dka simulation scenario

For example, you could develop a diabetic scenario in which the prehospital provider encounters an altered patient with incomprehensible speech. A well-staged environment allows for greater student buy-in. Simulation provides a safe environment where learning is enhanced through the deliberate practice of skills and controlled management of a variety of clinical encounters. your express consent. Geeky Medics accepts no liability for loss of any kind incurred as a result of reliance upon the information provided in this video. DKA can develop within 24 hours and is potentially life threatening, requiring prompt recognition and therapeutic intervention. 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. Hypothermia may be present if the patient has been unconscious and exposed for some time. 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. Twitter: http://www.twitter.com/geekymedics This allows us to get in touch for more details if required. Before trainees arrival into the simulation area, the simulator is already preprogrammed for DKA. 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. The use of a simulated, evolving case scenario was an effective method of exposing nursing students to complex patient care. Place one hand on the patients forehead and the other under the chin. This guide has been created to assist students in preparing for emergencysimulationsessionsas part of their training,it is not intended to be relied upon for patient care. This simulation session therefore aims to make the case come alive, and show this known case in a clinical context. If the patient is conscious, sit themuprightas this can also help with oxygenation. Calculate the patients current fluid balance using their fluid balance chart (e.g. Keywords: diabetic ketoacidosis, simulation, expertise, emergency medicine Introduction Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes mellitus, most . Int J Evid Based Healthc. Trainee will get to know how professionals behave during management of a critically ill patient. Patients with DKA require fluid resuscitation to restore circulatory volume, clear ketones, correct electrolyte abnormalities and increase renal perfusion. Each clinical case scenario allows you to work through history taking, investigations, diagnosis and management. 1. % Inspect theairwayfor obviousobstruction. Depending on scenario complexity, team dynamic and treatment modalities, this simulation may take 1020 minutes. See our blood glucose measurement guide for more details. Strategies of high-performing paramedic educational programs. 3. JEMS. Join the Geeky Medics community: - 2500+ OSCE Flashcards: https://geekymedics.com/osce-flashcards/ J Nurs Educ. Schneider Sarver PA, Senczakowicz EA, Slovensky BM. Forty percent of respondents reported excessive daytime sleepiness. The Pratcice However, this leads to confusion. 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 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. 2011;15:108109. This field is for validation purposes and should be left unchanged. 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. 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. 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. Immersive simulations are mentally exhausting because they create an intense and stressful atmosphere requiring the learner to work outside their comfort zone. Use blankets to re-warm patients who are mild to moderately hypothermic. They have had no clinical exposure or any clinical experience. Published August 2015. Medical Simulation Scenarios are text documents outlining the various details of a simulation - everything from patient simulator settings to debriefing notes. A collection of free medical student quizzes to put your medical and surgical knowledge to the test! 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. Makeup may be used to depict gender, hollow eyes and cheeks, produce pallor or display bruises and scars. You might also be interested in our awesome bank of 700+ OSCE Stations. The scenario would include an if-then algorithm. Laschinger S, Medves J, Pulling C, et al. The researchers found that long shift hours (24hrs), working overtime and marital/relationship stress were strongly correlated. Introduceyourselfto thepatientincluding yournameandrole. In keeping with the case study, as a treatment marker is reached, the instructor should place emphasis on physiological, pharmacological, environmental and psychosocial issues. I assigned true to life parking codes, and added some extra parking for the superfluous US Express AI. 3. Groups of more than seven may struggle with meeting objectives due to insufficient functional rolls. to maintaining your privacy and will not share your personal information without Simulation provides a safe environment where learning is enhanced through the deliberate practice of skills and controlled management of a variety of clinical encounters. The main purpose of the simulation is to draw a line from the theoretical, boring biochemistry to the clinical manifestations. 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. 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). Facilitator to ask how often to measure BMs Conclusions This technical report describes the design and implementation of a simulation scenario on DKA for emergency medicine trainees. Trainee will describe the changes in vital signs, the major metabolic, fluid, and electrolyte. <>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 595.32 841.92] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> 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. Centers for Disease Control and Prevention. ABG, venepuncture). As with the animated lecture, the simulation is strongly dependent on a focused case study. Terms of Use. 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 . 2010;49:578586. DOWNLOAD Diabetic Ketoacidosis By the end of this scenario, the learner will be able to: 1. One of the key differences with the immersive simulation is that the instructor is absent from the simulation environment. Extremities: mild cyanosis, no clubbing or edema (verbalized by instructors); pulses equal, and symmetrical (elucidated by trainees). If the patientloses consciousnessand there areno signs of lifeon assessment, put out acrash callandcommence CPR. Insert at least onewide-bore intravenous cannula(14G or 16G) and take blood tests as discussed below. Some error has occurred while processing your request. She had developed nausea, extreme fatigue, mild disorientation, and blurred vision toward the end of the soccer match. MassBay EMS Program Integrates Training for Dogs, Heat Waves Are Killing More LA Homeless People. 3. 2007. Diabetes UK with the Joint British Diabetes Societies Inpatient Care Group. When erroneous treatment is delivered, the instructor can end the simulation. VbQuX#R M21 Simulation Scenario. This is particularly important for core cases and low-frequency, high-stakes procedures and encounters. endobj 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 Instructors should write a case study for the simulation before the session. Check out our other awesome clinical skills resources including: This session provides additional clinical support material for the theoretical PBL session. A blood glucose level may already be available from earlier investigations (e.g. 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. Use washable, non-toxic paints to imitate various body emissions. Much time was wasted explaining why it did not matter. Example: If the provider immediately evaluates blood glucose, then the reading will display 45 mg/dL. Diabetic ketoacidosis (DKA) is a common, potentially lethal disease. Diabetic Ketoacidosis (DKA) Clinical Pathway Emergency Department | Children's Hospital of Philadelphia You may need further help or advice from a senior staff member and you shouldnot delay seeking help if you have concerns about your patient. The choice of fluid type, rate of administration and volume should be tailored to the individual patient based upon their vital signs and electrolytes. We do not use passive visualizing materials such as videotapes or DVD other than vital signs shown on the monitors. insulin-dependent type 2 diabetes), Altered consciousness (e.g. A strong emphasis is placed on the focused, methodical examination of a specific medical problem and the decision-based treatment options available. Prehosp Emerg Care. Trainee will be respectful to others and their views during the PBL session. An hour was . A GCS of 8 or below warrants urgent expert help from an anaesthetist. An arterial blood gas (ABG) can provide lots of useful information to guide management including: A chest X-ray may be indicated if abnormalities are noted on auscultation (e.g. It should only be inserted in unconscious patients as it is otherwise poorly tolerated and may induce gagging and aspiration. 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. In an animated lecture, its important that the student group have an instructor so they can ask direct questions. The teaching of diabetic assessment and management, like many other medical emergencies, lends itself well to case-based simulation. The optimal number of simulation participants is four to seven individuals, depending on the case study objectives. Please note that by doing so you agree to be added to our monthly email newsletter distribution list. The impetus for creating and implementing the high-fidelity diabetic ketoacidosis (DKA) simulation was based on a needs assessment and reviewing of undergraduate nursing students' examination statistics in a second semester medical-surgical course. 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. Circulating nurse in the emergency room (ER). Please enable scripts and reload this page. 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. Performing an ECG should not delay the emergency management of DKA. 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. Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario Cureus. 2011;15:108109. Standardized patient as the voice of the simulator (or the simulation operator may play this role). Discuss the patients current clinical condition with aseniorclinicianusing anSBARR style handover. See ourintravenous cannulation guidefor more details. Trainee will learn to collaborate with peers to decide on appropriate interventions, tests, and therapy. The normal reference range for fasting plasma glucose is 4.0 5.8 mmol/l. See ourdocumentation guidesfor more details. The Theory 5. Regardless of the underlying cause of airway obstruction, seekimmediate expert supportfrom an anaesthetist and the emergency medical team (often referred to as the crash team). 2003;78:783788. The faculty member/course coordinator of Simulation Design 2008;6:278302. The simulation experience serves to give substance to the theoretical words and concepts that the students encountered during the PBL sessions. 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. Open the patients airwayusing ahead-tiltchin-lift manoeuvre: 1. <> Therefore, we have to emphasize the importance of airway, breathing, and circulation in the very sick patient in any clinical setting. type 1 diabetes) Complete insulin insensitivity (e.g. The file explaining the session is sent to instructors 1 week before the sessions. This environment doesnt allow the student to identify presentation cues, be active in their own learning or apply their skills without endangering the lives of patients.(2). Your message has been successfully sent to your colleague. The DKA simulation incorporates cue recognition, analysis of cues, generation of solutions, nursing interventions, and evaluation of outcomes, including effective communication and psychosocial concerns. 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 learning environment should closely mimic real-world applications. Over the years, some groups happened to have the simulation session before the completion of the theoretical PBL session. 2. In this case scenario, dehydration is one of the most serious immediate issues. SimMan Nursing Scenarios Software. 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. We believe it is important to have active, participatory learning by having conversations with the trainees in the form of questions and answers. A number of key modifiers are described that allow for the adjustment of case . A patient presenting with altered level of consciousness and a blood sugar level below 80 mg/dL should be considered hypoglycemic, and treatment modalities should be consistent with those for a diabetic patient. As this is an interactive discussion session, any needed debriefing and/or explanation is given during the sessions. Should any changes be made to the current management of their underlying condition(s)? Just place the BR2_KDCA file into your addons scenery folder: C:\\Program Files\\Microsoft Games\\Microsoft Flight Simulator X\\Addon Scenery\\Scenery. Both external and internal potassium balances are disturbed during the development and treatment of DKA. GRAPH. If foreign material is present, attempt removal using suction. The student group should be encouraged to collaborate on management options and to perform skills. diagnosis of DKA Trigger 3, ABG show acidosis and high BM and normal potassium. 2. You may be asked to review a patient with DKA due to confusion, reduced level of consciousness, tachycardia, hypotension and/or vomiting. In some cases, normal saline with additional potassium is required to prevent overcorrection of serum potassium levels which would otherwise result in hypokalaemia. 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. We try to provide sufficient realism.. A collection of communication skills guides, for common OSCE scenarios, including history taking and information giving. COVID-19 Screening in the Pediatric Emergency Department. In other words, they do not have clinical experience, but they have clinical knowledge. Stage 3: Ongoing management and monitoring of DKA 1 hour after initiation of treatment. A comprehensive collection of medical revision notes that cover a broad range of clinical topics. DO NOT perform any examination or procedure on patients based purely on the content of these videos. 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). We also show them IV bags containing saline and Ringers lactate, as well as show them IV infusion sets. Antibiotics should be prescribed in keeping with local guidelines. Scenarios. Please try again soon. Geeky Medics accepts no liability for loss of any kind incurred as a result of reliance upon the information provided in this video. endobj Ziv A, Wolpe PR, Small SD, et al. Blood sugar issues in the Type II diabetic will have a gradual onset, with diagnosis generally resulting from routine laboratory exams.(1). >> Patterson PD, Weaver M, Frank R, et al. Trainee will increase knowledge of professional behaviors during the simulation. Please write a single word answer in lowercase (this is an anti-spam measure). Make sure tore-assessthe patient after anyintervention. 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. Trainee will practice or observe good teamwork skills, both as a leader and a team player. Case-based education adds a real-world aspect to the learning environment. 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. Well done, youve now stabilised the patient and theyre doing much better.

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