Prehosp Emerg Care. Review the patientsoxygen saturation(SpO2): Auscultate the chest to screen for evidence of respiratory pathology (e.g. An animated lecture may be described as a pseudo-simulation environment. Emergency medical services workLife characteristics contribute to clinically significant excessive daytime sleepiness. The Simulation Laboratory session follows after a completed PBL session, and is aimed at making the case come alive, while providing a clinical perspective to preclinical students. This session provides additional clinical support material for the theoretical PBL session. Recognize the signs and symptoms of a patient presenting with diabetic ketoacidosis. Catheterisethe patient to closelymonitor urine outputto guide fluid resuscitation and need for escalation. Much time was wasted explaining why it did not matter. Alert a senior immediately if you have any concerns about the consciousness level of a patient. SimMan Nursing Scenarios Software. type 1 diabetes) Complete insulin insensitivity (e.g. Antibiotics should be prescribed in keeping with local guidelines. Trainee will correlate the underlying pathophysiology with symptoms and signs as exhibited by the simulation session. Stage 1: Initial assessment of acutely unwell pregnant woman and diagnosis of DKA. Clearlydocument your ABCDE assessment, including history, examination, observations, investigations, interventions, and the patients response. Management of diabetic ketoacidosis in adults. 2011;15:108109. Given such a small group, the students indicated that they feel more involved than they would with a larger group (eg, the whole class.) Join the Geeky Medics community: 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). Performing an ECG should not delay the emergency management of DKA. Please try again soon. The student group is given a short introduction into a closed simulation environment. 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. Insert the airway bevel-end first, vertically along the floor of the nose with a slight twisting action. Initially, we used a blood pressure cuff to generate the blood pressure values. Check out our NEW & IMPROVED quiz platform at geekyquiz.com, To be the first to know about our latest videos, subscribe to our YouTube channel . The scenario would include an if-then algorithm. Tilt the forehead back whilst lifting the chin forwards to extend the neck. In the final 10 minutes, we show how the patient has a good recovery after fluid replacement. 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). In this manner, the students have to apply their knowledge at the appropriate points during the progression of the scenario. This simulation session therefore aims to make the case come alive, and show this known case in a clinical context. Well done, youve now stabilised the patient and theyre doing much better. A pre-briefing session is conducted prior to the start of the simulation scenario. Each performance measure is separated into cognitive, behavioral or technical categories. See ourfluid prescribing guidefor more details onresuscitation fluids. A comprehensive collection of clinical examination OSCE guides that include step-by-step images of key steps, video demonstrations and PDF mark schemes. Refer to your local guidelines which should provide a clear protocol for the management of DKA. 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 following scenarios are available for download and are designed to meet your multi-disciplinary nursing needs. We used the Medical Education Technologies Inc. (METI) Human Patient Stimulator (HPS, METI Sarasoto, Fl). Use blankets to re-warm patients who are mild to moderately hypothermic. Airway adjuncts are often helpful and in some cases essential to maintain a patients airway. 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). - 2500+ OSCE Flashcards: https://geekymedics.com/osce-flashcards/ Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. Conclusion 1 0 obj DKA can develop within 24 hours and is potentially life threatening, requiring prompt recognition and therapeutic intervention. Trainee will recognize the need for therapy and suggest an appropriate therapy in a simulated environment. A collection of data interpretation guides to help you learn how to interpret various laboratory and radiology investigations. Review thepatients notes,chartsandrecent investigation results. 3 0 obj Subscribe to our newsletter to be the first to know about our latest content: https://geekymedics.com/newsletter/ Simulation provides a safe environment where learning is enhanced through the deliberate practice of skills and controlled management of a variety of clinical encounters. We have been presenting Simulation Laboratory sessions to our preclinical medical students (first and second years). Administer oxygen to all critically unwell patients during yourinitialassessment. A comprehensive collection of medical revision notes that cover a broad range of clinical topics. Scenarios. Keyword Highlighting 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. Patients with DKA require fluid resuscitation to restore circulatory volume, clear ketones, correct electrolyte abnormalities and increase renal perfusion. insulin-dependent type 2 diabetes), Altered consciousness (e.g. Acad Med. Each PBL case typically goes over 23 days, affording the students periods to find information for the case. In some cases, normal saline with additional potassium is required to prevent overcorrection of serum potassium levels which would otherwise result in hypokalaemia. 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. Medical Simulation Scenarios are text documents outlining the various details of a simulation - everything from patient simulator settings to debriefing notes. This video demonstrates how to use the SOCRATES acronym when taking a history of pain or other symptoms. Capillary refill timemay be prolonged if the patient is hypovolaemic. 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. PBL in our institution is implemented as a small group (n 68 students) self study session with a facilitator, who incrementally discloses further information about the patient. 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. 3. The files are given in full in the web supplement (Appendix B, Supplemental Digital Content 2, https://links.lww.com/SIH/A2). Geeky Medics accepts no liability for loss of any kind incurred as a result of reliance upon the information provided in this video. 6. 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. The instructor should have visual access via one-way windows or cameras. Check out our other awesome clinical skills resources including: By joining Cureus, you agree to our 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. For more information, please refer to our Privacy Policy. 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. She is lethargic and slightly confused but can intermittently respond to questions. 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. x]o ]?9kgq~:)?hE )R6!up}\<8||\]}Y~;xp~yQ$#4~djX&{n_m-]^K1/~/AD Hv 99evs,;8}8zwnhFxV.kf-V^? Heart: S1 and S2 within normal limits; no S3/S4 or murmurs, normal rate and rhythm. Virtual patient simulation (VPS) is an interactive computer simulation that recreates real-world scenarios with the objectives of training, education, and assessment for health care providers [].Virtual simulation has been used extensively to adapt nursing education to the COVID-19 pandemic context [], such as social distancing and/or confinement. PA EMT Said COVID Patient Didnt Need to Go to the Hospital. In this section, we have to guide them as to what they should do first for the patient in this critical condition (ie, treat the A, B, Cs of airway, breathing, and circulation) before we can confirm the diagnosis. If any obstruction is encountered, remove the tube and try the left nostril. <>>> Data is temporarily unavailable. Calculate the patients current fluid balance using their fluid balance chart (e.g. Manikin staging can provide strong cues. We now provide the students with handouts of the data to save time and provide consistency. After the first voluntary session in 2006, feedback from the medical students indicated that they would like to receive this handout. To read Pages full Research Review column, visit www.jems.com/patient-care. Both external and internal potassium balances are disturbed during the development and treatment of DKA. 3. 2 The evaluation of potassium deficits is complicated by potassium exit from . 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. She does not take this regularly. type 1 diabetes), Complete insulin insensitivity (e.g. - Examples 05:45 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. Development of simulation scenarios for an adolescent patient with diabetic ketoacidosis. 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. Target Learner Groups The Pratcice opioids, sedatives, anxiolytics, insulin, oral hypoglycaemic medications). See ourintravenous cannulation guidefor more details. 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. - 700+ OSCE Stations: https://geekymedics.com/osce-stations/ Some manikin models support a variety of human functions, such as capillary and facial cyanosis, facial sweating, foley catheter and IV placement, blood pressure generation, cardiac rhythms and abnormalities, defibrillation, cardioversion, external pacing and vital sign generation. >> Fernandez AR, Mac Crawford J, Pennell ML, et al. your express consent. With your index and other fingers placed behind the angle of the mandible, apply steady upwards and forward pressure to lift the mandible. She had developed nausea, extreme fatigue, mild disorientation, and blurred vision toward the end of the soccer match. Review the patients drug chart for medications which may cause a reduced level of consciousness (e.g. 2. 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. Does the patient need a referral toHDU/ICU? 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. 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 Using SOCRATES in History Taking | OSCE | Communication Skills, Diabetic Ketoacidosis (DKA) | Acute Management | ABCDE. Search for Similar Articles In this section, we have to help the trainee to institute definitive therapy based on the underlying biochemical abnormalities. Use washable, non-toxic paints to imitate various body emissions. DIABETIC KETOACIDOSIS MODULE: ENDOCRINOLOGY / METABOLIC TARGET: ALL PAEDIATRIC TRAINEES;NURSING STAFF BACKGROUND: DKA occurs when a relative or absolute lack of insulin leads to the inability to metabolise glucose. The students are in their first year. Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes mellitus, most common in patients with type 1 diabetes in particular due to a deficiency or absence of insulin [1].. 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. The use of case-based simulation, although more complicated and time consuming for the instructor, immerses the students in the subject matter. We also show them IV bags containing saline and Ringers lactate, as well as show them IV infusion sets. *=NdL/c2XSJn8:I Jb8'.8>N*[L .hxw6afq40DX3c~>abt'Q,8y(BZu(vKBTufIR. Case-based education adds a real-world aspect to the learning environment. Supplemental digital content is available for this article. However, this turned out to be too slow, took too much time, and could not continuously demonstrate the direction of changes. Inspect theairwayfor obviousobstruction. Initially, we required the students to write down the vital signs. At the end of the previous section, the trainee can make the diagnosis of DKA but has not confirmed it yet. Diabetic ketoacidosis (DKA) is a common, potentially lethal disease. See ourCXR interpretation guidefor more details. Trainee will be respectful to others and their views during the PBL session. Refer to your local guidelines for further details. Discuss the patients current clinical condition with aseniorclinicianusing anSBARR style handover. <>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 595.32 841.92] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> The students mentioned that they did not obtain the maximum value from the simulation session under these circumstances. #geekymedics #fyp #fypviral #studytok #medicalstudentuk #medtok #studytips #studytipsforstudents #medstudentuk #premed #medschoolfinals #shorts, Cardiovascular Exam Tips - DON'T FORGET these 3 things , Watch this video to find out the most COMMONLY FORGOTTEN components of the cardiovascular history! Save this video to help prepare for your upcoming OSCEs and dont forget to follow Geeky Medics! Makeup may be used to depict gender, hollow eyes and cheeks, produce pallor or display bruises and scars. Simulation Scenario for Anesthesia Providers Clark Obr, MD*, Anthony Mueller, MD . The debriefing environment should be removed from the location where the simulation took place. We combined both to indicate the continuity of the curriculum, and the building on prior knowledge. You may be trying to access this site from a secured browser on the server. - PSA Question Pack: https://geekymedics.com/psa-question-bank/ 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. 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. Environment & Manikin 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 Theory This may produce better retention of the subject matter and help students adapt to emergency scenes before going into the field. Adds true to life parking codes and extra parking for AI. The researchers found that long shift hours (24hrs), working overtime and marital/relationship stress were strongly correlated. Depending on scenario complexity, team dynamic and treatment modalities, this simulation may take 1020 minutes. A blood glucose level may already be available from earlier investigations (e.g. Instructors should write a case study for the simulation before the session. We guide the group to suggest fluid. The students have acquired all the applicable theoretical knowledge of the case during the previous multiday PBL sessions. to below 12 mmol/L) an infusion containing normal saline and 5% dextrose is typically commenced to prevent the development of hypoglycaemia, whilst allowing insulin therapy to continue to suppress ketogenesis and reduce serum electrolyte concentrations. JEMS. The trainees have had background knowledge of biochemistry because they had completed the PBL case. VbQuX#R M21 Facebook: http://www.facebook.com/geekymedics Diabetic ketoacidosis; Simulation training; Medical students. 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. 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. Immersive Simulations Indeed, it is the only thing that ever has.". Debriefing Therefore, we have to emphasize the importance of airway, breathing, and circulation in the very sick patient in any clinical setting. It involves working through the following steps: Each stage of the ABCDE approach involvesclinicalassessment,investigationsandinterventions. <> 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. These simulation sessions seem to work because the medical students do have prior knowledge. If the provider starts an IV and gives dextrose, then the patients alertness will increase, respirations will normalize and repeated blood glucose will read 210 mg/dL over a two-minute interval. 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 . modify the keyword list to augment your search. On the basis of the feedback from the students, they indicated that they believed the small group sessions are better. This is particularly important for core . Make sure to re-assess the patient after any intervention. "Never doubt that a small group of thoughtful, committed citizens can change the world. Instagram: https://instagram.com/geekymedics 2. 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. A strong emphasis is placed on the focused, methodical examination of a specific medical problem and the decision-based treatment options available. Groups of more than seven may struggle with meeting objectives due to insufficient functional rolls. In the simulated environment, trainees will ask questions on how to interpret the data that they observe on the monitors and interpretation of clinical signs and symptoms on the manikin. 3. The instructors role is to facilitate active learning through a combination of learning styles. doi: 10.7759/cureus.1286. Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. The main purpose of the simulation is to draw a line from the theoretical, boring biochemistry to the clinical manifestations. In keeping with the case study, as a treatment marker is reached, the instructor should place emphasis on physiological, pharmacological, environmental and psychosocial issues. Revisit history taking to explore relevant medical history and identify any precipitating factors for DKA. 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. 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. DO NOT perform any examination or procedure on patients based purely on the content of these videos. 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)? and Intubation lubricants can mimic drooling. 2. We give the history of the patient to the trainees. Stage 2: Emergency management of DKA and consideration of abnormal CTG. Consider active re-warming techniques in patients with severe hypothermia. A collection of free medical student quizzes to put your medical and surgical knowledge to the test! Cureus 9(5): e1286. This is particularly important for core cases and low-frequency, high-stakes procedures and encounters. In this case scenario, dehydration is one of the most serious immediate issues. If the patient is confused you might be able to get a collateral history from staff or family members as appropriate. J Nurs Educ. Margolis GS, Romer GA, Fernandez AR, et al. Advance the airway until it lies within the pharynx. Perform urinalysis and send the urine for culture if urinary tract infection is suspected. Trainee will appropriately request assistance and use available resources. cellulitis). Twitter: http://www.twitter.com/geekymedics Forty percent of respondents reported excessive daytime sleepiness. Privacy Policy A simulation training session is described designed to acquaint emergency medicine residents with the presentation and management of diabetic ketoacidosis through the use of simulation. Given 6 to 8 back-to-back sessions, it is critical that every session starts and ends on time! 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. Similar to a ward round, where the instructor would say: Come and listen to this patient with an aortic stenosis. #geekymedics #fyp #fypviral #studytok #medicalstudentuk #medtok #studytips #studytipsforstudents #medstudentuk #premed #medschoolfinals, Cardiovascular History Tips - DON'T FORGET these 3 things . - Exacerbating & relieving factors 05:12