When erroneous treatment is delivered, the instructor can end the simulation. Creating a Simulation Experience to Promote Clinical Judgment JEMS. Testing a diabetes keotacidosis simulation in critical care nursing: A 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. See ourCXR interpretation guidefor more details. From the Department of Anesthesiology, Pennsylvania State University College of Medicine, Hershey, PA. Dr. Murray is on the Speakers Bureau of METI, Sarasota, FL. Prehosp Emerg Care. DO NOT perform any examination or procedure on patients based purely on the content of these videos. In keeping with the case study, as a treatment marker is reached, the instructor should place emphasis on physiological, pharmacological, environmental and psychosocial issues. Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario Schneider Sarver PA, Senczakowicz EA, Slovensky BM. areas of lipohypertrophy) if it is unclear if the patient is diabetic. Diabetic ketoacidosis simulator: a new learning tool for a life Simulation provides a safe environment where learning is enhanced through the deliberate practice of skills and controlled management of a variety of clinical encounters. 2 The evaluation of potassium deficits is complicated by potassium exit from . Administer oxygen to all critically unwell patients during yourinitialassessment. 3. They should be used in conjunction with the maneuvres mentioned above as the position of the head and neck need to be maintained to keep the airway aligned. Properly interpret a venous blood gas (VBG) and basic metabolic panel in a patient presenting with diabetic ketoacidosis. Published August 2015. Immersive Simulations Open the patients airwayusing ahead-tiltchin-lift manoeuvre: 1. Search for Similar Articles Trainee will be able to apply skills of communication with the simulated patient in a semiacute crisis to get sufficient important information for a final diagnosis. 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 . - Associated symptoms 03:04 Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario 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. This typically involves the use of anon-rebreathe maskwith an oxygen flow rate of15L. This is a combination of the modified traditional lecture within scenario-based learning. PDF Medicine Simulation Scenario Diabetic Ketoacidosis: An Emergency Keywords: diabetic ketoacidosis, simulation, expertise, emergency medicine Introduction Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes mellitus, most . Circulating nurse in the emergency room (ER). 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. Interactive lecture/discussion with use of monitors that show the vital signs of the simulated patient on manikin. - PSA Question Pack: https://geekymedics.com/psa-question-bank/ 1 Potassium losses occurring both before and during treatment of DKA must be replaced. 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). type 1 diabetes), Complete insulin insensitivity (e.g. Calculate the patients current fluid balance using their fluid balance chart (e.g. A comprehensive collection of OSCE guides to common clinical procedures, including step-by-step images of key steps, video demonstrations and PDF mark schemes. Groups of fewer than four students dont allow for optimal collaboration. 34 - Diabetic Ketoacidosis in Pregnancy | Obgyn Key The normal reference range for fasting plasma glucose is 4.0 5.8 mmol/l. 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. Please note that by doing so you agree to be added to our monthly email newsletter distribution list. A collection of interactive medical and surgical clinical case scenarios to put your diagnostic and management skills to the test. A well-staged environment allows for greater student buy-in. 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. Keyword Highlighting Review the patients drug chart for medications which may cause a reduced level of consciousness (e.g. Kymera Systems Inc | SCADA Online Demo Ignition unilateral coarse crackles may be present if the patient has pneumonia which may have been the precipitant for DKA). Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. An events progression section should include patient status changes, as well as a time/treatment continuum that incorporates if-then event progressions. Despite this increased calorie intake, she noticed an unexplained 20 lbs weight loss. 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. Note that if-thens must also include negative patient outcomes for when the provider doesnt take appropriate action. The teaching of diabetic assessment and management, like many other medical emergencies, lends itself well to case-based simulation. 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. The patient synopsis should include such standard aspects as age, sex, ethnicity, medical history, medications and allergies. Diabetic ketoacidosis; Simulation training; Medical students. If an obstruction is visible within the airway, use afingersweeporsuctionto remove it. - Site 01:12 Blood sugar issues in the Type II diabetic will have a gradual onset, with diagnosis generally resulting from routine laboratory exams.(1). Available if the trainee asks: arterial blood gas, glucose, electrolytes, BUN and plasma osmolality (please see last section of Appendix B, Supplemental Digital Content 2, https://links.lww.com/SIH/A2, for values). Consider any precipitating factors for the development of DKA and involve the diabetes team in the patients care. Performing an ECG should not delay the emergency management of DKA. The main purpose of the simulation is to draw a line from the theoretical, boring biochemistry to the clinical manifestations. We now provide the students with handouts of the data to save time and provide consistency. 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. This is a 25-year-old woman with a medical history of diabetes medicated with 40 units insulin per day. The questionnaire for the assessment of the session is given in full in the web-based supplement (Appendix A, Supplemental Digital Content 1, https://links.lww.com/SIH/A1). 4. In other words, they do not have clinical experience, but they have clinical knowledge. Trainee will practice or observe good teamwork skills, both as a leader and a team player. dq-]gX4 `L'u7myx) rpjf0z,.y`VMyx-&Ju`U0 You may search for similar articles that contain these same keywords or you may Trainee will recognize the need for therapy and suggest an appropriate therapy in a simulated environment. We combined both to indicate the continuity of the curriculum, and the building on prior knowledge. 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). VbQuX#R M21 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. Simulation student Scenario- DKA-Peds.docx - DIABETIC 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. Does the patient need a referral toHDU/ICU? Stage 1: Initial assessment of acutely unwell pregnant woman and diagnosis of DKA. Antibiotics should be prescribed in keeping with local guidelines. Each clinical case scenario allows you to work through history taking, investigations, diagnosis and management. 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 . These are not learning objectives in this program. Pediatric Emergency Medicine Didactics and Simulation (PEMDAS This is particularly important for core cases and low-frequency, high-stakes procedures and encounters. They have had no clinical exposure or any clinical experience. Deteriorationshould be recognised quickly and acted upon immediately. Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario Check out our other awesome clinical skills resources including: 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). A collection of surgery revision notes covering key surgical topics. Groups of more than seven may struggle with meeting objectives due to insufficient functional rolls. The 60 minutes training time consists of four 15-minute sections divided as follows. 2. We then start the DKA state. See Appendix D, Supplemental Digital Content 4, https://links.lww.com/SIH/A4. 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. Trainee will improve their understanding of clinical practice through reflective assessment of actual cases during the prior PBL sessions. cloudy urine may indicate urinary tract infection). Adds true to life parking codes and extra parking for AI. . We do not use passive visualizing materials such as videotapes or DVD other than vital signs shown on the monitors. This environment doesnt allow the student to identify presentation cues, be active in their own learning or apply their skills without endangering the lives of patients.(2). GRAPH. . A blood glucose level may already be available from earlier investigations (e.g. After initial insulin therapy has reduced plasma blood glucose levels (e.g. This video demonstrates how to use the SOCRATES acronym when taking a history of pain or other symptoms. PDF Diabetic Ketoacidosis in the Obstetric Population: A Simulation The trainees have had background knowledge of biochemistry because they had completed the PBL case. 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. Inspect for evidence of self-injection sites (e.g. Medical Simulation Scenarios are text documents outlining the various details of a simulation - everything from patient simulator settings to debriefing notes. Trainee will increase knowledge of professional behaviors during the simulation. 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. However, this leads to confusion. 4. The student group is given a short introduction into a closed simulation environment. There are just a few more things to do. PDF DKA Sim Scenario - ABCD (Diabetes Care) Ltd Using SOCRATES in History Taking | OSCE | Communication Skills, Diabetic Ketoacidosis (DKA) | Acute Management | ABCDE. - 2500+ OSCE Flashcards: https://geekymedics.com/osce-flashcards/ If the patient is suspected to have sufferedsignificanttraumawith potential spinal involvement, perform ajaw-thrustrather than a head-tilt chin-lift manoeuvre: 2. There are several causes of DKA, which we remember by the "five I's". Animated lectures, however, must work within the framework of a focused case study, which requires increased preparation time. Some manikin models support a variety of human functions, such as capillary and facial cyanosis, facial sweating, foley catheter and IV placement, blood pressure generation, cardiac rhythms and abnormalities, defibrillation, cardioversion, external pacing and vital sign generation. <>>> A comprehensive collection of medical revision notes that cover a broad range of clinical topics. 2. 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.) Diabetic Ketoacidosis (DKA) Clinical Pathway Emergency Department Trainee will correlate the underlying pathophysiology with symptoms and signs as exhibited by the simulation session. The learning objectives follow the American College of Graduate Medical Education (ACGME) Core Compentencies. 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. DOWNLOAD Diabetic Ketoacidosis By the end of this scenario, the learner will be able to: 1. Introduceyourselfto whoever has requested a review of the patient andlistencarefullyto their handover. 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. 2 0 obj Extremities: mild cyanosis, no clubbing or edema (verbalized by instructors); pulses equal, and symmetrical (elucidated by trainees). A fixed-rate intravenous insulin infusion should be commenced initially to suppress ketogenesis, reduce blood glucose levels and address electrolyte disturbances. Each performance measure is separated into cognitive, behavioral or technical categories. 3 0 obj The instructor should have visual access via one-way windows or cameras. - 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 collection of data interpretation guides to help you learn how to interpret various laboratory and radiology investigations. We ask the trainee why the blood pressure is so low or heart rate is so high, and how we should treat it. 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. The relationship between sleep, fatigue and patient and provider safety. Ketones show 5.5. Both external and internal potassium balances are disturbed during the development and treatment of DKA. Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. - Severity 05:32 PDF Medicine Simulation Scenario Diabetic Ketoacidosis: An Emergency - Cureus If the patient has COPD and a history of CO2retention you should switch to aventuri maskas soon as possible andtitrate oxygen appropriately. 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. Conclusion Intubation lubricants can mimic drooling. Trainee will be respectful to others and their views during the PBL session. Animated Lecture Place one hand on the patients forehead and the other under the chin. Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario. - PDF Conclusions This technical report describes the design and implementation of a simulation scenario on DKA for emergency medicine trainees. 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. By joining Cureus, you agree to our Refer to your local guidelines for further details. Section snippets . 2. After entering the environment, the student doesnt have the option of leaving the simulation until the learning objectives and performance measures are achieved. - Over 3000 Free MCQs: https://geekyquiz.com/ 2. PA EMT Said COVID Patient Didnt Need to Go to the Hospital. As a next step, we will let one of the trainees talk to the patient, and prompt to ask medical questions such as previous medical issues or recent drug use for them to practice asking questions to generate a differential diagnosis (in this case, other causes for confusion). Your message has been successfully sent to your colleague. For instance, one of the questions is: Why is Tiffany dehydrated? There are several possible reasons and mechanisms (as outlined in Appendix B, fourth 15 minutes, Supplemental Digital Content 2, https://links.lww.com/SIH/A2), which the students can mention. Similar to a ward round, where the instructor would say: Come and listen to this patient with an aortic stenosis. An hour was . Marx JA, Hockberger RS, Walls RM. Recognize the signs and symptoms of a patient presenting with diabetic ketoacidosis. This article originally appeared in March 2011 JEMS as Diabetes Demonstration: Simulation-based learning works best., Simulation Training Ideal for Diabetic Patients, CMS Begins Reprocessing Retroactive Payments, Documents Detail EMTs Failure to Aid Tyre Nichols, New Course Lets Bystanders Be the Help Until Help Arrives, All Paramedic Recruits in New Castle County (DE) Obtain NRP Certification, International Prehospital Medicine Institute Literature Review, March 2023. 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. Case-based education adds a real-world aspect to the learning environment. 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. The learning environment should closely mimic real-world applications. Trainee will get to know how professionals behave during management of a critically ill patient. 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. Simulation provides a safe environment where learning is enhanced through the deliberate practice of skills and controlled management of a variety of clinical encounters. Available from: [. If the patient loses consciousness and there are no signs of life on assessment, put out a crash call and commence CPR. Inspect the urine currently in the catheter bag and note its appearance (e.g. modify the keyword list to augment your search. 2011;15:108109. stream Diabetes UK with the Joint British Diabetes Societies Inpatient Care Group. Yes: if the patient can talk, their airway is patent and you can move on to the assessment of breathing. The Pratcice If an infection is suspected, IV antibioticsshould be administered as soon as possible. cellulitis). Creating a Simulation Experience to Promote Clinical Judgment Simulation Training Ideal for Diabetic Patients - JEMS Int J Evid Based Healthc. If you have any scenarios you would be willing to share with the simulation community, please forward them to me. Trigger 4, Pathway 1l of saline required over 1hour and insulin infusion need prescribing and making up in 50ml syringe. 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. Facilitator to ask how often to measure BMs See ourhistory taking guidesfor more details. Simulation in Healthcare4(4):232-236, Winter 2009. Nandate, Koichiro MD, PhD; Abola, Ramon MD; Murray, W Bosseau MB; Whitfield, Carol PhD; Lang, Charles PhD; Sinz, Elizabeth MD.