The students have acquired all the applicable theoretical knowledge of the case during the previous multiday PBL sessions. A nasopharyngeal airway is a soft plastic tube with a bevel at one end and a flange at the other. Facebook: http://www.facebook.com/geekymedics Forty percent of respondents reported excessive daytime sleepiness. Nandate, Koichiro MD, PhD; Abola, Ramon MD; Murray, W Bosseau MB; Whitfield, Carol PhD; Lang, Charles PhD; Sinz, Elizabeth MD. Margolis GS, Romer GA, Fernandez AR, et al. 2011;15:108109. Indeed, it is the only thing that ever has.". - 150+ PDF OSCE Checklists: https://geekymedics.com/pdf-osce-checklists/ 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 the first voluntary session in 2006, feedback from the medical students indicated that they would like to receive this handout. See ourintravenous cannulation guidefor more details. However, this turned out to be too slow, took too much time, and could not continuously demonstrate the direction of changes. 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. After the initial treatment is initiated, by showing a simulated urine and blood, and by getting them to smell ketones, we can enable the trainee to confirm the diagnosis of DKA. This field is for validation purposes and should be left unchanged. - Character 02:14 This video demonstrates how to use the SOCRATES acronym when taking a history of pain or other symptoms. A collection of interactive medical and surgical clinical case scenarios to put your diagnostic and management skills to the test. Trainee will recognize the need for therapy and suggest an appropriate therapy in a simulated environment. your express consent. stream 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. You can check out our guide to using SOCRATES here: https://geekymedics.com/the-socrates-acronym-in-history-taking/ Tilt the forehead back whilst lifting the chin forwards to extend the neck. 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. DY{Qb"(EgN$QI*%XN1F""0a5 We also show them IV bags containing saline and Ringers lactate, as well as show them IV infusion sets. Please note that by doing so you agree to be added to our monthly email newsletter distribution list. If the patient has clinical signs ofanaphylaxis(e.g. - Exacerbating & relieving factors 05:12 If the patientloses consciousnessand there areno signs of lifeon assessment, put out acrash callandcommence CPR. Performing an ECG should not delay the emergency management of DKA. In the meantime, you should re-assess and maintain the patients airway. We give the history of the patient to the trainees. Place one hand on the patients forehead and the other under the chin. Twitter: http://www.twitter.com/geekymedics It involves a facilitating instructor, a small learner group and conceptual aspects of environmental and manikin staging to provide sensory cues. Refer to your local guidelines for further details. can be reemphasized, and the effects of fluid therapy demonstrated. 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. 3. The students are in their first year. DO NOT perform any examination or procedure on patients based purely on the content of these videos. If foreign material is present, attempt removal using suction. Development of simulation scenarios for an adolescent patient with diabetic ketoacidosis. A comprehensive collection of OSCE guides to common clinical procedures, including step-by-step images of key steps, video demonstrations and PDF mark schemes. They should introduce the student group to the environment, assign roles for each learner and guide the decision-making process. In some cases, normal saline with additional potassium is required to prevent overcorrection of serum potassium levels which would otherwise result in hypokalaemia. Emergency medical services workLife characteristics contribute to clinically significant excessive daytime sleepiness. Are any further assessments or interventions required? If an obstruction is visible within the airway, use afingersweeporsuctionto remove it. 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. Review thepatients notes,chartsandrecent investigation results. Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. 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. Trainee will increase knowledge of professional behaviors during the simulation. Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. 1. If the patient loses consciousness and there are no signs of life on assessment, put out a crash call and commence CPR. If fever is present, make sure to consider co-existing infection. x]o ]?9kgq~:)?hE )R6!up}\<8||\]}Y~;xp~yQ$#4~djX&{n_m-]^K1/~/AD Hv 99evs,;8}8zwnhFxV.kf-V^? This simulation session therefore aims to make the case come alive, and show this known case in a clinical context. 2007. We combined both to indicate the continuity of the curriculum, and the building on prior knowledge. You should have another member of the clinical team aiding you in your ABCDE assessment, such a nurse, who can perform observations, take samples to the lab and catheterise if appropriate. Environment & Manikin 1-6. 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! 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). 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)? Over the years, some groups happened to have the simulation session before the completion of the theoretical PBL session. Each clinical case scenario allows you to work through history taking, investigations, diagnosis and management. Initially, we used a blood pressure cuff to generate the blood pressure values. %PDF-1.5 areas of lipohypertrophy) if it is unclear if the patient is diabetic. - Associated symptoms 03:04 Glycosuria leads to urinary losses of potassium through osmotic diuresis. Case-based education adds a real-world aspect to the learning environment. Keywords: diabetic ketoacidosis, simulation, expertise, emergency medicine Introduction Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes mellitus, most . Problems are addressed as they are identified and the patient is re-assessed regularly to monitor their response to treatment. Similar to a ward round, where the instructor would say: Come and listen to this patient with an aortic stenosis. ABG, venepuncture). Refer to your local guidelines for further details. www.cdc.gov/diabetes/statistics/prev/national/. 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). insulin-dependent type 2 diabetes), Altered consciousness (e.g. Simulation in Healthcare4(4):232-236, Winter 2009. DO NOT perform any examination or procedure on patients based purely on the content of these videos. insulin-dependent type 2 diabetes) Symptoms Typical symptoms of DKA include: Palpitations Nausea Vomiting Sweating Thirst Weight loss Leg cramps Clinical signs Typical clinical signs of DKA include: Tachycardia Hypotension 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. The student group is given a short introduction into a closed simulation environment. The use of case-based simulation, although more complicated and time consuming for the instructor, immerses the students in the subject matter. By joining Cureus, you agree to our Competency-based medical education has seen widespread adoption in the field along with ongoing work in the areas of . >> Fernandez AR, Mac Crawford J, Pennell ML, et al. If an infection is suspected, IV antibioticsshould be administered as soon as possible. LYqC+pJ&6X4onfBT#?=R}.p8N3+Dk,P4tIgWB}-L'=8;_G >,K#.e89XnG'B~NtR Catheterisethe patient to closelymonitor urine outputto guide fluid resuscitation and need for escalation. A fixed-rate intravenous insulin infusion should be commenced initially to suppress ketogenesis, reduce blood glucose levels and address electrolyte disturbances. Weight, Height: Not given, normal appearing (as per simulator) but has lost 20 lbs recently. - 700+ OSCE Stations: https://geekymedics.com/osce-stations/ SimMan Nursing Scenarios Software. 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. The instructors role is to facilitate active learning through a combination of learning styles. to below 12 mmol/L) an infusion containing normal saline and 5% dextrose is typically commenced to prevent the development of hypoglycaemia, whilst allowing insulin therapy to continue to suppress ketogenesis and reduce serum electrolyte concentrations. Highlight selected keywords in the article text. Laschinger S, Medves J, Pulling C, et al. We have been presenting Simulation Laboratory sessions to our preclinical medical students (first and second years). You may be trying to access this site from a secured browser on the server. I assigned true to life parking codes, and added some extra parking for the superfluous US Express AI. DIABETIC KETOACIDOSIS MODULE: ENDOCRINOLOGY / METABOLIC TARGET: ALL PAEDIATRIC TRAINEES;NURSING STAFF BACKGROUND: DKA occurs when a relative or absolute lack of insulin leads to the inability to metabolise glucose. Deteriorationshould be recognised quickly and acted upon immediately. Introduceyourselfto thepatientincluding yournameandrole. Several environments may be suitable for your classroom. dq-]gX4 `L'u7myx) rpjf0z,.y`VMyx-&Ju`U0 In this manner, the students have to apply their knowledge at the appropriate points during the progression of the scenario. Discuss the patients current clinical condition with aseniorclinicianusing anSBARR style handover. Review the patientscurrent medicationsand check any regular medications areprescribed appropriately. As with the animated lecture, the simulation is strongly dependent on a focused case study. Using SOCRATES in History Taking | OSCE | Communication Skills, Diabetic Ketoacidosis (DKA) | Acute Management | ABCDE. Centers for Disease Control and Prevention. 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. Extremities: mild cyanosis, no clubbing or edema (verbalized by instructors); pulses equal, and symmetrical (elucidated by trainees). Strategies of high-performing paramedic educational programs. Trainee will practice or observe good teamwork skills, both as a leader and a team player. See ourhistory taking guidesfor more details. 3. The Pratcice Simulation provides a safe environment where learning is enhanced through the deliberate practice of skills and controlled management of a variety of clinical encounters. 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. There are actually two sets of educational objectives: the first set is for the theoretical PBL sessions, and the 2nd set is for the Simulation Session. At the end of the previous section, the trainee can make the diagnosis of DKA but has not confirmed it yet. Inspect for evidence of self-injection sites (e.g. During an immersive simulation, its imperative the group uses critical-thinking skills and group collaboration independently. Trainee will describe the changes in vital signs, the major metabolic, fluid, and electrolyte. KDCA, Ronald Reagan Washington National Airport, DC. Diabetes (type 1 and type 2) in children and young people: diagnosis and management. - Severity 05:32 We try to provide sufficient realism.. Inspect the urine currently in the catheter bag and note its appearance (e.g. However, this leads to confusion. In this section, we have to help the trainee to institute definitive therapy based on the underlying biochemical abnormalities. 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. 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). may email you for journal alerts and information, but is committed % 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].. - Examples 05:45 Measure the patients capillary blood glucose and ketone levels to confirm the diagnosis and guide the management of DKA. Facilitator to ask how often to measure BMs Search for Similar Articles A number of key modifiers are described that allow for the adjustment of case . *=NdL/c2XSJn8:I Jb8'.8>N*[L .hxw6afq40DX3c~>abt'Q,8y(BZu(vKBTufIR. modify the keyword list to augment your search. 4 0 obj 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. 2008;6:278302. You might also be interested in our awesome bank of 700+ OSCE Stations. Note that if-thens must also include negative patient outcomes for when the provider doesnt take appropriate action. Inspect for evidence of infection on the skin (e.g. DKA can develop within 24 hours and is potentially life threatening, requiring prompt recognition and therapeutic intervention. 2 0 obj Effectiveness of simulation on health profession students knowledge, skills, confidence and satisfaction. Geeky Medics accepts no liability for loss of any kind incurred as a result of reliance upon the information provided in this video. and TikTok: https://www.tiktok.com/@geekymedics Patients with DKA require fluid resuscitation to restore circulatory volume, clear ketones, correct electrolyte abnormalities and increase renal perfusion. JEMS. The validity of the HFS-DKA scenario was verified by a certified diabetes nurse educator, a registered nurse, and a clinical nurse educator. 1. Standardized patient as the voice of the simulator (or the simulation operator may play this role). Many of the preclinical students have never seen a real life clinical monitor or even an intravenous (IV) setup. Clinical Simulation in Nursing, Volume 39, 2020, pp. The students are in their first year. Wolters Kluwer Health Alert a senior immediately if you have any concerns about the consciousness level of a patient. For similar reasons, we do not believe a videotaped session will keep the students attention as much as these live simulator sessions. A collection of surgery revision notes covering key surgical topics. confusion, coma), All critically unwell patients should have. Acad Med. endobj The use of a simulated, evolving case scenario was an effective method of exposing nursing students to complex patient care. Chapters: They have had no clinical exposure or any clinical experience. 2. 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. Both external and internal potassium balances are disturbed during the development and treatment of DKA. 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. Please enable scripts and reload this page. Cureus 9(5): e1286. A comprehensive collection of clinical examination OSCE guides that include step-by-step images of key steps, video demonstrations and PDF mark schemes. She is lethargic and slightly confused but can intermittently respond to questions. 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). 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. 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. 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. Published August 2015. type 1 diabetes), Complete insulin insensitivity (e.g. If the patient has COPD and a history of CO2retention you should switch to aventuri maskas soon as possible andtitrate oxygen appropriately. - Timing 03:23 One of the key differences with the immersive simulation is that the instructor is absent from the simulation environment. Download: http://teamworkmatters.ocbmedia.com/media/DKA-Simulation-Scenario.docx Categories: 5th Year MBChB paeds scenario, Emergency Department, Human Factors, Interprofessional / multidisciplinary, Non-technical skills, Paediatrics, Postgraduate / newly qualified, Undergraduate / pre-registration Rating It was 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). The normal reference range for fasting plasma glucose is 4.0 5.8 mmol/l. Groups of fewer than four students dont allow for optimal collaboration. The Theory Open the patients mouth to ensure there is no foreign material that may be pushed into the larynx. The reason for inserting the airway upside down initially is to reduce the risk of pushing the tongue backwards and worsening airway obstruction. We then start the DKA state. See Appendix D, Supplemental Digital Content 4, https://links.lww.com/SIH/A4. 2. COVID-19 Screening in the Pediatric Emergency Department. endobj Perform urinalysis and send the urine for culture if urinary tract infection is suspected. As this is a PBL session, the trainees are not given any references. Initially, we required the students to write down the vital signs. 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. 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. Given such a small group, the students indicated that they feel more involved than they would with a larger group (eg, the whole class.) They have had no clinical exposure or any clinical experience. 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. This typically involves the use of anon-rebreathe maskwith an oxygen flow rate of15L. Available from: [. Using the arterial line, the scenario becomes much more dynamic. 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. An hour was . The simulation session is also hosted as an interactive session. Using your thumbs, slightly open the mouth by downward displacement of the chin. Advance the airway until it lies within the pharynx. 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). 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. 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. The choice of fluid type, rate of administration and volume should be tailored to the individual patient based upon their vital signs and electrolytes. Depending on scenario complexity, team dynamic and treatment modalities, this simulation may take 1020 minutes. It involves working through the following steps: Each stage of the ABCDE approach involvesclinicalassessment,investigationsandinterventions. The questionnaire for the assessment of the session is given in full in the web-based supplement (Appendix A, Supplemental Digital Content 1, https://links.lww.com/SIH/A1). 3 0 obj Surgical dressings and imitation blood can support medical history. Your message has been successfully sent to your colleague. 2. A comprehensive collection of medical revision notes that cover a broad range of clinical topics. Trainee will correlate the underlying pathophysiology with symptoms and signs as exhibited by the simulation session. An animated lecture may be described as a pseudo-simulation environment. Trainee will learn to collaborate with peers to decide on appropriate interventions, tests, and therapy. 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. Instead, instructors should combine case- and simulation-based techniques when teaching diabetic assessment. 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). Make sure to re-assess the patient after any intervention. MassBay EMS Program Integrates Training for Dogs, Heat Waves Are Killing More LA Homeless People. We are looking for declaration of DKA and request for pathway. 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. Intubation lubricants can mimic drooling. We have 18 to 20 PBL groups for an hour each in the week after their PBL DKA session. The lecture allows for understanding of concepts prior to action, and instructor feedback is immediate. Askhow the patient is feeling as this may provide some useful information about their current symptoms. Blood sugar issues in the Type II diabetic will have a gradual onset, with diagnosis generally resulting from routine laboratory exams.(1). As individuals with uncontrolled type I . In keeping with the case study, as a treatment marker is reached, the instructor should place emphasis on physiological, pharmacological, environmental and psychosocial issues. The objective is to give as many visual and tactile cues concerning the patient condition and background as possible. - Site 01:12 <> Makeup may be used to depict gender, hollow eyes and cheeks, produce pallor or display bruises and scars. Immersive simulations are mentally exhausting because they create an intense and stressful atmosphere requiring the learner to work outside their comfort zone. 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). Often, the learner group will be unaware of these behaviors, but the instructor can key into the first few comments made during the transition between rooms. Therefore, the same file is also sent to the participants before the session. Geeky Medics accepts no liability for loss of any kind incurred as a result of reliance upon the information provided in this video. 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 . Therefore, we have to emphasize the importance of airway, breathing, and circulation in the very sick patient in any clinical setting. You may be asked to review a patient with DKA due to confusion, reduced level of consciousness, tachycardia, hypotension and/or vomiting. You may search for similar articles that contain these same keywords or you may Scenarios. 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).
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