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). 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. Each PBL case typically goes over 23 days, affording the students periods to find information for the case. dq-]gX4 `L'u7myx) rpjf0z,.y`VMyx-&Ju`U0 LYqC+pJ&6X4onfBT#?=R}.p8N3+Dk,P4tIgWB}-L'=8;_G >,K#.e89XnG'B~NtR 2007. 2. Inspect for evidence of self-injection sites (e.g. See ourdocumentation guidesfor more details. With your index and other fingers placed behind the angle of the mandible, apply steady upwards and forward pressure to lift the mandible. You may be trying to access this site from a secured browser on the server. Refer to your local guidelines for further details. The students mentioned that they did not obtain the maximum value from the simulation session under these circumstances. Ziv A, Wolpe PR, Small SD, et al. A collection of free medical student quizzes to put your medical and surgical knowledge to the test! 2. Tilt the forehead back whilst lifting the chin forwards to extend the neck. 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. Introduceyourselfto whoever has requested a review of the patient andlistencarefullyto their handover. However, this leads to confusion. - Exacerbating & relieving factors 05:12 Mosby:Philadelphia. She Died the Next Day. If fever is present, make sure to consider co-existing infection. 5. Published August 2015. 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. type 1 diabetes), Complete insulin insensitivity (e.g. The 60 minutes training time consists of four 15-minute sections divided as follows. 2008;6:278302. Standardized patient as the voice of the simulator (or the simulation operator may play this role). Keyword Highlighting areas of lipohypertrophy) if it is unclear if the patient is diabetic. DO NOT perform any examination or procedure on patients based purely on the content of these videos. Strategies of high-performing paramedic educational programs. Yes: if the patient can talk, their airway is patent and you can move on to the assessment of breathing. Categories: Emergency Medicine, Medical Education Keywords: diabetic ketoacidosis, simulation, expertise, emergency medicine . 4. insulin-dependent type 2 diabetes), Altered consciousness (e.g. 1. >> Fernandez AR, Mac Crawford J, Pennell ML, et al. #geekymedics #fyp #fypviral #studytok #medicalstudentuk #medtok #studytips #studytipsforstudents #medstudentuk #premed #medschoolfinals, Cardiovascular History Tips - DON'T FORGET these 3 things . 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). The files are given in full in the web supplement (Appendix B, Supplemental Digital Content 2, https://links.lww.com/SIH/A2). Cureus 9(5): e1286. Trainee will get to know how professionals behave during management of a critically ill patient. By joining Cureus, you agree to our 3. We then start the DKA state. See Appendix D, Supplemental Digital Content 4, https://links.lww.com/SIH/A4. Diabetic ketoacidosis; Simulation training; Medical students. Acad Med. The Pratcice This video demonstrates how to use the SOCRATES acronym when taking a history of pain or other symptoms. She began experiencing progressively worsening thirst, increased appetite, and excessively increased urination. We have 18 to 20 PBL groups for an hour each in the week after their PBL DKA session. ABG, venepuncture). We believe it is important to have active, participatory learning by having conversations with the trainees in the form of questions and answers. 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. GRAPH. - Severity 05:32 Please try after some time. - Medical Finals Question Pack: https://geekymedics.com/medical-student-finals-questions/ a simulation training session designed to acquaint emergency medicine residents with the presentation and management of diabetic ketoacidosis (DKA) through the use of simulation. <>>> Hypothermia may be present if the patient has been unconscious and exposed for some time. Glycosuria leads to urinary losses of potassium through osmotic diuresis. Laschinger S, Medves J, Pulling C, et al. - 150+ PDF OSCE Checklists: https://geekymedics.com/pdf-osce-checklists/ 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. 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. 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 an animated lecture, its important that the student group have an instructor so they can ask direct questions. Given 6 to 8 back-to-back sessions, it is critical that every session starts and ends on time! 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. For example, you could develop a diabetic scenario in which the prehospital provider encounters an altered patient with incomprehensible speech. The instructor can also gauge the direction the debriefing session should follow or be alerted to possible problems or conflicts in treatment opinions. 1) Please read through this document as it will help you prepare for your upcoming simulation on DKA. 3. Physician working in the emergency department. They should introduce the student group to the environment, assign roles for each learner and guide the decision-making process. Stage 1: Initial assessment of acutely unwell pregnant woman and diagnosis of DKA. Use blankets to re-warm patients who are mild to moderately hypothermic. Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. 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. Therefore, the session is divided into four sections of 15 minutes each, so that the facilitator is constantly aware of being on time (or not), even after the first 15 minutes period. oral fluids, intravenous fluids, urine output, drain output, stool output, vomiting) to inform resuscitation efforts. 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. Airway adjuncts are often helpful and in some cases essential to maintain a patients airway. Many of the preclinical students have never seen a real life clinical monitor or even an intravenous (IV) setup. See ourintravenous cannulation guidefor more details. Intubation lubricants can mimic drooling. tall tented T waves in hyperkalaemia). - Site 01:12 The students are in their basic science course. The main goal is to establish a safe learning environment for the learner [9, 13 . - Over 3000 Free MCQs: https://geekyquiz.com/ "Never doubt that a small group of thoughtful, committed citizens can change the world. Because of this consciousness status, it is very difficult to obtain information of cardiovascular, pulmonary, renal, hepatic, endocrine, hematology, or coagulation status other than uncontrolled diabetes. 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. 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). 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. 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. Finally, we summarize the course and give them time for questions. A debriefing section with pre-established questions allows the instructor to review the main focus and performance measures with the student group. If the patient is suspected to have sufferedsignificanttraumawith potential spinal involvement, perform ajaw-thrustrather than a head-tilt chin-lift manoeuvre: 2. Conclusion Twitter: http://www.twitter.com/geekymedics 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. Alert a senior immediately if you have any concerns about the consciousness level of a patient. It should only be inserted in unconscious patients as it is otherwise poorly tolerated and may induce gagging and aspiration. 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! Diabetic ketoacidosis (DKA) is a common, potentially lethal disease. Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario Cureus. Manikin staging can provide strong cues. 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. Review the patientsoxygen saturation(SpO2): Auscultate the chest to screen for evidence of respiratory pathology (e.g. 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). 4. 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. x]o ]?9kgq~:)?hE )R6!up}\<8||\]}Y~;xp~yQ$#4~djX&{n_m-]^K1/~/AD Hv 99evs,;8}8zwnhFxV.kf-V^? If foreign material is present, attempt removal using suction. Animated Lecture NPAs are typically better tolerated in patients who are partly or fully conscious compared to oropharyngeal airways. Diabetes mellitus affects nearly 7.8% of the U.S. population, with approximately 510% of this group affected by Type I and 9095% by Type II.1 Diabetes is the most common type of endocrine disease and was the seventh leading underlying cause of death listed on death certificates in 2006. 2003;78:783788. The DKA simulation incorporates cue recognition, analysis of cues, generation of solutions, nursing interventions, and evaluation of outcomes, including effective communication and psychosocial concerns. Simulation in Healthcare4(4):232-236, Winter 2009. Case-based education adds a real-world aspect to the learning environment. 2. The trainees have had background knowledge of biochemistry because they had completed the PBL case. Animated lectures, however, must work within the framework of a focused case study, which requires increased preparation time. may email you for journal alerts and information, but is committed TheABCDEapproach can be used to perform a systematic assessment of a critically unwell patient. You can check out our guide to using SOCRATES here: https://geekymedics.com/the-socrates-acronym-in-history-taking/ MassBay EMS Program Integrates Training for Dogs, Heat Waves Are Killing More LA Homeless People. The Theory and Introduceyourselfto thepatientincluding yournameandrole. }HyEf,#$/JSRU9+CF6k\'/z+i`[ 5JudK*Zly^g%[jCK)H[)Y=Qp0/r9o9HW_zF}pTzI~'|q.~:=Y T 9w! In the meantime, you can perform some basic airway manoeuvres to help maintain the airway whilst awaiting senior input. Groups of fewer than four students dont allow for optimal collaboration. Geeky Medics accepts no liability for loss of any kind incurred as a result of reliance upon the information provided in this video. If the patient loses consciousness and there are no signs of life on assessment, put out a crash call and commence CPR. Simulation-based medical education: An ethical imperative. 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 . 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. angioedema, rash) commence appropriate treatment as discussed in ouranaphylaxis guide. 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. reduced air entry, coarse crackles) to screen for evidence of pneumonia. This allows us to get in touch for more details if required. From the Department of Anesthesiology, Pennsylvania State University College of Medicine, Hershey, PA. Dr. Murray is on the Speakers Bureau of METI, Sarasota, FL. The simulation session is also hosted as an interactive session. See ourfluid prescribing guidefor more details onresuscitation fluids. 3. This is particularly important for core . <> Trainee will describe the changes in vital signs, the major metabolic, fluid, and electrolyte. Join the Geeky Medics community: A collection of surgery revision notes covering key surgical topics. to maintaining your privacy and will not share your personal information without Schneider Sarver PA, Senczakowicz EA, Slovensky BM. Trainee will be respectful to others and their views during the PBL session. Place one hand on the patients forehead and the other under the chin. An oropharyngeal airway is a curved plastic tube with a flange on one end that sits between the tongue and hard palate to relieve soft palate obstruction. 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.. COVID-19 Screening in the Pediatric Emergency Department. Therefore, we have to emphasize the importance of airway, breathing, and circulation in the very sick patient in any clinical setting. Clinical Simulation in Nursing, Volume 39, 2020, pp. If any obstruction is encountered, remove the tube and try the left nostril. Int J Evid Based Healthc. Advance the airway until it lies within the pharynx. Please note that by doing so you agree to be added to our monthly email newsletter distribution list. 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 an infection is suspected, IV antibioticsshould be administered as soon as possible. The consequences (low blood pressure, high heart rate, central nervous system status, etc.) When erroneous treatment is delivered, the instructor can end the simulation. 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)? 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 . This is particularly important for core cases and low-frequency, high-stakes procedures and encounters. These are not learning objectives in this program. Typically potassium levels should be maintained between 4.0 5.5 mmol/L and close monitoring is required. 1 0 obj Make sure tore-assessthe patient after anyintervention. On arrival to the ER, standard monitors (electrocardiogram [ECG] and pulse oximetry [SpO2]) and end-tidal carbon dioxide (ETCO2) concentration were placed, and the patient was given oxygen by nasal cannulae. 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. Case-based simulation should include two to three broad-focus objectives, as well as 1020 specific performance measures that the student should accomplish. His Wife Gave Him CPR. - Timing 03:23 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. Effectiveness of simulation on health profession students knowledge, skills, confidence and satisfaction. Your message has been successfully sent to your colleague. For more information, please refer to our Privacy Policy. 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. 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. Ketones show 5.5. Both external and internal potassium balances are disturbed during the development and treatment of DKA. The use of simulation-based instruction enables a student to learn at their own pace and allows them to repeat sequential steps to gain confidence and proficiency. Simulation provides a safe environment where learning is enhanced through the deliberate practice of skills and controlled management of a variety of clinical encounters. After initial insulin therapy has reduced plasma blood glucose levels (e.g. Another example: At one minute into the scenario, the patient becomes unresponsive and their breathing becomes shallow. 2 The evaluation of potassium deficits is complicated by potassium exit from . (1) According to Centers for Disease Control and Prevention (CDC), 223,619 deaths were attributed to diabetes in 2005. Instagram: https://instagram.com/geekymedics Review the patientscurrent medicationsand check any regular medications areprescribed appropriately. This simulation session therefore aims to make the case come alive, and show this known case in a clinical context. 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 . A collection of data interpretation guides to help you learn how to interpret various laboratory and radiology investigations. This session provides additional clinical support material for the theoretical PBL session. 2009;13:505511. If an obstruction is visible within the airway, use afingersweeporsuctionto remove it. Therefore, the same file is also sent to the participants before the session. TikTok: https://www.tiktok.com/@geekymedics They have had no clinical exposure or any clinical experience. 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. Recognize the signs and symptoms of a patient presenting with diabetic ketoacidosis. 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. Open the patients airwayusing ahead-tiltchin-lift manoeuvre: 1. Insert at least onewide-bore intravenous cannula(14G or 16G) and take blood tests as discussed below. Depending on scenario complexity, team dynamic and treatment modalities, this simulation may take 1020 minutes. 4. KDCA, Ronald Reagan Washington National Airport, DC. 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. The researchers found that long shift hours (24hrs), working overtime and marital/relationship stress were strongly correlated. The immersive simulation is performed when the instructor feels comfortable with the acquired knowledge and skill base presented in the animated lecture or when the student group has sufficient practical experience to apply the cognitive, behavioral and technical skills outlined in the case scenario.

Lisa Rowland Brasher Net Worth, Afc Wimbledon Wages, Articles D