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dka simulation scenario

The DKA simulation incorporates cue recognition, analysis of cues, generation of solutions, nursing interventions, and evaluation of outcomes, including effective communication and psychosocial concerns. Please try after some time. cellulitis). 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. Instagram: https://instagram.com/geekymedics Many of the preclinical students have never seen a real life clinical monitor or even an intravenous (IV) setup. Classroom Dynamics PDF DKA Sim Scenario - ABCD (Diabetes Care) Ltd The students are in their basic science course. 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. She Died the Next Day. Laschinger S, Medves J, Pulling C, et al. 3 0 obj 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). - 2500+ OSCE Flashcards: https://geekymedics.com/osce-flashcards/ Use blankets to re-warm patients who are mild to moderately hypothermic. 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. Refer to your local guidelines which should provide a clear protocol for the management of DKA. In the meantime, you should re-assess and maintain the patients airway. 1 Potassium losses occurring both before and during treatment of DKA must be replaced. - Examples 05:45 The Pratcice The instructors have to appreciate that the trainees participating in this simulation have not seen a diabetic patient in either a ward or ER, but that they have knowledge of the underlying physiology. Review the patients drug chart for medications which may cause a reduced level of consciousness (e.g. 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. Surgical dressings and imitation blood can support medical history. A collection of interactive medical and surgical clinical case scenarios to put your diagnostic and management skills to the test. Medical Simulation Scenarios are text documents outlining the various details of a simulation - everything from patient simulator settings to debriefing notes. 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. 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 60 minutes training time consists of four 15-minute sections divided as follows. Diabetic ketoacidosis; Simulation training; Medical students. - 700+ OSCE Stations: https://geekymedics.com/osce-stations/ - Radiation 02:45 Tilt the forehead back whilst lifting the chin forwards to extend the neck. The optimal number of simulation participants is four to seven individuals, depending on the case study objectives. 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. Properly interpret a venous blood gas (VBG) and basic metabolic panel in a patient presenting with diabetic ketoacidosis. A traditional classroom lecture format allows for student participation but limits the instructors ability to create realistic situations. Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario Marx JA, Hockberger RS, Walls RM. Review the patientsoxygen saturation(SpO2): Auscultate the chest to screen for evidence of respiratory pathology (e.g. Each performance measure is separated into cognitive, behavioral or technical categories. . The students worked on the underlying physiology during a week long PBL session and are therefore familiar with the theoretical aspects of DKA. This video demonstrates how to use the SOCRATES acronym when taking a history of pain or other symptoms. 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. Trainee will practice or observe good teamwork skills, both as a leader and a team player. 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. 2003;78:783788. Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario Administer oxygen to all critically unwell patients during yourinitialassessment. Diabetes (type 1 and type 2) in children and young people: diagnosis and management. It was dq-]gX4 `L'u7myx) rpjf0z,.y`VMyx-&Ju`U0 In keeping with the case study, as a treatment marker is reached, the instructor should place emphasis on physiological, pharmacological, environmental and psychosocial issues. You may be asked to review a patient with DKA due to confusion, reduced level of consciousness, tachycardia, hypotension and/or vomiting. 1. The researchers found that long shift hours (24hrs), working overtime and marital/relationship stress were strongly correlated. 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). If the patient is suspected to have sufferedsignificanttraumawith potential spinal involvement, perform ajaw-thrustrather than a head-tilt chin-lift manoeuvre: 2. 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. DKA can develop within 24 hours and is potentially life threatening, requiring prompt recognition and therapeutic intervention. 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). Heart: S1 and S2 within normal limits; no S3/S4 or murmurs, normal rate and rhythm. - Exacerbating & relieving factors 05:12 The required potassium replacement varies greatly. The facilitator guides the group only when necessary. Scenarios thesimtech A collection of surgery revision notes covering key surgical topics. 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. "Never doubt that a small group of thoughtful, committed citizens can change the world. Note that if-thens must also include negative patient outcomes for when the provider doesnt take appropriate action. doi: 10.7759/cureus.1286. can be reemphasized, and the effects of fluid therapy demonstrated. Case-based education adds a real-world aspect to the learning environment. Scenario in a Nutshell Diabetic ketoacidosis (DKA) in pregnancy. Use washable, non-toxic paints to imitate various body emissions. She is lethargic and slightly confused but can intermittently respond to questions. The students are in their first year. Despite this increased calorie intake, she noticed an unexplained 20 lbs weight loss. Schneider Sarver PA, Senczakowicz EA, Slovensky BM. 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]). Using the arterial line, the scenario becomes much more dynamic. Diabetic Ketoacidosis in the Obstetric Population: A Simulation The instructor can also gauge the direction the debriefing session should follow or be alerted to possible problems or conflicts in treatment opinions. 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. may email you for journal alerts and information, but is committed Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario Diabetic Ketoacidosis in the Obstetric Population: A Simulation They have had no clinical exposure or any clinical experience. Margolis GS, Romer GA, Fernandez AR, et al. The student group should be encouraged to collaborate on management options and to perform skills. The following scenarios are available for download and are designed to meet your multi-disciplinary nursing needs. PDF Medicine Simulation Scenario Diabetic Ketoacidosis: An Emergency - Cureus The students mentioned that they did not obtain the maximum value from the simulation session under these circumstances. Open the patients airwayusing ahead-tiltchin-lift manoeuvre: 1. 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. An oxygen mask is also demonstrated as an alternative device, as these early trainees had mostly not yet seen any of these devices. For example, you could develop a diabetic scenario in which the prehospital provider encounters an altered patient with incomprehensible speech. The simulators do not have rock steady vital sign values, and the students were unsure as to write down 121 or 122 mm Hg as the systolic blood pressure. Makeup may be used to depict gender, hollow eyes and cheeks, produce pallor or display bruises and scars. A fixed-rate intravenous insulin infusion should be commenced initially to suppress ketogenesis, reduce blood glucose levels and address electrolyte disturbances. 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. Inspect for evidence of infection on the skin (e.g. 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). 2. Lets discuss your options. 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. 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. Immersive simulations are mentally exhausting because they create an intense and stressful atmosphere requiring the learner to work outside their comfort zone. 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. Indeed, it is the only thing that ever has.". <> 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. Effectiveness of simulation on health profession students knowledge, skills, confidence and satisfaction. In other words, they do not have clinical experience, but they have clinical knowledge. Well done, youve now stabilised the patient and theyre doing much better. We try to provide sufficient realism.. Geeky Medics accepts no liability for loss of any kind incurred as a result of reliance upon the information provided in this video. 2011;15:108109. 5. 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)? Askhow the patient is feeling as this may provide some useful information about their current symptoms. Data is temporarily unavailable. Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. The files are given in full in the web supplement (Appendix B, Supplemental Digital Content 2, https://links.lww.com/SIH/A2). There are just a few more things to do. After entering the environment, the student doesnt have the option of leaving the simulation until the learning objectives and performance measures are achieved. See ourintravenous cannulation guidefor more details. Diabetic Ketoacidosis (DKA) Clinical Pathway Emergency Department | Children's Hospital of Philadelphia See ourfluid prescribing guidefor more details onresuscitation fluids. 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. Trainee will appropriately request assistance and use available resources. Diabetes UK with the Joint British Diabetes Societies Inpatient Care Group. See ourhistory taking guidesfor more details. www.cdc.gov/diabetes/statistics/prev/national/. The teaching of diabetic assessment and management, like many other medical emergencies, lends itself well to case-based simulation. Groups of fewer than four students dont allow for optimal collaboration. 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. Outcomes Educating Nursing Students Using an Evolving, Simulated Case - Timing 03:23 Diabetic Ketoacidosis (DKA) | Acute Management | ABCDE Check out our NEW & IMPROVED quiz platform at geekyquiz.com, To be the first to know about our latest videos, subscribe to our YouTube channel . Trainee will be respectful to others and their views during the PBL session. This allows us to get in touch for more details if required. Prehosp Emerg Care. Its important to train and educate students of prehospital care on key indicators of a diabetic emergency. Simulation Training Ideal for Diabetic Patients - JEMS - Character 02:14 This simulation session therefore aims to make the case come alive, and show this known case in a clinical context. DKA can develop within 24 hours and is potentially life threatening, requiring prompt recognition and therapeutic intervention. Endocrine - thesimbook.com As this is an interactive discussion session, any needed debriefing and/or explanation is given during the sessions. The learning environment should closely mimic real-world applications. If you have any scenarios you would be willing to share with the simulation community, please forward them . Re-assessthe patient using theABCDE approachto identify any changes in their clinical condition and assess the effectiveness of your previous interventions. Case-based simulation should include two to three broad-focus objectives, as well as 1020 specific performance measures that the student should accomplish. Intubation lubricants can mimic drooling. Place one hand on the patients forehead and the other under the chin. Simulation-based medical education: An ethical imperative. <> Does the patient need reviewing by a specialist? See ourdocumentation guidesfor more details. areas of lipohypertrophy) if it is unclear if the patient is diabetic. 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. It was developed for anesthesiology resident physicians with some background knowledge and experience caring for critically ill patients. She had developed nausea, extreme fatigue, mild disorientation, and blurred vision toward the end of the soccer match. Perform urinalysis and send the urine for culture if urinary tract infection is suspected. Available from: [, NICE guidelines. stream An animated lecture may be described as a pseudo-simulation environment. There are several causes of DKA, which we remember by the "five I's". Observe and discuss the effects of therapy in a mathematically modeled physiological simulator. 6. The learning objectives follow the American College of Graduate Medical Education (ACGME) Core Compentencies. Available from: [. Geeky Medics accepts no liability for loss of any kind incurred as a result of reliance upon the information provided in this video. 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 . 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. PA EMT Said COVID Patient Didnt Need to Go to the Hospital. See ourCXR interpretation guidefor more details. NPAs should not be used in patients who may have sustained a skull base fracture, due to the small but life-threatening risk of entering the cranial vault with the NPA. Research Watch Box:Sleep, Fatigue & SafetyBy David Page, MS, NREMT-P KDCA for FSX - Fly Away Simulation Its best, however, to allow the student group to continue so theyre able to evaluate their decision-making processes during debriefing. opioids, sedatives, anxiolytics, insulin, oral hypoglycaemic medications). On the basis of the feedback from the students, they indicated that they believed the small group sessions are better. See our blood glucose measurement guide for more details. Airway adjuncts are often helpful and in some cases essential to maintain a patients airway. A patient with Type I diabetes will often have symptoms related to blood sugar imbalances that appear abruptly with polydipsia, polyuria, polyphagia and rapid weight loss.