dka simulation scenario

A collection of communication skills guides, for common OSCE scenarios, including history taking and information giving. 1. An oxygen mask is also demonstrated as an alternative device, as these early trainees had mostly not yet seen any of these devices. 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. Effectiveness of simulation on health profession students knowledge, skills, confidence and satisfaction. His Wife Gave Him CPR. For example, you could develop a diabetic scenario in which the prehospital provider encounters an altered patient with incomprehensible speech. A comprehensive collection of OSCE guides to common clinical procedures, including step-by-step images of key steps, video demonstrations and PDF mark schemes. Refer to your local guidelines which should provide a clear protocol for the management of DKA. Makeup may be used to depict gender, hollow eyes and cheeks, produce pallor or display bruises and scars. In an animated lecture, its important that the student group have an instructor so they can ask direct questions. After the first voluntary session in 2006, feedback from the medical students indicated that they would like to receive this handout. - Timing 03:23 Marx JA, Hockberger RS, Walls RM. Groups of fewer than four students dont allow for optimal collaboration. 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. You can check out our guide to using SOCRATES here: https://geekymedics.com/the-socrates-acronym-in-history-taking/ This field is for validation purposes and should be left unchanged. <> Indeed, it is the only thing that ever has.". Intubation lubricants can mimic drooling. 2017 May 29;9(5):e1286. A collection of free medical student quizzes to put your medical and surgical knowledge to the test! Animated Lecture Review the patientsoxygen saturation(SpO2): Auscultate the chest to screen for evidence of respiratory pathology (e.g. 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. The choice of fluid type, rate of administration and volume should be tailored to the individual patient based upon their vital signs and electrolytes. 4 0 obj In the meantime, you can perform some basic airway manoeuvres to help maintain the airway whilst awaiting senior input. Forty percent of respondents reported excessive daytime sleepiness. This may produce better retention of the subject matter and help students adapt to emergency scenes before going into the field. You may be asked to review a patient with DKA due to confusion, reduced level of consciousness, tachycardia, hypotension and/or vomiting. A strong emphasis is placed on the focused, methodical examination of a specific medical problem and the decision-based treatment options available. See ourCXR interpretation guidefor more details. 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. Stage 3: Ongoing management and monitoring of DKA 1 hour after initiation of treatment. When erroneous treatment is delivered, the instructor can end the simulation. The addition of a fluid infusion containing some potassium allows insulin therapy to continue to suppress ketogenesis and normalise plasma pH whilst preventing the development of hypokalaemia. 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 . Emergency medical services workLife characteristics contribute to clinically significant excessive daytime sleepiness. The instructor should have visual access via one-way windows or cameras. A traditional classroom lecture format allows for student participation but limits the instructors ability to create realistic situations. Healthcare Students' Psychological Well-Being in a Diabetic Ketoacidosis Simulation. 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. Make sure tore-assessthe patient after anyintervention. 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. Problems are addressed as they are identified and the patient is re-assessed regularly to monitor their response to treatment. A hyperglycemic patient may present with tachypnea, which often presents as Kussmauls respirations, tachycardia, orthostatic blood pressure changes and other signs of dehydration and diabetic ketoacidosis (DKA). The normal reference range for fasting plasma glucose is 4.0 5.8 mmol/l. The students are in their basic science course. Extremities: mild cyanosis, no clubbing or edema (verbalized by instructors); pulses equal, and symmetrical (elucidated by trainees). Therefore, we have to emphasize the importance of airway, breathing, and circulation in the very sick patient in any clinical setting. A patient presenting with altered level of consciousness and a blood sugar level below 80 mg/dL should be considered hypoglycemic, and treatment modalities should be consistent with those for a diabetic patient. 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. - 2500+ OSCE Flashcards: https://geekymedics.com/osce-flashcards/ The files are given in full in the web supplement (Appendix B, Supplemental Digital Content 2, https://links.lww.com/SIH/A2). Its important to train and educate students of prehospital care on key indicators of a diabetic emergency. 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. DO NOT perform any examination or procedure on patients based purely on the content of these videos. 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). 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. 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. 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). 4. We then start the DKA state. See Appendix D, Supplemental Digital Content 4, https://links.lww.com/SIH/A4. Please try again soon. The simulation session is also hosted as an interactive session. <>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 595.32 841.92] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> 3. His Heart Stopped On a Treadmill. Available from: [, NICE guidelines. For instance, one of the questions is: Why is Tiffany dehydrated? There are several possible reasons and mechanisms (as outlined in Appendix B, fourth 15 minutes, Supplemental Digital Content 2, https://links.lww.com/SIH/A2), which the students can mention. We try to provide sufficient realism.. General: Moaning, asking what has happening to her. By joining Cureus, you agree to our The consequences (low blood pressure, high heart rate, central nervous system status, etc.) - 150+ PDF OSCE Checklists: https://geekymedics.com/pdf-osce-checklists/ #geekymedics #fyp #fypviral #studytok #medicalstudentuk #medtok #studytips #studytipsforstudents #medstudentuk #premed #medschoolfinals, Cardiovascular History Tips - DON'T FORGET these 3 things . We now provide the students with handouts of the data to save time and provide consistency. may email you for journal alerts and information, but is committed As with the animated lecture, the simulation is strongly dependent on a focused case study. If any obstruction is encountered, remove the tube and try the left nostril. A GCS of 8 or below warrants urgent expert help from an anaesthetist. Diabetic Ketoacidosis (DKA) Clinical Pathway Emergency Department | Children's Hospital of Philadelphia An animated lecture may be described as a pseudo-simulation environment. The trainees have had background knowledge of biochemistry because they had completed the PBL case. Consider active re-warming techniques in patients with severe hypothermia. Another example: At one minute into the scenario, the patient becomes unresponsive and their breathing becomes shallow. Classroom Dynamics 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. 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. The 60 minutes training time consists of four 15-minute sections divided as follows. Inspect the urine currently in the catheter bag and note its appearance (e.g. PA EMT Said COVID Patient Didnt Need to Go to the Hospital. If the patientloses consciousnessand there areno signs of lifeon assessment, put out acrash callandcommence CPR. Case-based education adds a real-world aspect to the learning environment. Just place the BR2_KDCA file into your addons scenery folder: C:\\Program Files\\Microsoft Games\\Microsoft Flight Simulator X\\Addon Scenery\\Scenery. A collection of data interpretation guides to help you learn how to interpret various laboratory and radiology investigations. If you have any scenarios you would be willing to share with the simulation community, please forward them . Simulation in Healthcare4(4):232-236, Winter 2009. Case-based simulation should include two to three broad-focus objectives, as well as 1020 specific performance measures that the student should accomplish. Review thepatients notes,chartsandrecent investigation results. 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. Often, the learner group will be unaware of these behaviors, but the instructor can key into the first few comments made during the transition between rooms. 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. If the patient loses consciousness and there are no signs of life on assessment, put out a crash call and commence CPR. Simulation Scenario for Anesthesia Providers Clark Obr, MD*, Anthony Mueller, MD . Animated lectures, however, must work within the framework of a focused case study, which requires increased preparation time. Catheterisethe patient to closelymonitor urine outputto guide fluid resuscitation and need for escalation. Instructors should write a case study for the simulation before the session. Diabetic ketoacidosis; Simulation training; Medical students. The learning environment should closely mimic real-world applications. See ourfluid prescribing guidefor more details onresuscitation fluids. The instructors role is to facilitate active learning through a combination of learning styles. 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). Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario Cureus. www.cdc.gov/diabetes/statistics/prev/national/. 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). Open the patients airwayusing ahead-tiltchin-lift manoeuvre: 1. The researchers found that long shift hours (24hrs), working overtime and marital/relationship stress were strongly correlated. 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. You may need further help or advice from a senior staff member and you shouldnot delay seeking help if you have concerns about your patient. Environment & Manikin opioids, sedatives, anxiolytics, insulin, oral hypoglycaemic medications). Causes: Any situation arising in a diabetic that requires increased insulin without that demand being met can result in DKA. Margolis GS, Romer GA, Fernandez AR, et al. This leads to hyperglycaemia, osmotic diuresis, and dehydration. Supplemental digital content is available for this article. diagnosis of DKA Trigger 3, ABG show acidosis and high BM and normal potassium. Trainee will practice or observe good teamwork skills, both as a leader and a team player. Instagram: https://instagram.com/geekymedics 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. Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. Introduceyourselfto thepatientincluding yournameandrole. The following scenarios are available for download and are designed to meet your multi-disciplinary nursing needs. "Never doubt that a small group of thoughtful, committed citizens can change the world. Several environments may be suitable for your classroom. The students have acquired all the applicable theoretical knowledge of the case during the previous multiday PBL sessions. DKA can be caused by either: Absolute insulin deficiency (e.g. We believe it is important to have active, participatory learning by having conversations with the trainees in the form of questions and answers. Categories: Emergency Medicine, Medical Education Keywords: diabetic ketoacidosis, simulation, expertise, emergency medicine . As this is an interactive discussion session, any needed debriefing and/or explanation is given during the sessions. TheABCDEapproach can be used to perform a systematic assessment of a critically unwell patient. Lets discuss your options. She is lethargic and slightly confused but can intermittently respond to questions. Initially, we used a blood pressure cuff to generate the blood pressure values. Please write a single word answer in lowercase (this is an anti-spam measure). One of the key differences with the immersive simulation is that the instructor is absent from the simulation environment.