dka simulation scenario

DKA can develop within 24 hours and is potentially life threatening, requiring prompt recognition and therapeutic intervention. Cureus 9(5): e1286. Typically potassium levels should be maintained between 4.0 5.5 mmol/L and close monitoring is required. This is a 25-year-old woman with a medical history of diabetes medicated with 40 units insulin per day. - 2500+ OSCE Flashcards: https://geekymedics.com/osce-flashcards/ As this is an interactive discussion session, any needed debriefing and/or explanation is given during the sessions. endobj Two abstracts related to sleepiness in the EMS workforce were presented at the National Association of EMS Physicians symposium in January. On the basis of the feedback from the students, they indicated that they believed the small group sessions are better. The reason for inserting the airway upside down initially is to reduce the risk of pushing the tongue backwards and worsening airway obstruction. 34 - Diabetic Ketoacidosis in Pregnancy | Obgyn Key If any obstruction is encountered, remove the tube and try the left nostril. 6. In other words, they do not have clinical experience, but they have clinical knowledge. SimMan offers you the ability to provide simulation education to challenge and test your students clinical and decision-making skills during realistic patient care scenarios. 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. Data Description All the product records are stored at /user/spark/dataset/retail_db/products All the category records are stored at /user/spark/dataset /ret. See ourintravenous cannulation guidefor more details. 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. 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. Standardized patient as the voice of the simulator (or the simulation operator may play this role). Inspect the urine currently in the catheter bag and note its appearance (e.g. Diabetic ketoacidosis (DKA) is a common, potentially lethal disease. Please try after some time. Rosens Emergency Medicine: Concepts and Clinical Practice. Search for Similar Articles 2) Complete the assigned suggested readings 3) Complete the presimulation preparation virtual simulation game (Instructor will provide link) 4) Once you have completed reading this document and prepared for your simulation, please: a. (1), The assessment of a diabetic patient is best taught as a case-based simulation. Therefore, the same file is also sent to the participants before the session. Physician working in the emergency department. PDF Diabetic Ketoacidosis in the Obstetric Population: A Simulation Diabetes (type 1 and type 2) in children and young people: diagnosis and management. Cureus is on a mission to change the long-standing paradigm of medical publishing, where submitting research can be costly, complex and time-consuming. Patients with DKA require fluid resuscitation to restore circulatory volume, clear ketones, correct electrolyte abnormalities and increase renal perfusion. "Never doubt that a small group of thoughtful, committed citizens can change the world. The student group should be encouraged to collaborate on management options and to perform skills. This is particularly important for core cases and low-frequency, high-stakes procedures and encounters. 2017 May 29;9(5):e1286. As individuals with uncontrolled type I . 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. 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. Simulation student Scenario- DKA-Peds.docx - DIABETIC GRAPH. Centers for Disease Control and Prevention. % There are several causes of DKA, which we remember by the "five I's". angioedema, rash) commence appropriate treatment as discussed in ouranaphylaxis guide. His Wife Gave Him CPR. Debriefing Administer oxygen to all critically unwell patients during yourinitialassessment. Finally, we summarize the course and give them time for questions. 3. In some cases, normal saline with additional potassium is required to prevent overcorrection of serum potassium levels which would otherwise result in hypokalaemia. This environment doesnt allow the student to identify presentation cues, be active in their own learning or apply their skills without endangering the lives of patients.(2). 1. A comprehensive collection of clinical examination OSCE guides that include step-by-step images of key steps, video demonstrations and PDF mark schemes. Diabetes mellitus affects nearly 7.8% of the U.S. population, with approximately 510% of this group affected by Type I and 9095% by Type II.1 Diabetes is the most common type of endocrine disease and was the seventh leading underlying cause of death listed on death certificates in 2006. (1) According to Centers for Disease Control and Prevention (CDC), 223,619 deaths were attributed to diabetes in 2005. Keywords: diabetic ketoacidosis, simulation, expertise, emergency medicine Introduction Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes mellitus, most . - 150+ PDF OSCE Checklists: https://geekymedics.com/pdf-osce-checklists/ Data is temporarily unavailable. cellulitis). Below is a collection of donated scenarios for you to use or modify. - Character 02:14 If the patient isunconsciousorunresponsive, start thebasic life support(BLS)algorithmas per resuscitation guidelines. Animated Lecture Creating a Simulation Experience to Promote Clinical Judgment Given 6 to 8 back-to-back sessions, it is critical that every session starts and ends on time! The use of simulation-based instruction enables a student to learn at their own pace and allows them to repeat sequential steps to gain confidence and proficiency. Refer to your local guidelines for further details. 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! This simulation session therefore aims to make the case come alive, and show this known case in a clinical context. Advance the airway until it lies within the pharynx. If an infection is suspected, IV antibioticsshould be administered as soon as possible. If you have any scenarios you would be willing to share with the simulation community, please forward them . - Timing 03:23 Does the patient need reviewing by a specialist? - Over 3000 Free MCQs: https://geekyquiz.com/ 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. You may be asked to review a patient with DKA due to confusion, reduced level of consciousness, tachycardia, hypotension and/or vomiting. For similar reasons, we do not believe a videotaped session will keep the students attention as much as these live simulator sessions. The faculty member/course coordinator of Simulation Design This allows us to get in touch for more details if required. Are any further assessments or interventions required? Simulation Training Ideal for Diabetic Patients - JEMS In this case scenario, dehydration is one of the most serious immediate issues. 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. Perform urinalysis and send the urine for culture if urinary tract infection is suspected. The researchers found that long shift hours (24hrs), working overtime and marital/relationship stress were strongly correlated. Recognize the signs and symptoms of a patient presenting with diabetic ketoacidosis. Another example: At one minute into the scenario, the patient becomes unresponsive and their breathing becomes shallow. Lets discuss your options. modify the keyword list to augment your search. #geekymedics #fyp #fypviral #studytok #medicalstudentuk #medtok #studytips #studytipsforstudents #medstudentuk #premed #medschoolfinals, Cardiovascular History Tips - DON'T FORGET these 3 things . Categories: Emergency Medicine, Medical Education Keywords: diabetic ketoacidosis, simulation, expertise, emergency medicine . In the final 10 minutes, we show how the patient has a good recovery after fluid replacement. The simulation experience serves to give substance to the theoretical words and concepts that the students encountered during the PBL sessions. Make sure tore-assessthe patient after anyintervention. Makeup may be used to depict gender, hollow eyes and cheeks, produce pallor or display bruises and scars. She Died the Next Day. 2 0 obj Using the arterial line, the scenario becomes much more dynamic. MassBay EMS Program Integrates Training for Dogs, Heat Waves Are Killing More LA Homeless People. - Site 01:12 A GCS of 8 or below warrants urgent expert help from an anaesthetist. If the patient is suspected to have sufferedsignificanttraumawith potential spinal involvement, perform ajaw-thrustrather than a head-tilt chin-lift manoeuvre: 2. Clinical Simulation in Nursing, Volume 39, 2020, pp. Geeky Medics accepts no liability for loss of any kind incurred as a result of reliance upon the information provided in this video. Make sure to re-assess the patient after any intervention. 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). Hypothermia may be present if the patient has been unconscious and exposed for some time. 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. ABG, venepuncture). If the patient loses consciousness and there are no signs of life on assessment, put out a crash call and commence CPR. 5. The use of a simulated, evolving case scenario was an effective method of exposing nursing students to complex patient care. It involves working through the following steps: Each stage of the ABCDE approach involvesclinicalassessment,investigationsandinterventions. See ourCXR interpretation guidefor more details. In the meantime, you should re-assess and maintain the patients airway. 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. 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. The following scenarios are available for download and are designed to meet your multi-disciplinary nursing needs. 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. Review thepatients notes,chartsandrecent investigation results. We have 18 to 20 PBL groups for an hour each in the week after their PBL DKA session. Your message has been successfully sent to your colleague. Manikin staging can provide strong cues. The normal reference range for fasting plasma glucose is 4.0 5.8 mmol/l. Before trainees arrival into the simulation area, the simulator is already preprogrammed for DKA. An oxygen mask is also demonstrated as an alternative device, as these early trainees had mostly not yet seen any of these devices. Instructors should write a case study for the simulation before the session. Clearly communicate how often would you like the patients observations relayed to you by other staff members. Abdomen: The abdominal examination reveals diffuse mild epigastric tenderness to deep palpitation but neither rebound tenderness nor guarding (result of examination given by patient or by instructor). Facebook: http://www.facebook.com/geekymedics >> Fernandez AR, Mac Crawford J, Pennell ML, et al. 1 0 obj your express consent. As this is a PBL session, the trainees are not given any references. Outcomes Educating Nursing Students Using an Evolving, Simulated Case Margolis GS, Romer GA, Fernandez AR, et al. We combined both to indicate the continuity of the curriculum, and the building on prior knowledge. Geeky Medics accepts no liability for loss of any kind incurred as a result of reliance upon the information provided in this video. Creating a Simulation Experience to Promote Clinical Judgment 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. 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. LYqC+pJ&6X4onfBT#?=R}.p8N3+Dk,P4tIgWB}-L'=8;_G >,K#.e89XnG'B~NtR Extremities: mild cyanosis, no clubbing or edema (verbalized by instructors); pulses equal, and symmetrical (elucidated by trainees). 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 . 3. 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. Trainee will increase knowledge of professional behaviors during the simulation. *=NdL/c2XSJn8:I Jb8'.8>N*[L .hxw6afq40DX3c~>abt'Q,8y(BZu(vKBTufIR. A blood glucose level may already be available from earlier investigations (e.g. Classroom Dynamics We have been presenting Simulation Laboratory sessions to our preclinical medical students (first and second years). Stage 3: Ongoing management and monitoring of DKA 1 hour after initiation of treatment. <> endobj This guide provides an overview of the recognition and immediate management of diabetic ketoacidosis (DKA)using an ABCDE approach. Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario. - PDF Just place the BR2_KDCA file into your addons scenery folder: C:\\Program Files\\Microsoft Games\\Microsoft Flight Simulator X\\Addon Scenery\\Scenery. You can check out our guide to using SOCRATES here: https://geekymedics.com/the-socrates-acronym-in-history-taking/ Inspect for evidence of infection on the skin (e.g. Vital Signs: BP, 90/30 mm Hg (ECG shows normal sinus rhythm); central venous pressure, 0 to 2 cm H. Lungs: All lung fields are clear to auscultation without wheeze or rhonchi, and the respiratory pattern is typical of Kussmaul breathing, ie, large deep tidal volumes and increased respiratory rate. Alert a senior immediately if you have any concerns about the consciousness level of a patient. . Forty percent of respondents reported excessive daytime sleepiness. Facilitator to ask how often to measure BMs Indeed, it is the only thing that ever has.". 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. PDF Medicine Simulation Scenario Diabetic Ketoacidosis: An Emergency - Cureus 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. Diabetic Ketoacidosis (DKA) | Acute Management | ABCDE 2 The evaluation of potassium deficits is complicated by potassium exit from . Management of diabetic ketoacidosis in adults. The facilitator guides the group only when necessary. It may be necessary toexposethe patient during your assessment: remember to prioritise patient dignity and conservation of body heat. PDF Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario A traditional classroom lecture format allows for student participation but limits the instructors ability to create realistic situations. Twitter: http://www.twitter.com/geekymedics Please try again soon. 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 4 0 obj 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). 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. During an immersive simulation, its imperative the group uses critical-thinking skills and group collaboration independently. Introduceyourselfto thepatientincluding yournameandrole. 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)? }HyEf,#$/JSRU9+CF6k\'/z+i`[ 5JudK*Zly^g%[jCK)H[)Y=Qp0/r9o9HW_zF}pTzI~'|q.~:=Y T 9w! This leads to hyperglycaemia, osmotic diuresis, and dehydration. A comprehensive collection of OSCE guides to common clinical procedures, including step-by-step images of key steps, video demonstrations and PDF mark schemes. Calculate the patients current fluid balance using their fluid balance chart (e.g. Each clinical case scenario allows you to work through history taking, investigations, diagnosis and management. Clearlydocument your ABCDE assessment, including history, examination, observations, investigations, interventions, and the patients response. If the patient has clinical signs ofanaphylaxis(e.g. 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. Available from: [. An animated lecture may be described as a pseudo-simulation environment. A patient with Type I diabetes will often have symptoms related to blood sugar imbalances that appear abruptly with polydipsia, polyuria, polyphagia and rapid weight loss. - Onset 01:48 Diabetes UK with the Joint British Diabetes Societies Inpatient Care Group. 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. dq-]gX4 `L'u7myx) rpjf0z,.y`VMyx-&Ju`U0 Research Watch Box:Sleep, Fatigue & SafetyBy David Page, MS, NREMT-P As the name says, this screen is used to graph and plot any parameter. 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. Int J Evid Based Healthc. Trainee will correlate the underlying pathophysiology with symptoms and signs as exhibited by the simulation session. Trainee will recognize the need for therapy and suggest an appropriate therapy in a simulated environment. Mosby:Philadelphia. A collection of communication skills guides, for common OSCE scenarios, including history taking and information giving. The teaching of diabetic assessment and management, like many other medical emergencies, lends itself well to case-based simulation. opioids, sedatives, anxiolytics, insulin, oral hypoglycaemic medications).

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