2011;15:108109. Simulation provides a safe environment where learning is enhanced through the deliberate practice of skills and controlled management of a variety of clinical encounters. This is particularly important for core cases and low-frequency, high-stakes procedures and encounters. The choice of fluid type, rate of administration and volume should be tailored to the individual patient based upon their vital signs and electrolytes. Download: http://teamworkmatters.ocbmedia.com/media/DKA-Simulation-Scenario.docx Categories: 5th Year MBChB paeds scenario, Emergency Department, Human Factors, Interprofessional / multidisciplinary, Non-technical skills, Paediatrics, Postgraduate / newly qualified, Undergraduate / pre-registration Rating Refer to your local guidelines for further details. endobj A well-staged environment allows for greater student buy-in. A GCS of 8 or below warrants urgent expert help from an anaesthetist. It was - Medical Finals Question Pack: https://geekymedics.com/medical-student-finals-questions/ If the patient isunconsciousorunresponsive, start thebasic life support(BLS)algorithmas per resuscitation guidelines. Standardized patient as the voice of the simulator (or the simulation operator may play this role). In the final 10 minutes, we show how the patient has a good recovery after fluid replacement. The consequences (low blood pressure, high heart rate, central nervous system status, etc.) The students are in their basic science course. DOI 10.7759/cureus.1286. (1) The assessment of a diabetic patient is best taught as a. Using your thumbs, slightly open the mouth by downward displacement of the chin. The main goal is to establish a safe learning environment for the learner [9, 13 . Geeky Medics accepts no liability for loss of any kind incurred as a result of reliance upon the information provided in this video. Open the patients airwayusing ahead-tiltchin-lift manoeuvre: 1. 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. For similar reasons, we do not believe a videotaped session will keep the students attention as much as these live simulator 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). Depending on scenario complexity, team dynamic and treatment modalities, this simulation may take 1020 minutes. may email you for journal alerts and information, but is committed Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. Terms of Use. The required potassium replacement varies greatly. 2003;78:783788. In the meantime, you should re-assess and maintain the patients airway. % This is a 25-year-old woman with a medical history of diabetes medicated with 40 units insulin per day. Assess the patients level of consciousness using the AVPU scale: If a more detailed assessment of the patients level of consciousness is required, use the Glasgow Coma Scale (GCS). See Table 4 for a suggested standardized script. In this section, we have to help the trainee to institute definitive therapy based on the underlying biochemical abnormalities. 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. <> Reduced urine output (oliguria) is typically defined as less than 0.5ml/kg/hour in an adult. 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. 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 Does the patient need a referral toHDU/ICU? Catheterisethe patient to closelymonitor urine outputto guide fluid resuscitation and need for escalation. 3. - PSA Question Pack: https://geekymedics.com/psa-question-bank/ Use washable, non-toxic paints to imitate various body emissions. Trainee will learn to collaborate with peers to decide on appropriate interventions, tests, and therapy. Before trainees arrival into the simulation area, the simulator is already preprogrammed for DKA. Healthcare Students' Psychological Well-Being in a Diabetic Ketoacidosis Simulation. NPAs are typically better tolerated in patients who are partly or fully conscious compared to oropharyngeal airways. <>>> This allows the learner group to make a psychological break from the patient and environment while beginning the reflection process. A blood glucose level may already be available from earlier investigations (e.g. Immersive Simulations It may be necessary toexposethe patient during your assessment: remember to prioritise patient dignity and conservation of body heat. Animated Lecture Categories: Emergency Medicine, Medical Education Keywords: diabetic ketoacidosis, simulation, expertise, emergency medicine . unilateral coarse crackles may be present if the patient has pneumonia which may have been the precipitant for DKA). 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. If the patient loses consciousness and there are no signs of life on assessment, put out a crash call and commence CPR. A comprehensive collection of OSCE guides to common clinical procedures, including step-by-step images of key steps, video demonstrations and PDF mark schemes. - Onset 01:48 Well done, youve now stabilised the patient and theyre doing much better. Immersive simulations are mentally exhausting because they create an intense and stressful atmosphere requiring the learner to work outside their comfort zone. Trainee will practice or observe good teamwork skills, both as a leader and a team player. This field is for validation purposes and should be left unchanged. The relationship between sleep, fatigue and patient and provider safety. Debriefing 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). Prehosp Emerg Care. In some cases, normal saline with additional potassium is required to prevent overcorrection of serum potassium levels which would otherwise result in hypokalaemia. Int J Evid Based Healthc. The patient was placed in the supine position and was a little confused as well as drowsy but at times had a good verbal response (Glasgow Coma Scale 15/15). The scenario would include an if-then algorithm. stream A collection of interactive medical and surgical clinical case scenarios to put your diagnostic and management skills to the test. 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. We believe it is important to have active, participatory learning by having conversations with the trainees in the form of questions and answers. Review the patients drug chart for medications which may cause a reduced level of consciousness (e.g. Stage 3: Ongoing management and monitoring of DKA 1 hour after initiation of treatment. The debriefing environment should be removed from the location where the simulation took place. Management of diabetic ketoacidosis in adults. Airway adjuncts are often helpful and in some cases essential to maintain a patients airway. Advance the airway until it lies within the pharynx. A hyperglycemic patient may present with tachypnea, which often presents as Kussmauls respirations, tachycardia, orthostatic blood pressure changes and other signs of dehydration and diabetic ketoacidosis (DKA). Stage 1: Initial assessment of acutely unwell pregnant woman and diagnosis of DKA. Hypothermia may be present if the patient has been unconscious and exposed for some time. 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 leads to hyperglycaemia, osmotic diuresis, and dehydration. 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. 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. 2 The evaluation of potassium deficits is complicated by potassium exit from . Often, the learner group will be unaware of these behaviors, but the instructor can key into the first few comments made during the transition between rooms. Problems are addressed as they are identified and the patient is re-assessed regularly to monitor their response to treatment. Performing an ECG should not delay the emergency management of DKA. 6. An integral part of a PBL session is for trainees to be able to navigate through huge literature bases. 1-6. You can check out our guide to using SOCRATES here: https://geekymedics.com/the-socrates-acronym-in-history-taking/ Prehosp Emerg Care. Measure the patients capillary blood glucose and ketone levels to confirm the diagnosis and guide the management of DKA. Make sure tore-assessthe patient after anyintervention. 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 does not take this regularly. It was developed for anesthesiology resident physicians with some background knowledge and experience caring for critically ill patients. A comprehensive collection of clinical examination OSCE guides that include step-by-step images of key steps, video demonstrations and PDF mark schemes. Adds true to life parking codes and extra parking for AI. Perform urinalysis and send the urine for culture if urinary tract infection is suspected. >> Fernandez AR, Mac Crawford J, Pennell ML, et al. A nasopharyngeal airway is a soft plastic tube with a bevel at one end and a flange at the other. 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. However, this leads to confusion. Twitter: http://www.twitter.com/geekymedics type 1 diabetes), Complete insulin insensitivity (e.g. DKA can develop within 24 hours and is potentially life threatening, requiring prompt recognition and therapeutic intervention. 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. Acad Med. Effectiveness of simulation on health profession students knowledge, skills, confidence and satisfaction. Margolis GS, Romer GA, Fernandez AR, et al. 3 0 obj The normal reference range for fasting plasma glucose is 4.0 5.8 mmol/l. #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! There are just a few more things to do. From the Department of Anesthesiology, Pennsylvania State University College of Medicine, Hershey, PA. Dr. Murray is on the Speakers Bureau of METI, Sarasota, FL. 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). 2. - Introduction 00:00 The optimal number of simulation participants is four to seven individuals, depending on the case study objectives. If the patientloses consciousnessand there areno signs of lifeon assessment, put out acrash callandcommence CPR. Subscribe to our newsletter to be the first to know about our latest content: https://geekymedics.com/newsletter/ The learning environment should closely mimic real-world applications. Trainee will improve their understanding of clinical practice through reflective assessment of actual cases during the prior PBL sessions. Available from: [. One of the key differences with the immersive simulation is that the instructor is absent from the simulation environment. 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. Diabetes (type 1 and type 2) in children and young people: diagnosis and management. You may be trying to access this site from a secured browser on the server. Inspect the urine currently in the catheter bag and note its appearance (e.g. The use of a simulated, evolving case scenario was an effective method of exposing nursing students to complex patient 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. It should only be inserted in unconscious patients as it is otherwise poorly tolerated and may induce gagging and aspiration. Makeup may be used to depict gender, hollow eyes and cheeks, produce pallor or display bruises and scars. Invasive monitors, including a left radial intraarterial and a right subclavian IV catheter, were placed. Are any further assessments or interventions required? 5. Development of simulation scenarios for an adolescent patient with diabetic ketoacidosis. 2010;49:578586. - Over 3000 Free MCQs: https://geekyquiz.com/ In this case scenario, dehydration is one of the most serious immediate issues. tall tented T waves in hyperkalaemia). Facilitator to ask how often to measure BMs 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. 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.. 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 is lethargic and slightly confused but can intermittently respond to questions. Simulation provides a safe environment where learning is enhanced through the deliberate practice of skills and controlled management of a variety of clinical encounters. Please enable scripts and reload this page. Inspect for evidence of infection on the skin (e.g. Blood sugar issues in the Type II diabetic will have a gradual onset, with diagnosis generally resulting from routine laboratory exams.(1). Please try after some time. TheABCDEapproach can be used to perform a systematic assessment of a critically unwell patient. Deteriorationshould be recognised quickly and acted upon immediately. A debriefing section with pre-established questions allows the instructor to review the main focus and performance measures with the student group. 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 strong emphasis is placed on the focused, methodical examination of a specific medical problem and the decision-based treatment options available. Review the patientscurrent medicationsand check any regular medications areprescribed appropriately. This video demonstrates how to use the SOCRATES acronym when taking a history of pain or other symptoms. Antibiotics should be prescribed in keeping with local guidelines. This guide provides an overview of the recognition and immediate management of diabetic ketoacidosis (DKA)using an ABCDE approach. Nandate, Koichiro MD, PhD; Abola, Ramon MD; Murray, W Bosseau MB; Whitfield, Carol PhD; Lang, Charles PhD; Sinz, Elizabeth MD. The patient synopsis should include such standard aspects as age, sex, ethnicity, medical history, medications and allergies. 4. Heart: S1 and S2 within normal limits; no S3/S4 or murmurs, normal rate and rhythm. Should any changes be made to the current management of their underlying condition(s)? The students mentioned that they did not obtain the maximum value from the simulation session under these circumstances. Competency-based medical education has seen widespread adoption in the field along with ongoing work in the areas of . I assigned true to life parking codes, and added some extra parking for the superfluous US Express AI. Typically potassium levels should be maintained between 4.0 5.5 mmol/L and close monitoring is required. Centers for Disease Control and Prevention. 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. - Timing 03:23 Yes: if the patient can talk, their airway is patent and you can move on to the assessment of breathing. *=NdL/c2XSJn8:I Jb8'.8>N*[L .hxw6afq40DX3c~>abt'Q,8y(BZu(vKBTufIR. 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. We combined both to indicate the continuity of the curriculum, and the building on prior knowledge. If the patient is confused you might be able to get a collateral history from staff or family members as appropriate. Trainee will describe the changes in vital signs, the major metabolic, fluid, and electrolyte. For more information, please refer to our Privacy Policy. VbQuX#R M21 Initially, we required the students to write down the vital signs. 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! A fixed-rate intravenous insulin infusion should be commenced initially to suppress ketogenesis, reduce blood glucose levels and address electrolyte disturbances. Join the Geeky Medics community: Experience has shown that the more experienced the provider, the more detailed the environmental and manikin staging should be, because providers are trained to take in and interpret visual cues as indicators of patient status. DOWNLOAD Diabetic Ketoacidosis By the end of this scenario, the learner will be able to: 1. 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 . We introduce the Simulation Laboratory and the Simulator, and demonstrate: pulses, eyes blinking, pupil constriction, gas moves in and out of mouth (place hand over mouth), chest moves up and down. The lecture allows for understanding of concepts prior to action, and instructor feedback is immediate. opioids, sedatives, anxiolytics, insulin, oral hypoglycaemic medications). 3. 1) Please read through this document as it will help you prepare for your upcoming simulation on DKA. DO NOT perform any examination or procedure on patients based purely on the content of these videos. 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. She Died the Next Day. 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. Discuss the patients current clinical condition with aseniorclinicianusing anSBARR style handover. 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. The simulation session is also hosted as an interactive session. Cureus is on a mission to change the long-standing paradigm of medical publishing, where submitting research can be costly, complex and time-consuming. cloudy urine may indicate urinary tract infection). The validity of the HFS-DKA scenario was verified by a certified diabetes nurse educator, a registered nurse, and a clinical nurse educator. 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]). 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. In keeping with the case study, as a treatment marker is reached, the instructor should place emphasis on physiological, pharmacological, environmental and psychosocial issues. Lets discuss your options. When erroneous treatment is delivered, the instructor can end the simulation. Given 6 to 8 back-to-back sessions, it is critical that every session starts and ends on time! Diabetic ketoacidosis (DKA) is a common, potentially lethal disease. 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. DKA can develop within 24 hours and is potentially life threatening, requiring prompt recognition and therapeutic intervention. The facilitator guides the group only when necessary. The student group should be encouraged to collaborate on management options and to perform skills. to maintaining your privacy and will not share your personal information without Please try again soon. oral fluids, intravenous fluids, urine output, drain output, stool output, vomiting) to inform resuscitation efforts.

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