If fever is present, make sure to consider co-existing infection. 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! The scenario would include an if-then algorithm. %PDF-1.5 Invasive monitors, including a left radial intraarterial and a right subclavian IV catheter, were placed. Clearly communicate how often would you like the patients observations relayed to you by other staff members. Does the patient need a referral toHDU/ICU? Antibiotics should be prescribed in keeping with local guidelines. Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario Trainee will describe the changes in vital signs, the major metabolic, fluid, and electrolyte. The students have acquired all the applicable theoretical knowledge of the case during the previous multiday PBL sessions. 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. The use of a simulated, evolving case scenario was an effective method of exposing nursing students to complex patient care. Works with Traffic 2005, but . Alert a senior immediately if you have any concerns about the consciousness level of a patient. 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. Trainee will learn to collaborate with peers to decide on appropriate interventions, tests, and therapy. Please note that by doing so you agree to be added to our monthly email newsletter distribution list. 1 Potassium losses occurring both before and during treatment of DKA must be replaced. We have been presenting Simulation Laboratory sessions to our preclinical medical students (first and second years). The students mentioned that they did not obtain the maximum value from the simulation session under these circumstances. This field is for validation purposes and should be left unchanged. These are not learning objectives in this program. General: Moaning, asking what has happening to her. 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 . As with the animated lecture, the simulation is strongly dependent on a focused case study. The following scenarios are available for download and are designed to meet your multi-disciplinary nursing needs. 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. The debriefing environment should be removed from the location where the simulation took place. 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. <>>> It was Target Learner Groups to maintaining your privacy and will not share your personal information without The student group is given a short introduction into a closed simulation environment. A traditional classroom lecture format allows for student participation but limits the instructors ability to create realistic situations. Scenarios. With your index and other fingers placed behind the angle of the mandible, apply steady upwards and forward pressure to lift the mandible. 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). - Over 3000 Free MCQs: https://geekyquiz.com/ Immersive Simulations 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. 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 . 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. 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. 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. Tilt the forehead back whilst lifting the chin forwards to extend the neck. At the end of the previous section, the trainee can make the diagnosis of DKA but has not confirmed it yet. Some error has occurred while processing your request. If the patient is suspected to have sufferedsignificanttraumawith potential spinal involvement, perform ajaw-thrustrather than a head-tilt chin-lift manoeuvre: 2. oral fluids, intravenous fluids, urine output, drain output, stool output, vomiting) to inform resuscitation efforts. A blood glucose level may already be available from earlier investigations (e.g. Diabetic ketoacidosis; Simulation training; Medical students. 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. They should introduce the student group to the environment, assign roles for each learner and guide the decision-making process. This video demonstrates how to use the SOCRATES acronym when taking a history of pain or other symptoms. opioids, sedatives, anxiolytics, insulin, oral hypoglycaemic medications). 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. Immersive simulations are mentally exhausting because they create an intense and stressful atmosphere requiring the learner to work outside their comfort zone. 3. Therefore, we should not have to take much time on this issue, but we have to focus on the relationship between the biochemistry and clinical signs and symptoms by asking why the patient is dehydrated, why acidosis develops, why respiration is rapid and deep (Kussmaul) respirations, and what the rationale for inpatient treatment is. type 1 diabetes) Complete insulin insensitivity (e.g. You may be trying to access this site from a secured browser on the server. Properly interpret a venous blood gas (VBG) and basic metabolic panel in a patient presenting with diabetic ketoacidosis. Ziv A, Wolpe PR, Small SD, et al. Medical simulation technology is a powerful tool for training physicians but papers dealing with DKA simulators are scarce. DO NOT perform any examination or procedure on patients based purely on the content of these videos. Similar to a ward round, where the instructor would say: Come and listen to this patient with an aortic stenosis. The instructor should have visual access via one-way windows or cameras. Problems are addressed as they are identified and the patient is re-assessed regularly to monitor their response to treatment. Subscribe to our newsletter to be the first to know about our latest content: https://geekymedics.com/newsletter/ "Never doubt that a small group of thoughtful, committed citizens can change the world. Terms of Use. Each performance measure is separated into cognitive, behavioral or technical categories. reduced air entry, coarse crackles) to screen for evidence of pneumonia. 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. I assigned true to life parking codes, and added some extra parking for the superfluous US Express AI. 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. An hour was . Yes: if the patient can talk, their airway is patent and you can move on to the assessment of breathing. The facilitator guides the group only when necessary. cloudy urine may indicate urinary tract infection). <>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 595.32 841.92] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> Simulation Scenario. - Medical Finals Question Pack: https://geekymedics.com/medical-student-finals-questions/ Insert the oropharyngeal airway in the upside-down position until you reach the junction of the hard and soft palate, at which point you should rotate it 180. 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. 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. Both external and internal potassium balances are disturbed during the development and treatment of DKA. <> DKA can develop within 24 hours and is potentially life threatening, requiring prompt recognition and therapeutic intervention. 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). We guide the group to suggest fluid. You may be asked to review a patient with DKA due to confusion, reduced level of consciousness, tachycardia, hypotension and/or vomiting. Using your thumbs, slightly open the mouth by downward displacement of the chin. For more information, please refer to our Privacy Policy. A fixed-rate intravenous insulin infusion should be commenced initially to suppress ketogenesis, reduce blood glucose levels and address electrolyte disturbances. The students are in their basic science course. You can check out our guide to using SOCRATES here: https://geekymedics.com/the-socrates-acronym-in-history-taking/ - Exacerbating & relieving factors 05:12 2017 May 29;9(5):e1286. 1. - Character 02:14 The Theory Schneider Sarver PA, Senczakowicz EA, Slovensky BM. 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. 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. The instructor can also gauge the direction the debriefing session should follow or be alerted to possible problems or conflicts in treatment opinions. 2. For similar reasons, we do not believe a videotaped session will keep the students attention as much as these live simulator sessions. LYqC+pJ&6X4onfBT#?=R}.p8N3+Dk,P4tIgWB}-L'=8;_G >,K#.e89XnG'B~NtR We then start the DKA state. See Appendix D, Supplemental Digital Content 4, https://links.lww.com/SIH/A4. Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario Cureus. It should only be inserted in unconscious patients as it is otherwise poorly tolerated and may induce gagging and aspiration. A nasopharyngeal airway is a soft plastic tube with a bevel at one end and a flange at the other. An events progression section should include patient status changes, as well as a time/treatment continuum that incorporates if-then event progressions. Trainee will appropriately request assistance and use available resources. 1. This is particularly important for core . PA EMT Said COVID Patient Didnt Need to Go to the Hospital. Case-based simulation should include two to three broad-focus objectives, as well as 1020 specific performance measures that the student should accomplish. Inspect theairwayfor obviousobstruction. 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. During an immersive simulation, its imperative the group uses critical-thinking skills and group collaboration independently. After initial insulin therapy has reduced plasma blood glucose levels (e.g. Despite this increased calorie intake, she noticed an unexplained 20 lbs weight loss. An animated lecture may be described as a pseudo-simulation environment. 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). If the patient has clinical signs ofanaphylaxis(e.g. 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. Deteriorationshould be recognised quickly and acted upon immediately. This leads to hyperglycaemia, osmotic diuresis, and dehydration. This is a combination of the modified traditional lecture within scenario-based learning. diagnosis of DKA Trigger 3, ABG show acidosis and high BM and normal potassium. 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. 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). Available from: [. Make sure to re-assess the patient after any intervention. The instructors role is to facilitate active learning through a combination of learning styles. 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. 1-6. The learning objectives follow the American College of Graduate Medical Education (ACGME) Core Compentencies. }HyEf,#$/JSRU9+CF6k\'/z+i`[ 5JudK*Zly^g%[jCK)H[)Y=Qp0/r9o9HW_zF}pTzI~'|q.~:=Y T 9w! 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. areas of lipohypertrophy) if it is unclear if the patient is diabetic. 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. Intubation lubricants can mimic drooling. . Cureus is on a mission to change the long-standing paradigm of medical publishing, where submitting research can be costly, complex and time-consuming. A number of key modifiers are described that allow for the adjustment of case . In keeping with the case study, as a treatment marker is reached, the instructor should place emphasis on physiological, pharmacological, environmental and psychosocial issues. In the final 10 minutes, we show how the patient has a good recovery after fluid replacement. Available from: [, NICE guidelines. If an infection is suspected, IV antibioticsshould be administered as soon as possible. If you have any scenarios you would be willing to share with the simulation community, please forward them . Medical Simulation Scenarios are text documents outlining the various details of a simulation - everything from patient simulator settings to debriefing notes. Finally, we summarize the course and give them time for questions. This allows the learner group to make a psychological break from the patient and environment while beginning the reflection process. The Theory You might also be interested in our awesome bank of 700+ OSCE Stations. It involves a facilitating instructor, a small learner group and conceptual aspects of environmental and manikin staging to provide sensory cues.