Black Obgyn Columbia, Sc, Crofters Religion Witchcraft, Articles D

There are several causes of DKA, which we remember by the "five I's". Its best, however, to allow the student group to continue so theyre able to evaluate their decision-making processes during debriefing. See ourdocumentation guidesfor more details. Development of simulation scenarios for an adolescent patient with diabetic ketoacidosis. Properly interpret a venous blood gas (VBG) and basic metabolic panel in a patient presenting with diabetic ketoacidosis. 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. Below is a collection of donated scenarios for you to use or modify. We are looking for declaration of DKA and request for pathway. Are any further assessments or interventions required? Seek senior helpif the patient shows no signs of improvement or if you have any concerns. She is lethargic and slightly confused but can intermittently respond to questions. Instagram: https://instagram.com/geekymedics Emergency medical services workLife characteristics contribute to clinically significant excessive daytime sleepiness. 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. The use of case-based simulation, although more complicated and time consuming for the instructor, immerses the students in the subject matter. Its absolutely necessary to follow all immersive simulations with a positive, emotionally safe and nonjudgmental debriefing environment. The students worked on the underlying physiology during a week long PBL session and are therefore familiar with the theoretical aspects of DKA. endobj Margolis GS, Romer GA, Fernandez AR, et al. 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. Measure the patients capillary blood glucose and ketone levels to confirm the diagnosis and guide the management of DKA. The objective is to give as many visual and tactile cues concerning the patient condition and background as possible. - 700+ OSCE Stations: https://geekymedics.com/osce-stations/ This may produce better retention of the subject matter and help students adapt to emergency scenes before going into the field. 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 students have acquired all the applicable theoretical knowledge of the case during the previous multiday PBL sessions. A patient with Type I diabetes will often have symptoms related to blood sugar imbalances that appear abruptly with polydipsia, polyuria, polyphagia and rapid weight loss. Make sure tore-assessthe patient after anyintervention. Revisit history taking to explore relevant medical history and identify any precipitating factors for DKA. 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. 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. This allows the learner group to make a psychological break from the patient and environment while beginning the reflection process. x]o ]?9kgq~:)?hE )R6!up}\<8||\]}Y~;xp~yQ$#4~djX&{n_m-]^K1/~/AD Hv 99evs,;8}8zwnhFxV.kf-V^? Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes mellitus, most common in patients with type 1 diabetes in particular due to a deficiency or absence of insulin [1].. Facilitator to ask how often to measure BMs His Wife Gave Him CPR. confusion, coma), All critically unwell patients should have. 3. Trainee will recognize and interpret the clinical signs and symptoms and the typical history of a patient with DKA, as well as understand the major causative factors of DKA. Make sure to re-assess the patient after any intervention. - PSA Question Pack: https://geekymedics.com/psa-question-bank/ If the patient is conscious, sit themuprightas this can also help with oxygenation. We also show them IV bags containing saline and Ringers lactate, as well as show them IV infusion sets. DONT FORGET these 3 key components of the cardiovascular exam for your upcoming OSCEs Save this video to watch later and dont forget to follow Geeky Medics! Note that if-thens must also include negative patient outcomes for when the provider doesnt take appropriate action. Does the patient need reviewing by a specialist? Groups of more than seven may struggle with meeting objectives due to insufficient functional rolls. - Exacerbating & relieving factors 05:12 Blood sugar issues in the Type II diabetic will have a gradual onset, with diagnosis generally resulting from routine laboratory exams.(1). For more information, please refer to our Privacy Policy. Trainee will recognize the need for therapy and suggest an appropriate therapy in a simulated environment. The instructor can also gauge the direction the debriefing session should follow or be alerted to possible problems or conflicts in treatment opinions. 3. }HyEf,#$/JSRU9+CF6k\'/z+i`[ 5JudK*Zly^g%[jCK)H[)Y=Qp0/r9o9HW_zF}pTzI~'|q.~:=Y T 9w! 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. We have spent many hours debating whether the small group format was a waste of time. A collection of communication skills guides, for common OSCE scenarios, including history taking and information giving. If you have any scenarios you would be willing to share with the simulation community, please forward them to me. See our blood glucose measurement guide for more details. Management of diabetic ketoacidosis in adults. Therefore, we have to emphasize the importance of airway, breathing, and circulation in the very sick patient in any clinical setting. Adds true to life parking codes and extra parking for AI. After initial insulin therapy has reduced plasma blood glucose levels (e.g. Antibiotics should be prescribed in keeping with local guidelines. A strong emphasis is placed on the focused, methodical examination of a specific medical problem and the decision-based treatment options available. Immersive simulations are mentally exhausting because they create an intense and stressful atmosphere requiring the learner to work outside their comfort zone. 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. Using the arterial line, the scenario becomes much more dynamic. If foreign material is present, attempt removal using suction. 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). 3 0 obj If the patient isunconsciousorunresponsive, start thebasic life support(BLS)algorithmas per resuscitation guidelines. 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. <> Because of the early stage (first year) of their medical careers, they have not yet seen vital sign monitoring, or patients, so these clinical aspects are introduced and emphasized. 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. Simulation Scenario. 2011;15:108109. Classroom Dynamics Int J Evid Based Healthc. In the context of DKA, a patients consciousness level may be reduced. 2008;6:278302. Observe and discuss the effects of therapy in a mathematically modeled physiological simulator. Discuss the patients current clinical condition with aseniorclinicianusing anSBARR style handover. Geeky Medics accepts no liability for loss of any kind incurred as a result of reliance upon the information provided in this video. Marx JA, Hockberger RS, Walls RM. 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. Geeky Medics accepts no liability for loss of any kind incurred as a result of reliance upon the information provided in this video. 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 debriefing section with pre-established questions allows the instructor to review the main focus and performance measures with the student group. An oxygen mask is also demonstrated as an alternative device, as these early trainees had mostly not yet seen any of these devices. Askhow the patient is feeling as this may provide some useful information about their current symptoms. Typically potassium levels should be maintained between 4.0 5.5 mmol/L and close monitoring is required. After entering the environment, the student doesnt have the option of leaving the simulation until the learning objectives and performance measures are achieved. You might also be interested in our awesome bank of 700+ OSCE Stations. We guide the group to suggest fluid. 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. Surgical dressings and imitation blood can support medical history. If an obstruction is visible within the airway, use afingersweeporsuctionto remove it. This leads to hyperglycaemia, osmotic diuresis, and dehydration. See ourintravenous cannulation guidefor more details. 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. The reason for inserting the airway upside down initially is to reduce the risk of pushing the tongue backwards and worsening airway obstruction. Indeed, it is the only thing that ever has.". The DKA simulation incorporates cue recognition, analysis of cues, generation of solutions, nursing interventions, and evaluation of outcomes, including effective communication and psychosocial concerns. - 150+ PDF OSCE Checklists: https://geekymedics.com/pdf-osce-checklists/ Clearly communicate how often would you like the patients observations relayed to you by other staff members. They have had no clinical exposure or any clinical experience. 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. She had developed nausea, extreme fatigue, mild disorientation, and blurred vision toward the end of the soccer match. DKA can develop within 24 hours and is potentially life threatening, requiring prompt recognition and therapeutic intervention. tall tented T waves in hyperkalaemia). Anesthetic Management Using the Oxygen Reserve Index for Tracheal Resection and Tracheal End-to-E A Scoping Review of the Impact of COVID-19 on Kidney Transplant Patients in the United States, Alabama College of Osteopathic Medicine Research, Baylor Scott & White Medical Center Department of Neurosurgery, California Institute of Behavioral Neurosciences & Psychology, Contemporary Reviews in Neurology and Neurosurgery, DMIMS School of Epidemiology and Public Health, Simulation, Biodesign, & Innovation In Medical Education, The Florida Medical Student Research Publications, University of Florida-Jacksonville Neurosurgery, VCOM Clinical, Biomedical, and Educational Research, American Red Cross Scientific Advisory Council, Canadian Association of Radiation Oncology, International Liaison Committee on Resuscitation, International Pediatric Simulation Society, Medical Society of Delaware Academic Channel, Society for Healthcare & Research Development, Surgically Targeted Radiation Therapy for Brain Tumors: Clinical Case Review, Clinical and Economic Benefits of Autologous Epidermal Grafting, Defining Health in the Era of Value-Based Care, Optimization Strategies for Organ Donation and Utilization, MR-Guided Radiation Therapy: Clinical Applications & Experiences, Multiple Brain Metastases: Exceptional Outcomes from Stereotactic Radiosurgery, Proton Therapy: Advanced Applications for the Most Challenging Cases, Radiation Therapy as a Modality to Create Abscopal Effects: Current and Future Practices, Clinical Applications and Benefits Using Closed-Incision Negative Pressure Therapy for Incision and Surrounding Soft Tissue Management, Negative Pressure Wound Therapy with Instillation, NPWT with Instillation and Dwell: Clinical Results in Cleansing and Removal of Infectious Material with Novel Dressings. An hour was . Each clinical case scenario allows you to work through history taking, investigations, diagnosis and management. 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. 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. This simulation session therefore aims to make the case come alive, and show this known case in a clinical context. Prehosp Emerg Care. 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. Inspect for evidence of infection on the skin (e.g. Your message has been successfully sent to your colleague. 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 . 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. 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). Keywords: diabetic ketoacidosis, simulation, expertise, emergency medicine Introduction Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes mellitus, most . We now provide the students with handouts of the data to save time and provide consistency. These are not learning objectives in this program. DKA can be caused by either: Absolute insulin deficiency (e.g. As with the animated lecture, the simulation is strongly dependent on a focused case study. In this section, we have to help the trainee to institute definitive therapy based on the underlying biochemical abnormalities. Perform urinalysis and send the urine for culture if urinary tract infection is suspected. 5. Despite this increased calorie intake, she noticed an unexplained 20 lbs weight loss. If the patientloses consciousnessand there areno signs of lifeon assessment, put out acrash callandcommence CPR. Deteriorationshould be recognised quickly and acted upon immediately. 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. A well-staged environment allows for greater student buy-in. Physician working in the emergency department. >> Patterson PD, Weaver M, Frank R, et al. DO NOT perform any examination or procedure on patients based purely on the content of these videos. 6. 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. 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). Diabetes (type 1 and type 2) in children and young people: diagnosis and management. 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. 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. She began experiencing progressively worsening thirst, increased appetite, and excessively increased urination. 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. Trainee will get to know how professionals behave during management of a critically ill patient. Review the patientscurrent medicationsand check any regular medications areprescribed appropriately. 3. 2. Trainee will increase knowledge of professional behaviors during the simulation. 2007. - Severity 05:32 In the final 10 minutes, we show how the patient has a good recovery after fluid replacement.