Similar to a ward round, where the instructor would say: Come and listen to this patient with an aortic stenosis. . 1 0 obj 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). Refer to your local guidelines which should provide a clear protocol for the management of DKA. Diabetes (type 1 and type 2) in children and young people: diagnosis and management. 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]). Please try again soon. opioids, sedatives, anxiolytics, insulin, oral hypoglycaemic medications). The learning objectives follow the American College of Graduate Medical Education (ACGME) Core Compentencies. Just place the BR2_KDCA file into your addons scenery folder: C:\\Program Files\\Microsoft Games\\Microsoft Flight Simulator X\\Addon Scenery\\Scenery. Geeky Medics accepts no liability for loss of any kind incurred as a result of reliance upon the information provided in this video. 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. Refer to your local guidelines for further details. Hypothermia may be present if the patient has been unconscious and exposed for some time. Cureus 9(5): e1286. - 2500+ OSCE Flashcards: https://geekymedics.com/osce-flashcards/ Subscribe to our newsletter to be the first to know about our latest content: https://geekymedics.com/newsletter/ We believe it is important to have active, participatory learning by having conversations with the trainees in the form of questions and answers. PA EMT Said COVID Patient Didnt Need to Go to the NYC Unions Demand Reinstatement, Back Pay for Workers Fired for Refusing President Biden to End COVID-19 Emergencies on May 11. It was Diabetes UK with the Joint British Diabetes Societies Inpatient Care Group. We found it more important to have the students full attention so that they could concentrate on concepts and not on menial tasks such as recording data. Standardized patient as the voice of the simulator (or the simulation operator may play this role). It was developed for anesthesiology resident physicians with some background knowledge and experience caring for critically ill patients. Example: If the provider immediately evaluates blood glucose, then the reading will display 45 mg/dL. This simulation session therefore aims to make the case come alive, and show this known case in a clinical context. Acad Med. 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). Does the patient need a referral toHDU/ICU? Measure the patients capillary blood glucose and ketone levels to confirm the diagnosis and guide the management of DKA. MassBay EMS Program Integrates Training for Dogs, Heat Waves Are Killing More LA Homeless People. unilateral coarse crackles may be present if the patient has pneumonia which may have been the precipitant for DKA). Marx JA, Hockberger RS, Walls RM. The students worked on the underlying physiology during a week long PBL session and are therefore familiar with the theoretical aspects of DKA. See ourdocumentation guidesfor more details. Makeup may be used to depict gender, hollow eyes and cheeks, produce pallor or display bruises and scars. The faculty member/course coordinator of Simulation Design 2003;78:783788. 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. Ketones show 5.5. Animated Lecture 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. Introduceyourselfto thepatientincluding yournameandrole. 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. Search for Similar Articles Make sure tore-assessthe patient after anyintervention. can be reemphasized, and the effects of fluid therapy demonstrated. If an infection is suspected, IV antibioticsshould be administered as soon as possible. Review thepatients notes,chartsandrecent investigation results. A collection of data interpretation guides to help you learn how to interpret various laboratory and radiology investigations. Trainee will learn to collaborate with peers to decide on appropriate interventions, tests, and therapy. 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! 2. Another example: At one minute into the scenario, the patient becomes unresponsive and their breathing becomes shallow. The student group should be encouraged to collaborate on management options and to perform skills. Adds true to life parking codes and extra parking for AI. Her medical, social, and family histories are not clear at the time of admission to the emergency department. This article originally appeared in March 2011 JEMS as Diabetes Demonstration: Simulation-based learning works best., Simulation Training Ideal for Diabetic Patients, CMS Begins Reprocessing Retroactive Payments, Documents Detail EMTs Failure to Aid Tyre Nichols, New Course Lets Bystanders Be the Help Until Help Arrives, All Paramedic Recruits in New Castle County (DE) Obtain NRP Certification, International Prehospital Medicine Institute Literature Review, March 2023. - Associated symptoms 03:04 Works with Traffic 2005, but . We combined both to indicate the continuity of the curriculum, and the building on prior knowledge. We have been presenting Simulation Laboratory sessions to our preclinical medical students (first and second years). If the patientloses consciousnessand there areno signs of lifeon assessment, put out acrash callandcommence CPR. 1. 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. Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. We also show them IV bags containing saline and Ringers lactate, as well as show them IV infusion sets. Alert a senior immediately if you have any concerns about the consciousness level of a patient. She began experiencing progressively worsening thirst, increased appetite, and excessively increased urination. There are actually two sets of educational objectives: the first set is for the theoretical PBL sessions, and the 2nd set is for the Simulation Session. These simulation sessions seem to work because the medical students do have prior knowledge. 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 . The consequences (low blood pressure, high heart rate, central nervous system status, etc.) The following scenarios are available for download and are designed to meet your multi-disciplinary nursing needs. 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. If an obstruction is visible within the airway, use afingersweeporsuctionto remove it. DO NOT perform any examination or procedure on patients based purely on the content of these videos. 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). Review the patientscurrent medicationsand check any regular medications areprescribed appropriately. She had developed nausea, extreme fatigue, mild disorientation, and blurred vision toward the end of the soccer match. If the patient isunconsciousorunresponsive, start thebasic life support(BLS)algorithmas per resuscitation guidelines. *=NdL/c2XSJn8:I Jb8'.8>N*[L .hxw6afq40DX3c~>abt'Q,8y(BZu(vKBTufIR. In this section, we have to help the trainee to institute definitive therapy based on the underlying biochemical abnormalities. Tilt the forehead back whilst lifting the chin forwards to extend the neck. endobj Depending on scenario complexity, team dynamic and treatment modalities, this simulation may take 1020 minutes. diagnosis of DKA Trigger 3, ABG show acidosis and high BM and normal potassium. Two abstracts related to sleepiness in the EMS workforce were presented at the National Association of EMS Physicians symposium in January. Make sure thepatientsnotes,observationchartandprescriptionchartare easily accessible. JEMS. Lets discuss your options. . Stage 3: Ongoing management and monitoring of DKA 1 hour after initiation of treatment. Insert at least onewide-bore intravenous cannula(14G or 16G) and take blood tests as discussed below. On arrival to the ER, standard monitors (electrocardiogram [ECG] and pulse oximetry [SpO2]) and end-tidal carbon dioxide (ETCO2) concentration were placed, and the patient was given oxygen by nasal cannulae. The 60 minutes training time consists of four 15-minute sections divided as follows. 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. Medical Simulation Scenarios are text documents outlining the various details of a simulation - everything from patient simulator settings to debriefing notes. In the simulated environment, trainees will ask questions on how to interpret the data that they observe on the monitors and interpretation of clinical signs and symptoms on the manikin. "Never doubt that a small group of thoughtful, committed citizens can change the world. 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. 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. Effectiveness of simulation on health profession students knowledge, skills, confidence and satisfaction. doi: 10.7759/cureus.1286. Place one hand on the patients forehead and the other under the chin. Yes: if the patient can talk, their airway is patent and you can move on to the assessment of breathing. In some cases, normal saline with additional potassium is required to prevent overcorrection of serum potassium levels which would otherwise result in hypokalaemia.