dka simulation scenario

After the first voluntary session in 2006, feedback from the medical students indicated that they would like to receive this handout. KDCA, Ronald Reagan Washington National Airport, DC. Tilt the forehead back whilst lifting the chin forwards to extend the neck. tall tented T waves in hyperkalaemia). 2017 May 29;9(5):e1286. 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. Circulating nurse in the emergency room (ER). Intubation lubricants can mimic drooling. In this manner, the students have to apply their knowledge at the appropriate points during the progression of the scenario. 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. 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. After initial insulin therapy has reduced plasma blood glucose levels (e.g. Each performance measure is separated into cognitive, behavioral or technical categories. Medical Simulation Scenarios are text documents outlining the various details of a simulation - everything from patient simulator settings to debriefing notes. Laschinger S, Medves J, Pulling C, et al. The scenario would include an if-then algorithm. Surgical dressings and imitation blood can support medical history. 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.. a simulation training session designed to acquaint emergency medicine residents with the presentation and management of diabetic ketoacidosis (DKA) through the use of simulation. After entering the environment, the student doesnt have the option of leaving the simulation until the learning objectives and performance measures are achieved. Conclusion: Our DKA simulator is a new tool whose objective is the training in a severe, frequent and complex situation, and can be used to improve the approach made by the junior physicians to the real diabetic . 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. Please enable scripts and reload this page. An animated lecture may be described as a pseudo-simulation environment. Search for Similar Articles Works with Traffic 2005, but . Introduceyourselfto whoever has requested a review of the patient andlistencarefullyto their handover. In keeping with the case study, as a treatment marker is reached, the instructor should place emphasis on physiological, pharmacological, environmental and psychosocial issues. Alert a senior immediately if you have any concerns about the consciousness level of a patient. The use of case-based simulation, although more complicated and time consuming for the instructor, immerses the students in the subject matter. Interactive lecture/discussion with use of monitors that show the vital signs of the simulated patient on manikin. 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. During an immersive simulation, its imperative the group uses critical-thinking skills and group collaboration independently. Competency-based medical education has seen widespread adoption in the field along with ongoing work in the areas of . Refer to your local guidelines for further details. 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. 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. 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 believe it is important to have active, participatory learning by having conversations with the trainees in the form of questions and answers. Weight, Height: Not given, normal appearing (as per simulator) but has lost 20 lbs recently. 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. 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. diagnosis of DKA Trigger 3, ABG show acidosis and high BM and normal potassium. We try to provide sufficient realism.. The authors of the second study reported that poor sleep quality (60% of respondents) and extreme fatigue (55% of respondents) are independently associated with safety risks on the job. Inspect theairwayfor obviousobstruction. There are just a few more things to do. Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. Using your thumbs, slightly open the mouth by downward displacement of the chin. Emergency medical services workLife characteristics contribute to clinically significant excessive daytime sleepiness. 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. Schneider Sarver PA, Senczakowicz EA, Slovensky BM. Margolis GS, Romer GA, Fernandez AR, et al. Urinary tract infections are a common DKA precipitant. This field is for validation purposes and should be left unchanged. You may be trying to access this site from a secured browser on the server. 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 teaching of diabetic assessment and management, like many other medical emergencies, lends itself well to case-based simulation. Does the patient need reviewing by a specialist? Instead, instructors should combine case- and simulation-based techniques when teaching diabetic assessment. Its best, however, to allow the student group to continue so theyre able to evaluate their decision-making processes during debriefing. Strategies of high-performing paramedic educational programs. Properly interpret a venous blood gas (VBG) and basic metabolic panel in a patient presenting with diabetic ketoacidosis. It should only be inserted in unconscious patients as it is otherwise poorly tolerated and may induce gagging and aspiration. Wolters Kluwer Health Published August 2015. Environment & Manikin Categories: Emergency Medicine, Medical Education Keywords: diabetic ketoacidosis, simulation, expertise, emergency medicine . vD0 x@FFJ{m[ 3//Oh|JR7! Open the patients airwayusing ahead-tiltchin-lift manoeuvre: 1. Measure the patients capillary blood glucose and ketone levels to confirm the diagnosis and guide the management of DKA. The instructor should have visual access via one-way windows or cameras. This leads to hyperglycaemia, osmotic diuresis, and dehydration. 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. "Never doubt that a small group of thoughtful, committed citizens can change the world. Forty percent of respondents reported excessive daytime sleepiness. We are looking for declaration of DKA and request for pathway. A collection of interactive medical and surgical clinical case scenarios to put your diagnostic and management skills to the test. The Theory The lecture allows for understanding of concepts prior to action, and instructor feedback is immediate. There are several causes of DKA, which we remember by the "five I's". Chapters: For example, you could develop a diabetic scenario in which the prehospital provider encounters an altered patient with incomprehensible speech. The choice of fluid type, rate of administration and volume should be tailored to the individual patient based upon their vital signs and electrolytes. 1-6. Discuss the patients current clinical condition with aseniorclinicianusing anSBARR style handover. angioedema, rash) commence appropriate treatment as discussed in ouranaphylaxis guide. We combined both to indicate the continuity of the curriculum, and the building on prior knowledge. 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. As this is a value-added session that demonstrates new concepts, such as the vital signs on a clinical monitor, there are no assessment instruments to measure gaining of understanding. Trainee will correlate the underlying pathophysiology with symptoms and signs as exhibited by the simulation session. Patients with DKA require fluid resuscitation to restore circulatory volume, clear ketones, correct electrolyte abnormalities and increase renal perfusion. As individuals with uncontrolled type I . Please try after some time. Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario Cureus. A well-staged environment allows for greater student buy-in. Supplemental digital content is available for this article. As this is a PBL session, the trainees are not given any references. Int J Evid Based Healthc. 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. Trigger 4, Pathway 1l of saline required over 1hour and insulin infusion need prescribing and making up in 50ml syringe. 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. Are any further assessments or interventions required? In the final 10 minutes, we show how the patient has a good recovery after fluid replacement. Therefore, the same file is also sent to the participants before the session. Performing an ECG should not delay the emergency management of DKA. endobj - Radiation 02:45 MassBay EMS Program Integrates Training for Dogs, Heat Waves Are Killing More LA Homeless People. On the basis of the feedback from the students, they indicated that they believed the small group sessions are better. 4 0 obj See ourdocumentation guidesfor more details. Twitter: http://www.twitter.com/geekymedics Makeup may be used to depict gender, hollow eyes and cheeks, produce pallor or display bruises and scars. Trainee will increase knowledge of professional behaviors during the simulation. The optimal number of simulation participants is four to seven individuals, depending on the case study objectives. A fixed-rate intravenous insulin infusion should be commenced initially to suppress ketogenesis, reduce blood glucose levels and address electrolyte disturbances. Trainee will recognize the need for therapy and suggest an appropriate therapy in a simulated environment. - Severity 05:32 The students have acquired all the applicable theoretical knowledge of the case during the previous multiday PBL sessions. Ziv A, Wolpe PR, Small SD, et al. 2. This is particularly important for core . It was developed for anesthesiology resident physicians with some background knowledge and experience caring for critically ill patients. stream Clearlydocument your ABCDE assessment, including history, examination, observations, investigations, interventions, and the patients response. The normal reference range for fasting plasma glucose is 4.0 5.8 mmol/l. Groups of fewer than four students dont allow for optimal collaboration. - Site 01:12 Adds true to life parking codes and extra parking for AI. Note that if-thens must also include negative patient outcomes for when the provider doesnt take appropriate action. A list of the requirements (monitors, props, and others) is given in Tables 2 and 3, as well as in the web supplement (Appendix C, Supplemental Digital Content 3, https://links.lww.com/SIH/A3). Simulation in Healthcare4(4):232-236, Winter 2009. She Died the Next Day. Advance the airway until it lies within the pharynx. The reason for inserting the airway upside down initially is to reduce the risk of pushing the tongue backwards and worsening airway obstruction. This may produce better retention of the subject matter and help students adapt to emergency scenes before going into the field. The relationship between sleep, fatigue and patient and provider safety. Scenarios. 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. 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 60 minutes training time consists of four 15-minute sections divided as follows. 1 0 obj We give the history of the patient to the trainees. One of the key differences with the immersive simulation is that the instructor is absent from the simulation environment. insulin-dependent type 2 diabetes) Symptoms Typical symptoms of DKA include: Palpitations Nausea Vomiting Sweating Thirst Weight loss Leg cramps Clinical signs Typical clinical signs of DKA include: Tachycardia Hypotension 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. For similar reasons, we do not believe a videotaped session will keep the students attention as much as these live simulator sessions. Should any changes be made to the current management of their underlying condition(s)? Perform urinalysis and send the urine for culture if urinary tract infection is suspected. Its absolutely necessary to follow all immersive simulations with a positive, emotionally safe and nonjudgmental debriefing environment. The learning objectives follow the American College of Graduate Medical Education (ACGME) Core Compentencies. >> Fernandez AR, Mac Crawford J, Pennell ML, et al. type 1 diabetes), Complete insulin insensitivity (e.g. insulin-dependent type 2 diabetes), Altered consciousness (e.g. 1. 5. Physician working in the emergency department. may email you for journal alerts and information, but is committed Use washable, non-toxic paints to imitate various body emissions. 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. Causes: Any situation arising in a diabetic that requires increased insulin without that demand being met can result in DKA. However, we should not spend too much time on (not become distracted with) explaining unfamiliar monitors for the present trainees, such as central venous pressure or ETCO2 concentration. Mosby:Philadelphia. Typically potassium levels should be maintained between 4.0 5.5 mmol/L and close monitoring is required. See ourhistory taking guidesfor more details. Therefore, we have to emphasize the importance of airway, breathing, and circulation in the very sick patient in any clinical setting. }HyEf,#$/JSRU9+CF6k\'/z+i`[ 5JudK*Zly^g%[jCK)H[)Y=Qp0/r9o9HW_zF}pTzI~'|q.~:=Y T 9w! 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. - Over 3000 Free MCQs: https://geekyquiz.com/ Using the arterial line, the scenario becomes much more dynamic. In other words, they do not have clinical experience, but they have clinical knowledge. Calculate the patients current fluid balance using their fluid balance chart (e.g. 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. Conclusion We also show them IV bags containing saline and Ringers lactate, as well as show them IV infusion sets. 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. Blood sugar issues in the Type II diabetic will have a gradual onset, with diagnosis generally resulting from routine laboratory exams.(1). 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. The students are in their first year. Geeky Medics accepts no liability for loss of any kind incurred as a result of reliance upon the information provided in this video. 4. 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. See ourCXR interpretation guidefor more details. Depending on scenario complexity, team dynamic and treatment modalities, this simulation may take 1020 minutes. 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. (1), The assessment of a diabetic patient is best taught as a case-based simulation. 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]). - Timing 03:23 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). His Wife Gave Him CPR. Diabetes UK with the Joint British Diabetes Societies Inpatient Care Group. Insert at least onewide-bore intravenous cannula(14G or 16G) and take blood tests as discussed below. 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! 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. Refer to your local guidelines for further details. - Medical Finals Question Pack: https://geekymedics.com/medical-student-finals-questions/ Another example: At one minute into the scenario, the patient becomes unresponsive and their breathing becomes shallow. See Table 4 for a suggested standardized script. 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. PA EMT Said COVID Patient Didnt Need to Go to the Hospital. Animated lectures, however, must work within the framework of a focused case study, which requires increased preparation time. His Heart Stopped On a Treadmill. Capillary refill timemay be prolonged if the patient is hypovolaemic. 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. Prehosp Emerg Care. ABG, venepuncture). Target Learner Groups 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. cellulitis). Insert the airway bevel-end first, vertically along the floor of the nose with a slight twisting action. Inspect for evidence of self-injection sites (e.g. These simulation sessions seem to work because the medical students do have prior knowledge. DO NOT perform any examination or procedure on patients based purely on the content of these videos. The objective is to give as many visual and tactile cues concerning the patient condition and background as possible. Given 6 to 8 back-to-back sessions, it is critical that every session starts and ends on time! 2008;6:278302. >> Patterson PD, Weaver M, Frank R, et al. Facilitator to ask how often to measure BMs 2003;78:783788. A number of key modifiers are described that allow for the adjustment of case . Problems are addressed as they are identified and the patient is re-assessed regularly to monitor their response to treatment. If the patient is confused you might be able to get a collateral history from staff or family members as appropriate. Make sure tore-assessthe patient after anyintervention. It may be necessary toexposethe patient during your assessment: remember to prioritise patient dignity and conservation of body heat. 3 0 obj JEMS. We used the Medical Education Technologies Inc. (METI) Human Patient Stimulator (HPS, METI Sarasoto, Fl). Debriefing The main goal is to establish a safe learning environment for the learner [9, 13 . Subscribe to our newsletter to be the first to know about our latest content: https://geekymedics.com/newsletter/ For diabetic assessment involving DKA, staging may include the use of a container with a small amount of acetone placed near the manikin because many students may not know what acetone smells like but will expect to smell something. Example: If the provider immediately evaluates blood glucose, then the reading will display 45 mg/dL. Initially, we required the students to write down the vital signs. DO NOT perform any examination or procedure on patients based purely on the content of these videos. The facilitator guides the group only when necessary. Just place the BR2_KDCA file into your addons scenery folder: C:\\Program Files\\Microsoft Games\\Microsoft Flight Simulator X\\Addon Scenery\\Scenery. If the patient is conscious, sit themuprightas this can also help with oxygenation. NPAs are typically better tolerated in patients who are partly or fully conscious compared to oropharyngeal airways. A debriefing section with pre-established questions allows the instructor to review the main focus and performance measures with the student group. See ourfluid prescribing guidefor more details onresuscitation fluids. Given such a small group, the students indicated that they feel more involved than they would with a larger group (eg, the whole class.) %PDF-1.5 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.

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