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. - Character 02:14 The students are in their basic science course. 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). (1) According to Centers for Disease Control and Prevention (CDC), 223,619 deaths were attributed to diabetes in 2005. However, we should not spend too much time on (not become distracted with) explaining unfamiliar monitors for the present trainees, such as central venous pressure or ETCO2 concentration. A comprehensive collection of OSCE guides to common clinical procedures, including step-by-step images of key steps, video demonstrations and PDF mark schemes. Refer to your local guidelines for further details. 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]). See our blood glucose measurement guide for more details. Urinary tract infections are a common DKA precipitant. 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. endobj Trainee will appropriately request assistance and use available resources. and Search for Similar Articles - 2500+ OSCE Flashcards: https://geekymedics.com/osce-flashcards/ 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. Trainee will practice or observe good teamwork skills, both as a leader and a team player. Stage 3: Ongoing management and monitoring of DKA 1 hour after initiation of treatment. The main purpose of the simulation is to draw a line from the theoretical, boring biochemistry to the clinical manifestations. This typically involves the use of anon-rebreathe maskwith an oxygen flow rate of15L. The validity of the HFS-DKA scenario was verified by a certified diabetes nurse educator, a registered nurse, and a clinical nurse educator. To read Pages full Research Review column, visit www.jems.com/patient-care. Scenarios thesimtech Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journals Web site (www.simulationinhealthcare.com). - Onset 01:48 a simulation training session designed to acquaint emergency medicine residents with the presentation and management of diabetic ketoacidosis (DKA) through the use of simulation. 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. A strong emphasis is placed on the focused, methodical examination of a specific medical problem and the decision-based treatment options available. Calculate the patients current fluid balance using their fluid balance chart (e.g. Diabetic Ketoacidosis (DKA) Clinical Pathway Emergency Department The DKA simulation incorporates cue recognition, analysis of cues, generation of solutions, nursing interventions, and evaluation of outcomes, including effective communication and psychosocial concerns. 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. - PSA Question Pack: https://geekymedics.com/psa-question-bank/ 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. 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. Diabetes UK with the Joint British Diabetes Societies Inpatient Care Group. Schneider Sarver PA, Senczakowicz EA, Slovensky BM. Assessment & Treatment of Five Diabetic Emergencies - JEMS We believe it is important to have active, participatory learning by having conversations with the trainees in the form of questions and answers. The student group should be encouraged to collaborate on management options and to perform skills. 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. If the patient isunconsciousorunresponsive, start thebasic life support(BLS)algorithmas per resuscitation guidelines. Its important to train and educate students of prehospital care on key indicators of a diabetic emergency. Each clinical case scenario allows you to work through history taking, investigations, diagnosis and management. PDF Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario A collection of surgery revision notes covering key surgical topics. If fever is present, make sure to consider co-existing infection. Refer to your local guidelines which should provide a clear protocol for the management of DKA. Assess the patients level of consciousness using the AVPU scale: If a more detailed assessment of the patients level of consciousness is required, use the Glasgow Coma Scale (GCS). Please try after some time. 2011;15:108109. The use of a simulated, evolving case scenario was an effective method of exposing nursing students to complex patient care. We used the Medical Education Technologies Inc. (METI) Human Patient Stimulator (HPS, METI Sarasoto, Fl). stream Teaching nursing management of diabetic ketoacidosis: a description of Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario Cureus. This is a combination of the modified traditional lecture within scenario-based learning. Adds true to life parking codes and extra parking for AI. Given 6 to 8 back-to-back sessions, it is critical that every session starts and ends on time! Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. If the patient is conscious, sit themuprightas this can also help with oxygenation. Groups of fewer than four students dont allow for optimal collaboration. A chest X-ray should not delay the emergency management of DKA. Alert a senior immediately if you have any concerns about the consciousness level of a patient. A patient with Type I diabetes will often have symptoms related to blood sugar imbalances that appear abruptly with polydipsia, polyuria, polyphagia and rapid weight loss. You may search for similar articles that contain these same keywords or you may Before trainees arrival into the simulation area, the simulator is already preprogrammed for DKA. Conclusions This technical report describes the design and implementation of a simulation scenario on DKA for emergency medicine trainees. SimMan Nursing Scenarios Software - laerdal.com 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. LYqC+pJ&6X4onfBT#?=R}.p8N3+Dk,P4tIgWB}-L'=8;_G >,K#.e89XnG'B~NtR 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. areas of lipohypertrophy) if it is unclear if the patient is diabetic. During an immersive simulation, its imperative the group uses critical-thinking skills and group collaboration independently. www.cdc.gov/diabetes/statistics/prev/national/. 5. 2011;15:108109. Typically potassium levels should be maintained between 4.0 5.5 mmol/L and close monitoring is required. Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. 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). 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. The students are in their first year. 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. endobj PBL was introduced at our institution in 1995. 2. In the meantime, you should re-assess and maintain the patients airway. This allows us to get in touch for more details if required. Are any further assessments or interventions required? Prior to starting the scenario, the instructor should introduce a short summary of the case study and ask open-ended questions regarding the management direction. - Geeky Medics OSCE App: https://geekymedics.com/geeky-medics-app/ For similar reasons, we do not believe a videotaped session will keep the students attention as much as these live simulator sessions. Available from: [. 2. The simulation experience serves to give substance to the theoretical words and concepts that the students encountered during the PBL sessions. type 1 diabetes), Complete insulin insensitivity (e.g. Trainee will learn to collaborate with peers to decide on appropriate interventions, tests, and therapy. 1. 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 This video demonstrates how to use the SOCRATES acronym when taking a history of pain or other symptoms. Airway adjuncts are often helpful and in some cases essential to maintain a patients airway. Supplemental digital content is available for this article. 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). 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 . KDCA for FSX - Fly Away Simulation This is a 25-year-old woman with a medical history of diabetes medicated with 40 units insulin per day. Manikin staging can provide strong cues. 4. Therefore, the same file is also sent to the participants before the session. 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. An individual student can get an immediate answer to a question, the facilitator can see puzzled expressions on faces, and the PBL group could get answers that they could not get during their prior PBL group discussions. There are several causes of DKA, which we remember by the "five I's". Discuss the patients current clinical condition with aseniorclinicianusing anSBARR style handover. your express consent. Healthcare Students' Psychological Well-Being in a Diabetic Ketoacidosis Simulation. 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 the final 10 minutes, we show how the patient has a good recovery after fluid replacement. 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 . DOWNLOAD Diabetic Ketoacidosis By the end of this scenario, the learner will be able to: 1. Each performance measure is separated into cognitive, behavioral or technical categories. 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.. Standardized patient as the voice of the simulator (or the simulation operator may play this role). Works with Traffic 2005, but . Clearly communicate how often would you like the patients observations relayed to you by other staff members. Prehosp Emerg Care. 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. The 60 minutes training time consists of four 15-minute sections divided as follows. The use of case-based simulation, although more complicated and time consuming for the instructor, immerses the students in the subject matter. 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. His Heart Stopped On a Treadmill. 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. Simulation provides a safe environment where learning is enhanced through the deliberate practice of skills and controlled management of a variety of clinical encounters.

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