- Onset 01:48 Properly interpret a venous blood gas (VBG) and basic metabolic panel in a patient presenting with diabetic ketoacidosis. Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare, Get new journal Tables of Contents sent right to your email inbox, SIH_13_4_2018_08_03_KOBAYASHI_17-00153_SDC5.tif; [Other] (3.04 MB), SIH_4_4_2009_10_29_NANDATE_200199_SDC2.doc; [Word] (68 KB), SIH_4_4_2009_10_29_NANDATE_200199_SDC3.doc; [Word] (29 KB), SIH_4_4_2009_10_29_NANDATE_200199_SDC4.doc; [Word] (40 KB), Simulation of Diabetic Ketoacidosis for Cellular and Molecular Basics of Medical Practice, Articles in PubMed by Koichiro Nandate, MD, PhD, Articles in Google Scholar by Koichiro Nandate, MD, PhD, Other articles in this journal by Koichiro Nandate, MD, PhD, Privacy Policy (Updated December 15, 2022). If you have any scenarios you would be willing to share with the simulation community, please forward them to me. Just place the BR2_KDCA file into your addons scenery folder: C:\\Program Files\\Microsoft Games\\Microsoft Flight Simulator X\\Addon Scenery\\Scenery. 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. 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 patient synopsis should include such standard aspects as age, sex, ethnicity, medical history, medications and allergies. KDCA, Ronald Reagan Washington National Airport, DC. (1) The assessment of a diabetic patient is best taught as a. Trigger 4, Pathway 1l of saline required over 1hour and insulin infusion need prescribing and making up in 50ml syringe. Evenly balancing performance measures will ensure the student has the opportunity to critically think through patient treatment and to practice new or support previously learned behaviors and technical skills. stream A traditional classroom lecture format allows for student participation but limits the instructors ability to create realistic situations. 2008;6:278302. The instructor can also gauge the direction the debriefing session should follow or be alerted to possible problems or conflicts in treatment opinions. Keyword Highlighting - Timing 03:23 Glycosuria leads to urinary losses of potassium through osmotic diuresis. Scenario in a Nutshell Diabetic ketoacidosis (DKA) in pregnancy. Trainee will increase knowledge of professional behaviors during the simulation. 4. Initially, we had a white board available, but the temptation (and habits) were just too strong, and the simulator sessions tended to become one way lectures, rather than an interactive, 2 way discussion.. Heart: S1 and S2 within normal limits; no S3/S4 or murmurs, normal rate and rhythm. It was developed for anesthesiology resident physicians with some background knowledge and experience caring for critically ill patients. Subscribe to our newsletter to be the first to know about our latest content: https://geekymedics.com/newsletter/ - Associated symptoms 03:04 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). to maintaining your privacy and will not share your personal information without During an immersive simulation, its imperative the group uses critical-thinking skills and group collaboration independently. Available if the trainee asks: arterial blood gas, glucose, electrolytes, BUN and plasma osmolality (please see last section of Appendix B, Supplemental Digital Content 2, https://links.lww.com/SIH/A2, for values). Its important to train and educate students of prehospital care on key indicators of a diabetic emergency. Finally, we summarize the course and give them time for questions. Another example: At one minute into the scenario, the patient becomes unresponsive and their breathing becomes shallow. dq-]gX4 `L'u7myx) rpjf0z,.y`VMyx-&Ju`U0 There are several causes of DKA, which we remember by the "five I's". You may be trying to access this site from a secured browser on the server. We now provide the students with handouts of the data to save time and provide consistency. can be reemphasized, and the effects of fluid therapy demonstrated. DY{Qb"(EgN$QI*%XN1F""0a5 Forty percent of respondents reported excessive daytime sleepiness. Simulation provides a safe environment where learning is enhanced through the deliberate practice of skills and controlled management of a variety of clinical encounters. If the patient is suspected to have sufferedsignificanttraumawith potential spinal involvement, perform ajaw-thrustrather than a head-tilt chin-lift manoeuvre: 2. 5. "Never doubt that a small group of thoughtful, committed citizens can change the world. Highlight selected keywords in the article text. Consider any precipitating factors for the development of DKA and involve the diabetes team in the patients care. Please note that by doing so you agree to be added to our monthly email newsletter distribution list. Using SOCRATES in History Taking | OSCE | Communication Skills, Diabetic Ketoacidosis (DKA) | Acute Management | ABCDE. 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. Revisit history taking to explore relevant medical history and identify any precipitating factors for DKA. Debriefing The relationship between sleep, fatigue and patient and provider safety. 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)? For similar reasons, we do not believe a videotaped session will keep the students attention as much as these live simulator sessions. The DKA simulation incorporates cue recognition, analysis of cues, generation of solutions, nursing interventions, and evaluation of outcomes, including effective communication and psychosocial concerns. Diabetic ketoacidosis (DKA) is a common, potentially lethal disease. endobj Stage 1: Initial assessment of acutely unwell pregnant woman and diagnosis of DKA. Open the patients mouth to ensure there is no foreign material that may be pushed into the larynx. Causes: Any situation arising in a diabetic that requires increased insulin without that demand being met can result in DKA. Measure the patients capillary blood glucose and ketone levels to confirm the diagnosis and guide the management of DKA. %PDF-1.5 However, this leads to confusion. Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. 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. DKA can develop within 24 hours and is potentially life threatening, requiring prompt recognition and therapeutic intervention. Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. Medical Simulation Scenarios are text documents outlining the various details of a simulation - everything from patient simulator settings to debriefing notes. Capillary refill timemay be prolonged if the patient is hypovolaemic. If the patient has COPD and a history of CO2retention you should switch to aventuri maskas soon as possible andtitrate oxygen appropriately. 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. Instead, instructors should combine case- and simulation-based techniques when teaching diabetic assessment. angioedema, rash) commence appropriate treatment as discussed in ouranaphylaxis guide. We used the Medical Education Technologies Inc. (METI) Human Patient Stimulator (HPS, METI Sarasoto, Fl). 3 0 obj The instructor should have visual access via one-way windows or cameras. Cureus 9(5): e1286. In other words, they do not have clinical experience, but they have clinical knowledge. Each PBL case typically goes over 23 days, affording the students periods to find information for the case. You may search for similar articles that contain these same keywords or you may Review the patientsoxygen saturation(SpO2): Auscultate the chest to screen for evidence of respiratory pathology (e.g. - Over 3000 Free MCQs: https://geekyquiz.com/ 1) Please read through this document as it will help you prepare for your upcoming simulation on DKA. The reason for inserting the airway upside down initially is to reduce the risk of pushing the tongue backwards and worsening airway obstruction. We try to provide sufficient realism.. DKA can be caused by either: Absolute insulin deficiency (e.g. If an infection is suspected, IV antibioticsshould be administered as soon as possible. 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. Groups of fewer than four students dont allow for optimal collaboration. Prehosp Emerg Care. This allows the learner group to make a psychological break from the patient and environment while beginning the reflection process. The validity of the HFS-DKA scenario was verified by a certified diabetes nurse educator, a registered nurse, and a clinical nurse educator. Please enable scripts and reload this page. MassBay EMS Program Integrates Training for Dogs, Heat Waves Are Killing More LA Homeless People. - Severity 05:32 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). Diabetes UK with the Joint British Diabetes Societies Inpatient Care Group. This is a combination of the modified traditional lecture within scenario-based learning. Management of diabetic ketoacidosis in adults. 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. The 60 minutes training time consists of four 15-minute sections divided as follows. Data is temporarily unavailable. Medical simulation technology is a powerful tool for training physicians but papers dealing with DKA simulators are scarce. However, this turned out to be too slow, took too much time, and could not continuously demonstrate the direction of changes. - Character 02:14 Antibiotics should be prescribed in keeping with local guidelines. 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). Clinical Simulation in Nursing, Volume 39, 2020, pp. Nandate, Koichiro MD, PhD; Abola, Ramon MD; Murray, W Bosseau MB; Whitfield, Carol PhD; Lang, Charles PhD; Sinz, Elizabeth MD. Immersive simulations are mentally exhausting because they create an intense and stressful atmosphere requiring the learner to work outside their comfort zone. Please write a single word answer in lowercase (this is an anti-spam measure). x]o ]?9kgq~:)?hE )R6!up}\<8||\]}Y~;xp~yQ$#4~djX&{n_m-]^K1/~/AD Hv 99evs,;8}8zwnhFxV.kf-V^? In this section, we have to help the trainee to institute definitive therapy based on the underlying biochemical abnormalities. This session provides additional clinical support material for the theoretical PBL session. An oxygen mask is also demonstrated as an alternative device, as these early trainees had mostly not yet seen any of these devices. Chapters: A fixed-rate intravenous insulin infusion should be commenced initially to suppress ketogenesis, reduce blood glucose levels and address electrolyte disturbances. 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. Before trainees arrival into the simulation area, the simulator is already preprogrammed for DKA. Section snippets . Given such a small group, the students indicated that they feel more involved than they would with a larger group (eg, the whole class.) 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. Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario Cureus. Therefore, we have to emphasize the importance of airway, breathing, and circulation in the very sick patient in any clinical setting. In the context of DKA, a patients consciousness level may be reduced. Use an effectiveSBARR handoverto communicate the key information effectively to other medical staff. See ourfluid prescribing guidefor more details onresuscitation fluids. JEMS. 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 Instructors should write a case study for the simulation before the session. VbQuX#R M21 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). 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: [, NICE guidelines. Animated Lecture oral fluids, intravenous fluids, urine output, drain output, stool output, vomiting) to inform resuscitation efforts. With your index and other fingers placed behind the angle of the mandible, apply steady upwards and forward pressure to lift the mandible. It may be necessary toexposethe patient during your assessment: remember to prioritise patient dignity and conservation of body heat.
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