dka simulation scenariocorbin redhounds football state championship

3. Therefore, the same file is also sent to the participants before the session. 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. x]o ]?9kgq~:)?hE )R6!up}\<8||\]}Y~;xp~yQ$#4~djX&{n_m-]^K1/~/AD Hv 99evs,;8}8zwnhFxV.kf-V^? - Introduction 00:00 2003;78:783788. It may be necessary toexposethe patient during your assessment: remember to prioritise patient dignity and conservation of body heat. diagnosis of DKA Trigger 3, ABG show acidosis and high BM and normal potassium. Regardless of the underlying cause of airway obstruction, seekimmediate expert supportfrom an anaesthetist and the emergency medical team (often referred to as the crash team). Using the arterial line, the scenario becomes much more dynamic. This is particularly important for core . Example: If the provider immediately evaluates blood glucose, then the reading will display 45 mg/dL. 2 The evaluation of potassium deficits is complicated by potassium exit from . Your message has been successfully sent to your colleague. www.cdc.gov/diabetes/statistics/prev/national/. See ourdocumentation guidesfor more details. Research Watch Box:Sleep, Fatigue & SafetyBy David Page, MS, NREMT-P It involves working through the following steps: Each stage of the ABCDE approach involvesclinicalassessment,investigationsandinterventions. We combined both to indicate the continuity of the curriculum, and the building on prior knowledge. The instructors role is to facilitate active learning through a combination of learning styles. Geeky Medics accepts no liability for loss of any kind incurred as a result of reliance upon the information provided in this video. 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). Trainee will improve their understanding of clinical practice through reflective assessment of actual cases during the prior PBL sessions. 2. A traditional classroom lecture format allows for student participation but limits the instructors ability to create realistic situations. You may be asked to review a patient with DKA due to confusion, reduced level of consciousness, tachycardia, hypotension and/or vomiting. cloudy urine may indicate urinary tract infection). To read Pages full Research Review column, visit www.jems.com/patient-care. type 1 diabetes), Complete insulin insensitivity (e.g. Inspect for evidence of self-injection sites (e.g. Lets discuss your options. A comprehensive collection of medical revision notes that cover a broad range of clinical topics. COVID-19 Screening in the Pediatric Emergency Department. 1 Potassium losses occurring both before and during treatment of DKA must be replaced. Each performance measure is separated into cognitive, behavioral or technical categories. 3 0 obj Please enable scripts and reload this page. The objective is to give as many visual and tactile cues concerning the patient condition and background as possible. Margolis GS, Romer GA, Fernandez AR, et al. Calculate the patients current fluid balance using their fluid balance chart (e.g. Intubation lubricants can mimic drooling. We then start the DKA state. See Appendix D, Supplemental Digital Content 4, https://links.lww.com/SIH/A4. Properly interpret a venous blood gas (VBG) and basic metabolic panel in a patient presenting with diabetic ketoacidosis. LYqC+pJ&6X4onfBT#?=R}.p8N3+Dk,P4tIgWB}-L'=8;_G >,K#.e89XnG'B~NtR 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. <> In the meantime, you can perform some basic airway manoeuvres to help maintain the airway whilst awaiting senior input. If the patient is confused you might be able to get a collateral history from staff or family members as appropriate. 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. Medical simulation technology is a powerful tool for training physicians but papers dealing with DKA simulators are scarce. Review the patientscurrent medicationsand check any regular medications areprescribed appropriately. 1) Please read through this document as it will help you prepare for your upcoming simulation on DKA. Instructors should write a case study for the simulation before the session. ABG, venepuncture). 1. (1), The assessment of a diabetic patient is best taught as a case-based simulation. Check out our other awesome clinical skills resources including: DKA can be caused by either: Absolute insulin deficiency (e.g. You might also be interested in our awesome bank of 700+ OSCE Stations. 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. I assigned true to life parking codes, and added some extra parking for the superfluous US Express AI. The 60 minutes training time consists of four 15-minute sections divided as follows. If the patient has COPD and a history of CO2retention you should switch to aventuri maskas soon as possible andtitrate oxygen appropriately. Tilt the forehead back whilst lifting the chin forwards to extend the neck. This field is for validation purposes and should be left unchanged. Paediatric DKA | Simulation Education 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). 2008;6:278302. Use an effectiveSBARR handoverto communicate the key information effectively to other medical staff. Data is temporarily unavailable. We do point out the blood pressure (BP) cuff, but these medical students in their first year do not really need to know how the BP values are generated, they need to understand the origin and therapy for the low blood pressure. Facebook: http://www.facebook.com/geekymedics "Never doubt that a small group of thoughtful, committed citizens can change the world. 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. 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). opioids, sedatives, anxiolytics, insulin, oral hypoglycaemic medications). General: Moaning, asking what has happening to her. An events progression section should include patient status changes, as well as a time/treatment continuum that incorporates if-then event progressions. The student group is given a short introduction into a closed simulation environment. Revisit history taking to explore relevant medical history and identify any precipitating factors for DKA. Simulation Training Ideal for Diabetic Patients - JEMS Catheterisethe patient to closelymonitor urine outputto guide fluid resuscitation and need for escalation. >> Patterson PD, Weaver M, Frank R, et al. A well-staged environment allows for greater student buy-in. The simulation experience serves to give substance to the theoretical words and concepts that the students encountered during the PBL sessions. 2009;13:505511. Adds true to life parking codes and extra parking for AI. This is a combination of the modified traditional lecture within scenario-based learning. insulin-dependent type 2 diabetes), Altered consciousness (e.g. The consequences (low blood pressure, high heart rate, central nervous system status, etc.) The Simulation Laboratory session follows after a completed PBL session, and is aimed at making the case come alive, while providing a clinical perspective to preclinical students. It was Join the Geeky Medics community: The debriefing environment should be removed from the location where the simulation took place. However, this leads to confusion. 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. In other words, they do not have clinical experience, but they have clinical knowledge. Make sure tore-assessthe patient after anyintervention. Given such a small group, the students indicated that they feel more involved than they would with a larger group (eg, the whole class.) The instructor can also gauge the direction the debriefing session should follow or be alerted to possible problems or conflicts in treatment opinions. Scenario in a Nutshell Diabetic ketoacidosis (DKA) in pregnancy. Target Learner Groups Make sure thepatientsnotes,observationchartandprescriptionchartare easily accessible. 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. Some error has occurred while processing your request. You may search for similar articles that contain these same keywords or you may DY{Qb"(EgN$QI*%XN1F""0a5 Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario type 1 diabetes) Complete insulin insensitivity (e.g. After entering the environment, the student doesnt have the option of leaving the simulation until the learning objectives and performance measures are achieved. In the final 10 minutes, we show how the patient has a good recovery after fluid replacement. . Weight, Height: Not given, normal appearing (as per simulator) but has lost 20 lbs recently. 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. Geeky Medics accepts no liability for loss of any kind incurred as a result of reliance upon the information provided in this video. 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. Hypothermia may be present if the patient has been unconscious and exposed for some time. may email you for journal alerts and information, but is committed 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. A blood glucose level may already be available from earlier investigations (e.g. See Table 4 for a suggested standardized script. It involves a facilitating instructor, a small learner group and conceptual aspects of environmental and manikin staging to provide sensory cues. Marx JA, Hockberger RS, Walls RM. A list of the requirements (monitors, props, and others) is given in Tables 2 and 3, as well as in the web supplement (Appendix C, Supplemental Digital Content 3, https://links.lww.com/SIH/A3). Development of simulation scenarios for an adolescent patient with diabetic ketoacidosis. Kymera Systems Inc | SCADA Online Demo Ignition Simulation Scenario. 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. If the patient loses consciousness and there are no signs of life on assessment, put out a crash call and commence CPR. They have had no clinical exposure or any clinical experience. If the patient is conscious, sit themuprightas this can also help with oxygenation. 4. Please note that by doing so you agree to be added to our monthly email newsletter distribution list. The optimal number of simulation participants is four to seven individuals, depending on the case study objectives. 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. Another example: At one minute into the scenario, the patient becomes unresponsive and their breathing becomes shallow. She Died the Next Day. Open the patients airwayusing ahead-tiltchin-lift manoeuvre: 1. A fixed-rate intravenous insulin infusion should be commenced initially to suppress ketogenesis, reduce blood glucose levels and address electrolyte disturbances. DO NOT perform any examination or procedure on patients based purely on the content of these videos. A chest X-ray should not delay the emergency management of DKA. If you have any scenarios you would be willing to share with the simulation community, please forward them to me. 2. Debriefing Wolters Kluwer Health A nasopharyngeal airway is a soft plastic tube with a bevel at one end and a flange at the other. The relationship between sleep, fatigue and patient and provider safety. tall tented T waves in hyperkalaemia). Assessment & Treatment of Five Diabetic Emergencies - JEMS cellulitis). Trainee will increase knowledge of professional behaviors during the 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. Please try after some time. From the Department of Anesthesiology, Pennsylvania State University College of Medicine, Hershey, PA. Dr. Murray is on the Speakers Bureau of METI, Sarasota, FL. Initially, we used a blood pressure cuff to generate the blood pressure values. J Nurs Educ. - Examples 05:45 His Heart Stopped On a Treadmill. Review the patientsoxygen saturation(SpO2): Auscultate the chest to screen for evidence of respiratory pathology (e.g. They have had no clinical exposure or any clinical experience. Laschinger S, Medves J, Pulling C, et al. Centers for Disease Control and Prevention. It should only be inserted in unconscious patients as it is otherwise poorly tolerated and may induce gagging and aspiration. 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. 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. Review the patients drug chart for medications which may cause a reduced level of consciousness (e.g. 1-6. This simulation session therefore aims to make the case come alive, and show this known case in a clinical context. - Associated symptoms 03:04 Please write a single word answer in lowercase (this is an anti-spam measure). The trainees have had background knowledge of biochemistry because they had completed the PBL case. Askhow the patient is feeling as this may provide some useful information about their current symptoms. Capillary refill timemay be prolonged if the patient is hypovolaemic. Well done, youve now stabilised the patient and theyre doing much better. - 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. Its absolutely necessary to follow all immersive simulations with a positive, emotionally safe and nonjudgmental debriefing environment. 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 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. 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). Its important to train and educate students of prehospital care on key indicators of a diabetic emergency. Over the years, some groups happened to have the simulation session before the completion of the theoretical PBL session. Review thepatients notes,chartsandrecent investigation results. Stage 2: Emergency management of DKA and consideration of abnormal CTG. 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. endobj Prehosp Emerg Care. Twitter: http://www.twitter.com/geekymedics Instead, instructors should combine case- and simulation-based techniques when teaching diabetic assessment. Creating a Simulation Experience to Promote Clinical Judgment Supplemental digital content is available for this article. Prehosp Emerg Care. We do not use passive visualizing materials such as videotapes or DVD other than vital signs shown on the monitors. Both external and internal potassium balances are disturbed during the development and treatment of DKA. 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. Glycosuria leads to urinary losses of potassium through osmotic diuresis. Causes: Any situation arising in a diabetic that requires increased insulin without that demand being met can result in DKA. 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]). Refer to your local guidelines for further details. TikTok: https://www.tiktok.com/@geekymedics As with the animated lecture, the simulation is strongly dependent on a focused case study. Using SOCRATES in History Taking | OSCE | Communication Skills, Diabetic Ketoacidosis (DKA) | Acute Management | ABCDE. Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. 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). In the context of DKA, a patients consciousness level may be reduced. Therefore, we have to emphasize the importance of airway, breathing, and circulation in the very sick patient in any clinical setting. Animated Lecture The facilitator guides the group only when necessary. - Geeky Medics OSCE App: https://geekymedics.com/geeky-medics-app/ - PSA Question Pack: https://geekymedics.com/psa-question-bank/ Vital Signs: BP, 90/30 mm Hg (ECG shows normal sinus rhythm); central venous pressure, 0 to 2 cm H. Lungs: All lung fields are clear to auscultation without wheeze or rhonchi, and the respiratory pattern is typical of Kussmaul breathing, ie, large deep tidal volumes and increased respiratory rate. Highlight selected keywords in the article text. This video demonstrates how to use the SOCRATES acronym when taking a history of pain or other symptoms. - Character 02:14 We have 18 to 20 PBL groups for an hour each in the week after their PBL DKA session. See ourintravenous cannulation guidefor more details. Despite this increased calorie intake, she noticed an unexplained 20 lbs weight loss. 3. Depending on scenario complexity, team dynamic and treatment modalities, this simulation may take 1020 minutes. 3. In this section, we have to help the trainee to institute definitive therapy based on the underlying biochemical abnormalities. Diabetes (type 1 and type 2) in children and young people: diagnosis and management. Conclusion The Theory SimMan Nursing Scenarios Software. Simulation Scenario for Anesthesia Providers Clark Obr, MD*, Anthony Mueller, MD . Heart: S1 and S2 within normal limits; no S3/S4 or murmurs, normal rate and rhythm. Just place the BR2_KDCA file into your addons scenery folder: C:\\Program Files\\Microsoft Games\\Microsoft Flight Simulator X\\Addon Scenery\\Scenery. Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. - 700+ OSCE Stations: https://geekymedics.com/osce-stations/ A collection of free medical student quizzes to put your medical and surgical knowledge to the test! As this is a PBL session, the trainees are not given any references. 1 0 obj Strategies of high-performing paramedic educational programs. The students are in their basic science course. Simulation provides a safe environment where learning is enhanced through the deliberate practice of skills and controlled management of a variety of clinical encounters. 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].. If any obstruction is encountered, remove the tube and try the left nostril. She had developed nausea, extreme fatigue, mild disorientation, and blurred vision toward the end of the soccer match. 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. 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. 34 - Diabetic Ketoacidosis in Pregnancy | Obgyn Key

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