We also show them IV bags containing saline and Ringers lactate, as well as show them IV infusion sets. Cureus 9(5): e1286. The required potassium replacement varies greatly. Research Watch Box:Sleep, Fatigue & SafetyBy David Page, MS, NREMT-P
If the patient is conscious, sit themuprightas this can also help with oxygenation. Effectiveness of simulation on health profession students knowledge, skills, confidence and satisfaction. - Site 01:12 DKA can develop within 24 hours and is potentially life threatening, requiring prompt recognition and therapeutic intervention. 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. . modify the keyword list to augment your search. Simulation provides a safe environment where learning is enhanced through the deliberate practice of skills and controlled management of a variety of clinical encounters. Therefore, the same file is also sent to the participants before the session. The learning environment should closely mimic real-world applications. Review the patientscurrent medicationsand check any regular medications areprescribed appropriately. Extremities: mild cyanosis, no clubbing or edema (verbalized by instructors); pulses equal, and symmetrical (elucidated by trainees). 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. stream
Use an effectiveSBARR handoverto communicate the key information effectively to other medical staff. 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. 4. The facilitator guides the group only when necessary. Available from: [, NICE guidelines. Adds true to life parking codes and extra parking for AI. Alert a senior immediately if you have any concerns about the consciousness level of a patient. Advance the airway until it lies within the pharynx. 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. Its best, however, to allow the student group to continue so theyre able to evaluate their decision-making processes during debriefing. *=NdL/c2XSJn8:I Jb8'.8>N*[L .hxw6afq40DX3c~>abt'Q,8y(BZu(vKBTufIR. to maintaining your privacy and will not share your personal information without
Introduceyourselfto thepatientincluding yournameandrole. 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.. Medical simulation technology is a powerful tool for training physicians but papers dealing with DKA simulators are scarce. - Exacerbating & relieving factors 05:12 Are any further assessments or interventions required? 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). 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)? 2. 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. As the name says, this screen is used to graph and plot any parameter. Just place the BR2_KDCA file into your addons scenery folder: C:\\Program Files\\Microsoft Games\\Microsoft Flight Simulator X\\Addon Scenery\\Scenery. 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. Emergency medical services workLife characteristics contribute to clinically significant excessive daytime sleepiness. A comprehensive collection of clinical examination OSCE guides that include step-by-step images of key steps, video demonstrations and PDF mark schemes. 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. Some error has occurred while processing your request. It should only be inserted in unconscious patients as it is otherwise poorly tolerated and may induce gagging and aspiration. Reduced urine output (oliguria) is typically defined as less than 0.5ml/kg/hour in an adult. Invasive monitors, including a left radial intraarterial and a right subclavian IV catheter, were placed. Prehosp Emerg Care. The instructors never expect the trainees to exhibit full understanding of pathophysiology and skills in the treatment but do give them a few important points to understand the diagnosis and initial treatment of the patients with DKA. Measure the patients capillary blood glucose and ketone levels to confirm the diagnosis and guide the management of DKA. The lecture allows for understanding of concepts prior to action, and instructor feedback is immediate. 3. 1. 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. Consider any precipitating factors for the development of DKA and involve the diabetes team in the patients care. In the meantime, you should re-assess and maintain the patients airway. You can check out our guide to using SOCRATES here: https://geekymedics.com/the-socrates-acronym-in-history-taking/ A collection of interactive medical and surgical clinical case scenarios to put your diagnostic and management skills to the test. At the end of the previous section, the trainee can make the diagnosis of DKA but has not confirmed it yet. Place one hand on the patients forehead and the other under the chin. 2011;15:108109. We do not use passive visualizing materials such as videotapes or DVD other than vital signs shown on the monitors. A chest X-ray should not delay the emergency management of DKA. Facilitator to ask how often to measure BMs Typically potassium levels should be maintained between 4.0 5.5 mmol/L and close monitoring is required. We are looking for declaration of DKA and request for pathway. Competency-based medical education has seen widespread adoption in the field along with ongoing work in the areas of . 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. Open the patients mouth to ensure there is no foreign material that may be pushed into the larynx. NPAs are typically better tolerated in patients who are partly or fully conscious compared to oropharyngeal airways. Performing an ECG should not delay the emergency management of DKA. 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. We demonstrate to the trainees the significant changes on the monitors by asking them to point out any changes on the simulator (clinical examination) and the vital signs (monitor parameters). Trainee will appropriately request assistance and use available resources. Consider active re-warming techniques in patients with severe hypothermia. Its important to train and educate students of prehospital care on key indicators of a diabetic emergency. If the patient loses consciousness and there are no signs of life on assessment, put out a crash call and commence CPR. cloudy urine may indicate urinary tract infection). 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. - Severity 05:32 - Medical Finals Question Pack: https://geekymedics.com/medical-student-finals-questions/ After initial insulin therapy has reduced plasma blood glucose levels (e.g. These are not learning objectives in this program. can be reemphasized, and the effects of fluid therapy demonstrated. Using SOCRATES in History Taking | OSCE | Communication Skills, Diabetic Ketoacidosis (DKA) | Acute Management | ABCDE. Groups of fewer than four students dont allow for optimal collaboration. Each clinical case scenario allows you to work through history taking, investigations, diagnosis and management. 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. This field is for validation purposes and should be left unchanged. %PDF-1.5
A nasopharyngeal airway is a soft plastic tube with a bevel at one end and a flange at the other. It was developed for anesthesiology resident physicians with some background knowledge and experience caring for critically ill patients. - Introduction 00:00 For similar reasons, we do not believe a videotaped session will keep the students attention as much as these live simulator sessions. 5. Target Learner Groups The simulation experience serves to give substance to the theoretical words and concepts that the students encountered during the PBL sessions. The students have acquired all the applicable theoretical knowledge of the case during the previous multiday PBL sessions. Both external and internal potassium balances are disturbed during the development and treatment of DKA. 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. Discuss the patients current clinical condition with aseniorclinicianusing anSBARR style handover. 2 0 obj
Blood sugar issues in the Type II diabetic will have a gradual onset, with diagnosis generally resulting from routine laboratory exams.(1). <>
Diabetes (type 1 and type 2) in children and young people: diagnosis and management. Standardized patient as the voice of the simulator (or the simulation operator may play this role). 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. Tilt the forehead back whilst lifting the chin forwards to extend the neck. A collection of free medical student quizzes to put your medical and surgical knowledge to the test! You may be trying to access this site from a secured browser on the server. 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. 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. ABG, venepuncture). Conclusions This technical report describes the design and implementation of a simulation scenario on DKA for emergency medicine trainees. Management of diabetic ketoacidosis in adults. Check out our other awesome clinical skills resources including: Wolters Kluwer Health
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].. JEMS. Ziv A, Wolpe PR, Small SD, et al. Trainee will get to know how professionals behave during management of a critically ill patient. Instagram: https://instagram.com/geekymedics 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. They should introduce the student group to the environment, assign roles for each learner and guide the decision-making process. Scenarios. - 2500+ OSCE Flashcards: https://geekymedics.com/osce-flashcards/ PA EMT Said COVID Patient Didnt Need to Go to the Hospital. 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. 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. To read Pages full Research Review column, visit www.jems.com/patient-care. Marx JA, Hockberger RS, Walls RM. 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 had developed nausea, extreme fatigue, mild disorientation, and blurred vision toward the end of the soccer match. 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 LYqC+pJ&6X4onfBT#?=R}.p8N3+Dk,P4tIgWB}-L'=8;_G >,K#.e89XnG'B~NtR Case-based education adds a real-world aspect to the learning environment. We do point out the blood pressure (BP) cuff, but these medical students in their first year do not really need to know how the BP values are generated, they need to understand the origin and therapy for the low blood pressure. We then start the DKA state. See Appendix D, Supplemental Digital Content 4, https://links.lww.com/SIH/A4. Highlight selected keywords in the article text. One of the key differences with the immersive simulation is that the instructor is absent from the simulation environment. Refer to your local guidelines for further details. See ourfluid prescribing guidefor more details onresuscitation fluids. 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. dq-]gX4
`L'u7myx) rpjf0z,.y`VMyx-&Ju`U0 Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. 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 . doi: 10.7759/cureus.1286. 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. DOWNLOAD Diabetic Ketoacidosis By the end of this scenario, the learner will be able to: 1. Weight, Height: Not given, normal appearing (as per simulator) but has lost 20 lbs recently. 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 Given 6 to 8 back-to-back sessions, it is critical that every session starts and ends on time! 3. The debriefing environment should be removed from the location where the simulation took place. reduced air entry, coarse crackles) to screen for evidence of pneumonia. Anesthetic Management Using the Oxygen Reserve Index for Tracheal Resection and Tracheal End-to-E A Scoping Review of the Impact of COVID-19 on Kidney Transplant Patients in the United States, Alabama College of Osteopathic Medicine Research, Baylor Scott & White Medical Center Department of Neurosurgery, California Institute of Behavioral Neurosciences & Psychology, Contemporary Reviews in Neurology and Neurosurgery, DMIMS School of Epidemiology and Public Health, Simulation, Biodesign, & Innovation In Medical Education, The Florida Medical Student Research Publications, University of Florida-Jacksonville Neurosurgery, VCOM Clinical, Biomedical, and Educational Research, American Red Cross Scientific Advisory Council, Canadian Association of Radiation Oncology, International Liaison Committee on Resuscitation, International Pediatric Simulation Society, Medical Society of Delaware Academic Channel, Society for Healthcare & Research Development, Surgically Targeted Radiation Therapy for Brain Tumors: Clinical Case Review, Clinical and Economic Benefits of Autologous Epidermal Grafting, Defining Health in the Era of Value-Based Care, Optimization Strategies for Organ Donation and Utilization, MR-Guided Radiation Therapy: Clinical Applications & Experiences, Multiple Brain Metastases: Exceptional Outcomes from Stereotactic Radiosurgery, Proton Therapy: Advanced Applications for the Most Challenging Cases, Radiation Therapy as a Modality to Create Abscopal Effects: Current and Future Practices, Clinical Applications and Benefits Using Closed-Incision Negative Pressure Therapy for Incision and Surrounding Soft Tissue Management, Negative Pressure Wound Therapy with Instillation, NPWT with Instillation and Dwell: Clinical Results in Cleansing and Removal of Infectious Material with Novel Dressings. Initially, we required the students to write down the vital signs. 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. We try to provide sufficient realism.. Should any changes be made to the current management of their underlying condition(s)? In keeping with the case study, as a treatment marker is reached, the instructor should place emphasis on physiological, pharmacological, environmental and psychosocial issues. SimMan Nursing Scenarios Software. Does the patient need reviewing by a specialist? 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. A fixed-rate intravenous insulin infusion should be commenced initially to suppress ketogenesis, reduce blood glucose levels and address electrolyte disturbances. The students mentioned that they did not obtain the maximum value from the simulation session under these circumstances. Use washable, non-toxic paints to imitate various body emissions. 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. You may be asked to review a patient with DKA due to confusion, reduced level of consciousness, tachycardia, hypotension and/or vomiting. We do have a wig that we place on the patient, but we do not try for full realism. For instance, if we mimicked the noise and traffic of a real emergency department, this would constitute excessive realism, and become a distraction to beginner medical students.
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