dka simulation scenario

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. - Site 01:12 We have 18 to 20 PBL groups for an hour each in the week after their PBL DKA session. It should only be inserted in unconscious patients as it is otherwise poorly tolerated and may induce gagging and aspiration. Circulating nurse in the emergency room (ER). Advance the airway until it lies within the pharynx. When erroneous treatment is delivered, the instructor can end the simulation. Discuss the patients current clinical condition with aseniorclinicianusing anSBARR style handover. 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.) 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. Animated Lecture The students are in their first year. TheABCDEapproach can be used to perform a systematic assessment of a critically unwell patient. Note that if-thens must also include negative patient outcomes for when the provider doesnt take appropriate action. Are any further assessments or interventions required? - Over 3000 Free MCQs: https://geekyquiz.com/ Standardized patient as the voice of the simulator (or the simulation operator may play this role). Inspect for evidence of infection on the skin (e.g. 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. x]o ]?9kgq~:)?hE )R6!up}\<8||\]}Y~;xp~yQ$#4~djX&{n_m-]^K1/~/AD Hv 99evs,;8}8zwnhFxV.kf-V^? . This is a combination of the modified traditional lecture within scenario-based learning. 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. . Keyword Highlighting The simulation experience serves to give substance to the theoretical words and concepts that the students encountered during the PBL sessions. Evenly balancing performance measures will ensure the student has the opportunity to critically think through patient treatment and to practice new or support previously learned behaviors and technical skills. The use of a simulated, evolving case scenario was an effective method of exposing nursing students to complex patient care. Join the Geeky Medics community: A strong emphasis is placed on the focused, methodical examination of a specific medical problem and the decision-based treatment options available. Makeup may be used to depict gender, hollow eyes and cheeks, produce pallor or display bruises and scars. Competency-based medical education has seen widespread adoption in the field along with ongoing work in the areas of . - PSA Question Pack: https://geekymedics.com/psa-question-bank/ Categories: Emergency Medicine, Medical Education Keywords: diabetic ketoacidosis, simulation, expertise, emergency medicine . Given such a small group, the students indicated that they feel more involved than they would with a larger group (eg, the whole class.) Therefore, we have to emphasize the importance of airway, breathing, and circulation in the very sick patient in any clinical setting. Patients with DKA require fluid resuscitation to restore circulatory volume, clear ketones, correct electrolyte abnormalities and increase renal perfusion. His Heart Stopped On a Treadmill. We then start the DKA state. See Appendix D, Supplemental Digital Content 4, https://links.lww.com/SIH/A4. tall tented T waves in hyperkalaemia). Privacy Policy GRAPH. 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 . Ask for anotherclinicalmemberofstafftoassistyou if possible. Data Description All the product records are stored at /user/spark/dataset/retail_db/products All the category records are stored at /user/spark/dataset /ret. You should have another member of the clinical team aiding you in your ABCDE assessment, such a nurse, who can perform observations, take samples to the lab and catheterise if appropriate. In keeping with the case study, as a treatment marker is reached, the instructor should place emphasis on physiological, pharmacological, environmental and psychosocial issues. Adds true to life parking codes and extra parking for AI. 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. 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). After initial insulin therapy has reduced plasma blood glucose levels (e.g. Groups of fewer than four students dont allow for optimal collaboration. DO NOT perform any examination or procedure on patients based purely on the content of these videos. Each performance measure is separated into cognitive, behavioral or technical categories. 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. 3. Trainee will appropriately request assistance and use available resources. The validity of the HFS-DKA scenario was verified by a certified diabetes nurse educator, a registered nurse, and a clinical nurse educator. The file explaining the session is sent to instructors 1 week before the sessions. 5. 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. Trainee will improve their understanding of clinical practice through reflective assessment of actual cases during the prior PBL sessions. Measure the patients capillary blood glucose and ketone levels to confirm the diagnosis and guide the management of DKA. We guide the group to suggest fluid. 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. Trainee will increase knowledge of professional behaviors during the simulation. SimMan Nursing Scenarios Software. Therefore, the same file is also sent to the participants before the session. COVID-19 Screening in the Pediatric Emergency Department. An events progression section should include patient status changes, as well as a time/treatment continuum that incorporates if-then event progressions. Simulation student Scenario- DKA-Peds.docx - DIABETIC - Medical Finals Question Pack: https://geekymedics.com/medical-student-finals-questions/ KDCA, Ronald Reagan Washington National Airport, DC. In the meantime, you should re-assess and maintain the patients airway. Heart: S1 and S2 within normal limits; no S3/S4 or murmurs, normal rate and rhythm. Diabetic ketoacidosis; Simulation training; Medical students. We do have a wig that we place on the patient, but we do not try for full realism. For instance, if we mimicked the noise and traffic of a real emergency department, this would constitute excessive realism, and become a distraction to beginner medical students. 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. Administer oxygen to all critically unwell patients during yourinitialassessment. may email you for journal alerts and information, but is committed If the patient is confused you might be able to get a collateral history from staff or family members as appropriate. 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). - Associated symptoms 03:04 Capillary refill timemay be prolonged if the patient is hypovolaemic. The faculty member/course coordinator of Simulation Design 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). The students are in their first year. In this case scenario, dehydration is one of the most serious immediate issues. Should any changes be made to the current management of their underlying condition(s)? Some error has occurred while processing your request. . Similar to a ward round, where the instructor would say: Come and listen to this patient with an aortic stenosis. See ourhistory taking guidesfor more details. In this section, we have to help the trainee to institute definitive therapy based on the underlying biochemical abnormalities. 2008;6:278302. 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. Over the years, some groups happened to have the simulation session before the completion of the theoretical PBL session. 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. Its best, however, to allow the student group to continue so theyre able to evaluate their decision-making processes during debriefing. 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 Outcomes Educating Nursing Students Using an Evolving, Simulated Case 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. 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. 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. A collection of free medical student quizzes to put your medical and surgical knowledge to the test! angioedema, rash) commence appropriate treatment as discussed in ouranaphylaxis guide. A traditional classroom lecture format allows for student participation but limits the instructors ability to create realistic situations. Review the patients drug chart for medications which may cause a reduced level of consciousness (e.g. This field is for validation purposes and should be left unchanged. Forty percent of respondents reported excessive daytime sleepiness. Many of the preclinical students have never seen a real life clinical monitor or even an intravenous (IV) setup. The normal reference range for fasting plasma glucose is 4.0 5.8 mmol/l. Does the patient need a referral toHDU/ICU? 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 well-staged environment allows for greater student buy-in. It was 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. Simulation in Healthcare4(4):232-236, Winter 2009. doi: 10.7759/cureus.1286. The main purpose of the simulation is to draw a line from the theoretical, boring biochemistry to the clinical manifestations. You may be trying to access this site from a secured browser on the server. >> Fernandez AR, Mac Crawford J, Pennell ML, et al. Each PBL case typically goes over 23 days, affording the students periods to find information for the case. 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). Urinary tract infections are a common DKA precipitant. It involves a facilitating instructor, a small learner group and conceptual aspects of environmental and manikin staging to provide sensory cues. See ourCXR interpretation guidefor more details. You can check out our guide to using SOCRATES here: https://geekymedics.com/the-socrates-acronym-in-history-taking/ - Exacerbating & relieving factors 05:12 Simulation of Diabetic Ketoacidosis for Cellular and Molecul Please write a single word answer in lowercase (this is an anti-spam measure). An animated lecture may be described as a pseudo-simulation environment. The students are in their basic science course. The students have acquired all the applicable theoretical knowledge of the case during the previous multiday PBL sessions. For more information, please refer to our Privacy Policy. type 1 diabetes), Complete insulin insensitivity (e.g. We believe it is important to have active, participatory learning by having conversations with the trainees in the form of questions and answers. Please try after some time. cloudy urine may indicate urinary tract infection). In the context of DKA, a patients consciousness level may be reduced. Creating a Simulation Experience to Promote Clinical Judgment Place one hand on the patients forehead and the other under the chin. Before trainees arrival into the simulation area, the simulator is already preprogrammed for DKA. Rosens Emergency Medicine: Concepts and Clinical Practice. Facebook: http://www.facebook.com/geekymedics Use blankets to re-warm patients who are mild to moderately hypothermic. Use washable, non-toxic paints to imitate various body emissions. Alert a senior immediately if you have any concerns about the consciousness level of a patient. Strategies of high-performing paramedic educational programs. Despite this increased calorie intake, she noticed an unexplained 20 lbs weight loss. Stage 2: Emergency management of DKA and consideration of abnormal CTG. An integral part of a PBL session is for trainees to be able to navigate through huge literature bases. 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. Cureus 9(5): e1286. 4. The files are given in full in the web supplement (Appendix B, Supplemental Digital Content 2, https://links.lww.com/SIH/A2). Management of diabetic ketoacidosis in adults. Her medical, social, and family histories are not clear at the time of admission to the emergency department. She does not take this regularly. The students are in their basic science course. Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes mellitus, most common in patients with type 1 diabetes in particular due to a deficiency or absence of insulin [1].. 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]). endobj DONT FORGET these 3 key components of the cardiovascular exam for your upcoming OSCEs Save this video to watch later and dont forget to follow Geeky Medics! 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. Diabetic Ketoacidosis in the Obstetric Population: A 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. The use of case-based simulation, although more complicated and time consuming for the instructor, immerses the students in the subject matter. Inspect for evidence of self-injection sites (e.g. See Table 4 for a suggested standardized script. Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. 3. If you have any scenarios you would be willing to share with the simulation community, please forward them to me. MassBay EMS Program Integrates Training for Dogs, Heat Waves Are Killing More LA Homeless People. 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. Make sure to re-assess the patient after any intervention. Indeed, it is the only thing that ever has.". Make sure tore-assessthe patient after anyintervention. Acad Med. 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). 2. <>>> 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. >> Patterson PD, Weaver M, Frank R, et al. 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. Feel the slow and tardy pulse, we consider these PBL sessions as an example of a Look here, see this use of a full human simulator in the hierarchy of learning strategies with a full human simulator (Table 1). Diabetic Ketoacidosis (DKA) Clinical Pathway Emergency Department Instead, instructors should combine case- and simulation-based techniques when teaching diabetic assessment. Lets discuss your options. We ask the trainee why the blood pressure is so low or heart rate is so high, and how we should treat it. Geeky Medics accepts no liability for loss of any kind incurred as a result of reliance upon the information provided in this video. Use an effectiveSBARR handoverto communicate the key information effectively to other medical staff. 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. Kymera Systems Inc | SCADA Online Demo Ignition 1 Potassium losses occurring both before and during treatment of DKA must be replaced. An hour was . Just place the BR2_KDCA file into your addons scenery folder: C:\\Program Files\\Microsoft Games\\Microsoft Flight Simulator X\\Addon Scenery\\Scenery. The Theory Diabetes (type 1 and type 2) in children and young people: diagnosis and management. areas of lipohypertrophy) if it is unclear if the patient is diabetic. We give the history of the patient to the trainees. Medical simulation technology is a powerful tool for training physicians but papers dealing with DKA simulators are scarce. Ketones show 5.5. DOI 10.7759/cureus.1286. 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. 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. To read Pages full Research Review column, visit www.jems.com/patient-care. 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. 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. Prehosp Emerg Care. Margolis GS, Romer GA, Fernandez AR, et al. 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 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. Calculate the patients current fluid balance using their fluid balance chart (e.g. These simulation sessions seem to work because the medical students do have prior knowledge. Inspect the urine currently in the catheter bag and note its appearance (e.g. Stage 1: Initial assessment of acutely unwell pregnant woman and diagnosis of DKA. 1. 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. 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. modify the keyword list to augment your search. If an infection is suspected, IV antibioticsshould be administered as soon as possible. 2009;13:505511. The trainees have had background knowledge of biochemistry because they had completed the PBL case. Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario Yes: if the patient can talk, their airway is patent and you can move on to the assessment of breathing. endobj JEMS. insulin-dependent type 2 diabetes), Altered consciousness (e.g. 3 0 obj Creating a Simulation Experience to Promote Clinical Judgment

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