The main purpose of the simulation is to draw a line from the theoretical, boring biochemistry to the clinical manifestations. Development of simulation scenarios for an adolescent patient with diabetic ketoacidosis. One of the key differences with the immersive simulation is that the instructor is absent from the simulation environment. Terms of Use. 3. Lets discuss your options. The objective is to give as many visual and tactile cues concerning the patient condition and background as possible. endobj
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. 2009;13:505511. PBL was introduced at our institution in 1995. With your index and other fingers placed behind the angle of the mandible, apply steady upwards and forward pressure to lift the mandible. 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. Privacy Policy However, this turned out to be too slow, took too much time, and could not continuously demonstrate the direction of changes. Are any further assessments or interventions required? Intubation lubricants can mimic drooling. This typically involves the use of anon-rebreathe maskwith an oxygen flow rate of15L. Consider any precipitating factors for the development of DKA and involve the diabetes team in the patients care. www.cdc.gov/diabetes/statistics/prev/national/. 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. 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). 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. Acad Med. In this section, we have to guide them as to what they should do first for the patient in this critical condition (ie, treat the A, B, Cs of airway, breathing, and circulation) before we can confirm the diagnosis. Properly interpret a venous blood gas (VBG) and basic metabolic panel in a patient presenting with diabetic ketoacidosis. DO NOT perform any examination or procedure on patients based purely on the content of these videos. Typically potassium levels should be maintained between 4.0 5.5 mmol/L and close monitoring is required. >> Fernandez AR, Mac Crawford J, Pennell ML, et al. 3 0 obj
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If the patient has COPD and a history of CO2retention you should switch to aventuri maskas soon as possible andtitrate oxygen appropriately. In the final 10 minutes, we show how the patient has a good recovery after fluid replacement. 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. 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! 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. This allows us to get in touch for more details if required. If an infection is suspected, IV antibioticsshould be administered as soon as possible. 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. Catheterisethe patient to closelymonitor urine outputto guide fluid resuscitation and need for escalation. 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. A comprehensive collection of OSCE guides to common clinical procedures, including step-by-step images of key steps, video demonstrations and PDF mark schemes. 2 0 obj
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. The 60 minutes training time consists of four 15-minute sections divided as follows. Please write a single word answer in lowercase (this is an anti-spam measure). Published August 2015. A strong emphasis is placed on the focused, methodical examination of a specific medical problem and the decision-based treatment options available. Initially, we required the students to write down the vital signs. Simulation in Healthcare4(4):232-236, Winter 2009. Review the patients drug chart for medications which may cause a reduced level of consciousness (e.g. opioids, sedatives, anxiolytics, insulin, oral hypoglycaemic medications). 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. We do not use passive visualizing materials such as videotapes or DVD other than vital signs shown on the monitors. The patient synopsis should include such standard aspects as age, sex, ethnicity, medical history, medications and allergies. The files are given in full in the web supplement (Appendix B, Supplemental Digital Content 2, https://links.lww.com/SIH/A2). - Site 01:12 Example: If the provider immediately evaluates blood glucose, then the reading will display 45 mg/dL. - Timing 03:23 Measure the patients capillary blood glucose and ketone levels to confirm the diagnosis and guide the management of DKA. Blood sugar issues in the Type II diabetic will have a gradual onset, with diagnosis generally resulting from routine laboratory exams.(1). The researchers found that long shift hours (24hrs), working overtime and marital/relationship stress were strongly correlated. Revisit history taking to explore relevant medical history and identify any precipitating factors for DKA. You may search for similar articles that contain these same keywords or you may
Trainee will learn to collaborate with peers to decide on appropriate interventions, tests, and therapy. 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. Debriefing
Target Learner Groups 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). Works with Traffic 2005, but . Review the patientscurrent medicationsand check any regular medications areprescribed appropriately. We give the history of the patient to the trainees. can be reemphasized, and the effects of fluid therapy demonstrated. Manikin staging can provide strong cues. 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. Similar to a ward round, where the instructor would say: Come and listen to this patient with an aortic stenosis. Finally, we summarize the course and give them time for questions. Each performance measure is separated into cognitive, behavioral or technical categories. DO NOT perform any examination or procedure on patients based purely on the content of these videos. The student group should be encouraged to collaborate on management options and to perform skills. Invasive monitors, including a left radial intraarterial and a right subclavian IV catheter, were placed. Geeky Medics accepts no liability for loss of any kind incurred as a result of reliance upon the information provided in this video. 1. 2. - Exacerbating & relieving factors 05:12 Standardized patient as the voice of the simulator (or the simulation operator may play this role). 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. Facebook: http://www.facebook.com/geekymedics Rosens Emergency Medicine: Concepts and Clinical Practice. A comprehensive collection of medical revision notes that cover a broad range of clinical topics. Laschinger S, Medves J, Pulling C, et al. TikTok: https://www.tiktok.com/@geekymedics DKA can develop within 24 hours and is potentially life threatening, requiring prompt recognition and therapeutic intervention. 1. Keywords: diabetic ketoacidosis, simulation, expertise, emergency medicine Introduction Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes mellitus, most . Nandate, Koichiro MD, PhD; Abola, Ramon MD; Murray, W Bosseau MB; Whitfield, Carol PhD; Lang, Charles PhD; Sinz, Elizabeth MD. We try to provide sufficient realism.. The students mentioned that they did not obtain the maximum value from the simulation session under these circumstances. After the first voluntary session in 2006, feedback from the medical students indicated that they would like to receive this handout. Problems are addressed as they are identified and the patient is re-assessed regularly to monitor their response to treatment. - Geeky Medics OSCE App: https://geekymedics.com/geeky-medics-app/ You could also ask a student to smear a small amount of acetone on a piece of glass to see how volatile it is, helping them understand why its being exhaled by the DKA 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. Geeky Medics accepts no liability for loss of any kind incurred as a result of reliance upon the information provided in this video. Stage 1: Initial assessment of acutely unwell pregnant woman and diagnosis of DKA. Immersive Simulations
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. A debriefing section with pre-established questions allows the instructor to review the main focus and performance measures with the student group. . 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. Tilt the forehead back whilst lifting the chin forwards to extend the neck. 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. 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. Diabetic Ketoacidosis (DKA) Clinical Pathway Emergency Department | Children's Hospital of Philadelphia 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. Strategies of high-performing paramedic educational programs. Performing an ECG should not delay the emergency management of DKA. a simulation training session designed to acquaint emergency medicine residents with the presentation and management of diabetic ketoacidosis (DKA) through the use of simulation. It involves working through the following steps: Each stage of the ABCDE approach involvesclinicalassessment,investigationsandinterventions. We ask the trainee why the blood pressure is so low or heart rate is so high, and how we should treat it. Trainee will improve their understanding of clinical practice through reflective assessment of actual cases during the prior PBL sessions. KDCA, Ronald Reagan Washington National Airport, DC. 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. Schneider Sarver PA, Senczakowicz EA, Slovensky BM. The required potassium replacement varies greatly. 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. Initially, we had a white board available, but the temptation (and habits) were just too strong, and the simulator sessions tended to become one way lectures, rather than an interactive, 2 way discussion.. 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). Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. - Over 3000 Free MCQs: https://geekyquiz.com/ An events progression section should include patient status changes, as well as a time/treatment continuum that incorporates if-then event progressions. DKA can be caused by either: Absolute insulin deficiency (e.g. At the end of the previous section, the trainee can make the diagnosis of DKA but has not confirmed it yet. It was 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. 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. As individuals with uncontrolled type I . If the patient is conscious, sit themuprightas this can also help with oxygenation. Diabetes (type 1 and type 2) in children and young people: diagnosis and management. 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). reduced air entry, coarse crackles) to screen for evidence of pneumonia. However, this leads to confusion. - 700+ OSCE Stations: https://geekymedics.com/osce-stations/ The Theory
You may be trying to access this site from a secured browser on the server. Join the Geeky Medics community: The main goal is to establish a safe learning environment for the learner [9, 13 . The use of a simulated, evolving case scenario was an effective method of exposing nursing students to complex patient care. (1), The assessment of a diabetic patient is best taught as a case-based simulation. <>
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. 2011;15:108109. 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. Inspect for evidence of self-injection sites (e.g. By joining Cureus, you agree to our This is particularly important for core . *=NdL/c2XSJn8:I Jb8'.8>N*[L .hxw6afq40DX3c~>abt'Q,8y(BZu(vKBTufIR. See ourdocumentation guidesfor more details. and endobj
Review the patientsoxygen saturation(SpO2): Auscultate the chest to screen for evidence of respiratory pathology (e.g. If you have any scenarios you would be willing to share with the simulation community, please forward them . Several environments may be suitable for your classroom. A collection of interactive medical and surgical clinical case scenarios to put your diagnostic and management skills to the test. As this is a PBL session, the trainees are not given any references. - 150+ PDF OSCE Checklists: https://geekymedics.com/pdf-osce-checklists/ 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. We have been presenting Simulation Laboratory sessions to our preclinical medical students (first and second years). If the patientloses consciousnessand there areno signs of lifeon assessment, put out acrash callandcommence CPR. Hypothermia may be present if the patient has been unconscious and exposed for some time. 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 instructors role is to facilitate active learning through a combination of learning styles. 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. MassBay EMS Program Integrates Training for Dogs, Heat Waves Are Killing More LA Homeless People. The students are in their basic science course. A collection of data interpretation guides to help you learn how to interpret various laboratory and radiology investigations. J Nurs Educ. 1-6. We have 18 to 20 PBL groups for an hour each in the week after their PBL DKA session. Forty percent of respondents reported excessive daytime sleepiness. Stage 2: Emergency management of DKA and consideration of abnormal CTG. 4. ABG, venepuncture). If you have any scenarios you would be willing to share with the simulation community, please forward them to me. Capillary refill timemay be prolonged if the patient is hypovolaemic. 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. #geekymedics #fyp #fypviral #studytok #medicalstudentuk #medtok #studytips #studytipsforstudents #medstudentuk #premed #medschoolfinals, Cardiovascular History Tips - DON'T FORGET these 3 things .