dka simulation scenario dka simulation scenario

}HyEf,#$/JSRU9+CF6k\'/z+i`[ 5JudK*Zly^g%[jCK)H[)Y=Qp0/r9o9HW_zF}pTzI~'|q.~:=Y T 9w! Conclusions This technical report describes the design and implementation of a simulation scenario on DKA for emergency medicine trainees. See our blood glucose measurement guide for more details. Int J Evid Based Healthc. Geeky Medics accepts no liability for loss of any kind incurred as a result of reliance upon the information provided in this video. As the name says, this screen is used to graph and plot any parameter. Invasive monitors, including a left radial intraarterial and a right subclavian IV catheter, were placed. Your message has been successfully sent to your colleague. The lecture allows for understanding of concepts prior to action, and instructor feedback is immediate. Airway adjuncts are often helpful and in some cases essential to maintain a patients airway. Diabetic ketoacidosis (DKA) is a common, potentially lethal disease. Moses Lake (WA) Fire Department Gets $3.3M Grant for more Firefighters, Woman Who Crashed into Responders, Killing PA Firefighter, Gets Prison, Three Apparent Gas Explosions at San Bernardino (CA) Mountain Homes, Enid (OK) Fire Department Begins SWAT Medic Program to Assist Police, FDNY EMS Providers Win COVID-19-Linked Free Speech Lawsuit, Coronavirus Origins Still a Mystery Three Years into Pandemic. Circulating nurse in the emergency room (ER). Section snippets . Subscribe to our newsletter to be the first to know about our latest content: https://geekymedics.com/newsletter/ They should introduce the student group to the environment, assign roles for each learner and guide the decision-making process. Chapters: The faculty member/course coordinator of Simulation Design Inspect theairwayfor obviousobstruction. #geekymedics #fyp #fypviral #studytok #medicalstudentuk #medtok #studytips #studytipsforstudents #medstudentuk #premed #medschoolfinals, Cardiovascular History Tips - DON'T FORGET these 3 things . See ourdocumentation guidesfor more details. modify the keyword list to augment your search. - Site 01:12 2011;15:108109. areas of lipohypertrophy) if it is unclear if the patient is diabetic. unilateral coarse crackles may be present if the patient has pneumonia which may have been the precipitant for DKA). to maintaining your privacy and will not share your personal information without This style also doesnt mimic an actual scene, and a student may feel that treatment modalities and skills are performed at a slower rate than real-world applications. Animated Lecture If an obstruction is visible within the airway, use afingersweeporsuctionto remove it. DO NOT perform any examination or procedure on patients based purely on the content of these videos. Trainee will improve their understanding of clinical practice through reflective assessment of actual cases during the prior PBL sessions. DO NOT perform any examination or procedure on patients based purely on the content of these videos. After entering the environment, the student doesnt have the option of leaving the simulation until the learning objectives and performance measures are achieved. Standardized patient as the voice of the simulator (or the simulation operator may play this role). 3. - 700+ OSCE Stations: https://geekymedics.com/osce-stations/ Alert a senior immediately if you have any concerns about the consciousness level of a patient. Immersive Simulations The choice of fluid type, rate of administration and volume should be tailored to the individual patient based upon their vital signs and electrolytes. Causes: Any situation arising in a diabetic that requires increased insulin without that demand being met can result in DKA. As this is a value-added session that demonstrates new concepts, such as the vital signs on a clinical monitor, there are no assessment instruments to measure gaining of understanding. Nandate, Koichiro MD, PhD; Abola, Ramon MD; Murray, W Bosseau MB; Whitfield, Carol PhD; Lang, Charles PhD; Sinz, Elizabeth MD. When erroneous treatment is delivered, the instructor can end the simulation. Twitter: http://www.twitter.com/geekymedics (1) The assessment of a diabetic patient is best taught as a. In this section, we have to help the trainee to institute definitive therapy based on the underlying biochemical abnormalities. There are several causes of DKA, which we remember by the "five I's". 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 also show them IV bags containing saline and Ringers lactate, as well as show them IV infusion sets. Effectiveness of simulation on health profession students knowledge, skills, confidence and satisfaction. Classroom Dynamics Research Watch Box:Sleep, Fatigue & SafetyBy David Page, MS, NREMT-P 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. SimMan Nursing Scenarios Software. DY{Qb"(EgN$QI*%XN1F""0a5 <>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 595.32 841.92] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> His Wife Gave Him CPR. The main purpose of the simulation is to draw a line from the theoretical, boring biochemistry to the clinical manifestations. For diabetic assessment involving DKA, staging may include the use of a container with a small amount of acetone placed near the manikin because many students may not know what acetone smells like but will expect to smell something. 2003;78:783788. A collection of communication skills guides, for common OSCE scenarios, including history taking and information giving. Immersive simulations are mentally exhausting because they create an intense and stressful atmosphere requiring the learner to work outside their comfort zone. Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario Cureus. After initial insulin therapy has reduced plasma blood glucose levels (e.g. Inspect for evidence of self-injection sites (e.g. The files are given in full in the web supplement (Appendix B, Supplemental Digital Content 2, https://links.lww.com/SIH/A2). 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. Trainee will appropriately request assistance and use available resources. 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. This simulation session therefore aims to make the case come alive, and show this known case in a clinical context. Its absolutely necessary to follow all immersive simulations with a positive, emotionally safe and nonjudgmental debriefing environment. . Depending on scenario complexity, team dynamic and treatment modalities, this simulation may take 1020 minutes. 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). type 1 diabetes), Complete insulin insensitivity (e.g. We now provide the students with handouts of the data to save time and provide consistency. 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. Using the arterial line, the scenario becomes much more dynamic. This field is for validation purposes and should be left unchanged. 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. - 150+ PDF OSCE Checklists: https://geekymedics.com/pdf-osce-checklists/ You may search for similar articles that contain these same keywords or you may 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). 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. A comprehensive collection of medical revision notes that cover a broad range of clinical topics. Extremities: mild cyanosis, no clubbing or edema (verbalized by instructors); pulses equal, and symmetrical (elucidated by trainees). Deteriorationshould be recognised quickly and acted upon immediately. See ourhistory taking guidesfor more details. Instagram: https://instagram.com/geekymedics One of the key differences with the immersive simulation is that the instructor is absent from the simulation environment. In the context of DKA, a patients consciousness level may be reduced. Another example: At one minute into the scenario, the patient becomes unresponsive and their breathing becomes shallow. These are not learning objectives in this program. Development of simulation scenarios for an adolescent patient with diabetic ketoacidosis. Groups of more than seven may struggle with meeting objectives due to insufficient functional rolls. GRAPH. In keeping with the case study, as a treatment marker is reached, the instructor should place emphasis on physiological, pharmacological, environmental and psychosocial issues. 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. >> Fernandez AR, Mac Crawford J, Pennell ML, et al. 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. This is a combination of the modified traditional lecture within scenario-based learning. Tilt the forehead back whilst lifting the chin forwards to extend the neck. This allows us to get in touch for more details if required. Given such a small group, the students indicated that they feel more involved than they would with a larger group (eg, the whole class.) Reduced urine output (oliguria) is typically defined as less than 0.5ml/kg/hour in an adult. dq-]gX4 `L'u7myx) rpjf0z,.y`VMyx-&Ju`U0 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. 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. 2008;6:278302. Makeup may be used to depict gender, hollow eyes and cheeks, produce pallor or display bruises and scars. The Pratcice KDCA, Ronald Reagan Washington National Airport, DC. For similar reasons, we do not believe a videotaped session will keep the students attention as much as these live simulator sessions. Please write a single word answer in lowercase (this is an anti-spam measure). 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. Askhow the patient is feeling as this may provide some useful information about their current symptoms. In other words, they do not have clinical experience, but they have clinical knowledge. The scenario would include an if-then algorithm. vD0 x@FFJ{m[ 3//Oh|JR7! J Nurs Educ. 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. DOI 10.7759/cureus.1286. 2009;13:505511. 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. Seek senior helpif the patient shows no signs of improvement or if you have any concerns. Keyword Highlighting 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.) 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. #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! Centers for Disease Control and Prevention. As individuals with uncontrolled type I . Measure the patients capillary blood glucose and ketone levels to confirm the diagnosis and guide the management of DKA. Refer to your local guidelines which should provide a clear protocol for the management of DKA. Refer to your local guidelines for further details. In an animated lecture, its important that the student group have an instructor so they can ask direct questions. Cureus is on a mission to change the long-standing paradigm of medical publishing, where submitting research can be costly, complex and time-consuming. insulin-dependent type 2 diabetes), Altered consciousness (e.g. If you have any scenarios you would be willing to share with the simulation community, please forward them . <> After the initial treatment is initiated, by showing a simulated urine and blood, and by getting them to smell ketones, we can enable the trainee to confirm the diagnosis of DKA. 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). 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. DKA can develop within 24 hours and is potentially life threatening, requiring prompt recognition and therapeutic intervention. - Character 02:14 The learning objectives follow the American College of Graduate Medical Education (ACGME) Core Compentencies. You may be trying to access this site from a secured browser on the server. Recognize the signs and symptoms of a patient presenting with diabetic ketoacidosis. 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). Forty percent of respondents reported excessive daytime sleepiness. Case-based education adds a real-world aspect to the learning environment. They have had no clinical exposure or any clinical experience. We combined both to indicate the continuity of the curriculum, and the building on prior knowledge. Perform urinalysis and send the urine for culture if urinary tract infection is suspected. Scenarios. Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. Trainee will learn to collaborate with peers to decide on appropriate interventions, tests, and therapy. Should any changes be made to the current management of their underlying condition(s)? 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. It was Refer to your local guidelines for further details. 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. Case-based simulation should include two to three broad-focus objectives, as well as 1020 specific performance measures that the student should accomplish. 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. Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario Capillary refill timemay be prolonged if the patient is hypovolaemic. TheABCDEapproach can be used to perform a systematic assessment of a critically unwell patient. Simulation provides a safe environment where learning is enhanced through the deliberate practice of skills and controlled management of a variety of clinical encounters. 2 The evaluation of potassium deficits is complicated by potassium exit from . 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). Are any further assessments or interventions required? endobj 2. Please try after some time. The normal reference range for fasting plasma glucose is 4.0 5.8 mmol/l. 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. Clinical Simulation in Nursing, Volume 39, 2020, pp. Observe and discuss the effects of therapy in a mathematically modeled physiological simulator. 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. The facilitator guides the group only when necessary. 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].. 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.