The following scenarios are available for download and are designed to meet your multi-disciplinary nursing needs. It was Medical Simulation Scenarios are text documents outlining the various details of a simulation - everything from patient simulator settings to debriefing notes. 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. Invasive monitors, including a left radial intraarterial and a right subclavian IV catheter, were placed. - Timing 03:23 Revisit history taking to explore relevant medical history and identify any precipitating factors for DKA. This video demonstrates how to use the SOCRATES acronym when taking a history of pain or other symptoms. 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 . PDF Adult Type I Diabetic Ketoacidosis Pre-simulation Preparation Student This allows us to get in touch for more details if required. Diabetic ketoacidosis (DKA) is a common, potentially lethal disease. Please note that by doing so you agree to be added to our monthly email newsletter distribution list. Standardized patient as the voice of the simulator (or the simulation operator may play this role). Debriefing
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. We introduce the Simulation Laboratory and the Simulator, and demonstrate: pulses, eyes blinking, pupil constriction, gas moves in and out of mouth (place hand over mouth), chest moves up and down. <>>>
3. Pediatric Emergency Medicine Didactics and Simulation (PEMDAS Data Description All the product records are stored at /user/spark/dataset/retail_db/products All the category records are stored at /user/spark/dataset /ret. There are just a few more things to do. As with the animated lecture, the simulation is strongly dependent on a focused case study. Paediatric DKA | Simulation Education We have 18 to 20 PBL groups for an hour each in the week after their PBL DKA session. The main goal is to establish a safe learning environment for the learner [9, 13 . #geekymedics #fyp #fypviral #studytok #medicalstudentuk #medtok #studytips #studytipsforstudents #medstudentuk #premed #medschoolfinals, Cardiovascular History Tips - DON'T FORGET these 3 things . Alert a senior immediately if you have any concerns about the consciousness level of a patient. Trainee will recognize and interpret the clinical signs and symptoms and the typical history of a patient with DKA, as well as understand the major causative factors of DKA. Search for Similar Articles
Should any changes be made to the current management of their underlying condition(s)? These are not learning objectives in this program. A collection of anatomy notes covering the key anatomy concepts that medical students need to learn. It should only be inserted in unconscious patients as it is otherwise poorly tolerated and may induce gagging and aspiration. If an infection is suspected, IV antibioticsshould be administered as soon as possible. In the first, the authors expanded the National Registrys Longitudinal EMT Attributes and Demographic (LEADS) study by resurveying 1,600 EMS workers about their sleepiness while at work. 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. Urinary tract infections are a common DKA precipitant. The main purpose of the simulation is to draw a line from the theoretical, boring biochemistry to the clinical manifestations. After entering the environment, the student doesnt have the option of leaving the simulation until the learning objectives and performance measures are achieved. The relationship between sleep, fatigue and patient and provider safety. Simulation provides a safe environment where learning is enhanced through the deliberate practice of skills and controlled management of a variety of clinical encounters. Chapters: To read Pages full Research Review column, visit www.jems.com/patient-care. - Examples 05:45 Review the patientscurrent medicationsand check any regular medications areprescribed appropriately. The students are in their basic science course. Cureus is on a mission to change the long-standing paradigm of medical publishing, where submitting research can be costly, complex and time-consuming. (1), The assessment of a diabetic patient is best taught as a case-based simulation. Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario Cureus. 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 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. The validity of the HFS-DKA scenario was verified by a certified diabetes nurse educator, a registered nurse, and a clinical nurse educator. DO NOT perform any examination or procedure on patients based purely on the content of these videos. Geeky Medics accepts no liability for loss of any kind incurred as a result of reliance upon the information provided in this video. Please enable scripts and reload this page. Trainee will improve their understanding of clinical practice through reflective assessment of actual cases during the prior PBL sessions. Make sure to re-assess the patient after any intervention. See ourfluid prescribing guidefor more details onresuscitation fluids. An animated lecture may be described as a pseudo-simulation environment. a simulation training session designed to acquaint emergency medicine residents with the presentation and management of diabetic ketoacidosis (DKA) through the use of simulation. The file explaining the session is sent to instructors 1 week before the sessions. 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). For more information, please refer to our Privacy Policy. diagnosis of DKA Trigger 3, ABG show acidosis and high BM and normal potassium. A comprehensive collection of clinical examination OSCE guides that include step-by-step images of key steps, video demonstrations and PDF mark schemes. 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. Please try after some time. We are looking for declaration of DKA and request for pathway. Much time was wasted explaining why it did not matter. PDF Diabetic Ketoacidosis in the Obstetric Population: A Simulation Management of diabetic ketoacidosis in adults. 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. 1. This leads to hyperglycaemia, osmotic diuresis, and dehydration. Simulation Training Ideal for Diabetic Patients - JEMS 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. If you have any scenarios you would be willing to share with the simulation community, please forward them . A comprehensive collection of medical revision notes that cover a broad range of clinical topics. Tilt the forehead back whilst lifting the chin forwards to extend the neck. PDF Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario . See ourdocumentation guidesfor more details. Does the patient need reviewing by a specialist? DKA can develop within 24 hours and is potentially life threatening, requiring prompt recognition and therapeutic intervention. Acad Med. 2 The evaluation of potassium deficits is complicated by potassium exit from . If the provider starts an IV and gives dextrose, then the patients alertness will increase, respirations will normalize and repeated blood glucose will read 210 mg/dL over a two-minute interval. 2017 May 29;9(5):e1286. Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes mellitus, most common in patients with type 1 diabetes in particular due to a deficiency or absence of insulin [1].. The learning environment should closely mimic real-world applications. See Table 4 for a suggested standardized script. In this case scenario, dehydration is one of the most serious immediate issues. 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.. 2011;15:108109. Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario opioids, sedatives, anxiolytics, insulin, oral hypoglycaemic medications). Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario One advantage to the animated lecture style is the ability to introduce treatment options in a methodically guided approach thats in conjunction with simultaneous environmental stimulus. By joining Cureus, you agree to our The teaching of diabetic assessment and management, like many other medical emergencies, lends itself well to case-based simulation. 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. Over the years, some groups happened to have the simulation session before the completion of the theoretical PBL session. endobj
We do not use passive visualizing materials such as videotapes or DVD other than vital signs shown on the monitors. 2. insulin-dependent type 2 diabetes), Altered consciousness (e.g. Observe and discuss the effects of therapy in a mathematically modeled physiological simulator. 5. 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. Depending on scenario complexity, team dynamic and treatment modalities, this simulation may take 1020 minutes. The patient synopsis should include such standard aspects as age, sex, ethnicity, medical history, medications and allergies. If any obstruction is encountered, remove the tube and try the left nostril. 2009;13:505511. 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). Keyword Highlighting
When a group treatment decision is made that would be contraindicated or harmful to the patient, the instructor can redirect the learner group while maintaining an atmosphere inclined toward independent thinking. Capillary refill timemay be prolonged if the patient is hypovolaemic. We combined both to indicate the continuity of the curriculum, and the building on prior knowledge. 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. A well-staged environment allows for greater student buy-in. 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. She Died the Next Day. - Associated symptoms 03:04 PBL was introduced at our institution in 1995. This is a 25-year-old woman with a medical history of diabetes medicated with 40 units insulin per day. Insert at least onewide-bore intravenous cannula(14G or 16G) and take blood tests as discussed below. Finally, we summarize the course and give them time for questions. Heart: S1 and S2 within normal limits; no S3/S4 or murmurs, normal rate and rhythm. 4. Groups of more than seven may struggle with meeting objectives due to insufficient functional rolls. This is particularly important for core . Categories: Emergency Medicine, Medical Education Keywords: diabetic ketoacidosis, simulation, expertise, emergency medicine . Ziv A, Wolpe PR, Small SD, et al. Strategies of high-performing paramedic educational programs. The Pratcice
Simulation-based medical education: An ethical imperative. We try to provide sufficient realism.. PA EMT Said COVID Patient Didnt Need to Go to the Hospital. %PDF-1.5
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. Glycosuria leads to urinary losses of potassium through osmotic diuresis. If the patient loses consciousness and there are no signs of life on assessment, put out a crash call and commence CPR. This typically involves the use of anon-rebreathe maskwith an oxygen flow rate of15L. Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario Privacy Policy Nandate, Koichiro MD, PhD; Abola, Ramon MD; Murray, W Bosseau MB; Whitfield, Carol PhD; Lang, Charles PhD; Sinz, Elizabeth MD. Subscribe to our newsletter to be the first to know about our latest content: https://geekymedics.com/newsletter/ Inspect the urine currently in the catheter bag and note its appearance (e.g. A pre-briefing session is conducted prior to the start of the simulation scenario. She was taken to the Emergency Department from her soccer game because she complained of nausea, extreme fatigue, mild disorientation, and blurred vision toward the end of the soccer match. She is lethargic and slightly confused but can intermittently respond to questions. See ourhistory taking guidesfor more details. Problems are addressed as they are identified and the patient is re-assessed regularly to monitor their response to treatment. endobj
Physician working in the emergency department. Instructors should write a case study for the simulation before the session. 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. >> Patterson PD, Weaver M, Frank R, et al. J Nurs Educ. In keeping with the case study, as a treatment marker is reached, the instructor should place emphasis on physiological, pharmacological, environmental and psychosocial issues. We do point out the blood pressure (BP) cuff, but these medical students in their first year do not really need to know how the BP values are generated, they need to understand the origin and therapy for the low blood pressure. You may be trying to access this site from a secured browser on the server. >> Fernandez AR, Mac Crawford J, Pennell ML, et al. Recognize the signs and symptoms of a patient presenting with diabetic ketoacidosis. This guide provides an overview of the recognition and immediate management of diabetic ketoacidosis (DKA)using an ABCDE approach. If the patient is suspected to have sufferedsignificanttraumawith potential spinal involvement, perform ajaw-thrustrather than a head-tilt chin-lift manoeuvre: 2. The Theory
Catheterisethe patient to closelymonitor urine outputto guide fluid resuscitation and need for escalation. Inspect for evidence of infection on the skin (e.g. If the patient is conscious, sit themuprightas this can also help with oxygenation. We are adding to their theoretical knowledge by introducing them to physical objects, dynamic moving vital sign signals, and a moving, breathing simulated patient to make the case come alive. Conclusion
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. 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 . An oxygen mask is also demonstrated as an alternative device, as these early trainees had mostly not yet seen any of these devices. Conclusions This technical report describes the design and implementation of a simulation scenario on DKA for emergency medicine trainees. Yes: if the patient can talk, their airway is patent and you can move on to the assessment of breathing. 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. 4 0 obj
The DKA simulation incorporates cue recognition, analysis of cues, generation of solutions, nursing interventions, and evaluation of outcomes, including effective communication and psychosocial concerns. The simulation session is also hosted as an interactive session. DOI 10.7759/cureus.1286. 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. Administer oxygen to all critically unwell patients during yourinitialassessment. Circulating nurse in the emergency room (ER). The students have acquired all the applicable theoretical knowledge of the case during the previous multiday PBL sessions. A debriefing section with pre-established questions allows the instructor to review the main focus and performance measures with the student group.