Your message has been successfully sent to your colleague. A pre-briefing session is conducted prior to the start of the simulation scenario. Insert at least onewide-bore intravenous cannula(14G or 16G) and take blood tests as discussed below. Trainee will increase knowledge of professional behaviors during the simulation. If the patient is suspected to have sufferedsignificanttraumawith potential spinal involvement, perform ajaw-thrustrather than a head-tilt chin-lift manoeuvre: 2. 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. We give the history of the patient to the trainees. Antibiotics should be prescribed in keeping with local guidelines. The students are in their basic science course. Urinary tract infections are a common DKA precipitant. Performing an ECG should not delay the emergency management of DKA. A hyperglycemic patient may present with tachypnea, which often presents as Kussmauls respirations, tachycardia, orthostatic blood pressure changes and other signs of dehydration and diabetic ketoacidosis (DKA). You may search for similar articles that contain these same keywords or you may If foreign material is present, attempt removal using suction. type 1 diabetes), Complete insulin insensitivity (e.g. Nandate, Koichiro MD, PhD; Abola, Ramon MD; Murray, W Bosseau MB; Whitfield, Carol PhD; Lang, Charles PhD; Sinz, Elizabeth MD. After the initial treatment is initiated, by showing a simulated urine and blood, and by getting them to smell ketones, we can enable the trainee to confirm the diagnosis of DKA. 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. Groups of more than seven may struggle with meeting objectives due to insufficient functional rolls. The following scenarios are available for download and are designed to meet your multi-disciplinary nursing needs. 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. Some error has occurred while processing your request. As the name says, this screen is used to graph and plot any parameter. A strong emphasis is placed on the focused, methodical examination of a specific medical problem and the decision-based treatment options available. They have had no clinical exposure or any clinical experience. "Never doubt that a small group of thoughtful, committed citizens can change the world. KDCA, Ronald Reagan Washington National Airport, DC. - Geeky Medics OSCE App: https://geekymedics.com/geeky-medics-app/ The Theory Makeup may be used to depict gender, hollow eyes and cheeks, produce pallor or display bruises and scars. <>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 595.32 841.92] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> You may be trying to access this site from a secured browser on the server. 3. Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare, Get new journal Tables of Contents sent right to your email inbox, SIH_13_4_2018_08_03_KOBAYASHI_17-00153_SDC5.tif; [Other] (3.04 MB), SIH_4_4_2009_10_29_NANDATE_200199_SDC2.doc; [Word] (68 KB), SIH_4_4_2009_10_29_NANDATE_200199_SDC3.doc; [Word] (29 KB), SIH_4_4_2009_10_29_NANDATE_200199_SDC4.doc; [Word] (40 KB), Simulation of Diabetic Ketoacidosis for Cellular and Molecular Basics of Medical Practice, Articles in PubMed by Koichiro Nandate, MD, PhD, Articles in Google Scholar by Koichiro Nandate, MD, PhD, Other articles in this journal by Koichiro Nandate, MD, PhD, Privacy Policy (Updated December 15, 2022). 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. Make sure tore-assessthe patient after anyintervention. x]o ]?9kgq~:)?hE )R6!up}\<8||\]}Y~;xp~yQ$#4~djX&{n_m-]^K1/~/AD Hv 99evs,;8}8zwnhFxV.kf-V^? 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. We believe it is important to have active, participatory learning by having conversations with the trainees in the form of questions and answers. 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. If any obstruction is encountered, remove the tube and try the left nostril. - Severity 05:32 A collection of data interpretation guides to help you learn how to interpret various laboratory and radiology investigations. Two abstracts related to sleepiness in the EMS workforce were presented at the National Association of EMS Physicians symposium in January. This may produce better retention of the subject matter and help students adapt to emergency scenes before going into the field. Initially, we required the students to write down the vital signs. Facebook: http://www.facebook.com/geekymedics Classroom Dynamics Given such a small group, the students indicated that they feel more involved than they would with a larger group (eg, the whole class.) 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. - Site 01:12 Review thepatients notes,chartsandrecent investigation results. 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. Typically potassium levels should be maintained between 4.0 5.5 mmol/L and close monitoring is required. Collectblood testsafter cannulating the patient including: An ECG should be performed to screen for cardiac pathology such as arrhythmias which may be precipitated by electrolyte abnormalities (e.g. 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. Categories: Emergency Medicine, Medical Education Keywords: diabetic ketoacidosis, simulation, expertise, emergency medicine . Does the patient need a referral toHDU/ICU? This guide has been created to assist students in preparing for emergencysimulationsessionsas part of their training,it is not intended to be relied upon for patient care. VbQuX#R M21 <>>> Trainee will practice or observe good teamwork skills, both as a leader and a team player. The student group is given a short introduction into a closed simulation environment. The student group should be encouraged to collaborate on management options and to perform skills. Despite this increased calorie intake, she noticed an unexplained 20 lbs weight loss. Instead, instructors should combine case- and simulation-based techniques when teaching diabetic assessment. Refer to your local guidelines which should provide a clear protocol for the management of DKA. Healthcare Students' Psychological Well-Being in a Diabetic Ketoacidosis Simulation. 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. areas of lipohypertrophy) if it is unclear if the patient is diabetic. Using SOCRATES in History Taking | OSCE | Communication Skills, Diabetic Ketoacidosis (DKA) | Acute Management | ABCDE. Clinical Simulation in Nursing, Volume 39, 2020, pp. endobj 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. You may be asked to review a patient with DKA due to confusion, reduced level of consciousness, tachycardia, hypotension and/or vomiting. tall tented T waves in hyperkalaemia). 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. Hypothermia may be present if the patient has been unconscious and exposed for some time. Simulation Scenario. Place one hand on the patients forehead and the other under the chin. Manikin staging can provide strong cues. MassBay EMS Program Integrates Training for Dogs, Heat Waves Are Killing More LA Homeless People. The students worked on the underlying physiology during a week long PBL session and are therefore familiar with the theoretical aspects of DKA. Terms of Use. A collection of anatomy notes covering the key anatomy concepts that medical students need to learn. Catheterisethe patient to closelymonitor urine outputto guide fluid resuscitation and need for escalation. Open the patients airwayusing ahead-tiltchin-lift manoeuvre: 1. Note that if-thens must also include negative patient outcomes for when the provider doesnt take appropriate action. Example: If the provider immediately evaluates blood glucose, then the reading will display 45 mg/dL. - Introduction 00:00 DIABETIC KETOACIDOSIS MODULE: ENDOCRINOLOGY / METABOLIC TARGET: ALL PAEDIATRIC TRAINEES;NURSING STAFF BACKGROUND: DKA occurs when a relative or absolute lack of insulin leads to the inability to metabolise glucose. A debriefing section with pre-established questions allows the instructor to review the main focus and performance measures with the student group. Capillary refill timemay be prolonged if the patient is hypovolaemic. Groups of fewer than four students dont allow for optimal collaboration. The Pratcice Introduceyourselfto thepatientincluding yournameandrole. 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. Data is temporarily unavailable. See our blood glucose measurement guide for more details. and PBL was introduced at our institution in 1995. This video demonstrates how to use the SOCRATES acronym when taking a history of pain or other symptoms. His Heart Stopped On a Treadmill. It may be necessary toexposethe patient during your assessment: remember to prioritise patient dignity and conservation of body heat. Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario 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. Please write a single word answer in lowercase (this is an anti-spam measure). 2. stream The choice of fluid type, rate of administration and volume should be tailored to the individual patient based upon their vital signs and electrolytes. 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). Geeky Medics accepts no liability for loss of any kind incurred as a result of reliance upon the information provided in this video. Inspect for evidence of self-injection sites (e.g. Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. 2007. TikTok: https://www.tiktok.com/@geekymedics The students have acquired all the applicable theoretical knowledge of the case during the previous multiday PBL sessions. Simulation Scenario for Anesthesia Providers Clark Obr, MD*, Anthony Mueller, MD . 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. General: Moaning, asking what has happening to her. unilateral coarse crackles may be present if the patient has pneumonia which may have been the precipitant for DKA). An integral part of a PBL session is for trainees to be able to navigate through huge literature bases. We guide the group to suggest fluid. Alert a senior immediately if you have any concerns about the consciousness level of a patient. Section snippets . However, this turned out to be too slow, took too much time, and could not continuously demonstrate the direction of changes. Yes: if the patient can talk, their airway is patent and you can move on to the assessment of breathing. 3 0 obj Physician working in the emergency department. Blood sugar issues in the Type II diabetic will have a gradual onset, with diagnosis generally resulting from routine laboratory exams.(1). The students mentioned that they did not obtain the maximum value from the simulation session under these circumstances. endobj Refer to your local guidelines for further details. Highlight selected keywords in the article text. dq-]gX4 `L'u7myx) rpjf0z,.y`VMyx-&Ju`U0 1-6. An events progression section should include patient status changes, as well as a time/treatment continuum that incorporates if-then event progressions. 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). The instructors role is to facilitate active learning through a combination of learning styles. Circulating nurse in the emergency room (ER). A traditional classroom lecture format allows for student participation but limits the instructors ability to create realistic situations. 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. 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. After the first voluntary session in 2006, feedback from the medical students indicated that they would like to receive this handout. 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. Anesthetic Management Using the Oxygen Reserve Index for Tracheal Resection and Tracheal End-to-E A Scoping Review of the Impact of COVID-19 on Kidney Transplant Patients in the United States, Alabama College of Osteopathic Medicine Research, Baylor Scott & White Medical Center Department of Neurosurgery, California Institute of Behavioral Neurosciences & Psychology, Contemporary Reviews in Neurology and Neurosurgery, DMIMS School of Epidemiology and Public Health, Simulation, Biodesign, & Innovation In Medical Education, The Florida Medical Student Research Publications, University of Florida-Jacksonville Neurosurgery, VCOM Clinical, Biomedical, and Educational Research, American Red Cross Scientific Advisory Council, Canadian Association of Radiation Oncology, International Liaison Committee on Resuscitation, International Pediatric Simulation Society, Medical Society of Delaware Academic Channel, Society for Healthcare & Research Development, Surgically Targeted Radiation Therapy for Brain Tumors: Clinical Case Review, Clinical and Economic Benefits of Autologous Epidermal Grafting, Defining Health in the Era of Value-Based Care, Optimization Strategies for Organ Donation and Utilization, MR-Guided Radiation Therapy: Clinical Applications & Experiences, Multiple Brain Metastases: Exceptional Outcomes from Stereotactic Radiosurgery, Proton Therapy: Advanced Applications for the Most Challenging Cases, Radiation Therapy as a Modality to Create Abscopal Effects: Current and Future Practices, Clinical Applications and Benefits Using Closed-Incision Negative Pressure Therapy for Incision and Surrounding Soft Tissue Management, Negative Pressure Wound Therapy with Instillation, NPWT with Instillation and Dwell: Clinical Results in Cleansing and Removal of Infectious Material with Novel Dressings. By joining Cureus, you agree to our The validity of the HFS-DKA scenario was verified by a certified diabetes nurse educator, a registered nurse, and a clinical nurse educator. Revisit history taking to explore relevant medical history and identify any precipitating factors for DKA. SimMan Nursing Scenarios Software. It was Are any further assessments or interventions required? 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.
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