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. . type 1 diabetes), Complete insulin insensitivity (e.g. If the patient has clinical signs ofanaphylaxis(e.g. It was developed for anesthesiology resident physicians with some background knowledge and experience caring for critically ill patients. 4. This field is for validation purposes and should be left unchanged. Please enable scripts and reload this page. Administer oxygen to all critically unwell patients during yourinitialassessment. We have spent many hours debating whether the small group format was a waste of time. The files are given in full in the web supplement (Appendix B, Supplemental Digital Content 2, https://links.lww.com/SIH/A2). Margolis GS, Romer GA, Fernandez AR, et al. These are not learning objectives in this program. Classroom Dynamics See Table 4 for a suggested standardized script. Inspect for evidence of self-injection sites (e.g. Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario 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. Inspect the urine currently in the catheter bag and note its appearance (e.g. 2. Catheterisethe patient to closelymonitor urine outputto guide fluid resuscitation and need for escalation. *=NdL/c2XSJn8:I Jb8'.8>N*[L .hxw6afq40DX3c~>abt'Q,8y(BZu(vKBTufIR. One advantage to the animated lecture style is the ability to introduce treatment options in a methodically guided approach thats in conjunction with simultaneous environmental stimulus. The students are in their first year. type 1 diabetes) Complete insulin insensitivity (e.g. 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].. Prehosp Emerg Care. However, this turned out to be too slow, took too much time, and could not continuously demonstrate the direction of changes. Use blankets to re-warm patients who are mild to moderately hypothermic. A chest X-ray should not delay the emergency management of DKA. 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. It should only be inserted in unconscious patients as it is otherwise poorly tolerated and may induce gagging and aspiration. 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! stream 1. 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. This is particularly important for core . 3 0 obj a simulation training session designed to acquaint emergency medicine residents with the presentation and management of diabetic ketoacidosis (DKA) through the use of simulation. In the first, the authors expanded the National Registrys Longitudinal EMT Attributes and Demographic (LEADS) study by resurveying 1,600 EMS workers about their sleepiness while at work. During an immersive simulation, its imperative the group uses critical-thinking skills and group collaboration independently. vD0 x@FFJ{m[ 3//Oh|JR7! The required potassium replacement varies greatly. The trainees have had background knowledge of biochemistry because they had completed the PBL case. Please write a single word answer in lowercase (this is an anti-spam measure). 2010;49:578586. Using your thumbs, slightly open the mouth by downward displacement of the chin. 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. Chapters: The Theory If fever is present, make sure to consider co-existing infection. cloudy urine may indicate urinary tract infection). After entering the environment, the student doesnt have the option of leaving the simulation until the learning objectives and performance measures are achieved. If you have any scenarios you would be willing to share with the simulation community, please forward them to me. 2011;15:108109. 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)? 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. Forty percent of respondents reported excessive daytime sleepiness. Terms of Use. We combined both to indicate the continuity of the curriculum, and the building on prior knowledge. 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). Are any further assessments or interventions required? 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. <>>> Trainee will describe the changes in vital signs, the major metabolic, fluid, and electrolyte. The instructor should have visual access via one-way windows or cameras. 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. Diabetic ketoacidosis (DKA) is a common, potentially lethal disease. Simulation provides a safe environment where learning is enhanced through the deliberate practice of skills and controlled management of a variety of clinical encounters. Insert the airway bevel-end first, vertically along the floor of the nose with a slight twisting action. When erroneous treatment is delivered, the instructor can end the simulation. 4. SimMan Nursing Scenarios Software. Use an effectiveSBARR handoverto communicate the key information effectively to other medical staff. The use of a simulated, evolving case scenario was an effective method of exposing nursing students to complex patient care. DY{Qb"(EgN$QI*%XN1F""0a5 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. modify the keyword list to augment your search. If any obstruction is encountered, remove the tube and try the left nostril. See ourhistory taking guidesfor more details. We also show them IV bags containing saline and Ringers lactate, as well as show them IV infusion sets. This is a 25-year-old woman with a medical history of diabetes medicated with 40 units insulin per day. The objective is to give as many visual and tactile cues concerning the patient condition and background as possible. Advance the airway until it lies within the pharynx. Medical simulation technology is a powerful tool for training physicians but papers dealing with DKA simulators are scarce. 2017 May 29;9(5):e1286. The main purpose of the simulation is to draw a line from the theoretical, boring biochemistry to the clinical manifestations. Calculate the patients current fluid balance using their fluid balance chart (e.g. A collection of free medical student quizzes to put your medical and surgical knowledge to the test! Acad Med. 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. 4. 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. oral fluids, intravenous fluids, urine output, drain output, stool output, vomiting) to inform resuscitation efforts. Its important to train and educate students of prehospital care on key indicators of a diabetic emergency. 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. Cureus 9(5): e1286. to maintaining your privacy and will not share your personal information without You may search for similar articles that contain these same keywords or you may A debriefing section with pre-established questions allows the instructor to review the main focus and performance measures with the student group. MassBay EMS Program Integrates Training for Dogs, Heat Waves Are Killing More LA Homeless People. 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. and Observe and discuss the effects of therapy in a mathematically modeled physiological simulator. Recognize the signs and symptoms of a patient presenting with diabetic ketoacidosis. 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). Experience has shown that the more experienced the provider, the more detailed the environmental and manikin staging should be, because providers are trained to take in and interpret visual cues as indicators of patient status. Scenarios. We ask the trainee why the blood pressure is so low or heart rate is so high, and how we should treat it. . A collection of data interpretation guides to help you learn how to interpret various laboratory and radiology investigations. In this section, we have to guide them as to what they should do first for the patient in this critical condition (ie, treat the A, B, Cs of airway, breathing, and circulation) before we can confirm the diagnosis. 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. 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 some cases, normal saline with additional potassium is required to prevent overcorrection of serum potassium levels which would otherwise result in hypokalaemia. Extremities: mild cyanosis, no clubbing or edema (verbalized by instructors); pulses equal, and symmetrical (elucidated by trainees). Using the arterial line, the scenario becomes much more dynamic. #geekymedics #fyp #fypviral #studytok #medicalstudentuk #medtok #studytips #studytipsforstudents #medstudentuk #premed #medschoolfinals, Cardiovascular History Tips - DON'T FORGET these 3 things . - Introduction 00:00 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. Diabetic ketoacidosis; Simulation training; Medical students. It was In this section, we have to help the trainee to institute definitive therapy based on the underlying biochemical abnormalities. 2003;78:783788. The facilitator guides the group only when necessary. In other words, they do not have clinical experience, but they have clinical knowledge. We believe it is important to have active, participatory learning by having conversations with the trainees in the form of questions and answers. Therefore, the same file is also sent to the participants before the session. Reduced urine output (oliguria) is typically defined as less than 0.5ml/kg/hour in an adult. Despite this increased calorie intake, she noticed an unexplained 20 lbs weight loss. 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]). An oxygen mask is also demonstrated as an alternative device, as these early trainees had mostly not yet seen any of these devices. Available from: [. Facilitator to ask how often to measure BMs www.cdc.gov/diabetes/statistics/prev/national/. Should any changes be made to the current management of their underlying condition(s)? Groups of fewer than four students dont allow for optimal collaboration. Privacy Policy Deteriorationshould be recognised quickly and acted upon immediately. - Site 01:12 I assigned true to life parking codes, and added some extra parking for the superfluous US Express AI. 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. Standardized patient as the voice of the simulator (or the simulation operator may play this role). Geeky Medics accepts no liability for loss of any kind incurred as a result of reliance upon the information provided in this video. Adds true to life parking codes and extra parking for AI. If the patient isunconsciousorunresponsive, start thebasic life support(BLS)algorithmas per resuscitation guidelines. They have had no clinical exposure or any clinical experience. Check the patency of the patients right nostril and if required (depending on the model of NPA) insert a safety pin through the flange of the NPA. She had developed nausea, extreme fatigue, mild disorientation, and blurred vision toward the end of the soccer match. The following scenarios are available for download and are designed to meet your multi-disciplinary nursing needs. We have been presenting Simulation Laboratory sessions to our preclinical medical students (first and second years). - 2500+ OSCE Flashcards: https://geekymedics.com/osce-flashcards/ See our blood glucose measurement guide for more details. A comprehensive collection of medical revision notes that cover a broad range of clinical topics. 3. A fixed-rate intravenous insulin infusion should be commenced initially to suppress ketogenesis, reduce blood glucose levels and address electrolyte disturbances. Keyword Highlighting Ziv A, Wolpe PR, Small SD, et al. After the first voluntary session in 2006, feedback from the medical students indicated that they would like to receive this handout. 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. Inspect theairwayfor obviousobstruction. The simulation session is also hosted as an interactive session. Review the patients drug chart for medications which may cause a reduced level of consciousness (e.g. 2. Subscribe to our newsletter to be the first to know about our latest content: https://geekymedics.com/newsletter/ 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). Introduceyourselfto whoever has requested a review of the patient andlistencarefullyto their handover. You may be trying to access this site from a secured browser on the server. The Theory Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario Cureus. If the patient is confused you might be able to get a collateral history from staff or family members as appropriate. A strong emphasis is placed on the focused, methodical examination of a specific medical problem and the decision-based treatment options available. unilateral coarse crackles may be present if the patient has pneumonia which may have been the precipitant for DKA). She tends to drink sugar containing fluids (soda) when she is thirsty, and she eats fast foods (cream-filled muffins) when she is hungry. Facebook: http://www.facebook.com/geekymedics In the meantime, you should re-assess and maintain the patients airway. Keywords: diabetic ketoacidosis, simulation, expertise, emergency medicine Introduction Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes mellitus, most . If the patient is suspected to have sufferedsignificanttraumawith potential spinal involvement, perform ajaw-thrustrather than a head-tilt chin-lift manoeuvre: 2. 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). dq-]gX4 `L'u7myx) rpjf0z,.y`VMyx-&Ju`U0 Its best, however, to allow the student group to continue so theyre able to evaluate their decision-making processes during debriefing. 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. See ourdocumentation guidesfor more details. 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The relationship between sleep, fatigue and patient and provider safety. 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. areas of lipohypertrophy) if it is unclear if the patient is diabetic. Make sure tore-assessthe patient after anyintervention. Depending on scenario complexity, team dynamic and treatment modalities, this simulation may take 1020 minutes. 1 Potassium losses occurring both before and during treatment of DKA must be replaced. Does the patient need reviewing by a specialist? Other details are also important, including descriptions regarding patient language skill, social history, socioeconomic history, family history, religious practices or beliefs pertinent to treatment, and descriptive signs and symptoms. 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. confusion, coma), All critically unwell patients should have. Supplemental digital content is available for this article. 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. Clinical Simulation in Nursing, Volume 39, 2020, pp. Review the patientscurrent medicationsand check any regular medications areprescribed appropriately. In the context of DKA, a patients consciousness level may be reduced. 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). Place one hand on the patients forehead and the other under the chin. Simulation Scenario. COVID-19 Screening in the Pediatric Emergency Department. Consider any precipitating factors for the development of DKA and involve the diabetes team in the patients care. Using SOCRATES in History Taking | OSCE | Communication Skills, Diabetic Ketoacidosis (DKA) | Acute Management | ABCDE. Example: If the provider immediately evaluates blood glucose, then the reading will display 45 mg/dL. Much time was wasted explaining why it did not matter. Clearlydocument your ABCDE assessment, including history, examination, observations, investigations, interventions, and the patients response. Marx JA, Hockberger RS, Walls RM. Review the patientsoxygen saturation(SpO2): Auscultate the chest to screen for evidence of respiratory pathology (e.g. Circulating nurse in the emergency room (ER). GRAPH. Its absolutely necessary to follow all immersive simulations with a positive, emotionally safe and nonjudgmental debriefing environment. 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). Lets discuss your options. Simulation-based medical education: An ethical imperative. - Onset 01:48 Performing an ECG should not delay the emergency management of DKA. TheABCDEapproach can be used to perform a systematic assessment of a critically unwell patient. Instagram: https://instagram.com/geekymedics As this is a PBL session, the trainees are not given any references. may email you for journal alerts and information, but is committed This allows the learner group to make a psychological break from the patient and environment while beginning the reflection process. Works with Traffic 2005, but . 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. The main goal is to establish a safe learning environment for the learner [9, 13 . Well done, youve now stabilised the patient and theyre doing much better. Schneider Sarver PA, Senczakowicz EA, Slovensky BM. 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. It involves a facilitating instructor, a small learner group and conceptual aspects of environmental and manikin staging to provide sensory cues. An events progression section should include patient status changes, as well as a time/treatment continuum that incorporates if-then event progressions. . ABG, venepuncture). An hour was . 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. Physician working in the emergency department. Antibiotics should be prescribed in keeping with local guidelines. 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. We guide the group to suggest fluid. As individuals with uncontrolled type I . Trainee will get to know how professionals behave during management of a critically ill patient. Trainee will learn to collaborate with peers to decide on appropriate interventions, tests, and therapy. This leads to hyperglycaemia, osmotic diuresis, and dehydration. The researchers found that long shift hours (24hrs), working overtime and marital/relationship stress were strongly correlated. Patients with DKA require fluid resuscitation to restore circulatory volume, clear ketones, correct electrolyte abnormalities and increase renal perfusion. 2 The evaluation of potassium deficits is complicated by potassium exit from . If the patient is conscious, sit themuprightas this can also help with oxygenation. It may be necessary toexposethe patient during your assessment: remember to prioritise patient dignity and conservation of body heat. This is a combination of the modified traditional lecture within scenario-based learning. Diabetes (type 1 and type 2) in children and young people: diagnosis and management. She does not take this regularly. Use washable, non-toxic paints to imitate various body emissions.