dka simulation scenario
They should introduce the student group to the environment, assign roles for each learner and guide the decision-making process. We give the history of the patient to the trainees. See Table 4 for a suggested standardized script. - Introduction 00:00 See ourCXR interpretation guidefor more details. As with the animated lecture, the simulation is strongly dependent on a focused case study. - Geeky Medics OSCE App: https://geekymedics.com/geeky-medics-app/ 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). This simulation session therefore aims to make the case come alive, and show this known case in a clinical context. The Theory 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. If the patient is conscious, sit themuprightas this can also help with oxygenation. One advantage to the animated lecture style is the ability to introduce treatment options in a methodically guided approach thats in conjunction with simultaneous environmental stimulus. We also show them IV bags containing saline and Ringers lactate, as well as show them IV infusion sets. Cureus 9(5): e1286. <> 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 . cloudy urine may indicate urinary tract infection). JEMS. Case-based simulation should include two to three broad-focus objectives, as well as 1020 specific performance measures that the student should accomplish. 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. <> Check out our other awesome clinical skills resources including: 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). Reduced urine output (oliguria) is typically defined as less than 0.5ml/kg/hour in an adult. However, this leads to confusion. opioids, sedatives, anxiolytics, insulin, oral hypoglycaemic medications). DO NOT perform any examination or procedure on patients based purely on the content of these videos. DO NOT perform any examination or procedure on patients based purely on the content of these videos. 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. Review thepatients notes,chartsandrecent investigation results. For example, you could develop a diabetic scenario in which the prehospital provider encounters an altered patient with incomprehensible speech. 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. An animated lecture may be described as a pseudo-simulation environment. DKA can develop within 24 hours and is potentially life threatening, requiring prompt recognition and therapeutic intervention. 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. Glycosuria leads to urinary losses of potassium through osmotic diuresis. type 1 diabetes) Complete insulin insensitivity (e.g. The instructors role is to facilitate active learning through a combination of learning styles. www.cdc.gov/diabetes/statistics/prev/national/. She does not take this regularly. Immersive Simulations 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. Available from: [. The instructor can also gauge the direction the debriefing session should follow or be alerted to possible problems or conflicts in treatment opinions. Both external and internal potassium balances are disturbed during the development and treatment of DKA. Yes: if the patient can talk, their airway is patent and you can move on to the assessment of breathing. The students worked on the underlying physiology during a week long PBL session and are therefore familiar with the theoretical aspects of DKA. %PDF-1.5 Chapters: The learning environment should closely mimic real-world applications. 2017 May 29;9(5):e1286. The consequences (low blood pressure, high heart rate, central nervous system status, etc.) Discuss the patients current clinical condition with aseniorclinicianusing anSBARR style handover. 3. Kymera Systems Inc | SCADA Online Demo Ignition We try to provide sufficient realism.. This leads to hyperglycaemia, osmotic diuresis, and dehydration. You can plot as many parameters as you want and can choose to display either Historical data or have the graphs update as often as new data comes in and view them in Real-time. Instructors should write a case study for the simulation before the session. VbQuX#R M21 Each clinical case scenario allows you to work through history taking, investigations, diagnosis and management. 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. Trainee will learn to collaborate with peers to decide on appropriate interventions, tests, and therapy. The file explaining the session is sent to instructors 1 week before the sessions. This video demonstrates how to use the SOCRATES acronym when taking a history of pain or other symptoms. Diabetic Ketoacidosis (DKA) Clinical Pathway Emergency Department Subscribe to our newsletter to be the first to know about our latest content: https://geekymedics.com/newsletter/ As individuals with uncontrolled type I . Published August 2015. Available from: [, NICE guidelines. Highlight selected keywords in the article text. The students are in their first year. Trainee will appropriately request assistance and use available resources. 34 - Diabetic Ketoacidosis in Pregnancy | Obgyn Key Diabetes (type 1 and type 2) in children and young people: diagnosis and management. PBL was introduced at our institution in 1995. She began experiencing progressively worsening thirst, increased appetite, and excessively increased urination. If any obstruction is encountered, remove the tube and try the left nostril. DOI 10.7759/cureus.1286. 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). Diabetic Ketoacidosis (DKA) | Acute Management | ABCDE On the basis of the feedback from the students, they indicated that they believed the small group sessions are better. 4. Given such a small group, the students indicated that they feel more involved than they would with a larger group (eg, the whole class.) Blood sugar issues in the Type II diabetic will have a gradual onset, with diagnosis generally resulting from routine laboratory exams.(1). Forty percent of respondents reported excessive daytime sleepiness. The researchers found that long shift hours (24hrs), working overtime and marital/relationship stress were strongly correlated. 2009;13:505511. Review the patients drug chart for medications which may cause a reduced level of consciousness (e.g. Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario Finally, we summarize the course and give them time for questions. endobj Observe and discuss the effects of therapy in a mathematically modeled physiological simulator. Are any further assessments or interventions required? Many of the preclinical students have never seen a real life clinical monitor or even an intravenous (IV) setup. In other words, they do not have clinical experience, but they have clinical knowledge. 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. When erroneous treatment is delivered, the instructor can end the simulation. Measure the patients capillary blood glucose and ketone levels to confirm the diagnosis and guide the management of DKA. Adds true to life parking codes and extra parking for AI. Patients with DKA require fluid resuscitation to restore circulatory volume, clear ketones, correct electrolyte abnormalities and increase renal perfusion. Antibiotics should be prescribed in keeping with local guidelines. KDCA for FSX - Fly Away Simulation Interactive lecture/discussion with use of monitors that show the vital signs of the simulated patient on manikin. Insert the airway bevel-end first, vertically along the floor of the nose with a slight twisting action. Research Watch Box:Sleep, Fatigue & SafetyBy David Page, MS, NREMT-P During an immersive simulation, its imperative the group uses critical-thinking skills and group collaboration independently. >> Fernandez AR, Mac Crawford J, Pennell ML, et al. to maintaining your privacy and will not share your personal information without Deteriorationshould be recognised quickly and acted upon immediately. stream Her medical, social, and family histories are not clear at the time of admission to the emergency department. If the patient is confused you might be able to get a collateral history from staff or family members as appropriate. Trainee will get to know how professionals behave during management of a critically ill patient. Inspect for evidence of infection on the skin (e.g. 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. ABG, venepuncture). The simulation session is also hosted as an interactive session. Recognize the signs and symptoms of a patient presenting with diabetic ketoacidosis. Trainee will be able to apply skills of communication with the simulated patient in a semiacute crisis to get sufficient important information for a final diagnosis. - Associated symptoms 03:04 Introduceyourselfto thepatientincluding yournameandrole. insulin-dependent type 2 diabetes), Altered consciousness (e.g. A comprehensive collection of OSCE guides to common clinical procedures, including step-by-step images of key steps, video demonstrations and PDF mark schemes. 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. 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). confusion, coma), All critically unwell patients should have. Simulation Scenario. We do point out the blood pressure (BP) cuff, but these medical students in their first year do not really need to know how the BP values are generated, they need to understand the origin and therapy for the low blood pressure. Should any changes be made to the current management of their underlying condition(s)? A chest X-ray should not delay the emergency management of DKA. 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. 2010;49:578586. Trainee will practice or observe good teamwork skills, both as a leader and a team player. doi: 10.7759/cureus.1286. These simulation sessions seem to work because the medical students do have prior knowledge. Please enable scripts and reload this page. dq-]gX4 `L'u7myx) rpjf0z,.y`VMyx-&Ju`U0 A collection of data interpretation guides to help you learn how to interpret various laboratory and radiology investigations. Revisit history taking to explore relevant medical history and identify any precipitating factors for DKA. An oropharyngeal airway is a curved plastic tube with a flange on one end that sits between the tongue and hard palate to relieve soft palate obstruction. One of the key differences with the immersive simulation is that the instructor is absent from the simulation environment. 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. DY{Qb"(EgN$QI*%XN1F""0a5 - Site 01:12 We are looking for declaration of DKA and request for pathway. PDF Medicine Simulation Scenario Diabetic Ketoacidosis: An Emergency can be reemphasized, and the effects of fluid therapy demonstrated.
dka simulation scenario