dka simulation scenario dka simulation scenario

For more information, please refer to our Privacy Policy. A comprehensive collection of clinical examination OSCE guides that include step-by-step images of key steps, video demonstrations and PDF mark schemes. His Wife Gave Him 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. Another example: At one minute into the scenario, the patient becomes unresponsive and their breathing becomes shallow. - Geeky Medics OSCE App: https://geekymedics.com/geeky-medics-app/ A collection of surgery revision notes covering key surgical topics. PDF Adult Type I Diabetic Ketoacidosis Pre-simulation Preparation Student It was developed for anesthesiology resident physicians with some background knowledge and experience caring for critically ill patients. Prehosp Emerg Care. . %PDF-1.5 J Nurs Educ. Observe and discuss the effects of therapy in a mathematically modeled physiological simulator. If the patient loses consciousness and there are no signs of life on assessment, put out a crash call and commence CPR. Does the patient need a referral toHDU/ICU? 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. Indeed, it is the only thing that ever has.". The consequences (low blood pressure, high heart rate, central nervous system status, etc.) The faculty member/course coordinator of Simulation Design An events progression section should include patient status changes, as well as a time/treatment continuum that incorporates if-then event progressions. Perform urinalysis and send the urine for culture if urinary tract infection is suspected. Join the Geeky Medics community: 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. The addition of a fluid infusion containing some potassium allows insulin therapy to continue to suppress ketogenesis and normalise plasma pH whilst preventing the development of hypokalaemia. Makeup may be used to depict gender, hollow eyes and cheeks, produce pallor or display bruises and scars. Please try after some time. The main purpose of the simulation is to draw a line from the theoretical, boring biochemistry to the clinical manifestations. 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. They have had no clinical exposure or any clinical experience. In this section, we have to help the trainee to institute definitive therapy based on the underlying biochemical abnormalities. The instructors role is to facilitate active learning through a combination of learning styles. YouTube Video VVVram5yRUhROGJRUW1sZk5kQVFDXzV3LjMxakdNallNcng0, YouTube Video VVVram5yRUhROGJRUW1sZk5kQVFDXzV3LkJPVjVZMzBKczY4, YouTube Video VVVram5yRUhROGJRUW1sZk5kQVFDXzV3LkxEM2VkQzB2NTBr, Start typing to see results or hit ESC to close, Deep Vein Thrombosis (DVT) Examination OSCE Guide, Pre-hospital Advanced Life Support (ALS) OSCE Guide, Adult Choking (Basic Life Support) OSCE Guide, Paediatric Intravenous Cannulation OSCE Guide, Intrauterine System (Mirena) Counselling OSCE guide, Geeky Medics OSCE Book | Clinical Examination, Paediatric Gastro-oesophageal Reflux Disease, A Career as a GP with Special Interest with Dr Fiona Mosgrove, Absolute insulin deficiency (e.g. 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. 1) Please read through this document as it will help you prepare for your upcoming simulation on DKA. GRAPH. Immersive simulations are mentally exhausting because they create an intense and stressful atmosphere requiring the learner to work outside their comfort zone. 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. Simulation provides a safe environment where learning is enhanced through the deliberate practice of skills and controlled management of a variety of clinical encounters. This is a 25-year-old woman with a medical history of diabetes medicated with 40 units insulin per day. 34 - Diabetic Ketoacidosis in Pregnancy | Obgyn Key endobj Before trainees arrival into the simulation area, the simulator is already preprogrammed for DKA. A collection of free medical student quizzes to put your medical and surgical knowledge to the test! 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. 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. Ziv A, Wolpe PR, Small SD, et al. Introduceyourselfto whoever has requested a review of the patient andlistencarefullyto their handover. The students are in their first year. PDF Diabetic Ketoacidosis in the Obstetric Population: A Simulation endobj 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. Revisit history taking to explore relevant medical history and identify any precipitating factors for DKA. See ourdocumentation guidesfor more details. Similar to a ward round, where the instructor would say: Come and listen to this patient with an aortic stenosis. 1 0 obj In the meantime, you can perform some basic airway manoeuvres to help maintain the airway whilst awaiting senior input. Insert the oropharyngeal airway in the upside-down position until you reach the junction of the hard and soft palate, at which point you should rotate it 180. Introduceyourselfto thepatientincluding yournameandrole. Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. On arrival to the ER, standard monitors (electrocardiogram [ECG] and pulse oximetry [SpO2]) and end-tidal carbon dioxide (ETCO2) concentration were placed, and the patient was given oxygen by nasal cannulae. DY{Qb"(EgN$QI*%XN1F""0a5 Using your thumbs, slightly open the mouth by downward displacement of the chin. confusion, coma), All critically unwell patients should have. Two abstracts related to sleepiness in the EMS workforce were presented at the National Association of EMS Physicians symposium in January. Simulation of Diabetic Ketoacidosis for Cellular and Molecul DKA can develop within 24 hours and is potentially life threatening, requiring prompt recognition and therapeutic intervention. Keyword Highlighting Typically potassium levels should be maintained between 4.0 5.5 mmol/L and close monitoring is required. Scenarios. Intubation lubricants can mimic drooling. Catheterisethe patient to closelymonitor urine outputto guide fluid resuscitation and need for escalation. A traditional classroom lecture format allows for student participation but limits the instructors ability to create realistic situations. Please enable scripts and reload this page. Please note that by doing so you agree to be added to our monthly email newsletter distribution list. Heart: S1 and S2 within normal limits; no S3/S4 or murmurs, normal rate and rhythm. Much time was wasted explaining why it did not matter. Classroom Dynamics MassBay EMS Program Integrates Training for Dogs, Heat Waves Are Killing More LA Homeless People. Antibiotics should be prescribed in keeping with local guidelines. Pediatric Emergency Medicine Didactics and Simulation (PEMDAS type 1 diabetes) Complete insulin insensitivity (e.g. With your index and other fingers placed behind the angle of the mandible, apply steady upwards and forward pressure to lift the mandible. We give the history of the patient to the trainees. Use blankets to re-warm patients who are mild to moderately hypothermic. Diabetic Ketoacidosis (DKA) Clinical Pathway Emergency Department A number of key modifiers are described that allow for the adjustment of case . Int J Evid Based Healthc. A comprehensive collection of medical revision notes that cover a broad range of clinical topics. Forty percent of respondents reported excessive daytime sleepiness. CCA 175 Real Time Exam Scenario 17 | JOIN Multiple DataFrames | Save as After initial insulin therapy has reduced plasma blood glucose levels (e.g. 2 0 obj LYqC+pJ&6X4onfBT#?=R}.p8N3+Dk,P4tIgWB}-L'=8;_G >,K#.e89XnG'B~NtR In other words, they do not have clinical experience, but they have clinical knowledge. This is particularly important for core . <> Trainee will learn to collaborate with peers to decide on appropriate interventions, tests, and therapy. The patient was placed in the supine position and was a little confused as well as drowsy but at times had a good verbal response (Glasgow Coma Scale 15/15). 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. - Associated symptoms 03:04 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. *=NdL/c2XSJn8:I Jb8'.8>N*[L .hxw6afq40DX3c~>abt'Q,8y(BZu(vKBTufIR. These simulation sessions seem to work because the medical students do have prior knowledge. A fixed-rate intravenous insulin infusion should be commenced initially to suppress ketogenesis, reduce blood glucose levels and address electrolyte disturbances. This guide provides an overview of the recognition and immediate management of diabetic ketoacidosis (DKA)using an ABCDE approach. 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. 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. Please try again soon. A patient presenting with altered level of consciousness and a blood sugar level below 80 mg/dL should be considered hypoglycemic, and treatment modalities should be consistent with those for a diabetic patient. Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario She Died the Next Day. In some cases, normal saline with additional potassium is required to prevent overcorrection of serum potassium levels which would otherwise result in hypokalaemia. 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. The relationship between sleep, fatigue and patient and provider safety. PDF Medicine Simulation Scenario Diabetic Ketoacidosis: An Emergency - Cureus 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. Facilitator to ask how often to measure BMs to maintaining your privacy and will not share your personal information without Performing an ECG should not delay the emergency management of DKA. I assigned true to life parking codes, and added some extra parking for the superfluous US Express AI. As this is a PBL session, the trainees are not given any references. Initially, we used a blood pressure cuff to generate the blood pressure values. Diabetic Ketoacidosis in the Obstetric Population: A Simulation Each performance measure is separated into cognitive, behavioral or technical categories. opioids, sedatives, anxiolytics, insulin, oral hypoglycaemic medications). A collection of interactive medical and surgical clinical case scenarios to put your diagnostic and management skills to the test. 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. Search for Similar Articles We combined both to indicate the continuity of the curriculum, and the building on prior knowledge. Diabetic Ketoacidosis (DKA) | Acute Management | ABCDE Its best, however, to allow the student group to continue so theyre able to evaluate their decision-making processes during debriefing. The teaching of diabetic assessment and management, like many other medical emergencies, lends itself well to case-based simulation. . In the context of DKA, a patients consciousness level may be reduced. 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. After entering the environment, the student doesnt have the option of leaving the simulation until the learning objectives and performance measures are achieved. If the patient is conscious, sit themuprightas this can also help with oxygenation. 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. - Timing 03:23 The choice of fluid type, rate of administration and volume should be tailored to the individual patient based upon their vital signs and electrolytes. Effectiveness of simulation on health profession students knowledge, skills, confidence and satisfaction. Simulation Scenario. 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. Over the years, some groups happened to have the simulation session before the completion of the theoretical PBL session. His Heart Stopped On a Treadmill. ABG, venepuncture). 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. The facilitator guides the group only when necessary. 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. Given 6 to 8 back-to-back sessions, it is critical that every session starts and ends on time! Trainee will correlate the underlying pathophysiology with symptoms and signs as exhibited by the simulation session. PDF Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario Medical simulation technology is a powerful tool for training physicians but papers dealing with DKA simulators are scarce. - Radiation 02:45 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. unilateral coarse crackles may be present if the patient has pneumonia which may have been the precipitant for DKA). Simulation student Scenario- DKA-Peds.docx - DIABETIC KDCA, Ronald Reagan Washington National Airport, DC. For similar reasons, we do not believe a videotaped session will keep the students attention as much as these live simulator sessions. A comprehensive collection of OSCE guides to common clinical procedures, including step-by-step images of key steps, video demonstrations and PDF mark schemes. Use washable, non-toxic paints to imitate various body emissions. Prehosp Emerg Care. Kymera Systems Inc | SCADA Online Demo Ignition The instructor should have visual access via one-way windows or cameras. reduced air entry, coarse crackles) to screen for evidence of pneumonia. Your message has been successfully sent to your colleague. In this manner, the students have to apply their knowledge at the appropriate points during the progression of the scenario. Inspect for evidence of self-injection sites (e.g. Insert at least onewide-bore intravenous cannula(14G or 16G) and take blood tests as discussed below. Diabetic ketoacidosis (DKA) is a common, potentially lethal disease. <>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 595.32 841.92] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> We are looking for declaration of DKA and request for pathway. Stage 2: Emergency management of DKA and consideration of abnormal CTG. The lecture allows for understanding of concepts prior to action, and instructor feedback is immediate. Clearlydocument your ABCDE assessment, including history, examination, observations, investigations, interventions, and the patients response. 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 . }HyEf,#$/JSRU9+CF6k\'/z+i`[ 5JudK*Zly^g%[jCK)H[)Y=Qp0/r9o9HW_zF}pTzI~'|q.~:=Y T 9w! A nasopharyngeal airway is a soft plastic tube with a bevel at one end and a flange at the other. See ourCXR interpretation guidefor more details. Simulation in Healthcare4(4):232-236, Winter 2009. Highlight selected keywords in the article text. - Severity 05:32 We have been presenting Simulation Laboratory sessions to our preclinical medical students (first and second years). The reason for inserting the airway upside down initially is to reduce the risk of pushing the tongue backwards and worsening airway obstruction. Immersive Simulations Causes: Any situation arising in a diabetic that requires increased insulin without that demand being met can result in DKA. If the patient is suspected to have sufferedsignificanttraumawith potential spinal involvement, perform ajaw-thrustrather than a head-tilt chin-lift manoeuvre: 2. A debriefing section with pre-established questions allows the instructor to review the main focus and performance measures with the student group. You may be trying to access this site from a secured browser on the server. Please write a single word answer in lowercase (this is an anti-spam measure). We then start the DKA state. See Appendix D, Supplemental Digital Content 4, https://links.lww.com/SIH/A4. The Theory Given such a small group, the students indicated that they feel more involved than they would with a larger group (eg, the whole class.) You may be asked to review a patient with DKA due to confusion, reduced level of consciousness, tachycardia, hypotension and/or vomiting. Tilt the forehead back whilst lifting the chin forwards to extend the neck. The instructor can also gauge the direction the debriefing session should follow or be alerted to possible problems or conflicts in treatment opinions. Diabetic Ketoacidosis in the Obstetric Population: A Simulation a simulation training session designed to acquaint emergency medicine residents with the presentation and management of diabetic ketoacidosis (DKA) through the use of simulation.