dka simulation scenario

<> Diabetic ketoacidosis; Simulation training; Medical students. Conclusions This technical report describes the design and implementation of a simulation scenario on DKA for emergency medicine trainees. The Pratcice TheABCDEapproach can be used to perform a systematic assessment of a critically unwell patient. Trainee will increase knowledge of professional behaviors during the simulation. Much time was wasted explaining why it did not matter. Trigger 4, Pathway 1l of saline required over 1hour and insulin infusion need prescribing and making up in 50ml syringe. - 700+ OSCE Stations: https://geekymedics.com/osce-stations/ They have had no clinical exposure or any clinical experience. We try to provide sufficient realism.. 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. DKA can develop within 24 hours and is potentially life threatening, requiring prompt recognition and therapeutic intervention. 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. 2009;13:505511. If the patient loses consciousness and there are no signs of life on assessment, put out a crash call and commence CPR. 2. Should any changes be made to the current management of their underlying condition(s)? A nasopharyngeal airway is a soft plastic tube with a bevel at one end and a flange at the other. Centers for Disease Control and Prevention. Geeky Medics accepts no liability for loss of any kind incurred as a result of reliance upon the information provided in this video. This field is for validation purposes and should be left unchanged. The learning environment should closely mimic real-world applications. Initially, we required the students to write down the vital signs. Makeup may be used to depict gender, hollow eyes and cheeks, produce pallor or display bruises and scars. She Died the Next Day. % Just place the BR2_KDCA file into your addons scenery folder: C:\\Program Files\\Microsoft Games\\Microsoft Flight Simulator X\\Addon Scenery\\Scenery. Lets discuss your options. Its important to train and educate students of prehospital care on key indicators of a diabetic emergency. opioids, sedatives, anxiolytics, insulin, oral hypoglycaemic medications). may email you for journal alerts and information, but is committed One of the key differences with the immersive simulation is that the instructor is absent from the simulation environment. Prehosp Emerg Care. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journals Web site (www.simulationinhealthcare.com). Groups of fewer than four students dont allow for optimal collaboration. 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. 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. - 2500+ OSCE Flashcards: https://geekymedics.com/osce-flashcards/ 3. 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. To read Pages full Research Review column, visit www.jems.com/patient-care. MassBay EMS Program Integrates Training for Dogs, Heat Waves Are Killing More LA Homeless People. Cureus is on a mission to change the long-standing paradigm of medical publishing, where submitting research can be costly, complex and time-consuming. Recognize the signs and symptoms of a patient presenting with diabetic ketoacidosis. 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). In the final 10 minutes, we show how the patient has a good recovery after fluid replacement. 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. Open the patients mouth to ensure there is no foreign material that may be pushed into the larynx. Acad Med. 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 . Use blankets to re-warm patients who are mild to moderately hypothermic. Geeky Medics accepts no liability for loss of any kind incurred as a result of reliance upon the information provided in this video. Manikin staging can provide strong cues. The choice of fluid type, rate of administration and volume should be tailored to the individual patient based upon their vital signs and electrolytes. 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). 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. Simulation provides a safe environment where learning is enhanced through the deliberate practice of skills and controlled management of a variety of clinical encounters. Laschinger S, Medves J, Pulling C, et al. Check out our other awesome clinical skills resources including: 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. As with the animated lecture, the simulation is strongly dependent on a focused case study. Competency-based medical education has seen widespread adoption in the field along with ongoing work in the areas of . DKA can be caused by either: Absolute insulin deficiency (e.g. 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. A chest X-ray should not delay the emergency management of DKA. DO NOT perform any examination or procedure on patients based purely on the content of these videos. }HyEf,#$/JSRU9+CF6k\'/z+i`[ 5JudK*Zly^g%[jCK)H[)Y=Qp0/r9o9HW_zF}pTzI~'|q.~:=Y T 9w! These simulation sessions seem to work because the medical students do have prior knowledge. 6. The simulation experience serves to give substance to the theoretical words and concepts that the students encountered during the PBL sessions. Debriefing Forty percent of respondents reported excessive daytime sleepiness. This leads to hyperglycaemia, osmotic diuresis, and dehydration. During an immersive simulation, its imperative the group uses critical-thinking skills and group collaboration independently. DKA can develop within 24 hours and is potentially life threatening, requiring prompt recognition and therapeutic intervention. We guide the group to suggest fluid. Open the patients airwayusing ahead-tiltchin-lift manoeuvre: 1. - 150+ PDF OSCE Checklists: https://geekymedics.com/pdf-osce-checklists/ Introduceyourselfto thepatientincluding yournameandrole. 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. Groups of more than seven may struggle with meeting objectives due to insufficient functional rolls. - Site 01:12 The relationship between sleep, fatigue and patient and provider safety. 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. PBL was introduced at our institution in 1995. The lecture allows for understanding of concepts prior to action, and instructor feedback is immediate. Indeed, it is the only thing that ever has.". The scenario would include an if-then algorithm. If fever is present, make sure to consider co-existing infection. Introduceyourselfto whoever has requested a review of the patient andlistencarefullyto their handover. 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. Finally, we summarize the course and give them time for questions. This simulation session therefore aims to make the case come alive, and show this known case in a clinical context. We also show them IV bags containing saline and Ringers lactate, as well as show them IV infusion sets. 2 The evaluation of potassium deficits is complicated by potassium exit from . The instructor should have visual access via one-way windows or cameras. Twitter: http://www.twitter.com/geekymedics The trainees have had background knowledge of biochemistry because they had completed the PBL case. Strategies of high-performing paramedic educational programs. 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. After the first voluntary session in 2006, feedback from the medical students indicated that they would like to receive this handout. 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 instructors role is to facilitate active learning through a combination of learning styles. Wolters Kluwer Health Interactive lecture/discussion with use of monitors that show the vital signs of the simulated patient on manikin. DO NOT perform any examination or procedure on patients based purely on the content of these videos. The students are in their first year. 2011;15:108109. Regardless of the underlying cause of airway obstruction, seekimmediate expert supportfrom an anaesthetist and the emergency medical team (often referred to as the crash team). See ourhistory taking guidesfor more details. If the patient isunconsciousorunresponsive, start thebasic life support(BLS)algorithmas per resuscitation guidelines. Extremities: mild cyanosis, no clubbing or edema (verbalized by instructors); pulses equal, and symmetrical (elucidated by trainees). Consider active re-warming techniques in patients with severe hypothermia. For example, you could develop a diabetic scenario in which the prehospital provider encounters an altered patient with incomprehensible speech. (1), The assessment of a diabetic patient is best taught as a case-based simulation. For more information, please refer to our Privacy Policy. 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. Research Watch Box:Sleep, Fatigue & SafetyBy David Page, MS, NREMT-P 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 students have acquired all the applicable theoretical knowledge of the case during the previous multiday PBL sessions. Does the patient need a referral toHDU/ICU? 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. Works with Traffic 2005, but . Askhow the patient is feeling as this may provide some useful information about their current symptoms. In the context of DKA, a patients consciousness level may be reduced. We used the Medical Education Technologies Inc. (METI) Human Patient Stimulator (HPS, METI Sarasoto, Fl). The instructors have to appreciate that the trainees participating in this simulation have not seen a diabetic patient in either a ward or ER, but that they have knowledge of the underlying physiology. 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. 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. Please write a single word answer in lowercase (this is an anti-spam measure). to maintaining your privacy and will not share your personal information without Hypothermia may be present if the patient has been unconscious and exposed for some time. 4. Airway adjuncts are often helpful and in some cases essential to maintain a patients airway. Scenarios. If you have any scenarios you would be willing to share with the simulation community, please forward them . Trainee will appropriately request assistance and use available resources. This is particularly important for core cases and low-frequency, high-stakes procedures and encounters. Physician working in the emergency department. We have 18 to 20 PBL groups for an hour each in the week after their PBL DKA session. Ketones show 5.5. - Over 3000 Free MCQs: https://geekyquiz.com/ Consider any precipitating factors for the development of DKA and involve the diabetes team in the patients care. Two abstracts related to sleepiness in the EMS workforce were presented at the National Association of EMS Physicians symposium in January. The instructor can also gauge the direction the debriefing session should follow or be alerted to possible problems or conflicts in treatment opinions. By joining Cureus, you agree to our Her medical, social, and family histories are not clear at the time of admission to the emergency department. An oxygen mask is also demonstrated as an alternative device, as these early trainees had mostly not yet seen any of these devices. LYqC+pJ&6X4onfBT#?=R}.p8N3+Dk,P4tIgWB}-L'=8;_G >,K#.e89XnG'B~NtR If the patientloses consciousnessand there areno signs of lifeon assessment, put out acrash callandcommence CPR. and Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. Ask for anotherclinicalmemberofstafftoassistyou if possible. NPAs are typically better tolerated in patients who are partly or fully conscious compared to oropharyngeal airways. 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. The students are in their first year. We believe it is important to have active, participatory learning by having conversations with the trainees in the form of questions and answers. 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.. 1) Please read through this document as it will help you prepare for your upcoming simulation on DKA. As this is a PBL session, the trainees are not given any references. From the Department of Anesthesiology, Pennsylvania State University College of Medicine, Hershey, PA. Dr. Murray is on the Speakers Bureau of METI, Sarasota, FL. The student group is given a short introduction into a closed simulation environment. The normal reference range for fasting plasma glucose is 4.0 5.8 mmol/l. The teaching of diabetic assessment and management, like many other medical emergencies, lends itself well to case-based simulation. 4 0 obj Prior to starting the scenario, the instructor should introduce a short summary of the case study and ask open-ended questions regarding the management direction. 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. Nandate, Koichiro MD, PhD; Abola, Ramon MD; Murray, W Bosseau MB; Whitfield, Carol PhD; Lang, Charles PhD; Sinz, Elizabeth MD. 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. Terms of Use. Standardized patient as the voice of the simulator (or the simulation operator may play this role). Example: If the provider immediately evaluates blood glucose, then the reading will display 45 mg/dL. . A comprehensive collection of clinical examination OSCE guides that include step-by-step images of key steps, video demonstrations and PDF mark schemes. Administer oxygen to all critically unwell patients during yourinitialassessment. 3. This session provides additional clinical support material for the theoretical PBL session. If an obstruction is visible within the airway, use afingersweeporsuctionto remove it. Trainee will learn to collaborate with peers to decide on appropriate interventions, tests, and therapy. It was developed for anesthesiology resident physicians with some background knowledge and experience caring for critically ill patients. diagnosis of DKA Trigger 3, ABG show acidosis and high BM and normal potassium. SimMan Nursing Scenarios Software. 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. Are any further assessments or interventions required? DOI 10.7759/cureus.1286. The validity of the HFS-DKA scenario was verified by a certified diabetes nurse educator, a registered nurse, and a clinical nurse educator. Therefore, we have to emphasize the importance of airway, breathing, and circulation in the very sick patient in any clinical setting. Case-based simulation should include two to three broad-focus objectives, as well as 1020 specific performance measures that the student should accomplish. 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. We are looking for declaration of DKA and request for pathway. Calculate the patients current fluid balance using their fluid balance chart (e.g. <> Weight, Height: Not given, normal appearing (as per simulator) but has lost 20 lbs recently. Inspect theairwayfor obviousobstruction. See Table 4 for a suggested standardized script. We do not use passive visualizing materials such as videotapes or DVD other than vital signs shown on the monitors. This allows the learner group to make a psychological break from the patient and environment while beginning the reflection process. 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. If foreign material is present, attempt removal using suction. dq-]gX4 `L'u7myx) rpjf0z,.y`VMyx-&Ju`U0 Refer to your local guidelines which should provide a clear protocol for the management of DKA. stream Stage 3: Ongoing management and monitoring of DKA 1 hour after initiation of treatment. Typically potassium levels should be maintained between 4.0 5.5 mmol/L and close monitoring is required. We combined both to indicate the continuity of the curriculum, and the building on prior knowledge. However, this leads to confusion. Below is a collection of donated scenarios for you to use or modify. Antibiotics should be prescribed in keeping with local guidelines. We ask the trainee why the blood pressure is so low or heart rate is so high, and how we should treat it. I assigned true to life parking codes, and added some extra parking for the superfluous US Express AI. The required potassium replacement varies greatly. It involves a facilitating instructor, a small learner group and conceptual aspects of environmental and manikin staging to provide sensory cues. Revisit history taking to explore relevant medical history and identify any precipitating factors for DKA. Join the Geeky Medics community: Problems are addressed as they are identified and the patient is re-assessed regularly to monitor their response to treatment. 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. 5. 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. You may be trying to access this site from a secured browser on the server. Invasive monitors, including a left radial intraarterial and a right subclavian IV catheter, were placed. On the basis of the feedback from the students, they indicated that they believed the small group sessions are better. 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). 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. Make sure to re-assess the patient after any intervention. 1-6. If the patient is suspected to have sufferedsignificanttraumawith potential spinal involvement, perform ajaw-thrustrather than a head-tilt chin-lift manoeuvre: 2. (1) According to Centers for Disease Control and Prevention (CDC), 223,619 deaths were attributed to diabetes in 2005. Insert at least onewide-bore intravenous cannula(14G or 16G) and take blood tests as discussed below. The main purpose of the simulation is to draw a line from the theoretical, boring biochemistry to the clinical manifestations. Use an effectiveSBARR handoverto communicate the key information effectively to other medical staff. TikTok: https://www.tiktok.com/@geekymedics KDCA, Ronald Reagan Washington National Airport, DC. 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. It involves working through the following steps: Each stage of the ABCDE approach involvesclinicalassessment,investigationsandinterventions. Management of diabetic ketoacidosis in adults. 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 . Please try after some time. In this manner, the students have to apply their knowledge at the appropriate points during the progression of the scenario. A well-staged environment allows for greater student buy-in. A pre-briefing session is conducted prior to the start of the simulation scenario. Initially, we used a blood pressure cuff to generate the blood pressure values. - Medical Finals Question Pack: https://geekymedics.com/medical-student-finals-questions/ Search for Similar Articles Catheterisethe patient to closelymonitor urine outputto guide fluid resuscitation and need for escalation. 2003;78:783788. modify the keyword list to augment your search. type 1 diabetes) Complete insulin insensitivity (e.g. Cureus 9(5): e1286. insulin-dependent type 2 diabetes), Altered consciousness (e.g. As the name says, this screen is used to graph and plot any parameter. 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 0 obj 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. Data Description All the product records are stored at /user/spark/dataset/retail_db/products All the category records are stored at /user/spark/dataset /ret. 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. The patient synopsis should include such standard aspects as age, sex, ethnicity, medical history, medications and allergies.

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