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. A collection of data interpretation guides to help you learn how to interpret various laboratory and radiology investigations. As the name says, this screen is used to graph and plot any parameter. 1 0 obj 1-6. It may be necessary toexposethe patient during your assessment: remember to prioritise patient dignity and conservation of body heat. Clinical Simulation in Nursing, Volume 39, 2020, pp. Published August 2015. DY{Qb"(EgN$QI*%XN1F""0a5 confusion, coma), All critically unwell patients should have. Note that if-thens must also include negative patient outcomes for when the provider doesnt take appropriate action. 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). Animated lectures, however, must work within the framework of a focused case study, which requires increased preparation time. JEMS. Askhow the patient is feeling as this may provide some useful information about their current symptoms. Glycosuria leads to urinary losses of potassium through osmotic diuresis. Research Watch Box:Sleep, Fatigue & SafetyBy David Page, MS, NREMT-P - Onset 01:48 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. Ask for anotherclinicalmemberofstafftoassistyou if possible. Use blankets to re-warm patients who are mild to moderately hypothermic. 2009;13:505511. She tends to drink sugar containing fluids (soda) when she is thirsty, and she eats fast foods (cream-filled muffins) when she is hungry. In this case scenario, dehydration is one of the most serious immediate issues. As this is a PBL session, the trainees are not given any references. The students have acquired all the applicable theoretical knowledge of the case during the previous multiday PBL sessions. We combined both to indicate the continuity of the curriculum, and the building on prior knowledge. See ourhistory taking guidesfor more details. Generaltipsfor applying anABCDEapproachin an emergency setting include: Acute scenarios typically begin with abriefhandoverfrom a member of thenursing staffincluding thepatients name,age,backgroundand thereasonthereviewhas been requested. Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario - 150+ PDF OSCE Checklists: https://geekymedics.com/pdf-osce-checklists/ Acad Med. Scenario in a Nutshell Diabetic ketoacidosis (DKA) in pregnancy. The scenario would include an if-then algorithm. There are just a few more things to do. You may be asked to review a patient with DKA due to confusion, reduced level of consciousness, tachycardia, hypotension and/or vomiting. - Over 3000 Free MCQs: https://geekyquiz.com/ We used the Medical Education Technologies Inc. (METI) Human Patient Stimulator (HPS, METI Sarasoto, Fl). Observe and discuss the effects of therapy in a mathematically modeled physiological simulator. 3. 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. endobj Makeup may be used to depict gender, hollow eyes and cheeks, produce pallor or display bruises and scars. 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. Trainee will practice or observe good teamwork skills, both as a leader and a team player. Scenarios. Each PBL case typically goes over 23 days, affording the students periods to find information for the case. Consider any precipitating factors for the development of DKA and involve the diabetes team in the patients care. Please try after some time. Prehosp Emerg Care. Antibiotics should be prescribed in keeping with local guidelines. After the first voluntary session in 2006, feedback from the medical students indicated that they would like to receive this handout. 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. We believe it is important to have active, participatory learning by having conversations with the trainees in the form of questions and answers. Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario Cureus. 4 0 obj Indeed, it is the only thing that ever has.". This is particularly important for core cases and low-frequency, high-stakes procedures and encounters. LYqC+pJ&6X4onfBT#?=R}.p8N3+Dk,P4tIgWB}-L'=8;_G >,K#.e89XnG'B~NtR Please write a single word answer in lowercase (this is an anti-spam measure). We have spent many hours debating whether the small group format was a waste of time. Stage 3: Ongoing management and monitoring of DKA 1 hour after initiation of treatment. 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 . The instructor should have visual access via one-way windows or cameras. Therefore, the same file is also sent to the participants before the session. When erroneous treatment is delivered, the instructor can end the simulation. Lets discuss your options. From the Department of Anesthesiology, Pennsylvania State University College of Medicine, Hershey, PA. Dr. Murray is on the Speakers Bureau of METI, Sarasota, FL. Patients with DKA require fluid resuscitation to restore circulatory volume, clear ketones, correct electrolyte abnormalities and increase renal perfusion. The required potassium replacement varies greatly. Depending on scenario complexity, team dynamic and treatment modalities, this simulation may take 1020 minutes. 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. Trainee will appropriately request assistance and use available resources. Diabetes (type 1 and type 2) in children and young people: diagnosis and management. Conclusion You may search for similar articles that contain these same keywords or you may 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. MassBay EMS Program Integrates Training for Dogs, Heat Waves Are Killing More LA Homeless People. During an immersive simulation, its imperative the group uses critical-thinking skills and group collaboration independently. Stage 1: Initial assessment of acutely unwell pregnant woman and diagnosis of DKA. 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. Please note that by doing so you agree to be added to our monthly email newsletter distribution list. We then start the DKA state. See Appendix D, Supplemental Digital Content 4, https://links.lww.com/SIH/A4. The instructors have to appreciate that the trainees participating in this simulation have not seen a diabetic patient in either a ward or ER, but that they have knowledge of the underlying physiology. Both external and internal potassium balances are disturbed during the development and treatment of DKA. The normal reference range for fasting plasma glucose is 4.0 5.8 mmol/l. Simulation provides a safe environment where learning is enhanced through the deliberate practice of skills and controlled management of a variety of clinical encounters. 1 Potassium losses occurring both before and during treatment of DKA must be replaced. - Site 01:12 The learning environment should closely mimic real-world applications. Measure the patients capillary blood glucose and ketone levels to confirm the diagnosis and guide the management of DKA. It involves a facilitating instructor, a small learner group and conceptual aspects of environmental and manikin staging to provide sensory cues. To read Pages full Research Review column, visit www.jems.com/patient-care. 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. 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. PA EMT Said COVID Patient Didnt Need to Go to the Hospital. A comprehensive collection of medical revision notes that cover a broad range of clinical topics. - Timing 03:23 Supplemental digital content is available for this article. may email you for journal alerts and information, but is committed Interactive lecture/discussion with use of monitors that show the vital signs of the simulated patient on manikin. *=NdL/c2XSJn8:I Jb8'.8>N*[L .hxw6afq40DX3c~>abt'Q,8y(BZu(vKBTufIR. Diabetic ketoacidosis (DKA) is a common, potentially lethal disease. x]o ]?9kgq~:)?hE )R6!up}\<8||\]}Y~;xp~yQ$#4~djX&{n_m-]^K1/~/AD Hv 99evs,;8}8zwnhFxV.kf-V^? 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. can be reemphasized, and the effects of fluid therapy demonstrated. You might also be interested in our awesome bank of 700+ OSCE Stations. Case-based education adds a real-world aspect to the learning environment. Inspect theairwayfor obviousobstruction. Search for Similar Articles Tilt the forehead back whilst lifting the chin forwards to extend the neck. As individuals with uncontrolled type I . We try to provide sufficient realism.. The simulators do not have rock steady vital sign values, and the students were unsure as to write down 121 or 122 mm Hg as the systolic blood pressure. 2008;6:278302. We also show them IV bags containing saline and Ringers lactate, as well as show them IV infusion sets. See Table 4 for a suggested standardized script. In some cases, normal saline with additional potassium is required to prevent overcorrection of serum potassium levels which would otherwise result in hypokalaemia. 3. Highlight selected keywords in the article text. The trainees have had background knowledge of biochemistry because they had completed the PBL case. cloudy urine may indicate urinary tract infection). A comprehensive collection of OSCE guides to common clinical procedures, including step-by-step images of key steps, video demonstrations and PDF mark schemes. 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. DONT FORGET these 3 key components of the cardiovascular exam for your upcoming OSCEs Save this video to watch later and dont forget to follow Geeky Medics! Chapters: The lecture allows for understanding of concepts prior to action, and instructor feedback is immediate. This allows us to get in touch for more details if required. Manikin staging can provide strong cues. Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. SimMan offers you the ability to provide simulation education to challenge and test your students clinical and decision-making skills during realistic patient care 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.) Open the patients mouth to ensure there is no foreign material that may be pushed into the larynx.