Simulation Training Ideal for Diabetic Patients - JEMS It should only be inserted in unconscious patients as it is otherwise poorly tolerated and may induce gagging and aspiration. Terms of Use. 2011;15:108109. As with the animated lecture, the simulation is strongly dependent on a focused case study. Effectiveness of simulation on health profession students knowledge, skills, confidence and satisfaction. Seek senior helpif the patient shows no signs of improvement or if you have any concerns. Geeky Medics accepts no liability for loss of any kind incurred as a result of reliance upon the information provided in this video. Problems are addressed as they are identified and the patient is re-assessed regularly to monitor their response to treatment. Int J Evid Based Healthc. The required potassium replacement varies greatly. See ourdocumentation guidesfor more details. - Introduction 00:00 Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. Diabetic ketoacidosis; Simulation training; Medical students. There are actually two sets of educational objectives: the first set is for the theoretical PBL sessions, and the 2nd set is for the Simulation Session. <> The Theory The choice of fluid type, rate of administration and volume should be tailored to the individual patient based upon their vital signs and electrolytes. JEMS. In an animated lecture, its important that the student group have an instructor so they can ask direct questions. An events progression section should include patient status changes, as well as a time/treatment continuum that incorporates if-then event progressions. The students are in their basic science course. Trigger 4, Pathway 1l of saline required over 1hour and insulin infusion need prescribing and making up in 50ml syringe. Lets discuss your options. <>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 595.32 841.92] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> Surgical dressings and imitation blood can support medical history. 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Competency-based medical education has seen widespread adoption in the field along with ongoing work in the areas of . 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. Recognize the signs and symptoms of a patient presenting with diabetic ketoacidosis. A well-staged environment allows for greater student buy-in. CCA 175 Real Time Exam Scenario 17 | JOIN Multiple DataFrames | Save as Several environments may be suitable for your classroom. In keeping with the case study, as a treatment marker is reached, the instructor should place emphasis on physiological, pharmacological, environmental and psychosocial issues. The relationship between sleep, fatigue and patient and provider safety. The 60 minutes training time consists of four 15-minute sections divided as follows. Simulation-based medical education: An ethical imperative. 3. Instead, instructors should combine case- and simulation-based techniques when teaching diabetic assessment. 1. Respiratory Failure in the Course of Treatment of Diabetic Ketoacidosis His Wife Gave Him CPR. Administer oxygen to all critically unwell patients during yourinitialassessment. Scenario in a Nutshell Diabetic ketoacidosis (DKA) in pregnancy. The students mentioned that they did not obtain the maximum value from the simulation session under these circumstances. Please note that by doing so you agree to be added to our monthly email newsletter distribution list. If foreign material is present, attempt removal using suction. MassBay EMS Program Integrates Training for Dogs, Heat Waves Are Killing More LA Homeless People. A chest X-ray should not delay the emergency management of DKA. Management of diabetic ketoacidosis in adults. 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. 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 . In the meantime, you should re-assess and maintain the patients airway. - Exacerbating & relieving factors 05:12 TikTok: https://www.tiktok.com/@geekymedics Often, the learner group will be unaware of these behaviors, but the instructor can key into the first few comments made during the transition between rooms. Available from: [. This typically involves the use of anon-rebreathe maskwith an oxygen flow rate of15L. KDCA, Ronald Reagan Washington National Airport, DC. Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. #geekymedics #fyp #fypviral #studytok #medicalstudentuk #medtok #studytips #studytipsforstudents #medstudentuk #premed #medschoolfinals, Cardiovascular History Tips - DON'T FORGET these 3 things . "Never doubt that a small group of thoughtful, committed citizens can change the world. The Theory Tilt the forehead back whilst lifting the chin forwards to extend the neck. A nasopharyngeal airway is a soft plastic tube with a bevel at one end and a flange at the other. The student group should be encouraged to collaborate on management options and to perform skills. Extremities: mild cyanosis, no clubbing or edema (verbalized by instructors); pulses equal, and symmetrical (elucidated by trainees). Simulation Scenario. Creating a Simulation Experience to Promote Clinical Judgment The trainees have had background knowledge of biochemistry because they had completed the PBL case. 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. - PSA Question Pack: https://geekymedics.com/psa-question-bank/ This guide has been created to assist students in preparing for emergencysimulationsessionsas part of their training,it is not intended to be relied upon for patient care. 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. A blood glucose level may already be available from earlier investigations (e.g. We ask the trainee why the blood pressure is so low or heart rate is so high, and how we should treat it. These are not learning objectives in this program. 2. Indeed, it is the only thing that ever has.". An hour was . Immersive simulations are mentally exhausting because they create an intense and stressful atmosphere requiring the learner to work outside their comfort zone. Nandate, Koichiro MD, PhD; Abola, Ramon MD; Murray, W Bosseau MB; Whitfield, Carol PhD; Lang, Charles PhD; Sinz, Elizabeth MD. This is particularly important for core . In the meantime, you can perform some basic airway manoeuvres to help maintain the airway whilst awaiting senior input. Conclusion: Our DKA simulator is a new tool whose objective is the training in a severe, frequent and complex situation, and can be used to improve the approach made by the junior physicians to the real diabetic . Groups of more than seven may struggle with meeting objectives due to insufficient functional rolls. Case-based education adds a real-world aspect to the learning environment. Given 6 to 8 back-to-back sessions, it is critical that every session starts and ends on time! DO NOT perform any examination or procedure on patients based purely on the content of these videos. 3. KDCA for FSX - Fly Away Simulation General: Moaning, asking what has happening to her. Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario Cureus. 4 0 obj Simulation provides a safe environment where learning is enhanced through the deliberate practice of skills and controlled management of a variety of clinical encounters. 3 0 obj Reduced urine output (oliguria) is typically defined as less than 0.5ml/kg/hour in an adult. Review thepatients notes,chartsandrecent investigation results. This allows us to get in touch for more details if required. - Timing 03:23 If you have any scenarios you would be willing to share with the simulation community, please forward them . Inspect for evidence of infection on the skin (e.g. 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. PDF DKA Sim Scenario - ABCD (Diabetes Care) Ltd A number of key modifiers are described that allow for the adjustment of case . Heart: S1 and S2 within normal limits; no S3/S4 or murmurs, normal rate and rhythm. Paediatric DKA | Simulation Education Physician working in the emergency department. Trainee will correlate the underlying pathophysiology with symptoms and signs as exhibited by the simulation session. A collection of surgery revision notes covering key surgical topics. 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 . 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 Another example: At one minute into the scenario, the patient becomes unresponsive and their breathing becomes shallow. When erroneous treatment is delivered, the instructor can end the simulation. Catheterisethe patient to closelymonitor urine outputto guide fluid resuscitation and need for escalation. 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. The file explaining the session is sent to instructors 1 week before the sessions. Using the arterial line, the scenario becomes much more dynamic. 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. In this section, we have to help the trainee to institute definitive therapy based on the underlying biochemical abnormalities. DY{Qb"(EgN$QI*%XN1F""0a5 4. Calculate the patients current fluid balance using their fluid balance chart (e.g. Strategies of high-performing paramedic educational programs. 2010;49:578586. Each performance measure is separated into cognitive, behavioral or technical categories. Diabetes (type 1 and type 2) in children and young people: diagnosis and management. We also show them IV bags containing saline and Ringers lactate, as well as show them IV infusion sets. 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. 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. Outcomes Educating Nursing Students Using an Evolving, Simulated Case Should any changes be made to the current management of their underlying condition(s)? Askhow the patient is feeling as this may provide some useful information about their current symptoms. 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 integral part of a PBL session is for trainees to be able to navigate through huge literature bases. Wolters Kluwer Health Clinical Simulation in Nursing, Volume 39, 2020, pp. Make sure to re-assess the patient after any intervention. 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. 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. Consider any precipitating factors for the development of DKA and involve the diabetes team in the patients care. From the Department of Anesthesiology, Pennsylvania State University College of Medicine, Hershey, PA. Dr. Murray is on the Speakers Bureau of METI, Sarasota, FL. - Medical Finals Question Pack: https://geekymedics.com/medical-student-finals-questions/ Your message has been successfully sent to your colleague. Creating a Simulation Experience to Promote Clinical Judgment An oropharyngeal airway is a curved plastic tube with a flange on one end that sits between the tongue and hard palate to relieve soft palate obstruction. #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! 2 The evaluation of potassium deficits is complicated by potassium exit from . Simulation provides a safe environment where learning is enhanced through the deliberate practice of skills and controlled management of a variety of clinical encounters. Using your thumbs, slightly open the mouth by downward displacement of the chin. The students are in their basic science course. 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). A comprehensive collection of medical revision notes that cover a broad range of clinical topics. Diabetic Ketoacidosis in the Obstetric Population: A Simulation NPAs are typically better tolerated in patients who are partly or fully conscious compared to oropharyngeal airways. Conclusions This technical report describes the design and implementation of a simulation scenario on DKA for emergency medicine trainees. Schneider Sarver PA, Senczakowicz EA, Slovensky BM. It was The questionnaire for the assessment of the session is given in full in the web-based supplement (Appendix A, Supplemental Digital Content 1, https://links.lww.com/SIH/A1). Weight, Height: Not given, normal appearing (as per simulator) but has lost 20 lbs recently. Cureus 9(5): e1286. In this case scenario, dehydration is one of the most serious immediate issues. dq-]gX4 `L'u7myx) rpjf0z,.y`VMyx-&Ju`U0 This field is for validation purposes and should be left unchanged. Insert the airway bevel-end first, vertically along the floor of the nose with a slight twisting action. type 1 diabetes), Complete insulin insensitivity (e.g. 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). Diabetic Ketoacidosis (DKA) | Acute Management | ABCDE Therefore, the same file is also sent to the participants before the session. If the patient loses consciousness and there are no signs of life on assessment, put out a crash call and commence CPR. Open the patients airwayusing ahead-tiltchin-lift manoeuvre: 1. In some cases, normal saline with additional potassium is required to prevent overcorrection of serum potassium levels which would otherwise result in hypokalaemia. Review the patientsoxygen saturation(SpO2): Auscultate the chest to screen for evidence of respiratory pathology (e.g. The use of case-based simulation, although more complicated and time consuming for the instructor, immerses the students in the subject matter. 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. 1-6. 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. After the first voluntary session in 2006, feedback from the medical students indicated that they would like to receive this handout. Please enable scripts and reload this page. diagnosis of DKA Trigger 3, ABG show acidosis and high BM and normal potassium. 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. 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. Ketones show 5.5. She tends to drink sugar containing fluids (soda) when she is thirsty, and she eats fast foods (cream-filled muffins) when she is hungry. 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. Each clinical case scenario allows you to work through history taking, investigations, diagnosis and management. PDF Adult Type I Diabetic Ketoacidosis Pre-simulation Preparation Student You can check out our guide to using SOCRATES here: https://geekymedics.com/the-socrates-acronym-in-history-taking/ Airway adjuncts are often helpful and in some cases essential to maintain a patients airway. Capillary refill timemay be prolonged if the patient is hypovolaemic. Acad Med. 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]). 1 Potassium losses occurring both before and during treatment of DKA must be replaced. Marx JA, Hockberger RS, Walls RM. Initially, we required the students to write down the vital signs. 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. Search for Similar Articles For instance, one of the questions is: Why is Tiffany dehydrated? There are several possible reasons and mechanisms (as outlined in Appendix B, fourth 15 minutes, Supplemental Digital Content 2, https://links.lww.com/SIH/A2), which the students can mention. The simulation experience serves to give substance to the theoretical words and concepts that the students encountered during the PBL sessions. You may be trying to access this site from a secured browser on the server. As this is an interactive discussion session, any needed debriefing and/or explanation is given during the sessions. 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. Advance the airway until it lies within the pharynx. Diabetic ketoacidosis simulator: a new learning tool for a life Published August 2015. Circulating nurse in the emergency room (ER). your express consent. Hypothermia may be present if the patient has been unconscious and exposed for some time. Review the patients drug chart for medications which may cause a reduced level of consciousness (e.g. The scenario would include an if-then algorithm. endobj areas of lipohypertrophy) if it is unclear if the patient is diabetic. Makeup may be used to depict gender, hollow eyes and cheeks, produce pallor or display bruises and scars. They have had no clinical exposure or any clinical experience. Diabetic Ketoacidosis (DKA) Clinical Pathway Emergency Department You may be asked to review a patient with DKA due to confusion, reduced level of consciousness, tachycardia, hypotension and/or vomiting. doi: 10.7759/cureus.1286. Ziv A, Wolpe PR, Small SD, et al. Yes: if the patient can talk, their airway is patent and you can move on to the assessment of breathing. Stage 1: Initial assessment of acutely unwell pregnant woman and diagnosis of DKA. . Alert a senior immediately if you have any concerns about the consciousness level of a patient. A collection of data interpretation guides to help you learn how to interpret various laboratory and radiology investigations. 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. 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). Groups of fewer than four students dont allow for optimal collaboration. The learning objectives follow the American College of Graduate Medical Education (ACGME) Core Compentencies. A comprehensive collection of OSCE guides to common clinical procedures, including step-by-step images of key steps, video demonstrations and PDF mark schemes. TheABCDEapproach can be used to perform a systematic assessment of a critically unwell patient. Medical Simulation Scenarios are text documents outlining the various details of a simulation - everything from patient simulator settings to debriefing notes. 4. 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. ABG, venepuncture). This is a combination of the modified traditional lecture within scenario-based learning. The learning environment should closely mimic real-world applications. 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.. Simulation in Healthcare4(4):232-236, Winter 2009. 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. Clearlydocument your ABCDE assessment, including history, examination, observations, investigations, interventions, and the patients response. Over the years, some groups happened to have the simulation session before the completion of the theoretical PBL session. 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. For more information, please refer to our Privacy Policy. 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. If the patient has COPD and a history of CO2retention you should switch to aventuri maskas soon as possible andtitrate oxygen appropriately. Instagram: https://instagram.com/geekymedics 3. PDF Medicine Simulation Scenario Diabetic Ketoacidosis: An Emergency - Cureus