dka simulation scenario

3. Immersive Simulations The required potassium replacement varies greatly. Physician working in the emergency department. areas of lipohypertrophy) if it is unclear if the patient is diabetic. Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario angioedema, rash) commence appropriate treatment as discussed in ouranaphylaxis guide. 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. We then start the DKA state. See Appendix D, Supplemental Digital Content 4, https://links.lww.com/SIH/A4. 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. The use of a simulated, evolving case scenario was an effective method of exposing nursing students to complex patient care. Interactive lecture/discussion with use of monitors that show the vital signs of the simulated patient on manikin. Forty percent of respondents reported excessive daytime sleepiness. A comprehensive collection of OSCE guides to common clinical procedures, including step-by-step images of key steps, video demonstrations and PDF mark schemes. A traditional classroom lecture format allows for student participation but limits the instructors ability to create realistic situations. Surgical dressings and imitation blood can support medical history. 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. Alert a senior immediately if you have any concerns about the consciousness level of a patient. After initial insulin therapy has reduced plasma blood glucose levels (e.g. Consider any precipitating factors for the development of DKA and involve the diabetes team in the patients care. See our blood glucose measurement guide for more details. DKA can develop within 24 hours and is potentially life threatening, requiring prompt recognition and therapeutic intervention. After entering the environment, the student doesnt have the option of leaving the simulation until the learning objectives and performance measures are achieved. 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. It should only be inserted in unconscious patients as it is otherwise poorly tolerated and may induce gagging and aspiration. The students are in their basic science course. 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. Scenario in a Nutshell Diabetic ketoacidosis (DKA) in pregnancy. 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 The choice of fluid type, rate of administration and volume should be tailored to the individual patient based upon their vital signs and electrolytes. Airway adjuncts are often helpful and in some cases essential to maintain a patients airway. can be reemphasized, and the effects of fluid therapy demonstrated. Place one hand on the patients forehead and the other under the chin. Simulation in Healthcare4(4):232-236, Winter 2009. Intubation lubricants can mimic drooling. - Introduction 00:00 Depending on scenario complexity, team dynamic and treatment modalities, this simulation may take 1020 minutes. If the patient isunconsciousorunresponsive, start thebasic life support(BLS)algorithmas per resuscitation guidelines. Ziv A, Wolpe PR, Small SD, et al. DO NOT perform any examination or procedure on patients based purely on the content of these videos. We used the Medical Education Technologies Inc. (METI) Human Patient Stimulator (HPS, METI Sarasoto, Fl). During an immersive simulation, its imperative the group uses critical-thinking skills and group collaboration independently. This may produce better retention of the subject matter and help students adapt to emergency scenes before going into the field. See Table 4 for a suggested standardized script. 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. This leads to hyperglycaemia, osmotic diuresis, and dehydration. An oxygen mask is also demonstrated as an alternative device, as these early trainees had mostly not yet seen any of these devices. The students are in their basic science course. This typically involves the use of anon-rebreathe maskwith an oxygen flow rate of15L. unilateral coarse crackles may be present if the patient has pneumonia which may have been the precipitant for DKA). To read Pages full Research Review column, visit www.jems.com/patient-care. 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). We are looking for declaration of DKA and request for pathway. Centers for Disease Control and Prevention. This field is for validation purposes and should be left unchanged. 2 0 obj For similar reasons, we do not believe a videotaped session will keep the students attention as much as these live simulator sessions. Questionswhich may need to be considered include: The next team of doctors on shift should bemade awareof any patient in their department who hasrecently deteriorated. 3. 34 - Diabetic Ketoacidosis in Pregnancy | Obgyn Key - Severity 05:32 Using your thumbs, slightly open the mouth by downward displacement of the chin. DOI 10.7759/cureus.1286. Diabetic Ketoacidosis in the Obstetric Population: A Simulation Trainee will practice or observe good teamwork skills, both as a leader and a team player. Kymera Systems Inc | SCADA Online Demo Ignition The students are in their first year. In some cases, normal saline with additional potassium is required to prevent overcorrection of serum potassium levels which would otherwise result in hypokalaemia. 2007. The lecture allows for understanding of concepts prior to action, and instructor feedback is immediate. Groups of more than seven may struggle with meeting objectives due to insufficient functional rolls. 1) Please read through this document as it will help you prepare for your upcoming simulation on DKA. Stage 3: Ongoing management and monitoring of DKA 1 hour after initiation of treatment. These are not learning objectives in this program. I assigned true to life parking codes, and added some extra parking for the superfluous US Express AI. type 1 diabetes) Complete insulin insensitivity (e.g. Animated Lecture Simulation Scenario. Using SOCRATES in History Taking | OSCE | Communication Skills, Diabetic Ketoacidosis (DKA) | Acute Management | ABCDE. 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. We also show them IV bags containing saline and Ringers lactate, as well as show them IV infusion sets. The learning environment should closely mimic real-world applications. Int J Evid Based Healthc. KDCA, Ronald Reagan Washington National Airport, DC. 1 0 obj 2010;49:578586. endobj Many of the preclinical students have never seen a real life clinical monitor or even an intravenous (IV) setup. Instructors should write a case study for the simulation before the session. This is a combination of the modified traditional lecture within scenario-based learning. Some error has occurred while processing your request. Terms of Use. Are any further assessments or interventions required? Research Watch Box:Sleep, Fatigue & SafetyBy David Page, MS, NREMT-P Over the years, some groups happened to have the simulation session before the completion of the theoretical PBL session. 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. 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. If the patient is suspected to have sufferedsignificanttraumawith potential spinal involvement, perform ajaw-thrustrather than a head-tilt chin-lift manoeuvre: 2. %PDF-1.5 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. As individuals with uncontrolled type I . 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). Make sure to re-assess the patient after any intervention. 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. 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. Heart: S1 and S2 within normal limits; no S3/S4 or murmurs, normal rate and rhythm. Given such a small group, the students indicated that they feel more involved than they would with a larger group (eg, the whole class.) Each PBL case typically goes over 23 days, affording the students periods to find information for the case. An hour was . The teaching of diabetic assessment and management, like many other medical emergencies, lends itself well to case-based simulation. The files are given in full in the web supplement (Appendix B, Supplemental Digital Content 2, https://links.lww.com/SIH/A2). It involves working through the following steps: Each stage of the ABCDE approach involvesclinicalassessment,investigationsandinterventions. Available from: [, NICE guidelines. This simulation session therefore aims to make the case come alive, and show this known case in a clinical context. - Examples 05:45 Tilt the forehead back whilst lifting the chin forwards to extend the neck. Evenly balancing performance measures will ensure the student has the opportunity to critically think through patient treatment and to practice new or support previously learned behaviors and technical skills. Because of this consciousness status, it is very difficult to obtain information of cardiovascular, pulmonary, renal, hepatic, endocrine, hematology, or coagulation status other than uncontrolled diabetes. This allows us to get in touch for more details if required. 2011;15:108109. Available from: [. The file explaining the session is sent to instructors 1 week before the sessions. 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. Case-based education adds a real-world aspect to the learning environment. Diabetes UK with the Joint British Diabetes Societies Inpatient Care Group. Classroom Dynamics 2. Well done, youve now stabilised the patient and theyre doing much better. She tends to drink sugar containing fluids (soda) when she is thirsty, and she eats fast foods (cream-filled muffins) when she is hungry. Outcomes Educating Nursing Students Using an Evolving, Simulated Case 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 . 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. 2. Trainee will correlate the underlying pathophysiology with symptoms and signs as exhibited by the simulation session. type 1 diabetes), Complete insulin insensitivity (e.g. We ask the trainee why the blood pressure is so low or heart rate is so high, and how we should treat it. Categories: Emergency Medicine, Medical Education Keywords: diabetic ketoacidosis, simulation, expertise, emergency medicine . Given 6 to 8 back-to-back sessions, it is critical that every session starts and ends on time! Capillary refill timemay be prolonged if the patient is hypovolaemic. A comprehensive collection of clinical examination OSCE guides that include step-by-step images of key steps, video demonstrations and PDF mark schemes. Hypothermia may be present if the patient has been unconscious and exposed for some time. For more information, please refer to our Privacy Policy. The simulation session is also hosted as an interactive session. Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. Inspect for evidence of infection on the skin (e.g. Facebook: http://www.facebook.com/geekymedics When erroneous treatment is delivered, the instructor can end the simulation. Respiratory Failure in the Course of Treatment of Diabetic Ketoacidosis Simulation student Scenario- DKA-Peds.docx - DIABETIC A collection of anatomy notes covering the key anatomy concepts that medical students need to learn. 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 the patient is conscious, sit themuprightas this can also help with oxygenation. A nasopharyngeal airway is a soft plastic tube with a bevel at one end and a flange at the other. Refer to your local guidelines which should provide a clear protocol for the management of DKA. The simulation experience serves to give substance to the theoretical words and concepts that the students encountered during the PBL sessions. This is a 25-year-old woman with a medical history of diabetes medicated with 40 units insulin per day. 1-6. (1) According to Centers for Disease Control and Prevention (CDC), 223,619 deaths were attributed to diabetes in 2005. 2017 May 29;9(5):e1286. Keywords: diabetic ketoacidosis, simulation, expertise, emergency medicine Introduction Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes mellitus, most . We guide the group to suggest fluid. The Pratcice 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. - Site 01:12 After the first voluntary session in 2006, feedback from the medical students indicated that they would like to receive this handout. Stage 1: Initial assessment of acutely unwell pregnant woman and diagnosis of DKA. In an animated lecture, its important that the student group have an instructor so they can ask direct questions. 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. Patients with DKA require fluid resuscitation to restore circulatory volume, clear ketones, correct electrolyte abnormalities and increase renal perfusion. 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. Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario your express consent. If foreign material is present, attempt removal using suction. 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. and This guide provides an overview of the recognition and immediate management of diabetic ketoacidosis (DKA)using an ABCDE approach. may email you for journal alerts and information, but is committed Please try after some time. Medical simulation technology is a powerful tool for training physicians but papers dealing with DKA simulators are scarce. Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario. - PDF confusion, coma), All critically unwell patients should have. She does not take this regularly. The instructor should have visual access via one-way windows or cameras. Conclusions This technical report describes the design and implementation of a simulation scenario on DKA for emergency medicine trainees. Search for Similar Articles The relationship between sleep, fatigue and patient and provider safety. A pre-briefing session is conducted prior to the start of the simulation scenario. oral fluids, intravenous fluids, urine output, drain output, stool output, vomiting) to inform resuscitation efforts. Open the patients airwayusing ahead-tiltchin-lift manoeuvre: 1. 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Yes: if the patient can talk, their airway is patent and you can move on to the assessment of breathing. Make sure tore-assessthe patient after anyintervention. Geeky Medics accepts no liability for loss of any kind incurred as a result of reliance upon the information provided in this video. In this section, we have to help the trainee to institute definitive therapy based on the underlying biochemical abnormalities. Ketones show 5.5. See ourhistory taking guidesfor more details. Wolters Kluwer Health stream There are just a few more things to do. Both external and internal potassium balances are disturbed during the development and treatment of DKA. This is particularly important for core . Trainee will learn to collaborate with peers to decide on appropriate interventions, tests, and therapy. Weight, Height: Not given, normal appearing (as per simulator) but has lost 20 lbs recently. Observe and discuss the effects of therapy in a mathematically modeled physiological simulator. Debriefing We believe it is important to have active, participatory learning by having conversations with the trainees in the form of questions and answers. Geeky Medics accepts no liability for loss of any kind incurred as a result of reliance upon the information provided in this video. The learning objectives follow the American College of Graduate Medical Education (ACGME) Core Compentencies. The scenario would include an if-then algorithm. Therefore, the same file is also sent to the participants before the session. We have 18 to 20 PBL groups for an hour each in the week after their PBL DKA session. Properly interpret a venous blood gas (VBG) and basic metabolic panel in a patient presenting with diabetic ketoacidosis. As the name says, this screen is used to graph and plot any parameter. Note that if-thens must also include negative patient outcomes for when the provider doesnt take appropriate action. As this is an interactive discussion session, any needed debriefing and/or explanation is given during the sessions. - Medical Finals Question Pack: https://geekymedics.com/medical-student-finals-questions/ 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. Each performance measure is separated into cognitive, behavioral or technical categories. His Heart Stopped On a Treadmill. Testing a diabetes keotacidosis simulation in critical care nursing: A Introduceyourselfto whoever has requested a review of the patient andlistencarefullyto their handover. In this case scenario, dehydration is one of the most serious immediate issues. reduced air entry, coarse crackles) to screen for evidence of pneumonia. The instructor can also gauge the direction the debriefing session should follow or be alerted to possible problems or conflicts in treatment opinions. Laschinger S, Medves J, Pulling C, et al. 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. 2. We found it more important to have the students full attention so that they could concentrate on concepts and not on menial tasks such as recording data. Inspect the urine currently in the catheter bag and note its appearance (e.g. Works with Traffic 2005, but . Please write a single word answer in lowercase (this is an anti-spam measure). You may be asked to review a patient with DKA due to confusion, reduced level of consciousness, tachycardia, hypotension and/or vomiting. TikTok: https://www.tiktok.com/@geekymedics 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. Paediatric DKA | Simulation Education Assessment & Treatment of Five Diabetic Emergencies - JEMS Other details are also important, including descriptions regarding patient language skill, social history, socioeconomic history, family history, religious practices or beliefs pertinent to treatment, and descriptive signs and symptoms. Instagram: https://instagram.com/geekymedics She is lethargic and slightly confused but can intermittently respond to questions. 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.) Acad Med. Assess the patients level of consciousness using the AVPU scale: If a more detailed assessment of the patients level of consciousness is required, use the Glasgow Coma Scale (GCS). Initially, we required the students to write down the vital signs. 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. DKA can be caused by either: Absolute insulin deficiency (e.g. 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. DO NOT perform any examination or procedure on patients based purely on the content of these videos. Emergency medical services workLife characteristics contribute to clinically significant excessive daytime sleepiness. - Geeky Medics OSCE App: https://geekymedics.com/geeky-medics-app/ Administer oxygen to all critically unwell patients during yourinitialassessment. - Onset 01:48 On the basis of the feedback from the students, they indicated that they believed the small group sessions are better. - 150+ PDF OSCE Checklists: https://geekymedics.com/pdf-osce-checklists/ The main goal is to establish a safe learning environment for the learner [9, 13 . Insert the airway bevel-end first, vertically along the floor of the nose with a slight twisting action. They have had no clinical exposure or any clinical experience. Revisit history taking to explore relevant medical history and identify any precipitating factors for DKA. This is particularly important for core cases and low-frequency, high-stakes procedures and encounters. We try to provide sufficient realism.. Make sure thepatientsnotes,observationchartandprescriptionchartare easily accessible. 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. If an infection is suspected, IV antibioticsshould be administered as soon as possible. Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario Cureus. If you have any scenarios you would be willing to share with the simulation community, please forward them to me. Askhow the patient is feeling as this may provide some useful information about their current symptoms. 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. Creating a Simulation Experience to Promote Clinical Judgment Several environments may be suitable for your classroom. Target Learner Groups Development of simulation scenarios for an adolescent patient with diabetic ketoacidosis. Diabetic Ketoacidosis (DKA) Clinical Pathway Emergency Department | Children's Hospital of Philadelphia (1), The assessment of a diabetic patient is best taught as a case-based simulation. PDF Adult Type I Diabetic Ketoacidosis Pre-simulation Preparation Student Her medical, social, and family histories are not clear at the time of admission to the emergency department. You can check out our guide to using SOCRATES here: https://geekymedics.com/the-socrates-acronym-in-history-taking/

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