Trainee will practice or observe good teamwork skills, both as a leader and a team player. Trainee will improve their understanding of clinical practice through reflective assessment of actual cases during the prior PBL sessions. Geeky Medics accepts no liability for loss of any kind incurred as a result of reliance upon the information provided in this video. Standardized patient as the voice of the simulator (or the simulation operator may play this role). We have spent many hours debating whether the small group format was a waste of time. For similar reasons, we do not believe a videotaped session will keep the students attention as much as these live simulator sessions. DKA can develop within 24 hours and is potentially life threatening, requiring prompt recognition and therapeutic intervention. For more information, please refer to our Privacy Policy. Section snippets . Immersive Simulations Place one hand on the patients forehead and the other under the chin. The simulation session is also hosted as an interactive session. Extremities: mild cyanosis, no clubbing or edema (verbalized by instructors); pulses equal, and symmetrical (elucidated by trainees). If the patient loses consciousness and there are no signs of life on assessment, put out a crash call and commence CPR. Many of the preclinical students have never seen a real life clinical monitor or even an intravenous (IV) setup. - 700+ OSCE Stations: https://geekymedics.com/osce-stations/ KDCA, Ronald Reagan Washington National Airport, DC. We combined both to indicate the continuity of the curriculum, and the building on prior knowledge. The researchers found that long shift hours (24hrs), working overtime and marital/relationship stress were strongly correlated. Deteriorationshould be recognised quickly and acted upon immediately. Research Watch Box:Sleep, Fatigue & SafetyBy David Page, MS, NREMT-P 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. 2. stream Review the patientscurrent medicationsand check any regular medications areprescribed appropriately. She tends to drink sugar containing fluids (soda) when she is thirsty, and she eats fast foods (cream-filled muffins) when she is hungry. They should introduce the student group to the environment, assign roles for each learner and guide the decision-making process. 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 in Healthcare4(4):232-236, Winter 2009. www.cdc.gov/diabetes/statistics/prev/national/. By joining Cureus, you agree to our to maintaining your privacy and will not share your personal information without 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. General: Moaning, asking what has happening to her. A simulation training session is described designed to acquaint emergency medicine residents with the presentation and management of diabetic ketoacidosis through the use of simulation. Testing a diabetes keotacidosis simulation in critical care nursing: A We ask the trainee why the blood pressure is so low or heart rate is so high, and how we should treat it. Animated Lecture Interactive lecture/discussion with use of monitors that show the vital signs of the simulated patient on manikin. 2 The evaluation of potassium deficits is complicated by potassium exit from . The file explaining the session is sent to instructors 1 week before the sessions. 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. This guide has been created to assist students in preparing for emergencysimulationsessionsas part of their training,it is not intended to be relied upon for patient care. ABG, venepuncture). After entering the environment, the student doesnt have the option of leaving the simulation until the learning objectives and performance measures are achieved. 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. 1. A comprehensive collection of clinical examination OSCE guides that include step-by-step images of key steps, video demonstrations and PDF mark schemes. Nandate, Koichiro MD, PhD; Abola, Ramon MD; Murray, W Bosseau MB; Whitfield, Carol PhD; Lang, Charles PhD; Sinz, Elizabeth MD. In the context of DKA, a patients consciousness level may be reduced. 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]). 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. Insert the airway bevel-end first, vertically along the floor of the nose with a slight twisting action. - Medical Finals Question Pack: https://geekymedics.com/medical-student-finals-questions/ Diabetes UK with the Joint British Diabetes Societies Inpatient Care Group. Askhow the patient is feeling as this may provide some useful information about their current symptoms. The students mentioned that they did not obtain the maximum value from the simulation session under these circumstances. Highlight selected keywords in the article text. In other words, they do not have clinical experience, but they have clinical knowledge. Terms of Use. 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. A debriefing section with pre-established questions allows the instructor to review the main focus and performance measures with the student group. Its absolutely necessary to follow all immersive simulations with a positive, emotionally safe and nonjudgmental debriefing environment. Glycosuria leads to urinary losses of potassium through osmotic diuresis. She began experiencing progressively worsening thirst, increased appetite, and excessively increased urination. This is a 25-year-old woman with a medical history of diabetes medicated with 40 units insulin per day. 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. Heart: S1 and S2 within normal limits; no S3/S4 or murmurs, normal rate and rhythm. Management of diabetic ketoacidosis in adults. If foreign material is present, attempt removal using suction. 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. 4. This simulation session therefore aims to make the case come alive, and show this known case in a clinical context. These simulation sessions seem to work because the medical students do have prior knowledge. If you'd like to support us and get something great in return, check out our awesome products: You don't need to tell us which article this feedback relates to, as we automatically capture that information for you. Measure the patients capillary blood glucose and ketone levels to confirm the diagnosis and guide the management of DKA. We have 18 to 20 PBL groups for an hour each in the week after their PBL DKA session. Stage 3: Ongoing management and monitoring of DKA 1 hour after initiation of treatment. We used the Medical Education Technologies Inc. (METI) Human Patient Stimulator (HPS, METI Sarasoto, Fl). Perform urinalysis and send the urine for culture if urinary tract infection is suspected. These are not learning objectives in this program. 2. Adds true to life parking codes and extra parking for AI. 2003;78:783788. Effectiveness of simulation on health profession students knowledge, skills, confidence and satisfaction. 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. - Associated symptoms 03:04 Ketones show 5.5. Data is temporarily unavailable. 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. Immersive simulations are mentally exhausting because they create an intense and stressful atmosphere requiring the learner to work outside their comfort zone. 2008;6:278302. 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. 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. Use an effectiveSBARR handoverto communicate the key information effectively to other medical staff. 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 Introduceyourselfto whoever has requested a review of the patient andlistencarefullyto their handover. We then start the DKA state. See Appendix D, Supplemental Digital Content 4, https://links.lww.com/SIH/A4. We try to provide sufficient realism.. Her medical, social, and family histories are not clear at the time of admission to the emergency department. 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. The main goal is to establish a safe learning environment for the learner [9, 13 . Instructors should write a case study for the simulation before the session. There are just a few more things to do. At the end of the previous section, the trainee can make the diagnosis of DKA but has not confirmed it yet. The facilitator guides the group only when necessary. Administer oxygen to all critically unwell patients during yourinitialassessment. Facilitator to ask how often to measure BMs Re-assessthe patient using theABCDE approachto identify any changes in their clinical condition and assess the effectiveness of your previous interventions. Endocrine - thesimbook.com - Over 3000 Free MCQs: https://geekyquiz.com/ 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. 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. Please try again soon. Invasive monitors, including a left radial intraarterial and a right subclavian IV catheter, were placed. 1) Please read through this document as it will help you prepare for your upcoming simulation on DKA. Circulating nurse in the emergency room (ER). The students are in their first year. opioids, sedatives, anxiolytics, insulin, oral hypoglycaemic medications). She does not take this regularly. One of the key differences with the immersive simulation is that the instructor is absent from the simulation environment. Makeup may be used to depict gender, hollow eyes and cheeks, produce pallor or display bruises and scars. If an infection is suspected, IV antibioticsshould be administered as soon as possible. Conclusions This technical report describes the design and implementation of a simulation scenario on DKA for emergency medicine trainees. DKA can be caused by either: Absolute insulin deficiency (e.g. }HyEf,#$/JSRU9+CF6k\'/z+i`[ 5JudK*Zly^g%[jCK)H[)Y=Qp0/r9o9HW_zF}pTzI~'|q.~:=Y T 9w! If the patient is suspected to have sufferedsignificanttraumawith potential spinal involvement, perform ajaw-thrustrather than a head-tilt chin-lift manoeuvre: 2. 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. type 1 diabetes) Complete insulin insensitivity (e.g. Catheterisethe patient to closelymonitor urine outputto guide fluid resuscitation and need for escalation. Simulation Training Ideal for Diabetic Patients - JEMS . 6. In the meantime, you should re-assess and maintain the patients airway. A number of key modifiers are described that allow for the adjustment of case . This is particularly important for core cases and low-frequency, high-stakes procedures and encounters. 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. cloudy urine may indicate urinary tract infection). This session provides additional clinical support material for the theoretical PBL session. (1) The assessment of a diabetic patient is best taught as a. Hypothermia may be present if the patient has been unconscious and exposed for some time. Strategies of high-performing paramedic educational programs. Note that if-thens must also include negative patient outcomes for when the provider doesnt take appropriate action. Facebook: http://www.facebook.com/geekymedics The following scenarios are available for download and are designed to meet your multi-disciplinary nursing needs. In this manner, the students have to apply their knowledge at the appropriate points during the progression of the scenario. After initial insulin therapy has reduced plasma blood glucose levels (e.g. Diabetic Ketoacidosis (DKA) Clinical Pathway Emergency Department | Children's Hospital of Philadelphia Revisit history taking to explore relevant medical history and identify any precipitating factors for DKA. tall tented T waves in hyperkalaemia). 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. Trainee will be able to apply skills of communication with the simulated patient in a semiacute crisis to get sufficient important information for a final diagnosis. . - Radiation 02:45 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 This is particularly important for core . If the patient has clinical signs ofanaphylaxis(e.g. (1), The assessment of a diabetic patient is best taught as a case-based simulation. Clinical Simulation in Nursing, Volume 39, 2020, pp. Stage 2: Emergency management of DKA and consideration of abnormal CTG. 3. Paediatric DKA | Simulation Education dq-]gX4 `L'u7myx) rpjf0z,.y`VMyx-&Ju`U0 Blood sugar issues in the Type II diabetic will have a gradual onset, with diagnosis generally resulting from routine laboratory exams.(1). 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. 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! Insert the oropharyngeal airway in the upside-down position until you reach the junction of the hard and soft palate, at which point you should rotate it 180. <>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 595.32 841.92] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> 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. 4. In this section, we have to help the trainee to institute definitive therapy based on the underlying biochemical abnormalities. 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. Properly interpret a venous blood gas (VBG) and basic metabolic panel in a patient presenting with diabetic ketoacidosis. 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 education adds a real-world aspect to the learning environment. Maintain head-tilt chin-lift or jaw thrust and assess the patency of the patients airway by looking, listening and feeling for signs of breathing. Medical simulation technology is a powerful tool for training physicians but papers dealing with DKA simulators are scarce. your express consent. They have had no clinical exposure or any clinical experience.