dka simulation scenario dka simulation scenario

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. 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). 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. 2008;6:278302. 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 student group should be encouraged to collaborate on management options and to perform skills. It was developed for anesthesiology resident physicians with some background knowledge and experience caring for critically ill patients. We used the Medical Education Technologies Inc. (METI) Human Patient Stimulator (HPS, METI Sarasoto, Fl). 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. 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. After the first voluntary session in 2006, feedback from the medical students indicated that they would like to receive this handout. We guide the group to suggest fluid. The files are given in full in the web supplement (Appendix B, Supplemental Digital Content 2, https://links.lww.com/SIH/A2). Finally, we summarize the course and give them time for questions. Each performance measure is separated into cognitive, behavioral or technical categories. 3. There are several causes of DKA, which we remember by the "five I's". During the debriefing process that follows the simulation, well-balanced performance measures will guide feedback toward accomplished tasks and may illustrate existing decision-making, behavioral or technical skill deficits. 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. Initially, we required the students to write down the vital signs. Margolis GS, Romer GA, Fernandez AR, et al. vD0 x@FFJ{m[ 3//Oh|JR7! This allows us to get in touch for more details if required. We are adding to their theoretical knowledge by introducing them to physical objects, dynamic moving vital sign signals, and a moving, breathing simulated patient to make the case come alive. If the patientloses consciousnessand there areno signs of lifeon assessment, put out acrash callandcommence CPR. DY{Qb"(EgN$QI*%XN1F""0a5 Revisit history taking to explore relevant medical history and identify any precipitating factors for DKA. 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. Catheterisethe patient to closelymonitor urine outputto guide fluid resuscitation and need for escalation. Simulation in Healthcare4(4):232-236, Winter 2009. Please try again soon. Several environments may be suitable for your classroom. Calculate the patients current fluid balance using their fluid balance chart (e.g. Weight, Height: Not given, normal appearing (as per simulator) but has lost 20 lbs recently. 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. Trigger 4, Pathway 1l of saline required over 1hour and insulin infusion need prescribing and making up in 50ml syringe. Rosens Emergency Medicine: Concepts and Clinical Practice. Using the arterial line, the scenario becomes much more dynamic. We have 18 to 20 PBL groups for an hour each in the week after their PBL DKA session. Using SOCRATES in History Taking | OSCE | Communication Skills, Diabetic Ketoacidosis (DKA) | Acute Management | ABCDE. Invasive monitors, including a left radial intraarterial and a right subclavian IV catheter, were placed. In the meantime, you can perform some basic airway manoeuvres to help maintain the airway whilst awaiting senior input. can be reemphasized, and the effects of fluid therapy demonstrated. Make sure to re-assess the patient after any intervention. The validity of the HFS-DKA scenario was verified by a certified diabetes nurse educator, a registered nurse, and a clinical nurse educator. Instead, instructors should combine case- and simulation-based techniques when teaching diabetic assessment. 2. - 700+ OSCE Stations: https://geekymedics.com/osce-stations/ 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. Both external and internal potassium balances are disturbed during the development and treatment of DKA. - Introduction 00:00 This field is for validation purposes and should be left unchanged. TheABCDEapproach can be used to perform a systematic assessment of a critically unwell patient. <> 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. "Never doubt that a small group of thoughtful, committed citizens can change the world. - Geeky Medics OSCE App: https://geekymedics.com/geeky-medics-app/ In an animated lecture, its important that the student group have an instructor so they can ask direct questions. Open the patients mouth to ensure there is no foreign material that may be pushed into the larynx. 1. The relationship between sleep, fatigue and patient and provider safety. If you have any scenarios you would be willing to share with the simulation community, please forward them to me. 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. 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. 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. Performing an ECG should not delay the emergency management of DKA. MassBay EMS Program Integrates Training for Dogs, Heat Waves Are Killing More LA Homeless People. Review the patientsoxygen saturation(SpO2): Auscultate the chest to screen for evidence of respiratory pathology (e.g. Does the patient need reviewing by a specialist? The reason for inserting the airway upside down initially is to reduce the risk of pushing the tongue backwards and worsening airway obstruction. The following scenarios are available for download and are designed to meet your multi-disciplinary nursing needs. - Medical Finals Question Pack: https://geekymedics.com/medical-student-finals-questions/ Prehosp Emerg Care. Trainee will increase knowledge of professional behaviors during the simulation. 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. JEMS. She was taken to the Emergency Department from her soccer game because she complained of nausea, extreme fatigue, mild disorientation, and blurred vision toward the end of the soccer match. One of the key differences with the immersive simulation is that the instructor is absent from the simulation environment. Immersive Simulations YouTube Video VVVram5yRUhROGJRUW1sZk5kQVFDXzV3LjMxakdNallNcng0, YouTube Video VVVram5yRUhROGJRUW1sZk5kQVFDXzV3LkJPVjVZMzBKczY4, YouTube Video VVVram5yRUhROGJRUW1sZk5kQVFDXzV3LkxEM2VkQzB2NTBr, Start typing to see results or hit ESC to close, Deep Vein Thrombosis (DVT) Examination OSCE Guide, Pre-hospital Advanced Life Support (ALS) OSCE Guide, Adult Choking (Basic Life Support) OSCE Guide, Paediatric Intravenous Cannulation OSCE Guide, Intrauterine System (Mirena) Counselling OSCE guide, Geeky Medics OSCE Book | Clinical Examination, Paediatric Gastro-oesophageal Reflux Disease, A Career as a GP with Special Interest with Dr Fiona Mosgrove, Absolute insulin deficiency (e.g. Debriefing The simulation session is also hosted as an interactive 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. Trainee will get to know how professionals behave during management of a critically ill patient. Search for Similar Articles Please try after some time. If the patient has clinical signs ofanaphylaxis(e.g. diagnosis of DKA Trigger 3, ABG show acidosis and high BM and normal potassium. The choice of fluid type, rate of administration and volume should be tailored to the individual patient based upon their vital signs and electrolytes. Keywords: diabetic ketoacidosis, simulation, expertise, emergency medicine Introduction Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes mellitus, most . endobj The instructor should have visual access via one-way windows or cameras. In the meantime, you should re-assess and maintain the patients airway. See our blood glucose measurement guide for more details. Schneider Sarver PA, Senczakowicz EA, Slovensky BM. 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. Hypothermia may be present if the patient has been unconscious and exposed for some time. For more information, please refer to our Privacy Policy. and Development of simulation scenarios for an adolescent patient with diabetic ketoacidosis. A collection of interactive medical and surgical clinical case scenarios to put your diagnostic and management skills to the test. GRAPH. 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. If the patient is confused you might be able to get a collateral history from staff or family members as appropriate. #geekymedics #fyp #fypviral #studytok #medicalstudentuk #medtok #studytips #studytipsforstudents #medstudentuk #premed #medschoolfinals, Cardiovascular History Tips - DON'T FORGET these 3 things . We also show them IV bags containing saline and Ringers lactate, as well as show them IV infusion sets. The students are in their first year. DO NOT perform any examination or procedure on patients based purely on the content of these videos. Subscribe to our newsletter to be the first to know about our latest content: https://geekymedics.com/newsletter/ The normal reference range for fasting plasma glucose is 4.0 5.8 mmol/l. Manikin staging can provide strong cues. Physician working in the emergency department. Published August 2015. The students are in their first year. The student group is given a short introduction into a closed simulation environment. - Radiation 02:45 Trainee will improve their understanding of clinical practice through reflective assessment of actual cases during the prior PBL sessions. Facilitator to ask how often to measure BMs Works with Traffic 2005, but . Diabetic ketoacidosis (DKA) is a common, potentially lethal disease. - Site 01:12 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. You may be trying to access this site from a secured browser on the server. Groups of fewer than four students dont allow for optimal collaboration. His Wife Gave Him CPR. 2017 May 29;9(5):e1286. 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. In keeping with the case study, as a treatment marker is reached, the instructor should place emphasis on physiological, pharmacological, environmental and psychosocial issues. Stage 2: Emergency management of DKA and consideration of abnormal CTG. Simulation Scenario for Anesthesia Providers Clark Obr, MD*, Anthony Mueller, MD . Geeky Medics accepts no liability for loss of any kind incurred as a result of reliance upon the information provided in this video. cellulitis). If the patient isunconsciousorunresponsive, start thebasic life support(BLS)algorithmas per resuscitation guidelines. This is particularly important for core . An oxygen mask is also demonstrated as an alternative device, as these early trainees had mostly not yet seen any of these devices. If the patient is suspected to have sufferedsignificanttraumawith potential spinal involvement, perform ajaw-thrustrather than a head-tilt chin-lift manoeuvre: 2. The simulation experience serves to give substance to the theoretical words and concepts that the students encountered during the PBL sessions. DOWNLOAD Diabetic Ketoacidosis By the end of this scenario, the learner will be able to: 1. See ourdocumentation guidesfor more details. Example: If the provider immediately evaluates blood glucose, then the reading will display 45 mg/dL. A well-staged environment allows for greater student buy-in. 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. In the context of DKA, a patients consciousness level may be reduced. Many of the preclinical students have never seen a real life clinical monitor or even an intravenous (IV) setup. Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. Regardless of the underlying cause of airway obstruction, seekimmediate expert supportfrom an anaesthetist and the emergency medical team (often referred to as the crash team). Use an effectiveSBARR handoverto communicate the key information effectively to other medical staff. J Nurs Educ. The faculty member/course coordinator of Simulation Design Join the Geeky Medics community: 1) Please read through this document as it will help you prepare for your upcoming simulation on DKA. They have had no clinical exposure or any clinical experience. However, this turned out to be too slow, took too much time, and could not continuously demonstrate the direction of changes. Surgical dressings and imitation blood can support medical history. Twitter: http://www.twitter.com/geekymedics to maintaining your privacy and will not share your personal information without Ziv A, Wolpe PR, Small SD, et al. 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. This simulation session therefore aims to make the case come alive, and show this known case in a clinical context. Refer to your local guidelines for further details. unilateral coarse crackles may be present if the patient has pneumonia which may have been the precipitant for DKA). endobj 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. A strong emphasis is placed on the focused, methodical examination of a specific medical problem and the decision-based treatment options available. Each PBL case typically goes over 23 days, affording the students periods to find information for the case. After entering the environment, the student doesnt have the option of leaving the simulation until the learning objectives and performance measures are achieved. Measure the patients capillary blood glucose and ketone levels to confirm the diagnosis and guide the management of DKA. General: Moaning, asking what has happening to her. tall tented T waves in hyperkalaemia). 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]). In this case scenario, dehydration is one of the most serious immediate issues. This article originally appeared in March 2011 JEMS as Diabetes Demonstration: Simulation-based learning works best., Simulation Training Ideal for Diabetic Patients, CMS Begins Reprocessing Retroactive Payments, Documents Detail EMTs Failure to Aid Tyre Nichols, New Course Lets Bystanders Be the Help Until Help Arrives, All Paramedic Recruits in New Castle County (DE) Obtain NRP Certification, International Prehospital Medicine Institute Literature Review, March 2023.