Check out our NEW & IMPROVED quiz platform at geekyquiz.com, To be the first to know about our latest videos, subscribe to our YouTube channel . Initially, we required the students to write down the vital signs. endobj At the end of the previous section, the trainee can make the diagnosis of DKA but has not confirmed it yet. A traditional classroom lecture format allows for student participation but limits the instructors ability to create realistic situations. Example: If the provider immediately evaluates blood glucose, then the reading will display 45 mg/dL. 2 The evaluation of potassium deficits is complicated by potassium exit from . Immersive Simulations 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! The 60 minutes training time consists of four 15-minute sections divided as follows. Debriefing doi: 10.7759/cureus.1286. cellulitis). 2. Clearly communicate how often would you like the patients observations relayed to you by other staff members. The file explaining the session is sent to instructors 1 week before the sessions. Simulation provides a safe environment where learning is enhanced through the deliberate practice of skills and controlled management of a variety of clinical encounters. - Exacerbating & relieving factors 05:12 <>>> PDF Diabetic Ketoacidosis in the Obstetric Population: A Simulation Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario 3. This session provides additional clinical support material for the theoretical PBL session. 2011;15:108109. type 1 diabetes) Complete insulin insensitivity (e.g. This is particularly important for core cases and low-frequency, high-stakes procedures and encounters. Reduced urine output (oliguria) is typically defined as less than 0.5ml/kg/hour in an adult. Simulation Training Ideal for Diabetic Patients - JEMS x]o ]?9kgq~:)?hE )R6!up}\<8||\]}Y~;xp~yQ$#4~djX&{n_m-]^K1/~/AD Hv 99evs,;8}8zwnhFxV.kf-V^? After entering the environment, the student doesnt have the option of leaving the simulation until the learning objectives and performance measures are achieved. cloudy urine may indicate urinary tract infection). 3 0 obj 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. #geekymedics #fyp #fypviral #studytok #medicalstudentuk #medtok #studytips #studytipsforstudents #medstudentuk #premed #medschoolfinals, Cardiovascular History Tips - DON'T FORGET these 3 things . Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. 2011;15:108109. Mosby:Philadelphia. - Onset 01:48 The objective is to give as many visual and tactile cues concerning the patient condition and background as possible. ABG, venepuncture). 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 . 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. Perform urinalysis and send the urine for culture if urinary tract infection is suspected. Join the Geeky Medics community: to maintaining your privacy and will not share your personal information without modify the keyword list to augment your search. - 2500+ OSCE Flashcards: https://geekymedics.com/osce-flashcards/ Another example: At one minute into the scenario, the patient becomes unresponsive and their breathing becomes shallow. 2017 May 29;9(5):e1286. 2. 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. Case-based education adds a real-world aspect to the learning environment. Simulation Scenario. 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. Simulation Scenario for Anesthesia Providers Clark Obr, MD*, Anthony Mueller, MD . She Died the Next Day. 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. Re-assessthe patient using theABCDE approachto identify any changes in their clinical condition and assess the effectiveness of your previous interventions. Heart: S1 and S2 within normal limits; no S3/S4 or murmurs, normal rate and rhythm. oral fluids, intravenous fluids, urine output, drain output, stool output, vomiting) to inform resuscitation efforts. Refer to your local guidelines for further details. DKA can be caused by either: Absolute insulin deficiency (e.g. Data is temporarily unavailable. The files are given in full in the web supplement (Appendix B, Supplemental Digital Content 2, https://links.lww.com/SIH/A2). dq-]gX4 `L'u7myx) rpjf0z,.y`VMyx-&Ju`U0 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 The students worked on the underlying physiology during a week long PBL session and are therefore familiar with the theoretical aspects of DKA. CCA 175 Real Time Exam Scenario 17 | JOIN Multiple DataFrames | Save as Trainee will be able to apply skills of communication with the simulated patient in a semiacute crisis to get sufficient important information for a final diagnosis. Diabetes (type 1 and type 2) in children and young people: diagnosis and management. 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. A collection of anatomy notes covering the key anatomy concepts that medical students need to learn. DO NOT perform any examination or procedure on patients based purely on the content of these videos. Refer to your local guidelines which should provide a clear protocol for the management of DKA. See ourCXR interpretation guidefor more details. There are several causes of DKA, which we remember by the "five I's". Performing an ECG should not delay the emergency management of DKA. Review the patientscurrent medicationsand check any regular medications areprescribed appropriately. Each performance measure is separated into cognitive, behavioral or technical categories. PBL was introduced at our institution in 1995. Subscribe to our newsletter to be the first to know about our latest content: https://geekymedics.com/newsletter/ Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. 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. These simulation sessions seem to work because the medical students do have prior knowledge. We ask the trainee why the blood pressure is so low or heart rate is so high, and how we should treat it. Available if the trainee asks: arterial blood gas, glucose, electrolytes, BUN and plasma osmolality (please see last section of Appendix B, Supplemental Digital Content 2, https://links.lww.com/SIH/A2, for values). - Site 01:12 1) Please read through this document as it will help you prepare for your upcoming simulation on DKA. On the basis of the feedback from the students, they indicated that they believed the small group sessions are better. We are looking for declaration of DKA and request for pathway. General: Moaning, asking what has happening to her. Stage 1: Initial assessment of acutely unwell pregnant woman and diagnosis of DKA. The student group is given a short introduction into a closed simulation environment. Ask for anotherclinicalmemberofstafftoassistyou if possible. The main purpose of the simulation is to draw a line from the theoretical, boring biochemistry to the clinical manifestations. If the patientloses consciousnessand there areno signs of lifeon assessment, put out acrash callandcommence CPR. diagnosis of DKA Trigger 3, ABG show acidosis and high BM and normal potassium. 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. Depending on scenario complexity, team dynamic and treatment modalities, this simulation may take 1020 minutes. (1) According to Centers for Disease Control and Prevention (CDC), 223,619 deaths were attributed to diabetes in 2005. Does the patient need reviewing by a specialist? Simulation in Healthcare4(4):232-236, Winter 2009. 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. Given such a small group, the students indicated that they feel more involved than they would with a larger group (eg, the whole class.) Works with Traffic 2005, but . www.cdc.gov/diabetes/statistics/prev/national/. >> Patterson PD, Weaver M, Frank R, et al. 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. type 1 diabetes), Complete insulin insensitivity (e.g. Trainee will correlate the underlying pathophysiology with symptoms and signs as exhibited by the simulation session. The instructor should have visual access via one-way windows or cameras. Chapters: Creating a Simulation Experience to Promote Clinical Judgment 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. 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). Discuss the patients current clinical condition with aseniorclinicianusing anSBARR style handover. A strong emphasis is placed on the focused, methodical examination of a specific medical problem and the decision-based treatment options available. Trigger 4, Pathway 1l of saline required over 1hour and insulin infusion need prescribing and making up in 50ml syringe. Laschinger S, Medves J, Pulling C, et al. Use washable, non-toxic paints to imitate various body emissions. Open the patients airwayusing ahead-tiltchin-lift manoeuvre: 1. - Radiation 02:45 Trainee will recognize the need for therapy and suggest an appropriate therapy in a simulated environment. Two abstracts related to sleepiness in the EMS workforce were presented at the National Association of EMS Physicians symposium in January. The teaching of diabetic assessment and management, like many other medical emergencies, lends itself well to case-based simulation. Some error has occurred while processing your request. When erroneous treatment is delivered, the instructor can end the simulation. The instructor can also gauge the direction the debriefing session should follow or be alerted to possible problems or conflicts in treatment opinions. Trainee will improve their understanding of clinical practice through reflective assessment of actual cases during the prior PBL sessions. Surgical dressings and imitation blood can support medical history. Conclusions This technical report describes the design and implementation of a simulation scenario on DKA for emergency medicine trainees. The optimal number of simulation participants is four to seven individuals, depending on the case study objectives. Centers for Disease Control and Prevention. The Theory Review thepatients notes,chartsandrecent investigation results. Animated lectures, however, must work within the framework of a focused case study, which requires increased preparation time. The students are in their first year. 3. Creating a Simulation Experience to Promote Clinical Judgment We combined both to indicate the continuity of the curriculum, and the building on prior knowledge. This field is for validation purposes and should be left unchanged. 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. This simulation session therefore aims to make the case come alive, and show this known case in a clinical context. The trainees have had background knowledge of biochemistry because they had completed the PBL case. Well done, youve now stabilised the patient and theyre doing much better. Causes: Any situation arising in a diabetic that requires increased insulin without that demand being met can result in DKA. Trainee will increase knowledge of professional behaviors during the simulation. However, this leads to confusion. We introduce the Simulation Laboratory and the Simulator, and demonstrate: pulses, eyes blinking, pupil constriction, gas moves in and out of mouth (place hand over mouth), chest moves up and down. Some manikin models support a variety of human functions, such as capillary and facial cyanosis, facial sweating, foley catheter and IV placement, blood pressure generation, cardiac rhythms and abnormalities, defibrillation, cardioversion, external pacing and vital sign generation. Inspect for evidence of self-injection sites (e.g. We now provide the students with handouts of the data to save time and provide consistency. See ourintravenous cannulation guidefor more 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. 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. Competency-based medical education has seen widespread adoption in the field along with ongoing work in the areas of . Trainee will learn to collaborate with peers to decide on appropriate interventions, tests, and therapy. Scenario in a Nutshell Diabetic ketoacidosis (DKA) in pregnancy. We have spent many hours debating whether the small group format was a waste of time. PDF Adult Type I Diabetic Ketoacidosis Pre-simulation Preparation Student Simulation of Diabetic Ketoacidosis for Cellular and Molecul MassBay EMS Program Integrates Training for Dogs, Heat Waves Are Killing More LA Homeless People. Use blankets to re-warm patients who are mild to moderately hypothermic. 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. As this is an interactive discussion session, any needed debriefing and/or explanation is given during the sessions. Hypothermia may be present if the patient has been unconscious and exposed for some time. As individuals with uncontrolled type I . 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. Case-based simulation should include two to three broad-focus objectives, as well as 1020 specific performance measures that the student should accomplish. This is particularly important for core . can be reemphasized, and the effects of fluid therapy demonstrated. Cureus is on a mission to change the long-standing paradigm of medical publishing, where submitting research can be costly, complex and time-consuming. She does not take this regularly. 3. His Heart Stopped On a Treadmill. 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. Please enable scripts and reload this page. Over the years, some groups happened to have the simulation session before the completion of the theoretical PBL session. Prehosp Emerg Care. Makeup may be used to depict gender, hollow eyes and cheeks, produce pallor or display bruises and scars. The simulation session is also hosted as an interactive session. A patient presenting with altered level of consciousness and a blood sugar level below 80 mg/dL should be considered hypoglycemic, and treatment modalities should be consistent with those for a diabetic patient. In this case scenario, dehydration is one of the most serious immediate issues. We try to provide sufficient realism.. If the patient isunconsciousorunresponsive, start thebasic life support(BLS)algorithmas per resuscitation guidelines. Acad Med. 2009;13:505511. If foreign material is present, attempt removal using suction. Because of this consciousness status, it is very difficult to obtain information of cardiovascular, pulmonary, renal, hepatic, endocrine, hematology, or coagulation status other than uncontrolled diabetes. They have had no clinical exposure or any clinical experience. See ourdocumentation guidesfor more details. After initial insulin therapy has reduced plasma blood glucose levels (e.g. 2. Endocrine - thesimbook.com Its best, however, to allow the student group to continue so theyre able to evaluate their decision-making processes during debriefing. In other words, they do not have clinical experience, but they have clinical knowledge. Manikin staging can provide strong cues. See ourhistory taking guidesfor more details. Both external and internal potassium balances are disturbed during the development and treatment of DKA. Askhow the patient is feeling as this may provide some useful information about their current symptoms. Geeky Medics accepts no liability for loss of any kind incurred as a result of reliance upon the information provided in this video. Despite this increased calorie intake, she noticed an unexplained 20 lbs weight loss. The DKA simulation incorporates cue recognition, analysis of cues, generation of solutions, nursing interventions, and evaluation of outcomes, including effective communication and psychosocial concerns. A chest X-ray should not delay the emergency management of DKA. . It was developed for anesthesiology resident physicians with some background knowledge and experience caring for critically ill patients. stream 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). 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. Indeed, it is the only thing that ever has.". Diabetic Ketoacidosis (DKA) Clinical Pathway Emergency Department | Children's Hospital of Philadelphia 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. Emergency medical services workLife characteristics contribute to clinically significant excessive daytime sleepiness. The simulation experience serves to give substance to the theoretical words and concepts that the students encountered during the PBL sessions. The instructors role is to facilitate active learning through a combination of learning styles. 3. See Table 4 for a suggested standardized script. 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). This is a combination of the modified traditional lecture within scenario-based learning. areas of lipohypertrophy) if it is unclear if the patient is diabetic. 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. Its absolutely necessary to follow all immersive simulations with a positive, emotionally safe and nonjudgmental debriefing environment. Using SOCRATES in History Taking | OSCE | Communication Skills, Diabetic Ketoacidosis (DKA) | Acute Management | ABCDE. Trainee will describe the changes in vital signs, the major metabolic, fluid, and electrolyte. Does the patient need a referral toHDU/ICU? A comprehensive collection of medical revision notes that cover a broad range of clinical topics. Other details are also important, including descriptions regarding patient language skill, social history, socioeconomic history, family history, religious practices or beliefs pertinent to treatment, and descriptive signs and symptoms. With your index and other fingers placed behind the angle of the mandible, apply steady upwards and forward pressure to lift the mandible. Diabetic Ketoacidosis in the Obstetric Population: A Simulation Keyword Highlighting 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. A collection of interactive medical and surgical clinical case scenarios to put your diagnostic and management skills to the test. The validity of the HFS-DKA scenario was verified by a certified diabetes nurse educator, a registered nurse, and a clinical nurse educator. The consequences (low blood pressure, high heart rate, central nervous system status, etc.) Marx JA, Hockberger RS, Walls RM. Rosens Emergency Medicine: Concepts and Clinical Practice. For similar reasons, we do not believe a videotaped session will keep the students attention as much as these live simulator sessions. 1. Make sure to re-assess the patient after any intervention. Introduceyourselfto whoever has requested a review of the patient andlistencarefullyto their handover. Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario 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. 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. 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. Prehosp Emerg Care. Medical simulation technology is a powerful tool for training physicians but papers dealing with DKA simulators are scarce. Privacy Policy Please write a single word answer in lowercase (this is an anti-spam measure). 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. Ketones show 5.5. Diabetes UK with the Joint British Diabetes Societies Inpatient Care Group. Immersive simulations are mentally exhausting because they create an intense and stressful atmosphere requiring the learner to work outside their comfort zone. Revisit history taking to explore relevant medical history and identify any precipitating factors for DKA. An animated lecture may be described as a pseudo-simulation environment. 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. DY{Qb"(EgN$QI*%XN1F""0a5 Its important to train and educate students of prehospital care on key indicators of a diabetic emergency. We guide the group to suggest fluid. Simulation provides a safe environment where learning is enhanced through the deliberate practice of skills and controlled management of a variety of clinical encounters. VbQuX#R M21 TikTok: https://www.tiktok.com/@geekymedics An oxygen mask is also demonstrated as an alternative device, as these early trainees had mostly not yet seen any of these devices. This typically involves the use of anon-rebreathe maskwith an oxygen flow rate of15L. 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. Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario 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)? Tilt the forehead back whilst lifting the chin forwards to extend the neck. endobj GRAPH. A fixed-rate intravenous insulin infusion should be commenced initially to suppress ketogenesis, reduce blood glucose levels and address electrolyte disturbances.
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