Several environments may be suitable for your classroom. A number of key modifiers are described that allow for the adjustment of case . Refer to your local guidelines for further details. Twitter: http://www.twitter.com/geekymedics endobj
The students are in their basic science course. She Died the Next Day. It was developed for anesthesiology resident physicians with some background knowledge and experience caring for critically ill patients. Does the patient need a referral toHDU/ICU? She began experiencing progressively worsening thirst, increased appetite, and excessively increased urination. Please enable scripts and reload this page. This video demonstrates how to use the SOCRATES acronym when taking a history of pain or other symptoms. This guide provides an overview of the recognition and immediate management of diabetic ketoacidosis (DKA)using an ABCDE approach. Mosby:Philadelphia. The validity of the HFS-DKA scenario was verified by a certified diabetes nurse educator, a registered nurse, and a clinical nurse educator. confusion, coma), All critically unwell patients should have. Insert at least onewide-bore intravenous cannula(14G or 16G) and take blood tests as discussed below. She is lethargic and slightly confused but can intermittently respond to questions. Management of diabetic ketoacidosis in adults. 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. 1-6. We try to provide sufficient realism.. Inspect the urine currently in the catheter bag and note its appearance (e.g. Trainee will improve their understanding of clinical practice through reflective assessment of actual cases during the prior PBL sessions. 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. Reduced urine output (oliguria) is typically defined as less than 0.5ml/kg/hour in an adult. 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. Causes: Any situation arising in a diabetic that requires increased insulin without that demand being met can result in DKA. Using SOCRATES in History Taking | OSCE | Communication Skills, Diabetic Ketoacidosis (DKA) | Acute Management | ABCDE. In keeping with the case study, as a treatment marker is reached, the instructor should place emphasis on physiological, pharmacological, environmental and psychosocial issues. Effectiveness of simulation on health profession students knowledge, skills, confidence and satisfaction. 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. <>
Geeky Medics accepts no liability for loss of any kind incurred as a result of reliance upon the information provided in this video. On the basis of the feedback from the students, they indicated that they believed the small group sessions are better. Does the patient need reviewing by a specialist? DO NOT perform any examination or procedure on patients based purely on the content of these videos. The required potassium replacement varies greatly. Conclusions This technical report describes the design and implementation of a simulation scenario on DKA for emergency medicine trainees. You can check out our guide to using SOCRATES here: https://geekymedics.com/the-socrates-acronym-in-history-taking/ The consequences (low blood pressure, high heart rate, central nervous system status, etc.) Manikin staging can provide strong cues. 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. PBL was introduced at our institution in 1995. For similar reasons, we do not believe a videotaped session will keep the students attention as much as these live simulator sessions. Laschinger S, Medves J, Pulling C, et al. Consider any precipitating factors for the development of DKA and involve the diabetes team in the patients care. Development of simulation scenarios for an adolescent patient with diabetic ketoacidosis. 4. Patients with DKA require fluid resuscitation to restore circulatory volume, clear ketones, correct electrolyte abnormalities and increase renal perfusion. Performing an ECG should not delay the emergency management of DKA. Ziv A, Wolpe PR, Small SD, et al. The objective is to give as many visual and tactile cues concerning the patient condition and background as possible. The learning environment should closely mimic real-world applications. If the patient is conscious, sit themuprightas this can also help with oxygenation. 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. In this case scenario, dehydration is one of the most serious immediate issues. "Never doubt that a small group of thoughtful, committed citizens can change the world. 6. Case-based education adds a real-world aspect to the learning environment. These simulation sessions seem to work because the medical students do have prior knowledge. Cureus is on a mission to change the long-standing paradigm of medical publishing, where submitting research can be costly, complex and time-consuming. DKA can develop within 24 hours and is potentially life threatening, requiring prompt recognition and therapeutic intervention. See Table 4 for a suggested standardized script. NPAs are typically better tolerated in patients who are partly or fully conscious compared to oropharyngeal airways. Each PBL case typically goes over 23 days, affording the students periods to find information for the case. An integral part of a PBL session is for trainees to be able to navigate through huge literature bases. Animated lectures, however, must work within the framework of a focused case study, which requires increased preparation time. 2008;6:278302. Healthcare Students' Psychological Well-Being in a Diabetic Ketoacidosis Simulation. With your index and other fingers placed behind the angle of the mandible, apply steady upwards and forward pressure to lift the mandible. 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. may email you for journal alerts and information, but is committed
Her medical, social, and family histories are not clear at the time of admission to the emergency department. We do not use passive visualizing materials such as videotapes or DVD other than vital signs shown on the monitors. 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 reason for inserting the airway upside down initially is to reduce the risk of pushing the tongue backwards and worsening airway obstruction. #geekymedics #fyp #fypviral #studytok #medicalstudentuk #medtok #studytips #studytipsforstudents #medstudentuk #premed #medschoolfinals, Cardiovascular History Tips - DON'T FORGET these 3 things . 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 simulation experience serves to give substance to the theoretical words and concepts that the students encountered during the PBL sessions. - Geeky Medics OSCE App: https://geekymedics.com/geeky-medics-app/ Trainee will learn to collaborate with peers to decide on appropriate interventions, tests, and therapy. The teaching of diabetic assessment and management, like many other medical emergencies, lends itself well to case-based simulation. Insert the airway bevel-end first, vertically along the floor of the nose with a slight twisting action. Just place the BR2_KDCA file into your addons scenery folder: C:\\Program Files\\Microsoft Games\\Microsoft Flight Simulator X\\Addon Scenery\\Scenery. 2009;13:505511. Standardized patient as the voice of the simulator (or the simulation operator may play this role). Ask for anotherclinicalmemberofstafftoassistyou if possible. This is particularly important for core . 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. DO NOT perform any examination or procedure on patients based purely on the content of these videos. As with the animated lecture, the simulation is strongly dependent on a focused case study. Stage 3: Ongoing management and monitoring of DKA 1 hour after initiation of treatment. If an obstruction is visible within the airway, use afingersweeporsuctionto remove it. Please try after some time. An individual student can get an immediate answer to a question, the facilitator can see puzzled expressions on faces, and the PBL group could get answers that they could not get during their prior PBL group discussions. 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. 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. 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. 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. Terms of Use. If you have any scenarios you would be willing to share with the simulation community, please forward them . Trainee will recognize the need for therapy and suggest an appropriate therapy in a simulated environment. Seek senior helpif the patient shows no signs of improvement or if you have any concerns. Simulation Scenario for Anesthesia Providers Clark Obr, MD*, Anthony Mueller, MD . Medical simulation technology is a powerful tool for training physicians but papers dealing with DKA simulators are scarce. 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. 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. Initially, we used a blood pressure cuff to generate the blood pressure values. YouTube Video VVVram5yRUhROGJRUW1sZk5kQVFDXzV3LjMxakdNallNcng0, YouTube Video VVVram5yRUhROGJRUW1sZk5kQVFDXzV3LkJPVjVZMzBKczY4, YouTube Video VVVram5yRUhROGJRUW1sZk5kQVFDXzV3LkxEM2VkQzB2NTBr, Start typing to see results or hit ESC to close, Deep Vein Thrombosis (DVT) Examination OSCE Guide, Pre-hospital Advanced Life Support (ALS) OSCE Guide, Adult Choking (Basic Life Support) OSCE Guide, Paediatric Intravenous Cannulation OSCE Guide, Intrauterine System (Mirena) Counselling OSCE guide, Geeky Medics OSCE Book | Clinical Examination, Paediatric Gastro-oesophageal Reflux Disease, A Career as a GP with Special Interest with Dr Fiona Mosgrove, Absolute insulin deficiency (e.g. Both external and internal potassium balances are disturbed during the development and treatment of DKA. The diabetes with DKA clinical pathway is a detailed plan of the course of care for pediatric patients seen in the emergency department with diabetic ketoacidosis. Extremities: mild cyanosis, no clubbing or edema (verbalized by instructors); pulses equal, and symmetrical (elucidated by trainees). 3. Diabetic ketoacidosis; Simulation training; Medical students. Should any changes be made to the current management of their underlying condition(s)? Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. 2. DKA can develop within 24 hours and is potentially life threatening, requiring prompt recognition and therapeutic intervention. Clinical Simulation in Nursing, Volume 39, 2020, pp. The students have acquired all the applicable theoretical knowledge of the case during the previous multiday PBL sessions. 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. A collection of interactive medical and surgical clinical case scenarios to put your diagnostic and management skills to the test. In the meantime, you should re-assess and maintain the patients airway. The instructor should have visual access via one-way windows or cameras. We have 18 to 20 PBL groups for an hour each in the week after their PBL DKA session. Deteriorationshould be recognised quickly and acted upon immediately. You might also be interested in our awesome bank of 700+ OSCE Stations. 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. Open the patients airwayusing ahead-tiltchin-lift manoeuvre: 1. Nandate, Koichiro MD, PhD; Abola, Ramon MD; Murray, W Bosseau MB; Whitfield, Carol PhD; Lang, Charles PhD; Sinz, Elizabeth MD. - Medical Finals Question Pack: https://geekymedics.com/medical-student-finals-questions/ 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. In this manner, the students have to apply their knowledge at the appropriate points during the progression of the scenario. Diabetic ketoacidosis (DKA) is a common, potentially lethal disease. If the patient has COPD and a history of CO2retention you should switch to aventuri maskas soon as possible andtitrate oxygen appropriately. Privacy Policy Groups of fewer than four students dont allow for optimal collaboration. If you have any scenarios you would be willing to share with the simulation community, please forward them to me. Vital Signs: BP, 90/30 mm Hg (ECG shows normal sinus rhythm); central venous pressure, 0 to 2 cm H. Lungs: All lung fields are clear to auscultation without wheeze or rhonchi, and the respiratory pattern is typical of Kussmaul breathing, ie, large deep tidal volumes and increased respiratory rate. Keywords: diabetic ketoacidosis, simulation, expertise, emergency medicine Introduction Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes mellitus, most . Some error has occurred while processing your request. Could we not just do this as a large group session to all 160 students (versus 20 1-hour sessions to groups of eight students)? Use an effectiveSBARR handoverto communicate the key information effectively to other medical staff. The debriefing environment should be removed from the location where the simulation took place. 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. A pre-briefing session is conducted prior to the start of the simulation scenario. We believe it is important to have active, participatory learning by having conversations with the trainees in the form of questions and answers. Emergency medical services workLife characteristics contribute to clinically significant excessive daytime sleepiness. We used the Medical Education Technologies Inc. (METI) Human Patient Stimulator (HPS, METI Sarasoto, 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). 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. Simulation Scenario. Inspect for evidence of self-injection sites (e.g. 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. Advance the airway until it lies within the pharynx. We are looking for declaration of DKA and request for pathway. Below is a collection of donated scenarios for you to use or modify. 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. Urinary tract infections are a common DKA precipitant. This allows the learner group to make a psychological break from the patient and environment while beginning the reflection process. The main goal is to establish a safe learning environment for the learner [9, 13 . Trainee will describe the changes in vital signs, the major metabolic, fluid, and electrolyte. We guide the group to suggest fluid. A collection of free medical student quizzes to put your medical and surgical knowledge to the test! TikTok: https://www.tiktok.com/@geekymedics Initially, we required the students to write down the vital signs. For more information, please refer to our Privacy Policy. 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). Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario Strategies of high-performing paramedic educational programs. . We have spent many hours debating whether the small group format was a waste of time. 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.) Make sure to re-assess the patient after any intervention. They have had no clinical exposure or any clinical experience. Furthermore, we demonstrate and explain the basic parameters (ECG, SpO2, BP, capnography), using an interactive format of questions and answers, and encourage the group to observe the normal values. The 60 minutes training time consists of four 15-minute sections divided as follows. As this is an interactive discussion session, any needed debriefing and/or explanation is given during the sessions. 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. See ourdocumentation guidesfor more details. DKA can be caused by either: Absolute insulin deficiency (e.g. In an animated lecture, its important that the student group have an instructor so they can ask direct questions. In this section, we have to guide them as to what they should do first for the patient in this critical condition (ie, treat the A, B, Cs of airway, breathing, and circulation) before we can confirm the diagnosis. 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. Trainee will get to know how professionals behave during management of a critically ill patient. Trainee will appropriately request assistance and use available resources. When erroneous treatment is delivered, the instructor can end the simulation. Administer oxygen to all critically unwell patients during yourinitialassessment. 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].. vD0
x@FFJ{m[ 3//Oh|JR7! In the final 10 minutes, we show how the patient has a good recovery after fluid replacement. >> Fernandez AR, Mac Crawford J, Pennell ML, et al. The facilitator guides the group only when necessary. A comprehensive collection of clinical examination OSCE guides that include step-by-step images of key steps, video demonstrations and PDF mark schemes. Capillary refill timemay be prolonged if the patient is hypovolaemic. Prehosp Emerg Care. The trainees have had background knowledge of biochemistry because they had completed the PBL case. 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. MassBay EMS Program Integrates Training for Dogs, Heat Waves Are Killing More LA Homeless People. Available from: [, NICE guidelines. 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. doi: 10.7759/cureus.1286. 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. Properly interpret a venous blood gas (VBG) and basic metabolic panel in a patient presenting with diabetic ketoacidosis. Prehosp Emerg Care. Scenarios. %PDF-1.5
PA EMT Said COVID Patient Didnt Need to Go to the Hospital. 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. However, this turned out to be too slow, took too much time, and could not continuously demonstrate the direction of changes. Trainee will correlate the underlying pathophysiology with symptoms and signs as exhibited by the simulation session. can be reemphasized, and the effects of fluid therapy demonstrated. unilateral coarse crackles may be present if the patient has pneumonia which may have been the precipitant for DKA). A comprehensive collection of OSCE guides to common clinical procedures, including step-by-step images of key steps, video demonstrations and PDF mark schemes. During an immersive simulation, its imperative the group uses critical-thinking skills and group collaboration independently. These are not learning objectives in this program. This leads to hyperglycaemia, osmotic diuresis, and dehydration. LYqC+pJ&6X4onfBT#?=R}.p8N3+Dk,P4tIgWB}-L'=8;_G >,K#.e89XnG'B~NtR DOI 10.7759/cureus.1286. As the name says, this screen is used to graph and plot any parameter. Refer to your local guidelines for further details. 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. Physician working in the emergency department. 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. This is a combination of the modified traditional lecture within scenario-based learning. Catheterisethe patient to closelymonitor urine outputto guide fluid resuscitation and need for escalation. Search for Similar Articles
At the end of the previous section, the trainee can make the diagnosis of DKA but has not confirmed it yet. Interactive lecture/discussion with use of monitors that show the vital signs of the simulated patient on manikin. Please note that by doing so you agree to be added to our monthly email newsletter distribution list. (1) According to Centers for Disease Control and Prevention (CDC), 223,619 deaths were attributed to diabetes in 2005. 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. See ourCXR interpretation guidefor more details. Rosens Emergency Medicine: Concepts and Clinical Practice. One of the key differences with the immersive simulation is that the instructor is absent from the simulation environment. If foreign material is present, attempt removal using suction. Another example: At one minute into the scenario, the patient becomes unresponsive and their breathing becomes shallow. Immersive Simulations
www.cdc.gov/diabetes/statistics/prev/national/. 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: [. Scenario in a Nutshell Diabetic ketoacidosis (DKA) in pregnancy. }HyEf,#$/JSRU9+CF6k\'/z+i`[
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However, this leads to confusion. 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. - 150+ PDF OSCE Checklists: https://geekymedics.com/pdf-osce-checklists/ 1 Potassium losses occurring both before and during treatment of DKA must be replaced. Example: If the provider immediately evaluates blood glucose, then the reading will display 45 mg/dL. Subscribe to our newsletter to be the first to know about our latest content: https://geekymedics.com/newsletter/ Check the patency of the patients right nostril and if required (depending on the model of NPA) insert a safety pin through the flange of the NPA. your express consent. 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. Its important to train and educate students of prehospital care on key indicators of a diabetic emergency. Review the patientscurrent medicationsand check any regular medications areprescribed appropriately. We also show them IV bags containing saline and Ringers lactate, as well as show them IV infusion sets. Over the years, some groups happened to have the simulation session before the completion of the theoretical PBL session. 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. SimMan Nursing Scenarios Software. Conclusion
1. Published August 2015. Stage 2: Emergency management of DKA and consideration of abnormal CTG. insulin-dependent type 2 diabetes), Altered consciousness (e.g. They have had no clinical exposure or any clinical experience. In the context of DKA, a patients consciousness level may be reduced. The Theory
See our blood glucose measurement guide for more details. See ourfluid prescribing guidefor more details onresuscitation fluids. The students are in their basic science course. Competency-based medical education has seen widespread adoption in the field along with ongoing work in the areas of . 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 . #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! 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. His Heart Stopped On a Treadmill. 2 0 obj
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. Adds true to life parking codes and extra parking for AI. Problems are addressed as they are identified and the patient is re-assessed regularly to monitor their response to treatment.