- 150+ PDF OSCE Checklists: https://geekymedics.com/pdf-osce-checklists/ 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). Extremities: mild cyanosis, no clubbing or edema (verbalized by instructors); pulses equal, and symmetrical (elucidated by trainees). This is particularly important for core cases and low-frequency, high-stakes procedures and encounters. Inspect the urine currently in the catheter bag and note its appearance (e.g. 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 . The relationship between sleep, fatigue and patient and provider safety. 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. If the patient is suspected to have sufferedsignificanttraumawith potential spinal involvement, perform ajaw-thrustrather than a head-tilt chin-lift manoeuvre: 2. 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. By joining Cureus, you agree to our 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. Available from: [. 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. Works with Traffic 2005, but . The students mentioned that they did not obtain the maximum value from the simulation session under these circumstances. DO NOT perform any examination or procedure on patients based purely on the content of these videos. - Exacerbating & relieving factors 05:12 Therefore, we have to emphasize the importance of airway, breathing, and circulation in the very sick patient in any clinical setting. The validity of the HFS-DKA scenario was verified by a certified diabetes nurse educator, a registered nurse, and a clinical nurse educator. We used the Medical Education Technologies Inc. (METI) Human Patient Stimulator (HPS, METI Sarasoto, Fl). 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 main purpose of the simulation is to draw a line from the theoretical, boring biochemistry to the clinical manifestations. 3. Please write a single word answer in lowercase (this is an anti-spam measure). - 700+ OSCE Stations: https://geekymedics.com/osce-stations/ Depending on scenario complexity, team dynamic and treatment modalities, this simulation may take 1020 minutes. 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. to maintaining your privacy and will not share your personal information without We have spent many hours debating whether the small group format was a waste of time. 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. Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario At the end of the previous section, the trainee can make the diagnosis of DKA but has not confirmed it yet. Pediatric Emergency Medicine Didactics and Simulation (PEMDAS The 60 minutes training time consists of four 15-minute sections divided as follows. You might also be interested in our awesome bank of 700+ OSCE Stations. 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. After initial insulin therapy has reduced plasma blood glucose levels (e.g. Medical simulation technology is a powerful tool for training physicians but papers dealing with DKA simulators are scarce. 4. Please try again soon. J Nurs Educ. Case-based education adds a real-world aspect to the learning environment. Creating a Simulation Experience to Promote Clinical Judgment 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. - Medical Finals Question Pack: https://geekymedics.com/medical-student-finals-questions/ Simulation provides a safe environment where learning is enhanced through the deliberate practice of skills and controlled management of a variety of clinical encounters. Askhow the patient is feeling as this may provide some useful information about their current symptoms. Initially, we required the students to write down the vital signs. Interactive lecture/discussion with use of monitors that show the vital signs of the simulated patient on manikin. 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. Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario *=NdL/c2XSJn8:I Jb8'.8>N*[L .hxw6afq40DX3c~>abt'Q,8y(BZu(vKBTufIR. Management of diabetic ketoacidosis in adults. Diabetes (type 1 and type 2) in children and young people: diagnosis and management. TheABCDEapproach can be used to perform a systematic assessment of a critically unwell patient. Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario They should introduce the student group to the environment, assign roles for each learner and guide the decision-making process. 2010;49:578586. Revisit history taking to explore relevant medical history and identify any precipitating factors for DKA. Trainee will recognize the need for therapy and suggest an appropriate therapy in a simulated environment. Simulation Scenario for Anesthesia Providers Clark Obr, MD*, Anthony Mueller, MD *Corresponding author: clark-obr@uiowa.edu Abstract Introduction: This simulation on diabetic ketoacidosis (DKA) in . Patients with DKA require fluid resuscitation to restore circulatory volume, clear ketones, correct electrolyte abnormalities and increase renal perfusion. PDF Adult Type I Diabetic Ketoacidosis Pre-simulation Preparation Student Refer to your local guidelines which should provide a clear protocol for the management of DKA. 1 Potassium losses occurring both before and during treatment of DKA must be replaced. I assigned true to life parking codes, and added some extra parking for the superfluous US Express AI. 2 0 obj 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). If you have any scenarios you would be willing to share with the simulation community, please forward them to me. Introduceyourselfto whoever has requested a review of the patient andlistencarefullyto their handover. A chest X-ray should not delay the emergency management of DKA. See ourintravenous cannulation guidefor more details. Below is a collection of donated scenarios for you to use or modify. Groups of more than seven may struggle with meeting objectives due to insufficient functional rolls. In other words, they do not have clinical experience, but they have clinical knowledge. MassBay EMS Program Integrates Training for Dogs, Heat Waves Are Killing More LA Homeless People. Consider active re-warming techniques in patients with severe hypothermia. 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. Review the patientsoxygen saturation(SpO2): Auscultate the chest to screen for evidence of respiratory pathology (e.g. A collection of interactive medical and surgical clinical case scenarios to put your diagnostic and management skills to the test. COVID-19 Screening in the Pediatric Emergency Department. The DKA simulation incorporates cue recognition, analysis of cues, generation of solutions, nursing interventions, and evaluation of outcomes, including effective communication and psychosocial concerns. Geeky Medics accepts no liability for loss of any kind incurred as a result of reliance upon the information provided in this video. Tilt the forehead back whilst lifting the chin forwards to extend the neck. Join the Geeky Medics community: Target Learner Groups 1. Simulation of Diabetic Ketoacidosis for Cellular and Molecul JEMS. cloudy urine may indicate urinary tract infection). Clearly communicate how often would you like the patients observations relayed to you by other staff members. Deteriorationshould be recognised quickly and acted upon immediately. 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. - Over 3000 Free MCQs: https://geekyquiz.com/ Properly interpret a venous blood gas (VBG) and basic metabolic panel in a patient presenting with diabetic ketoacidosis. The student group is given a short introduction into a closed simulation environment. 1 0 obj Keyword Highlighting <> and Research Watch Box:Sleep, Fatigue & SafetyBy David Page, MS, NREMT-P 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. 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. - PSA Question Pack: https://geekymedics.com/psa-question-bank/ This typically involves the use of anon-rebreathe maskwith an oxygen flow rate of15L. 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. The use of a simulated, evolving case scenario was an effective method of exposing nursing students to complex patient care. It involves working through the following steps: Each stage of the ABCDE approach involvesclinicalassessment,investigationsandinterventions. Animated Lecture We have been presenting Simulation Laboratory sessions to our preclinical medical students (first and second years). Trainee will get to know how professionals behave during management of a critically ill patient. 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. They have had no clinical exposure or any clinical experience. As this is an interactive discussion session, any needed debriefing and/or explanation is given during the sessions. On the basis of the feedback from the students, they indicated that they believed the small group sessions are better. If the patient has COPD and a history of CO2retention you should switch to aventuri maskas soon as possible andtitrate oxygen appropriately. 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. The main goal is to establish a safe learning environment for the learner [9, 13 . DY{Qb"(EgN$QI*%XN1F""0a5 Physician working in the emergency department. 2. It involves a facilitating instructor, a small learner group and conceptual aspects of environmental and manikin staging to provide sensory cues. Introduceyourselfto thepatientincluding yournameandrole. 3. 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). - Radiation 02:45 If the patient has clinical signs ofanaphylaxis(e.g. 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. 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. In this manner, the students have to apply their knowledge at the appropriate points during the progression of the scenario. 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 file explaining the session is sent to instructors 1 week before the sessions. 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. 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. Diabetes UK with the Joint British Diabetes Societies Inpatient Care Group. The students are in their basic science course. The learning environment should closely mimic real-world applications. insulin-dependent type 2 diabetes), Altered consciousness (e.g. Teaching nursing management of diabetic ketoacidosis: a description of type 1 diabetes), Complete insulin insensitivity (e.g. After the first voluntary session in 2006, feedback from the medical students indicated that they would like to receive this handout. Standardized patient as the voice of the simulator (or the simulation operator may play this role). Instructors should write a case study for the simulation before the session. oral fluids, intravenous fluids, urine output, drain output, stool output, vomiting) to inform resuscitation efforts. Trigger 4, Pathway 1l of saline required over 1hour and insulin infusion need prescribing and making up in 50ml syringe. Effectiveness of simulation on health profession students knowledge, skills, confidence and satisfaction. Kymera Systems Inc | SCADA Online Demo Ignition Trainee will learn to collaborate with peers to decide on appropriate interventions, tests, and therapy. 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. Immersive Simulations If an obstruction is visible within the airway, use afingersweeporsuctionto remove it. 6. An integral part of a PBL session is for trainees to be able to navigate through huge literature bases. Instagram: https://instagram.com/geekymedics 2. In the final 10 minutes, we show how the patient has a good recovery after fluid replacement. Section snippets . We then start the DKA state. See Appendix D, Supplemental Digital Content 4, https://links.lww.com/SIH/A4. As this is a PBL session, the trainees are not given any references. 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. Please enable scripts and reload this page. - Severity 05:32 Over the years, some groups happened to have the simulation session before the completion of the theoretical PBL session. Int J Evid Based Healthc. Diabetic ketoacidosis simulator: a new learning tool for a life A collection of anatomy notes covering the key anatomy concepts that medical students need to learn. 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. Trainee will describe the changes in vital signs, the major metabolic, fluid, and electrolyte. Rosens Emergency Medicine: Concepts and Clinical Practice. Simulation student Scenario- DKA-Peds.docx - DIABETIC In the meantime, you can perform some basic airway manoeuvres to help maintain the airway whilst awaiting senior input. Using your thumbs, slightly open the mouth by downward displacement of the chin. If the patientloses consciousnessand there areno signs of lifeon assessment, put out acrash callandcommence CPR. We now provide the students with handouts of the data to save time and provide consistency. Classroom Dynamics Make sure tore-assessthe patient after anyintervention. 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. DKA can develop within 24 hours and is potentially life threatening, requiring prompt recognition and therapeutic intervention. They should be used in conjunction with the maneuvres mentioned above as the position of the head and neck need to be maintained to keep the airway aligned. - 2500+ OSCE Flashcards: https://geekymedics.com/osce-flashcards/ 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). A comprehensive collection of clinical examination OSCE guides that include step-by-step images of key steps, video demonstrations and PDF mark schemes. It may be necessary toexposethe patient during your assessment: remember to prioritise patient dignity and conservation of body heat. See our blood glucose measurement guide for more details. - Examples 05:45 From the Department of Anesthesiology, Pennsylvania State University College of Medicine, Hershey, PA. Dr. Murray is on the Speakers Bureau of METI, Sarasota, FL. Abdomen: The abdominal examination reveals diffuse mild epigastric tenderness to deep palpitation but neither rebound tenderness nor guarding (result of examination given by patient or by instructor). The simulation session is also hosted as an interactive session. Prehosp Emerg Care. Testing a diabetes keotacidosis simulation in critical care nursing: A She does not take this regularly. We guide the group to suggest fluid. Pediatric Emergency Medicine Didactics and Simulation (PEMDAS His Wife Gave Him CPR. A traditional classroom lecture format allows for student participation but limits the instructors ability to create realistic situations. 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].. Terms of Use. PBL was introduced at our institution in 1995. diagnosis of DKA Trigger 3, ABG show acidosis and high BM and normal potassium. Assessment & Treatment of Five Diabetic Emergencies - JEMS Antibiotics should be prescribed in keeping with local guidelines. Diabetic Ketoacidosis in the Obstetric Population: A Simulation Conclusion Laschinger S, Medves J, Pulling C, et al. 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. You may search for similar articles that contain these same keywords or you may This is a combination of the modified traditional lecture within scenario-based learning. Using SOCRATES in History Taking | OSCE | Communication Skills, Diabetic Ketoacidosis (DKA) | Acute Management | ABCDE. Typically potassium levels should be maintained between 4.0 5.5 mmol/L and close monitoring is required. 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. These are not learning objectives in this program. 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. We try to provide sufficient realism.. 3. 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). Highlight selected keywords in the article text. - Onset 01:48 The files are given in full in the web supplement (Appendix B, Supplemental Digital Content 2, https://links.lww.com/SIH/A2). Well done, youve now stabilised the patient and theyre doing much better. Lets discuss your options. We also show them IV bags containing saline and Ringers lactate, as well as show them IV infusion sets. type 1 diabetes) Complete insulin insensitivity (e.g. 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 the meantime, you should re-assess and maintain the patients airway. An events progression section should include patient status changes, as well as a time/treatment continuum that incorporates if-then event progressions. The consequences (low blood pressure, high heart rate, central nervous system status, etc.) She tends to drink sugar containing fluids (soda) when she is thirsty, and she eats fast foods (cream-filled muffins) when she is hungry. 2007. stream Inspect theairwayfor obviousobstruction. Stage 1: Initial assessment of acutely unwell pregnant woman and diagnosis of DKA. The impetus for creating and implementing the high-fidelity diabetic ketoacidosis (DKA) simulation was based on a needs assessment and reviewing of undergraduate nursing students' examination statistics in a second semester medical-surgical course. 2) Complete the assigned suggested readings 3) Complete the presimulation preparation virtual simulation game (Instructor will provide link) 4) Once you have completed reading this document and prepared for your simulation, please: a. General: Moaning, asking what has happening to her. Marx JA, Hockberger RS, Walls RM. PA EMT Said COVID Patient Didnt Need to Go to the Hospital. We give the history of the patient to the trainees. Diabetic Ketoacidosis in the Obstetric Population: A Simulation Much time was wasted explaining why it did not matter. 1. Scenarios. 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. 2. Acad Med. If an infection is suspected, IV antibioticsshould be administered as soon as possible. 1) Please read through this document as it will help you prepare for your upcoming simulation on DKA. Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario 3. One of the key differences with the immersive simulation is that the instructor is absent from the simulation environment. 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. Trainee will appropriately request assistance and use available resources. 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. These simulation sessions seem to work because the medical students do have prior knowledge. In the context of DKA, a patients consciousness level may be reduced. 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 faculty member/course coordinator of Simulation Design Hypothermia may be present if the patient has been unconscious and exposed for some time. Causes: Any situation arising in a diabetic that requires increased insulin without that demand being met can result in DKA. PDF Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario 4 0 obj You may be asked to review a patient with DKA due to confusion, reduced level of consciousness, tachycardia, hypotension and/or vomiting. a simulation training session designed to acquaint emergency medicine residents with the presentation and management of diabetic ketoacidosis (DKA) through the use of simulation. Refer to your local guidelines for further details. PDF Medicine Simulation Scenario Diabetic Ketoacidosis: An Emergency A collection of free medical student quizzes to put your medical and surgical knowledge to the test! An oxygen mask is also demonstrated as an alternative device, as these early trainees had mostly not yet seen any of these devices. Check out our other awesome clinical skills resources including: In this section, we have to help the trainee to institute definitive therapy based on the underlying biochemical abnormalities.