In keeping with the case study, as a treatment marker is reached, the instructor should place emphasis on physiological, pharmacological, environmental and psychosocial issues. A fixed-rate intravenous insulin infusion should be commenced initially to suppress ketogenesis, reduce blood glucose levels and address electrolyte disturbances. Diabetes UK with the Joint British Diabetes Societies Inpatient Care Group. vD0
x@FFJ{m[ 3//Oh|JR7! Review the patientsoxygen saturation(SpO2): Auscultate the chest to screen for evidence of respiratory pathology (e.g. Given such a small group, the students indicated that they feel more involved than they would with a larger group (eg, the whole class.) www.cdc.gov/diabetes/statistics/prev/national/. 2017 May 29;9(5):e1286. She is lethargic and slightly confused but can intermittently respond to questions. 2011;15:108109. - 150+ PDF OSCE Checklists: https://geekymedics.com/pdf-osce-checklists/ For more information, please refer to our Privacy Policy. Immersive simulations are mentally exhausting because they create an intense and stressful atmosphere requiring the learner to work outside their comfort zone. Trainee will learn to collaborate with peers to decide on appropriate interventions, tests, and therapy. Problems are addressed as they are identified and the patient is re-assessed regularly to monitor their response to treatment. 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. Does the patient need reviewing by a specialist? Diabetic ketoacidosis; Simulation training; Medical students. Are any further assessments or interventions required? The students are in their first year. Facilitator to ask how often to measure BMs 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. The Theory
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). A chest X-ray should not delay the emergency management of DKA. This typically involves the use of anon-rebreathe maskwith an oxygen flow rate of15L. If the patient is suspected to have sufferedsignificanttraumawith potential spinal involvement, perform ajaw-thrustrather than a head-tilt chin-lift manoeuvre: 2. See ourfluid prescribing guidefor more details onresuscitation fluids. Weight, Height: Not given, normal appearing (as per simulator) but has lost 20 lbs recently. His Heart Stopped On a Treadmill. 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. Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario Make sure to re-assess the patient after any intervention. Heart: S1 and S2 within normal limits; no S3/S4 or murmurs, normal rate and rhythm. 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. can be reemphasized, and the effects of fluid therapy demonstrated. A comprehensive collection of medical revision notes that cover a broad range of clinical topics. opioids, sedatives, anxiolytics, insulin, oral hypoglycaemic medications). The faculty member/course coordinator of Simulation Design See Table 4 for a suggested standardized script. It should only be inserted in unconscious patients as it is otherwise poorly tolerated and may induce gagging and aspiration. After entering the environment, the student doesnt have the option of leaving the simulation until the learning objectives and performance measures are achieved. In some cases, normal saline with additional potassium is required to prevent overcorrection of serum potassium levels which would otherwise result in hypokalaemia. Finally, we summarize the course and give them time for questions. Scenario in a Nutshell Diabetic ketoacidosis (DKA) in pregnancy. An hour was . 3. A collection of surgery revision notes covering key surgical topics. 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. Geeky Medics accepts no liability for loss of any kind incurred as a result of reliance upon the information provided in this video. Using the arterial line, the scenario becomes much more dynamic. Blood sugar issues in the Type II diabetic will have a gradual onset, with diagnosis generally resulting from routine laboratory exams.(1). MassBay EMS Program Integrates Training for Dogs, Heat Waves Are Killing More LA Homeless People. If any obstruction is encountered, remove the tube and try the left nostril. Inspect the urine currently in the catheter bag and note its appearance (e.g. She had developed nausea, extreme fatigue, mild disorientation, and blurred vision toward the end of the soccer match. and Development of simulation scenarios for an adolescent patient with diabetic ketoacidosis. In this case scenario, dehydration is one of the most serious immediate issues. At the end of the previous section, the trainee can make the diagnosis of DKA but has not confirmed it yet. We are looking for declaration of DKA and request for pathway. Trainee will correlate the underlying pathophysiology with symptoms and signs as exhibited by the simulation session. The choice of fluid type, rate of administration and volume should be tailored to the individual patient based upon their vital signs and electrolytes. Trigger 4, Pathway 1l of saline required over 1hour and insulin infusion need prescribing and making up in 50ml syringe. Seek senior helpif the patient shows no signs of improvement or if you have any concerns. The student group should be encouraged to collaborate on management options and to perform skills. There are just a few more things to do. Laschinger S, Medves J, Pulling C, et al. The Theory
Inspect theairwayfor obviousobstruction. A collection of data interpretation guides to help you learn how to interpret various laboratory and radiology investigations. If the patient is confused you might be able to get a collateral history from staff or family members as appropriate. Please try again soon. diagnosis of DKA Trigger 3, ABG show acidosis and high BM and normal potassium. The files are given in full in the web supplement (Appendix B, Supplemental Digital Content 2, https://links.lww.com/SIH/A2). The reason for inserting the airway upside down initially is to reduce the risk of pushing the tongue backwards and worsening airway obstruction. Medical simulation technology is a powerful tool for training physicians but papers dealing with DKA simulators are scarce. The debriefing environment should be removed from the location where the simulation took place. 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. endobj
Circulating nurse in the emergency room (ER). Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. 2010;49:578586. I assigned true to life parking codes, and added some extra parking for the superfluous US Express AI. 1 0 obj
There are several causes of DKA, which we remember by the "five I's". See ourintravenous cannulation guidefor more details. areas of lipohypertrophy) if it is unclear if the patient is diabetic. Published August 2015. The learning environment should closely mimic real-world applications. After initial insulin therapy has reduced plasma blood glucose levels (e.g. Calculate the patients current fluid balance using their fluid balance chart (e.g. For example, you could develop a diabetic scenario in which the prehospital provider encounters an altered patient with incomprehensible speech. 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). Medical Simulation Scenarios are text documents outlining the various details of a simulation - everything from patient simulator settings to debriefing notes. - Onset 01:48 Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. TheABCDEapproach can be used to perform a systematic assessment of a critically unwell patient. We combined both to indicate the continuity of the curriculum, and the building on prior knowledge. Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario Cureus. A list of the requirements (monitors, props, and others) is given in Tables 2 and 3, as well as in the web supplement (Appendix C, Supplemental Digital Content 3, https://links.lww.com/SIH/A3). 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. Facebook: http://www.facebook.com/geekymedics Stage 2: Emergency management of DKA and consideration of abnormal CTG. 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. Antibiotics should be prescribed in keeping with local guidelines. We do not use passive visualizing materials such as videotapes or DVD other than vital signs shown on the monitors. In this section, we have to guide them as to what they should do first for the patient in this critical condition (ie, treat the A, B, Cs of airway, breathing, and circulation) before we can confirm the diagnosis. doi: 10.7759/cureus.1286. We ask the trainee why the blood pressure is so low or heart rate is so high, and how we should treat it. Simulation-based medical education: An ethical imperative. A nasopharyngeal airway is a soft plastic tube with a bevel at one end and a flange at the other. 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. The following scenarios are available for download and are designed to meet your multi-disciplinary nursing needs. 5. Before trainees arrival into the simulation area, the simulator is already preprogrammed for DKA. Effectiveness of simulation on health profession students knowledge, skills, confidence and satisfaction. Competency-based medical education has seen widespread adoption in the field along with ongoing work in the areas of . The use of case-based simulation, although more complicated and time consuming for the instructor, immerses the students in the subject matter. Perform urinalysis and send the urine for culture if urinary tract infection is suspected. Simulation in Healthcare4(4):232-236, Winter 2009. By joining Cureus, you agree to our Over the years, some groups happened to have the simulation session before the completion of the theoretical PBL session. Moses Lake (WA) Fire Department Gets $3.3M Grant for more Firefighters, Woman Who Crashed into Responders, Killing PA Firefighter, Gets Prison, Three Apparent Gas Explosions at San Bernardino (CA) Mountain Homes, Enid (OK) Fire Department Begins SWAT Medic Program to Assist Police, FDNY EMS Providers Win COVID-19-Linked Free Speech Lawsuit, Coronavirus Origins Still a Mystery Three Years into Pandemic. Stage 1: Initial assessment of acutely unwell pregnant woman and diagnosis of DKA. The file explaining the session is sent to instructors 1 week before the sessions. A collection of communication skills guides, for common OSCE scenarios, including history taking and information giving. Much time was wasted explaining why it did not matter. 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. 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. Animated lectures, however, must work within the framework of a focused case study, which requires increased preparation time. 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. This is a 25-year-old woman with a medical history of diabetes medicated with 40 units insulin per day. They should introduce the student group to the environment, assign roles for each learner and guide the decision-making process. In this section, we have to help the trainee to institute definitive therapy based on the underlying biochemical abnormalities. endobj
Available from: [. This guide provides an overview of the recognition and immediate management of diabetic ketoacidosis (DKA)using an ABCDE approach. Works with Traffic 2005, but . 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. In an animated lecture, its important that the student group have an instructor so they can ask direct questions. Check out our other awesome clinical skills resources including: Deteriorationshould be recognised quickly and acted upon immediately. Another example: At one minute into the scenario, the patient becomes unresponsive and their breathing becomes shallow. Simulation Scenario for Anesthesia Providers Clark Obr, MD*, Anthony Mueller, MD . Insert the airway bevel-end first, vertically along the floor of the nose with a slight twisting action. After the first voluntary session in 2006, feedback from the medical students indicated that they would like to receive this handout. The students worked on the underlying physiology during a week long PBL session and are therefore familiar with the theoretical aspects of DKA. 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. Cureus 9(5): e1286. Please enable scripts and reload this page. This allows us to get in touch for more details if required. This leads to hyperglycaemia, osmotic diuresis, and dehydration. 3. Properly interpret a venous blood gas (VBG) and basic metabolic panel in a patient presenting with diabetic ketoacidosis. The scenario would include an if-then algorithm. Instructors should write a case study for the simulation before the session. Open the patients airwayusing ahead-tiltchin-lift manoeuvre: 1. 2009;13:505511. You may be asked to review a patient with DKA due to confusion, reduced level of consciousness, tachycardia, hypotension and/or vomiting. Twitter: http://www.twitter.com/geekymedics A blood glucose level may already be available from earlier investigations (e.g. 1-6. The facilitator guides the group only when necessary. An events progression section should include patient status changes, as well as a time/treatment continuum that incorporates if-then event progressions. In the context of DKA, a patients consciousness level may be reduced. We have been presenting Simulation Laboratory sessions to our preclinical medical students (first and second years). It involves working through the following steps: Each stage of the ABCDE approach involvesclinicalassessment,investigationsandinterventions. Subscribe to our newsletter to be the first to know about our latest content: https://geekymedics.com/newsletter/ Lets discuss your options. Rosens Emergency Medicine: Concepts and Clinical Practice. See ourdocumentation guidesfor more details. Clinical Simulation in Nursing, Volume 39, 2020, pp. 3. Animated Lecture
Observe and discuss the effects of therapy in a mathematically modeled physiological simulator. You might also be interested in our awesome bank of 700+ OSCE Stations. Patients with DKA require fluid resuscitation to restore circulatory volume, clear ketones, correct electrolyte abnormalities and increase renal perfusion. Well done, youve now stabilised the patient and theyre doing much better. . As this is a value-added session that demonstrates new concepts, such as the vital signs on a clinical monitor, there are no assessment instruments to measure gaining of understanding. An oxygen mask is also demonstrated as an alternative device, as these early trainees had mostly not yet seen any of these devices. As this is a PBL session, the trainees are not given any references. If the patient has clinical signs ofanaphylaxis(e.g. 3. As the name says, this screen is used to graph and plot any parameter. For similar reasons, we do not believe a videotaped session will keep the students attention as much as these live simulator sessions. Note that if-thens must also include negative patient outcomes for when the provider doesnt take appropriate action. 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. 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. General: Moaning, asking what has happening to her. Please note that by doing so you agree to be added to our monthly email newsletter distribution list. Use an effectiveSBARR handoverto communicate the key information effectively to other medical staff. 3.