Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario To read Pages full Research Review column, visit www.jems.com/patient-care. Each PBL case typically goes over 23 days, affording the students periods to find information for the case. The DKA simulation incorporates cue recognition, analysis of cues, generation of solutions, nursing interventions, and evaluation of outcomes, including effective communication and psychosocial concerns. PDF DKA Sim Scenario - ABCD (Diabetes Care) Ltd (1), The assessment of a diabetic patient is best taught as a case-based simulation. Antibiotics should be prescribed in keeping with local guidelines. Yes: if the patient can talk, their airway is patent and you can move on to the assessment of breathing. 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. Cureus 9(5): e1286. 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). They should introduce the student group to the environment, assign roles for each learner and guide the decision-making process. Geeky Medics accepts no liability for loss of any kind incurred as a result of reliance upon the information provided in this video. 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. Immersive simulations are mentally exhausting because they create an intense and stressful atmosphere requiring the learner to work outside their comfort zone. Marx JA, Hockberger RS, Walls RM. In keeping with the case study, as a treatment marker is reached, the instructor should place emphasis on physiological, pharmacological, environmental and psychosocial issues. Using your thumbs, slightly open the mouth by downward displacement of the chin. Pediatric Emergency Medicine Didactics and Simulation (PEMDAS The instructor should have visual access via one-way windows or cameras. PDF Medicine Simulation Scenario Diabetic Ketoacidosis: An Emergency The file explaining the session is sent to instructors 1 week before the sessions. Simulation in Healthcare4(4):232-236, Winter 2009. This allows the learner group to make a psychological break from the patient and environment while beginning the reflection process. The relationship between sleep, fatigue and patient and provider safety. Emergency medical services workLife characteristics contribute to clinically significant excessive daytime sleepiness. This leads to hyperglycaemia, osmotic diuresis, and dehydration. As with the animated lecture, the simulation is strongly dependent on a focused case study. Clearly communicate how often would you like the patients observations relayed to you by other staff members. Advance the airway until it lies within the pharynx. PDF Diabetic Ketoacidosis in the Obstetric Population: A Simulation Research Watch Box:Sleep, Fatigue & SafetyBy David Page, MS, NREMT-P A collection of free medical student quizzes to put your medical and surgical knowledge to the test! Case-based simulation should include two to three broad-focus objectives, as well as 1020 specific performance measures that the student should accomplish. If the patient isunconsciousorunresponsive, start thebasic life support(BLS)algorithmas per resuscitation guidelines. Simulation Scenario. DY{Qb"(EgN$QI*%XN1F""0a5 Groups of fewer than four students dont allow for optimal collaboration. Similar to a ward round, where the instructor would say: Come and listen to this patient with an aortic stenosis. 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). 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. Immersive Simulations See ourfluid prescribing guidefor more details onresuscitation fluids. Forty percent of respondents reported excessive daytime sleepiness. Several environments may be suitable for your classroom. It was Works with Traffic 2005, but . Insert at least onewide-bore intravenous cannula(14G or 16G) and take blood tests as discussed below. If any obstruction is encountered, remove the tube and try the left nostril. A comprehensive collection of clinical examination OSCE guides that include step-by-step images of key steps, video demonstrations and PDF mark schemes. Testing a diabetes keotacidosis simulation in critical care nursing: A Clearlydocument your ABCDE assessment, including history, examination, observations, investigations, interventions, and the patients response. 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.) Healthcare Students' Psychological Well-Being in a Diabetic Ketoacidosis Simulation. General: Moaning, asking what has happening to her. Ketones show 5.5. Animated lectures, however, must work within the framework of a focused case study, which requires increased preparation time. The scenario would include an if-then algorithm. Centers for Disease Control and Prevention. 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. In the first, the authors expanded the National Registrys Longitudinal EMT Attributes and Demographic (LEADS) study by resurveying 1,600 EMS workers about their sleepiness while at work. In this manner, the students have to apply their knowledge at the appropriate points during the progression of the scenario. There are just a few more things to do. As this is a PBL session, the trainees are not given any references. Discuss the patients current clinical condition with aseniorclinicianusing anSBARR style handover. The instructors role is to facilitate active learning through a combination of learning styles. She tends to drink sugar containing fluids (soda) when she is thirsty, and she eats fast foods (cream-filled muffins) when she is hungry. Development of simulation scenarios for an adolescent patient with diabetic ketoacidosis. Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario Each clinical case scenario allows you to work through history taking, investigations, diagnosis and management. 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. She does not take this regularly. The immersive simulation is performed when the instructor feels comfortable with the acquired knowledge and skill base presented in the animated lecture or when the student group has sufficient practical experience to apply the cognitive, behavioral and technical skills outlined in the case scenario. You may be asked to review a patient with DKA due to confusion, reduced level of consciousness, tachycardia, hypotension and/or vomiting. DKA can develop within 24 hours and is potentially life threatening, requiring prompt recognition and therapeutic intervention. The researchers found that long shift hours (24hrs), working overtime and marital/relationship stress were strongly correlated. If an obstruction is visible within the airway, use afingersweeporsuctionto remove it. >> Fernandez AR, Mac Crawford J, Pennell ML, et al. Insert the airway bevel-end first, vertically along the floor of the nose with a slight twisting action. your express consent. 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. These are not learning objectives in this program. - Onset 01:48 reduced air entry, coarse crackles) to screen for evidence of pneumonia. In the meantime, you can perform some basic airway manoeuvres to help maintain the airway whilst awaiting senior input. 2011;15:108109. Trigger 4, Pathway 1l of saline required over 1hour and insulin infusion need prescribing and making up in 50ml syringe. In the meantime, you should re-assess and maintain the patients airway. She began experiencing progressively worsening thirst, increased appetite, and excessively increased urination. Trainee will be respectful to others and their views during the PBL session. The main goal is to establish a safe learning environment for the learner [9, 13 . 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 %PDF-1.5 Subscribe to our newsletter to be the first to know about our latest content: https://geekymedics.com/newsletter/ In an animated lecture, its important that the student group have an instructor so they can ask direct questions. Pediatric Emergency Medicine Didactics and Simulation (PEMDAS Before trainees arrival into the simulation area, the simulator is already preprogrammed for DKA. In some cases, normal saline with additional potassium is required to prevent overcorrection of serum potassium levels which would otherwise result in hypokalaemia. 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A traditional classroom lecture format allows for student participation but limits the instructors ability to create realistic situations. Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario. - PDF Two abstracts related to sleepiness in the EMS workforce were presented at the National Association of EMS Physicians symposium in January. This session provides additional clinical support material for the theoretical PBL session. Patients with DKA require fluid resuscitation to restore circulatory volume, clear ketones, correct electrolyte abnormalities and increase renal perfusion. 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. <> The use of a simulated, evolving case scenario was an effective method of exposing nursing students to complex patient care. Hypothermia may be present if the patient has been unconscious and exposed for some time. Consider active re-warming techniques in patients with severe hypothermia. We have been presenting Simulation Laboratory sessions to our preclinical medical students (first and second years). After the first voluntary session in 2006, feedback from the medical students indicated that they would like to receive this handout. Please note that by doing so you agree to be added to our monthly email newsletter distribution list. Observe and discuss the effects of therapy in a mathematically modeled physiological simulator. 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. 1 Potassium losses occurring both before and during treatment of DKA must be replaced. 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. Instagram: https://instagram.com/geekymedics Measure the patients capillary blood glucose and ketone levels to confirm the diagnosis and guide the management of DKA. Stage 3: Ongoing management and monitoring of DKA 1 hour after initiation of treatment. - Over 3000 Free MCQs: https://geekyquiz.com/ 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. Instructors should write a case study for the simulation before the session. Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. Open the patients airwayusing ahead-tiltchin-lift manoeuvre: 1. The student group is given a short introduction into a closed simulation environment. On arrival to the ER, standard monitors (electrocardiogram [ECG] and pulse oximetry [SpO2]) and end-tidal carbon dioxide (ETCO2) concentration were placed, and the patient was given oxygen by nasal cannulae. The Theory TheABCDEapproach can be used to perform a systematic assessment of a critically unwell patient. 1 0 obj 2017 May 29;9(5):e1286. For more information, please refer to our Privacy Policy. 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). Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. Highlight selected keywords in the article text. Indeed, it is the only thing that ever has.". The simulation experience serves to give substance to the theoretical words and concepts that the students encountered during the PBL sessions. Diabetic ketoacidosis; Simulation training; Medical students. Consider any precipitating factors for the development of DKA and involve the diabetes team in the patients care. This is particularly important for core cases and low-frequency, high-stakes procedures and encounters. You can check out our guide to using SOCRATES here: https://geekymedics.com/the-socrates-acronym-in-history-taking/ - Geeky Medics OSCE App: https://geekymedics.com/geeky-medics-app/ Diabetes (type 1 and type 2) in children and young people: diagnosis and management. Environment & Manikin Stage 2: Emergency management of DKA and consideration of abnormal CTG. Ziv A, Wolpe PR, Small SD, et al. PBL was introduced at our institution in 1995. 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). DKA can be caused by either: Absolute insulin deficiency (e.g. Wolters Kluwer Health Join the Geeky Medics community: 2. See our blood glucose measurement guide for more details. Make sure tore-assessthe patient after anyintervention. Trainee will increase knowledge of professional behaviors during the simulation. This is particularly important for core . We combined both to indicate the continuity of the curriculum, and the building on prior knowledge. 1. 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. 3. 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). <>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 595.32 841.92] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> 3. A well-staged environment allows for greater student buy-in. Trainee will describe the changes in vital signs, the major metabolic, fluid, and electrolyte. Keywords: diabetic ketoacidosis, simulation, expertise, emergency medicine Introduction Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes mellitus, most . The following scenarios are available for download and are designed to meet your multi-disciplinary nursing needs. Supplemental digital content is available for this article. Given 6 to 8 back-to-back sessions, it is critical that every session starts and ends on time! Each performance measure is separated into cognitive, behavioral or technical categories. Management of diabetic ketoacidosis in adults. 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 have 18 to 20 PBL groups for an hour each in the week after their PBL DKA session. Reduced urine output (oliguria) is typically defined as less than 0.5ml/kg/hour in an adult. This is a 25-year-old woman with a medical history of diabetes medicated with 40 units insulin per day. Manikin staging can provide strong cues. The lecture allows for understanding of concepts prior to action, and instructor feedback is immediate. See ourdocumentation guidesfor more details. may email you for journal alerts and information, but is committed Assess the patients pulse and blood pressure: Inspect the patient from the end of the bed: they may appear drowsy, confused and/or clammy/pale. diagnosis of DKA Trigger 3, ABG show acidosis and high BM and normal potassium. 2011;15:108109. We then start the DKA state. See Appendix D, Supplemental Digital Content 4, https://links.lww.com/SIH/A4. 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. 2. Simulation Training Ideal for Diabetic Patients - JEMS vD0 x@FFJ{m[ 3//Oh|JR7! Are any further assessments or interventions required? Available from: [. can be reemphasized, and the effects of fluid therapy demonstrated. NPAs are typically better tolerated in patients who are partly or fully conscious compared to oropharyngeal airways. Calculate the patients current fluid balance using their fluid balance chart (e.g. Diabetic Ketoacidosis (DKA) | Acute Management | ABCDE It involves working through the following steps: Each stage of the ABCDE approach involvesclinicalassessment,investigationsandinterventions. For example, you could develop a diabetic scenario in which the prehospital provider encounters an altered patient with incomprehensible speech. Its important to train and educate students of prehospital care on key indicators of a diabetic emergency. Diabetic Ketoacidosis in the Obstetric Population: A Simulation One of the key differences with the immersive simulation is that the instructor is absent from the simulation environment. - Site 01:12 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). }HyEf,#$/JSRU9+CF6k\'/z+i`[ 5JudK*Zly^g%[jCK)H[)Y=Qp0/r9o9HW_zF}pTzI~'|q.~:=Y T 9w! If the patient is suspected to have sufferedsignificanttraumawith potential spinal involvement, perform ajaw-thrustrather than a head-tilt chin-lift manoeuvre: 2. Extremities: mild cyanosis, no clubbing or edema (verbalized by instructors); pulses equal, and symmetrical (elucidated by trainees). - Timing 03:23 >> Patterson PD, Weaver M, Frank R, et al. Introduceyourselfto thepatientincluding yournameandrole. 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. confusion, coma), All critically unwell patients should have. Laschinger S, Medves J, Pulling C, et al. - Character 02:14 Initially, we required the students to write down the vital signs. A collection of surgery revision notes covering key surgical topics. The objective is to give as many visual and tactile cues concerning the patient condition and background as possible. Both external and internal potassium balances are disturbed during the development and treatment of DKA. Glycosuria leads to urinary losses of potassium through osmotic diuresis. endobj 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. 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. Cureus is on a mission to change the long-standing paradigm of medical publishing, where submitting research can be costly, complex and time-consuming. Simulation-based medical education: An ethical imperative. Categories: Emergency Medicine, Medical Education Keywords: diabetic ketoacidosis, simulation, expertise, emergency medicine .
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