Administer oxygen to all critically unwell patients during yourinitialassessment. DOI 10.7759/cureus.1286. Causes: Any situation arising in a diabetic that requires increased insulin without that demand being met can result in DKA. We try to provide sufficient realism.. Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. However, this leads to confusion. VbQuX#R M21 Review the patientscurrent medicationsand check any regular medications areprescribed appropriately. unilateral coarse crackles may be present if the patient has pneumonia which may have been the precipitant for DKA). A well-staged environment allows for greater student buy-in. >> Patterson PD, Weaver M, Frank R, et al. A comprehensive collection of medical revision notes that cover a broad range of clinical topics. 1) Please read through this document as it will help you prepare for your upcoming simulation on DKA. A collection of interactive medical and surgical clinical case scenarios to put your diagnostic and management skills to the test. Groups of more than seven may struggle with meeting objectives due to insufficient functional rolls. insulin-dependent type 2 diabetes) Symptoms Typical symptoms of DKA include: Palpitations Nausea Vomiting Sweating Thirst Weight loss Leg cramps Clinical signs Typical clinical signs of DKA include: Tachycardia Hypotension 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. 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. Data is temporarily unavailable. Its best, however, to allow the student group to continue so theyre able to evaluate their decision-making processes during debriefing. Urinary tract infections are a common DKA precipitant. reduced air entry, coarse crackles) to screen for evidence of pneumonia. If the patient isunconsciousorunresponsive, start thebasic life support(BLS)algorithmas per resuscitation guidelines. <>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 595.32 841.92] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> This allows us to get in touch for more details if required. The use of case-based simulation, although more complicated and time consuming for the instructor, immerses the students in the subject matter. 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. Make sure tore-assessthe patient after anyintervention. Several environments may be suitable for your classroom. As the name says, this screen is used to graph and plot any parameter. Inspect for evidence of infection on the skin (e.g. Facilitator to ask how often to measure BMs They have had no clinical exposure or any clinical experience. It was developed for anesthesiology resident physicians with some background knowledge and experience caring for critically ill patients. During an immersive simulation, its imperative the group uses critical-thinking skills and group collaboration independently. Each performance measure is separated into cognitive, behavioral or technical categories. Invasive monitors, including a left radial intraarterial and a right subclavian IV catheter, were placed. If you have any scenarios you would be willing to share with the simulation community, please forward them to me. In the context of DKA, a patients consciousness level may be reduced. Standardized patient as the voice of the simulator (or the simulation operator may play this role). If you have any scenarios you would be willing to share with the simulation community, please forward them . Catheterisethe patient to closelymonitor urine outputto guide fluid resuscitation and need for escalation. The trainees have had background knowledge of biochemistry because they had completed the PBL case. 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. 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. Case-based education adds a real-world aspect to the learning environment. The 60 minutes training time consists of four 15-minute sections divided as follows. Keywords: diabetic ketoacidosis, simulation, expertise, emergency medicine Introduction Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes mellitus, most . - Geeky Medics OSCE App: https://geekymedics.com/geeky-medics-app/ A strong emphasis is placed on the focused, methodical examination of a specific medical problem and the decision-based treatment options available. If the patientloses consciousnessand there areno signs of lifeon assessment, put out acrash callandcommence CPR. Trainee will practice or observe good teamwork skills, both as a leader and a team player. 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. 3. Well done, youve now stabilised the patient and theyre doing much better. Animated Lecture Reduced urine output (oliguria) is typically defined as less than 0.5ml/kg/hour in an adult. By joining Cureus, you agree to our In the final 10 minutes, we show how the patient has a good recovery after fluid replacement. Lets discuss your options. The validity of the HFS-DKA scenario was verified by a certified diabetes nurse educator, a registered nurse, and a clinical nurse educator. Before trainees arrival into the simulation area, the simulator is already preprogrammed for DKA. Performing an ECG should not delay the emergency management of DKA. Ziv A, Wolpe PR, Small SD, et al. 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 . Acad Med. The DKA simulation incorporates cue recognition, analysis of cues, generation of solutions, nursing interventions, and evaluation of outcomes, including effective communication and psychosocial concerns. 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). The reason for inserting the airway upside down initially is to reduce the risk of pushing the tongue backwards and worsening airway obstruction. Trainee will get to know how professionals behave during management of a critically ill patient. The objective is to give as many visual and tactile cues concerning the patient condition and background as possible. If the provider starts an IV and gives dextrose, then the patients alertness will increase, respirations will normalize and repeated blood glucose will read 210 mg/dL over a two-minute interval. GRAPH. The debriefing environment should be removed from the location where the simulation took place. General: Moaning, asking what has happening to her. Effectiveness of simulation on health profession students knowledge, skills, confidence and satisfaction. - Timing 03:23 Refer to your local guidelines for further details. Just place the BR2_KDCA file into your addons scenery folder: C:\\Program Files\\Microsoft Games\\Microsoft Flight Simulator X\\Addon Scenery\\Scenery. 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. As with the animated lecture, the simulation is strongly dependent on a focused case study. to maintaining your privacy and will not share your personal information without 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). A collection of communication skills guides, for common OSCE scenarios, including history taking and information giving. Centers for Disease Control and Prevention. Development of simulation scenarios for an adolescent patient with diabetic ketoacidosis. Available from: [, NICE guidelines. #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! Insert the airway bevel-end first, vertically along the floor of the nose with a slight twisting action. 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. A comprehensive collection of clinical examination OSCE guides that include step-by-step images of key steps, video demonstrations and PDF mark schemes. Over the years, some groups happened to have the simulation session before the completion of the theoretical PBL session. Int J Evid Based Healthc. 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. Its important to train and educate students of prehospital care on key indicators of a diabetic emergency. This is particularly important for core cases and low-frequency, high-stakes procedures and encounters. This guide has been created to assist students in preparing for emergencysimulationsessionsas part of their training,it is not intended to be relied upon for patient care. The simulation experience serves to give substance to the theoretical words and concepts that the students encountered during the PBL sessions. 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). 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. If the patient is conscious, sit themuprightas this can also help with oxygenation. Insert at least onewide-bore intravenous cannula(14G or 16G) and take blood tests as discussed below. We combined both to indicate the continuity of the curriculum, and the building on prior knowledge. The students are in their first year. Should any changes be made to the current management of their underlying condition(s)? Seek senior helpif the patient shows no signs of improvement or if you have any concerns. endobj Nandate, Koichiro MD, PhD; Abola, Ramon MD; Murray, W Bosseau MB; Whitfield, Carol PhD; Lang, Charles PhD; Sinz, Elizabeth MD. Schneider Sarver PA, Senczakowicz EA, Slovensky BM. Categories: Emergency Medicine, Medical Education Keywords: diabetic ketoacidosis, simulation, expertise, emergency medicine . We have 18 to 20 PBL groups for an hour each in the week after their PBL DKA session. Healthcare Students' Psychological Well-Being in a Diabetic Ketoacidosis Simulation. In the meantime, you can perform some basic airway manoeuvres to help maintain the airway whilst awaiting senior input. - 150+ PDF OSCE Checklists: https://geekymedics.com/pdf-osce-checklists/ - Severity 05:32 Heart: S1 and S2 within normal limits; no S3/S4 or murmurs, normal rate and rhythm. Airway adjuncts are often helpful and in some cases essential to maintain a patients airway. diagnosis of DKA Trigger 3, ABG show acidosis and high BM and normal potassium. A collection of free medical student quizzes to put your medical and surgical knowledge to the test! Trainee will learn to collaborate with peers to decide on appropriate interventions, tests, and therapy. www.cdc.gov/diabetes/statistics/prev/national/. your express consent. DO NOT perform any examination or procedure on patients based purely on the content of these videos. An integral part of a PBL session is for trainees to be able to navigate through huge literature bases. 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. ABG, venepuncture). You can check out our guide to using SOCRATES here: https://geekymedics.com/the-socrates-acronym-in-history-taking/ 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. DIABETIC KETOACIDOSIS MODULE: ENDOCRINOLOGY / METABOLIC TARGET: ALL PAEDIATRIC TRAINEES;NURSING STAFF BACKGROUND: DKA occurs when a relative or absolute lack of insulin leads to the inability to metabolise glucose. 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. Chapters: 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. Despite this increased calorie intake, she noticed an unexplained 20 lbs weight loss. 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. 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). His Wife Gave Him CPR. 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. After entering the environment, the student doesnt have the option of leaving the simulation until the learning objectives and performance measures are achieved. 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 surgery revision notes covering key surgical topics. 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)? DKA can develop within 24 hours and is potentially life threatening, requiring prompt recognition and therapeutic intervention. Inspect for evidence of self-injection sites (e.g. We demonstrate to the trainees the significant changes on the monitors by asking them to point out any changes on the simulator (clinical examination) and the vital signs (monitor parameters). They should introduce the student group to the environment, assign roles for each learner and guide the decision-making process. The students are in their basic science course. Initially, we used a blood pressure cuff to generate the blood pressure values. Deteriorationshould be recognised quickly and acted upon immediately. Make sure thepatientsnotes,observationchartandprescriptionchartare easily accessible. YouTube Video VVVram5yRUhROGJRUW1sZk5kQVFDXzV3LjMxakdNallNcng0, YouTube Video VVVram5yRUhROGJRUW1sZk5kQVFDXzV3LkJPVjVZMzBKczY4, YouTube Video VVVram5yRUhROGJRUW1sZk5kQVFDXzV3LkxEM2VkQzB2NTBr, Start typing to see results or hit ESC to close, Deep Vein Thrombosis (DVT) Examination OSCE Guide, Pre-hospital Advanced Life Support (ALS) OSCE Guide, Adult Choking (Basic Life Support) OSCE Guide, Paediatric Intravenous Cannulation OSCE Guide, Intrauterine System (Mirena) Counselling OSCE guide, Geeky Medics OSCE Book | Clinical Examination, Paediatric Gastro-oesophageal Reflux Disease, A Career as a GP with Special Interest with Dr Fiona Mosgrove, Absolute insulin deficiency (e.g. Surgical dressings and imitation blood can support medical history. 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). can be reemphasized, and the effects of fluid therapy demonstrated. Geeky Medics accepts no liability for loss of any kind incurred as a result of reliance upon the information provided in this video. Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario Cureus. The following scenarios are available for download and are designed to meet your multi-disciplinary nursing needs. The students mentioned that they did not obtain the maximum value from the simulation session under these circumstances. An events progression section should include patient status changes, as well as a time/treatment continuum that incorporates if-then event progressions. This leads to hyperglycaemia, osmotic diuresis, and dehydration. Consider active re-warming techniques in patients with severe hypothermia. The scenario would include an if-then algorithm. 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. Manikin staging can provide strong cues. Conclusions This technical report describes the design and implementation of a simulation scenario on DKA for emergency medicine trainees. Weight, Height: Not given, normal appearing (as per simulator) but has lost 20 lbs recently. Keyword Highlighting 3. We have been presenting Simulation Laboratory sessions to our preclinical medical students (first and second years). Trainee will recognize the need for therapy and suggest an appropriate therapy in a simulated environment. Please try after some time. Depending on scenario complexity, team dynamic and treatment modalities, this simulation may take 1020 minutes. 2010;49:578586. 2007. We now provide the students with handouts of the data to save time and provide consistency. Recognize the signs and symptoms of a patient presenting with diabetic ketoacidosis. - 2500+ OSCE Flashcards: https://geekymedics.com/osce-flashcards/ endobj 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.
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