*=NdL/c2XSJn8:I Jb8'.8>N*[L .hxw6afq40DX3c~>abt'Q,8y(BZu(vKBTufIR. Please note that by doing so you agree to be added to our monthly email newsletter distribution list. See ourfluid prescribing guidefor more details onresuscitation fluids. 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. reduced air entry, coarse crackles) to screen for evidence of pneumonia. 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. stream Simulation in Healthcare4(4):232-236, Winter 2009. In some cases, normal saline with additional potassium is required to prevent overcorrection of serum potassium levels which would otherwise result in hypokalaemia. The impetus for creating and implementing the high-fidelity diabetic ketoacidosis (DKA) simulation was based on a needs assessment and reviewing of undergraduate nursing students' examination statistics in a second semester medical-surgical course. Use washable, non-toxic paints to imitate various body emissions. - Introduction 00:00 Please try again soon. As individuals with uncontrolled type I . For more information, please refer to our Privacy Policy. Simulation Scenario. >> Fernandez AR, Mac Crawford J, Pennell ML, et al. Alert a senior immediately if you have any concerns about the consciousness level of a patient. GRAPH. In keeping with the case study, as a treatment marker is reached, the instructor should place emphasis on physiological, pharmacological, environmental and psychosocial issues. Mosby:Philadelphia. Both external and internal potassium balances are disturbed during the development and treatment of DKA. If the patient isunconsciousorunresponsive, start thebasic life support(BLS)algorithmas per resuscitation guidelines. If an infection is suspected, IV antibioticsshould be administered as soon as possible. % A traditional classroom lecture format allows for student participation but limits the instructors ability to create realistic situations. The reason for inserting the airway upside down initially is to reduce the risk of pushing the tongue backwards and worsening airway obstruction. (1) According to Centers for Disease Control and Prevention (CDC), 223,619 deaths were attributed to diabetes in 2005. Prehosp Emerg Care. Reprints: Koichiro Nandate, MD, PhD, Department of Anesthesiology, Milton S. Hershey Medical Center, Pennsylvania State University College of Medicine, 500 University Drive Box 850, Hershey, PA 17033 (e-mail: [emailprotected]). See ourdocumentation guidesfor more details. You can check out our guide to using SOCRATES here: https://geekymedics.com/the-socrates-acronym-in-history-taking/ Lets discuss your options. Keywords: diabetic ketoacidosis, simulation, expertise, emergency medicine Introduction Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes mellitus, most . Case-based education adds a real-world aspect to the learning environment. 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. %PDF-1.5 Below is a collection of donated scenarios for you to use or modify. She tends to drink sugar containing fluids (soda) when she is thirsty, and she eats fast foods (cream-filled muffins) when she is hungry. 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. Trainee will describe the changes in vital signs, the major metabolic, fluid, and electrolyte. For example, you could develop a diabetic scenario in which the prehospital provider encounters an altered patient with incomprehensible speech. We then start the DKA state. See Appendix D, Supplemental Digital Content 4, https://links.lww.com/SIH/A4. MassBay EMS Program Integrates Training for Dogs, Heat Waves Are Killing More LA Homeless People. 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. 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. The students have acquired all the applicable theoretical knowledge of the case during the previous multiday PBL sessions. The 60 minutes training time consists of four 15-minute sections divided as follows. An oxygen mask is also demonstrated as an alternative device, as these early trainees had mostly not yet seen any of these devices. 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. 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. The normal reference range for fasting plasma glucose is 4.0 5.8 mmol/l. Vital Signs: BP, 90/30 mm Hg (ECG shows normal sinus rhythm); central venous pressure, 0 to 2 cm H. Lungs: All lung fields are clear to auscultation without wheeze or rhonchi, and the respiratory pattern is typical of Kussmaul breathing, ie, large deep tidal volumes and increased respiratory rate. Simulation provides a safe environment where learning is enhanced through the deliberate practice of skills and controlled management of a variety of clinical encounters. 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. She began experiencing progressively worsening thirst, increased appetite, and excessively increased urination. Ketones show 5.5. 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. 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].. Depending on scenario complexity, team dynamic and treatment modalities, this simulation may take 1020 minutes. - Examples 05:45 Immersive simulations are mentally exhausting because they create an intense and stressful atmosphere requiring the learner to work outside their comfort zone. 1) Please read through this document as it will help you prepare for your upcoming simulation on DKA. 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. It was For similar reasons, we do not believe a videotaped session will keep the students attention as much as these live simulator sessions. The optimal number of simulation participants is four to seven individuals, depending on the case study objectives. unilateral coarse crackles may be present if the patient has pneumonia which may have been the precipitant for DKA). The Theory The simulation experience serves to give substance to the theoretical words and concepts that the students encountered during the PBL sessions. TikTok: https://www.tiktok.com/@geekymedics Insert at least onewide-bore intravenous cannula(14G or 16G) and take blood tests as discussed below. Each performance measure is separated into cognitive, behavioral or technical categories. CCA 175 Real Time Exam Scenario 17 | JOIN Multiple DataFrames | Save as LYqC+pJ&6X4onfBT#?=R}.p8N3+Dk,P4tIgWB}-L'=8;_G >,K#.e89XnG'B~NtR Conclusion If the patient is suspected to have sufferedsignificanttraumawith potential spinal involvement, perform ajaw-thrustrather than a head-tilt chin-lift manoeuvre: 2. A well-staged environment allows for greater student buy-in. 1. Use blankets to re-warm patients who are mild to moderately hypothermic. Urinary tract infections are a common DKA precipitant. With your index and other fingers placed behind the angle of the mandible, apply steady upwards and forward pressure to lift the mandible. Simulation student Scenario- DKA-Peds.docx - DIABETIC Trainee will get to know how professionals behave during management of a critically ill patient. . Highlight selected keywords in the article text. <>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 595.32 841.92] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> Several environments may be suitable for your classroom. Its best, however, to allow the student group to continue so theyre able to evaluate their decision-making processes during debriefing. After the first voluntary session in 2006, feedback from the medical students indicated that they would like to receive this handout. Creating a Simulation Experience to Promote Clinical Judgment endobj We also show them IV bags containing saline and Ringers lactate, as well as show them IV infusion sets. DY{Qb"(EgN$QI*%XN1F""0a5 We ask the trainee why the blood pressure is so low or heart rate is so high, and how we should treat it. DO NOT perform any examination or procedure on patients based purely on the content of these videos. x]o ]?9kgq~:)?hE )R6!up}\<8||\]}Y~;xp~yQ$#4~djX&{n_m-]^K1/~/AD Hv 99evs,;8}8zwnhFxV.kf-V^? Measure the patients capillary blood glucose and ketone levels to confirm the diagnosis and guide the management of DKA. If the patientloses consciousnessand there areno signs of lifeon assessment, put out acrash callandcommence CPR. J Nurs Educ. Outcomes Educating Nursing Students Using an Evolving, Simulated Case <> DO NOT perform any examination or procedure on patients based purely on the content of these videos. Diabetic Ketoacidosis (DKA) Clinical Pathway Emergency Department In other words, they do not have clinical experience, but they have clinical knowledge. 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. may email you for journal alerts and information, but is committed An events progression section should include patient status changes, as well as a time/treatment continuum that incorporates if-then event progressions. Centers for Disease Control and Prevention. Case-based simulation should include two to three broad-focus objectives, as well as 1020 specific performance measures that the student should accomplish. Pediatric Emergency Medicine Didactics and Simulation (PEMDAS Open the patients airwayusing ahead-tiltchin-lift manoeuvre: 1. - Exacerbating & relieving factors 05:12 This may produce better retention of the subject matter and help students adapt to emergency scenes before going into the field. - Medical Finals Question Pack: https://geekymedics.com/medical-student-finals-questions/ 1. a simulation training session designed to acquaint emergency medicine residents with the presentation and management of diabetic ketoacidosis (DKA) through the use of simulation. The DKA simulation incorporates cue recognition, analysis of cues, generation of solutions, nursing interventions, and evaluation of outcomes, including effective communication and psychosocial concerns. 2 0 obj You may be asked to review a patient with DKA due to confusion, reduced level of consciousness, tachycardia, hypotension and/or vomiting. type 1 diabetes), Complete insulin insensitivity (e.g. 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). 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. The teaching of diabetic assessment and management, like many other medical emergencies, lends itself well to case-based simulation. angioedema, rash) commence appropriate treatment as discussed in ouranaphylaxis guide. 2011;15:108109. A collection of data interpretation guides to help you learn how to interpret various laboratory and radiology investigations. The file explaining the session is sent to instructors 1 week before the sessions. Keyword Highlighting Standardized patient as the voice of the simulator (or the simulation operator may play this role). The Theory We are looking for declaration of DKA and request for pathway. PDF Medicine Simulation Scenario Diabetic Ketoacidosis: An Emergency - Cureus She does not take this regularly. Manikin staging can provide strong cues. Healthcare Students' Psychological Well-Being in a Diabetic Ketoacidosis Simulation. Ziv A, Wolpe PR, Small SD, et al. 2007. Properly interpret a venous blood gas (VBG) and basic metabolic panel in a patient presenting with diabetic ketoacidosis. Use an effectiveSBARR handoverto communicate the key information effectively to other medical staff. There are several causes of DKA, which we remember by the "five I's". 1 0 obj Cureus 9(5): e1286. Inspect theairwayfor obviousobstruction. 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 . PDF Medicine Simulation Scenario Diabetic Ketoacidosis: An Emergency PBL was introduced at our institution in 1995. Review the patientsoxygen saturation(SpO2): Auscultate the chest to screen for evidence of respiratory pathology (e.g. This allows the learner group to make a psychological break from the patient and environment while beginning the reflection process. - Timing 03:23 endobj A collection of free medical student quizzes to put your medical and surgical knowledge to the test! It may be necessary toexposethe patient during your assessment: remember to prioritise patient dignity and conservation of body heat. Each clinical case scenario allows you to work through history taking, investigations, diagnosis and management. Therefore, we have to emphasize the importance of airway, breathing, and circulation in the very sick patient in any clinical setting.
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