The students worked on the underlying physiology during a week long PBL session and are therefore familiar with the theoretical aspects of DKA. >> Fernandez AR, Mac Crawford J, Pennell ML, et al. modify the keyword list to augment your search. doi: 10.7759/cureus.1286. >> Patterson PD, Weaver M, Frank R, et al. 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. . They have had no clinical exposure or any clinical experience. *=NdL/c2XSJn8:I Jb8'.8>N*[L .hxw6afq40DX3c~>abt'Q,8y(BZu(vKBTufIR. Respiratory Failure in the Course of Treatment of Diabetic Ketoacidosis . Therefore, the same file is also sent to the participants before the session. Trainee will correlate the underlying pathophysiology with symptoms and signs as exhibited by the simulation session. The students are in their basic science course. This is a 25-year-old woman with a medical history of diabetes medicated with 40 units insulin per day. Highlight selected keywords in the article text. 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. She is lethargic and slightly confused but can intermittently respond to questions. Two abstracts related to sleepiness in the EMS workforce were presented at the National Association of EMS Physicians symposium in January. Example: If the provider immediately evaluates blood glucose, then the reading will display 45 mg/dL. Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. Healthcare Students' Psychological Well-Being in a Diabetic Ketoacidosis Simulation. Urinary tract infections are a common DKA precipitant. Wolters Kluwer Health DKA can develop within 24 hours and is potentially life threatening, requiring prompt recognition and therapeutic intervention. Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare, Get new journal Tables of Contents sent right to your email inbox, SIH_13_4_2018_08_03_KOBAYASHI_17-00153_SDC5.tif; [Other] (3.04 MB), SIH_4_4_2009_10_29_NANDATE_200199_SDC2.doc; [Word] (68 KB), SIH_4_4_2009_10_29_NANDATE_200199_SDC3.doc; [Word] (29 KB), SIH_4_4_2009_10_29_NANDATE_200199_SDC4.doc; [Word] (40 KB), Simulation of Diabetic Ketoacidosis for Cellular and Molecular Basics of Medical Practice, Articles in PubMed by Koichiro Nandate, MD, PhD, Articles in Google Scholar by Koichiro Nandate, MD, PhD, Other articles in this journal by Koichiro Nandate, MD, PhD, Privacy Policy (Updated December 15, 2022). Much time was wasted explaining why it did not matter. Advance the airway until it lies within the pharynx. 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. This allows the learner group to make a psychological break from the patient and environment while beginning the reflection process. A fixed-rate intravenous insulin infusion should be commenced initially to suppress ketogenesis, reduce blood glucose levels and address electrolyte disturbances. Teaching nursing management of diabetic ketoacidosis: a description of Target Learner Groups Catheterisethe patient to closelymonitor urine outputto guide fluid resuscitation and need for escalation. Intubation lubricants can mimic drooling. - Medical Finals Question Pack: https://geekymedics.com/medical-student-finals-questions/ If the patient is confused you might be able to get a collateral history from staff or family members as appropriate. Twitter: http://www.twitter.com/geekymedics 2009;13:505511. Discuss the patients current clinical condition with aseniorclinicianusing anSBARR style handover. The consequences (low blood pressure, high heart rate, central nervous system status, etc.) A debriefing section with pre-established questions allows the instructor to review the main focus and performance measures with the student group. Download: http://teamworkmatters.ocbmedia.com/media/DKA-Simulation-Scenario.docx Categories: 5th Year MBChB paeds scenario, Emergency Department, Human Factors, Interprofessional / multidisciplinary, Non-technical skills, Paediatrics, Postgraduate / newly qualified, Undergraduate / pre-registration Rating 3. 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. - Severity 05:32 Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario. - PDF Prehosp Emerg Care. Revisit history taking to explore relevant medical history and identify any precipitating factors for DKA. DKA can develop within 24 hours and is potentially life threatening, requiring prompt recognition and therapeutic intervention. The learning objectives follow the American College of Graduate Medical Education (ACGME) Core Compentencies. Environment & Manikin Competency-based medical education has seen widespread adoption in the field along with ongoing work in the areas of . Observe and discuss the effects of therapy in a mathematically modeled physiological simulator. Review the patientsoxygen saturation(SpO2): Auscultate the chest to screen for evidence of respiratory pathology (e.g. A collection of anatomy notes covering the key anatomy concepts that medical students need to learn. 3. Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario Initially, we used a blood pressure cuff to generate the blood pressure values. Keyword Highlighting PDF Adult Type I Diabetic Ketoacidosis Pre-simulation Preparation Student This allows us to get in touch for more details if required. Available from: [, NICE guidelines. 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. 3. Many of the preclinical students have never seen a real life clinical monitor or even an intravenous (IV) setup. }HyEf,#$/JSRU9+CF6k\'/z+i`[ 5JudK*Zly^g%[jCK)H[)Y=Qp0/r9o9HW_zF}pTzI~'|q.~:=Y T 9w! Trainee will appropriately request assistance and use available resources. It involves working through the following steps: Each stage of the ABCDE approach involvesclinicalassessment,investigationsandinterventions. Emergency medical services workLife characteristics contribute to clinically significant excessive daytime sleepiness. 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). Ask for anotherclinicalmemberofstafftoassistyou if possible. Groups of fewer than four students dont allow for optimal collaboration. Creating a Simulation Experience to Promote Clinical Judgment 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. Scenario in a Nutshell Diabetic ketoacidosis (DKA) in pregnancy. Margolis GS, Romer GA, Fernandez AR, et al. 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. Some error has occurred while processing your request. tall tented T waves in hyperkalaemia). For similar reasons, we do not believe a videotaped session will keep the students attention as much as these live simulator sessions. 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. You may search for similar articles that contain these same keywords or you may The researchers found that long shift hours (24hrs), working overtime and marital/relationship stress were strongly correlated. Open the patients airwayusing ahead-tiltchin-lift manoeuvre: 1. your express consent. Lets discuss your options. 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. 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. See ourhistory taking guidesfor more details. 2008;6:278302. (1) According to Centers for Disease Control and Prevention (CDC), 223,619 deaths were attributed to diabetes in 2005. Trainee will increase knowledge of professional behaviors during the simulation. Manikin staging can provide strong cues. A comprehensive collection of clinical examination OSCE guides that include step-by-step images of key steps, video demonstrations and PDF mark schemes. Insert at least onewide-bore intravenous cannula(14G or 16G) and take blood tests as discussed below. Insert the airway bevel-end first, vertically along the floor of the nose with a slight twisting action. Use blankets to re-warm patients who are mild to moderately hypothermic. confusion, coma), All critically unwell patients should have. We found it more important to have the students full attention so that they could concentrate on concepts and not on menial tasks such as recording data. 2. . 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. 1. Simulation student Scenario- DKA-Peds.docx - DIABETIC In the meantime, you can perform some basic airway manoeuvres to help maintain the airway whilst awaiting senior input. The learning environment should closely mimic real-world applications. A number of key modifiers are described that allow for the adjustment of case . Nandate, Koichiro MD, PhD; Abola, Ramon MD; Murray, W Bosseau MB; Whitfield, Carol PhD; Lang, Charles PhD; Sinz, Elizabeth MD. Simulation-based medical education: An ethical imperative. The diabetes with DKA clinical pathway is a detailed plan of the course of care for pediatric patients seen in the emergency department with diabetic ketoacidosis. 2017 May 29;9(5):e1286. The students have acquired all the applicable theoretical knowledge of the case during the previous multiday PBL sessions. Conclusion oral fluids, intravenous fluids, urine output, drain output, stool output, vomiting) to inform resuscitation efforts. It should only be inserted in unconscious patients as it is otherwise poorly tolerated and may induce gagging and aspiration. The students are in their first year. Depending on scenario complexity, team dynamic and treatment modalities, this simulation may take 1020 minutes. Makeup may be used to depict gender, hollow eyes and cheeks, produce pallor or display bruises and scars. This field is for validation purposes and should be left unchanged. - Radiation 02:45 This video demonstrates how to use the SOCRATES acronym when taking a history of pain or other symptoms. Effectiveness of simulation on health profession students knowledge, skills, confidence and satisfaction. The normal reference range for fasting plasma glucose is 4.0 5.8 mmol/l. This article originally appeared in March 2011 JEMS as Diabetes Demonstration: Simulation-based learning works best., Simulation Training Ideal for Diabetic Patients, CMS Begins Reprocessing Retroactive Payments, Documents Detail EMTs Failure to Aid Tyre Nichols, New Course Lets Bystanders Be the Help Until Help Arrives, All Paramedic Recruits in New Castle County (DE) Obtain NRP Certification, International Prehospital Medicine Institute Literature Review, March 2023. Centers for Disease Control and Prevention. www.cdc.gov/diabetes/statistics/prev/national/. Glycosuria leads to urinary losses of potassium through osmotic diuresis. Her medical, social, and family histories are not clear at the time of admission to the emergency department. This may produce better retention of the subject matter and help students adapt to emergency scenes before going into the field. Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. We have 18 to 20 PBL groups for an hour each in the week after their PBL DKA session. Inspect theairwayfor obviousobstruction. If the patient has clinical signs ofanaphylaxis(e.g. An integral part of a PBL session is for trainees to be able to navigate through huge literature bases. By joining Cureus, you agree to our The lecture allows for understanding of concepts prior to action, and instructor feedback is immediate. LYqC+pJ&6X4onfBT#?=R}.p8N3+Dk,P4tIgWB}-L'=8;_G >,K#.e89XnG'B~NtR I assigned true to life parking codes, and added some extra parking for the superfluous US Express AI. She began experiencing progressively worsening thirst, increased appetite, and excessively increased urination. Trainee will improve their understanding of clinical practice through reflective assessment of actual cases during the prior PBL sessions. 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. Its best, however, to allow the student group to continue so theyre able to evaluate their decision-making processes during debriefing. 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. type 1 diabetes) Complete insulin insensitivity (e.g. Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario 2003;78:783788. In the meantime, you should re-assess and maintain the patients airway. A pre-briefing session is conducted prior to the start of the simulation scenario. Subscribe to our newsletter to be the first to know about our latest content: https://geekymedics.com/newsletter/ Inspect for evidence of infection on the skin (e.g. 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. Outcomes Educating Nursing Students Using an Evolving, Simulated Case Stage 1: Initial assessment of acutely unwell pregnant woman and diagnosis of DKA. 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. Section snippets . Standardized patient as the voice of the simulator (or the simulation operator may play this role). Search for Similar Articles Scenarios. The relationship between sleep, fatigue and patient and provider safety. Make sure tore-assessthe patient after anyintervention. In some cases, normal saline with additional potassium is required to prevent overcorrection of serum potassium levels which would otherwise result in hypokalaemia. Laschinger S, Medves J, Pulling C, et al. #geekymedics #fyp #fypviral #studytok #medicalstudentuk #medtok #studytips #studytipsforstudents #medstudentuk #premed #medschoolfinals, Cardiovascular History Tips - DON'T FORGET these 3 things . 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). Blood sugar issues in the Type II diabetic will have a gradual onset, with diagnosis generally resulting from routine laboratory exams.(1). Trainee will describe the changes in vital signs, the major metabolic, fluid, and electrolyte. 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. 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. Mosby:Philadelphia. 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 . A strong emphasis is placed on the focused, methodical examination of a specific medical problem and the decision-based treatment options available. #geekymedics #fyp #fypviral #studytok #medicalstudentuk #medtok #studytips #studytipsforstudents #medstudentuk #premed #medschoolfinals #shorts, Cardiovascular Exam Tips - DON'T FORGET these 3 things , Watch this video to find out the most COMMONLY FORGOTTEN components of the cardiovascular history! Save this video to help prepare for your upcoming OSCEs and dont forget to follow Geeky Medics! 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. A blood glucose level may already be available from earlier investigations (e.g. Instagram: https://instagram.com/geekymedics This is an important period, as this is where the students see the theoretical concept (metabolic acidosis), come to life as for instance large tidal volumes. Problems are addressed as they are identified and the patient is re-assessed regularly to monitor their response to treatment. Refer to your local guidelines which should provide a clear protocol for the management of DKA. - Exacerbating & relieving factors 05:12 These simulation sessions seem to work because the medical students do have prior knowledge. Below is a collection of donated scenarios for you to use or modify. JEMS. It was - Onset 01:48 Schneider Sarver PA, Senczakowicz EA, Slovensky BM. Simulation provides a safe environment where learning is enhanced through the deliberate practice of skills and controlled management of a variety of clinical encounters. This is a combination of the modified traditional lecture within scenario-based learning. 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). %PDF-1.5 Your message has been successfully sent to your colleague. Trainee will recognize the need for therapy and suggest an appropriate therapy in a simulated environment. 2. 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. The questionnaire for the assessment of the session is given in full in the web-based supplement (Appendix A, Supplemental Digital Content 1, https://links.lww.com/SIH/A1). 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. An animated lecture may be described as a pseudo-simulation environment. We ask the trainee why the blood pressure is so low or heart rate is so high, and how we should treat it. Recognize the signs and symptoms of a patient presenting with diabetic ketoacidosis. A collection of surgery revision notes covering key surgical topics. Yes: if the patient can talk, their airway is patent and you can move on to the assessment of breathing. We have been presenting Simulation Laboratory sessions to our preclinical medical students (first and second years). 3. 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. NPAs are typically better tolerated in patients who are partly or fully conscious compared to oropharyngeal airways. See ourdocumentation guidesfor more details. Introduceyourselfto whoever has requested a review of the patient andlistencarefullyto their handover. Prehosp Emerg Care. Before trainees arrival into the simulation area, the simulator is already preprogrammed for DKA. Indeed, it is the only thing that ever has.". Performing an ECG should not delay the emergency management of DKA. Rosens Emergency Medicine: Concepts and Clinical Practice. Available from: [. Geeky Medics accepts no liability for loss of any kind incurred as a result of reliance upon the information provided in this video. <> 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! Clearlydocument your ABCDE assessment, including history, examination, observations, investigations, interventions, and the patients response. Creating a Simulation Experience to Promote Clinical Judgment We used the Medical Education Technologies Inc. (METI) Human Patient Stimulator (HPS, METI Sarasoto, Fl). This guide provides an overview of the recognition and immediate management of diabetic ketoacidosis (DKA)using an ABCDE approach. Keywords: diabetic ketoacidosis, simulation, expertise, emergency medicine Introduction Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes mellitus, most . His Heart Stopped On a Treadmill. to maintaining your privacy and will not share your personal information without 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. 2007. DOI 10.7759/cureus.1286. If the patientloses consciousnessand there areno signs of lifeon assessment, put out acrash callandcommence CPR. Trainee will be able to apply skills of communication with the simulated patient in a semiacute crisis to get sufficient important information for a final diagnosis. 4. Over the years, some groups happened to have the simulation session before the completion of the theoretical PBL session. There are actually two sets of educational objectives: the first set is for the theoretical PBL sessions, and the 2nd set is for the Simulation Session. - Examples 05:45 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). - Introduction 00:00 1 0 obj endobj She does not take this regularly. There are several causes of DKA, which we remember by the "five I's". 2011;15:108109. diagnosis of DKA Trigger 3, ABG show acidosis and high BM and normal potassium. reduced air entry, coarse crackles) to screen for evidence of pneumonia. 1. Each PBL case typically goes over 23 days, affording the students periods to find information for the case. Stage 3: Ongoing management and monitoring of DKA 1 hour after initiation of treatment. 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].. After entering the environment, the student doesnt have the option of leaving the simulation until the learning objectives and performance measures are achieved. You can check out our guide to using SOCRATES here: https://geekymedics.com/the-socrates-acronym-in-history-taking/ Cureus 9(5): e1286. Both external and internal potassium balances are disturbed during the development and treatment of DKA. The use of simulation-based instruction enables a student to learn at their own pace and allows them to repeat sequential steps to gain confidence and proficiency. The optimal number of simulation participants is four to seven individuals, depending on the case study objectives. This session provides additional clinical support material for the theoretical PBL session. 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. 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.