% Below is a collection of donated scenarios for you to use or modify. 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. cellulitis). Use washable, non-toxic paints to imitate various body emissions. Strategies of high-performing paramedic educational programs. The students are in their first year. We now provide the students with handouts of the data to save time and provide consistency. insulin-dependent type 2 diabetes), Altered consciousness (e.g. The instructors have to appreciate that the trainees participating in this simulation have not seen a diabetic patient in either a ward or ER, but that they have knowledge of the underlying physiology. The instructors role is to facilitate active learning through a combination of learning styles. "Never doubt that a small group of thoughtful, committed citizens can change the world. Therefore, the same file is also sent to the participants before the session. In this case scenario, dehydration is one of the most serious immediate issues. Geeky Medics accepts no liability for loss of any kind incurred as a result of reliance upon the information provided in this video. Insert at least onewide-bore intravenous cannula(14G or 16G) and take blood tests as discussed below. She began experiencing progressively worsening thirst, increased appetite, and excessively increased urination. Insert the oropharyngeal airway in the upside-down position until you reach the junction of the hard and soft palate, at which point you should rotate it 180. 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. If the patient has COPD and a history of CO2retention you should switch to aventuri maskas soon as possible andtitrate oxygen appropriately. During an immersive simulation, its imperative the group uses critical-thinking skills and group collaboration independently. 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. Lets discuss your options. 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. Diabetic ketoacidosis; Simulation training; Medical students. Over the years, some groups happened to have the simulation session before the completion of the theoretical PBL session. 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. 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). TikTok: https://www.tiktok.com/@geekymedics It may be necessary toexposethe patient during your assessment: remember to prioritise patient dignity and conservation of body heat. 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. Please write a single word answer in lowercase (this is an anti-spam measure). You may search for similar articles that contain these same keywords or you may Circulating nurse in the emergency room (ER). Physician working in the emergency department. Acad Med. Simulation provides a safe environment where learning is enhanced through the deliberate practice of skills and controlled management of a variety of clinical encounters. Open the patients airwayusing ahead-tiltchin-lift manoeuvre: 1. The normal reference range for fasting plasma glucose is 4.0 5.8 mmol/l. If the patientloses consciousnessand there areno signs of lifeon assessment, put out acrash callandcommence CPR. Using the arterial line, the scenario becomes much more dynamic. endobj A nasopharyngeal airway is a soft plastic tube with a bevel at one end and a flange at the other. 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. 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. After initial insulin therapy has reduced plasma blood glucose levels (e.g. Similar to a ward round, where the instructor would say: Come and listen to this patient with an aortic stenosis. A collection of anatomy notes covering the key anatomy concepts that medical students need to learn. Place one hand on the patients forehead and the other under the chin. Immersive simulations are mentally exhausting because they create an intense and stressful atmosphere requiring the learner to work outside their comfort zone. Interactive lecture/discussion with use of monitors that show the vital signs of the simulated patient on manikin. If fever is present, make sure to consider co-existing infection. In this section, we have to help the trainee to institute definitive therapy based on the underlying biochemical abnormalities. As this is an interactive discussion session, any needed debriefing and/or explanation is given during the sessions. If the patient is confused you might be able to get a collateral history from staff or family members as appropriate. Target Learner Groups Alert a senior immediately if you have any concerns about the consciousness level of a patient. The researchers found that long shift hours (24hrs), working overtime and marital/relationship stress were strongly correlated. Note that if-thens must also include negative patient outcomes for when the provider doesnt take appropriate action. A collection of data interpretation guides to help you learn how to interpret various laboratory and radiology investigations. It was COVID-19 Screening in the Pediatric Emergency Department. Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario - Examples 05:45 Questionswhich may need to be considered include: The next team of doctors on shift should bemade awareof any patient in their department who hasrecently deteriorated. The Theory Review the patientscurrent medicationsand check any regular medications areprescribed appropriately. 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. Centers for Disease Control and Prevention. doi: 10.7759/cureus.1286. 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 See Table 4 for a suggested standardized script. It was developed for anesthesiology resident physicians with some background knowledge and experience caring for critically ill patients. The objective is to give as many visual and tactile cues concerning the patient condition and background as possible. Measure the patients capillary blood glucose and ketone levels to confirm the diagnosis and guide the management of DKA. Prehosp Emerg Care. This leads to hyperglycaemia, osmotic diuresis, and dehydration. The Simulation Laboratory session follows after a completed PBL session, and is aimed at making the case come alive, while providing a clinical perspective to preclinical students. 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)? Emergency medical services workLife characteristics contribute to clinically significant excessive daytime sleepiness. reduced air entry, coarse crackles) to screen for evidence of pneumonia. However, this leads to confusion. 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. DKA can be caused by either: Absolute insulin deficiency (e.g. Simulation Scenario for Anesthesia Providers Clark Obr, MD*, Anthony Mueller, MD . She had developed nausea, extreme fatigue, mild disorientation, and blurred vision toward the end of the soccer match. On the basis of the feedback from the students, they indicated that they believed the small group sessions are better. Therefore, the session is divided into four sections of 15 minutes each, so that the facilitator is constantly aware of being on time (or not), even after the first 15 minutes period. Each PBL case typically goes over 23 days, affording the students periods to find information for the case. A collection of free medical student quizzes to put your medical and surgical knowledge to the test! One of the key differences with the immersive simulation is that the instructor is absent from the simulation environment. >> Patterson PD, Weaver M, Frank R, et al. Schneider Sarver PA, Senczakowicz EA, Slovensky BM. 2017 May 29;9(5):e1286. ABG, venepuncture). Laschinger S, Medves J, Pulling C, et al. Trainee will appropriately request assistance and use available resources. See our blood glucose measurement guide for more details. Scenarios. Seek senior helpif the patient shows no signs of improvement or if you have any concerns. The relationship between sleep, fatigue and patient and provider safety. Introduceyourselfto thepatientincluding yournameandrole. 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. MassBay EMS Program Integrates Training for Dogs, Heat Waves Are Killing More LA Homeless People. 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 . Clearlydocument your ABCDE assessment, including history, examination, observations, investigations, interventions, and the patients response. Airway adjuncts are often helpful and in some cases essential to maintain a patients airway. 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. Instagram: https://instagram.com/geekymedics Your message has been successfully sent to your colleague. Clinical Simulation in Nursing, Volume 39, 2020, pp. See ourdocumentation guidesfor more details. 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. 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. Use an effectiveSBARR handoverto communicate the key information effectively to other medical staff. Nandate, Koichiro MD, PhD; Abola, Ramon MD; Murray, W Bosseau MB; Whitfield, Carol PhD; Lang, Charles PhD; Sinz, Elizabeth MD. A patient presenting with altered level of consciousness and a blood sugar level below 80 mg/dL should be considered hypoglycemic, and treatment modalities should be consistent with those for a diabetic patient. 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. It should only be inserted in unconscious patients as it is otherwise poorly tolerated and may induce gagging and aspiration. 2011;15:108109. Some manikin models support a variety of human functions, such as capillary and facial cyanosis, facial sweating, foley catheter and IV placement, blood pressure generation, cardiac rhythms and abnormalities, defibrillation, cardioversion, external pacing and vital sign generation. Published August 2015. 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. Should any changes be made to the current management of their underlying condition(s)? 2008;6:278302. Data is temporarily unavailable. There are just a few more things to do. The use of a simulated, evolving case scenario was an effective method of exposing nursing students to complex patient care. (1) According to Centers for Disease Control and Prevention (CDC), 223,619 deaths were attributed to diabetes in 2005. For similar reasons, we do not believe a videotaped session will keep the students attention as much as these live simulator sessions. 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. 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. Classroom Dynamics This session provides additional clinical support material for the theoretical PBL session. This allows the learner group to make a psychological break from the patient and environment while beginning the reflection process. Animated lectures, however, must work within the framework of a focused case study, which requires increased preparation time. Trainee will be respectful to others and their views during the PBL session. Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. may email you for journal alerts and information, but is committed In the meantime, you can perform some basic airway manoeuvres to help maintain the airway whilst awaiting senior input. vD0 x@FFJ{m[ 3//Oh|JR7! Geeky Medics accepts no liability for loss of any kind incurred as a result of reliance upon the information provided in this video. Its important to train and educate students of prehospital care on key indicators of a diabetic emergency. Trainee will increase knowledge of professional behaviors during the simulation. The faculty member/course coordinator of Simulation Design . Maintain head-tilt chin-lift or jaw thrust and assess the patency of the patients airway by looking, listening and feeling for signs of breathing. Depending on scenario complexity, team dynamic and treatment modalities, this simulation may take 1020 minutes. 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. 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. Join the Geeky Medics community: 1. Int J Evid Based Healthc. 2010;49:578586. The DKA simulation incorporates cue recognition, analysis of cues, generation of solutions, nursing interventions, and evaluation of outcomes, including effective communication and psychosocial concerns. Marx JA, Hockberger RS, Walls RM. DY{Qb"(EgN$QI*%XN1F""0a5 Administer oxygen to all critically unwell patients during yourinitialassessment. We are looking for declaration of DKA and request for pathway. Are any further assessments or interventions required? 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. - Introduction 00:00 Instead, instructors should combine case- and simulation-based techniques when teaching diabetic assessment. 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. Please note that by doing so you agree to be added to our monthly email newsletter distribution list. 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. Twitter: http://www.twitter.com/geekymedics We ask the trainee why the blood pressure is so low or heart rate is so high, and how we should treat it. - Site 01:12 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. diagnosis of DKA Trigger 3, ABG show acidosis and high BM and normal potassium. Rosens Emergency Medicine: Concepts and Clinical Practice. - PSA Question Pack: https://geekymedics.com/psa-question-bank/ Subscribe to our newsletter to be the first to know about our latest content: https://geekymedics.com/newsletter/ You might also be interested in our awesome bank of 700+ OSCE Stations. We try to provide sufficient realism.. Simulation provides a safe environment where learning is enhanced through the deliberate practice of skills and controlled management of a variety of clinical encounters. - Over 3000 Free MCQs: https://geekyquiz.com/ Competency-based medical education has seen widespread adoption in the field along with ongoing work in the areas of . Inspect for evidence of infection on the skin (e.g. Using your thumbs, slightly open the mouth by downward displacement of the chin. 5. Makeup may be used to depict gender, hollow eyes and cheeks, produce pallor or display bruises and scars. Keyword Highlighting The instructor can also gauge the direction the debriefing session should follow or be alerted to possible problems or conflicts in treatment opinions. NPAs are typically better tolerated in patients who are partly or fully conscious compared to oropharyngeal airways. The student group should be encouraged to collaborate on management options and to perform skills. A well-staged environment allows for greater student buy-in. Facebook: http://www.facebook.com/geekymedics Supplemental digital content is available for this article. The students are in their first year. Diabetes UK with the Joint British Diabetes Societies Inpatient Care Group. They should be used in conjunction with the maneuvres mentioned above as the position of the head and neck need to be maintained to keep the airway aligned. Much time was wasted explaining why it did not matter. your express consent. Privacy Policy Initially, we used a blood pressure cuff to generate the blood pressure values. Observe and discuss the effects of therapy in a mathematically modeled physiological simulator. Make sure thepatientsnotes,observationchartandprescriptionchartare easily accessible. When erroneous treatment is delivered, the instructor can end the simulation. Groups of fewer than four students dont allow for optimal collaboration. 2011;15:108109. Stage 3: Ongoing management and monitoring of DKA 1 hour after initiation of treatment. To read Pages full Research Review column, visit www.jems.com/patient-care. 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). angioedema, rash) commence appropriate treatment as discussed in ouranaphylaxis guide. Its absolutely necessary to follow all immersive simulations with a positive, emotionally safe and nonjudgmental debriefing environment. Abstract Introduction: This simulation on diabetic ketoacidosis (DKA) in the obstetric population presents learners with one of the more commonly encountered etiologies of critical illness in the pregnant patient. 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). Using SOCRATES in History Taking | OSCE | Communication Skills, Diabetic Ketoacidosis (DKA) | Acute Management | ABCDE. This is particularly important for core . 1. 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 . Advance the airway until it lies within the pharynx. TheABCDEapproach can be used to perform a systematic assessment of a critically unwell patient. Consider active re-warming techniques in patients with severe hypothermia. Please try again soon. This typically involves the use of anon-rebreathe maskwith an oxygen flow rate of15L. She Died the Next Day. You may be trying to access this site from a secured browser on the server. Blood sugar issues in the Type II diabetic will have a gradual onset, with diagnosis generally resulting from routine laboratory exams.(1). Debriefing www.cdc.gov/diabetes/statistics/prev/national/. 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). - Timing 03:23 DO NOT perform any examination or procedure on patients based purely on the content of these videos. The choice of fluid type, rate of administration and volume should be tailored to the individual patient based upon their vital signs and electrolytes. 1 0 obj After entering the environment, the student doesnt have the option of leaving the simulation until the learning objectives and performance measures are achieved.
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