- Over 3000 Free MCQs: https://geekyquiz.com/ SimMan Nursing Scenarios Software. Recognize the signs and symptoms of a patient presenting with diabetic ketoacidosis. 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. 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. Performing an ECG should not delay the emergency management of DKA. On the basis of the feedback from the students, they indicated that they believed the small group sessions are better. The main purpose of the simulation is to draw a line from the theoretical, boring biochemistry to the clinical manifestations. From the Department of Anesthesiology, Pennsylvania State University College of Medicine, Hershey, PA. Dr. Murray is on the Speakers Bureau of METI, Sarasota, FL. See our blood glucose measurement guide for more details. 2011;15:108109. - 2500+ OSCE Flashcards: https://geekymedics.com/osce-flashcards/ Open the patients mouth to ensure there is no foreign material that may be pushed into the larynx. - Examples 05:45 Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario DOWNLOAD Diabetic Ketoacidosis By the end of this scenario, the learner will be able to: 1. A collection of data interpretation guides to help you learn how to interpret various laboratory and radiology investigations. Each PBL case typically goes over 23 days, affording the students periods to find information for the case. 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. 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. 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). This video demonstrates how to use the SOCRATES acronym when taking a history of pain or other symptoms. Inspect theairwayfor obviousobstruction. However, this leads to confusion. Chapters: The instructors role is to facilitate active learning through a combination of learning styles. 2009;13:505511. Simulation student Scenario- DKA-Peds.docx - DIABETIC If the patient is confused you might be able to get a collateral history from staff or family members as appropriate. We have spent many hours debating whether the small group format was a waste of time. The addition of a fluid infusion containing some potassium allows insulin therapy to continue to suppress ketogenesis and normalise plasma pH whilst preventing the development of hypokalaemia. Stage 3: Ongoing management and monitoring of DKA 1 hour after initiation of treatment. The use of a simulated, evolving case scenario was an effective method of exposing nursing students to complex patient care. NPAs are typically better tolerated in patients who are partly or fully conscious compared to oropharyngeal airways. Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario Cureus. We then start the DKA state. See Appendix D, Supplemental Digital Content 4, https://links.lww.com/SIH/A4. 2 The evaluation of potassium deficits is complicated by potassium exit from . Indeed, it is the only thing that ever has.". If the patient has COPD and a history of CO2retention you should switch to aventuri maskas soon as possible andtitrate oxygen appropriately. 4. Simulation of Diabetic Ketoacidosis for Cellular and Molecul 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. Airway adjuncts are often helpful and in some cases essential to maintain a patients airway. An integral part of a PBL session is for trainees to be able to navigate through huge literature bases. - Character 02:14 The student group should be encouraged to collaborate on management options and to perform skills. 2010;49:578586. DO NOT perform any examination or procedure on patients based purely on the content of these videos. Instagram: https://instagram.com/geekymedics The debriefing environment should be removed from the location where the simulation took place. If the patient is suspected to have sufferedsignificanttraumawith potential spinal involvement, perform ajaw-thrustrather than a head-tilt chin-lift manoeuvre: 2. areas of lipohypertrophy) if it is unclear if the patient is diabetic. Laschinger S, Medves J, Pulling C, et al. 3. She is lethargic and slightly confused but can intermittently respond to questions. In some cases, normal saline with additional potassium is required to prevent overcorrection of serum potassium levels which would otherwise result in hypokalaemia. Ziv A, Wolpe PR, Small SD, et al. Diabetic Ketoacidosis (DKA) Clinical Pathway Emergency Department 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). His Heart Stopped On a Treadmill. The instructions to the facilitators suggest a series of structured, sequential questions to the students (starting at one end, involving each student in turn, and repeatedly cycling around the group.) Please enable scripts and reload this page. 1 Potassium losses occurring both before and during treatment of DKA must be replaced. Typically potassium levels should be maintained between 4.0 5.5 mmol/L and close monitoring is required. Immersive Simulations Pediatric Emergency Medicine Didactics and Simulation (PEMDAS Research Watch Box:Sleep, Fatigue & SafetyBy David Page, MS, NREMT-P Properly interpret a venous blood gas (VBG) and basic metabolic panel in a patient presenting with diabetic ketoacidosis. TikTok: https://www.tiktok.com/@geekymedics 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. Open the patients airwayusing ahead-tiltchin-lift manoeuvre: 1. The reason for inserting the airway upside down initially is to reduce the risk of pushing the tongue backwards and worsening airway obstruction. As individuals with uncontrolled type I . Problems are addressed as they are identified and the patient is re-assessed regularly to monitor their response to treatment. An oxygen mask is also demonstrated as an alternative device, as these early trainees had mostly not yet seen any of these devices. Diabetic Ketoacidosis (DKA) | Acute Management | ABCDE 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 . Well done, youve now stabilised the patient and theyre doing much better. With your index and other fingers placed behind the angle of the mandible, apply steady upwards and forward pressure to lift the mandible. This is a 25-year-old woman with a medical history of diabetes medicated with 40 units insulin per day. Generaltipsfor applying anABCDEapproachin an emergency setting include: Acute scenarios typically begin with abriefhandoverfrom a member of thenursing staffincluding thepatients name,age,backgroundand thereasonthereviewhas been requested. 6. MassBay EMS Program Integrates Training for Dogs, Heat Waves Are Killing More LA Homeless People. We try to provide sufficient realism.. 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. Deteriorationshould be recognised quickly and acted upon immediately. 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. 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. can be reemphasized, and the effects of fluid therapy demonstrated. 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) Please read through this document as it will help you prepare for your upcoming simulation on DKA. Antibiotics should be prescribed in keeping with local guidelines. It was developed for anesthesiology resident physicians with some background knowledge and experience caring for critically ill patients. Effectiveness of simulation on health profession students knowledge, skills, confidence and satisfaction. We are looking for declaration of DKA and request for pathway. 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)? 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. Geeky Medics accepts no liability for loss of any kind incurred as a result of reliance upon the information provided in this video. 34 - Diabetic Ketoacidosis in Pregnancy | Obgyn Key Trainee will practice or observe good teamwork skills, both as a leader and a team player. The student group is given a short introduction into a closed simulation environment. Its important to train and educate students of prehospital care on key indicators of a diabetic emergency. Classroom Dynamics See ourdocumentation guidesfor more details. 3 0 obj type 1 diabetes) Complete insulin insensitivity (e.g. Wolters Kluwer Health There are just a few more things to do. to maintaining your privacy and will not share your personal information without DKA can develop within 24 hours and is potentially life threatening, requiring prompt recognition and therapeutic intervention. The simulation experience serves to give substance to the theoretical words and concepts that the students encountered during the PBL sessions. Consider active re-warming techniques in patients with severe hypothermia. Target Learner Groups 1. His Wife Gave Him CPR. 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. In this section, we have to help the trainee to institute definitive therapy based on the underlying biochemical abnormalities. J Nurs Educ. Clearlydocument your ABCDE assessment, including history, examination, observations, investigations, interventions, and the patients response. If the patient is conscious, sit themuprightas this can also help with oxygenation. oral fluids, intravenous fluids, urine output, drain output, stool output, vomiting) to inform resuscitation efforts. Section snippets . KDCA, Ronald Reagan Washington National Airport, DC. Twitter: http://www.twitter.com/geekymedics Consider any precipitating factors for the development of DKA and involve the diabetes team in the patients care. 1 0 obj The main goal is to establish a safe learning environment for the learner [9, 13 . >> Fernandez AR, Mac Crawford J, Pennell ML, et al. If an obstruction is visible within the airway, use afingersweeporsuctionto remove it. PDF Medicine Simulation Scenario Diabetic Ketoacidosis: An Emergency - Cureus Advance the airway until it lies within the pharynx. Management of diabetic ketoacidosis in adults. The Theory 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. Mosby:Philadelphia. The choice of fluid type, rate of administration and volume should be tailored to the individual patient based upon their vital signs and electrolytes. dq-]gX4 `L'u7myx) rpjf0z,.y`VMyx-&Ju`U0 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. 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. 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. Medical Simulation Scenarios are text documents outlining the various details of a simulation - everything from patient simulator settings to debriefing notes. Diabetic Ketoacidosis (DKA) Clinical Pathway Emergency Department | Children's Hospital of Philadelphia 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. Does the patient need a referral toHDU/ICU? This field is for validation purposes and should be left unchanged. SimMan Nursing Scenarios Software - laerdal.com #geekymedics #fyp #fypviral #studytok #medicalstudentuk #medtok #studytips #studytipsforstudents #medstudentuk #premed #medschoolfinals, Cardiovascular History Tips - DON'T FORGET these 3 things . Available from: [. Prehosp Emerg Care. We also show them IV bags containing saline and Ringers lactate, as well as show them IV infusion sets. 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). <> Please write a single word answer in lowercase (this is an anti-spam measure). Moses Lake (WA) Fire Department Gets $3.3M Grant for more Firefighters, Woman Who Crashed into Responders, Killing PA Firefighter, Gets Prison, Three Apparent Gas Explosions at San Bernardino (CA) Mountain Homes, Enid (OK) Fire Department Begins SWAT Medic Program to Assist Police, FDNY EMS Providers Win COVID-19-Linked Free Speech Lawsuit, Coronavirus Origins Still a Mystery Three Years into Pandemic. Terms of Use. Trainee will increase knowledge of professional behaviors during the simulation. Scenarios. 4. TheABCDEapproach can be used to perform a systematic assessment of a critically unwell patient. 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. Despite this increased calorie intake, she noticed an unexplained 20 lbs weight loss. 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. LYqC+pJ&6X4onfBT#?=R}.p8N3+Dk,P4tIgWB}-L'=8;_G >,K#.e89XnG'B~NtR Trainee will improve their understanding of clinical practice through reflective assessment of actual cases during the prior PBL sessions. We do not use passive visualizing materials such as videotapes or DVD other than vital signs shown on the monitors. Perform urinalysis and send the urine for culture if urinary tract infection is suspected. doi: 10.7759/cureus.1286. Please note that by doing so you agree to be added to our monthly email newsletter distribution list. 4 0 obj 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). Endocrine - thesimbook.com 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. 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. Hypothermia may be present if the patient has been unconscious and exposed for some time. We have 18 to 20 PBL groups for an hour each in the week after their PBL DKA session. KDCA for FSX - Fly Away Simulation Kymera Systems Inc | SCADA Online Demo Ignition Competency-based medical education has seen widespread adoption in the field along with ongoing work in the areas of . Margolis GS, Romer GA, Fernandez AR, et al. A comprehensive collection of clinical examination OSCE guides that include step-by-step images of key steps, video demonstrations and PDF mark schemes. The instructor should have visual access via one-way windows or cameras. }HyEf,#$/JSRU9+CF6k\'/z+i`[ 5JudK*Zly^g%[jCK)H[)Y=Qp0/r9o9HW_zF}pTzI~'|q.~:=Y T 9w! 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. The students are in their first year. The validity of the HFS-DKA scenario was verified by a certified diabetes nurse educator, a registered nurse, and a clinical nurse educator. Should any changes be made to the current management of their underlying condition(s)? Using the arterial line, the scenario becomes much more dynamic. Cureus is on a mission to change the long-standing paradigm of medical publishing, where submitting research can be costly, complex and time-consuming. "Never doubt that a small group of thoughtful, committed citizens can change the world. As with the animated lecture, the simulation is strongly dependent on a focused case study. 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