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A collection of interactive medical and surgical clinical case scenarios to put your diagnostic and management skills to the test. Administer oxygen to all critically unwell patients during yourinitialassessment. 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. When erroneous treatment is delivered, the instructor can end the simulation. Experience has shown that the more experienced the provider, the more detailed the environmental and manikin staging should be, because providers are trained to take in and interpret visual cues as indicators of patient status. - Exacerbating & relieving factors 05:12 We then start the DKA state. See Appendix D, Supplemental Digital Content 4, https://links.lww.com/SIH/A4. 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). Before trainees arrival into the simulation area, the simulator is already preprogrammed for DKA. Performing an ECG should not delay the emergency management of DKA. <> The facilitator guides the group only when necessary. Make sure thepatientsnotes,observationchartandprescriptionchartare easily accessible. A comprehensive collection of OSCE guides to common clinical procedures, including step-by-step images of key steps, video demonstrations and PDF mark schemes. Please enable scripts and reload this page. Stage 1: Initial assessment of acutely unwell pregnant woman and diagnosis of DKA. 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). There are several causes of DKA, which we remember by the "five I's". Consider any precipitating factors for the development of DKA and involve the diabetes team in the patients care. The Theory You might also be interested in our awesome bank of 700+ OSCE Stations. Does the patient need a referral toHDU/ICU? (1) The assessment of a diabetic patient is best taught as a. Available from: [. The use of case-based simulation, although more complicated and time consuming for the instructor, immerses the students in the subject matter. }HyEf,#$/JSRU9+CF6k\'/z+i`[ 5JudK*Zly^g%[jCK)H[)Y=Qp0/r9o9HW_zF}pTzI~'|q.~:=Y T 9w! Over the years, some groups happened to have the simulation session before the completion of the theoretical PBL session. The main purpose of the simulation is to draw a line from the theoretical, boring biochemistry to the clinical manifestations. If the patient has COPD and a history of CO2retention you should switch to aventuri maskas soon as possible andtitrate oxygen appropriately. This is particularly important for core . Given such a small group, the students indicated that they feel more involved than they would with a larger group (eg, the whole class.) type 1 diabetes) Complete insulin insensitivity (e.g. 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. 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. PA EMT Said COVID Patient Didnt Need to Go to the Hospital. Instagram: https://instagram.com/geekymedics Groups of more than seven may struggle with meeting objectives due to insufficient functional rolls. "Never doubt that a small group of thoughtful, committed citizens can change the world. In this manner, the students have to apply their knowledge at the appropriate points during the progression of the scenario. Perform urinalysis and send the urine for culture if urinary tract infection is suspected. Introduceyourselfto whoever has requested a review of the patient andlistencarefullyto their handover. Trigger 4, Pathway 1l of saline required over 1hour and insulin infusion need prescribing and making up in 50ml syringe. modify the keyword list to augment your search. See ourfluid prescribing guidefor more details onresuscitation fluids. Case-based education adds a real-world aspect to the learning environment. 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. The faculty member/course coordinator of Simulation Design Both external and internal potassium balances are disturbed during the development and treatment of DKA. Askhow the patient is feeling as this may provide some useful information about their current symptoms. #geekymedics #fyp #fypviral #studytok #medicalstudentuk #medtok #studytips #studytipsforstudents #medstudentuk #premed #medschoolfinals, Cardiovascular History Tips - DON'T FORGET these 3 things . The main goal is to establish a safe learning environment for the learner [9, 13 . Intubation lubricants can mimic drooling. dq-]gX4 `L'u7myx) rpjf0z,.y`VMyx-&Ju`U0 and Adds true to life parking codes and extra parking for AI. Inspect the urine currently in the catheter bag and note its appearance (e.g. LYqC+pJ&6X4onfBT#?=R}.p8N3+Dk,P4tIgWB}-L'=8;_G >,K#.e89XnG'B~NtR In this case scenario, dehydration is one of the most serious immediate issues. In an animated lecture, its important that the student group have an instructor so they can ask direct questions. Physician working in the emergency department. - Over 3000 Free MCQs: https://geekyquiz.com/ The consequences (low blood pressure, high heart rate, central nervous system status, etc.) Below is a collection of donated scenarios for you to use or modify. If the patient has clinical signs ofanaphylaxis(e.g. 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). 1) Please read through this document as it will help you prepare for your upcoming simulation on DKA. 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. His Wife Gave Him CPR. Insert the airway bevel-end first, vertically along the floor of the nose with a slight twisting action. 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. - Examples 05:45 Make sure to re-assess the patient after any intervention. 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. Emergency medical services workLife characteristics contribute to clinically significant excessive daytime sleepiness. Seek senior helpif the patient shows no signs of improvement or if you have any concerns. 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 . 1. The use of a simulated, evolving case scenario was an effective method of exposing nursing students to complex patient care. Medical simulation technology is a powerful tool for training physicians but papers dealing with DKA simulators are scarce. We do point out the blood pressure (BP) cuff, but these medical students in their first year do not really need to know how the BP values are generated, they need to understand the origin and therapy for the low blood pressure. Highlight selected keywords in the article text. Inspect for evidence of infection on the skin (e.g. 1-6. She tends to drink sugar containing fluids (soda) when she is thirsty, and she eats fast foods (cream-filled muffins) when she is hungry. COVID-19 Screening in the Pediatric Emergency Department. See ourdocumentation guidesfor more details. If fever is present, make sure to consider co-existing infection. 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. Initially, we required the students to write down the vital signs. . Discuss the patients current clinical condition with aseniorclinicianusing anSBARR style handover. A strong emphasis is placed on the focused, methodical examination of a specific medical problem and the decision-based treatment options available. Interactive lecture/discussion with use of monitors that show the vital signs of the simulated patient on manikin. The choice of fluid type, rate of administration and volume should be tailored to the individual patient based upon their vital signs and electrolytes. Trainee will be respectful to others and their views during the PBL session. Simulation-based medical education: An ethical imperative. 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). Consider active re-warming techniques in patients with severe hypothermia. PBL was introduced at our institution in 1995. 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. It involves working through the following steps: Each stage of the ABCDE approach involvesclinicalassessment,investigationsandinterventions. Categories: Emergency Medicine, Medical Education Keywords: diabetic ketoacidosis, simulation, expertise, emergency medicine . 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. 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. endobj oral fluids, intravenous fluids, urine output, drain output, stool output, vomiting) to inform resuscitation efforts. Debriefing Measure the patients capillary blood glucose and ketone levels to confirm the diagnosis and guide the management of DKA. I assigned true to life parking codes, and added some extra parking for the superfluous US Express AI. NPAs are typically better tolerated in patients who are partly or fully conscious compared to oropharyngeal airways. However, this turned out to be too slow, took too much time, and could not continuously demonstrate the direction of changes. Immersive simulations are mentally exhausting because they create an intense and stressful atmosphere requiring the learner to work outside their comfort zone. Inspect for evidence of self-injection sites (e.g. Stage 3: Ongoing management and monitoring of DKA 1 hour after initiation of treatment. Diabetic ketoacidosis (DKA) is a common, potentially lethal disease. A comprehensive collection of medical revision notes that cover a broad range of clinical topics. We combined both to indicate the continuity of the curriculum, and the building on prior knowledge. Standardized patient as the voice of the simulator (or the simulation operator may play this role). - 700+ OSCE Stations: https://geekymedics.com/osce-stations/ insulin-dependent type 2 diabetes), Altered consciousness (e.g. Search for Similar Articles Indeed, it is the only thing that ever has.". Each performance measure is separated into cognitive, behavioral or technical categories. 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. If you have any scenarios you would be willing to share with the simulation community, please forward them . angioedema, rash) commence appropriate treatment as discussed in ouranaphylaxis guide. As this is an interactive discussion session, any needed debriefing and/or explanation is given during the sessions. The teaching of diabetic assessment and management, like many other medical emergencies, lends itself well to case-based simulation. Chapters: Keyword Highlighting See our blood glucose measurement guide for more details. Trainee will increase knowledge of professional behaviors during the simulation. Surgical dressings and imitation blood can support medical history. A collection of surgery revision notes covering key surgical topics. areas of lipohypertrophy) if it is unclear if the patient is diabetic. 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. This is a combination of the modified traditional lecture within scenario-based learning. 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. Inspect theairwayfor obviousobstruction. Centers for Disease Control and Prevention. J Nurs Educ. In the meantime, you should re-assess and maintain the patients airway. 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. 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. 2017 May 29;9(5):e1286. A GCS of 8 or below warrants urgent expert help from an anaesthetist. Available from: [, NICE guidelines. Prehosp Emerg Care. Therefore, the same file is also sent to the participants before the session. 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. Diabetic ketoacidosis; Simulation training; Medical students. After initial insulin therapy has reduced plasma blood glucose levels (e.g. 1. 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. Animated lectures, however, must work within the framework of a focused case study, which requires increased preparation time. 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)? 4. Check out our other awesome clinical skills resources including: A well-staged environment allows for greater student buy-in. Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. 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 had developed nausea, extreme fatigue, mild disorientation, and blurred vision toward the end of the soccer match. 3. An animated lecture may be described as a pseudo-simulation environment. 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. <>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 595.32 841.92] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> 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. 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. She began experiencing progressively worsening thirst, increased appetite, and excessively increased urination. 1. Subscribe to our newsletter to be the first to know about our latest content: https://geekymedics.com/newsletter/ DO NOT perform any examination or procedure on patients based purely on the content of these videos. Environment & Manikin 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. DO NOT perform any examination or procedure on patients based purely on the content of these videos. The objective is to give as many visual and tactile cues concerning the patient condition and background as possible. 3. 3. For more information, please refer to our Privacy Policy. Place one hand on the patients forehead and the other under the chin. This is particularly important for core cases and low-frequency, high-stakes procedures and encounters. For example, if a student is to run a diabetic emergency in an extended living facility, the room should be staged with the appropriate bed, linens and medical equipment, and include personal artifacts and memorabilia normally found in such environments. Marx JA, Hockberger RS, Walls RM. 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. endobj 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. www.cdc.gov/diabetes/statistics/prev/national/. The simulation experience serves to give substance to the theoretical words and concepts that the students encountered during the PBL sessions. A chest X-ray should not delay the emergency management of DKA. 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). This may produce better retention of the subject matter and help students adapt to emergency scenes before going into the field. - Onset 01:48 If the patient isunconsciousorunresponsive, start thebasic life support(BLS)algorithmas per resuscitation guidelines. 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. The lecture allows for understanding of concepts prior to action, and instructor feedback is immediate. Several environments may be suitable for your classroom. Extremities: mild cyanosis, no clubbing or edema (verbalized by instructors); pulses equal, and symmetrical (elucidated by trainees). Section snippets . DY{Qb"(EgN$QI*%XN1F""0a5 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. Simulation Scenario for Anesthesia Providers Clark Obr, MD*, Anthony Mueller, MD . 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 . An oxygen mask is also demonstrated as an alternative device, as these early trainees had mostly not yet seen any of these devices. To read Pages full Research Review column, visit www.jems.com/patient-care. Competency-based medical education has seen widespread adoption in the field along with ongoing work in the areas of . % The validity of the HFS-DKA scenario was verified by a certified diabetes nurse educator, a registered nurse, and a clinical nurse educator. Geeky Medics accepts no liability for loss of any kind incurred as a result of reliance upon the information provided in this video. 2009;13:505511. 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). DKA can develop within 24 hours and is potentially life threatening, requiring prompt recognition and therapeutic intervention.