2009;13:505511. Instagram: https://instagram.com/geekymedics His Heart Stopped On a Treadmill. Simulation in Healthcare4(4):232-236, Winter 2009. Therefore, we have to emphasize the importance of airway, breathing, and circulation in the very sick patient in any clinical setting. In this manner, the students have to apply their knowledge at the appropriate points during the progression of the scenario. Testing a diabetes keotacidosis simulation in critical care nursing: A Teaching nursing management of diabetic ketoacidosis: a description of type 1 diabetes) Complete insulin insensitivity (e.g. Terms of Use. You should have another member of the clinical team aiding you in your ABCDE assessment, such a nurse, who can perform observations, take samples to the lab and catheterise if appropriate. 1) Please read through this document as it will help you prepare for your upcoming simulation on DKA. Check out our other awesome clinical skills resources including: The students are in their basic science course. In some cases, normal saline with additional potassium is required to prevent overcorrection of serum potassium levels which would otherwise result in hypokalaemia. 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. Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. confusion, coma), All critically unwell patients should have. If foreign material is present, attempt removal using suction. Review thepatients notes,chartsandrecent investigation results. 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. Data is temporarily unavailable. Simulation provides a safe environment where learning is enhanced through the deliberate practice of skills and controlled management of a variety of clinical encounters. Trainee will increase knowledge of professional behaviors during the simulation. A collection of communication skills guides, for common OSCE scenarios, including history taking and information giving. Refer to your local guidelines which should provide a clear protocol for the management of DKA. A comprehensive collection of medical revision notes that cover a broad range of clinical topics. For example, if a student is to run a diabetic emergency in an extended living facility, the room should be staged with the appropriate bed, linens and medical equipment, and include personal artifacts and memorabilia normally found in such environments. She is lethargic and slightly confused but can intermittently respond to questions. Simulation Scenario for Anesthesia Providers Clark Obr, MD*, Anthony Mueller, MD . 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. Circulating nurse in the emergency room (ER). <>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 595.32 841.92] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> This video demonstrates how to use the SOCRATES acronym when taking a history of pain or other symptoms. To read Pages full Research Review column, visit www.jems.com/patient-care. 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). TikTok: https://www.tiktok.com/@geekymedics Rosens Emergency Medicine: Concepts and Clinical Practice. Simulation provides a safe environment where learning is enhanced through the deliberate practice of skills and controlled management of a variety of clinical encounters. 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. 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. This is particularly important for core cases and low-frequency, high-stakes procedures and encounters. She does not take this regularly. ABG, venepuncture). 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 case scenario, dehydration is one of the most serious immediate issues. It may be necessary toexposethe patient during your assessment: remember to prioritise patient dignity and conservation of body heat. - Medical Finals Question Pack: https://geekymedics.com/medical-student-finals-questions/ SimMan Nursing Scenarios Software. A collection of interactive medical and surgical clinical case scenarios to put your diagnostic and management skills to the test. Observe and discuss the effects of therapy in a mathematically modeled physiological simulator. Inspect theairwayfor obviousobstruction. A fixed-rate intravenous insulin infusion should be commenced initially to suppress ketogenesis, reduce blood glucose levels and address electrolyte disturbances. (1), The assessment of a diabetic patient is best taught as a case-based simulation. 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. Your message has been successfully sent to your colleague. modify the keyword list to augment your search. She tends to drink sugar containing fluids (soda) when she is thirsty, and she eats fast foods (cream-filled muffins) when she is hungry. Clearlydocument your ABCDE assessment, including history, examination, observations, investigations, interventions, and the patients response. Check the patency of the patients right nostril and if required (depending on the model of NPA) insert a safety pin through the flange of the NPA. 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. 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 . - Over 3000 Free MCQs: https://geekyquiz.com/ 5. Nandate, Koichiro MD, PhD; Abola, Ramon MD; Murray, W Bosseau MB; Whitfield, Carol PhD; Lang, Charles PhD; Sinz, Elizabeth MD. This simulation session therefore aims to make the case come alive, and show this known case in a clinical context. We are looking for declaration of DKA and request for pathway. endobj Trainee will learn to collaborate with peers to decide on appropriate interventions, tests, and therapy. A GCS of 8 or below warrants urgent expert help from an anaesthetist. It should only be inserted in unconscious patients as it is otherwise poorly tolerated and may induce gagging and aspiration. Trainee will practice or observe good teamwork skills, both as a leader and a team player. Twitter: http://www.twitter.com/geekymedics You could also ask a student to smear a small amount of acetone on a piece of glass to see how volatile it is, helping them understand why its being exhaled by the DKA patient. As this is an interactive discussion session, any needed debriefing and/or explanation is given during the sessions. The file explaining the session is sent to instructors 1 week before the sessions. 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 . This guide provides an overview of the recognition and immediate management of diabetic ketoacidosis (DKA)using an ABCDE approach. Typically potassium levels should be maintained between 4.0 5.5 mmol/L and close monitoring is required. If any obstruction is encountered, remove the tube and try the left nostril. PDF Adult Type I Diabetic Ketoacidosis Pre-simulation Preparation Student Target Learner Groups 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. 3. Could we not just do this as a large group session to all 160 students (versus 20 1-hour sessions to groups of eight students)? An integral part of a PBL session is for trainees to be able to navigate through huge literature bases. 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). The main purpose of the simulation is to draw a line from the theoretical, boring biochemistry to the clinical manifestations. 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. DO NOT perform any examination or procedure on patients based purely on the content of these videos. Much time was wasted explaining why it did not matter. VbQuX#R M21 Please try after some time. Marx JA, Hockberger RS, Walls RM. If the patient isunconsciousorunresponsive, start thebasic life support(BLS)algorithmas per resuscitation guidelines. Groups of fewer than four students dont allow for optimal collaboration. Interactive lecture/discussion with use of monitors that show the vital signs of the simulated patient on manikin. 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. Research Watch Box:Sleep, Fatigue & SafetyBy David Page, MS, NREMT-P Extremities: mild cyanosis, no clubbing or edema (verbalized by instructors); pulses equal, and symmetrical (elucidated by trainees). Ketones show 5.5. Please try again soon. 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. 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. Please write a single word answer in lowercase (this is an anti-spam measure). Healthcare Students' Psychological Well-Being in a Diabetic Ketoacidosis Simulation. Abdomen: The abdominal examination reveals diffuse mild epigastric tenderness to deep palpitation but neither rebound tenderness nor guarding (result of examination given by patient or by instructor). The Theory 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. Instead, instructors should combine case- and simulation-based techniques when teaching diabetic assessment. Glycosuria leads to urinary losses of potassium through osmotic diuresis. Are any further assessments or interventions required? stream 4 0 obj Airway adjuncts are often helpful and in some cases essential to maintain a patients airway. We combined both to indicate the continuity of the curriculum, and the building on prior knowledge. 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 One of the key differences with the immersive simulation is that the instructor is absent from the simulation environment. Prehosp Emerg Care. However, this turned out to be too slow, took too much time, and could not continuously demonstrate the direction of changes. Our simulated patient is a 25-year-old woman, Tiffany, who has been taken to the Emergency Department from her soccer game by her boyfriend, Adam. reduced air entry, coarse crackles) to screen for evidence of pneumonia. Simulation-based medical education: An ethical imperative. We give the history of the patient to the trainees. 4. We used the Medical Education Technologies Inc. (METI) Human Patient Stimulator (HPS, METI Sarasoto, Fl). Published August 2015. You may search for similar articles that contain these same keywords or you may Questionswhich may need to be considered include: The next team of doctors on shift should bemade awareof any patient in their department who hasrecently deteriorated. 1. Administer oxygen to all critically unwell patients during yourinitialassessment. Diabetic Ketoacidosis (DKA) Clinical Pathway Emergency Department | Children's Hospital of Philadelphia In this section, we have to help the trainee to institute definitive therapy based on the underlying biochemical abnormalities. A collection of data interpretation guides to help you learn how to interpret various laboratory and radiology investigations. Diabetic ketoacidosis simulator: a new learning tool for a life "Never doubt that a small group of thoughtful, committed citizens can change the world. 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). We then start the DKA state. See Appendix D, Supplemental Digital Content 4, https://links.lww.com/SIH/A4. A number of key modifiers are described that allow for the adjustment of case . However, this leads to confusion. Stage 1: Initial assessment of acutely unwell pregnant woman and diagnosis of DKA. 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. Outcomes Educating Nursing Students Using an Evolving, Simulated Case Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario Cureus. As this is a PBL session, the trainees are not given any references. This allows the learner group to make a psychological break from the patient and environment while beginning the reflection process.