For example, you could develop a diabetic scenario in which the prehospital provider encounters an altered patient with incomprehensible speech. See ourfluid prescribing guidefor more details onresuscitation fluids. 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. - Over 3000 Free MCQs: https://geekyquiz.com/ CCA 175 Real Time Exam Scenario 17 | JOIN Multiple DataFrames | Save as 34 - Diabetic Ketoacidosis in Pregnancy | Obgyn Key As this is a PBL session, the trainees are not given any references. A number of key modifiers are described that allow for the adjustment of case . 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. It involves working through the following steps: Each stage of the ABCDE approach involvesclinicalassessment,investigationsandinterventions. The student group should be encouraged to collaborate on management options and to perform skills. 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. Healthcare Students' Psychological Well-Being in a Diabetic Ketoacidosis Simulation. This is particularly important for core cases and low-frequency, high-stakes procedures and encounters. We are looking for declaration of DKA and request for pathway. Marx JA, Hockberger RS, Walls RM. 4. 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. 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. A well-staged environment allows for greater student buy-in. Immersive Simulations Intubation lubricants can mimic drooling. Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. Introduceyourselfto thepatientincluding yournameandrole. The lecture allows for understanding of concepts prior to action, and instructor feedback is immediate. Geeky Medics accepts no liability for loss of any kind incurred as a result of reliance upon the information provided in this video. Scenarios thesimtech angioedema, rash) commence appropriate treatment as discussed in ouranaphylaxis guide. These are not learning objectives in this program. 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. Clinical Simulation in Nursing, Volume 39, 2020, pp. Therefore, the same file is also sent to the participants before the session. Diabetic Ketoacidosis (DKA) | Acute Management | ABCDE 2003;78:783788. 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. The learning environment should closely mimic real-world applications. DO NOT perform any examination or procedure on patients based purely on the content of these videos. Review the patientscurrent medicationsand check any regular medications areprescribed appropriately. Simulation Training Ideal for Diabetic Patients - JEMS type 1 diabetes), Complete insulin insensitivity (e.g. If the patient is conscious, sit themuprightas this can also help with oxygenation. Diabetic Ketoacidosis in the Obstetric Population: A Simulation 3. Invasive monitors, including a left radial intraarterial and a right subclavian IV catheter, were placed. Conclusions This technical report describes the design and implementation of a simulation scenario on DKA for emergency medicine trainees. 1) Please read through this document as it will help you prepare for your upcoming simulation on DKA. 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. 2010;49:578586. If the patient has COPD and a history of CO2retention you should switch to aventuri maskas soon as possible andtitrate oxygen appropriately. The DKA simulation incorporates cue recognition, analysis of cues, generation of solutions, nursing interventions, and evaluation of outcomes, including effective communication and psychosocial concerns. This may produce better retention of the subject matter and help students adapt to emergency scenes before going into the field. Capillary refill timemay be prolonged if the patient is hypovolaemic. Inspect the urine currently in the catheter bag and note its appearance (e.g. COVID-19 Screening in the Pediatric Emergency Department. Should any changes be made to the current management of their underlying condition(s)? 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. Nandate, Koichiro MD, PhD; Abola, Ramon MD; Murray, W Bosseau MB; Whitfield, Carol PhD; Lang, Charles PhD; Sinz, Elizabeth MD. Cureus is on a mission to change the long-standing paradigm of medical publishing, where submitting research can be costly, complex and time-consuming. In an animated lecture, its important that the student group have an instructor so they can ask direct questions. In this section, we have to help the trainee to institute definitive therapy based on the underlying biochemical abnormalities. 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). %PDF-1.5 Trigger 4, Pathway 1l of saline required over 1hour and insulin infusion need prescribing and making up in 50ml syringe. Prehosp Emerg Care. The instructions to the facilitators suggest a series of structured, sequential questions to the students (starting at one end, involving each student in turn, and repeatedly cycling around the group.) 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. 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). SimMan Nursing Scenarios Software. Trainee will improve their understanding of clinical practice through reflective assessment of actual cases during the prior PBL sessions. Tilt the forehead back whilst lifting the chin forwards to extend the neck. She had developed nausea, extreme fatigue, mild disorientation, and blurred vision toward the end of the soccer match. Keyword Highlighting Inspect theairwayfor obviousobstruction. Askhow the patient is feeling as this may provide some useful information about their current symptoms. There are several causes of DKA, which we remember by the "five I's". Medical Simulation Scenarios are text documents outlining the various details of a simulation - everything from patient simulator settings to debriefing notes. 2 The evaluation of potassium deficits is complicated by potassium exit from . Discuss the patients current clinical condition with aseniorclinicianusing anSBARR style handover. You may search for similar articles that contain these same keywords or you may After the first voluntary session in 2006, feedback from the medical students indicated that they would like to receive this handout. Patients with DKA require fluid resuscitation to restore circulatory volume, clear ketones, correct electrolyte abnormalities and increase renal perfusion. >> Fernandez AR, Mac Crawford J, Pennell ML, et al. 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. The teaching of diabetic assessment and management, like many other medical emergencies, lends itself well to case-based simulation. Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. A collection of communication skills guides, for common OSCE scenarios, including history taking and information giving. 2 0 obj The student group is given a short introduction into a closed simulation environment. 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! Management of diabetic ketoacidosis in adults. - 150+ PDF OSCE Checklists: https://geekymedics.com/pdf-osce-checklists/ <>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 595.32 841.92] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> The main purpose of the simulation is to draw a line from the theoretical, boring biochemistry to the clinical manifestations. 2. Refer to your local guidelines which should provide a clear protocol for the management of DKA. Case-based simulation should include two to three broad-focus objectives, as well as 1020 specific performance measures that the student should accomplish. Classroom Dynamics Initially, we required the students to write down the vital signs. See ourhistory taking guidesfor more details. Insert the airway bevel-end first, vertically along the floor of the nose with a slight twisting action. 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. . There are just a few more things to do. General: Moaning, asking what has happening to her. diagnosis of DKA Trigger 3, ABG show acidosis and high BM and normal potassium. The students worked on the underlying physiology during a week long PBL session and are therefore familiar with the theoretical aspects of DKA. 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. Ziv A, Wolpe PR, Small SD, et al. Diabetic Ketoacidosis in the Obstetric Population: A Simulation modify the keyword list to augment your search. Each PBL case typically goes over 23 days, affording the students periods to find information for the case. We have 18 to 20 PBL groups for an hour each in the week after their PBL DKA session. 2007. Prehosp Emerg Care. Given 6 to 8 back-to-back sessions, it is critical that every session starts and ends on time! DOI 10.7759/cureus.1286. Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario Trainee will learn to collaborate with peers to decide on appropriate interventions, tests, and therapy. Refer to your local guidelines for further details. Kymera Systems Inc | SCADA Online Demo Ignition 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. We then start the DKA state. See Appendix D, Supplemental Digital Content 4, https://links.lww.com/SIH/A4.