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. She does not take this regularly. As this is a PBL session, the trainees are not given any references. Indeed, it is the only thing that ever has.". 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. A collection of data interpretation guides to help you learn how to interpret various laboratory and radiology investigations. 2010;49:578586. Alert a senior immediately if you have any concerns about the consciousness level of a patient. The simulation session is also hosted as an interactive session. The teaching of diabetic assessment and management, like many other medical emergencies, lends itself well to case-based simulation. The debriefing environment should be removed from the location where the simulation took place. Prehosp Emerg Care. 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. PA EMT Said COVID Patient Didnt Need to Go to the Hospital. In this section, we have to help the trainee to institute definitive therapy based on the underlying biochemical abnormalities. Simulation in Healthcare4(4):232-236, Winter 2009. PBL was introduced at our institution in 1995. DOI 10.7759/cureus.1286. Simulation Scenario for Anesthesia Providers Clark Obr, MD*, Anthony Mueller, MD . Capillary refill timemay be prolonged if the patient is hypovolaemic. Prehosp Emerg Care. Diabetic ketoacidosis (DKA) is a common, potentially lethal disease. 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. We ask the trainee why the blood pressure is so low or heart rate is so high, and how we should treat it. 3. The trainees have had background knowledge of biochemistry because they had completed the PBL case. Given 6 to 8 back-to-back sessions, it is critical that every session starts and ends on time! Margolis GS, Romer GA, Fernandez AR, et al. 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. Please write a single word answer in lowercase (this is an anti-spam measure). Antibiotics should be prescribed in keeping with local guidelines. % There are several causes of DKA, which we remember by the "five I's". Therefore, the same file is also sent to the participants before the session. 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. 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. - Medical Finals Question Pack: https://geekymedics.com/medical-student-finals-questions/ Available from: [, NICE guidelines. It was In other words, they do not have clinical experience, but they have clinical knowledge. Refer to your local guidelines for further details. 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. Deteriorationshould be recognised quickly and acted upon immediately. insulin-dependent type 2 diabetes), Altered consciousness (e.g. www.cdc.gov/diabetes/statistics/prev/national/. <> In the final 10 minutes, we show how the patient has a good recovery after fluid replacement. Ziv A, Wolpe PR, Small SD, et al. Finally, we summarize the course and give them time for questions. The required potassium replacement varies greatly. 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 HFS-DKA simulation teaching consisted of pre-briefing (an hour), running simulation (30 minutes) and debriefing (an hour) for the high-fidelity simulator using the Lardeal SIM man . stream Over the years, some groups happened to have the simulation session before the completion of the theoretical PBL session. The file explaining the session is sent to instructors 1 week before the sessions. Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. 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). 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. Please try after some time. "Never doubt that a small group of thoughtful, committed citizens can change the world. Acad Med. 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. J Nurs Educ. TikTok: https://www.tiktok.com/@geekymedics 1) Please read through this document as it will help you prepare for your upcoming simulation on DKA. If an obstruction is visible within the airway, use afingersweeporsuctionto remove it. Classroom Dynamics 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. An oxygen mask is also demonstrated as an alternative device, as these early trainees had mostly not yet seen any of these devices. The student group should be encouraged to collaborate on management options and to perform skills. A simulation training session is described designed to acquaint emergency medicine residents with the presentation and management of diabetic ketoacidosis through the use of simulation. Mosby:Philadelphia. Wolters Kluwer Health Simulation provides a safe environment where learning is enhanced through the deliberate practice of skills and controlled management of a variety of clinical encounters. Refer to your local guidelines which should provide a clear protocol for the management of DKA. The normal reference range for fasting plasma glucose is 4.0 5.8 mmol/l. Facebook: http://www.facebook.com/geekymedics 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. An events progression section should include patient status changes, as well as a time/treatment continuum that incorporates if-then event progressions. In the meantime, you should re-assess and maintain the patients airway. In some cases, normal saline with additional potassium is required to prevent overcorrection of serum potassium levels which would otherwise result in hypokalaemia. If the patientloses consciousnessand there areno signs of lifeon assessment, put out acrash callandcommence CPR. If fever is present, make sure to consider co-existing infection. (1), The assessment of a diabetic patient is best taught as a case-based simulation. Use blankets to re-warm patients who are mild to moderately hypothermic. If you have any scenarios you would be willing to share with the simulation community, please forward them . (1) According to Centers for Disease Control and Prevention (CDC), 223,619 deaths were attributed to diabetes in 2005. We then start the DKA state. See Appendix D, Supplemental Digital Content 4, https://links.lww.com/SIH/A4. 2 The evaluation of potassium deficits is complicated by potassium exit from . NPAs are typically better tolerated in patients who are partly or fully conscious compared to oropharyngeal airways. Physician working in the emergency department. She is lethargic and slightly confused but can intermittently respond to questions. LYqC+pJ&6X4onfBT#?=R}.p8N3+Dk,P4tIgWB}-L'=8;_G >,K#.e89XnG'B~NtR However, this leads to confusion. A number of key modifiers are described that allow for the adjustment of case . Available from: [. We combined both to indicate the continuity of the curriculum, and the building on prior knowledge. 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)? A traditional classroom lecture format allows for student participation but limits the instructors ability to create realistic situations. In the context of DKA, a patients consciousness level may be reduced. The students are in their basic science course. 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. Given such a small group, the students indicated that they feel more involved than they would with a larger group (eg, the whole class.) A GCS of 8 or below warrants urgent expert help from an anaesthetist. The learning objectives follow the American College of Graduate Medical Education (ACGME) Core Compentencies. The main goal is to establish a safe learning environment for the learner [9, 13 . 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]). The instructions to the facilitators suggest a series of structured, sequential questions to the students (starting at one end, involving each student in turn, and repeatedly cycling around the group.) This leads to hyperglycaemia, osmotic diuresis, and dehydration. Reduced urine output (oliguria) is typically defined as less than 0.5ml/kg/hour in an adult. 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. COVID-19 Screening in the Pediatric Emergency Department. 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. Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. 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). Initially, we used a blood pressure cuff to generate the blood pressure values. As individuals with uncontrolled type I . The instructor can also gauge the direction the debriefing session should follow or be alerted to possible problems or conflicts in treatment opinions. A nasopharyngeal airway is a soft plastic tube with a bevel at one end and a flange at the other. If the patient has COPD and a history of CO2retention you should switch to aventuri maskas soon as possible andtitrate oxygen appropriately. 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. Scenarios. Supplemental digital content is available for this article. When erroneous treatment is delivered, the instructor can end the simulation. 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. 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. Trainee will be respectful to others and their views during the PBL session. 2. Askhow the patient is feeling as this may provide some useful information about their current symptoms. 2007. Perform urinalysis and send the urine for culture if urinary tract infection is suspected. The objective is to give as many visual and tactile cues concerning the patient condition and background as possible. Published August 2015. 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. Clinical Simulation in Nursing, Volume 39, 2020, pp. A comprehensive collection of OSCE guides to common clinical procedures, including step-by-step images of key steps, video demonstrations and PDF mark schemes. DO NOT perform any examination or procedure on patients based purely on the content of these videos. This typically involves the use of anon-rebreathe maskwith an oxygen flow rate of15L. JEMS. 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. In this case scenario, dehydration is one of the most serious immediate issues. The faculty member/course coordinator of Simulation Design They have had no clinical exposure or any clinical experience. See ourintravenous cannulation guidefor more details. As with the animated lecture, the simulation is strongly dependent on a focused case study. Instagram: https://instagram.com/geekymedics 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. We have 18 to 20 PBL groups for an hour each in the week after their PBL DKA session. Because of this consciousness status, it is very difficult to obtain information of cardiovascular, pulmonary, renal, hepatic, endocrine, hematology, or coagulation status other than uncontrolled diabetes. endobj The 60 minutes training time consists of four 15-minute sections divided as follows. Observe and discuss the effects of therapy in a mathematically modeled physiological simulator. A comprehensive collection of clinical examination OSCE guides that include step-by-step images of key steps, video demonstrations and PDF mark schemes. If you have any scenarios you would be willing to share with the simulation community, please forward them to me. She had developed nausea, extreme fatigue, mild disorientation, and blurred vision toward the end of the soccer match. This is particularly important for core cases and low-frequency, high-stakes procedures and encounters. The patient synopsis should include such standard aspects as age, sex, ethnicity, medical history, medications and allergies. This may produce better retention of the subject matter and help students adapt to emergency scenes before going into the field. Patients with DKA require fluid resuscitation to restore circulatory volume, clear ketones, correct electrolyte abnormalities and increase renal perfusion. Collectblood testsafter cannulating the patient including: An ECG should be performed to screen for cardiac pathology such as arrhythmias which may be precipitated by electrolyte abnormalities (e.g. - 150+ PDF OSCE Checklists: https://geekymedics.com/pdf-osce-checklists/ Prehosp Emerg Care. To read Pages full Research Review column, visit www.jems.com/patient-care. VbQuX#R M21 These are not learning objectives in this program. Stage 1: Initial assessment of acutely unwell pregnant woman and diagnosis of DKA. Inspect for evidence of self-injection sites (e.g. 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. Laschinger S, Medves J, Pulling C, et al. See Table 4 for a suggested standardized script. 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. Make sure to re-assess the patient after any intervention. Should any changes be made to the current management of their underlying condition(s)? Twitter: http://www.twitter.com/geekymedics We are looking for declaration of DKA and request for pathway. Strategies of high-performing paramedic educational programs. - Geeky Medics OSCE App: https://geekymedics.com/geeky-medics-app/ As the name says, this screen is used to graph and plot any parameter. The students are in their first year. dq-]gX4 `L'u7myx) rpjf0z,.y`VMyx-&Ju`U0 Trainee will practice or observe good teamwork skills, both as a leader and a team player. DY{Qb"(EgN$QI*%XN1F""0a5 1. Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. doi: 10.7759/cureus.1286. These simulation sessions seem to work because the medical students do have prior knowledge. Its important to train and educate students of prehospital care on key indicators of a diabetic emergency. During an immersive simulation, its imperative the group uses critical-thinking skills and group collaboration independently. endobj 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. x]o ]?9kgq~:)?hE )R6!up}\<8||\]}Y~;xp~yQ$#4~djX&{n_m-]^K1/~/AD Hv 99evs,;8}8zwnhFxV.kf-V^? Introduceyourselfto thepatientincluding yournameandrole. 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. 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].. - Associated symptoms 03:04 your express consent. 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. We used the Medical Education Technologies Inc. (METI) Human Patient Stimulator (HPS, METI Sarasoto, Fl). From the Department of Anesthesiology, Pennsylvania State University College of Medicine, Hershey, PA. Dr. Murray is on the Speakers Bureau of METI, Sarasota, FL. to maintaining your privacy and will not share your personal information without Ketones show 5.5. Subscribe to our newsletter to be the first to know about our latest content: https://geekymedics.com/newsletter/ #geekymedics #fyp #fypviral #studytok #medicalstudentuk #medtok #studytips #studytipsforstudents #medstudentuk #premed #medschoolfinals, Cardiovascular History Tips - DON'T FORGET these 3 things . You may search for similar articles that contain these same keywords or you may - Exacerbating & relieving factors 05:12 For example, you could develop a diabetic scenario in which the prehospital provider encounters an altered patient with incomprehensible speech. - 2500+ OSCE Flashcards: https://geekymedics.com/osce-flashcards/ Each performance measure is separated into cognitive, behavioral or technical categories. 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. For more information, please refer to our Privacy Policy. In the meantime, you can perform some basic airway manoeuvres to help maintain the airway whilst awaiting senior input. 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). Other details are also important, including descriptions regarding patient language skill, social history, socioeconomic history, family history, religious practices or beliefs pertinent to treatment, and descriptive signs and symptoms. 3. This allows the learner group to make a psychological break from the patient and environment while beginning the reflection process. Inspect theairwayfor obviousobstruction. reduced air entry, coarse crackles) to screen for evidence of pneumonia. Circulating nurse in the emergency room (ER). 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. Manikin staging can provide strong cues. Open the patients airwayusing ahead-tiltchin-lift manoeuvre: 1. The optimal number of simulation participants is four to seven individuals, depending on the case study objectives. For similar reasons, we do not believe a videotaped session will keep the students attention as much as these live simulator sessions. Similar to a ward round, where the instructor would say: Come and listen to this patient with an aortic stenosis. Join the Geeky Medics community: Clearlydocument your ABCDE assessment, including history, examination, observations, investigations, interventions, and the patients response. The DKA simulation incorporates cue recognition, analysis of cues, generation of solutions, nursing interventions, and evaluation of outcomes, including effective communication and psychosocial concerns. Environment & Manikin Geeky Medics accepts no liability for loss of any kind incurred as a result of reliance upon the information provided in this video. <>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 595.32 841.92] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> Marx JA, Hockberger RS, Walls RM. They have had no clinical exposure or any clinical experience. - Site 01:12 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. If the patient isunconsciousorunresponsive, start thebasic life support(BLS)algorithmas per resuscitation guidelines. Consider active re-warming techniques in patients with severe hypothermia. Advance the airway until it lies within the pharynx. Therefore, we have to emphasize the importance of airway, breathing, and circulation in the very sick patient in any clinical setting. (1) The assessment of a diabetic patient is best taught as a. 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). In keeping with the case study, as a treatment marker is reached, the instructor should place emphasis on physiological, pharmacological, environmental and psychosocial issues. 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 . If the patient is conscious, sit themuprightas this can also help with oxygenation. Trainee will describe the changes in vital signs, the major metabolic, fluid, and electrolyte. - Radiation 02:45 She began experiencing progressively worsening thirst, increased appetite, and excessively increased urination. 1-6. If the patient is suspected to have sufferedsignificanttraumawith potential spinal involvement, perform ajaw-thrustrather than a head-tilt chin-lift manoeuvre: 2. Data Description All the product records are stored at /user/spark/dataset/retail_db/products All the category records are stored at /user/spark/dataset /ret. Medical Simulation Scenarios are text documents outlining the various details of a simulation - everything from patient simulator settings to debriefing notes. cellulitis). . Please enable scripts and reload this page. After the first voluntary session in 2006, feedback from the medical students indicated that they would like to receive this handout. 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 is confused you might be able to get a collateral history from staff or family members as appropriate. 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. 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. If an infection is suspected, IV antibioticsshould be administered as soon as possible. - Character 02:14 After initial insulin therapy has reduced plasma blood glucose levels (e.g. It should only be inserted in unconscious patients as it is otherwise poorly tolerated and may induce gagging and aspiration.