dka simulation scenario

Trigger 4, Pathway 1l of saline required over 1hour and insulin infusion need prescribing and making up in 50ml syringe. Inspect theairwayfor obviousobstruction. VbQuX#R M21 DOI 10.7759/cureus.1286. 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. 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. 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. Are any further assessments or interventions required? 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. 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. GRAPH. Clearlydocument your ABCDE assessment, including history, examination, observations, investigations, interventions, and the patients response. Alert a senior immediately if you have any concerns about the consciousness level of a patient. Each clinical case scenario allows you to work through history taking, investigations, diagnosis and management. JEMS. Use an effectiveSBARR handoverto communicate the key information effectively to other medical staff. Therefore, we have to emphasize the importance of airway, breathing, and circulation in the very sick patient in any clinical setting. It was Administer oxygen to all critically unwell patients during yourinitialassessment. Depending on scenario complexity, team dynamic and treatment modalities, this simulation may take 1020 minutes. This simulation session therefore aims to make the case come alive, and show this known case in a clinical context. - Site 01:12 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. doi: 10.7759/cureus.1286. We try to provide sufficient realism.. The students are in their basic science course. A fixed-rate intravenous insulin infusion should be commenced initially to suppress ketogenesis, reduce blood glucose levels and address electrolyte disturbances. As this is a PBL session, the trainees are not given any references. Instructors should write a case study for the simulation before the session. PA EMT Said COVID Patient Didnt Need to Go to the Hospital. Lets discuss your options. 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. If the patient has clinical signs ofanaphylaxis(e.g. It was developed for anesthesiology resident physicians with some background knowledge and experience caring for critically ill patients. However, this leads to confusion. On the basis of the feedback from the students, they indicated that they believed the small group sessions are better. Data is temporarily unavailable. We then start the DKA state. See Appendix D, Supplemental Digital Content 4, https://links.lww.com/SIH/A4. 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). 2010;49:578586. If the patientloses consciousnessand there areno signs of lifeon assessment, put out acrash callandcommence CPR. <> Published August 2015. Two abstracts related to sleepiness in the EMS workforce were presented at the National Association of EMS Physicians symposium in January. Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. Case-based simulation should include two to three broad-focus objectives, as well as 1020 specific performance measures that the student should accomplish. DO NOT perform any examination or procedure on patients based purely on the content of these videos. Please try again soon. The instructor can also gauge the direction the debriefing session should follow or be alerted to possible problems or conflicts in treatment opinions. In the final 10 minutes, we show how the patient has a good recovery after fluid replacement. modify the keyword list to augment your search. There are several causes of DKA, which we remember by the "five I's". Extremities: mild cyanosis, no clubbing or edema (verbalized by instructors); pulses equal, and symmetrical (elucidated by trainees). Many of the preclinical students have never seen a real life clinical monitor or even an intravenous (IV) setup. 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. Calculate the patients current fluid balance using their fluid balance chart (e.g. 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. If you have any scenarios you would be willing to share with the simulation community, please forward them . Adds true to life parking codes and extra parking for AI. The debriefing environment should be removed from the location where the simulation took place. See ourdocumentation guidesfor more details. She had developed nausea, extreme fatigue, mild disorientation, and blurred vision toward the end of the soccer match. 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. Given such a small group, the students indicated that they feel more involved than they would with a larger group (eg, the whole class.) Indeed, it is the only thing that ever has.". cloudy urine may indicate urinary tract infection). Open the patients mouth to ensure there is no foreign material that may be pushed into the larynx. An integral part of a PBL session is for trainees to be able to navigate through huge literature bases. 2009;13:505511. They should introduce the student group to the environment, assign roles for each learner and guide the decision-making process. 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. - Geeky Medics OSCE App: https://geekymedics.com/geeky-medics-app/ Introduceyourselfto whoever has requested a review of the patient andlistencarefullyto their handover. If the patient is confused you might be able to get a collateral history from staff or family members as appropriate. DOWNLOAD Diabetic Ketoacidosis By the end of this scenario, the learner will be able to: 1. 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. 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. confusion, coma), All critically unwell patients should have. Antibiotics should be prescribed in keeping with local guidelines. Please try after some time. If the patient is suspected to have sufferedsignificanttraumawith potential spinal involvement, perform ajaw-thrustrather than a head-tilt chin-lift manoeuvre: 2. The students are in their first year. Therefore, the same file is also sent to the participants before the session. Its important to train and educate students of prehospital care on key indicators of a diabetic emergency. 4. The relationship between sleep, fatigue and patient and provider safety. 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. 3. 2. Animated Lecture His Heart Stopped On a Treadmill. Keyword Highlighting Clinical Simulation in Nursing, Volume 39, 2020, pp. DKA can develop within 24 hours and is potentially life threatening, requiring prompt recognition and therapeutic intervention. Trainee will increase knowledge of professional behaviors during the simulation. The students are in their first year. Each PBL case typically goes over 23 days, affording the students periods to find information for the case. J Nurs Educ. Development of simulation scenarios for an adolescent patient with diabetic ketoacidosis. 2011;15:108109. Intubation lubricants can mimic drooling. You should have another member of the clinical team aiding you in your ABCDE assessment, such a nurse, who can perform observations, take samples to the lab and catheterise if appropriate. It should only be inserted in unconscious patients as it is otherwise poorly tolerated and may induce gagging and aspiration. Hypothermia may be present if the patient has been unconscious and exposed for some time. 1) Please read through this document as it will help you prepare for your upcoming simulation on DKA. Simulation Scenario. 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. - Over 3000 Free MCQs: https://geekyquiz.com/ These simulation sessions seem to work because the medical students do have prior knowledge. diagnosis of DKA Trigger 3, ABG show acidosis and high BM and normal potassium. See our blood glucose measurement guide for more details. 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. Trainee will recognize the need for therapy and suggest an appropriate therapy in a simulated environment. Available if the trainee asks: arterial blood gas, glucose, electrolytes, BUN and plasma osmolality (please see last section of Appendix B, Supplemental Digital Content 2, https://links.lww.com/SIH/A2, for values). Using SOCRATES in History Taking | OSCE | Communication Skills, Diabetic Ketoacidosis (DKA) | Acute Management | ABCDE. Rosens Emergency Medicine: Concepts and Clinical Practice. However, this turned out to be too slow, took too much time, and could not continuously demonstrate the direction of changes. 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 . An oxygen mask is also demonstrated as an alternative device, as these early trainees had mostly not yet seen any of these devices. Diabetic ketoacidosis; Simulation training; Medical students. % A traditional classroom lecture format allows for student participation but limits the instructors ability to create realistic situations. In this section, we have to help the trainee to institute definitive therapy based on the underlying biochemical abnormalities. 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. During the debriefing process that follows the simulation, well-balanced performance measures will guide feedback toward accomplished tasks and may illustrate existing decision-making, behavioral or technical skill deficits. Strategies of high-performing paramedic educational programs. 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. Laschinger S, Medves J, Pulling C, et al. Discuss the patients current clinical condition with aseniorclinicianusing anSBARR style handover. If the patient is conscious, sit themuprightas this can also help with oxygenation. A debriefing section with pre-established questions allows the instructor to review the main focus and performance measures with the student group. 3. Well done, youve now stabilised the patient and theyre doing much better. The simulation session is also hosted as an interactive session. Insert at least onewide-bore intravenous cannula(14G or 16G) and take blood tests as discussed below. Scenarios. Highlight selected keywords in the article text. 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. Conclusion 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! Interactive lecture/discussion with use of monitors that show the vital signs of the simulated patient on manikin. Glycosuria leads to urinary losses of potassium through osmotic diuresis. Make sure thepatientsnotes,observationchartandprescriptionchartare easily accessible. Some error has occurred while processing your request. With your index and other fingers placed behind the angle of the mandible, apply steady upwards and forward pressure to lift the mandible. . Healthcare Students' Psychological Well-Being in a Diabetic Ketoacidosis Simulation. After the first voluntary session in 2006, feedback from the medical students indicated that they would like to receive this handout. A blood glucose level may already be available from earlier investigations (e.g. This session provides additional clinical support material for the theoretical PBL session. Environment & Manikin DKA can develop within 24 hours and is potentially life threatening, requiring prompt recognition and therapeutic intervention. 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. The learning environment should closely mimic real-world applications. Use washable, non-toxic paints to imitate various body emissions. Target Learner Groups Finally, we summarize the course and give them time for questions. Conclusions This technical report describes the design and implementation of a simulation scenario on DKA for emergency medicine trainees. Simulation in Healthcare4(4):232-236, Winter 2009. Blood sugar issues in the Type II diabetic will have a gradual onset, with diagnosis generally resulting from routine laboratory exams.(1). unilateral coarse crackles may be present if the patient has pneumonia which may have been the precipitant for DKA). COVID-19 Screening in the Pediatric Emergency Department. and We combined both to indicate the continuity of the curriculum, and the building on prior knowledge. DO NOT perform any examination or procedure on patients based purely on the content of these videos. 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. Diabetes UK with the Joint British Diabetes Societies Inpatient Care Group. The facilitator guides the group only when necessary. A comprehensive collection of medical revision notes that cover a broad range of clinical topics. 1 Potassium losses occurring both before and during treatment of DKA must be replaced. The DKA simulation incorporates cue recognition, analysis of cues, generation of solutions, nursing interventions, and evaluation of outcomes, including effective communication and psychosocial concerns. 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. 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. Review the patients drug chart for medications which may cause a reduced level of consciousness (e.g. #geekymedics #fyp #fypviral #studytok #medicalstudentuk #medtok #studytips #studytipsforstudents #medstudentuk #premed #medschoolfinals, Cardiovascular History Tips - DON'T FORGET these 3 things . She began experiencing progressively worsening thirst, increased appetite, and excessively increased urination. Another example: At one minute into the scenario, the patient becomes unresponsive and their breathing becomes shallow. A collection of free medical student quizzes to put your medical and surgical knowledge to the test! If an obstruction is visible within the airway, use afingersweeporsuctionto remove it. Open the patients airwayusing ahead-tiltchin-lift manoeuvre: 1. 2011;15:108109. <>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 595.32 841.92] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> Standardized patient as the voice of the simulator (or the simulation operator may play this role). Catheterisethe patient to closelymonitor urine outputto guide fluid resuscitation and need for escalation. See Table 4 for a suggested standardized script. 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. The reason for inserting the airway upside down initially is to reduce the risk of pushing the tongue backwards and worsening airway obstruction. DY{Qb"(EgN$QI*%XN1F""0a5 There are just a few more things to do. 1-6. - Introduction 00:00 Initially, we used a blood pressure cuff to generate the blood pressure values. As the name says, this screen is used to graph and plot any parameter. ABG, venepuncture). We do not use passive visualizing materials such as videotapes or DVD other than vital signs shown on the monitors. may email you for journal alerts and information, but is committed You may search for similar articles that contain these same keywords or you may She does not take this regularly. Classroom Dynamics The patient was placed in the supine position and was a little confused as well as drowsy but at times had a good verbal response (Glasgow Coma Scale 15/15). This is particularly important for core cases and low-frequency, high-stakes procedures and encounters. 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. 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. You may be trying to access this site from a secured browser on the server.

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