TikTok: https://www.tiktok.com/@geekymedics General: Moaning, asking what has happening to her. Similar to a ward round, where the instructor would say: Come and listen to this patient with an aortic stenosis. Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario For similar reasons, we do not believe a videotaped session will keep the students attention as much as these live simulator sessions. Scenario in a Nutshell Diabetic ketoacidosis (DKA) in pregnancy. 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. Each performance measure is separated into cognitive, behavioral or technical categories. endobj
www.cdc.gov/diabetes/statistics/prev/national/. A nasopharyngeal airway is a soft plastic tube with a bevel at one end and a flange at the other. . 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. Environment & Manikin
After initial insulin therapy has reduced plasma blood glucose levels (e.g. Circulating nurse in the emergency room (ER). Facilitator to ask how often to measure BMs Each PBL case typically goes over 23 days, affording the students periods to find information for the case. Emergency medical services workLife characteristics contribute to clinically significant excessive daytime sleepiness. Extremities: mild cyanosis, no clubbing or edema (verbalized by instructors); pulses equal, and symmetrical (elucidated by trainees). may email you for journal alerts and information, but is committed
Immersive simulations are mentally exhausting because they create an intense and stressful atmosphere requiring the learner to work outside their comfort zone. 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). This is particularly important for core cases and low-frequency, high-stakes procedures and encounters. Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario Cureus. Initially, we used a blood pressure cuff to generate the blood pressure values. diagnosis of DKA Trigger 3, ABG show acidosis and high BM and normal potassium. Evenly balancing performance measures will ensure the student has the opportunity to critically think through patient treatment and to practice new or support previously learned behaviors and technical skills. Debriefing
1) Please read through this document as it will help you prepare for your upcoming simulation on 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. Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. Diabetic Ketoacidosis (DKA) Clinical Pathway Emergency Department She does not take this regularly. Highlight selected keywords in the article text. The Theory
We guide the group to suggest fluid. Scenarios thesimtech One of the key differences with the immersive simulation is that the instructor is absent from the simulation environment. Performing an ECG should not delay the emergency management of DKA. The researchers found that long shift hours (24hrs), working overtime and marital/relationship stress were strongly correlated. 4 0 obj
Scenarios. - Examples 05:45 endobj
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. We have 18 to 20 PBL groups for an hour each in the week after their PBL DKA session. 5. confusion, coma), All critically unwell patients should have. The objective is to give as many visual and tactile cues concerning the patient condition and background as possible. 4. 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). Clearly communicate how often would you like the patients observations relayed to you by other staff members. The reason for inserting the airway upside down initially is to reduce the risk of pushing the tongue backwards and worsening airway obstruction. In this manner, the students have to apply their knowledge at the appropriate points during the progression of the scenario. Stage 3: Ongoing management and monitoring of DKA 1 hour after initiation of treatment. Problems are addressed as they are identified and the patient is re-assessed regularly to monitor their response to treatment. When erroneous treatment is delivered, the instructor can end the simulation. type 1 diabetes), Complete insulin insensitivity (e.g. You might also be interested in our awesome bank of 700+ OSCE Stations. A debriefing section with pre-established questions allows the instructor to review the main focus and performance measures with the student group. Diabetic Ketoacidosis (DKA) Clinical Pathway Emergency Department | Children's Hospital of Philadelphia This field is for validation purposes and should be left unchanged. Given 6 to 8 back-to-back sessions, it is critical that every session starts and ends on time! Heart: S1 and S2 within normal limits; no S3/S4 or murmurs, normal rate and rhythm. Assess the patients level of consciousness using the AVPU scale: If a more detailed assessment of the patients level of consciousness is required, use the Glasgow Coma Scale (GCS). Discuss the patients current clinical condition with aseniorclinicianusing anSBARR style handover. The students are in their basic science course. A pre-briefing session is conducted prior to the start of the simulation scenario. Yes: if the patient can talk, their airway is patent and you can move on to the assessment of breathing. Standardized patient as the voice of the simulator (or the simulation operator may play this role). oral fluids, intravenous fluids, urine output, drain output, stool output, vomiting) to inform resuscitation efforts. Tilt the forehead back whilst lifting the chin forwards to extend the neck. The simulation session is also hosted as an interactive session. The required potassium replacement varies greatly. An events progression section should include patient status changes, as well as a time/treatment continuum that incorporates if-then event progressions. The students have acquired all the applicable theoretical knowledge of the case during the previous multiday PBL sessions. 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. insulin-dependent type 2 diabetes), Altered consciousness (e.g. 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. A collection of communication skills guides, for common OSCE scenarios, including history taking and information giving. Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario Insert at least onewide-bore intravenous cannula(14G or 16G) and take blood tests as discussed below. Simulation-based medical education: An ethical imperative. - Introduction 00:00 Conclusion: Our DKA simulator is a new tool whose objective is the training in a severe, frequent and complex situation, and can be used to improve the approach made by the junior physicians to the real diabetic . From the Department of Anesthesiology, Pennsylvania State University College of Medicine, Hershey, PA. Dr. Murray is on the Speakers Bureau of METI, Sarasota, FL. If the patient has COPD and a history of CO2retention you should switch to aventuri maskas soon as possible andtitrate oxygen appropriately. Instagram: https://instagram.com/geekymedics reduced air entry, coarse crackles) to screen for evidence of pneumonia. Subscribe to our newsletter to be the first to know about our latest content: https://geekymedics.com/newsletter/ Patients with DKA require fluid resuscitation to restore circulatory volume, clear ketones, correct electrolyte abnormalities and increase renal perfusion. Consider any precipitating factors for the development of DKA and involve the diabetes team in the patients care. Check out our other awesome clinical skills resources including: See ourhistory taking guidesfor more details. The Pratcice
Teaching nursing management of diabetic ketoacidosis: a description of 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. 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. This allows the learner group to make a psychological break from the patient and environment while beginning the reflection process. MassBay EMS Program Integrates Training for Dogs, Heat Waves Are Killing More LA Homeless People. If any obstruction is encountered, remove the tube and try the left nostril. The DKA simulation incorporates cue recognition, analysis of cues, generation of solutions, nursing interventions, and evaluation of outcomes, including effective communication and psychosocial concerns. PDF Diabetic Ketoacidosis in the Obstetric Population: A Simulation 3. See our blood glucose measurement guide for more details. 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. 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. Keywords: diabetic ketoacidosis, simulation, expertise, emergency medicine Introduction Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes mellitus, most . Trainee will increase knowledge of professional behaviors during the simulation. 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 . Make sure thepatientsnotes,observationchartandprescriptionchartare easily accessible. Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario 2011;15:108109. Diabetic ketoacidosis simulator: a new learning tool for a life 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. Conclusions This technical report describes the design and implementation of a simulation scenario on DKA for emergency medicine trainees. Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario. - PDF She had developed nausea, extreme fatigue, mild disorientation, and blurred vision toward the end of the soccer match. The simulation experience serves to give substance to the theoretical words and concepts that the students encountered during the PBL sessions. Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. <>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 595.32 841.92] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>>
They have had no clinical exposure or any clinical experience. This guide provides an overview of the recognition and immediate management of diabetic ketoacidosis (DKA)using an ABCDE approach. Strategies of high-performing paramedic educational programs. 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. Terms of Use. After the first voluntary session in 2006, feedback from the medical students indicated that they would like to receive this handout. A collection of free medical student quizzes to put your medical and surgical knowledge to the test! DKA can develop within 24 hours and is potentially life threatening, requiring prompt recognition and therapeutic intervention. Search for Similar Articles
Stage 1: Initial assessment of acutely unwell pregnant woman and diagnosis of DKA. "Never doubt that a small group of thoughtful, committed citizens can change the world. Askhow the patient is feeling as this may provide some useful information about their current symptoms. This is particularly important for core . Perform urinalysis and send the urine for culture if urinary tract infection is suspected. . 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. - Character 02:14 It involves working through the following steps: Each stage of the ABCDE approach involvesclinicalassessment,investigationsandinterventions. Re-assessthe patient using theABCDE approachto identify any changes in their clinical condition and assess the effectiveness of your previous interventions. The choice of fluid type, rate of administration and volume should be tailored to the individual patient based upon their vital signs and electrolytes. If an obstruction is visible within the airway, use afingersweeporsuctionto remove it. We have spent many hours debating whether the small group format was a waste of time. Diabetes mellitus affects nearly 7.8% of the U.S. population, with approximately 510% of this group affected by Type I and 9095% by Type II.1 Diabetes is the most common type of endocrine disease and was the seventh leading underlying cause of death listed on death certificates in 2006. Adds true to life parking codes and extra parking for AI. The consequences (low blood pressure, high heart rate, central nervous system status, etc.) Airway adjuncts are often helpful and in some cases essential to maintain a patients airway. Surgical dressings and imitation blood can support medical history. In this case scenario, dehydration is one of the most serious immediate issues. Join the Geeky Medics community: Alert a senior immediately if you have any concerns about the consciousness level of a patient. Categories: Emergency Medicine, Medical Education Keywords: diabetic ketoacidosis, simulation, expertise, emergency medicine . Introduceyourselfto thepatientincluding yournameandrole. Research Watch Box:Sleep, Fatigue & SafetyBy David Page, MS, NREMT-P
A chest X-ray should not delay the emergency management of DKA. See Table 4 for a suggested standardized script. 1 0 obj
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. Groups of fewer than four students dont allow for optimal collaboration. Indeed, it is the only thing that ever has.". Stage 2: Emergency management of DKA and consideration of abnormal CTG. 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. Typically potassium levels should be maintained between 4.0 5.5 mmol/L and close monitoring is required. You can check out our guide to using SOCRATES here: https://geekymedics.com/the-socrates-acronym-in-history-taking/ %PDF-1.5
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. It may be necessary toexposethe patient during your assessment: remember to prioritise patient dignity and conservation of body heat. >> Fernandez AR, Mac Crawford J, Pennell ML, et al. The students are in their basic science course. (1) According to Centers for Disease Control and Prevention (CDC), 223,619 deaths were attributed to diabetes in 2005. His Wife Gave Him CPR. Medical Simulation Scenarios are text documents outlining the various details of a simulation - everything from patient simulator settings to debriefing notes. For example, you could develop a diabetic scenario in which the prehospital provider encounters an altered patient with incomprehensible speech. 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). Causes: Any situation arising in a diabetic that requires increased insulin without that demand being met can result in DKA. 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. 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). 1-6. In the context of DKA, a patients consciousness level may be reduced. Initially, we had a white board available, but the temptation (and habits) were just too strong, and the simulator sessions tended to become one way lectures, rather than an interactive, 2 way discussion.. See ourfluid prescribing guidefor more details onresuscitation fluids. Does the patient need reviewing by a specialist? Inspect for evidence of self-injection sites (e.g. Use washable, non-toxic paints to imitate various body emissions. opioids, sedatives, anxiolytics, insulin, oral hypoglycaemic medications). See ourintravenous cannulation guidefor more details. Two abstracts related to sleepiness in the EMS workforce were presented at the National Association of EMS Physicians symposium in January.