An events progression section should include patient status changes, as well as a time/treatment continuum that incorporates if-then event progressions. PBL was introduced at our institution in 1995. A collection of interactive medical and surgical clinical case scenarios to put your diagnostic and management skills to the test. tall tented T waves in hyperkalaemia). modify the keyword list to augment your search. 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). They have had no clinical exposure or any clinical experience. Its absolutely necessary to follow all immersive simulations with a positive, emotionally safe and nonjudgmental debriefing environment. Trainee will get to know how professionals behave during management of a critically ill patient. 3 0 obj Makeup may be used to depict gender, hollow eyes and cheeks, produce pallor or display bruises and scars. Rosens Emergency Medicine: Concepts and Clinical Practice. A fixed-rate intravenous insulin infusion should be commenced initially to suppress ketogenesis, reduce blood glucose levels and address electrolyte disturbances. 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. You may be trying to access this site from a secured browser on the server. Terms of Use. Consider active re-warming techniques in patients with severe hypothermia. 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. 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. She does not take this regularly. A comprehensive collection of OSCE guides to common clinical procedures, including step-by-step images of key steps, video demonstrations and PDF mark schemes. 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. TikTok: https://www.tiktok.com/@geekymedics In the context of DKA, a patients consciousness level may be reduced. 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.) Review the patientscurrent medicationsand check any regular medications areprescribed appropriately. 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. endobj Refer to your local guidelines for further details. 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. 3. Simulation provides a safe environment where learning is enhanced through the deliberate practice of skills and controlled management of a variety of clinical encounters. Clinical Simulation in Nursing, Volume 39, 2020, pp. Inspect theairwayfor obviousobstruction. Ask for anotherclinicalmemberofstafftoassistyou if possible. See our blood glucose measurement guide for more details. The learning environment should closely mimic real-world applications. Development of simulation scenarios for an adolescent patient with diabetic ketoacidosis. These are not learning objectives in this program. doi: 10.7759/cureus.1286. 2017 May 29;9(5):e1286. Generaltipsfor applying anABCDEapproachin an emergency setting include: Acute scenarios typically begin with abriefhandoverfrom a member of thenursing staffincluding thepatients name,age,backgroundand thereasonthereviewhas been requested. Groups of fewer than four students dont allow for optimal collaboration. Laschinger S, Medves J, Pulling C, et al. DOI 10.7759/cureus.1286. Properly interpret a venous blood gas (VBG) and basic metabolic panel in a patient presenting with diabetic ketoacidosis. Clearlydocument your ABCDE assessment, including history, examination, observations, investigations, interventions, and the patients response. DKA can develop within 24 hours and is potentially life threatening, requiring prompt recognition and therapeutic intervention. Are any further assessments or interventions required? Make sure tore-assessthe patient after anyintervention. - PSA Question Pack: https://geekymedics.com/psa-question-bank/ The students worked on the underlying physiology during a week long PBL session and are therefore familiar with the theoretical aspects of DKA. Data is temporarily unavailable. A comprehensive collection of medical revision notes that cover a broad range of clinical topics. (1) According to Centers for Disease Control and Prevention (CDC), 223,619 deaths were attributed to diabetes in 2005. 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. Indeed, it is the only thing that ever has.". 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. It may be necessary toexposethe patient during your assessment: remember to prioritise patient dignity and conservation of body heat. Does the patient need a referral toHDU/ICU? 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. This allows us to get in touch for more details if required. Each performance measure is separated into cognitive, behavioral or technical categories. 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. 5. Review the patientsoxygen saturation(SpO2): Auscultate the chest to screen for evidence of respiratory pathology (e.g. One of the key differences with the immersive simulation is that the instructor is absent from the simulation environment. Diabetes (type 1 and type 2) in children and young people: diagnosis and management. Use washable, non-toxic paints to imitate various body emissions. 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. can be reemphasized, and the effects of fluid therapy demonstrated. - Site 01:12 See Table 4 for a suggested standardized script. They have had no clinical exposure or any clinical experience. Conclusions This technical report describes the design and implementation of a simulation scenario on DKA for emergency medicine trainees. Highlight selected keywords in the article text. MassBay EMS Program Integrates Training for Dogs, Heat Waves Are Killing More LA Homeless People. Search for Similar Articles By joining Cureus, you agree to our In this section, we have to help the trainee to institute definitive therapy based on the underlying biochemical abnormalities. If fever is present, make sure to consider co-existing infection. She is lethargic and slightly confused but can intermittently respond to questions. opioids, sedatives, anxiolytics, insulin, oral hypoglycaemic medications). - 2500+ OSCE Flashcards: https://geekymedics.com/osce-flashcards/ The validity of the HFS-DKA scenario was verified by a certified diabetes nurse educator, a registered nurse, and a clinical nurse educator. 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. Catheterisethe patient to closelymonitor urine outputto guide fluid resuscitation and need for escalation. 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. 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. Strategies of high-performing paramedic educational programs. oral fluids, intravenous fluids, urine output, drain output, stool output, vomiting) to inform resuscitation efforts. Facilitator to ask how often to measure BMs % In keeping with the case study, as a treatment marker is reached, the instructor should place emphasis on physiological, pharmacological, environmental and psychosocial issues. Trainee will practice or observe good teamwork skills, both as a leader and a team player. This guide provides an overview of the recognition and immediate management of diabetic ketoacidosis (DKA)using an ABCDE approach. Keywords: diabetic ketoacidosis, simulation, expertise, emergency medicine Introduction Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes mellitus, most . 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. 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. She was taken to the Emergency Department from her soccer game because she complained of nausea, extreme fatigue, mild disorientation, and blurred vision toward the end of the soccer match. 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. Problems are addressed as they are identified and the patient is re-assessed regularly to monitor their response to treatment. Categories: Emergency Medicine, Medical Education Keywords: diabetic ketoacidosis, simulation, expertise, emergency medicine . The instructor should have visual access via one-way windows or cameras. 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). Administer oxygen to all critically unwell patients during yourinitialassessment. 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. Recognize the signs and symptoms of a patient presenting with diabetic ketoacidosis. 3. The consequences (low blood pressure, high heart rate, central nervous system status, etc.) In some cases, normal saline with additional potassium is required to prevent overcorrection of serum potassium levels which would otherwise result in hypokalaemia. This video demonstrates how to use the SOCRATES acronym when taking a history of pain or other symptoms. This session provides additional clinical support material for the theoretical PBL session. Some error has occurred while processing your request. 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. - Radiation 02:45 Well done, youve now stabilised the patient and theyre doing much better. We give the history of the patient to the trainees. 2009;13:505511. Acad Med. Target Learner Groups Facebook: http://www.facebook.com/geekymedics 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. 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 . Physician working in the emergency department. A number of key modifiers are described that allow for the adjustment of case . A nasopharyngeal airway is a soft plastic tube with a bevel at one end and a flange at the other. 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]). There are several causes of DKA, which we remember by the "five I's". The researchers found that long shift hours (24hrs), working overtime and marital/relationship stress were strongly correlated. "Never doubt that a small group of thoughtful, committed citizens can change the world. 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. A collection of anatomy notes covering the key anatomy concepts that medical students need to learn. 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). <> Animated Lecture Debriefing 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. Using your thumbs, slightly open the mouth by downward displacement of the chin. insulin-dependent type 2 diabetes), Altered consciousness (e.g. 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. Review thepatients notes,chartsandrecent investigation results. It was developed for anesthesiology resident physicians with some background knowledge and experience caring for critically ill patients. The use of simulation-based instruction enables a student to learn at their own pace and allows them to repeat sequential steps to gain confidence and proficiency. If the patient loses consciousness and there are no signs of life on assessment, put out a crash call and commence CPR. 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. . reduced air entry, coarse crackles) to screen for evidence of pneumonia. 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. As this is a PBL session, the trainees are not given any references. 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). 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. Its best, however, to allow the student group to continue so theyre able to evaluate their decision-making processes during debriefing. Insert the airway bevel-end first, vertically along the floor of the nose with a slight twisting action. Case-based education adds a real-world aspect to the learning environment. Calculate the patients current fluid balance using their fluid balance chart (e.g. The relationship between sleep, fatigue and patient and provider safety. 3. 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. }HyEf,#$/JSRU9+CF6k\'/z+i`[ 5JudK*Zly^g%[jCK)H[)Y=Qp0/r9o9HW_zF}pTzI~'|q.~:=Y T 9w! The files are given in full in the web supplement (Appendix B, Supplemental Digital Content 2, https://links.lww.com/SIH/A2). A comprehensive collection of clinical examination OSCE guides that include step-by-step images of key steps, video demonstrations and PDF mark schemes. When erroneous treatment is delivered, the instructor can end the simulation. DKA can develop within 24 hours and is potentially life threatening, requiring prompt recognition and therapeutic intervention. The 60 minutes training time consists of four 15-minute sections divided as follows. 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 . to maintaining your privacy and will not share your personal information without Blood sugar issues in the Type II diabetic will have a gradual onset, with diagnosis generally resulting from routine laboratory exams.(1). Initially, we used a blood pressure cuff to generate the blood pressure values. Antibiotics should be prescribed in keeping with local guidelines. Mosby:Philadelphia. - Character 02:14 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. Conclusion We guide the group to suggest fluid. 2010;49:578586. The facilitator guides the group only when necessary. 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. 2011;15:108109. Finally, we summarize the course and give them time for questions. Twitter: http://www.twitter.com/geekymedics endobj Trainee will improve their understanding of clinical practice through reflective assessment of actual cases during the prior PBL sessions. 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. Invasive monitors, including a left radial intraarterial and a right subclavian IV catheter, were placed. Alert a senior immediately if you have any concerns about the consciousness level of a patient. Place one hand on the patients forehead and the other under the chin. DO NOT perform any examination or procedure on patients based purely on the content of these videos. 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. Yes: if the patient can talk, their airway is patent and you can move on to the assessment of breathing. Check out our NEW & IMPROVED quiz platform at geekyquiz.com, To be the first to know about our latest videos, subscribe to our YouTube channel . 1-6. Trainee will increase knowledge of professional behaviors during the simulation. See ourintravenous cannulation guidefor more details. Instagram: https://instagram.com/geekymedics 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. She tends to drink sugar containing fluids (soda) when she is thirsty, and she eats fast foods (cream-filled muffins) when she is hungry. Int J Evid Based Healthc. We now provide the students with handouts of the data to save time and provide consistency. 4. Geeky Medics accepts no liability for loss of any kind incurred as a result of reliance upon the information provided in this video. Both external and internal potassium balances are disturbed during the development and treatment of DKA. 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). This simulation session therefore aims to make the case come alive, and show this known case in a clinical context. If you have any scenarios you would be willing to share with the simulation community, please forward them . 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 . TheABCDEapproach can be used to perform a systematic assessment of a critically unwell patient. You can check out our guide to using SOCRATES here: https://geekymedics.com/the-socrates-acronym-in-history-taking/ The instructors role is to facilitate active learning through a combination of learning styles. - Exacerbating & relieving factors 05:12 She began experiencing progressively worsening thirst, increased appetite, and excessively increased urination. Airway adjuncts are often helpful and in some cases essential to maintain a patients airway. 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. 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. Initially, we required the students to write down the vital signs. The debriefing environment should be removed from the location where the simulation took place. Interactive lecture/discussion with use of monitors that show the vital signs of the simulated patient on manikin. Therefore, we have to emphasize the importance of airway, breathing, and circulation in the very sick patient in any clinical setting. She had developed nausea, extreme fatigue, mild disorientation, and blurred vision toward the end of the soccer match. Intubation lubricants can mimic drooling. In an animated lecture, its important that the student group have an instructor so they can ask direct questions. 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. Works with Traffic 2005, but . They should introduce the student group to the environment, assign roles for each learner and guide the decision-making process. 3. 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. In the meantime, you can perform some basic airway manoeuvres to help maintain the airway whilst awaiting senior input. A pre-briefing session is conducted prior to the start of the simulation scenario. You may search for similar articles that contain these same keywords or you may DO NOT perform any examination or procedure on patients based purely on the content of these videos. Groups of more than seven may struggle with meeting objectives due to insufficient functional rolls. 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. Insert at least onewide-bore intravenous cannula(14G or 16G) and take blood tests as discussed below. Therefore, the same file is also sent to the participants before the session. - Timing 03:23 Trainee will be respectful to others and their views during the PBL session. Trigger 4, Pathway 1l of saline required over 1hour and insulin infusion need prescribing and making up in 50ml syringe. As individuals with uncontrolled type I . 4. Chapters: 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. . We used the Medical Education Technologies Inc. (METI) Human Patient Stimulator (HPS, METI Sarasoto, Fl). Simulation Scenario. The Theory An oxygen mask is also demonstrated as an alternative device, as these early trainees had mostly not yet seen any of these devices. Supplemental digital content is available for this article. %PDF-1.5 We combined both to indicate the continuity of the curriculum, and the building on prior knowledge. x]o ]?9kgq~:)?hE )R6!up}\<8||\]}Y~;xp~yQ$#4~djX&{n_m-]^K1/~/AD Hv 99evs,;8}8zwnhFxV.kf-V^? vD0 x@FFJ{m[ 3//Oh|JR7! Weight, Height: Not given, normal appearing (as per simulator) but has lost 20 lbs recently. Clearly communicate how often would you like the patients observations relayed to you by other staff members. It involves a facilitating instructor, a small learner group and conceptual aspects of environmental and manikin staging to provide sensory cues. The lecture allows for understanding of concepts prior to action, and instructor feedback is immediate. Its important to train and educate students of prehospital care on key indicators of a diabetic emergency. Review the patients drug chart for medications which may cause a reduced level of consciousness (e.g. Tilt the forehead back whilst lifting the chin forwards to extend the neck. Geeky Medics accepts no liability for loss of any kind incurred as a result of reliance upon the information provided in this video. Join the Geeky Medics community: Advance the airway until it lies within the pharynx. The optimal number of simulation participants is four to seven individuals, depending on the case study objectives. Much time was wasted explaining why it did not matter. cloudy urine may indicate urinary tract infection). Scenarios. Environment & Manikin 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. and #geekymedics #fyp #fypviral #studytok #medicalstudentuk #medtok #studytips #studytipsforstudents #medstudentuk #premed #medschoolfinals, Cardiovascular History Tips - DON'T FORGET these 3 things .
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