This is a 25-year-old woman with a medical history of diabetes medicated with 40 units insulin per day. There are just a few more things to do. Section snippets . - Timing 03:23 The reason for inserting the airway upside down initially is to reduce the risk of pushing the tongue backwards and worsening airway obstruction. Trainee will learn to collaborate with peers to decide on appropriate interventions, tests, and therapy. . The students have acquired all the applicable theoretical knowledge of the case during the previous multiday PBL sessions. 3. 4. 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. Note that if-thens must also include negative patient outcomes for when the provider doesnt take appropriate action. This is a combination of the modified traditional lecture within scenario-based learning. A GCS of 8 or below warrants urgent expert help from an anaesthetist. This guide provides an overview of the recognition and immediate management of diabetic ketoacidosis (DKA)using an ABCDE approach. KDCA, Ronald Reagan Washington National Airport, DC. Immersive simulations are mentally exhausting because they create an intense and stressful atmosphere requiring the learner to work outside their comfort zone. DO NOT perform any examination or procedure on patients based purely on the content of these videos. endobj If you have any scenarios you would be willing to share with the simulation community, please forward them . 2 0 obj 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. Mosby:Philadelphia. Insert at least onewide-bore intravenous cannula(14G or 16G) and take blood tests as discussed below. A collection of data interpretation guides to help you learn how to interpret various laboratory and radiology investigations. The learning environment should closely mimic real-world applications. Consider active re-warming techniques in patients with severe hypothermia. Join the Geeky Medics community: Trainee will improve their understanding of clinical practice through reflective assessment of actual cases during the prior PBL sessions. Invasive monitors, including a left radial intraarterial and a right subclavian IV catheter, were placed. For example, you could develop a diabetic scenario in which the prehospital provider encounters an altered patient with incomprehensible speech. - Exacerbating & relieving factors 05:12 The simulation experience serves to give substance to the theoretical words and concepts that the students encountered during the PBL sessions. - PSA Question Pack: https://geekymedics.com/psa-question-bank/ Acad Med. Nandate, Koichiro MD, PhD; Abola, Ramon MD; Murray, W Bosseau MB; Whitfield, Carol PhD; Lang, Charles PhD; Sinz, Elizabeth MD. 3. Clearlydocument your ABCDE assessment, including history, examination, observations, investigations, interventions, and the patients response. Int J Evid Based Healthc. - Over 3000 Free MCQs: https://geekyquiz.com/ <> Check out our other awesome clinical skills resources including: Trainee will appropriately request assistance and use available resources. Standardized patient as the voice of the simulator (or the simulation operator may play this role). We give the history of the patient to the trainees. Inspect the urine currently in the catheter bag and note its appearance (e.g. Properly interpret a venous blood gas (VBG) and basic metabolic panel in a patient presenting with diabetic ketoacidosis. 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. 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. 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. Problems are addressed as they are identified and the patient is re-assessed regularly to monitor their response to treatment. His Wife Gave Him CPR. 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. areas of lipohypertrophy) if it is unclear if the patient is diabetic. Glycosuria leads to urinary losses of potassium through osmotic diuresis. 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. Facebook: http://www.facebook.com/geekymedics An integral part of a PBL session is for trainees to be able to navigate through huge literature bases. 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. The use of a simulated, evolving case scenario was an effective method of exposing nursing students to complex patient care. If the patient is conscious, sit themuprightas this can also help with oxygenation. Consider any precipitating factors for the development of DKA and involve the diabetes team in the patients care. Simulation-based medical education: An ethical imperative. 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. 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. Conclusions This technical report describes the design and implementation of a simulation scenario on DKA for emergency medicine trainees. Inspect for evidence of infection on the skin (e.g. In this manner, the students have to apply their knowledge at the appropriate points during the progression of the scenario. In the meantime, you should re-assess and maintain the patients airway. 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 validity of the HFS-DKA scenario was verified by a certified diabetes nurse educator, a registered nurse, and a clinical nurse educator. Review thepatients notes,chartsandrecent investigation results. 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. Simulation in Healthcare4(4):232-236, Winter 2009. Review the patientsoxygen saturation(SpO2): Auscultate the chest to screen for evidence of respiratory pathology (e.g. Keywords: diabetic ketoacidosis, simulation, expertise, emergency medicine Introduction Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes mellitus, most . Trainee will recognize the need for therapy and suggest an appropriate therapy in a simulated environment. The students worked on the underlying physiology during a week long PBL session and are therefore familiar with the theoretical aspects of DKA. VbQuX#R M21 Advance the airway until it lies within the pharynx. dq-]gX4 `L'u7myx) rpjf0z,.y`VMyx-&Ju`U0 Both external and internal potassium balances are disturbed during the development and treatment of DKA. A chest X-ray should not delay the emergency management of DKA. Refer to your local guidelines which should provide a clear protocol for the management of DKA. The teaching of diabetic assessment and management, like many other medical emergencies, lends itself well to case-based simulation. Trainee will correlate the underlying pathophysiology with symptoms and signs as exhibited by the simulation session. Below is a collection of donated scenarios for you to use or modify. An hour was . Heart: S1 and S2 within normal limits; no S3/S4 or murmurs, normal rate and rhythm. Diabetic ketoacidosis; Simulation training; Medical students. Antibiotics should be prescribed in keeping with local guidelines. Emergency medical services workLife characteristics contribute to clinically significant excessive daytime sleepiness. See ourfluid prescribing guidefor more details onresuscitation fluids. Immersive Simulations 2010;49:578586. DKA can develop within 24 hours and is potentially life threatening, requiring prompt recognition and therapeutic intervention. If an infection is suspected, IV antibioticsshould be administered as soon as possible. PA EMT Said COVID Patient Didnt Need to Go to the Hospital. Instagram: https://instagram.com/geekymedics If the patientloses consciousnessand there areno signs of lifeon assessment, put out acrash callandcommence CPR. 1 0 obj Classroom Dynamics a simulation training session designed to acquaint emergency medicine residents with the presentation and management of diabetic ketoacidosis (DKA) through the use of simulation. type 1 diabetes) Complete insulin insensitivity (e.g. Seek senior helpif the patient shows no signs of improvement or if you have any concerns. Typically potassium levels should be maintained between 4.0 5.5 mmol/L and close monitoring is required. If the patient isunconsciousorunresponsive, start thebasic life support(BLS)algorithmas per resuscitation guidelines. The scenario would include an if-then algorithm. The files are given in full in the web supplement (Appendix B, Supplemental Digital Content 2, https://links.lww.com/SIH/A2). A nasopharyngeal airway is a soft plastic tube with a bevel at one end and a flange at the other. 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. 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. Just place the BR2_KDCA file into your addons scenery folder: C:\\Program Files\\Microsoft Games\\Microsoft Flight Simulator X\\Addon Scenery\\Scenery. They have had no clinical exposure or any clinical experience. The relationship between sleep, fatigue and patient and provider safety. 2011;15:108109. Trainee will increase knowledge of professional behaviors during the simulation. Each performance measure is separated into cognitive, behavioral or technical categories. 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. The main goal is to establish a safe learning environment for the learner [9, 13 . Diabetic Ketoacidosis (DKA) Clinical Pathway Emergency Department | Children's Hospital of Philadelphia This session provides additional clinical support material for the theoretical PBL session. 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. Causes: Any situation arising in a diabetic that requires increased insulin without that demand being met can result in DKA. - Medical Finals Question Pack: https://geekymedics.com/medical-student-finals-questions/ This leads to hyperglycaemia, osmotic diuresis, and dehydration. Laschinger S, Medves J, Pulling C, et al. JEMS. A comprehensive collection of clinical examination OSCE guides that include step-by-step images of key steps, video demonstrations and PDF mark schemes. 3. 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. An events progression section should include patient status changes, as well as a time/treatment continuum that incorporates if-then event progressions. For similar reasons, we do not believe a videotaped session will keep the students attention as much as these live simulator sessions. 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)? . 2. 2003;78:783788. 2017 May 29;9(5):e1286. We now provide the students with handouts of the data to save time and provide consistency. PBL was introduced at our institution in 1995. Airway adjuncts are often helpful and in some cases essential to maintain a patients airway. >> Patterson PD, Weaver M, Frank R, et al. 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). 1. We guide the group to suggest fluid. Diabetes UK with the Joint British Diabetes Societies Inpatient Care Group. <>>> At the end of the previous section, the trainee can make the diagnosis of DKA but has not confirmed it yet. The DKA simulation incorporates cue recognition, analysis of cues, generation of solutions, nursing interventions, and evaluation of outcomes, including effective communication and psychosocial concerns. 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 optimal number of simulation participants is four to seven individuals, depending on the case study objectives. 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. Geeky Medics accepts no liability for loss of any kind incurred as a result of reliance upon the information provided in this video. If fever is present, make sure to consider co-existing infection. 2. A blood glucose level may already be available from earlier investigations (e.g. Therefore, we have to emphasize the importance of airway, breathing, and circulation in the very sick patient in any clinical setting. Simulation provides a safe environment where learning is enhanced through the deliberate practice of skills and controlled management of a variety of clinical encounters. 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. The following scenarios are available for download and are designed to meet your multi-disciplinary nursing needs. - Character 02:14 We try to provide sufficient realism.. The students are in their first year. A number of key modifiers are described that allow for the adjustment of case . Perform urinalysis and send the urine for culture if urinary tract infection is suspected. Simulation Scenario. 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.