This typically involves the use of anon-rebreathe maskwith an oxygen flow rate of15L. A collection of communication skills guides, for common OSCE scenarios, including history taking and information giving. 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). 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. Despite this increased calorie intake, she noticed an unexplained 20 lbs weight loss. If an infection is suspected, IV antibioticsshould be administered as soon as possible. 2017 May 29;9(5):e1286. Prehosp Emerg Care. Medical Simulation Scenarios are text documents outlining the various details of a simulation - everything from patient simulator settings to debriefing notes. Administer oxygen to all critically unwell patients during yourinitialassessment. An hour was . The reason for inserting the airway upside down initially is to reduce the risk of pushing the tongue backwards and worsening airway obstruction. Open the patients mouth to ensure there is no foreign material that may be pushed into the larynx. 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. Make sure to re-assess the patient after any intervention. This is particularly important for core . The facilitator guides the group only when necessary. We then start the DKA state. See Appendix D, Supplemental Digital Content 4, https://links.lww.com/SIH/A4. Open the patients airwayusing ahead-tiltchin-lift manoeuvre: 1. <> Each performance measure is separated into cognitive, behavioral or technical categories. If the patient loses consciousness and there are no signs of life on assessment, put out a crash call and commence CPR. At the end of the previous section, the trainee can make the diagnosis of DKA but has not confirmed it yet. <>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 595.32 841.92] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> If the patient is conscious, sit themuprightas this can also help with oxygenation. Cureus is on a mission to change the long-standing paradigm of medical publishing, where submitting research can be costly, complex and time-consuming. 2. Case-based education adds a real-world aspect to the learning environment. 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 field is for validation purposes and should be left unchanged. 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. Immersive simulations are mentally exhausting because they create an intense and stressful atmosphere requiring the learner to work outside their comfort zone. Askhow the patient is feeling as this may provide some useful information about their current symptoms. 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. This is a 25-year-old woman with a medical history of diabetes medicated with 40 units insulin per day. In an animated lecture, its important that the student group have an instructor so they can ask direct questions. Alert a senior immediately if you have any concerns about the consciousness level of a patient. We try to provide sufficient realism.. 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. Please note that by doing so you agree to be added to our monthly email newsletter distribution list. 1 Potassium losses occurring both before and during treatment of DKA must be replaced. 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). Facilitator to ask how often to measure BMs The instructor can also gauge the direction the debriefing session should follow or be alerted to possible problems or conflicts in treatment opinions. A comprehensive collection of medical revision notes that cover a broad range of clinical topics. We are looking for declaration of DKA and request for pathway. DO NOT perform any examination or procedure on patients based purely on the content of these videos. Your message has been successfully sent to your colleague. Laschinger S, Medves J, Pulling C, et al. Instead, instructors should combine case- and simulation-based techniques when teaching diabetic assessment. Refer to your local guidelines which should provide a clear protocol for the management of DKA. Stage 2: Emergency management of DKA and consideration of abnormal CTG. The main purpose of the simulation is to draw a line from the theoretical, boring biochemistry to the clinical manifestations. Join the Geeky Medics community: In the meantime, you should re-assess and maintain the patients airway. <> Download: http://teamworkmatters.ocbmedia.com/media/DKA-Simulation-Scenario.docx Categories: 5th Year MBChB paeds scenario, Emergency Department, Human Factors, Interprofessional / multidisciplinary, Non-technical skills, Paediatrics, Postgraduate / newly qualified, Undergraduate / pre-registration Rating Search for Similar Articles Keywords: diabetic ketoacidosis, simulation, expertise, emergency medicine Introduction Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes mellitus, most . An oxygen mask is also demonstrated as an alternative device, as these early trainees had mostly not yet seen any of these devices. 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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. Place one hand on the patients forehead and the other under the chin. endobj 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. 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). If an obstruction is visible within the airway, use afingersweeporsuctionto remove it. PA EMT Said COVID Patient Didnt Need to Go to the Hospital. Before trainees arrival into the simulation area, the simulator is already preprogrammed for DKA. 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. Please write a single word answer in lowercase (this is an anti-spam measure). She tends to drink sugar containing fluids (soda) when she is thirsty, and she eats fast foods (cream-filled muffins) when she is hungry. DOI 10.7759/cureus.1286. The objective is to give as many visual and tactile cues concerning the patient condition and background as possible. modify the keyword list to augment your search. 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). endobj Are any further assessments or interventions required? }HyEf,#$/JSRU9+CF6k\'/z+i`[ 5JudK*Zly^g%[jCK)H[)Y=Qp0/r9o9HW_zF}pTzI~'|q.~:=Y T 9w! The learning objectives follow the American College of Graduate Medical Education (ACGME) Core Compentencies. Stage 3: Ongoing management and monitoring of DKA 1 hour after initiation of treatment. - 150+ PDF OSCE Checklists: https://geekymedics.com/pdf-osce-checklists/ 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 . Assess the patients level of consciousness using the AVPU scale: If a more detailed assessment of the patients level of consciousness is required, use the Glasgow Coma Scale (GCS). 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. 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. She is lethargic and slightly confused but can intermittently respond to questions. A collection of surgery revision notes covering key surgical topics. 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. Just place the BR2_KDCA file into your addons scenery folder: C:\\Program Files\\Microsoft Games\\Microsoft Flight Simulator X\\Addon Scenery\\Scenery. See ourintravenous cannulation guidefor more details. Similar to a ward round, where the instructor would say: Come and listen to this patient with an aortic stenosis. A comprehensive collection of clinical examination OSCE guides that include step-by-step images of key steps, video demonstrations and PDF mark schemes. unilateral coarse crackles may be present if the patient has pneumonia which may have been the precipitant for DKA). They should introduce the student group to the environment, assign roles for each learner and guide the decision-making process. Typically potassium levels should be maintained between 4.0 5.5 mmol/L and close monitoring is required. The simulation experience serves to give substance to the theoretical words and concepts that the students encountered during the PBL sessions. The faculty member/course coordinator of Simulation Design Clearlydocument your ABCDE assessment, including history, examination, observations, investigations, interventions, and the patients response. Well done, youve now stabilised the patient and theyre doing much better. >> Patterson PD, Weaver M, Frank R, et al. 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. I assigned true to life parking codes, and added some extra parking for the superfluous US Express AI. 2003;78:783788. TheABCDEapproach can be used to perform a systematic assessment of a critically unwell patient. your express consent. 2. After initial insulin therapy has reduced plasma blood glucose levels (e.g. Diabetic ketoacidosis (DKA) is a common, potentially lethal disease. Research Watch Box:Sleep, Fatigue & SafetyBy David Page, MS, NREMT-P Urinary tract infections are a common DKA precipitant. tall tented T waves in hyperkalaemia). Below is a collection of donated scenarios for you to use or modify. 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 students have acquired all the applicable theoretical knowledge of the case during the previous multiday PBL sessions. Please try after some time. 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. dq-]gX4 `L'u7myx) rpjf0z,.y`VMyx-&Ju`U0 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. Use washable, non-toxic paints to imitate various body emissions. 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. - Character 02:14 2) Complete the assigned suggested readings 3) Complete the presimulation preparation virtual simulation game (Instructor will provide link) 4) Once you have completed reading this document and prepared for your simulation, please: a. Abstract 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. 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.