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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. KDCA for FSX - Fly Away Simulation 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. Please try after some time. If you'd like to support us and get something great in return, check out our awesome products: You don't need to tell us which article this feedback relates to, as we automatically capture that information for you. Facilitator to ask how often to measure BMs If foreign material is present, attempt removal using suction. Consider any precipitating factors for the development of DKA and involve the diabetes team in the patients care. *=NdL/c2XSJn8:I Jb8'.8>N*[L .hxw6afq40DX3c~>abt'Q,8y(BZu(vKBTufIR. We give the history of the patient to the trainees. Clearly communicate how often would you like the patients observations relayed to you by other staff members. Trainee will recognize the need for therapy and suggest an appropriate therapy in a simulated environment. Diabetic Ketoacidosis in the Obstetric Population: A Simulation The files are given in full in the web supplement (Appendix B, Supplemental Digital Content 2, https://links.lww.com/SIH/A2). Diabetic Ketoacidosis in the Obstetric Population: A Simulation Simulation provides a safe environment where learning is enhanced through the deliberate practice of skills and controlled management of a variety of clinical encounters. Ziv A, Wolpe PR, Small SD, et al. CCA 175 Real Time Exam Scenario 17 | JOIN Multiple DataFrames | Save as After initial insulin therapy has reduced plasma blood glucose levels (e.g. Hypothermia may be present if the patient has been unconscious and exposed for some time. - Associated symptoms 03:04 The main purpose of the simulation is to draw a line from the theoretical, boring biochemistry to the clinical manifestations. Circulating nurse in the emergency room (ER). In the meantime, you can perform some basic airway manoeuvres to help maintain the airway whilst awaiting senior input. Trainee will get to know how professionals behave during management of a critically ill patient. Animated lectures, however, must work within the framework of a focused case study, which requires increased preparation time. reduced air entry, coarse crackles) to screen for evidence of pneumonia. Revisit history taking to explore relevant medical history and identify any precipitating factors for DKA. Trainee will correlate the underlying pathophysiology with symptoms and signs as exhibited by the simulation session. Terms of Use. 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.. If the patient is conscious, sit themuprightas this can also help with oxygenation. LYqC+pJ&6X4onfBT#?=R}.p8N3+Dk,P4tIgWB}-L'=8;_G >,K#.e89XnG'B~NtR 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). 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. (1) The assessment of a diabetic patient is best taught as a. For diabetic assessment involving DKA, staging may include the use of a container with a small amount of acetone placed near the manikin because many students may not know what acetone smells like but will expect to smell something. JEMS. Using your thumbs, slightly open the mouth by downward displacement of the chin. Please note that by doing so you agree to be added to our monthly email newsletter distribution list. Ask for anotherclinicalmemberofstafftoassistyou if possible. They have had no clinical exposure or any clinical experience. The students have acquired all the applicable theoretical knowledge of the case during the previous multiday PBL sessions. type 1 diabetes), Complete insulin insensitivity (e.g. VbQuX#R M21 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. Makeup may be used to depict gender, hollow eyes and cheeks, produce pallor or display bruises and scars. Deteriorationshould be recognised quickly and acted upon immediately. type 1 diabetes) Complete insulin insensitivity (e.g. It involves a facilitating instructor, a small learner group and conceptual aspects of environmental and manikin staging to provide sensory cues. 4 0 obj 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. www.cdc.gov/diabetes/statistics/prev/national/. Pediatric Emergency Medicine Didactics and Simulation (PEMDAS If the patient isunconsciousorunresponsive, start thebasic life support(BLS)algorithmas per resuscitation guidelines. Initially, we used a blood pressure cuff to generate the blood pressure values. Each PBL case typically goes over 23 days, affording the students periods to find information for the case. As individuals with uncontrolled type I . Discuss the patients current clinical condition with aseniorclinicianusing anSBARR style handover. His Wife Gave Him CPR. This is particularly important for core cases and low-frequency, high-stakes procedures and encounters. Make sure thepatientsnotes,observationchartandprescriptionchartare easily accessible. Assess the patients pulse and blood pressure: Inspect the patient from the end of the bed: they may appear drowsy, confused and/or clammy/pale. A blood glucose level may already be available from earlier investigations (e.g. Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario Cureus. The use of a simulated, evolving case scenario was an effective method of exposing nursing students to complex patient care. Refer to your local guidelines which should provide a clear protocol for the management of DKA. The DKA simulation incorporates cue recognition, analysis of cues, generation of solutions, nursing interventions, and evaluation of outcomes, including effective communication and psychosocial concerns. See ourfluid prescribing guidefor more details onresuscitation fluids. 3. 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. In an animated lecture, its important that the student group have an instructor so they can ask direct questions. DKA can develop within 24 hours and is potentially life threatening, requiring prompt recognition and therapeutic intervention. Refer to your local guidelines for further details. <>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 595.32 841.92] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> Mosby:Philadelphia. 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. The learning environment should closely mimic real-world applications. Two abstracts related to sleepiness in the EMS workforce were presented at the National Association of EMS Physicians symposium in January. a simulation training session designed to acquaint emergency medicine residents with the presentation and management of diabetic ketoacidosis (DKA) through the use of simulation. 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]). Schneider Sarver PA, Senczakowicz EA, Slovensky BM. vD0 x@FFJ{m[ 3//Oh|JR7! doi: 10.7759/cureus.1286. PDF Medicine Simulation Scenario Diabetic Ketoacidosis: An Emergency Respiratory Failure in the Course of Treatment of Diabetic Ketoacidosis 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. tall tented T waves in hyperkalaemia). DY{Qb"(EgN$QI*%XN1F""0a5 - 150+ PDF OSCE Checklists: https://geekymedics.com/pdf-osce-checklists/ 34 - Diabetic Ketoacidosis in Pregnancy | Obgyn Key Several environments may be suitable for your classroom. 1-6. We ask the trainee why the blood pressure is so low or heart rate is so high, and how we should treat it. Re-assessthe patient using theABCDE approachto identify any changes in their clinical condition and assess the effectiveness of your previous interventions. - Severity 05:32 PDF Medicine Simulation Scenario Diabetic Ketoacidosis: An Emergency - Cureus The students mentioned that they did not obtain the maximum value from the simulation session under these circumstances. . The trainees have had background knowledge of biochemistry because they had completed the PBL case. Inspect theairwayfor obviousobstruction. Wolters Kluwer Health SimMan Nursing Scenarios Software. Well done, youve now stabilised the patient and theyre doing much better. 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. Competency-based medical education has seen widespread adoption in the field along with ongoing work in the areas of . Many of the preclinical students have never seen a real life clinical monitor or even an intravenous (IV) setup. Weight, Height: Not given, normal appearing (as per simulator) but has lost 20 lbs recently. Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare, Get new journal Tables of Contents sent right to your email inbox, SIH_13_4_2018_08_03_KOBAYASHI_17-00153_SDC5.tif; [Other] (3.04 MB), SIH_4_4_2009_10_29_NANDATE_200199_SDC2.doc; [Word] (68 KB), SIH_4_4_2009_10_29_NANDATE_200199_SDC3.doc; [Word] (29 KB), SIH_4_4_2009_10_29_NANDATE_200199_SDC4.doc; [Word] (40 KB), Simulation of Diabetic Ketoacidosis for Cellular and Molecular Basics of Medical Practice, Articles in PubMed by Koichiro Nandate, MD, PhD, Articles in Google Scholar by Koichiro Nandate, MD, PhD, Other articles in this journal by Koichiro Nandate, MD, PhD, Privacy Policy (Updated December 15, 2022). If the patient has clinical signs ofanaphylaxis(e.g. This typically involves the use of anon-rebreathe maskwith an oxygen flow rate of15L. 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 Calculate the patients current fluid balance using their fluid balance chart (e.g. It involves working through the following steps: Each stage of the ABCDE approach involvesclinicalassessment,investigationsandinterventions. Extremities: mild cyanosis, no clubbing or edema (verbalized by instructors); pulses equal, and symmetrical (elucidated by trainees). 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. 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. Check out our other awesome clinical skills resources including: A number of key modifiers are described that allow for the adjustment of case . We are looking for declaration of DKA and request for pathway. Make sure tore-assessthe patient after anyintervention. If any obstruction is encountered, remove the tube and try the left nostril. Simulation Scenario. In the meantime, you should re-assess and maintain the patients airway. - 2500+ OSCE Flashcards: https://geekymedics.com/osce-flashcards/ Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario An events progression section should include patient status changes, as well as a time/treatment continuum that incorporates if-then event progressions. Introduceyourselfto whoever has requested a review of the patient andlistencarefullyto their handover. We have spent many hours debating whether the small group format was a waste of time. 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. 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 . Before trainees arrival into the simulation area, the simulator is already preprogrammed for DKA. The students worked on the underlying physiology during a week long PBL session and are therefore familiar with the theoretical aspects of DKA. It may be necessary toexposethe patient during your assessment: remember to prioritise patient dignity and conservation of body heat. 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. In this case scenario, dehydration is one of the most serious immediate issues. An hour was . A comprehensive collection of OSCE guides to common clinical procedures, including step-by-step images of key steps, video demonstrations and PDF mark schemes. There are just a few more things to do. Works with Traffic 2005, but . Your message has been successfully sent to your colleague. may email you for journal alerts and information, but is committed Despite this increased calorie intake, she noticed an unexplained 20 lbs weight loss. DO NOT perform any examination or procedure on patients based purely on the content of these videos. Similar to a ward round, where the instructor would say: Come and listen to this patient with an aortic stenosis. Simulation student Scenario- DKA-Peds.docx - DIABETIC Trainee will recognize and interpret the clinical signs and symptoms and the typical history of a patient with DKA, as well as understand the major causative factors of DKA. 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. Place one hand on the patients forehead and the other under the chin. PBL was introduced at our institution in 1995. Open the patients airwayusing ahead-tiltchin-lift manoeuvre: 1. 2. 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. 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. endobj 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. Instagram: https://instagram.com/geekymedics This video demonstrates how to use the SOCRATES acronym when taking a history of pain or other symptoms. Prehosp Emerg Care. 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. 1 0 obj Review thepatients notes,chartsandrecent investigation results. 2. Medical Simulation Scenarios are text documents outlining the various details of a simulation - everything from patient simulator settings to debriefing notes.Below is a collection of donated scenarios for you to use or modify. 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)? 2009;13:505511. SimMan Nursing Scenarios Software - laerdal.com Section snippets . See ourhistory taking guidesfor more details. For similar reasons, we do not believe a videotaped session will keep the students attention as much as these live simulator sessions. This guide provides an overview of the recognition and immediate management of diabetic ketoacidosis (DKA)using an ABCDE approach. The reason for inserting the airway upside down initially is to reduce the risk of pushing the tongue backwards and worsening airway obstruction. The instructor can also gauge the direction the debriefing session should follow or be alerted to possible problems or conflicts in treatment opinions. 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. 1) Please read through this document as it will help you prepare for your upcoming simulation on DKA. Highlight selected keywords in the article text. Cureus is on a mission to change the long-standing paradigm of medical publishing, where submitting research can be costly, complex and time-consuming. 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. 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 . To read Pages full Research Review column, visit www.jems.com/patient-care. As this is an interactive discussion session, any needed debriefing and/or explanation is given during the sessions. Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. Some error has occurred while processing your request. Twitter: http://www.twitter.com/geekymedics Its best, however, to allow the student group to continue so theyre able to evaluate their decision-making processes during debriefing. Inspect for evidence of self-injection sites (e.g. Medical Simulation Scenarios are text documents outlining the various details of a simulation - everything from patient simulator settings to debriefing notes. A comprehensive collection of medical revision notes that cover a broad range of clinical topics. 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). Open the patients mouth to ensure there is no foreign material that may be pushed into the larynx. Published August 2015. Emergency medical services workLife characteristics contribute to clinically significant excessive daytime sleepiness. (1) According to Centers for Disease Control and Prevention (CDC), 223,619 deaths were attributed to diabetes in 2005. 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. Research Watch Box:Sleep, Fatigue & SafetyBy David Page, MS, NREMT-P The objective is to give as many visual and tactile cues concerning the patient condition and background as possible. Interactive lecture/discussion with use of monitors that show the vital signs of the simulated patient on manikin. PDF Diabetic Ketoacidosis in the Obstetric Population: A Simulation >> Fernandez AR, Mac Crawford J, Pennell ML, et al. This simulation session therefore aims to make the case come alive, and show this known case in a clinical context. Does the patient need a referral toHDU/ICU? However, this turned out to be too slow, took too much time, and could not continuously demonstrate the direction of changes. We also show them IV bags containing saline and Ringers lactate, as well as show them IV infusion sets. A GCS of 8 or below warrants urgent expert help from an anaesthetist. Heart: S1 and S2 within normal limits; no S3/S4 or murmurs, normal rate and rhythm. can be reemphasized, and the effects of fluid therapy demonstrated. 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. Virtual patient simulation (VPS) is an interactive computer simulation that recreates real-world scenarios with the objectives of training, education, and assessment for health care providers [].Virtual simulation has been used extensively to adapt nursing education to the COVID-19 pandemic context [], such as social distancing and/or confinement. COVID-19 Screening in the Pediatric Emergency Department. In this manner, the students have to apply their knowledge at the appropriate points during the progression of the scenario. - Examples 05:45 Geeky Medics accepts no liability for loss of any kind incurred as a result of reliance upon the information provided in this video. Example: If the provider immediately evaluates blood glucose, then the reading will display 45 mg/dL. Recognize the signs and symptoms of a patient presenting with diabetic ketoacidosis. The students are in their basic science course. Trainee will increase knowledge of professional behaviors during the simulation. areas of lipohypertrophy) if it is unclear if the patient is diabetic. 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). 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. The instructor should have visual access via one-way windows or cameras. Observe and discuss the effects of therapy in a mathematically modeled physiological simulator. When erroneous treatment is delivered, the instructor can end the simulation. Lets discuss your options. MassBay EMS Program Integrates Training for Dogs, Heat Waves Are Killing More LA Homeless People. Acad Med. The instructors role is to facilitate active learning through a combination of learning styles. Capillary refill timemay be prolonged if the patient is hypovolaemic. If the patientloses consciousnessand there areno signs of lifeon assessment, put out acrash callandcommence CPR. Target Learner Groups Scenarios thesimtech