dka simulation scenario

The use of a simulated, evolving case scenario was an effective method of exposing nursing students to complex patient care. 3. Stage 1: Initial assessment of acutely unwell pregnant woman and diagnosis of DKA. In the context of DKA, a patients consciousness level may be reduced. Scenarios. The instructions to the facilitators suggest a series of structured, sequential questions to the students (starting at one end, involving each student in turn, and repeatedly cycling around the group.) In some cases, normal saline with additional potassium is required to prevent overcorrection of serum potassium levels which would otherwise result in hypokalaemia. x]o ]?9kgq~:)?hE )R6!up}\<8||\]}Y~;xp~yQ$#4~djX&{n_m-]^K1/~/AD Hv 99evs,;8}8zwnhFxV.kf-V^? Consider any precipitating factors for the development of DKA and involve the diabetes team in the patients care. She was taken to the Emergency Department from her soccer game because she complained of nausea, extreme fatigue, mild disorientation, and blurred vision toward the end of the soccer match. 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). Simulation provides a safe environment where learning is enhanced through the deliberate practice of skills and controlled management of a variety of clinical encounters. 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. Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario The objective is to give as many visual and tactile cues concerning the patient condition and background as possible. We have spent many hours debating whether the small group format was a waste of time. 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. Stage 2: Emergency management of DKA and consideration of abnormal CTG. If the patient has clinical signs ofanaphylaxis(e.g. Each performance measure is separated into cognitive, behavioral or technical categories. Before trainees arrival into the simulation area, the simulator is already preprogrammed for DKA. 2. See ourintravenous cannulation guidefor more details. See ourhistory taking guidesfor more details. Over the years, some groups happened to have the simulation session before the completion of the theoretical PBL session. Healthcare Students' Psychological Well-Being in a Diabetic Ketoacidosis Simulation. Finally, we summarize the course and give them time for questions. The student group is given a short introduction into a closed simulation environment. - Examples 05:45 Keyword Highlighting The use of case-based simulation, although more complicated and time consuming for the instructor, immerses the students in the subject matter. Diabetic ketoacidosis; Simulation training; Medical students. stream PA EMT Said COVID Patient Didnt Need to Go to the NYC Unions Demand Reinstatement, Back Pay for Workers Fired for Refusing President Biden to End COVID-19 Emergencies on May 11. A debriefing section with pre-established questions allows the instructor to review the main focus and performance measures with the student group. Antibiotics should be prescribed in keeping with local guidelines. 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. The scenario would include an if-then algorithm. The instructor can also gauge the direction the debriefing session should follow or be alerted to possible problems or conflicts in treatment opinions. In keeping with the case study, as a treatment marker is reached, the instructor should place emphasis on physiological, pharmacological, environmental and psychosocial issues. Typically potassium levels should be maintained between 4.0 5.5 mmol/L and close monitoring is required. Geeky Medics accepts no liability for loss of any kind incurred as a result of reliance upon the information provided in this video. Extremities: mild cyanosis, no clubbing or edema (verbalized by instructors); pulses equal, and symmetrical (elucidated by trainees). If the patient loses consciousness and there are no signs of life on assessment, put out a crash call and commence CPR. Using SOCRATES in History Taking | OSCE | Communication Skills, Diabetic Ketoacidosis (DKA) | Acute Management | ABCDE. 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. Supplemental digital content is available for this article. can be reemphasized, and the effects of fluid therapy demonstrated. At the end of the previous section, the trainee can make the diagnosis of DKA but has not confirmed it yet. If fever is present, make sure to consider co-existing infection. If an obstruction is visible within the airway, use afingersweeporsuctionto remove it. The 60 minutes training time consists of four 15-minute sections divided as follows. The file explaining the session is sent to instructors 1 week before the sessions. Case-based education adds a real-world aspect to the learning environment. If any obstruction is encountered, remove the tube and try the left nostril. 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. Many of the preclinical students have never seen a real life clinical monitor or even an intravenous (IV) setup. Laschinger S, Medves J, Pulling C, et al. and DO NOT perform any examination or procedure on patients based purely on the content of these videos. 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. An events progression section should include patient status changes, as well as a time/treatment continuum that incorporates if-then event progressions. Using your thumbs, slightly open the mouth by downward displacement of the chin. This is an important period, as this is where the students see the theoretical concept (metabolic acidosis), come to life as for instance large tidal volumes. Indeed, it is the only thing that ever has.". Review the patientsoxygen saturation(SpO2): Auscultate the chest to screen for evidence of respiratory pathology (e.g. Insert at least onewide-bore intravenous cannula(14G or 16G) and take blood tests as discussed below. Mosby:Philadelphia. PDF Diabetic Ketoacidosis in the Obstetric Population: A Simulation >> Patterson PD, Weaver M, Frank R, et al. Diabetic Ketoacidosis in the Obstetric Population: A Simulation Trainee will appropriately request assistance and use available resources. 1 0 obj Recognize the signs and symptoms of a patient presenting with diabetic ketoacidosis. Introduceyourselfto whoever has requested a review of the patient andlistencarefullyto their handover. Categories: Emergency Medicine, Medical Education Keywords: diabetic ketoacidosis, simulation, expertise, emergency medicine . Lets discuss your options. Our simulated patient is a 25-year-old woman, Tiffany, who has been taken to the Emergency Department from her soccer game by her boyfriend, Adam. When erroneous treatment is delivered, the instructor can end the simulation. The addition of a fluid infusion containing some potassium allows insulin therapy to continue to suppress ketogenesis and normalise plasma pH whilst preventing the development of hypokalaemia. Section snippets . Instructors should write a case study for the simulation before the session. 4. 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. Prehosp Emerg Care. Trainee will increase knowledge of professional behaviors during the simulation. If you have any scenarios you would be willing to share with the simulation community, please forward them to me. 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)? Search for Similar Articles cloudy urine may indicate urinary tract infection). If the patient has COPD and a history of CO2retention you should switch to aventuri maskas soon as possible andtitrate oxygen appropriately. As the name says, this screen is used to graph and plot any parameter. 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). In this manner, the students have to apply their knowledge at the appropriate points during the progression of the scenario. 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. The faculty member/course coordinator of Simulation Design Immersive Simulations 2. Askhow the patient is feeling as this may provide some useful information about their current symptoms. A strong emphasis is placed on the focused, methodical examination of a specific medical problem and the decision-based treatment options available. Highlight selected keywords in the article text. 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. Please try again soon. If an infection is suspected, IV antibioticsshould be administered as soon as possible. We used the Medical Education Technologies Inc. (METI) Human Patient Stimulator (HPS, METI Sarasoto, Fl). 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. This session provides additional clinical support material for the theoretical PBL session. Trigger 4, Pathway 1l of saline required over 1hour and insulin infusion need prescribing and making up in 50ml syringe. (1) The assessment of a diabetic patient is best taught as a. Assessment & Treatment of Five Diabetic Emergencies - JEMS Trainee will learn to collaborate with peers to decide on appropriate interventions, tests, and therapy. oral fluids, intravenous fluids, urine output, drain output, stool output, vomiting) to inform resuscitation efforts. Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario 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). Well done, youve now stabilised the patient and theyre doing much better. 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. These simulation sessions seem to work because the medical students do have prior knowledge. 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. Airway adjuncts are often helpful and in some cases essential to maintain a patients airway. Ask for anotherclinicalmemberofstafftoassistyou if possible. Creating a Simulation Experience to Promote Clinical Judgment 3. It involves a facilitating instructor, a small learner group and conceptual aspects of environmental and manikin staging to provide sensory cues. endobj She is lethargic and slightly confused but can intermittently respond to questions. Clearlydocument your ABCDE assessment, including history, examination, observations, investigations, interventions, and the patients response. Schneider Sarver PA, Senczakowicz EA, Slovensky BM. Trainee will practice or observe good teamwork skills, both as a leader and a team player. Therefore, we have to emphasize the importance of airway, breathing, and circulation in the very sick patient in any clinical setting. JEMS. Wolters Kluwer Health 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. Administer oxygen to all critically unwell patients during yourinitialassessment. This is a combination of the modified traditional lecture within scenario-based learning. Nandate, Koichiro MD, PhD; Abola, Ramon MD; Murray, W Bosseau MB; Whitfield, Carol PhD; Lang, Charles PhD; Sinz, Elizabeth MD. It may be necessary toexposethe patient during your assessment: remember to prioritise patient dignity and conservation of body heat. J Nurs Educ. The authors of the second study reported that poor sleep quality (60% of respondents) and extreme fatigue (55% of respondents) are independently associated with safety risks on the job. #geekymedics #fyp #fypviral #studytok #medicalstudentuk #medtok #studytips #studytipsforstudents #medstudentuk #premed #medschoolfinals, Cardiovascular History Tips - DON'T FORGET these 3 things . His Wife Gave Him CPR. Scenarios thesimtech 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. 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. 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. SimMan Nursing Scenarios Software. CCA 175 Real Time Exam Scenario 17 | JOIN Multiple DataFrames | Save as - Radiation 02:45 From the Department of Anesthesiology, Pennsylvania State University College of Medicine, Hershey, PA. Dr. Murray is on the Speakers Bureau of METI, Sarasota, FL. Classroom Dynamics During an immersive simulation, its imperative the group uses critical-thinking skills and group collaboration independently. Please note that by doing so you agree to be added to our monthly email newsletter distribution list. Refer to your local guidelines for further details. Each PBL case typically goes over 23 days, affording the students periods to find information for the case. Depending on scenario complexity, team dynamic and treatment modalities, this simulation may take 1020 minutes. Moses Lake (WA) Fire Department Gets $3.3M Grant for more Firefighters, Woman Who Crashed into Responders, Killing PA Firefighter, Gets Prison, Three Apparent Gas Explosions at San Bernardino (CA) Mountain Homes, Enid (OK) Fire Department Begins SWAT Medic Program to Assist Police, FDNY EMS Providers Win COVID-19-Linked Free Speech Lawsuit, Coronavirus Origins Still a Mystery Three Years into Pandemic. Please write a single word answer in lowercase (this is an anti-spam measure). Cureus is on a mission to change the long-standing paradigm of medical publishing, where submitting research can be costly, complex and time-consuming. Inspect theairwayfor obviousobstruction. As this is a PBL session, the trainees are not given any references. In the meantime, you should re-assess and maintain the patients airway. Target Learner Groups This is a 25-year-old woman with a medical history of diabetes medicated with 40 units insulin per day. You may need further help or advice from a senior staff member and you shouldnot delay seeking help if you have concerns about your patient. A traditional classroom lecture format allows for student participation but limits the instructors ability to create realistic situations. <> Hypothermia may be present if the patient has been unconscious and exposed for some time. Standardized patient as the voice of the simulator (or the simulation operator may play this role). }HyEf,#$/JSRU9+CF6k\'/z+i`[ 5JudK*Zly^g%[jCK)H[)Y=Qp0/r9o9HW_zF}pTzI~'|q.~:=Y T 9w! Reduced urine output (oliguria) is typically defined as less than 0.5ml/kg/hour in an adult. type 1 diabetes), Complete insulin insensitivity (e.g. Instead, instructors should combine case- and simulation-based techniques when teaching diabetic assessment. 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. Each clinical case scenario allows you to work through history taking, investigations, diagnosis and management. We are looking for declaration of DKA and request for pathway. Use an effectiveSBARR handoverto communicate the key information effectively to other medical staff. She had developed nausea, extreme fatigue, mild disorientation, and blurred vision toward the end of the soccer match. Simulation of Diabetic Ketoacidosis for Cellular and Molecul Marx JA, Hockberger RS, Walls RM. See ourdocumentation guidesfor more details. The students are in their basic science course. 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. Groups of more than seven may struggle with meeting objectives due to insufficient functional rolls. Weight, Height: Not given, normal appearing (as per simulator) but has lost 20 lbs recently. 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. We ask the trainee why the blood pressure is so low or heart rate is so high, and how we should treat it. 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. Its best, however, to allow the student group to continue so theyre able to evaluate their decision-making processes during debriefing. . Manikin staging can provide strong cues. Urinary tract infections are a common DKA precipitant. 3. 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. 34 - Diabetic Ketoacidosis in Pregnancy | Obgyn Key Privacy Policy A collection of surgery revision notes covering key surgical topics. The lecture allows for understanding of concepts prior to action, and instructor feedback is immediate. 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). You may search for similar articles that contain these same keywords or you may Simulation in Healthcare4(4):232-236, Winter 2009. 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].. 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 . Data Description All the product records are stored at /user/spark/dataset/retail_db/products All the category records are stored at /user/spark/dataset /ret. Join the Geeky Medics community: In an animated lecture, its important that the student group have an instructor so they can ask direct questions. She began experiencing progressively worsening thirst, increased appetite, and excessively increased urination. Published August 2015. They have had no clinical exposure or any clinical experience. tall tented T waves in hyperkalaemia). Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario. - PDF The researchers found that long shift hours (24hrs), working overtime and marital/relationship stress were strongly correlated. Conclusion diagnosis of DKA Trigger 3, ABG show acidosis and high BM and normal potassium. This simulation session therefore aims to make the case come alive, and show this known case in a clinical context. General: Moaning, asking what has happening to her. 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. 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). In the final 10 minutes, we show how the patient has a good recovery after fluid replacement. endobj PDF DKA Sim Scenario - ABCD (Diabetes Care) Ltd Stage 3: Ongoing management and monitoring of DKA 1 hour after initiation of treatment. We believe it is important to have active, participatory learning by having conversations with the trainees in the form of questions and answers. The student group should be encouraged to collaborate on management options and to perform skills. There are several causes of DKA, which we remember by the "five I's". 2 0 obj There are just a few more things to do. Use washable, non-toxic paints to imitate various body emissions. See Table 4 for a suggested standardized script. Perform urinalysis and send the urine for culture if urinary tract infection is suspected. An oxygen mask is also demonstrated as an alternative device, as these early trainees had mostly not yet seen any of these devices. Your message has been successfully sent to your colleague. Trainee will get to know how professionals behave during management of a critically ill patient. Effectiveness of simulation on health profession students knowledge, skills, confidence and satisfaction. We introduce the Simulation Laboratory and the Simulator, and demonstrate: pulses, eyes blinking, pupil constriction, gas moves in and out of mouth (place hand over mouth), chest moves up and down. 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). The students mentioned that they did not obtain the maximum value from the simulation session under these circumstances. However, this turned out to be too slow, took too much time, and could not continuously demonstrate the direction of changes. Animated Lecture Are any further assessments or interventions required? 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. 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. 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. Its absolutely necessary to follow all immersive simulations with a positive, emotionally safe and nonjudgmental debriefing environment. By joining Cureus, you agree to our Medical Simulation Scenarios are text documents outlining the various details of a simulation - everything from patient simulator settings to debriefing notes. Blood sugar issues in the Type II diabetic will have a gradual onset, with diagnosis generally resulting from routine laboratory exams.(1). Geeky Medics accepts no liability for loss of any kind incurred as a result of reliance upon the information provided in this video. A collection of anatomy notes covering the key anatomy concepts that medical students need to learn. Properly interpret a venous blood gas (VBG) and basic metabolic panel in a patient presenting with diabetic ketoacidosis. 4. Diabetic Ketoacidosis (DKA) | Acute Management | ABCDE Endocrine - thesimbook.com Available from: [, NICE guidelines. 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). 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). Measure the patients capillary blood glucose and ketone levels to confirm the diagnosis and guide the management of DKA. Keywords: diabetic ketoacidosis, simulation, expertise, emergency medicine Introduction Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes mellitus, most . Discuss the patients current clinical condition with aseniorclinicianusing anSBARR style handover. As individuals with uncontrolled type I . She tends to drink sugar containing fluids (soda) when she is thirsty, and she eats fast foods (cream-filled muffins) when she is hungry. For example, you could develop a diabetic scenario in which the prehospital provider encounters an altered patient with incomprehensible speech. NPAs are typically better tolerated in patients who are partly or fully conscious compared to oropharyngeal airways. Diabetic Ketoacidosis (DKA) Clinical Pathway Emergency Department *=NdL/c2XSJn8:I Jb8'.8>N*[L .hxw6afq40DX3c~>abt'Q,8y(BZu(vKBTufIR. This is particularly important for core . We have 18 to 20 PBL groups for an hour each in the week after their PBL DKA session. Trainee will recognize the need for therapy and suggest an appropriate therapy in a simulated environment. 2003;78:783788. It involves working through the following steps: Each stage of the ABCDE approach involvesclinicalassessment,investigationsandinterventions. PA EMT Said COVID Patient Didnt Need to Go to the Hospital. KDCA for FSX - Fly Away Simulation Paediatric DKA | Simulation Education TikTok: https://www.tiktok.com/@geekymedics The main purpose of the simulation is to draw a line from the theoretical, boring biochemistry to the clinical manifestations.