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). 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. DKA can develop within 24 hours and is potentially life threatening, requiring prompt recognition and therapeutic intervention. I assigned true to life parking codes, and added some extra parking for the superfluous US Express AI. Indeed, it is the only thing that ever has.". Well done, youve now stabilised the patient and theyre doing much better. Diabetes UK with the Joint British Diabetes Societies Inpatient Care Group. Available from: [. 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. modify the keyword list to augment your search. Cureus 9(5): e1286. The simulation session is also hosted as an interactive session. The lecture allows for understanding of concepts prior to action, and instructor feedback is immediate. If the patient has COPD and a history of CO2retention you should switch to aventuri maskas soon as possible andtitrate oxygen appropriately. If you have any scenarios you would be willing to share with the simulation community, please forward them . Chapters: 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. Privacy Policy Development of simulation scenarios for an adolescent patient with diabetic ketoacidosis. Hypothermia may be present if the patient has been unconscious and exposed for some time. This allows us to get in touch for more details if required. We used the Medical Education Technologies Inc. (METI) Human Patient Stimulator (HPS, METI Sarasoto, Fl). Nandate, Koichiro MD, PhD; Abola, Ramon MD; Murray, W Bosseau MB; Whitfield, Carol PhD; Lang, Charles PhD; Sinz, Elizabeth MD. These are not learning objectives in this program. 4. 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. A traditional classroom lecture format allows for student participation but limits the instructors ability to create realistic situations. Diabetic Ketoacidosis in the Obstetric Population: A Simulation Blood sugar issues in the Type II diabetic will have a gradual onset, with diagnosis generally resulting from routine laboratory exams.(1). Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario If the patient has clinical signs ofanaphylaxis(e.g. PA EMT Said COVID Patient Didnt Need to Go to the Hospital. Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. Terms of Use. Creating a Simulation Experience to Promote Clinical Judgment During an immersive simulation, its imperative the group uses critical-thinking skills and group collaboration independently. The consequences (low blood pressure, high heart rate, central nervous system status, etc.) Join the Geeky Medics community: DKA can develop within 24 hours and is potentially life threatening, requiring prompt recognition and therapeutic intervention. Use washable, non-toxic paints to imitate various body emissions. Adds true to life parking codes and extra parking for AI. A strong emphasis is placed on the focused, methodical examination of a specific medical problem and the decision-based treatment options available. 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. 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. Inspect the urine currently in the catheter bag and note its appearance (e.g. COVID-19 Screening in the Pediatric Emergency Department. As a next step, we will let one of the trainees talk to the patient, and prompt to ask medical questions such as previous medical issues or recent drug use for them to practice asking questions to generate a differential diagnosis (in this case, other causes for confusion). We then start the DKA state. See Appendix D, Supplemental Digital Content 4, https://links.lww.com/SIH/A4. If an obstruction is visible within the airway, use afingersweeporsuctionto remove it. cellulitis). If the patient isunconsciousorunresponsive, start thebasic life support(BLS)algorithmas per resuscitation guidelines. Are any further assessments or interventions required? 2017 May 29;9(5):e1286. MassBay EMS Program Integrates Training for Dogs, Heat Waves Are Killing More LA Homeless People. ABG, venepuncture). The Pratcice 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. Insert the airway bevel-end first, vertically along the floor of the nose with a slight twisting action. Please try after some time. Seek senior helpif the patient shows no signs of improvement or if you have any concerns. See ourdocumentation guidesfor more details. We try to provide sufficient realism.. 2. It was developed for anesthesiology resident physicians with some background knowledge and experience caring for critically ill patients. 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 . PDF Medicine Simulation Scenario Diabetic Ketoacidosis: An Emergency 4. The objective is to give as many visual and tactile cues concerning the patient condition and background as possible. Using your thumbs, slightly open the mouth by downward displacement of the chin. 2011;15:108109. Please write a single word answer in lowercase (this is an anti-spam measure). Two abstracts related to sleepiness in the EMS workforce were presented at the National Association of EMS Physicians symposium in January. Scenario in a Nutshell Diabetic ketoacidosis (DKA) in pregnancy. Despite this increased calorie intake, she noticed an unexplained 20 lbs weight loss. The scenario would include an if-then algorithm. 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. Twitter: http://www.twitter.com/geekymedics Search for Similar Articles 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. The main purpose of the simulation is to draw a line from the theoretical, boring biochemistry to the clinical manifestations. 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. If foreign material is present, attempt removal using suction. Endocrine - thesimbook.com If the patientloses consciousnessand there areno signs of lifeon assessment, put out acrash callandcommence CPR. 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 0 obj 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 - Radiation 02:45 Conclusions This technical report describes the design and implementation of a simulation scenario on DKA for emergency medicine trainees. type 1 diabetes) Complete insulin insensitivity (e.g. The students mentioned that they did not obtain the maximum value from the simulation session under these circumstances. PDF Diabetic Ketoacidosis in the Obstetric Population: A Simulation 3. - Medical Finals Question Pack: https://geekymedics.com/medical-student-finals-questions/ We also show them IV bags containing saline and Ringers lactate, as well as show them IV infusion sets. - Over 3000 Free MCQs: https://geekyquiz.com/ She had developed nausea, extreme fatigue, mild disorientation, and blurred vision toward the end of the soccer match. 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. Int J Evid Based Healthc. 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. Review thepatients notes,chartsandrecent investigation results. As with the animated lecture, the simulation is strongly dependent on a focused case study. KDCA for FSX - Fly Away Simulation - Timing 03:23 If the patient is conscious, sit themuprightas this can also help with oxygenation. Advance the airway until it lies within the pharynx. Simulation provides a safe environment where learning is enhanced through the deliberate practice of skills and controlled management of a variety of clinical encounters. In the context of DKA, a patients consciousness level may be reduced. DKA can be caused by either: Absolute insulin deficiency (e.g. Calculate the patients current fluid balance using their fluid balance chart (e.g. 1. 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. It should only be inserted in unconscious patients as it is otherwise poorly tolerated and may induce gagging and aspiration. See ourintravenous cannulation guidefor more details. From the Department of Anesthesiology, Pennsylvania State University College of Medicine, Hershey, PA. Dr. Murray is on the Speakers Bureau of METI, Sarasota, FL. Immersive Simulations A blood glucose level may already be available from earlier investigations (e.g. 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. 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. can be reemphasized, and the effects of fluid therapy demonstrated. Finally, we summarize the course and give them time for questions. 3. 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.. 1-6. An animated lecture may be described as a pseudo-simulation environment. Should any changes be made to the current management of their underlying condition(s)? PDF DKA Sim Scenario - ABCD (Diabetes Care) Ltd A GCS of 8 or below warrants urgent expert help from an anaesthetist. 2. - Examples 05:45 - 2500+ OSCE Flashcards: https://geekymedics.com/osce-flashcards/ 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. 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. 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). A comprehensive collection of OSCE guides to common clinical procedures, including step-by-step images of key steps, video demonstrations and PDF mark schemes. The 60 minutes training time consists of four 15-minute sections divided as follows. Immersive simulations are mentally exhausting because they create an intense and stressful atmosphere requiring the learner to work outside their comfort zone. Much time was wasted explaining why it did not matter. 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. In this section, we have to help the trainee to institute definitive therapy based on the underlying biochemical abnormalities. stream Depending on scenario complexity, team dynamic and treatment modalities, this simulation may take 1020 minutes. www.cdc.gov/diabetes/statistics/prev/national/. Your message has been successfully sent to your colleague. Airway adjuncts are often helpful and in some cases essential to maintain a patients airway. and This field is for validation purposes and should be left unchanged. Catheterisethe patient to closelymonitor urine outputto guide fluid resuscitation and need for escalation. Simulation Scenario for Anesthesia Providers Clark Obr, MD*, Anthony Mueller, MD . 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. We do not use passive visualizing materials such as videotapes or DVD other than vital signs shown on the monitors. This is a 25-year-old woman with a medical history of diabetes medicated with 40 units insulin per day. For example, you could develop a diabetic scenario in which the prehospital provider encounters an altered patient with incomprehensible speech. This leads to hyperglycaemia, osmotic diuresis, and dehydration. We have spent many hours debating whether the small group format was a waste of time. Using the arterial line, the scenario becomes much more dynamic. 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Child Course - Nursing EducationAuthor / Institution: Kelly McMunnclick here to download, Topic: PEA Arrest (pulseless electrical activity)Target: Internal MedicineAuthor / Institute: Jim Boseovski / Queen's Universityclick here to download, Topic: Pelvic FractureTarget: Senior Emergency Residents / Trauma TeamAuthor / Institution: Anonclick here to download, Topic: Penetrating Thoracic TraumaTarget: Senior Emergency Residents / Trauma TeamAuthor / Institution: Anonclick here to download, Topic: PneumoniaTarget: Internal MedicineAuthor / Institute: Jim Boseovski / Queen's Universityclick here to download, Topic: PneumoniaTitle: Community Acquired PneumoniaTarget: PGY1Author / Institution: Iain Arseneau, Babar Haroon / Dalhousie Universityclick here to download, Topic: Pulmonary EmbolismTarget: Internal MedicineAuthor / Institute: Jim Boseovski / Queen's Universityclick here to download, Topic: Ruptured Ectopic PregnancyTarget: Senior Emergency Residents / Trauma TeamAuthor / Institution: Anonclick here to download, Topic: SepsisTarget: PGY1Author / Institution: Allen Tran / Dalhousie Universityclick here to download, Topic: SepsisTitle: Sepsis - 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