dka simulation scenario dka simulation scenario

Lets discuss your options. 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). endobj 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. The Theory Her medical, social, and family histories are not clear at the time of admission to the emergency department. Airway adjuncts are often helpful and in some cases essential to maintain a patients airway. endobj Cureus 9(5): e1286. The Theory Over the years, some groups happened to have the simulation session before the completion of the theoretical PBL session. 4 0 obj Should any changes be made to the current management of their underlying condition(s)? 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. This leads to hyperglycaemia, osmotic diuresis, and dehydration. 4. Stage 3: Ongoing management and monitoring of DKA 1 hour after initiation of treatment. The main purpose of the simulation is to draw a line from the theoretical, boring biochemistry to the clinical manifestations. 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. A fixed-rate intravenous insulin infusion should be commenced initially to suppress ketogenesis, reduce blood glucose levels and address electrolyte disturbances. 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. Scenarios. However, this turned out to be too slow, took too much time, and could not continuously demonstrate the direction of changes. Cureus is on a mission to change the long-standing paradigm of medical publishing, where submitting research can be costly, complex and time-consuming. For similar reasons, we do not believe a videotaped session will keep the students attention as much as these live simulator sessions. 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.) Please enable scripts and reload this page. - Associated symptoms 03:04 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). The validity of the HFS-DKA scenario was verified by a certified diabetes nurse educator, a registered nurse, and a clinical nurse educator. 2017 May 29;9(5):e1286. PBL was introduced at our institution in 1995. Trainee will correlate the underlying pathophysiology with symptoms and signs as exhibited by the simulation session. Trainee will improve their understanding of clinical practice through reflective assessment of actual cases during the prior PBL sessions. See ourdocumentation guidesfor more details. Many of the preclinical students have never seen a real life clinical monitor or even an intravenous (IV) setup. This guide provides an overview of the recognition and immediate management of diabetic ketoacidosis (DKA)using an ABCDE approach. - Over 3000 Free MCQs: https://geekyquiz.com/ In other words, they do not have clinical experience, but they have clinical knowledge. You may be asked to review a patient with DKA due to confusion, reduced level of consciousness, tachycardia, hypotension and/or vomiting. Mosby:Philadelphia. If any obstruction is encountered, remove the tube and try the left nostril. Heart: S1 and S2 within normal limits; no S3/S4 or murmurs, normal rate and rhythm. 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. Categories: Emergency Medicine, Medical Education Keywords: diabetic ketoacidosis, simulation, expertise, emergency medicine . Intubation lubricants can mimic drooling. Inspect the urine currently in the catheter bag and note its appearance (e.g. The lecture allows for understanding of concepts prior to action, and instructor feedback is immediate. 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). 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. Trainee will be respectful to others and their views during the PBL session. J Nurs Educ. - 700+ OSCE Stations: https://geekymedics.com/osce-stations/ Refer to your local guidelines which should provide a clear protocol for the management of DKA. 1 0 obj General: Moaning, asking what has happening to her. Note that if-thens must also include negative patient outcomes for when the provider doesnt take appropriate action. Geeky Medics accepts no liability for loss of any kind incurred as a result of reliance upon the information provided in this video. 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. The students mentioned that they did not obtain the maximum value from the simulation session under these circumstances. This may produce better retention of the subject matter and help students adapt to emergency scenes before going into the field. Causes: Any situation arising in a diabetic that requires increased insulin without that demand being met can result in DKA. Schneider Sarver PA, Senczakowicz EA, Slovensky BM. 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. your express consent. 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. The 60 minutes training time consists of four 15-minute sections divided as follows. The file explaining the session is sent to instructors 1 week before the sessions. The simulation session is also hosted as an interactive session. With your index and other fingers placed behind the angle of the mandible, apply steady upwards and forward pressure to lift the mandible. can be reemphasized, and the effects of fluid therapy demonstrated. areas of lipohypertrophy) if it is unclear if the patient is diabetic. Revisit history taking to explore relevant medical history and identify any precipitating factors for DKA. Therefore, the same file is also sent to the participants before the session. We have 18 to 20 PBL groups for an hour each in the week after their PBL DKA session. We are looking for declaration of DKA and request for pathway. She tends to drink sugar containing fluids (soda) when she is thirsty, and she eats fast foods (cream-filled muffins) when she is hungry. 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. ABG, venepuncture). 1-6. Inspect theairwayfor obviousobstruction. 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. See ourintravenous cannulation guidefor more details. Capillary refill timemay be prolonged if the patient is hypovolaemic. 2 0 obj Trigger 4, Pathway 1l of saline required over 1hour and insulin infusion need prescribing and making up in 50ml syringe. As individuals with uncontrolled type I . Simulation Scenario for Anesthesia Providers Clark Obr, MD*, Anthony Mueller, MD . By joining Cureus, you agree to our Facilitator to ask how often to measure BMs If the patient loses consciousness and there are no signs of life on assessment, put out a crash call and commence CPR. % The students are in their basic science course. A number of key modifiers are described that allow for the adjustment of case . Does the patient need reviewing by a specialist? This session provides additional clinical support material for the theoretical PBL session. Its absolutely necessary to follow all immersive simulations with a positive, emotionally safe and nonjudgmental debriefing environment. The researchers found that long shift hours (24hrs), working overtime and marital/relationship stress were strongly correlated. 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). 2. Scenario in a Nutshell Diabetic ketoacidosis (DKA) in pregnancy. opioids, sedatives, anxiolytics, insulin, oral hypoglycaemic medications). Some error has occurred while processing your request. The use of a simulated, evolving case scenario was an effective method of exposing nursing students to complex patient care. We also show them IV bags containing saline and Ringers lactate, as well as show them IV infusion sets. 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. The students are in their first year. Just place the BR2_KDCA file into your addons scenery folder: C:\\Program Files\\Microsoft Games\\Microsoft Flight Simulator X\\Addon Scenery\\Scenery. 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. Advance the airway until it lies within the pharynx. Int J Evid Based Healthc. (1) According to Centers for Disease Control and Prevention (CDC), 223,619 deaths were attributed to diabetes in 2005. The student group should be encouraged to collaborate on management options and to perform skills. The learning objectives follow the American College of Graduate Medical Education (ACGME) Core Compentencies. The following scenarios are available for download and are designed to meet your multi-disciplinary nursing needs. 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). 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 . The students worked on the underlying physiology during a week long PBL session and are therefore familiar with the theoretical aspects of DKA. 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. 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. An individual student can get an immediate answer to a question, the facilitator can see puzzled expressions on faces, and the PBL group could get answers that they could not get during their prior PBL group discussions. Check out our other awesome clinical skills resources including: Open the patients airwayusing ahead-tiltchin-lift manoeuvre: 1. DONT FORGET these 3 key components of the cardiovascular exam for your upcoming OSCEs Save this video to watch later and dont forget to follow Geeky Medics! Join the Geeky Medics community: It may be necessary toexposethe patient during your assessment: remember to prioritise patient dignity and conservation of body heat. As this is an interactive discussion session, any needed debriefing and/or explanation is given during the sessions. Ziv A, Wolpe PR, Small SD, et al. Perform urinalysis and send the urine for culture if urinary tract infection is suspected. Refer to your local guidelines for further details. When a group treatment decision is made that would be contraindicated or harmful to the patient, the instructor can redirect the learner group while maintaining an atmosphere inclined toward independent thinking. 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. tall tented T waves in hyperkalaemia). Diabetic Ketoacidosis (DKA) Clinical Pathway Emergency Department | Children's Hospital of Philadelphia Simulation Scenario. Stage 1: Initial assessment of acutely unwell pregnant woman and diagnosis of DKA. Diabetes mellitus affects nearly 7.8% of the U.S. population, with approximately 510% of this group affected by Type I and 9095% by Type II.1 Diabetes is the most common type of endocrine disease and was the seventh leading underlying cause of death listed on death certificates in 2006. 2. Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. Each clinical case scenario allows you to work through history taking, investigations, diagnosis and management. 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. 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. The instructor can also gauge the direction the debriefing session should follow or be alerted to possible problems or conflicts in treatment opinions. Circulating nurse in the emergency room (ER). This typically involves the use of anon-rebreathe maskwith an oxygen flow rate of15L. Diabetic ketoacidosis; Simulation training; Medical students. JEMS. Alert a senior immediately if you have any concerns about the consciousness level of a patient. The instructors role is to facilitate active learning through a combination of learning styles. In the simulated environment, trainees will ask questions on how to interpret the data that they observe on the monitors and interpretation of clinical signs and symptoms on the manikin. LYqC+pJ&6X4onfBT#?=R}.p8N3+Dk,P4tIgWB}-L'=8;_G >,K#.e89XnG'B~NtR A comprehensive collection of medical revision notes that cover a broad range of clinical topics. 3. An events progression section should include patient status changes, as well as a time/treatment continuum that incorporates if-then event progressions. Groups of more than seven may struggle with meeting objectives due to insufficient functional rolls. Several environments may be suitable for your classroom. We do not use passive visualizing materials such as videotapes or DVD other than vital signs shown on the monitors. Centers for Disease Control and Prevention. Introduceyourselfto whoever has requested a review of the patient andlistencarefullyto their handover. 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 . If you have any scenarios you would be willing to share with the simulation community, please forward them . Below is a collection of donated scenarios for you to use or modify. The optimal number of simulation participants is four to seven individuals, depending on the case study objectives. Chapters: Open the patients mouth to ensure there is no foreign material that may be pushed into the larynx. Diabetic ketoacidosis (DKA) is a common, potentially lethal disease. angioedema, rash) commence appropriate treatment as discussed in ouranaphylaxis guide. Geeky Medics accepts no liability for loss of any kind incurred as a result of reliance upon the information provided in this video. Terms of Use. The debriefing environment should be removed from the location where the simulation took place. Wolters Kluwer Health (1), The assessment of a diabetic patient is best taught as a case-based simulation. - Radiation 02:45 The normal reference range for fasting plasma glucose is 4.0 5.8 mmol/l. Healthcare Students' Psychological Well-Being in a Diabetic Ketoacidosis Simulation. Laschinger S, Medves J, Pulling C, et al. SimMan Nursing Scenarios Software. Often, the learner group will be unaware of these behaviors, but the instructor can key into the first few comments made during the transition between rooms. Refer to your local guidelines for further details. We believe it is important to have active, participatory learning by having conversations with the trainees in the form of questions and answers. We have spent many hours debating whether the small group format was a waste of time. 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. If an obstruction is visible within the airway, use afingersweeporsuctionto remove it. Simulation provides a safe environment where learning is enhanced through the deliberate practice of skills and controlled management of a variety of clinical encounters. cloudy urine may indicate urinary tract infection). Conclusion 1 Potassium losses occurring both before and during treatment of DKA must be replaced. The Pratcice Before trainees arrival into the simulation area, the simulator is already preprogrammed for DKA. Are any further assessments or interventions required? Glycosuria leads to urinary losses of potassium through osmotic diuresis. A well-staged environment allows for greater student buy-in. The students have acquired all the applicable theoretical knowledge of the case during the previous multiday PBL sessions. %PDF-1.5 Antibiotics should be prescribed in keeping with local guidelines. Animated lectures, however, must work within the framework of a focused case study, which requires increased preparation time. In this case scenario, dehydration is one of the most serious immediate issues. #geekymedics #fyp #fypviral #studytok #medicalstudentuk #medtok #studytips #studytipsforstudents #medstudentuk #premed #medschoolfinals, Cardiovascular History Tips - DON'T FORGET these 3 things . We combined both to indicate the continuity of the curriculum, and the building on prior knowledge. GRAPH. We used the Medical Education Technologies Inc. (METI) Human Patient Stimulator (HPS, METI Sarasoto, Fl). You can plot as many parameters as you want and can choose to display either Historical data or have the graphs update as often as new data comes in and view them in Real-time. On the basis of the feedback from the students, they indicated that they believed the small group sessions are better. You can check out our guide to using SOCRATES here: https://geekymedics.com/the-socrates-acronym-in-history-taking/ 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. A collection of data interpretation guides to help you learn how to interpret various laboratory and radiology investigations. Assess the patients level of consciousness using the AVPU scale: If a more detailed assessment of the patients level of consciousness is required, use the Glasgow Coma Scale (GCS). Measure the patients capillary blood glucose and ketone levels to confirm the diagnosis and guide the management of DKA. 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. You may search for similar articles that contain these same keywords or you may In keeping with the case study, as a treatment marker is reached, the instructor should place emphasis on physiological, pharmacological, environmental and psychosocial issues. 1. 2. 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). Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. Marx JA, Hockberger RS, Walls RM. Section snippets . Problems are addressed as they are identified and the patient is re-assessed regularly to monitor their response to treatment. 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. Review the patients drug chart for medications which may cause a reduced level of consciousness (e.g. Typically potassium levels should be maintained between 4.0 5.5 mmol/L and close monitoring is required. 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. 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. Insert at least onewide-bore intravenous cannula(14G or 16G) and take blood tests as discussed below. They have had no clinical exposure or any clinical experience. Keywords: diabetic ketoacidosis, simulation, expertise, emergency medicine Introduction Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes mellitus, most . Download: http://teamworkmatters.ocbmedia.com/media/DKA-Simulation-Scenario.docx Categories: 5th Year MBChB paeds scenario, Emergency Department, Human Factors, Interprofessional / multidisciplinary, Non-technical skills, Paediatrics, Postgraduate / newly qualified, Undergraduate / pre-registration Rating 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. Medical Simulation Scenarios are text documents outlining the various details of a simulation - everything from patient simulator settings to debriefing notes. Please note that by doing so you agree to be added to our monthly email newsletter distribution list.