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This is particularly important for core cases and low-frequency, high-stakes procedures and encounters. You can check out our guide to using SOCRATES here: https://geekymedics.com/the-socrates-acronym-in-history-taking/ Adds true to life parking codes and extra parking for AI. Medical simulation technology is a powerful tool for training physicians but papers dealing with DKA simulators are scarce. 1) Please read through this document as it will help you prepare for your upcoming simulation on DKA. The impetus for creating and implementing the high-fidelity diabetic ketoacidosis (DKA) simulation was based on a needs assessment and reviewing of undergraduate nursing students' examination statistics in a second semester medical-surgical course. Please write a single word answer in lowercase (this is an anti-spam measure). 2009;13:505511. 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. The lecture allows for understanding of concepts prior to action, and instructor feedback is immediate. % We give the history of the patient to the trainees. The use of case-based simulation, although more complicated and time consuming for the instructor, immerses the students in the subject matter. 3. In this manner, the students have to apply their knowledge at the appropriate points during the progression of the scenario. A number of key modifiers are described that allow for the adjustment of case . The relationship between sleep, fatigue and patient and provider safety. areas of lipohypertrophy) if it is unclear if the patient is diabetic. Note that if-thens must also include negative patient outcomes for when the provider doesnt take appropriate action. You may be trying to access this site from a secured browser on the server. - 150+ PDF OSCE Checklists: https://geekymedics.com/pdf-osce-checklists/ Research Watch Box:Sleep, Fatigue & SafetyBy David Page, MS, NREMT-P 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. 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. Use an effectiveSBARR handoverto communicate the key information effectively to other medical staff. 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). The teaching of diabetic assessment and management, like many other medical emergencies, lends itself well to case-based simulation. Its important to train and educate students of prehospital care on key indicators of a diabetic emergency. 4 0 obj Works with Traffic 2005, but . Simulation Scenario. Groups of fewer than four students dont allow for optimal collaboration. Perform urinalysis and send the urine for culture if urinary tract infection is suspected. Heart: S1 and S2 within normal limits; no S3/S4 or murmurs, normal rate and rhythm. See ourfluid prescribing guidefor more details onresuscitation fluids. This field is for validation purposes and should be left unchanged. 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. Observe and discuss the effects of therapy in a mathematically modeled physiological simulator. Simulation provides a safe environment where learning is enhanced through the deliberate practice of skills and controlled management of a variety of clinical encounters. Clearlydocument your ABCDE assessment, including history, examination, observations, investigations, interventions, and the patients response. The faculty member/course coordinator of Simulation Design Review thepatients notes,chartsandrecent investigation results. This may produce better retention of the subject matter and help students adapt to emergency scenes before going into the field. This guide provides an overview of the recognition and immediate management of diabetic ketoacidosis (DKA)using an ABCDE approach. Management of diabetic ketoacidosis in adults. Geeky Medics accepts no liability for loss of any kind incurred as a result of reliance upon the information provided in this video. TheABCDEapproach can be used to perform a systematic assessment of a critically unwell patient. Initially, we used a blood pressure cuff to generate the blood pressure values. Consider any precipitating factors for the development of DKA and involve the diabetes team in the patients care. It was developed for anesthesiology resident physicians with some background knowledge and experience caring for critically ill patients. 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. Available from: [. As the name says, this screen is used to graph and plot any parameter. - Introduction 00:00 Depending on scenario complexity, team dynamic and treatment modalities, this simulation may take 1020 minutes. Open the patients airwayusing ahead-tiltchin-lift manoeuvre: 1. See ourCXR interpretation guidefor more details. 2008;6:278302. You may search for similar articles that contain these same keywords or you may The 60 minutes training time consists of four 15-minute sections divided as follows. As individuals with uncontrolled type I . These simulation sessions seem to work because the medical students do have prior knowledge. Your message has been successfully sent to your colleague. The student group is given a short introduction into a closed simulation environment. Does the patient need reviewing by a specialist? J Nurs Educ. Forty percent of respondents reported excessive daytime sleepiness. 1. We now provide the students with handouts of the data to save time and provide consistency. 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. 3. 1 0 obj diagnosis of DKA Trigger 3, ABG show acidosis and high BM and normal potassium. Does the patient need a referral toHDU/ICU? Intubation lubricants can mimic drooling. 2010;49:578586. Calculate the patients current fluid balance using their fluid balance chart (e.g. Please note that by doing so you agree to be added to our monthly email newsletter distribution list. Therefore, the same file is also sent to the participants before the session. She Died the Next Day. Trainee will correlate the underlying pathophysiology with symptoms and signs as exhibited by the simulation session. 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. 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]). DY{Qb"(EgN$QI*%XN1F""0a5 ABG, venepuncture). 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. Refer to your local guidelines for further details. By joining Cureus, you agree to our A strong emphasis is placed on the focused, methodical examination of a specific medical problem and the decision-based treatment options available. 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. Antibiotics should be prescribed in keeping with local guidelines. Measure the patients capillary blood glucose and ketone levels to confirm the diagnosis and guide the management of DKA. Interactive lecture/discussion with use of monitors that show the vital signs of the simulated patient on manikin. and She is lethargic and slightly confused but can intermittently respond to questions. Many of the preclinical students have never seen a real life clinical monitor or even an intravenous (IV) setup. In this section, we have to help the trainee to institute definitive therapy based on the underlying biochemical abnormalities. 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 . 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). endobj She had developed nausea, extreme fatigue, mild disorientation, and blurred vision toward the end of the soccer match. 2 The evaluation of potassium deficits is complicated by potassium exit from . - Radiation 02:45 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. It should only be inserted in unconscious patients as it is otherwise poorly tolerated and may induce gagging and aspiration. - Geeky Medics OSCE App: https://geekymedics.com/geeky-medics-app/ As a next step, we will let one of the trainees talk to the patient, and prompt to ask medical questions such as previous medical issues or recent drug use for them to practice asking questions to generate a differential diagnosis (in this case, other causes for confusion). 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. Stage 1: Initial assessment of acutely unwell pregnant woman and diagnosis of DKA. A collection of data interpretation guides to help you learn how to interpret various laboratory and radiology investigations. 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. #geekymedics #fyp #fypviral #studytok #medicalstudentuk #medtok #studytips #studytipsforstudents #medstudentuk #premed #medschoolfinals, Cardiovascular History Tips - DON'T FORGET these 3 things . Given 6 to 8 back-to-back sessions, it is critical that every session starts and ends on time! doi: 10.7759/cureus.1286. One of the key differences with the immersive simulation is that the instructor is absent from the simulation environment. Clinical Simulation in Nursing, Volume 39, 2020, pp. 2011;15:108109. Debriefing Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. Trainee will recognize the need for therapy and suggest an appropriate therapy in a simulated environment. Cureus is on a mission to change the long-standing paradigm of medical publishing, where submitting research can be costly, complex and time-consuming. We have been presenting Simulation Laboratory sessions to our preclinical medical students (first and second years). Animated lectures, however, must work within the framework of a focused case study, which requires increased preparation time. Introduceyourselfto whoever has requested a review of the patient andlistencarefullyto their handover. Diabetes UK with the Joint British Diabetes Societies Inpatient Care Group. Invasive monitors, including a left radial intraarterial and a right subclavian IV catheter, were placed. Facilitator to ask how often to measure BMs Inspect theairwayfor obviousobstruction. 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. 2. The students are in their basic science course. 5. 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. 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. 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)? 2011;15:108109. Make sure tore-assessthe patient after anyintervention. An hour was . The files are given in full in the web supplement (Appendix B, Supplemental Digital Content 2, https://links.lww.com/SIH/A2). }HyEf,#$/JSRU9+CF6k\'/z+i`[ 5JudK*Zly^g%[jCK)H[)Y=Qp0/r9o9HW_zF}pTzI~'|q.~:=Y T 9w! 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. Int J Evid Based Healthc. The learning environment should closely mimic real-world applications. A nasopharyngeal airway is a soft plastic tube with a bevel at one end and a flange at the other. The reason for inserting the airway upside down initially is to reduce the risk of pushing the tongue backwards and worsening airway obstruction. His Heart Stopped On a Treadmill. We also show them IV bags containing saline and Ringers lactate, as well as show them IV infusion sets. LYqC+pJ&6X4onfBT#?=R}.p8N3+Dk,P4tIgWB}-L'=8;_G >,K#.e89XnG'B~NtR 2 0 obj Margolis GS, Romer GA, Fernandez AR, et al. We have spent many hours debating whether the small group format was a waste of time. We guide the group to suggest fluid. Airway adjuncts are often helpful and in some cases essential to maintain a patients airway. 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). They have had no clinical exposure or any clinical experience. 2. 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. COVID-19 Screening in the Pediatric Emergency Department. Several environments may be suitable for your classroom. Geeky Medics accepts no liability for loss of any kind incurred as a result of reliance upon the information provided in this video. 4. A chest X-ray should not delay the emergency management of DKA. Facebook: http://www.facebook.com/geekymedics Finally, we summarize the course and give them time for questions. As with the animated lecture, the simulation is strongly dependent on a focused case study. 1. Causes: Any situation arising in a diabetic that requires increased insulin without that demand being met can result in DKA. For example, if a student is to run a diabetic emergency in an extended living facility, the room should be staged with the appropriate bed, linens and medical equipment, and include personal artifacts and memorabilia normally found in such environments. 1 Potassium losses occurring both before and during treatment of DKA must be replaced. stream - Timing 03:23 Simulation in Healthcare4(4):232-236, Winter 2009. 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. Trainee will learn to collaborate with peers to decide on appropriate interventions, tests, and therapy. This simulation session therefore aims to make the case come alive, and show this known case in a clinical context. 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. His Wife Gave Him CPR. The students are in their first year. your express consent. *=NdL/c2XSJn8:I Jb8'.8>N*[L .hxw6afq40DX3c~>abt'Q,8y(BZu(vKBTufIR. 6. reduced air entry, coarse crackles) to screen for evidence of pneumonia. Geeky Medics accepts no liability for loss of any kind incurred as a result of reliance upon the information provided in this video. Stage 3: Ongoing management and monitoring of DKA 1 hour after initiation of treatment. Check out our other awesome clinical skills resources including: Weight, Height: Not given, normal appearing (as per simulator) but has lost 20 lbs recently. Much time was wasted explaining why it did not matter. Virtual patient simulation (VPS) is an interactive computer simulation that recreates real-world scenarios with the objectives of training, education, and assessment for health care providers [].Virtual simulation has been used extensively to adapt nursing education to the COVID-19 pandemic context [], such as social distancing and/or confinement. Insert the airway bevel-end first, vertically along the floor of the nose with a slight twisting action. >> Fernandez AR, Mac Crawford J, Pennell ML, et al. If the patientloses consciousnessand there areno signs of lifeon assessment, put out acrash callandcommence CPR. 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. 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. (1) The assessment of a diabetic patient is best taught as a. Terms of Use. 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. Cureus 9(5): e1286. type 1 diabetes) Complete insulin insensitivity (e.g. Using the arterial line, the scenario becomes much more dynamic. If you have any scenarios you would be willing to share with the simulation community, please forward them . This session provides additional clinical support material for the theoretical PBL session. Published August 2015. The questionnaire for the assessment of the session is given in full in the web-based supplement (Appendix A, Supplemental Digital Content 1, https://links.lww.com/SIH/A1). The debriefing environment should be removed from the location where the simulation took place. Extremities: mild cyanosis, no clubbing or edema (verbalized by instructors); pulses equal, and symmetrical (elucidated by trainees). 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. <>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 595.32 841.92] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> The scenario would include an if-then algorithm. Patients with DKA require fluid resuscitation to restore circulatory volume, clear ketones, correct electrolyte abnormalities and increase renal perfusion. 4. 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). Rosens Emergency Medicine: Concepts and Clinical Practice. The main purpose of the simulation is to draw a line from the theoretical, boring biochemistry to the clinical manifestations. Effectiveness of simulation on health profession students knowledge, skills, confidence and satisfaction. Should any changes be made to the current management of their underlying condition(s)? The instructor should have visual access via one-way windows or cameras. 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. You might also be interested in our awesome bank of 700+ OSCE Stations. If the patient is suspected to have sufferedsignificanttraumawith potential spinal involvement, perform ajaw-thrustrather than a head-tilt chin-lift manoeuvre: 2. Despite this increased calorie intake, she noticed an unexplained 20 lbs weight loss. oral fluids, intravenous fluids, urine output, drain output, stool output, vomiting) to inform resuscitation efforts. 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. As this is a PBL session, the trainees are not given any references. Immersive simulations are mentally exhausting because they create an intense and stressful atmosphere requiring the learner to work outside their comfort zone. Ketones show 5.5. Insert at least onewide-bore intravenous cannula(14G or 16G) and take blood tests as discussed below. Competency-based medical education has seen widespread adoption in the field along with ongoing work in the areas of . The Pratcice You may need further help or advice from a senior staff member and you shouldnot delay seeking help if you have concerns about your patient. 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. For more information, please refer to our Privacy Policy. "Never doubt that a small group of thoughtful, committed citizens can change the world. Ask for anotherclinicalmemberofstafftoassistyou if possible. There are several causes of DKA, which we remember by the "five I's". 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 . - Site 01:12 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. Search for Similar Articles . Revisit history taking to explore relevant medical history and identify any precipitating factors for DKA. If the patient is confused you might be able to get a collateral history from staff or family members as appropriate. 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. Using your thumbs, slightly open the mouth by downward displacement of the chin. - 2500+ OSCE Flashcards: https://geekymedics.com/osce-flashcards/ Diabetic ketoacidosis (DKA) is a common, potentially lethal disease. Wolters Kluwer Health The normal reference range for fasting plasma glucose is 4.0 5.8 mmol/l. 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. 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