Please try again soon. The files are given in full in the web supplement (Appendix B, Supplemental Digital Content 2, https://links.lww.com/SIH/A2). Simulation provides a safe environment where learning is enhanced through the deliberate practice of skills and controlled management of a variety of clinical encounters. There are several causes of DKA, which we remember by the "five I's". Inspect for evidence of self-injection sites (e.g. Given 6 to 8 back-to-back sessions, it is critical that every session starts and ends on time! 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. 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. It involves working through the following steps: Each stage of the ABCDE approach involvesclinicalassessment,investigationsandinterventions. Debriefing We also show them IV bags containing saline and Ringers lactate, as well as show them IV infusion sets. Urinary tract infections are a common DKA precipitant. Nandate, Koichiro MD, PhD; Abola, Ramon MD; Murray, W Bosseau MB; Whitfield, Carol PhD; Lang, Charles PhD; Sinz, Elizabeth MD. DO NOT perform any examination or procedure on patients based purely on the content of these videos. Just place the BR2_KDCA file into your addons scenery folder: C:\\Program Files\\Microsoft Games\\Microsoft Flight Simulator X\\Addon Scenery\\Scenery. Prehosp Emerg Care. unilateral coarse crackles may be present if the patient has pneumonia which may have been the precipitant for DKA). Tilt the forehead back whilst lifting the chin forwards to extend the neck. Check out our other awesome clinical skills resources including: 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. "Never doubt that a small group of thoughtful, committed citizens can change the world. stream You might also be interested in our awesome bank of 700+ OSCE Stations. Intubation lubricants can mimic drooling. PBL was introduced at our institution in 1995. Administer oxygen to all critically unwell patients during yourinitialassessment. Properly interpret a venous blood gas (VBG) and basic metabolic panel in a patient presenting with diabetic ketoacidosis. Several environments may be suitable for your classroom. 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. A comprehensive collection of medical revision notes that cover a broad range of clinical topics. may email you for journal alerts and information, but is committed The lecture allows for understanding of concepts prior to action, and instructor feedback is immediate. Over the years, some groups happened to have the simulation session before the completion of the theoretical PBL session. 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. Animated lectures, however, must work within the framework of a focused case study, which requires increased preparation time. 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. 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. 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. An integral part of a PBL session is for trainees to be able to navigate through huge literature bases. As with the animated lecture, the simulation is strongly dependent on a focused case study. Using the arterial line, the scenario becomes much more dynamic. 3. 2. 1 0 obj We have spent many hours debating whether the small group format was a waste of time. Deteriorationshould be recognised quickly and acted upon immediately. 4. Alert a senior immediately if you have any concerns about the consciousness level of a patient. opioids, sedatives, anxiolytics, insulin, oral hypoglycaemic medications). 2 The evaluation of potassium deficits is complicated by potassium exit from . a simulation training session designed to acquaint emergency medicine residents with the presentation and management of diabetic ketoacidosis (DKA) through the use of simulation. Calculate the patients current fluid balance using their fluid balance chart (e.g. Each PBL case typically goes over 23 days, affording the students periods to find information for the case. 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. confusion, coma), All critically unwell patients should have. Target Learner Groups They have had no clinical exposure or any clinical experience. 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. Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario If the patientloses consciousnessand there areno signs of lifeon assessment, put out acrash callandcommence CPR. A GCS of 8 or below warrants urgent expert help from an anaesthetist. The teaching of diabetic assessment and management, like many other medical emergencies, lends itself well to case-based simulation. 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. Its absolutely necessary to follow all immersive simulations with a positive, emotionally safe and nonjudgmental debriefing environment. Consider active re-warming techniques in patients with severe hypothermia. 2009;13:505511. <>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 595.32 841.92] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> 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. Many of the preclinical students have never seen a real life clinical monitor or even an intravenous (IV) setup. 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. She Died the Next Day. . 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 . Similar to a ward round, where the instructor would say: Come and listen to this patient with an aortic stenosis. endobj - Examples 05:45 2011;15:108109. 2008;6:278302. type 1 diabetes) Complete insulin insensitivity (e.g. Geeky Medics accepts no liability for loss of any kind incurred as a result of reliance upon the information provided in this video. A pre-briefing session is conducted prior to the start of the simulation scenario. After entering the environment, the student doesnt have the option of leaving the simulation until the learning objectives and performance measures are achieved. Scenarios. Medical Simulation Scenarios are text documents outlining the various details of a simulation - everything from patient simulator settings to debriefing notes.Below is a collection of donated scenarios for you to use or modify. Manikin staging can provide strong cues. Open the patients airwayusing ahead-tiltchin-lift manoeuvre: 1. This leads to hyperglycaemia, osmotic diuresis, and dehydration. Marx JA, Hockberger RS, Walls RM. Some error has occurred while processing your request. 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. Catheterisethe patient to closelymonitor urine outputto guide fluid resuscitation and need for escalation. The validity of the HFS-DKA scenario was verified by a certified diabetes nurse educator, a registered nurse, and a clinical nurse educator. Animated Lecture We are looking for declaration of DKA and request for pathway. 3. 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. 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. The facilitator guides the group only when necessary. 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. DOWNLOAD Diabetic Ketoacidosis By the end of this scenario, the learner will be able to: 1. A chest X-ray should not delay the emergency management of DKA. Please write a single word answer in lowercase (this is an anti-spam measure). If the patient is confused you might be able to get a collateral history from staff or family members as appropriate. 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. Trainee will recognize the need for therapy and suggest an appropriate therapy in a simulated environment. It was developed for anesthesiology resident physicians with some background knowledge and experience caring for critically ill patients. After initial insulin therapy has reduced plasma blood glucose levels (e.g. Airway adjuncts are often helpful and in some cases essential to maintain a patients airway. If you have any scenarios you would be willing to share with the simulation community, please forward them . 3. She is lethargic and slightly confused but can intermittently respond to questions. Trainee will correlate the underlying pathophysiology with symptoms and signs as exhibited by the simulation session. Int J Evid Based Healthc. This video demonstrates how to use the SOCRATES acronym when taking a history of pain or other symptoms. 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. Review the patients drug chart for medications which may cause a reduced level of consciousness (e.g. Consider any precipitating factors for the development of DKA and involve the diabetes team in the patients care. Conclusions This technical report describes the design and implementation of a simulation scenario on DKA for emergency medicine trainees. <>>> If you have any scenarios you would be willing to share with the simulation community, please forward them to me. Introduceyourselfto thepatientincluding yournameandrole. Patients with DKA require fluid resuscitation to restore circulatory volume, clear ketones, correct electrolyte abnormalities and increase renal perfusion. As this is an interactive discussion session, any needed debriefing and/or explanation is given during the sessions. The use of case-based simulation, although more complicated and time consuming for the instructor, immerses the students in the subject matter. 1) Please read through this document as it will help you prepare for your upcoming simulation on DKA. - Exacerbating & relieving factors 05:12 The student group should be encouraged to collaborate on management options and to perform skills. Insert at least onewide-bore intravenous cannula(14G or 16G) and take blood tests as discussed below. DKA can be caused by either: Absolute insulin deficiency (e.g. 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. - Introduction 00:00 Subscribe to our newsletter to be the first to know about our latest content: https://geekymedics.com/newsletter/ Yes: if the patient can talk, their airway is patent and you can move on to the assessment of breathing. Revisit history taking to explore relevant medical history and identify any precipitating factors for DKA. Use washable, non-toxic paints to imitate various body emissions. Ziv A, Wolpe PR, Small SD, et al. A collection of data interpretation guides to help you learn how to interpret various laboratory and radiology investigations. 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. The choice of fluid type, rate of administration and volume should be tailored to the individual patient based upon their vital signs and electrolytes. Available from: [, NICE guidelines. Conclusion The simulation experience serves to give substance to the theoretical words and concepts that the students encountered during the PBL sessions. This typically involves the use of anon-rebreathe maskwith an oxygen flow rate of15L. 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. A collection of free medical student quizzes to put your medical and surgical knowledge to the test! Review thepatients notes,chartsandrecent investigation results. tall tented T waves in hyperkalaemia). The trainees have had background knowledge of biochemistry because they had completed the PBL case. These simulation sessions seem to work because the medical students do have prior knowledge. We now provide the students with handouts of the data to save time and provide consistency. Twitter: http://www.twitter.com/geekymedics SimMan offers you the ability to provide simulation education to challenge and test your students clinical and decision-making skills during realistic patient care scenarios. The students have acquired all the applicable theoretical knowledge of the case during the previous multiday PBL sessions. 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]). Does the patient need a referral toHDU/ICU? 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. This may produce better retention of the subject matter and help students adapt to emergency scenes before going into the field. However, this turned out to be too slow, took too much time, and could not continuously demonstrate the direction of changes. The students are in their first year. - 2500+ OSCE Flashcards: https://geekymedics.com/osce-flashcards/ Stage 3: Ongoing management and monitoring of DKA 1 hour after initiation of treatment. Effectiveness of simulation on health profession students knowledge, skills, confidence and satisfaction. (1) The assessment of a diabetic patient is best taught as a. Standardized patient as the voice of the simulator (or the simulation operator may play this role). 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. Using your thumbs, slightly open the mouth by downward displacement of the chin. Heart: S1 and S2 within normal limits; no S3/S4 or murmurs, normal rate and rhythm. If the patient has clinical signs ofanaphylaxis(e.g. SimMan Nursing Scenarios Software. Trainee will appropriately request assistance and use available resources. 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. In the meantime, you can perform some basic airway manoeuvres to help maintain the airway whilst awaiting senior input. An events progression section should include patient status changes, as well as a time/treatment continuum that incorporates if-then event progressions. Groups of fewer than four students dont allow for optimal collaboration. They have had no clinical exposure or any clinical experience. Cureus is on a mission to change the long-standing paradigm of medical publishing, where submitting research can be costly, complex and time-consuming. - PSA Question Pack: https://geekymedics.com/psa-question-bank/ Topic: Abdominal TraumaTitle: Motorcycle CrashTarget: Senior Emergency Residents / Trauma TeamAuthor / Institution: Tim Chaplin, Alison Archibaldclick here to download, Topic: Adrenal CrisisTarget: Senior Emergency Residents / Trauma TeamAuthor / Institution: Anonclick here to download, Topic: AnaphylaxisTarget: Internal MedicineAuthor / Institute: Jim Boseovski / Queen's Universityclick here to download, Topic: AnaphylaxisTitle: Anaphylaxis In An InpatientTarget: PGY1Author / Institution: Alison Rodger, Babar Haroon / Dalhousie Universityclick here to download, Topic: AnaphylaxisTitle: Bee Sting In An 8 Month OldAuthor / Institution: Katie Gordon / University of Maryland School of Medicineclick here to download, Topic: ApneaTitle: Drowning In A 3 Year OldAuthor / Institution: Katie Gordon / University of Maryland School of Medicineclick here to download, Topic: Asthmatic Protocol for EDTitle: Branching Scenario: 3 Treatment Routine ER - Pediatric PatientTargets: Emergency Department Staff and Respiratory Therapy StudentsAuthor / Instituation: Carl Rod, MS, RRT, RCP, Rose State College RT Clinical Simulation Labclick here to download, Topic: Atrial FibrillationTarget: Internal MedicineAuthor / Institute: Jim Boseovski / Queen's Universityclick here to download plus chart documents here, Topic: Bidirectional Ventricular Tachycardia from Digoxin ToxicityTarget: Senior Emergency Residents / Trauma TeamAuthor / Institution: Anonclick here to download, Topic: BradicadiaTitle: Bradycardic Arrest - Carotid Sinus MassTarget: PGY1Author / Institution: Babar Haroon / Dalhousie Universityclick here to download, Topic: BurnTitle: Cigarette FireTarget: Senior Emergency Residents / Trauma TeamAuthor / Institution: Tim Chaplin, Alison Archibaldclick here to download, Topic: BurnTitle: Meth Lab Explosion Target: Senior Emergency Residents / Trauma TeamAuthor / Institution: Tim Chaplin, Alison Archibaldclick here to download, Topic: Cardiac ArrestTarget: Inter-professional Team TrainingAuthor / Institution: Alim Nagji, Krista Dowhos / Joseph Brant Hospitalclick here to download, Topic: Chest and Abdominal TraumaTitle: Auto AccidentTarget: Senior Emergency Residents / Trauma TeamAuthor / Institution: Tim Chaplin, Alison Archibaldclick here to download, Topic: CHF (Congestive Heart Failure)Target: Internal MedicineAuthor / Institute: Jim Boseovski / Queen's Universityclick here to download, Topic: Communication, Interpersonal Skills, Mediating Conflict Title: Managing Family Members with Different Views Target: ICU FellowsAuthor / Institution: Ryan Fink, Miko Enomoto / OHSUclick here to download, Topic: Crohns FlareTitle: Complicated CrohnsTarget: PGY1Author / Institution:Allen Tran / Dalhousie Universityclick here to download, Topic: Delirious, Combative / Violent Patient Management Title: DeliriumTarget: ICU FellowsAuthor / Institution: Ryan Fink, Miko Enomoto / OHSUclick here to download, Topic: Delivering Bad NewsTitle: Delivering Bad News after a StrokeTarget: ICU FellowsAuthor / Institution: Ryan Fink, Miko Enomoto / OHSUclick here to download, Topic: Difficult AirwayTitle: Ace Inhibitor AngioedemaTarget: Mid - Senior Emergency ResidentsAuthor / Institution: Anonclick here to download, Topic: Difficult AirwayTitle: Difficult / Failed AirwayTarget: Mid - Senior Emergency ResidentsAuthor / Institution: Anonclick here to download, Topic: Disclosure of an Adverse EventTitle: Retained Guidewire from a Central LineTarget: ICU FellowsAuthor / Institution: Ryan Fink / OHSUclick here to download, Topic: DKA (Diabetic Ketoacidosis)Target: Internal MedicineAuthor / Institute: Jim Boseovski / Queen's Universityclick here to download, Topic: DKATarget: PGY1Author / Institution: Allen Tran, Babar Haroon / Dalhousie Universityclick here to download, Topic: Dyspnea (Shortness of Breath)Title: Acute Pulmonary Edema requiring intubationTarget: Senior Emergency ResidentsAuthor / Institution: Anonclick here to download, Topic: Dyspnea (Shortness of Breath)Title: Severe Asthma requiring intubationTarget: Senior Emergency ResidentsAuthor / Institution: Anonclick here to download, Topic: Electrical StormTarget: Internal MedicineAuthor / Institute: Jim Boseovski / Queen's Universityclick here to download plus chart documents here, Topic: Emergent Med-Surg ResponseTitle: MET/RRT ResponseTargets: Response Teams, House Staff and Respiratory Therapy StudentsAuthor / Instituation: Carl Rod, MS, RRT, RCP, Rose State College RT Clinical Simulation Labclick here to download, Topic: EtOH WithdrawalTitle: EtOH Withdrawal SiezureTarget: PGY1Author / Institution: Allen Tran, Babar Haroon / Dalhousie Universityclick here to download, Topic: Febrile NeutropeniaTarget: Internal MedicineAuthor / Institute: Jim Boseovski / Queen's Universityclick here to download, Topic: Head TraumaTitle: Four Storey FallTarget: Senior Emergency Residents / Trauma TeamAuthor / Institution: Tim Chaplin, Alison Archibaldclick here to download, Topic: Head TraumaTitle: Hit by MotorboatTarget: Senior Emergency Residents / Trauma TeamAuthor / Institution: Tim Chaplin, Alison Archibaldclick here to download, Topic: HypertensionTitle: Aortic DissectionTarget: Senior Emergency ResidentsAuthor / Institution: Anonclick here to download, Topic: HypertensionTitle: Autonomic DysreflexiaTarget: Senior Emergency ResidentsAuthor / Institution: Anonclick here to download, Topic: Hypertensive EmergencyTarget: Internal MedicineAuthor / Institute: Jim Boseovski / Queen's Universityclick here to download, Topic: Hypertensive EmergencyTitle: Diastolic Danger Hypertensive Urgency / EmergencyTarget: PGY1Author / Institution: Hailey Hobbs, Babar Haroon / Dalhousie Universityclick here to download, Topic: HypoxiaTarget: Inter-professional Team TrainingAuthor / Institution: Devin Sydorclick here to download, Topic: Inferior StemiTarget: Internal MedicineAuthor / Institute: Jim Boseovski / Queen's Universityclick here to download, Topic: Labor and delivery, postpartum hemorrhageTitle: Normal Delivery with PPHTarget: Maternal - Child Course - Nursing EducationAuthor / Institution: Kelly McMunnclick here to download, Topic: PEA Arrest (pulseless electrical activity)Target: Internal MedicineAuthor / Institute: Jim Boseovski / Queen's Universityclick here to download, Topic: Pelvic FractureTarget: Senior Emergency Residents / Trauma TeamAuthor / Institution: Anonclick here to download, Topic: Penetrating Thoracic TraumaTarget: Senior Emergency Residents / Trauma TeamAuthor / Institution: Anonclick here to download, Topic: PneumoniaTarget: Internal MedicineAuthor / Institute: Jim Boseovski / Queen's Universityclick here to download, Topic: PneumoniaTitle: Community Acquired PneumoniaTarget: PGY1Author / Institution: Iain Arseneau, Babar Haroon / Dalhousie Universityclick here to download, Topic: Pulmonary EmbolismTarget: Internal MedicineAuthor / Institute: Jim Boseovski / Queen's Universityclick here to download, Topic: Ruptured Ectopic PregnancyTarget: Senior Emergency Residents / Trauma TeamAuthor / Institution: Anonclick here to download, Topic: SepsisTarget: PGY1Author / Institution: Allen Tran / Dalhousie Universityclick here to download, Topic: SepsisTitle: Sepsis - 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