Diabetes (type 1 and type 2) in children and young people: diagnosis and management. 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. Use blankets to re-warm patients who are mild to moderately hypothermic. Keywords: diabetic ketoacidosis, simulation, expertise, emergency medicine Introduction Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes mellitus, most . It was Mosby:Philadelphia. As this is a PBL session, the trainees are not given any references. PDF Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. 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. Simulation provides a safe environment where learning is enhanced through the deliberate practice of skills and controlled management of a variety of clinical encounters. Acad Med. The DKA simulation incorporates cue recognition, analysis of cues, generation of solutions, nursing interventions, and evaluation of outcomes, including effective communication and psychosocial concerns. #geekymedics #fyp #fypviral #studytok #medicalstudentuk #medtok #studytips #studytipsforstudents #medstudentuk #premed #medschoolfinals, Cardiovascular History Tips - DON'T FORGET these 3 things . Recognize the signs and symptoms of a patient presenting with diabetic ketoacidosis. Hypothermia may be present if the patient has been unconscious and exposed for some time. The student group is given a short introduction into a closed simulation environment. Each clinical case scenario allows you to work through history taking, investigations, diagnosis and management. The instructor should have visual access via one-way windows or cameras. Does the patient need a referral toHDU/ICU? An events progression section should include patient status changes, as well as a time/treatment continuum that incorporates if-then event progressions. Margolis GS, Romer GA, Fernandez AR, et al. Join the Geeky Medics community: Healthcare Students' Psychological Well-Being in a Diabetic Ketoacidosis Simulation. If an infection is suspected, IV antibioticsshould be administered as soon as possible. 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. <> - Severity 05:32 Data is temporarily unavailable. An oxygen mask is also demonstrated as an alternative device, as these early trainees had mostly not yet seen any of these devices. Nandate, Koichiro MD, PhD; Abola, Ramon MD; Murray, W Bosseau MB; Whitfield, Carol PhD; Lang, Charles PhD; Sinz, Elizabeth MD. Inspect the urine currently in the catheter bag and note its appearance (e.g. We combined both to indicate the continuity of the curriculum, and the building on prior knowledge. Simulation in Healthcare4(4):232-236, Winter 2009. - Geeky Medics OSCE App: https://geekymedics.com/geeky-medics-app/ PBL was introduced at our institution in 1995. Insert at least onewide-bore intravenous cannula(14G or 16G) and take blood tests as discussed below. 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. }HyEf,#$/JSRU9+CF6k\'/z+i`[ 5JudK*Zly^g%[jCK)H[)Y=Qp0/r9o9HW_zF}pTzI~'|q.~:=Y T 9w! We have been presenting Simulation Laboratory sessions to our preclinical medical students (first and second years). Works with Traffic 2005, but . DKA can be caused by either: Absolute insulin deficiency (e.g. Review the patientscurrent medicationsand check any regular medications areprescribed appropriately. Urinary tract infections are a common DKA precipitant. As this is an interactive discussion session, any needed debriefing and/or explanation is given during the sessions. It was developed for anesthesiology resident physicians with some background knowledge and experience caring for critically ill patients. Instead, instructors should combine case- and simulation-based techniques when teaching diabetic assessment. 2 The evaluation of potassium deficits is complicated by potassium exit from . 1) Please read through this document as it will help you prepare for your upcoming simulation on DKA. Some error has occurred while processing your request. 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. Performing an ECG should not delay the emergency management of DKA. A collection of anatomy notes covering the key anatomy concepts that medical students need to learn. Assess the patients pulse and blood pressure: Inspect the patient from the end of the bed: they may appear drowsy, confused and/or clammy/pale. Review the patientsoxygen saturation(SpO2): Auscultate the chest to screen for evidence of respiratory pathology (e.g. 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. Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario. - PDF 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. Below is a collection of donated scenarios for you to use or modify. Should any changes be made to the current management of their underlying condition(s)? 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. Animated Lecture 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. See our blood glucose measurement guide for more details. Using the arterial line, the scenario becomes much more dynamic. A collection of data interpretation guides to help you learn how to interpret various laboratory and radiology investigations. If you have any scenarios you would be willing to share with the simulation community, please forward them to me. Capillary refill timemay be prolonged if the patient is hypovolaemic. 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. If the patient has clinical signs ofanaphylaxis(e.g. cloudy urine may indicate urinary tract infection). Our simulated patient is a 25-year-old woman, Tiffany, who has been taken to the Emergency Department from her soccer game by her boyfriend, Adam. The immersive simulation is performed when the instructor feels comfortable with the acquired knowledge and skill base presented in the animated lecture or when the student group has sufficient practical experience to apply the cognitive, behavioral and technical skills outlined in the case scenario. Interactive lecture/discussion with use of monitors that show the vital signs of the simulated patient on manikin. 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). 2003;78:783788. This may produce better retention of the subject matter and help students adapt to emergency scenes before going into the field. 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. Initially, we used a blood pressure cuff to generate the blood pressure values. We used the Medical Education Technologies Inc. (METI) Human Patient Stimulator (HPS, METI Sarasoto, Fl). We then start the DKA state. See Appendix D, Supplemental Digital Content 4, https://links.lww.com/SIH/A4. As individuals with uncontrolled type I . These are not learning objectives in this program. From the Department of Anesthesiology, Pennsylvania State University College of Medicine, Hershey, PA. Dr. Murray is on the Speakers Bureau of METI, Sarasota, FL. Facilitator to ask how often to measure BMs 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. Administer oxygen to all critically unwell patients during yourinitialassessment. Inspect for evidence of self-injection sites (e.g. The reason for inserting the airway upside down initially is to reduce the risk of pushing the tongue backwards and worsening airway obstruction. Groups of fewer than four students dont allow for optimal collaboration. 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. They have had no clinical exposure or any clinical experience. Using SOCRATES in History Taking | OSCE | Communication Skills, Diabetic Ketoacidosis (DKA) | Acute Management | ABCDE. This is particularly important for core . 1. Invasive monitors, including a left radial intraarterial and a right subclavian IV catheter, were placed. The simulation experience serves to give substance to the theoretical words and concepts that the students encountered during the PBL sessions. - 700+ OSCE Stations: https://geekymedics.com/osce-stations/ Trainee will learn to collaborate with peers to decide on appropriate interventions, tests, and therapy. Therefore, we have to emphasize the importance of airway, breathing, and circulation in the very sick patient in any clinical setting. A nasopharyngeal airway is a soft plastic tube with a bevel at one end and a flange at the other. - Examples 05:45 DOI 10.7759/cureus.1286. Management of diabetic ketoacidosis in adults. The patient synopsis should include such standard aspects as age, sex, ethnicity, medical history, medications and allergies. If the patient isunconsciousorunresponsive, start thebasic life support(BLS)algorithmas per resuscitation guidelines. 34 - Diabetic Ketoacidosis in Pregnancy | Obgyn Key DOWNLOAD Diabetic Ketoacidosis By the end of this scenario, the learner will be able to: 1. Rosens Emergency Medicine: Concepts and Clinical Practice. 2011;15:108109. Surgical dressings and imitation blood can support medical history. If any obstruction is encountered, remove the tube and try the left nostril. 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. cellulitis). diagnosis of DKA Trigger 3, ABG show acidosis and high BM and normal potassium. The students are in their first year. Despite this increased calorie intake, she noticed an unexplained 20 lbs weight loss. - Medical Finals Question Pack: https://geekymedics.com/medical-student-finals-questions/ 1-6. A well-staged environment allows for greater student buy-in. 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Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario Pediatric Emergency Medicine Didactics and Simulation (PEMDAS reduced air entry, coarse crackles) to screen for evidence of pneumonia. 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. Simulation Scenario for Anesthesia Providers Clark Obr, MD*, Anthony Mueller, MD . - Exacerbating & relieving factors 05:12 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. Please enable scripts and reload this page. J Nurs Educ. A collection of interactive medical and surgical clinical case scenarios to put your diagnostic and management skills to the test. PDF Medicine Simulation Scenario Diabetic Ketoacidosis: An Emergency insulin-dependent type 2 diabetes), Altered consciousness (e.g. The Pratcice . Classroom Dynamics She Died the Next Day. During an immersive simulation, its imperative the group uses critical-thinking skills and group collaboration independently. After initial insulin therapy has reduced plasma blood glucose levels (e.g. If an obstruction is visible within the airway, use afingersweeporsuctionto remove it. 3. Problems are addressed as they are identified and the patient is re-assessed regularly to monitor their response to treatment. If the patient is conscious, sit themuprightas this can also help with oxygenation. Deteriorationshould be recognised quickly and acted upon immediately. VbQuX#R M21 Given 6 to 8 back-to-back sessions, it is critical that every session starts and ends on time! 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. Make sure to re-assess the patient after any intervention. Review the patients drug chart for medications which may cause a reduced level of consciousness (e.g. Target Learner Groups We ask the trainee why the blood pressure is so low or heart rate is so high, and how we should treat it.