Problems are addressed as they are identified and the patient is re-assessed regularly to monitor their response to treatment. If an infection is suspected, IV antibioticsshould be administered as soon as possible. Airway adjuncts are often helpful and in some cases essential to maintain a patients airway. Capillary refill timemay be prolonged if the patient is hypovolaemic. }HyEf,#$/JSRU9+CF6k\'/z+i`[ 5JudK*Zly^g%[jCK)H[)Y=Qp0/r9o9HW_zF}pTzI~'|q.~:=Y T 9w! Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario 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)? 4. Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. - Character 02:14 This guide provides an overview of the recognition and immediate management of diabetic ketoacidosis (DKA)using an ABCDE approach. Below is a collection of donated scenarios for you to use or modify. The relationship between sleep, fatigue and patient and provider safety. I assigned true to life parking codes, and added some extra parking for the superfluous US Express AI. If the patient is confused you might be able to get a collateral history from staff or family members as appropriate. Clearly communicate how often would you like the patients observations relayed to you by other staff members. 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. 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 . Each clinical case scenario allows you to work through history taking, investigations, diagnosis and management. We are looking for declaration of DKA and request for pathway. The main purpose of the simulation is to draw a line from the theoretical, boring biochemistry to the clinical manifestations. Review the patientscurrent medicationsand check any regular medications areprescribed appropriately. Causes: Any situation arising in a diabetic that requires increased insulin without that demand being met can result in DKA. Terms of Use. %PDF-1.5 Emergency medical services workLife characteristics contribute to clinically significant excessive daytime sleepiness. The 60 minutes training time consists of four 15-minute sections divided as follows. 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. In keeping with the case study, as a treatment marker is reached, the instructor should place emphasis on physiological, pharmacological, environmental and psychosocial issues. See ourCXR interpretation guidefor more details. Well done, youve now stabilised the patient and theyre doing much better. The students are in their basic science course. - 2500+ OSCE Flashcards: https://geekymedics.com/osce-flashcards/ Inspect the urine currently in the catheter bag and note its appearance (e.g. She is lethargic and slightly confused but can intermittently respond to questions. endobj Introduceyourselfto thepatientincluding yournameandrole. Abdomen: The abdominal examination reveals diffuse mild epigastric tenderness to deep palpitation but neither rebound tenderness nor guarding (result of examination given by patient or by instructor). Effectiveness of simulation on health profession students knowledge, skills, confidence and satisfaction. Does the patient need reviewing by a specialist? General: Moaning, asking what has happening to her. Askhow the patient is feeling as this may provide some useful information about their current symptoms. The choice of fluid type, rate of administration and volume should be tailored to the individual patient based upon their vital signs and electrolytes. As this is an interactive discussion session, any needed debriefing and/or explanation is given during the sessions. 3. After entering the environment, the student doesnt have the option of leaving the simulation until the learning objectives and performance measures are achieved. 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. It was From the Department of Anesthesiology, Pennsylvania State University College of Medicine, Hershey, PA. Dr. Murray is on the Speakers Bureau of METI, Sarasota, FL. The Pratcice 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. Target Learner Groups Typically potassium levels should be maintained between 4.0 5.5 mmol/L and close monitoring is required. 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. With your index and other fingers placed behind the angle of the mandible, apply steady upwards and forward pressure to lift the mandible. (1), The assessment of a diabetic patient is best taught as a case-based simulation. >> Fernandez AR, Mac Crawford J, Pennell ML, et al. The normal reference range for fasting plasma glucose is 4.0 5.8 mmol/l. 2003;78:783788. 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. Open the patients airwayusing ahead-tiltchin-lift manoeuvre: 1. Intubation lubricants can mimic drooling. The students are in their basic science course. Assess the patients pulse and blood pressure: Inspect the patient from the end of the bed: they may appear drowsy, confused and/or clammy/pale. Please enable scripts and reload this page. A fixed-rate intravenous insulin infusion should be commenced initially to suppress ketogenesis, reduce blood glucose levels and address electrolyte disturbances. Indeed, it is the only thing that ever has.". Each performance measure is separated into cognitive, behavioral or technical categories. 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. can be reemphasized, and the effects of fluid therapy demonstrated. Ketones show 5.5. She had developed nausea, extreme fatigue, mild disorientation, and blurred vision toward the end of the soccer match. Example: If the provider immediately evaluates blood glucose, then the reading will display 45 mg/dL. *=NdL/c2XSJn8:I Jb8'.8>N*[L .hxw6afq40DX3c~>abt'Q,8y(BZu(vKBTufIR. Cureus is on a mission to change the long-standing paradigm of medical publishing, where submitting research can be costly, complex and time-consuming. If the patientloses consciousnessand there areno signs of lifeon assessment, put out acrash callandcommence CPR. - Severity 05:32 Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario Cureus. Please try again soon. Yes: if the patient can talk, their airway is patent and you can move on to the assessment of breathing. Before trainees arrival into the simulation area, the simulator is already preprogrammed for DKA. They have had no clinical exposure or any clinical experience. The students worked on the underlying physiology during a week long PBL session and are therefore familiar with the theoretical aspects of DKA. A nasopharyngeal airway is a soft plastic tube with a bevel at one end and a flange at the other. 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. Development of simulation scenarios for an adolescent patient with diabetic ketoacidosis. This allows the learner group to make a psychological break from the patient and environment while beginning the reflection process. a simulation training session designed to acquaint emergency medicine residents with the presentation and management of diabetic ketoacidosis (DKA) through the use of simulation. 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. 4. Diabetes (type 1 and type 2) in children and young people: diagnosis and management. Invasive monitors, including a left radial intraarterial and a right subclavian IV catheter, were placed. 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 student group should be encouraged to collaborate on management options and to perform skills. 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. >> Patterson PD, Weaver M, Frank R, et al. GRAPH. An oxygen mask is also demonstrated as an alternative device, as these early trainees had mostly not yet seen any of these devices. Given such a small group, the students indicated that they feel more involved than they would with a larger group (eg, the whole class.) 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.. - Onset 01:48 The instructor should have visual access via one-way windows or cameras. Antibiotics should be prescribed in keeping with local guidelines. As the name says, this screen is used to graph and plot any parameter. 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. 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. If the patient is suspected to have sufferedsignificanttraumawith potential spinal involvement, perform ajaw-thrustrather than a head-tilt chin-lift manoeuvre: 2. Simulation of Diabetic Ketoacidosis for Cellular and Molecul Paediatric DKA | Simulation Education 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. Marx JA, Hockberger RS, Walls RM. We used the Medical Education Technologies Inc. (METI) Human Patient Stimulator (HPS, METI Sarasoto, Fl). Research Watch Box:Sleep, Fatigue & SafetyBy David Page, MS, NREMT-P Diabetic Ketoacidosis (DKA) Clinical Pathway Emergency Department | Children's Hospital of Philadelphia You might also be interested in our awesome bank of 700+ OSCE Stations. A collection of data interpretation guides to help you learn how to interpret various laboratory and radiology investigations. 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. A collection of surgery revision notes covering key surgical topics. We have been presenting Simulation Laboratory sessions to our preclinical medical students (first and second years). The student group is given a short introduction into a closed simulation environment. TheABCDEapproach can be used to perform a systematic assessment of a critically unwell patient. Endocrine - thesimbook.com 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. 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. See ourfluid prescribing guidefor more details onresuscitation fluids. 2. Similar to a ward round, where the instructor would say: Come and listen to this patient with an aortic stenosis. Ziv A, Wolpe PR, Small SD, et al. PDF Medicine Simulation Scenario Diabetic Ketoacidosis: An Emergency PA EMT Said COVID Patient Didnt Need to Go to the Hospital. Please write a single word answer in lowercase (this is an anti-spam measure). Keywords: diabetic ketoacidosis, simulation, expertise, emergency medicine Introduction Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes mellitus, most commonly occurring in patients with type I diabetes. Interactive lecture/discussion with use of monitors that show the vital signs of the simulated patient on manikin. 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. Subscribe to our newsletter to be the first to know about our latest content: https://geekymedics.com/newsletter/ 1. DO NOT perform any examination or procedure on patients based purely on the content of these videos. - Geeky Medics OSCE App: https://geekymedics.com/geeky-medics-app/ If the patient is conscious, sit themuprightas this can also help with oxygenation. In the meantime, you can perform some basic airway manoeuvres to help maintain the airway whilst awaiting senior input. Pediatric Emergency Medicine Didactics and Simulation (PEMDAS They have had no clinical exposure or any clinical experience. The faculty member/course coordinator of Simulation Design The DKA simulation incorporates cue recognition, analysis of cues, generation of solutions, nursing interventions, and evaluation of outcomes, including effective communication and psychosocial concerns. Strategies of high-performing paramedic educational programs. unilateral coarse crackles may be present if the patient has pneumonia which may have been the precipitant for DKA). A GCS of 8 or below warrants urgent expert help from an anaesthetist. Review the patientsoxygen saturation(SpO2): Auscultate the chest to screen for evidence of respiratory pathology (e.g. It involves a facilitating instructor, a small learner group and conceptual aspects of environmental and manikin staging to provide sensory cues. Simulation-based medical education: An ethical imperative. By joining Cureus, you agree to our Please note that by doing so you agree to be added to our monthly email newsletter distribution list. Data is temporarily unavailable. 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. - Examples 05:45 For similar reasons, we do not believe a videotaped session will keep the students attention as much as these live simulator sessions. There are just a few more things to do. Mosby:Philadelphia. Clinical Simulation in Nursing, Volume 39, 2020, pp. 3. Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. Her medical, social, and family histories are not clear at the time of admission to the emergency department. Trainee will correlate the underlying pathophysiology with symptoms and signs as exhibited by the simulation session. A well-staged environment allows for greater student buy-in. Nandate, Koichiro MD, PhD; Abola, Ramon MD; Murray, W Bosseau MB; Whitfield, Carol PhD; Lang, Charles PhD; Sinz, Elizabeth MD. See ourhistory taking guidesfor more details. Initially, we used a blood pressure cuff to generate the blood pressure values. 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. This leads to hyperglycaemia, osmotic diuresis, and dehydration. Wolters Kluwer Health - Site 01:12 Trainee will practice or observe good teamwork skills, both as a leader and a team player. Diabetic ketoacidosis (DKA) is a common, potentially lethal disease. 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. Does the patient need a referral toHDU/ICU? opioids, sedatives, anxiolytics, insulin, oral hypoglycaemic medications). Outcomes Educating Nursing Students Using an Evolving, Simulated Case During an immersive simulation, its imperative the group uses critical-thinking skills and group collaboration independently. Anesthetic Management Using the Oxygen Reserve Index for Tracheal Resection and Tracheal End-to-E A Scoping Review of the Impact of COVID-19 on Kidney Transplant Patients in the United States, Alabama College of Osteopathic Medicine Research, Baylor Scott & White Medical Center Department of Neurosurgery, California Institute of Behavioral Neurosciences & Psychology, Contemporary Reviews in Neurology and Neurosurgery, DMIMS School of Epidemiology and Public Health, Simulation, Biodesign, & Innovation In Medical Education, The Florida Medical Student Research Publications, University of Florida-Jacksonville Neurosurgery, VCOM Clinical, Biomedical, and Educational Research, American Red Cross Scientific Advisory Council, Canadian Association of Radiation Oncology, International Liaison Committee on Resuscitation, International Pediatric Simulation Society, Medical Society of Delaware Academic Channel, Society for Healthcare & Research Development, Surgically Targeted Radiation Therapy for Brain Tumors: Clinical Case Review, Clinical and Economic Benefits of Autologous Epidermal Grafting, Defining Health in the Era of Value-Based Care, Optimization Strategies for Organ Donation and Utilization, MR-Guided Radiation Therapy: Clinical Applications & Experiences, Multiple Brain Metastases: Exceptional Outcomes from Stereotactic Radiosurgery, Proton Therapy: Advanced Applications for the Most Challenging Cases, Radiation Therapy as a Modality to Create Abscopal Effects: Current and Future Practices, Clinical Applications and Benefits Using Closed-Incision Negative Pressure Therapy for Incision and Surrounding Soft Tissue Management, Negative Pressure Wound Therapy with Instillation, NPWT with Instillation and Dwell: Clinical Results in Cleansing and Removal of Infectious Material with Novel Dressings. Therefore, the same file is also sent to the participants before the session. - 150+ PDF OSCE Checklists: https://geekymedics.com/pdf-osce-checklists/ The researchers found that long shift hours (24hrs), working overtime and marital/relationship stress were strongly correlated. To read Pages full Research Review column, visit www.jems.com/patient-care. Trainee will recognize the need for therapy and suggest an appropriate therapy in a simulated environment. DO NOT perform any examination or procedure on patients based purely on the content of these videos. 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 The authors of the second study reported that poor sleep quality (60% of respondents) and extreme fatigue (55% of respondents) are independently associated with safety risks on the job. - Radiation 02:45 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. 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. 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. Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. We guide the group to suggest fluid. 1 Potassium losses occurring both before and during treatment of DKA must be replaced. At the end of the previous section, the trainee can make the diagnosis of DKA but has not confirmed it yet. We now provide the students with handouts of the data to save time and provide consistency. KDCA, Ronald Reagan Washington National Airport, DC. Standardized patient as the voice of the simulator (or the simulation operator may play this role). DY{Qb"(EgN$QI*%XN1F""0a5 Chapters: This simulation session therefore aims to make the case come alive, and show this known case in a clinical context. Case-based education adds a real-world aspect to the learning environment. 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. Urinary tract infections are a common DKA precipitant. Depending on scenario complexity, team dynamic and treatment modalities, this simulation may take 1020 minutes. For example, you could develop a diabetic scenario in which the prehospital provider encounters an altered patient with incomprehensible speech. 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. Creating a Simulation Experience to Promote Clinical Judgment Cureus 9(5): e1286. 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. The patient synopsis should include such standard aspects as age, sex, ethnicity, medical history, medications and allergies. Diabetes UK with the Joint British Diabetes Societies Inpatient Care Group. Catheterisethe patient to closelymonitor urine outputto guide fluid resuscitation and need for escalation. A debriefing section with pre-established questions allows the instructor to review the main focus and performance measures with the student group. angioedema, rash) commence appropriate treatment as discussed in ouranaphylaxis guide. Instagram: https://instagram.com/geekymedics A blood glucose level may already be available from earlier investigations (e.g. DOI 10.7759/cureus.1286. We try to provide sufficient realism.. MassBay EMS Program Integrates Training for Dogs, Heat Waves Are Killing More LA Homeless People. The required potassium replacement varies greatly. Inspect for evidence of infection on the skin (e.g. 2. In this section, we have to help the trainee to institute definitive therapy based on the underlying biochemical abnormalities. 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.) Published August 2015. This style also doesnt mimic an actual scene, and a student may feel that treatment modalities and skills are performed at a slower rate than real-world applications. This is particularly important for core . Because of the early stage (first year) of their medical careers, they have not yet seen vital sign monitoring, or patients, so these clinical aspects are introduced and emphasized. Review the patients drug chart for medications which may cause a reduced level of consciousness (e.g. Debriefing When a group treatment decision is made that would be contraindicated or harmful to the patient, the instructor can redirect the learner group while maintaining an atmosphere inclined toward independent thinking. The validity of the HFS-DKA scenario was verified by a certified diabetes nurse educator, a registered nurse, and a clinical nurse educator. She does not take this regularly. 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. ABG, venepuncture). A comprehensive collection of clinical examination OSCE guides that include step-by-step images of key steps, video demonstrations and PDF mark schemes. Therefore, we have to emphasize the importance of airway, breathing, and circulation in the very sick patient in any clinical setting. 2. The files are given in full in the web supplement (Appendix B, Supplemental Digital Content 2, https://links.lww.com/SIH/A2). Conclusions This technical report describes the design and implementation of a simulation scenario on DKA for emergency medicine trainees. Much time was wasted explaining why it did not matter. 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. You can plot as many parameters as you want and can choose to display either Historical data or have the graphs update as often as new data comes in and view them in Real-time. If you have any scenarios you would be willing to share with the simulation community, please forward them to me. The simulation session is also hosted as an interactive session. Trainee will recognize and interpret the clinical signs and symptoms and the typical history of a patient with DKA, as well as understand the major causative factors of DKA. PDF Diabetic Ketoacidosis in the Obstetric Population: A Simulation
