dka simulation scenario

- Introduction 00:00 If you have any scenarios you would be willing to share with the simulation community, please forward them to me. 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. 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. Properly interpret a venous blood gas (VBG) and basic metabolic panel in a patient presenting with diabetic ketoacidosis. In this case scenario, dehydration is one of the most serious immediate issues. Urinary tract infections are a common DKA precipitant. The objective is to give as many visual and tactile cues concerning the patient condition and background as possible. 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. Please try after some time. For example, if a student is to run a diabetic emergency in an extended living facility, the room should be staged with the appropriate bed, linens and medical equipment, and include personal artifacts and memorabilia normally found in such environments. Over the years, some groups happened to have the simulation session before the completion of the theoretical PBL session. The Theory After the first voluntary session in 2006, feedback from the medical students indicated that they would like to receive this handout. 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. Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes mellitus, most common in patients with type 1 diabetes in particular due to a deficiency or absence of insulin [1].. Geeky Medics accepts no liability for loss of any kind incurred as a result of reliance upon the information provided in this video. 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. Wolters Kluwer Health Diabetic ketoacidosis (DKA) is a common, potentially lethal disease. - Associated symptoms 03:04 - Character 02:14 Insert at least onewide-bore intravenous cannula(14G or 16G) and take blood tests as discussed below. We give the history of the patient to the trainees. Each performance measure is separated into cognitive, behavioral or technical categories. This leads to hyperglycaemia, osmotic diuresis, and dehydration. Marx JA, Hockberger RS, Walls RM. Below is a collection of donated scenarios for you to use or modify. Consider any precipitating factors for the development of DKA and involve the diabetes team in the patients care. 2017 May 29;9(5):e1286. Int J Evid Based Healthc. type 1 diabetes) Complete insulin insensitivity (e.g. ABG, venepuncture). The main purpose of the simulation is to draw a line from the theoretical, boring biochemistry to the clinical manifestations. 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. Heart: S1 and S2 within normal limits; no S3/S4 or murmurs, normal rate and rhythm. Your message has been successfully sent to your colleague. Trainee will be respectful to others and their views during the PBL session. Available from: [. }HyEf,#$/JSRU9+CF6k\'/z+i`[ 5JudK*Zly^g%[jCK)H[)Y=Qp0/r9o9HW_zF}pTzI~'|q.~:=Y T 9w! 2. It involves working through the following steps: Each stage of the ABCDE approach involvesclinicalassessment,investigationsandinterventions. Simulation Scenario. Trainee will practice or observe good teamwork skills, both as a leader and a team player. Scenarios. 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). 1 0 obj JEMS. SimMan Nursing Scenarios Software. cellulitis). In the context of DKA, a patients consciousness level may be reduced. 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 . We have been presenting Simulation Laboratory sessions to our preclinical medical students (first and second years). - Onset 01:48 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. Depending on scenario complexity, team dynamic and treatment modalities, this simulation may take 1020 minutes. insulin-dependent type 2 diabetes), Altered consciousness (e.g. Margolis GS, Romer GA, Fernandez AR, et al. See our blood glucose measurement guide for more details. Catheterisethe patient to closelymonitor urine outputto guide fluid resuscitation and need for escalation. - PSA Question Pack: https://geekymedics.com/psa-question-bank/ Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario Problems are addressed as they are identified and the patient is re-assessed regularly to monitor their response to treatment. In some cases, normal saline with additional potassium is required to prevent overcorrection of serum potassium levels which would otherwise result in hypokalaemia. to below 12 mmol/L) an infusion containing normal saline and 5% dextrose is typically commenced to prevent the development of hypoglycaemia, whilst allowing insulin therapy to continue to suppress ketogenesis and reduce serum electrolyte concentrations. 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. Trainee will describe the changes in vital signs, the major metabolic, fluid, and electrolyte. your express consent. It was developed for anesthesiology resident physicians with some background knowledge and experience caring for critically ill patients. An integral part of a PBL session is for trainees to be able to navigate through huge literature bases. Healthcare Students' Psychological Well-Being in a Diabetic Ketoacidosis Simulation. NPAs are typically better tolerated in patients who are partly or fully conscious compared to oropharyngeal airways. Perform urinalysis and send the urine for culture if urinary tract infection is suspected. 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. The simulation experience serves to give substance to the theoretical words and concepts that the students encountered during the PBL sessions. Use an effectiveSBARR handoverto communicate the key information effectively to other medical staff. The students mentioned that they did not obtain the maximum value from the simulation session under these circumstances. 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. areas of lipohypertrophy) if it is unclear if the patient is diabetic. a simulation training session designed to acquaint emergency medicine residents with the presentation and management of diabetic ketoacidosis (DKA) through the use of simulation. Performing an ECG should not delay the emergency management of DKA. 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. The students have acquired all the applicable theoretical knowledge of the case during the previous multiday PBL sessions. 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). Discuss the patients current clinical condition with aseniorclinicianusing anSBARR style handover. 3. Inspect for evidence of self-injection sites (e.g. The patient synopsis should include such standard aspects as age, sex, ethnicity, medical history, medications and allergies. 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. The students are in their basic science course. - 700+ OSCE Stations: https://geekymedics.com/osce-stations/ 3. Available from: [, NICE guidelines. Prehosp Emerg Care. Please note that by doing so you agree to be added to our monthly email newsletter distribution list. 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. If fever is present, make sure to consider co-existing infection. 3. The file explaining the session is sent to instructors 1 week before the sessions. - Over 3000 Free MCQs: https://geekyquiz.com/ Invasive monitors, including a left radial intraarterial and a right subclavian IV catheter, were placed. Subscribe to our newsletter to be the first to know about our latest content: https://geekymedics.com/newsletter/ % Inspect theairwayfor obviousobstruction. This typically involves the use of anon-rebreathe maskwith an oxygen flow rate of15L. vD0 x@FFJ{m[ 3//Oh|JR7! The choice of fluid type, rate of administration and volume should be tailored to the individual patient based upon their vital signs and electrolytes. Makeup may be used to depict gender, hollow eyes and cheeks, produce pallor or display bruises and scars. Geeky Medics accepts no liability for loss of any kind incurred as a result of reliance upon the information provided in this video. We then start the DKA state. See Appendix D, Supplemental Digital Content 4, https://links.lww.com/SIH/A4. They should introduce the student group to the environment, assign roles for each learner and guide the decision-making process. DY{Qb"(EgN$QI*%XN1F""0a5 Another example: At one minute into the scenario, the patient becomes unresponsive and their breathing becomes shallow. His Heart Stopped On a Treadmill. 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. We now provide the students with handouts of the data to save time and provide consistency. (1), The assessment of a diabetic patient is best taught as a case-based simulation. Trigger 4, Pathway 1l of saline required over 1hour and insulin infusion need prescribing and making up in 50ml syringe. 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). 4. This allows us to get in touch for more details if required. In the final 10 minutes, we show how the patient has a good recovery after fluid replacement. Physician working in the emergency department. Please try again soon. By joining Cureus, you agree to our In the meantime, you can perform some basic airway manoeuvres to help maintain the airway whilst awaiting senior input. Centers for Disease Control and Prevention. to maintaining your privacy and will not share your personal information without <> 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. Ziv A, Wolpe PR, Small SD, et al. Keywords: diabetic ketoacidosis, simulation, expertise, emergency medicine Introduction Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes mellitus, most . - Exacerbating & relieving factors 05:12 Supplemental digital content is available for this article. COVID-19 Screening in the Pediatric Emergency Department. Nandate, Koichiro MD, PhD; Abola, Ramon MD; Murray, W Bosseau MB; Whitfield, Carol PhD; Lang, Charles PhD; Sinz, Elizabeth MD. 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. Recognize the signs and symptoms of a patient presenting with diabetic ketoacidosis. Simulation provides a safe environment where learning is enhanced through the deliberate practice of skills and controlled management of a variety of clinical encounters. She is lethargic and slightly confused but can intermittently respond to questions. The facilitator guides the group only when necessary. Emergency medical services workLife characteristics contribute to clinically significant excessive daytime sleepiness. Each PBL case typically goes over 23 days, affording the students periods to find information for the case. Trainee will recognize the need for therapy and suggest an appropriate therapy in a simulated environment. A comprehensive collection of OSCE guides to common clinical procedures, including step-by-step images of key steps, video demonstrations and PDF mark schemes. Each clinical case scenario allows you to work through history taking, investigations, diagnosis and management. 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 endobj Askhow the patient is feeling as this may provide some useful information about their current symptoms. Debriefing Review the patientsoxygen saturation(SpO2): Auscultate the chest to screen for evidence of respiratory pathology (e.g. You may be asked to review a patient with DKA due to confusion, reduced level of consciousness, tachycardia, hypotension and/or vomiting. Research Watch Box:Sleep, Fatigue & SafetyBy David Page, MS, NREMT-P Refer to your local guidelines for further details. You may be trying to access this site from a secured browser on the server. Highlight selected keywords in the article text. Given 6 to 8 back-to-back sessions, it is critical that every session starts and ends on time! See ourdocumentation guidesfor more details. We believe it is important to have active, participatory learning by having conversations with the trainees in the form of questions and answers. 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. - Site 01:12 The instructor can also gauge the direction the debriefing session should follow or be alerted to possible problems or conflicts in treatment opinions. 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 was taken to the Emergency Department from her soccer game because she complained of nausea, extreme fatigue, mild disorientation, and blurred vision toward the end of the soccer match. If an obstruction is visible within the airway, use afingersweeporsuctionto remove it. 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. The required potassium replacement varies greatly. Advance the airway until it lies within the pharynx. cloudy urine may indicate urinary tract infection). The instructors role is to facilitate active learning through a combination of learning styles. Immersive Simulations Both external and internal potassium balances are disturbed during the development and treatment of DKA. Please write a single word answer in lowercase (this is an anti-spam measure). After entering the environment, the student doesnt have the option of leaving the simulation until the learning objectives and performance measures are achieved. An events progression section should include patient status changes, as well as a time/treatment continuum that incorporates if-then event progressions. 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). Given such a small group, the students indicated that they feel more involved than they would with a larger group (eg, the whole class.) #geekymedics #fyp #fypviral #studytok #medicalstudentuk #medtok #studytips #studytipsforstudents #medstudentuk #premed #medschoolfinals #shorts, Cardiovascular Exam Tips - DON'T FORGET these 3 things , Watch this video to find out the most COMMONLY FORGOTTEN components of the cardiovascular history! Save this video to help prepare for your upcoming OSCEs and dont forget to follow Geeky Medics! 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. This guide provides an overview of the recognition and immediate management of diabetic ketoacidosis (DKA)using an ABCDE approach. This is particularly important for core cases and low-frequency, high-stakes procedures and encounters. endobj doi: 10.7759/cureus.1286. Clearly communicate how often would you like the patients observations relayed to you by other staff members. His Wife Gave Him CPR. 1) Please read through this document as it will help you prepare for your upcoming simulation on DKA. Medical simulation technology is a powerful tool for training physicians but papers dealing with DKA simulators are scarce. Does the patient need a referral toHDU/ICU? She Died the Next Day. We used the Medical Education Technologies Inc. (METI) Human Patient Stimulator (HPS, METI Sarasoto, Fl). The researchers found that long shift hours (24hrs), working overtime and marital/relationship stress were strongly correlated. I assigned true to life parking codes, and added some extra parking for the superfluous US Express AI. Two abstracts related to sleepiness in the EMS workforce were presented at the National Association of EMS Physicians symposium in January. reduced air entry, coarse crackles) to screen for evidence of pneumonia. The normal reference range for fasting plasma glucose is 4.0 5.8 mmol/l. Animated lectures, however, must work within the framework of a focused case study, which requires increased preparation time. 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. The validity of the HFS-DKA scenario was verified by a certified diabetes nurse educator, a registered nurse, and a clinical nurse educator. 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). We also show them IV bags containing saline and Ringers lactate, as well as show them IV infusion sets. (1) The assessment of a diabetic patient is best taught as a. opioids, sedatives, anxiolytics, insulin, oral hypoglycaemic medications). Intubation lubricants can mimic drooling. Section snippets . See ourCXR interpretation guidefor more details. endobj Check out our other awesome clinical skills resources including: Place one hand on the patients forehead and the other under the chin. 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 Strategies of high-performing paramedic educational programs. The DKA simulation incorporates cue recognition, analysis of cues, generation of solutions, nursing interventions, and evaluation of outcomes, including effective communication and psychosocial concerns. 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. 6. Reprints: Koichiro Nandate, MD, PhD, Department of Anesthesiology, Milton S. Hershey Medical Center, Pennsylvania State University College of Medicine, 500 University Drive Box 850, Hershey, PA 17033 (e-mail: [emailprotected]). 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. 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. 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.) TheABCDEapproach can be used to perform a systematic assessment of a critically unwell patient. 5. 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. "Never doubt that a small group of thoughtful, committed citizens can change the world. If the patient loses consciousness and there are no signs of life on assessment, put out a crash call and commence CPR. However, we should not spend too much time on (not become distracted with) explaining unfamiliar monitors for the present trainees, such as central venous pressure or ETCO2 concentration. Diabetes (type 1 and type 2) in children and young people: diagnosis and management. These simulation sessions seem to work because the medical students do have prior knowledge. MassBay EMS Program Integrates Training for Dogs, Heat Waves Are Killing More LA Homeless People. 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. As with the animated lecture, the simulation is strongly dependent on a focused case study. unilateral coarse crackles may be present if the patient has pneumonia which may have been the precipitant for DKA). Simulation Scenario for Anesthesia Providers Clark Obr, MD*, Anthony Mueller, MD . This is a combination of the modified traditional lecture within scenario-based learning. Clearlydocument your ABCDE assessment, including history, examination, observations, investigations, interventions, and the patients response. TikTok: https://www.tiktok.com/@geekymedics 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. Simulation Scenario for Anesthesia Providers Clark Obr, MD*, Anthony Mueller, MD *Corresponding author: clark-obr@uiowa.edu Abstract Introduction: This simulation on diabetic ketoacidosis (DKA) in . If foreign material is present, attempt removal using suction. This allows the learner group to make a psychological break from the patient and environment while beginning the reflection process. To read Pages full Research Review column, visit www.jems.com/patient-care. J Nurs Educ. Scenario in a Nutshell Diabetic ketoacidosis (DKA) in pregnancy. Trainee will learn to collaborate with peers to decide on appropriate interventions, tests, and therapy. Stage 2: Emergency management of DKA and consideration of abnormal CTG. - 150+ PDF OSCE Checklists: https://geekymedics.com/pdf-osce-checklists/