Scenario in a Nutshell Diabetic ketoacidosis (DKA) in pregnancy. 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. Trainee will appropriately request assistance and use available resources. 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. SimMan offers you the ability to provide simulation education to challenge and test your students clinical and decision-making skills during realistic patient care scenarios. From the Department of Anesthesiology, Pennsylvania State University College of Medicine, Hershey, PA. Dr. Murray is on the Speakers Bureau of METI, Sarasota, FL. 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). Both external and internal potassium balances are disturbed during the development and treatment of DKA. Simulation provides a safe environment where learning is enhanced through the deliberate practice of skills and controlled management of a variety of clinical encounters. Some manikin models support a variety of human functions, such as capillary and facial cyanosis, facial sweating, foley catheter and IV placement, blood pressure generation, cardiac rhythms and abnormalities, defibrillation, cardioversion, external pacing and vital sign generation. The Theory insulin-dependent type 2 diabetes) Symptoms Typical symptoms of DKA include: Palpitations Nausea Vomiting Sweating Thirst Weight loss Leg cramps Clinical signs Typical clinical signs of DKA include: Tachycardia Hypotension We ask the trainee why the blood pressure is so low or heart rate is so high, and how we should treat it. If the patient isunconsciousorunresponsive, start thebasic life support(BLS)algorithmas per resuscitation guidelines. Marx JA, Hockberger RS, Walls RM. 1-6. 3 0 obj During the debriefing process that follows the simulation, well-balanced performance measures will guide feedback toward accomplished tasks and may illustrate existing decision-making, behavioral or technical skill deficits. 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. The relationship between sleep, fatigue and patient and provider safety. 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. Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. 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]). PBL was introduced at our institution in 1995. Use an effectiveSBARR handoverto communicate the key information effectively to other medical staff. 3. Revisit history taking to explore relevant medical history and identify any precipitating factors for DKA. 3. For diabetic assessment involving DKA, staging may include the use of a container with a small amount of acetone placed near the manikin because many students may not know what acetone smells like but will expect to smell something. If the patientloses consciousnessand there areno signs of lifeon assessment, put out acrash callandcommence CPR. Inspect the urine currently in the catheter bag and note its appearance (e.g. % 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. In the meantime, you should re-assess and maintain the patients airway. Therefore, the same file is also sent to the participants before the session. 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. They should be used in conjunction with the maneuvres mentioned above as the position of the head and neck need to be maintained to keep the airway aligned. The optimal number of simulation participants is four to seven individuals, depending on the case study objectives. 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)? 4 0 obj The instructors never expect the trainees to exhibit full understanding of pathophysiology and skills in the treatment but do give them a few important points to understand the diagnosis and initial treatment of the patients with DKA. Lets discuss your options. opioids, sedatives, anxiolytics, insulin, oral hypoglycaemic medications). confusion, coma), All critically unwell patients should have. 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). 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. Case-based education adds a real-world aspect to the learning environment. The DKA simulation incorporates cue recognition, analysis of cues, generation of solutions, nursing interventions, and evaluation of outcomes, including effective communication and psychosocial concerns. As this is an interactive discussion session, any needed debriefing and/or explanation is given during the sessions. Supplemental digital content is available for this article. Instead, instructors should combine case- and simulation-based techniques when teaching diabetic assessment. Introduction: Diabetic ketoacidosis (DKA) is a life-threatening illness which classically presents with polyuria, polydipsia, and polyphagia that can rapidly progress to severe dehydration and altered mental status from cerebral edema. Patients with DKA require fluid resuscitation to restore circulatory volume, clear ketones, correct electrolyte abnormalities and increase renal perfusion. 2) Complete the assigned suggested readings 3) Complete the presimulation preparation virtual simulation game (Instructor will provide link) 4) Once you have completed reading this document and prepared for your simulation, please: a. Ziv A, Wolpe PR, Small SD, et al. Simulation Scenario for Anesthesia Providers Clark Obr, MD*, Anthony Mueller, MD . Ask for anotherclinicalmemberofstafftoassistyou if possible. Insert at least onewide-bore intravenous cannula(14G or 16G) and take blood tests as discussed below. Terms of Use. type 1 diabetes), Complete insulin insensitivity (e.g. The use of case-based simulation, although more complicated and time consuming for the instructor, immerses the students in the subject matter. Centers for Disease Control and Prevention. This is particularly important for core . Works with Traffic 2005, but . Using your thumbs, slightly open the mouth by downward displacement of the chin. Inspect theairwayfor obviousobstruction. Keywords: diabetic ketoacidosis, simulation, expertise, emergency medicine Introduction Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes mellitus, most commonly occurring in patients with type I diabetes. Clinical Simulation in Nursing, Volume 39, 2020, pp. 2. modify the keyword list to augment your search. See ourfluid prescribing guidefor more details onresuscitation fluids. Animated lectures, however, must work within the framework of a focused case study, which requires increased preparation time. - Onset 01:48 In this manner, the students have to apply their knowledge at the appropriate points during the progression of the scenario. The immersive simulation is performed when the instructor feels comfortable with the acquired knowledge and skill base presented in the animated lecture or when the student group has sufficient practical experience to apply the cognitive, behavioral and technical skills outlined in the case scenario. }HyEf,#$/JSRU9+CF6k\'/z+i`[ 5JudK*Zly^g%[jCK)H[)Y=Qp0/r9o9HW_zF}pTzI~'|q.~:=Y T 9w! Animated Lecture The normal reference range for fasting plasma glucose is 4.0 5.8 mmol/l. "Never doubt that a small group of thoughtful, committed citizens can change the world. If the patient loses consciousness and there are no signs of life on assessment, put out a crash call and commence CPR. 2007. Each performance measure is separated into cognitive, behavioral or technical categories. A collection of interactive medical and surgical clinical case scenarios to put your diagnostic and management skills to the test. A number of key modifiers are described that allow for the adjustment of case . 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. After entering the environment, the student doesnt have the option of leaving the simulation until the learning objectives and performance measures are achieved. His Wife Gave Him CPR. reduced air entry, coarse crackles) to screen for evidence of pneumonia. 3. On the basis of the feedback from the students, they indicated that they believed the small group sessions are better. We have been presenting Simulation Laboratory sessions to our preclinical medical students (first and second years). When erroneous treatment is delivered, the instructor can end the simulation. 1. We combined both to indicate the continuity of the curriculum, and the building on prior knowledge. This is a combination of the modified traditional lecture within scenario-based learning. x]o ]?9kgq~:)?hE )R6!up}\<8||\]}Y~;xp~yQ$#4~djX&{n_m-]^K1/~/AD Hv 99evs,;8}8zwnhFxV.kf-V^? For similar reasons, we do not believe a videotaped session will keep the students attention as much as these live simulator sessions. 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. Please note that by doing so you agree to be added to our monthly email newsletter distribution list. Physician working in the emergency department. Review the patients drug chart for medications which may cause a reduced level of consciousness (e.g. Trigger 4, Pathway 1l of saline required over 1hour and insulin infusion need prescribing and making up in 50ml syringe. The student group is given a short introduction into a closed simulation environment. dq-]gX4 `L'u7myx) rpjf0z,.y`VMyx-&Ju`U0 - Radiation 02:45 (1) According to Centers for Disease Control and Prevention (CDC), 223,619 deaths were attributed to diabetes in 2005. doi: 10.7759/cureus.1286. If you have any scenarios you would be willing to share with the simulation community, please forward them to me. Antibiotics should be prescribed in keeping with local guidelines. Immersive Simulations As with the animated lecture, the simulation is strongly dependent on a focused case study. Consider active re-warming techniques in patients with severe hypothermia. 2003;78:783788. Conclusion Just place the BR2_KDCA file into your addons scenery folder: C:\\Program Files\\Microsoft Games\\Microsoft Flight Simulator X\\Addon Scenery\\Scenery. We used the Medical Education Technologies Inc. (METI) Human Patient Stimulator (HPS, METI Sarasoto, Fl). 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 . They have had no clinical exposure or any clinical experience. 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. Geeky Medics accepts no liability for loss of any kind incurred as a result of reliance upon the information provided in this video. 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. Stage 2: Emergency management of DKA and consideration of abnormal CTG. Two abstracts related to sleepiness in the EMS workforce were presented at the National Association of EMS Physicians symposium in January. If an obstruction is visible within the airway, use afingersweeporsuctionto remove it. LYqC+pJ&6X4onfBT#?=R}.p8N3+Dk,P4tIgWB}-L'=8;_G >,K#.e89XnG'B~NtR It may be necessary toexposethe patient during your assessment: remember to prioritise patient dignity and conservation of body heat. We also show them IV bags containing saline and Ringers lactate, as well as show them IV infusion sets. 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. Make sure to re-assess the patient after any intervention. These simulation sessions seem to work because the medical students do have prior knowledge. If foreign material is present, attempt removal using suction. Should any changes be made to the current management of their underlying condition(s)? A blood glucose level may already be available from earlier investigations (e.g. Instructors should write a case study for the simulation before the session. Join the Geeky Medics community: 2. Given such a small group, the students indicated that they feel more involved than they would with a larger group (eg, the whole class.) Geeky Medics accepts no liability for loss of any kind incurred as a result of reliance upon the information provided in this video. 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. Refer to your local guidelines for further details. Many of the preclinical students have never seen a real life clinical monitor or even an intravenous (IV) setup. J Nurs Educ. A strong emphasis is placed on the focused, methodical examination of a specific medical problem and the decision-based treatment options available. 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. 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. A nasopharyngeal airway is a soft plastic tube with a bevel at one end and a flange at the other. Introduceyourselfto whoever has requested a review of the patient andlistencarefullyto their handover. 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. 1 Potassium losses occurring both before and during treatment of DKA must be replaced. 4. DO NOT perform any examination or procedure on patients based purely on the content of these videos. 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. Wolters Kluwer Health See Table 4 for a suggested standardized script. The students are in their basic science course. DO NOT perform any examination or procedure on patients based purely on the content of these videos. 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. The Simulation Laboratory session follows after a completed PBL session, and is aimed at making the case come alive, while providing a clinical perspective to preclinical students. Below is a collection of donated scenarios for you to use or modify. Using the arterial line, the scenario becomes much more dynamic. Diabetes (type 1 and type 2) in children and young people: diagnosis and management. - Timing 03:23 Mosby:Philadelphia. However, this leads to confusion. <> The reason for inserting the airway upside down initially is to reduce the risk of pushing the tongue backwards and worsening airway obstruction. In the context of DKA, a patients consciousness level may be reduced. Reduced urine output (oliguria) is typically defined as less than 0.5ml/kg/hour in an adult. Re-assessthe patient using theABCDE approachto identify any changes in their clinical condition and assess the effectiveness of your previous interventions. Laschinger S, Medves J, Pulling C, et al. oral fluids, intravenous fluids, urine output, drain output, stool output, vomiting) to inform resuscitation efforts. Inspect for evidence of infection on the skin (e.g. The choice of fluid type, rate of administration and volume should be tailored to the individual patient based upon their vital signs and electrolytes. Stage 1: Initial assessment of acutely unwell pregnant woman and diagnosis of DKA. Please write a single word answer in lowercase (this is an anti-spam measure). Available from: [, NICE guidelines. Please try again soon. Your message has been successfully sent to your colleague. The lecture allows for understanding of concepts prior to action, and instructor feedback is immediate. 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! Published August 2015. Catheterisethe patient to closelymonitor urine outputto guide fluid resuscitation and need for escalation. Typically potassium levels should be maintained between 4.0 5.5 mmol/L and close monitoring is required. angioedema, rash) commence appropriate treatment as discussed in ouranaphylaxis guide. Effectiveness of simulation on health profession students knowledge, skills, confidence and satisfaction. and Make sure tore-assessthe patient after anyintervention. GRAPH. Review thepatients notes,chartsandrecent investigation results. 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 . 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). Use blankets to re-warm patients who are mild to moderately hypothermic. If you'd like to support us and get something great in return, check out our awesome products: You don't need to tell us which article this feedback relates to, as we automatically capture that information for you. 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. 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. 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. Before trainees arrival into the simulation area, the simulator is already preprogrammed for DKA. Standardized patient as the voice of the simulator (or the simulation operator may play this role). In other words, they do not have clinical experience, but they have clinical knowledge. This is a 25-year-old woman with a medical history of diabetes medicated with 40 units insulin per day. Note that if-thens must also include negative patient outcomes for when the provider doesnt take appropriate action. Similar to a ward round, where the instructor would say: Come and listen to this patient with an aortic stenosis. Competency-based medical education has seen widespread adoption in the field along with ongoing work in the areas of . The patient synopsis should include such standard aspects as age, sex, ethnicity, medical history, medications and allergies. Diabetes UK with the Joint British Diabetes Societies Inpatient Care Group. Calculate the patients current fluid balance using their fluid balance chart (e.g. The use of a simulated, evolving case scenario was an effective method of exposing nursing students to complex patient care. Nandate, Koichiro MD, PhD; Abola, Ramon MD; Murray, W Bosseau MB; Whitfield, Carol PhD; Lang, Charles PhD; Sinz, Elizabeth MD. - PSA Question Pack: https://geekymedics.com/psa-question-bank/ Observe and discuss the effects of therapy in a mathematically modeled physiological simulator. This environment doesnt allow the student to identify presentation cues, be active in their own learning or apply their skills without endangering the lives of patients.(2). 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. Subscribe to our newsletter to be the first to know about our latest content: https://geekymedics.com/newsletter/ Available from: [. Each clinical case scenario allows you to work through history taking, investigations, diagnosis and management. Interactive lecture/discussion with use of monitors that show the vital signs of the simulated patient on manikin. Capillary refill timemay be prolonged if the patient is hypovolaemic. Healthcare Students' Psychological Well-Being in a Diabetic Ketoacidosis Simulation. In some cases, normal saline with additional potassium is required to prevent overcorrection of serum potassium levels which would otherwise result in hypokalaemia. Highlight selected keywords in the article text. 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.
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