Manikin staging can provide strong cues. Measure the patients capillary blood glucose and ketone levels to confirm the diagnosis and guide the management of DKA. Typically potassium levels should be maintained between 4.0 5.5 mmol/L and close monitoring is required. LYqC+pJ&6X4onfBT#?=R}.p8N3+Dk,P4tIgWB}-L'=8;_G >,K#.e89XnG'B~NtR This is particularly important for core cases and low-frequency, high-stakes procedures and encounters. The DKA simulation incorporates cue recognition, analysis of cues, generation of solutions, nursing interventions, and evaluation of outcomes, including effective communication and psychosocial concerns. 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. As this is an interactive discussion session, any needed debriefing and/or explanation is given during the sessions. If any obstruction is encountered, remove the tube and try the left nostril. (1), The assessment of a diabetic patient is best taught as a case-based simulation. For example, if a student is to run a diabetic emergency in an extended living facility, the room should be staged with the appropriate bed, linens and medical equipment, and include personal artifacts and memorabilia normally found in such environments. If an obstruction is visible within the airway, use afingersweeporsuctionto remove it. Marx JA, Hockberger RS, Walls RM. Make sure to re-assess the patient after any intervention. Nandate, Koichiro MD, PhD; Abola, Ramon MD; Murray, W Bosseau MB; Whitfield, Carol PhD; Lang, Charles PhD; Sinz, Elizabeth MD. 1-6. You may search for similar articles that contain these same keywords or you may Prehosp Emerg Care. Revisit history taking to explore relevant medical history and identify any precipitating factors for DKA. A GCS of 8 or below warrants urgent expert help from an anaesthetist. It involves a facilitating instructor, a small learner group and conceptual aspects of environmental and manikin staging to provide sensory cues. Abdomen: The abdominal examination reveals diffuse mild epigastric tenderness to deep palpitation but neither rebound tenderness nor guarding (result of examination given by patient or by instructor). This is a 25-year-old woman with a medical history of diabetes medicated with 40 units insulin per day. Stage 1: Initial assessment of acutely unwell pregnant woman and diagnosis of DKA. %PDF-1.5 Medical simulation technology is a powerful tool for training physicians but papers dealing with DKA simulators are scarce. your express consent. The files are given in full in the web supplement (Appendix B, Supplemental Digital Content 2, https://links.lww.com/SIH/A2). As this is a PBL session, the trainees are not given any references. opioids, sedatives, anxiolytics, insulin, oral hypoglycaemic medications). Available if the trainee asks: arterial blood gas, glucose, electrolytes, BUN and plasma osmolality (please see last section of Appendix B, Supplemental Digital Content 2, https://links.lww.com/SIH/A2, for values). - Over 3000 Free MCQs: https://geekyquiz.com/ diagnosis of DKA Trigger 3, ABG show acidosis and high BM and normal potassium. The learning objectives follow the American College of Graduate Medical Education (ACGME) Core Compentencies. 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. 4. Simulation provides a safe environment where learning is enhanced through the deliberate practice of skills and controlled management of a variety of clinical encounters. Mosby:Philadelphia. DKA can be caused by either: Absolute insulin deficiency (e.g. A collection of interactive medical and surgical clinical case scenarios to put your diagnostic and management skills to the test. 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. A collection of data interpretation guides to help you learn how to interpret various laboratory and radiology investigations. In keeping with the case study, as a treatment marker is reached, the instructor should place emphasis on physiological, pharmacological, environmental and psychosocial issues. Standardized patient as the voice of the simulator (or the simulation operator may play this role). The students mentioned that they did not obtain the maximum value from the simulation session under these circumstances. Ketones show 5.5. Please try after some time. <>>> Its important to train and educate students of prehospital care on key indicators of a diabetic emergency. endobj The student group should be encouraged to collaborate on management options and to perform skills. 2 The evaluation of potassium deficits is complicated by potassium exit from . Abstract 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. doi: 10.7759/cureus.1286. 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. Diabetic ketoacidosis; Simulation training; Medical students. We combined both to indicate the continuity of the curriculum, and the building on prior knowledge. 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. 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. His Wife Gave Him CPR. After entering the environment, the student doesnt have the option of leaving the simulation until the learning objectives and performance measures are achieved. You may be asked to review a patient with DKA due to confusion, reduced level of consciousness, tachycardia, hypotension and/or vomiting. 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. endobj Strategies of high-performing paramedic educational programs. Target Learner Groups 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). Stage 3: Ongoing management and monitoring of DKA 1 hour after initiation of treatment. The use of a simulated, evolving case scenario was an effective method of exposing nursing students to complex patient care. DY{Qb"(EgN$QI*%XN1F""0a5 type 1 diabetes) Complete insulin insensitivity (e.g. 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). A comprehensive collection of clinical examination OSCE guides that include step-by-step images of key steps, video demonstrations and PDF mark schemes. See ourdocumentation guidesfor more details. It was 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. 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. Geeky Medics accepts no liability for loss of any kind incurred as a result of reliance upon the information provided in this video. 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. Therefore, the session is divided into four sections of 15 minutes each, so that the facilitator is constantly aware of being on time (or not), even after the first 15 minutes period. Introduceyourselfto whoever has requested a review of the patient andlistencarefullyto their handover. In this section, we have to help the trainee to institute definitive therapy based on the underlying biochemical abnormalities. The Theory Supplemental digital content is available for this article. Margolis GS, Romer GA, Fernandez AR, et al. Does the patient need reviewing by a specialist? 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. A collection of anatomy notes covering the key anatomy concepts that medical students need to learn. Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. 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. (1) According to Centers for Disease Control and Prevention (CDC), 223,619 deaths were attributed to diabetes in 2005. Askhow the patient is feeling as this may provide some useful information about their current symptoms. Trainee will correlate the underlying pathophysiology with symptoms and signs as exhibited by the simulation session. DOI 10.7759/cureus.1286. Inspect for evidence of self-injection sites (e.g. - Onset 01:48 Well done, youve now stabilised the patient and theyre doing much better. DO NOT perform any examination or procedure on patients based purely on the content of these videos. Subscribe to our newsletter to be the first to know about our latest content: https://geekymedics.com/newsletter/ 3. Keywords: diabetic ketoacidosis, simulation, expertise, emergency medicine Introduction Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes mellitus, most . Weight, Height: Not given, normal appearing (as per simulator) but has lost 20 lbs recently. 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. Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. - 2500+ OSCE Flashcards: https://geekymedics.com/osce-flashcards/ KDCA, Ronald Reagan Washington National Airport, DC. Schneider Sarver PA, Senczakowicz EA, Slovensky BM. *=NdL/c2XSJn8:I Jb8'.8>N*[L .hxw6afq40DX3c~>abt'Q,8y(BZu(vKBTufIR. Published August 2015. Check the patency of the patients right nostril and if required (depending on the model of NPA) insert a safety pin through the flange of the NPA. insulin-dependent type 2 diabetes), Altered consciousness (e.g. Introduceyourselfto thepatientincluding yournameandrole. Much time was wasted explaining why it did not matter. x]o ]?9kgq~:)?hE )R6!up}\<8||\]}Y~;xp~yQ$#4~djX&{n_m-]^K1/~/AD Hv 99evs,;8}8zwnhFxV.kf-V^? 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. J Nurs Educ. 2 0 obj Over the years, some groups happened to have the simulation session before the completion of the theoretical PBL session. 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. Immersive simulations are mentally exhausting because they create an intense and stressful atmosphere requiring the learner to work outside their comfort zone. 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). Emergency medical services workLife characteristics contribute to clinically significant excessive daytime sleepiness. Using the arterial line, the scenario becomes much more dynamic. Heart: S1 and S2 within normal limits; no S3/S4 or murmurs, normal rate and rhythm. GRAPH. - Radiation 02:45 For example, you could develop a diabetic scenario in which the prehospital provider encounters an altered patient with incomprehensible speech. The debriefing environment should be removed from the location where the simulation took place. Highlight selected keywords in the article text. and These simulation sessions seem to work because the medical students do have prior knowledge. The students have acquired all the applicable theoretical knowledge of the case during the previous multiday PBL sessions. Development of simulation scenarios for an adolescent patient with diabetic ketoacidosis. Inspect for evidence of infection on the skin (e.g. Two abstracts related to sleepiness in the EMS workforce were presented at the National Association of EMS Physicians symposium in January. - Associated symptoms 03:04 Use an effectiveSBARR handoverto communicate the key information effectively to other medical staff. 2. In this manner, the students have to apply their knowledge at the appropriate points during the progression of the scenario. 2. 4. Intubation lubricants can mimic drooling. Wolters Kluwer Health As with the animated lecture, the simulation is strongly dependent on a focused case study. 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. Trainee will improve their understanding of clinical practice through reflective assessment of actual cases during the prior PBL sessions. 2010;49:578586. Initially, we used a blood pressure cuff to generate the blood pressure values. These are not learning objectives in this program. See Table 4 for a suggested standardized script. 2009;13:505511. A traditional classroom lecture format allows for student participation but limits the instructors ability to create realistic situations. Patients with DKA require fluid resuscitation to restore circulatory volume, clear ketones, correct electrolyte abnormalities and increase renal perfusion. Facebook: http://www.facebook.com/geekymedics 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 collection of free medical student quizzes to put your medical and surgical knowledge to the test! Circulating nurse in the emergency room (ER). Performing an ECG should not delay the emergency management of DKA. 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.
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