This simulation session therefore aims to make the case come alive, and show this known case in a clinical context. For more information, please refer to our Privacy Policy. A collection of communication skills guides, for common OSCE scenarios, including history taking and information giving. If foreign material is present, attempt removal using suction. Invasive monitors, including a left radial intraarterial and a right subclavian IV catheter, were placed. (1), The assessment of a diabetic patient is best taught as a case-based simulation. 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. Two abstracts related to sleepiness in the EMS workforce were presented at the National Association of EMS Physicians symposium in January. With your index and other fingers placed behind the angle of the mandible, apply steady upwards and forward pressure to lift the mandible. 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. 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This field is for validation purposes and should be left unchanged. Blood sugar issues in the Type II diabetic will have a gradual onset, with diagnosis generally resulting from routine laboratory exams.(1). Askhow the patient is feeling as this may provide some useful information about their current symptoms. Case-based education adds a real-world aspect to the learning environment. A comprehensive collection of clinical examination OSCE guides that include step-by-step images of key steps, video demonstrations and PDF mark schemes. 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. PDF Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario can be reemphasized, and the effects of fluid therapy demonstrated. Given 6 to 8 back-to-back sessions, it is critical that every session starts and ends on time! 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). reduced air entry, coarse crackles) to screen for evidence of pneumonia. 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. Antibiotics should be prescribed in keeping with local guidelines. 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. 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. Diabetic ketoacidosis (DKA) is a common, potentially lethal disease. Another example: At one minute into the scenario, the patient becomes unresponsive and their breathing becomes shallow. 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. 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. A traditional classroom lecture format allows for student participation but limits the instructors ability to create realistic situations. We combined both to indicate the continuity of the curriculum, and the building on prior knowledge. 4. A collection of surgery revision notes covering key surgical topics. His Heart Stopped On a Treadmill. Competency-based medical education has seen widespread adoption in the field along with ongoing work in the areas of . and SimMan Nursing Scenarios Software. This is particularly important for core cases and low-frequency, high-stakes procedures and encounters. Supplemental digital content is available for this article. Clearly communicate how often would you like the patients observations relayed to you by other staff members. - Character 02:14 Environment & Manikin Surgical dressings and imitation blood can support medical history. Scenarios. We guide the group to suggest fluid. A number of key modifiers are described that allow for the adjustment of case . Yes: if the patient can talk, their airway is patent and you can move on to the assessment of breathing. LYqC+pJ&6X4onfBT#?=R}.p8N3+Dk,P4tIgWB}-L'=8;_G >,K#.e89XnG'B~NtR For similar reasons, we do not believe a videotaped session will keep the students attention as much as these live simulator sessions. 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. This is a 25-year-old woman with a medical history of diabetes medicated with 40 units insulin per day. This allows us to get in touch for more details if required. The files are given in full in the web supplement (Appendix B, Supplemental Digital Content 2, https://links.lww.com/SIH/A2). 2. Diabetic ketoacidosis; Simulation training; Medical students. 2. Below is a collection of donated scenarios for you to use or modify. The students have acquired all the applicable theoretical knowledge of the case during the previous multiday PBL sessions. Refer to your local guidelines which should provide a clear protocol for the management of DKA. - PSA Question Pack: https://geekymedics.com/psa-question-bank/ Recognize the signs and symptoms of a patient presenting with diabetic ketoacidosis. We have 18 to 20 PBL groups for an hour each in the week after their PBL DKA session. If the patient is conscious, sit themuprightas this can also help with oxygenation. - Timing 03:23 }HyEf,#$/JSRU9+CF6k\'/z+i`[ 5JudK*Zly^g%[jCK)H[)Y=Qp0/r9o9HW_zF}pTzI~'|q.~:=Y T 9w! In the meantime, you should re-assess and maintain the patients airway. She is lethargic and slightly confused but can intermittently respond to questions. 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. The optimal number of simulation participants is four to seven individuals, depending on the case study objectives. 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). See ourdocumentation guidesfor more details. If fever is present, make sure to consider co-existing infection. The reason for inserting the airway upside down initially is to reduce the risk of pushing the tongue backwards and worsening airway obstruction. They have had no clinical exposure or any clinical experience. 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. 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. By joining Cureus, you agree to our This session provides additional clinical support material for the theoretical PBL session. Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. PDF Adult Type I Diabetic Ketoacidosis Pre-simulation Preparation Student 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). You might also be interested in our awesome bank of 700+ OSCE Stations. 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. DKA can be caused by either: Absolute insulin deficiency (e.g. cloudy urine may indicate urinary tract infection). 1. Please try again soon. We used the Medical Education Technologies Inc. (METI) Human Patient Stimulator (HPS, METI Sarasoto, Fl). Wolters Kluwer Health If the patientloses consciousnessand there areno signs of lifeon assessment, put out acrash callandcommence CPR. Using the arterial line, the scenario becomes much more dynamic. TheABCDEapproach can be used to perform a systematic assessment of a critically unwell patient. Interactive lecture/discussion with use of monitors that show the vital signs of the simulated patient on manikin. Creating a Simulation Experience to Promote Clinical Judgment Standardized patient as the voice of the simulator (or the simulation operator may play this role). This allows the learner group to make a psychological break from the patient and environment while beginning the reflection process. - Medical Finals Question Pack: https://geekymedics.com/medical-student-finals-questions/ - 150+ PDF OSCE Checklists: https://geekymedics.com/pdf-osce-checklists/ See ourCXR interpretation guidefor more details. Place one hand on the patients forehead and the other under the chin. 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)? 2007. The students are in their first year. 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. Inspect theairwayfor obviousobstruction. It involves a facilitating instructor, a small learner group and conceptual aspects of environmental and manikin staging to provide sensory cues. Each performance measure is separated into cognitive, behavioral or technical categories. 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. - Over 3000 Free MCQs: https://geekyquiz.com/ See ourhistory taking guidesfor more details. 3. To read Pages full Research Review column, visit www.jems.com/patient-care. You may be trying to access this site from a secured browser on the server. Well done, youve now stabilised the patient and theyre doing much better. This guide provides an overview of the recognition and immediate management of diabetic ketoacidosis (DKA)using an ABCDE approach. Trainee will recognize and interpret the clinical signs and symptoms and the typical history of a patient with DKA, as well as understand the major causative factors of DKA. A collection of anatomy notes covering the key anatomy concepts that medical students need to learn. COVID-19 Screening in the Pediatric Emergency Department. At the end of the previous section, the trainee can make the diagnosis of DKA but has not confirmed it yet. confusion, coma), All critically unwell patients should have. 2017 May 29;9(5):e1286. If you have any scenarios you would be willing to share with the simulation community, please forward them to me. In the meantime, you can perform some basic airway manoeuvres to help maintain the airway whilst awaiting senior input. Testing a diabetes keotacidosis simulation in critical care nursing: A The file explaining the session is sent to instructors 1 week before the sessions. The Theory Effectiveness of simulation on health profession students knowledge, skills, confidence and satisfaction. 1. 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. 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. We believe it is important to have active, participatory learning by having conversations with the trainees in the form of questions and answers. 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. Diabetic Ketoacidosis (DKA) Clinical Pathway Emergency Department SimMan Nursing Scenarios Software - laerdal.com 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. 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. Administer oxygen to all critically unwell patients during yourinitialassessment. The relationship between sleep, fatigue and patient and provider safety. VbQuX#R M21 Despite this increased calorie intake, she noticed an unexplained 20 lbs weight loss. 2008;6:278302. (1) The assessment of a diabetic patient is best taught as a. Keyword Highlighting cellulitis). Emergency medical services workLife characteristics contribute to clinically significant excessive daytime sleepiness. Pediatric Emergency Medicine Didactics and Simulation (PEMDAS A fixed-rate intravenous insulin infusion should be commenced initially to suppress ketogenesis, reduce blood glucose levels and address electrolyte disturbances. This is particularly important for core . The scenario would include an if-then algorithm. The facilitator guides the group only when necessary. A pre-briefing session is conducted prior to the start of the simulation scenario. 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 Maintain head-tilt chin-lift or jaw thrust and assess the patency of the patients airway by looking, listening and feeling for signs of breathing. Both external and internal potassium balances are disturbed during the development and treatment of DKA. Reprints: Koichiro Nandate, MD, PhD, Department of Anesthesiology, Milton S. Hershey Medical Center, Pennsylvania State University College of Medicine, 500 University Drive Box 850, Hershey, PA 17033 (e-mail: [emailprotected]). It was Abstract 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. - Severity 05:32 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. - 700+ OSCE Stations: https://geekymedics.com/osce-stations/ Ask for anotherclinicalmemberofstafftoassistyou if possible. A collection of free medical student quizzes to put your medical and surgical knowledge to the test! 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 main goal is to establish a safe learning environment for the learner [9, 13 . 2011;15:108109. If the patient has COPD and a history of CO2retention you should switch to aventuri maskas soon as possible andtitrate oxygen appropriately. 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. Healthcare Students' Psychological Well-Being in a Diabetic Ketoacidosis Simulation. PDF DKA Sim Scenario - ABCD (Diabetes Care) Ltd Animated Lecture Deteriorationshould be recognised quickly and acted upon immediately. Patients with DKA require fluid resuscitation to restore circulatory volume, clear ketones, correct electrolyte abnormalities and increase renal perfusion. Prehosp Emerg Care. Use blankets to re-warm patients who are mild to moderately hypothermic. A collection of interactive medical and surgical clinical case scenarios to put your diagnostic and management skills to the test. In the first, the authors expanded the National Registrys Longitudinal EMT Attributes and Demographic (LEADS) study by resurveying 1,600 EMS workers about their sleepiness while at work. Make sure to re-assess the patient after any intervention. Does the patient need a referral toHDU/ICU? The students are in their basic science course. The 60 minutes training time consists of four 15-minute sections divided as follows. Clearlydocument your ABCDE assessment, including history, examination, observations, investigations, interventions, and the patients response. Pediatric Emergency Medicine Didactics and Simulation (PEMDAS Observe and discuss the effects of therapy in a mathematically modeled physiological simulator. 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. The learning environment should closely mimic real-world applications. 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. We do have a wig that we place on the patient, but we do not try for full realism. For instance, if we mimicked the noise and traffic of a real emergency department, this would constitute excessive realism, and become a distraction to beginner medical students. Diabetic Ketoacidosis in the Obstetric Population: A Simulation The students are in their first year. These simulation sessions seem to work because the medical students do have prior knowledge. 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