Kymera Systems Inc | SCADA Online Demo Ignition oral fluids, intravenous fluids, urine output, drain output, stool output, vomiting) to inform resuscitation efforts. Observe and discuss the effects of therapy in a mathematically modeled physiological simulator. Alert a senior immediately if you have any concerns about the consciousness level of a patient. Extremities: mild cyanosis, no clubbing or edema (verbalized by instructors); pulses equal, and symmetrical (elucidated by trainees). Refer to your local guidelines for further details. 2. DKA can develop within 24 hours and is potentially life threatening, requiring prompt recognition and therapeutic intervention. Over the years, some groups happened to have the simulation session before the completion of the theoretical PBL session. A chest X-ray should not delay the emergency management of DKA. Instagram: https://instagram.com/geekymedics The following scenarios are available for download and are designed to meet your multi-disciplinary nursing needs. Therefore, the same file is also sent to the participants before the session. 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. Wolters Kluwer Health Does the patient need a referral toHDU/ICU? 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. She tends to drink sugar containing fluids (soda) when she is thirsty, and she eats fast foods (cream-filled muffins) when she is hungry. PA EMT Said COVID Patient Didnt Need to Go to the Hospital. The students are in their first year. Prehosp Emerg Care. The consequences (low blood pressure, high heart rate, central nervous system status, etc.) Diabetic Ketoacidosis (DKA) Clinical Pathway Emergency Department . Several environments may be suitable for your classroom. We give the history of the patient to the trainees. Strategies of high-performing paramedic educational programs. She is lethargic and slightly confused but can intermittently respond to questions. PDF Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario The patient synopsis should include such standard aspects as age, sex, ethnicity, medical history, medications and allergies. Published August 2015. 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 trainees have had background knowledge of biochemistry because they had completed the PBL case. You may be trying to access this site from a secured browser on the server. 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). Conclusions This technical report describes the design and implementation of a simulation scenario on DKA for emergency medicine trainees. Glycosuria leads to urinary losses of potassium through osmotic diuresis. Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario When erroneous treatment is delivered, the instructor can end the simulation. % It may be necessary toexposethe patient during your assessment: remember to prioritise patient dignity and conservation of body heat. In the final 10 minutes, we show how the patient has a good recovery after fluid replacement. This is particularly important for core . If the patient is conscious, sit themuprightas this can also help with oxygenation. DO NOT perform any examination or procedure on patients based purely on the content of these videos. 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. 2. Causes: Any situation arising in a diabetic that requires increased insulin without that demand being met can result in DKA. 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. Prehosp Emerg Care. If the patient is confused you might be able to get a collateral history from staff or family members as appropriate. 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. As this is an interactive discussion session, any needed debriefing and/or explanation is given during the sessions. - Medical Finals Question Pack: https://geekymedics.com/medical-student-finals-questions/ The normal reference range for fasting plasma glucose is 4.0 5.8 mmol/l. Refer to your local guidelines for further details. <> VbQuX#R M21 - Site 01:12 stream - Character 02:14 To read Pages full Research Review column, visit www.jems.com/patient-care. 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. tall tented T waves in hyperkalaemia). The use of case-based simulation, although more complicated and time consuming for the instructor, immerses the students in the subject matter. Many of the preclinical students have never seen a real life clinical monitor or even an intravenous (IV) setup. Stage 1: Initial assessment of acutely unwell pregnant woman and diagnosis of DKA. Trainee will appropriately request assistance and use available resources. 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. Development of simulation scenarios for an adolescent patient with diabetic ketoacidosis. 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.) 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. Each performance measure is separated into cognitive, behavioral or technical categories. diagnosis of DKA Trigger 3, ABG show acidosis and high BM and normal potassium. See ourfluid prescribing guidefor more details onresuscitation fluids. Antibiotics should be prescribed in keeping with local guidelines. If an infection is suspected, IV antibioticsshould be administered as soon as possible. We have 18 to 20 PBL groups for an hour each in the week after their PBL DKA session. Creating a Simulation Experience to Promote Clinical Judgment The DKA simulation incorporates cue recognition, analysis of cues, generation of solutions, nursing interventions, and evaluation of outcomes, including effective communication and psychosocial concerns. Creating a Simulation Experience to Promote Clinical Judgment The faculty member/course coordinator of Simulation Design Recognize the signs and symptoms of a patient presenting with diabetic ketoacidosis. Askhow the patient is feeling as this may provide some useful information about their current symptoms. However, this leads to confusion. 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). Review the patientsoxygen saturation(SpO2): Auscultate the chest to screen for evidence of respiratory pathology (e.g. The instructor should have visual access via one-way windows or cameras. These simulation sessions seem to work because the medical students do have prior knowledge. DOWNLOAD Diabetic Ketoacidosis By the end of this scenario, the learner will be able to: 1. After the first voluntary session in 2006, feedback from the medical students indicated that they would like to receive this handout. Effectiveness of simulation on health profession students knowledge, skills, confidence and satisfaction. Acad Med. Please try again soon. Lets discuss your options. 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. PDF Medicine Simulation Scenario Diabetic Ketoacidosis: An Emergency - Cureus Testing a diabetes keotacidosis simulation in critical care nursing: A Simulation Training Ideal for Diabetic Patients - JEMS In the context of DKA, a patients consciousness level may be reduced. www.cdc.gov/diabetes/statistics/prev/national/. Initially, we used a blood pressure cuff to generate the blood pressure values. 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. Use an effectiveSBARR handoverto communicate the key information effectively to other medical staff. 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. DKA can be caused by either: Absolute insulin deficiency (e.g. Highlight selected keywords in the article text. insulin-dependent type 2 diabetes), Altered consciousness (e.g. 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. and 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. 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. Animated Lecture General: Moaning, asking what has happening to her. (1) According to Centers for Disease Control and Prevention (CDC), 223,619 deaths were attributed to diabetes in 2005. In an animated lecture, its important that the student group have an instructor so they can ask direct questions. Despite this increased calorie intake, she noticed an unexplained 20 lbs weight loss. Diabetic Ketoacidosis (DKA) | Acute Management | ABCDE Its important to train and educate students of prehospital care on key indicators of a diabetic emergency. Chapters: Please write a single word answer in lowercase (this is an anti-spam measure). This leads to hyperglycaemia, osmotic diuresis, and dehydration. Review thepatients notes,chartsandrecent investigation results. 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. 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 had developed nausea, extreme fatigue, mild disorientation, and blurred vision toward the end of the soccer match. areas of lipohypertrophy) if it is unclear if the patient is diabetic. 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. See ourintravenous cannulation guidefor more details. 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. cellulitis). 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. Geeky Medics accepts no liability for loss of any kind incurred as a result of reliance upon the information provided in this video. Inspect theairwayfor obviousobstruction. Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario. - PDF If the patient loses consciousness and there are no signs of life on assessment, put out a crash call and commence CPR. A strong emphasis is placed on the focused, methodical examination of a specific medical problem and the decision-based treatment options available. The Pratcice Two abstracts related to sleepiness in the EMS workforce were presented at the National Association of EMS Physicians symposium in January. Using the arterial line, the scenario becomes much more dynamic. In the meantime, you should re-assess and maintain the patients airway. Diabetes (type 1 and type 2) in children and young people: diagnosis and management. Int J Evid Based Healthc. 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). Advance the airway until it lies within the pharynx. This typically involves the use of anon-rebreathe maskwith an oxygen flow rate of15L. endobj 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). Scenario in a Nutshell Diabetic ketoacidosis (DKA) in pregnancy. 2. 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. We demonstrate to the trainees the significant changes on the monitors by asking them to point out any changes on the simulator (clinical examination) and the vital signs (monitor parameters). ABG, venepuncture). You can check out our guide to using SOCRATES here: https://geekymedics.com/the-socrates-acronym-in-history-taking/ - Examples 05:45 Margolis GS, Romer GA, Fernandez AR, et al. This allows the learner group to make a psychological break from the patient and environment while beginning the reflection process. A GCS of 8 or below warrants urgent expert help from an anaesthetist. 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. 3. An arterial blood gas (ABG) can provide lots of useful information to guide management including: A chest X-ray may be indicated if abnormalities are noted on auscultation (e.g. The student group should be encouraged to collaborate on management options and to perform skills. Each PBL case typically goes over 23 days, affording the students periods to find information for the case. 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. SimMan Nursing Scenarios Software. Trainee will increase knowledge of professional behaviors during the simulation. Healthcare Students' Psychological Well-Being in a Diabetic Ketoacidosis Simulation. In this section, we have to help the trainee to institute definitive therapy based on the underlying biochemical abnormalities. Its absolutely necessary to follow all immersive simulations with a positive, emotionally safe and nonjudgmental debriefing environment. As this is a PBL session, the trainees are not given any references. Insert the oropharyngeal airway in the upside-down position until you reach the junction of the hard and soft palate, at which point you should rotate it 180. We have spent many hours debating whether the small group format was a waste of time. Consider any precipitating factors for the development of DKA and involve the diabetes team in the patients care. Just place the BR2_KDCA file into your addons scenery folder: C:\\Program Files\\Microsoft Games\\Microsoft Flight Simulator X\\Addon Scenery\\Scenery. Simulation-based medical education: An ethical imperative. Inspect for evidence of infection on the skin (e.g. The students are in their basic science course. Debriefing 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). Diabetic ketoacidosis (DKA) is a common, potentially lethal disease. Simulation in Healthcare4(4):232-236, Winter 2009. This is a 25-year-old woman with a medical history of diabetes medicated with 40 units insulin per day. 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. Initially, we had a white board available, but the temptation (and habits) were just too strong, and the simulator sessions tended to become one way lectures, rather than an interactive, 2 way discussion.. This may produce better retention of the subject matter and help students adapt to emergency scenes before going into the field. Reduced urine output (oliguria) is typically defined as less than 0.5ml/kg/hour in an adult. %PDF-1.5 3. Keywords: diabetic ketoacidosis, simulation, expertise, emergency medicine Introduction Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes mellitus, most commonly occurring in patients with type I diabetes. 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. JEMS. 2010;49:578586. 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. The diabetes with DKA clinical pathway is a detailed plan of the course of care for pediatric patients seen in the emergency department with diabetic ketoacidosis. Catheterisethe patient to closelymonitor urine outputto guide fluid resuscitation and need for escalation. 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. Inspect for evidence of self-injection sites (e.g. His Wife Gave Him CPR. The reason for inserting the airway upside down initially is to reduce the risk of pushing the tongue backwards and worsening airway obstruction. <> (1), The assessment of a diabetic patient is best taught as a case-based simulation. From the Department of Anesthesiology, Pennsylvania State University College of Medicine, Hershey, PA. Dr. Murray is on the Speakers Bureau of METI, Sarasota, FL. Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. endobj 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 It involves a facilitating instructor, a small learner group and conceptual aspects of environmental and manikin staging to provide sensory cues. 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. KDCA for FSX - Fly Away Simulation A comprehensive collection of medical revision notes that cover a broad range of clinical topics. Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario Cureus. Case-based education adds a real-world aspect to the learning environment. Use washable, non-toxic paints to imitate various body emissions. Deteriorationshould be recognised quickly and acted upon immediately. You may search for similar articles that contain these same keywords or you may The simulation experience serves to give substance to the theoretical words and concepts that the students encountered during the PBL sessions. Groups of fewer than four students dont allow for optimal collaboration. PBL was introduced at our institution in 1995. We used the Medical Education Technologies Inc. (METI) Human Patient Stimulator (HPS, METI Sarasoto, Fl). 4. Scenarios thesimtech We do not use passive visualizing materials such as videotapes or DVD other than vital signs shown on the monitors. Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario Therefore, we have to emphasize the importance of airway, breathing, and circulation in the very sick patient in any clinical setting. Makeup may be used to depict gender, hollow eyes and cheeks, produce pallor or display bruises and scars. DO NOT perform any examination or procedure on patients based purely on the content of these videos. Surgical dressings and imitation blood can support medical history. 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. If an obstruction is visible within the airway, use afingersweeporsuctionto remove it. Introduceyourselfto whoever has requested a review of the patient andlistencarefullyto their handover. The simulation session is also hosted as an interactive session. Blood sugar issues in the Type II diabetic will have a gradual onset, with diagnosis generally resulting from routine laboratory exams.(1). This video demonstrates how to use the SOCRATES acronym when taking a history of pain or other symptoms. *=NdL/c2XSJn8:I Jb8'.8>N*[L .hxw6afq40DX3c~>abt'Q,8y(BZu(vKBTufIR. 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.

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