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. Trainee will be respectful to others and their views during the PBL session. 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. A collection of communication skills guides, for common OSCE scenarios, including history taking and information giving. The scenario would include an if-then algorithm. - 700+ OSCE Stations: https://geekymedics.com/osce-stations/ Pediatric Emergency Medicine Didactics and Simulation (PEMDAS 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. This typically involves the use of anon-rebreathe maskwith an oxygen flow rate of15L. 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. 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 ABG, venepuncture). Example: If the provider immediately evaluates blood glucose, then the reading will display 45 mg/dL. Deteriorationshould be recognised quickly and acted upon immediately. Kymera Systems Inc | SCADA Online Demo Ignition Diabetes (type 1 and type 2) in children and young people: diagnosis and management. DKA can be caused by either: Absolute insulin deficiency (e.g. Instagram: https://instagram.com/geekymedics Each clinical case scenario allows you to work through history taking, investigations, diagnosis and management. You can check out our guide to using SOCRATES here: https://geekymedics.com/the-socrates-acronym-in-history-taking/ The patient synopsis should include such standard aspects as age, sex, ethnicity, medical history, medications and allergies. 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). The Pratcice Rosens Emergency Medicine: Concepts and Clinical Practice. Are any further assessments or interventions required? 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). 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. 2009;13:505511. 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). 2 0 obj % A fixed-rate intravenous insulin infusion should be commenced initially to suppress ketogenesis, reduce blood glucose levels and address electrolyte disturbances. Physician working in the 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. to maintaining your privacy and will not share your personal information without Trainee will appropriately request assistance and use available resources. Chapters: It should only be inserted in unconscious patients as it is otherwise poorly tolerated and may induce gagging and aspiration. Classroom Dynamics We have 18 to 20 PBL groups for an hour each in the week after their PBL DKA session. This may produce better retention of the subject matter and help students adapt to emergency scenes before going into the field. 34 - Diabetic Ketoacidosis in Pregnancy | Obgyn Key She does not take this regularly. 1) Please read through this document as it will help you prepare for your upcoming simulation on DKA. The students are in their basic science course. - Site 01:12 The simulation session is also hosted as an interactive session. Margolis GS, Romer GA, Fernandez AR, et al. 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. Makeup may be used to depict gender, hollow eyes and cheeks, produce pallor or display bruises and scars. Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. If the patient isunconsciousorunresponsive, start thebasic life support(BLS)algorithmas per resuscitation guidelines. As the name says, this screen is used to graph and plot any parameter. The Theory Tilt the forehead back whilst lifting the chin forwards to extend the neck. PDF Medicine Simulation Scenario Diabetic Ketoacidosis: An Emergency - Cureus With your index and other fingers placed behind the angle of the mandible, apply steady upwards and forward pressure to lift the mandible. Prehosp Emerg Care. The objective is to give as many visual and tactile cues concerning the patient condition and background as possible. GRAPH. She tends to drink sugar containing fluids (soda) when she is thirsty, and she eats fast foods (cream-filled muffins) when she is hungry. Discuss the patients current clinical condition with aseniorclinicianusing anSBARR style handover. 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. 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 Recognize the signs and symptoms of a patient presenting with diabetic ketoacidosis. Schneider Sarver PA, Senczakowicz EA, Slovensky BM. *=NdL/c2XSJn8:I Jb8'.8>N*[L .hxw6afq40DX3c~>abt'Q,8y(BZu(vKBTufIR. Extremities: mild cyanosis, no clubbing or edema (verbalized by instructors); pulses equal, and symmetrical (elucidated by trainees). A list of the requirements (monitors, props, and others) is given in Tables 2 and 3, as well as in the web supplement (Appendix C, Supplemental Digital Content 3, https://links.lww.com/SIH/A3). Prehosp Emerg Care. Antibiotics should be prescribed in keeping with local guidelines. Available from: [. A collection of data interpretation guides to help you learn how to interpret various laboratory and radiology investigations. The use of case-based simulation, although more complicated and time consuming for the instructor, immerses the students in the subject matter. Geeky Medics accepts no liability for loss of any kind incurred as a result of reliance upon the information provided in this video. 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. Well done, youve now stabilised the patient and theyre doing much better. We believe it is important to have active, participatory learning by having conversations with the trainees in the form of questions and answers. KDCA for FSX - Fly Away Simulation %PDF-1.5 - Exacerbating & relieving factors 05:12 The students worked on the underlying physiology during a week long PBL session and are therefore familiar with the theoretical aspects of DKA. 3. Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. 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. - Over 3000 Free MCQs: https://geekyquiz.com/ Clearlydocument your ABCDE assessment, including history, examination, observations, investigations, interventions, and the patients response. His Heart Stopped On a Treadmill. In the context of DKA, a patients consciousness level may be reduced. Keyword Highlighting The simulation experience serves to give substance to the theoretical words and concepts that the students encountered during the PBL sessions. Each performance measure is separated into cognitive, behavioral or technical categories. 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. The instructor should have visual access via one-way windows or cameras. Conclusions This technical report describes the design and implementation of a simulation scenario on DKA for emergency medicine trainees. The faculty member/course coordinator of Simulation Design This is particularly important for core . Instead, instructors should combine case- and simulation-based techniques when teaching diabetic assessment. Nandate, Koichiro MD, PhD; Abola, Ramon MD; Murray, W Bosseau MB; Whitfield, Carol PhD; Lang, Charles PhD; Sinz, Elizabeth MD. Data is temporarily unavailable. Indeed, it is the only thing that ever has.". Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario. - PDF LYqC+pJ&6X4onfBT#?=R}.p8N3+Dk,P4tIgWB}-L'=8;_G >,K#.e89XnG'B~NtR 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. 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. Airway adjuncts are often helpful and in some cases essential to maintain a patients airway. Your message has been successfully sent to your colleague. However, this turned out to be too slow, took too much time, and could not continuously demonstrate the direction of changes. 1. Published August 2015. Causes: Any situation arising in a diabetic that requires increased insulin without that demand being met can result in DKA. You may search for similar articles that contain these same keywords or you may Collectblood testsafter cannulating the patient including: An ECG should be performed to screen for cardiac pathology such as arrhythmias which may be precipitated by electrolyte abnormalities (e.g. Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario A number of key modifiers are described that allow for the adjustment of case . 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. Interactive lecture/discussion with use of monitors that show the vital signs of the simulated patient on manikin. The relationship between sleep, fatigue and patient and provider safety. Please enable scripts and reload this page. type 1 diabetes), Complete insulin insensitivity (e.g. 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. The file explaining the session is sent to instructors 1 week before the sessions. See ourintravenous cannulation guidefor more details. Conclusion: Our DKA simulator is a new tool whose objective is the training in a severe, frequent and complex situation, and can be used to improve the approach made by the junior physicians to the real diabetic . As with the animated lecture, the simulation is strongly dependent on a focused case study. One of the key differences with the immersive simulation is that the instructor is absent from the simulation environment. }HyEf,#$/JSRU9+CF6k\'/z+i`[ 5JudK*Zly^g%[jCK)H[)Y=Qp0/r9o9HW_zF}pTzI~'|q.~:=Y T 9w! Reduced urine output (oliguria) is typically defined as less than 0.5ml/kg/hour in an adult. Diabetic Ketoacidosis (DKA) Clinical Pathway Emergency Department Observe and discuss the effects of therapy in a mathematically modeled physiological simulator. If any obstruction is encountered, remove the tube and try the left nostril. 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. In this case scenario, dehydration is one of the most serious immediate issues. Join the Geeky Medics community: TikTok: https://www.tiktok.com/@geekymedics 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. A blood glucose level may already be available from earlier investigations (e.g. In keeping with the case study, as a treatment marker is reached, the instructor should place emphasis on physiological, pharmacological, environmental and psychosocial issues. NPAs are typically better tolerated in patients who are partly or fully conscious compared to oropharyngeal airways. A GCS of 8 or below warrants urgent expert help from an anaesthetist. The facilitator guides the group only when necessary. Lets discuss your options. 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 .