dka simulation scenario

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. A well-staged environment allows for greater student buy-in. By joining Cureus, you agree to our Trainee will recognize the need for therapy and suggest an appropriate therapy in a simulated environment. Simulation provides a safe environment where learning is enhanced through the deliberate practice of skills and controlled management of a variety of clinical encounters. This session provides additional clinical support material for the theoretical PBL session. A fixed-rate intravenous insulin infusion should be commenced initially to suppress ketogenesis, reduce blood glucose levels and address electrolyte disturbances. 1 0 obj Terms of Use. If you have any scenarios you would be willing to share with the simulation community, please forward them . A comprehensive collection of clinical examination OSCE guides that include step-by-step images of key steps, video demonstrations and PDF mark schemes. This typically involves the use of anon-rebreathe maskwith an oxygen flow rate of15L. 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. 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. Trainee will describe the changes in vital signs, the major metabolic, fluid, and electrolyte. Stage 2: Emergency management of DKA and consideration of abnormal CTG. 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. If the patient has COPD and a history of CO2retention you should switch to aventuri maskas soon as possible andtitrate oxygen appropriately. <> Facebook: http://www.facebook.com/geekymedics This guide provides an overview of the recognition and immediate management of diabetic ketoacidosis (DKA)using an ABCDE approach. This video demonstrates how to use the SOCRATES acronym when taking a history of pain or other symptoms. The diabetes with DKA clinical pathway is a detailed plan of the course of care for pediatric patients seen in the emergency department with diabetic ketoacidosis. Antibiotics should be prescribed in keeping with local guidelines. Review thepatients notes,chartsandrecent investigation results. endobj Inspect theairwayfor obviousobstruction. Inspect for evidence of self-injection sites (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. 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. The lecture allows for understanding of concepts prior to action, and instructor feedback is immediate. Effectiveness of simulation on health profession students knowledge, skills, confidence and satisfaction. For example, you could develop a diabetic scenario in which the prehospital provider encounters an altered patient with incomprehensible speech. Consider any precipitating factors for the development of DKA and involve the diabetes team in the patients care. Consider active re-warming techniques in patients with severe hypothermia. Ask for anotherclinicalmemberofstafftoassistyou if possible. Mosby:Philadelphia. Available from: [, NICE guidelines. Blood sugar issues in the Type II diabetic will have a gradual onset, with diagnosis generally resulting from routine laboratory exams.(1). 2010;49:578586. 2 The evaluation of potassium deficits is complicated by potassium exit from . 2. angioedema, rash) commence appropriate treatment as discussed in ouranaphylaxis guide. Initially, we required the students to write down the vital signs. Administer oxygen to all critically unwell patients during yourinitialassessment. Patients with DKA require fluid resuscitation to restore circulatory volume, clear ketones, correct electrolyte abnormalities and increase renal perfusion. The patient synopsis should include such standard aspects as age, sex, ethnicity, medical history, medications and allergies. 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. . Acad Med. 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. If the patient is conscious, sit themuprightas this can also help with oxygenation. As a next step, we will let one of the trainees talk to the patient, and prompt to ask medical questions such as previous medical issues or recent drug use for them to practice asking questions to generate a differential diagnosis (in this case, other causes for confusion). Collectblood testsafter cannulating the patient including: An ECG should be performed to screen for cardiac pathology such as arrhythmias which may be precipitated by electrolyte abnormalities (e.g. In this section, we have to help the trainee to institute definitive therapy based on the underlying biochemical abnormalities. cellulitis). See ourfluid prescribing guidefor more details onresuscitation fluids. - Examples 05:45 Using SOCRATES in History Taking | OSCE | Communication Skills, Diabetic Ketoacidosis (DKA) | Acute Management | ABCDE. This is particularly important for core . Vital Signs: BP, 90/30 mm Hg (ECG shows normal sinus rhythm); central venous pressure, 0 to 2 cm H. Lungs: All lung fields are clear to auscultation without wheeze or rhonchi, and the respiratory pattern is typical of Kussmaul breathing, ie, large deep tidal volumes and increased respiratory rate. 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. Ketones show 5.5. Well done, youve now stabilised the patient and theyre doing much better. 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). These are not learning objectives in this program. 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). Revisit history taking to explore relevant medical history and identify any precipitating factors for DKA. A chest X-ray should not delay the emergency management of DKA. diagnosis of DKA Trigger 3, ABG show acidosis and high BM and normal potassium. 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). Debriefing The file explaining the session is sent to instructors 1 week before the sessions. Strategies of high-performing paramedic educational programs. Prehosp Emerg Care. 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)? 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. We believe it is important to have active, participatory learning by having conversations with the trainees in the form of questions and answers. 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. DOI 10.7759/cureus.1286. MassBay EMS Program Integrates Training for Dogs, Heat Waves Are Killing More LA Homeless People. An animated lecture may be described as a pseudo-simulation environment. 3. Medical Simulation Scenarios are text documents outlining the various details of a simulation - everything from patient simulator settings to debriefing notes. After initial insulin therapy has reduced plasma blood glucose levels (e.g. - Associated symptoms 03:04 Keyword Highlighting As individuals with uncontrolled type I . 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. Use washable, non-toxic paints to imitate various body emissions. The validity of the HFS-DKA scenario was verified by a certified diabetes nurse educator, a registered nurse, and a clinical nurse educator. The Theory 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. Healthcare Students' Psychological Well-Being in a Diabetic Ketoacidosis Simulation. 4. This leads to hyperglycaemia, osmotic diuresis, and dehydration. LYqC+pJ&6X4onfBT#?=R}.p8N3+Dk,P4tIgWB}-L'=8;_G >,K#.e89XnG'B~NtR confusion, coma), All critically unwell patients should have. Check out our other awesome clinical skills resources including: See ourCXR interpretation guidefor more details. Catheterisethe patient to closelymonitor urine outputto guide fluid resuscitation and need for escalation. Trigger 4, Pathway 1l of saline required over 1hour and insulin infusion need prescribing and making up in 50ml syringe. They have had no clinical exposure or any clinical experience. Several environments may be suitable for your classroom. Inspect for evidence of infection on the skin (e.g. PA EMT Said COVID Patient Didnt Need to Go to the Hospital. Stage 1: Initial assessment of acutely unwell pregnant woman and diagnosis of DKA. 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. Groups of more than seven may struggle with meeting objectives due to insufficient functional rolls. vD0 x@FFJ{m[ 3//Oh|JR7! Physician working in the emergency department. This is particularly important for core cases and low-frequency, high-stakes procedures and encounters. 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. Emergency medical services workLife characteristics contribute to clinically significant excessive daytime sleepiness. We are looking for declaration of DKA and request for pathway. Open the patients airwayusing ahead-tiltchin-lift manoeuvre: 1. As this is an interactive discussion session, any needed debriefing and/or explanation is given during the sessions. 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. Supplemental digital content is available for this article. The relationship between sleep, fatigue and patient and provider safety. Cureus is on a mission to change the long-standing paradigm of medical publishing, where submitting research can be costly, complex and time-consuming. She had developed nausea, extreme fatigue, mild disorientation, and blurred vision toward the end of the soccer match. His Wife Gave Him CPR. An individual student can get an immediate answer to a question, the facilitator can see puzzled expressions on faces, and the PBL group could get answers that they could not get during their prior PBL group discussions. However, this turned out to be too slow, took too much time, and could not continuously demonstrate the direction of changes. If fever is present, make sure to consider co-existing infection. Medical simulation technology is a powerful tool for training physicians but papers dealing with DKA simulators are scarce. Keywords: diabetic ketoacidosis, simulation, expertise, emergency medicine Introduction Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes mellitus, most . This is a combination of the modified traditional lecture within scenario-based learning. 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. Stage 3: Ongoing management and monitoring of DKA 1 hour after initiation of treatment. 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. However, this leads to confusion. Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario Cureus. You may be trying to access this site from a secured browser on the server. Marx JA, Hockberger RS, Walls RM. unilateral coarse crackles may be present if the patient has pneumonia which may have been the precipitant for DKA). The student group should be encouraged to collaborate on management options and to perform skills. We have 18 to 20 PBL groups for an hour each in the week after their PBL DKA session. Twitter: http://www.twitter.com/geekymedics Open the patients mouth to ensure there is no foreign material that may be pushed into the larynx. 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. 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). % Trainee will learn to collaborate with peers to decide on appropriate interventions, tests, and therapy. may email you for journal alerts and information, but is committed An integral part of a PBL session is for trainees to be able to navigate through huge literature bases. Animated Lecture The learning objectives follow the American College of Graduate Medical Education (ACGME) Core Compentencies. A comprehensive collection of OSCE guides to common clinical procedures, including step-by-step images of key steps, video demonstrations and PDF mark schemes. DKA can be caused by either: Absolute insulin deficiency (e.g. The facilitator guides the group only when necessary. 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. 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). This article originally appeared in March 2011 JEMS as Diabetes Demonstration: Simulation-based learning works best., Simulation Training Ideal for Diabetic Patients, CMS Begins Reprocessing Retroactive Payments, Documents Detail EMTs Failure to Aid Tyre Nichols, New Course Lets Bystanders Be the Help Until Help Arrives, All Paramedic Recruits in New Castle County (DE) Obtain NRP Certification, International Prehospital Medicine Institute Literature Review, March 2023. Clinical Simulation in Nursing, Volume 39, 2020, pp. areas of lipohypertrophy) if it is unclear if the patient is diabetic. ABG, venepuncture). Note that if-thens must also include negative patient outcomes for when the provider doesnt take appropriate action. 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). In this manner, the students have to apply their knowledge at the appropriate points during the progression of the scenario. Trainee will appropriately request assistance and use available resources. You can check out our guide to using SOCRATES here: https://geekymedics.com/the-socrates-acronym-in-history-taking/ Weight, Height: Not given, normal appearing (as per simulator) but has lost 20 lbs recently. Int J Evid Based Healthc. 3. Diabetic ketoacidosis (DKA) is a common, potentially lethal disease. A traditional classroom lecture format allows for student participation but limits the instructors ability to create realistic situations. - Exacerbating & relieving factors 05:12 Refer to your local guidelines which should provide a clear protocol for the management of DKA. The instructors never expect the trainees to exhibit full understanding of pathophysiology and skills in the treatment but do give them a few important points to understand the diagnosis and initial treatment of the patients with DKA. It should only be inserted in unconscious patients as it is otherwise poorly tolerated and may induce gagging and aspiration. Alert a senior immediately if you have any concerns about the consciousness level of a patient. Clearlydocument your ABCDE assessment, including history, examination, observations, investigations, interventions, and the patients response. - Character 02:14 Heart: S1 and S2 within normal limits; no S3/S4 or murmurs, normal rate and rhythm. x]o ]?9kgq~:)?hE )R6!up}\<8||\]}Y~;xp~yQ$#4~djX&{n_m-]^K1/~/AD Hv 99evs,;8}8zwnhFxV.kf-V^? For similar reasons, we do not believe a videotaped session will keep the students attention as much as these live simulator sessions. - 2500+ OSCE Flashcards: https://geekymedics.com/osce-flashcards/ Its important to train and educate students of prehospital care on key indicators of a diabetic emergency. Hypothermia may be present if the patient has been unconscious and exposed for some time. 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). In keeping with the case study, as a treatment marker is reached, the instructor should place emphasis on physiological, pharmacological, environmental and psychosocial issues. and GRAPH. Section snippets . We ask the trainee why the blood pressure is so low or heart rate is so high, and how we should treat it. The students worked on the underlying physiology during a week long PBL session and are therefore familiar with the theoretical aspects of DKA. If you have any scenarios you would be willing to share with the simulation community, please forward them to me. The students are in their basic science course. Standardized patient as the voice of the simulator (or the simulation operator may play this role). You may be asked to review a patient with DKA due to confusion, reduced level of consciousness, tachycardia, hypotension and/or vomiting. Her medical, social, and family histories are not clear at the time of admission to the emergency department. TikTok: https://www.tiktok.com/@geekymedics DO NOT perform any examination or procedure on patients based purely on the content of these videos. Schneider Sarver PA, Senczakowicz EA, Slovensky BM. Trainee will correlate the underlying pathophysiology with symptoms and signs as exhibited by the simulation session. 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. reduced air entry, coarse crackles) to screen for evidence of pneumonia. 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. 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. 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. In the meantime, you should re-assess and maintain the patients airway. COVID-19 Screening in the Pediatric Emergency Department. She Died the Next Day. Ziv A, Wolpe PR, Small SD, et al. - Over 3000 Free MCQs: https://geekyquiz.com/ 2 0 obj Yes: if the patient can talk, their airway is patent and you can move on to the assessment of breathing. Animated lectures, however, must work within the framework of a focused case study, which requires increased preparation time. 1-6. Please try again soon. See Table 4 for a suggested standardized script. 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 . The debriefing environment should be removed from the location where the simulation took place. 4. Available from: [. 1. 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. Tilt the forehead back whilst lifting the chin forwards to extend the neck. (1), The assessment of a diabetic patient is best taught as a case-based simulation. Rosens Emergency Medicine: Concepts and Clinical Practice. 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. The DKA simulation incorporates cue recognition, analysis of cues, generation of solutions, nursing interventions, and evaluation of outcomes, including effective communication and psychosocial concerns. Two abstracts related to sleepiness in the EMS workforce were presented at the National Association of EMS Physicians symposium in January.

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