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. Mosby:Philadelphia.
PDF Adult Type I Diabetic Ketoacidosis Pre-simulation Preparation Student Insert at least onewide-bore intravenous cannula(14G or 16G) and take blood tests as discussed below. We now provide the students with handouts of the data to save time and provide consistency. <>
In this section, we have to help the trainee to institute definitive therapy based on the underlying biochemical abnormalities. 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. 2.
Simulation student Scenario- DKA-Peds.docx - DIABETIC This is particularly important for core cases and low-frequency, high-stakes procedures and encounters. Lets discuss your options. 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. insulin-dependent type 2 diabetes), Altered consciousness (e.g. 2009;13:505511. A comprehensive collection of clinical examination OSCE guides that include step-by-step images of key steps, video demonstrations and PDF mark schemes. DO NOT perform any examination or procedure on patients based purely on the content of these videos. 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. - Medical Finals Question Pack: https://geekymedics.com/medical-student-finals-questions/ On the basis of the feedback from the students, they indicated that they believed the small group sessions are better. Airway adjuncts are often helpful and in some cases essential to maintain a patients airway. One of the key differences with the immersive simulation is that the instructor is absent from the simulation environment. - Associated symptoms 03:04 Interactive lecture/discussion with use of monitors that show the vital signs of the simulated patient on manikin. Download: http://teamworkmatters.ocbmedia.com/media/DKA-Simulation-Scenario.docx Categories: 5th Year MBChB paeds scenario, Emergency Department, Human Factors, Interprofessional / multidisciplinary, Non-technical skills, Paediatrics, Postgraduate / newly qualified, Undergraduate / pre-registration Rating Prehosp Emerg Care.
Diabetic ketoacidosis simulator: a new learning tool for a life 6. 2010;49:578586. a simulation training session designed to acquaint emergency medicine residents with the presentation and management of diabetic ketoacidosis (DKA) through the use of simulation. dq-]gX4
`L'u7myx) rpjf0z,.y`VMyx-&Ju`U0 Typically potassium levels should be maintained between 4.0 5.5 mmol/L and close monitoring is required. They should introduce the student group to the environment, assign roles for each learner and guide the decision-making process. Much time was wasted explaining why it did not matter.
Teaching nursing management of diabetic ketoacidosis: a description of 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. Inspect for evidence of self-injection sites (e.g. Furthermore, we demonstrate and explain the basic parameters (ECG, SpO2, BP, capnography), using an interactive format of questions and answers, and encourage the group to observe the normal values. 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. Ask for anotherclinicalmemberofstafftoassistyou if possible. Healthcare Students' Psychological Well-Being in a Diabetic Ketoacidosis Simulation. If any obstruction is encountered, remove the tube and try the left nostril. Heart: S1 and S2 within normal limits; no S3/S4 or murmurs, normal rate and rhythm. DOI 10.7759/cureus.1286. If the patient is suspected to have sufferedsignificanttraumawith potential spinal involvement, perform ajaw-thrustrather than a head-tilt chin-lift manoeuvre: 2. tall tented T waves in hyperkalaemia). If foreign material is present, attempt removal using suction. 2. 3 0 obj
Askhow the patient is feeling as this may provide some useful information about their current symptoms. Available from: [, NICE guidelines. Laschinger S, Medves J, Pulling C, et al. General: Moaning, asking what has happening to her. - Introduction 00:00 Chapters: It was developed for anesthesiology resident physicians with some background knowledge and experience caring for critically ill patients. A collection of data interpretation guides to help you learn how to interpret various laboratory and radiology investigations.
Creating a Simulation Experience to Promote Clinical Judgment 1. This may produce better retention of the subject matter and help students adapt to emergency scenes before going into the field. 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. This typically involves the use of anon-rebreathe maskwith an oxygen flow rate of15L. Review thepatients notes,chartsandrecent investigation results. This guide provides an overview of the recognition and immediate management of diabetic ketoacidosis (DKA)using an ABCDE approach. We are looking for declaration of DKA and request for pathway. Management of diabetic ketoacidosis in adults. Centers for Disease Control and Prevention. Nandate, Koichiro MD, PhD; Abola, Ramon MD; Murray, W Bosseau MB; Whitfield, Carol PhD; Lang, Charles PhD; Sinz, Elizabeth MD. 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 the meantime, you can perform some basic airway manoeuvres to help maintain the airway whilst awaiting senior input. We also show them IV bags containing saline and Ringers lactate, as well as show them IV infusion sets. opioids, sedatives, anxiolytics, insulin, oral hypoglycaemic medications). With your index and other fingers placed behind the angle of the mandible, apply steady upwards and forward pressure to lift the mandible. PBL was introduced at our institution in 1995. 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 . - Onset 01:48 Therefore, the same file is also sent to the participants before the session. Its best, however, to allow the student group to continue so theyre able to evaluate their decision-making processes during debriefing. The validity of the HFS-DKA scenario was verified by a certified diabetes nurse educator, a registered nurse, and a clinical nurse educator. The main purpose of the simulation is to draw a line from the theoretical, boring biochemistry to the clinical manifestations. She Died the Next Day. Finally, we summarize the course and give them time for questions. Clearlydocument your ABCDE assessment, including history, examination, observations, investigations, interventions, and the patients response. This allows the learner group to make a psychological break from the patient and environment while beginning the reflection process. 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. Prehosp Emerg Care. 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. Despite this increased calorie intake, she noticed an unexplained 20 lbs weight loss. Works with Traffic 2005, but . If the patient has COPD and a history of CO2retention you should switch to aventuri maskas soon as possible andtitrate oxygen appropriately. A comprehensive collection of OSCE guides to common clinical procedures, including step-by-step images of key steps, video demonstrations and PDF mark schemes. Scenario in a Nutshell Diabetic ketoacidosis (DKA) in pregnancy. Given 6 to 8 back-to-back sessions, it is critical that every session starts and ends on time! She tends to drink sugar containing fluids (soda) when she is thirsty, and she eats fast foods (cream-filled muffins) when she is hungry. 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.
PDF Medicine Simulation Scenario Diabetic Ketoacidosis: An Emergency Simulation Training Ideal for Diabetic Patients - JEMS 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. 3. Acad Med. The required potassium replacement varies greatly. Should any changes be made to the current management of their underlying condition(s)? Indeed, it is the only thing that ever has.". . In the final 10 minutes, we show how the patient has a good recovery after fluid replacement. 3. 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. A well-staged environment allows for greater student buy-in. The students are in their first year. endobj
Diabetes UK with the Joint British Diabetes Societies Inpatient Care Group. Conclusion
4. Categories: Emergency Medicine, Medical Education Keywords: diabetic ketoacidosis, simulation, expertise, emergency medicine . Conclusions This technical report describes the design and implementation of a simulation scenario on DKA for emergency medicine trainees. An events progression section should include patient status changes, as well as a time/treatment continuum that incorporates if-then event progressions. ABG, venepuncture). The instructor can also gauge the direction the debriefing session should follow or be alerted to possible problems or conflicts in treatment opinions. (1) According to Centers for Disease Control and Prevention (CDC), 223,619 deaths were attributed to diabetes in 2005. 5. 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. Classroom Dynamics
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. This simulation session therefore aims to make the case come alive, and show this known case in a clinical context. 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). In some cases, normal saline with additional potassium is required to prevent overcorrection of serum potassium levels which would otherwise result in hypokalaemia. 2 0 obj
A nasopharyngeal airway is a soft plastic tube with a bevel at one end and a flange at the other. Maintain head-tilt chin-lift or jaw thrust and assess the patency of the patients airway by looking, listening and feeling for signs of breathing. 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. Trainee will learn to collaborate with peers to decide on appropriate interventions, tests, and therapy. Inspect the urine currently in the catheter bag and note its appearance (e.g. confusion, coma), All critically unwell patients should have. Inspect for evidence of infection on the skin (e.g.
KDCA for FSX - Fly Away Simulation 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 normal reference range for fasting plasma glucose is 4.0 5.8 mmol/l. 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. It involves a facilitating instructor, a small learner group and conceptual aspects of environmental and manikin staging to provide sensory cues. In the meantime, you should re-assess and maintain the patients airway. - Over 3000 Free MCQs: https://geekyquiz.com/ Insert the airway bevel-end first, vertically along the floor of the nose with a slight twisting action.