dka simulation scenario

As this is an interactive discussion session, any needed debriefing and/or explanation is given during the sessions. A comprehensive collection of medical revision notes that cover a broad range of clinical topics. <>>> Antibiotics should be prescribed in keeping with local guidelines. 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. 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. The scenario would include an if-then algorithm. Supplemental digital content is available for this article. They should introduce the student group to the environment, assign roles for each learner and guide the decision-making process. Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. 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. Patients with DKA require fluid resuscitation to restore circulatory volume, clear ketones, correct electrolyte abnormalities and increase renal perfusion. 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. For example, you could develop a diabetic scenario in which the prehospital provider encounters an altered patient with incomprehensible speech. Instead, instructors should combine case- and simulation-based techniques when teaching diabetic assessment. 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. See ourdocumentation guidesfor more details. 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. DY{Qb"(EgN$QI*%XN1F""0a5 Despite this increased calorie intake, she noticed an unexplained 20 lbs weight loss. - 150+ PDF OSCE Checklists: https://geekymedics.com/pdf-osce-checklists/ DOI 10.7759/cureus.1286. DO NOT perform any examination or procedure on patients based purely on the content of these videos. 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. After the first voluntary session in 2006, feedback from the medical students indicated that they would like to receive this handout. - 700+ OSCE Stations: https://geekymedics.com/osce-stations/ Her medical, social, and family histories are not clear at the time of admission to the emergency department. Privacy Policy The researchers found that long shift hours (24hrs), working overtime and marital/relationship stress were strongly correlated. Prehosp Emerg Care. insulin-dependent type 2 diabetes), Altered consciousness (e.g. Available from: [, NICE guidelines. Development of simulation scenarios for an adolescent patient with diabetic ketoacidosis. 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). Trainee will get to know how professionals behave during management of a critically ill patient. A collection of anatomy notes covering the key anatomy concepts that medical students need to learn. MassBay EMS Program Integrates Training for Dogs, Heat Waves Are Killing More LA Homeless People. In the final 10 minutes, we show how the patient has a good recovery after fluid replacement. Open the patients mouth to ensure there is no foreign material that may be pushed into the larynx. Scenario in a Nutshell Diabetic ketoacidosis (DKA) in pregnancy. You may be trying to access this site from a secured browser on the server. - Medical Finals Question Pack: https://geekymedics.com/medical-student-finals-questions/ An animated lecture may be described as a pseudo-simulation environment. The Theory Note that if-thens must also include negative patient outcomes for when the provider doesnt take appropriate action. 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. If you have any scenarios you would be willing to share with the simulation community, please forward them . It was developed for anesthesiology resident physicians with some background knowledge and experience caring for critically ill patients. The simulation experience serves to give substance to the theoretical words and concepts that the students encountered during the PBL sessions. Using the arterial line, the scenario becomes much more dynamic. 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. Some error has occurred while processing your request. 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 Similar to a ward round, where the instructor would say: Come and listen to this patient with an aortic stenosis. *=NdL/c2XSJn8:I Jb8'.8>N*[L .hxw6afq40DX3c~>abt'Q,8y(BZu(vKBTufIR. www.cdc.gov/diabetes/statistics/prev/national/. Because of the early stage (first year) of their medical careers, they have not yet seen vital sign monitoring, or patients, so these clinical aspects are introduced and emphasized. NPAs are typically better tolerated in patients who are partly or fully conscious compared to oropharyngeal airways. Debriefing The students are in their first year. Consider any precipitating factors for the development of DKA and involve the diabetes team in the patients care. His Wife Gave Him CPR. 4. We now provide the students with handouts of the data to save time and provide consistency. Review the patientsoxygen saturation(SpO2): Auscultate the chest to screen for evidence of respiratory pathology (e.g. - 2500+ OSCE Flashcards: https://geekymedics.com/osce-flashcards/ 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. General: Moaning, asking what has happening to her. endobj Before trainees arrival into the simulation area, the simulator is already preprogrammed for DKA. 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. <> Schneider Sarver PA, Senczakowicz EA, Slovensky BM. 5. This field is for validation purposes and should be left unchanged. Standardized patient as the voice of the simulator (or the simulation operator may play this role). diagnosis of DKA Trigger 3, ABG show acidosis and high BM and normal potassium. See ourhistory taking guidesfor more details. 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. tall tented T waves in hyperkalaemia). I assigned true to life parking codes, and added some extra parking for the superfluous US Express AI. Works with Traffic 2005, but . Using your thumbs, slightly open the mouth by downward displacement of the chin. An hour was . 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). Conclusion J Nurs Educ. Finally, we summarize the course and give them time for questions. Weight, Height: Not given, normal appearing (as per simulator) but has lost 20 lbs recently. If the patientloses consciousnessand there areno signs of lifeon assessment, put out acrash callandcommence CPR. Highlight selected keywords in the article text. 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. At the end of the previous section, the trainee can make the diagnosis of DKA but has not confirmed it yet. The students mentioned that they did not obtain the maximum value from the simulation session under these circumstances. 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 give the history of the patient to the trainees. They have had no clinical exposure or any clinical experience. Review thepatients notes,chartsandrecent investigation results. COVID-19 Screening in the Pediatric Emergency Department. Medical Simulation Scenarios are text documents outlining the various details of a simulation - everything from patient simulator settings to debriefing notes. 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. The files are given in full in the web supplement (Appendix B, Supplemental Digital Content 2, https://links.lww.com/SIH/A2). Geeky Medics accepts no liability for loss of any kind incurred as a result of reliance upon the information provided in this video. It was If you have any scenarios you would be willing to share with the simulation community, please forward them to me. We are adding to their theoretical knowledge by introducing them to physical objects, dynamic moving vital sign signals, and a moving, breathing simulated patient to make the case come alive. cloudy urine may indicate urinary tract infection). She Died the Next Day. When erroneous treatment is delivered, the instructor can end the simulation. As this is a PBL session, the trainees are not given any references. We then start the DKA state. See Appendix D, Supplemental Digital Content 4, https://links.lww.com/SIH/A4. type 1 diabetes) Complete insulin insensitivity (e.g. 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). Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. If any obstruction is encountered, remove the tube and try the left nostril. Initially, we required the students to write down the vital signs. Clinical Simulation in Nursing, Volume 39, 2020, pp. 1) Please read through this document as it will help you prepare for your upcoming simulation on DKA. Given such a small group, the students indicated that they feel more involved than they would with a larger group (eg, the whole class.) 2003;78:783788. Circulating nurse in the emergency room (ER). 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. A patient presenting with altered level of consciousness and a blood sugar level below 80 mg/dL should be considered hypoglycemic, and treatment modalities should be consistent with those for a diabetic patient. 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. can be reemphasized, and the effects of fluid therapy demonstrated. 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. Our simulated patient is a 25-year-old woman, Tiffany, who has been taken to the Emergency Department from her soccer game by her boyfriend, Adam. Interactive lecture/discussion with use of monitors that show the vital signs of the simulated patient on manikin. Stage 1: Initial assessment of acutely unwell pregnant woman and diagnosis of DKA. 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 patients drug chart for medications which may cause a reduced level of consciousness (e.g. Its absolutely necessary to follow all immersive simulations with a positive, emotionally safe and nonjudgmental debriefing environment. This is a 25-year-old woman with a medical history of diabetes medicated with 40 units insulin per day. Recognize the signs and symptoms of a patient presenting with diabetic ketoacidosis. We also show them IV bags containing saline and Ringers lactate, as well as show them IV infusion sets. . The teaching of diabetic assessment and management, like many other medical emergencies, lends itself well to case-based simulation. You may be asked to review a patient with DKA due to confusion, reduced level of consciousness, tachycardia, hypotension and/or vomiting. This allows us to get in touch for more details if required. We combined both to indicate the continuity of the curriculum, and the building on prior knowledge. 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. 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. Animated Lecture 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. The DKA simulation incorporates cue recognition, analysis of cues, generation of solutions, nursing interventions, and evaluation of outcomes, including effective communication and psychosocial concerns. The lecture allows for understanding of concepts prior to action, and instructor feedback is immediate. Observe and discuss the effects of therapy in a mathematically modeled physiological simulator. - Onset 01:48 Well done, youve now stabilised the patient and theyre doing much better. Ketones show 5.5. Manikin staging can provide strong cues. They should be used in conjunction with the maneuvres mentioned above as the position of the head and neck need to be maintained to keep the airway aligned. Glycosuria leads to urinary losses of potassium through osmotic diuresis. - Over 3000 Free MCQs: https://geekyquiz.com/ }HyEf,#$/JSRU9+CF6k\'/z+i`[ 5JudK*Zly^g%[jCK)H[)Y=Qp0/r9o9HW_zF}pTzI~'|q.~:=Y T 9w! Trainee will learn to collaborate with peers to decide on appropriate interventions, tests, and therapy. We have spent many hours debating whether the small group format was a waste of time. Simulation Scenario for Anesthesia Providers Clark Obr, MD*, Anthony Mueller, MD . DOWNLOAD Diabetic Ketoacidosis By the end of this scenario, the learner will be able to: 1. Categories: Emergency Medicine, Medical Education Keywords: diabetic ketoacidosis, simulation, expertise, emergency medicine . The instructors never expect the trainees to exhibit full understanding of pathophysiology and skills in the treatment but do give them a few important points to understand the diagnosis and initial treatment of the patients with DKA. 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. 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 relationship between sleep, fatigue and patient and provider safety. 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. Facebook: http://www.facebook.com/geekymedics 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. 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.. PBL was introduced at our institution in 1995. An oxygen mask is also demonstrated as an alternative device, as these early trainees had mostly not yet seen any of these devices. Seek senior helpif the patient shows no signs of improvement or if you have any concerns. 2. Each clinical case scenario allows you to work through history taking, investigations, diagnosis and management. (1) According to Centers for Disease Control and Prevention (CDC), 223,619 deaths were attributed to diabetes in 2005. Make sure thepatientsnotes,observationchartandprescriptionchartare easily accessible. 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. 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. 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. The authors of the second study reported that poor sleep quality (60% of respondents) and extreme fatigue (55% of respondents) are independently associated with safety risks on the job. Available from: [. 2. 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. In keeping with the case study, as a treatment marker is reached, the instructor should place emphasis on physiological, pharmacological, environmental and psychosocial issues. In this manner, the students have to apply their knowledge at the appropriate points during the progression of the scenario. She tends to drink sugar containing fluids (soda) when she is thirsty, and she eats fast foods (cream-filled muffins) when she is hungry. Blood sugar issues in the Type II diabetic will have a gradual onset, with diagnosis generally resulting from routine laboratory exams.(1). GRAPH. Lets discuss your options. A number of key modifiers are described that allow for the adjustment of case . The faculty member/course coordinator of Simulation Design The Pratcice Mosby:Philadelphia. We try to provide sufficient realism.. 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. angioedema, rash) commence appropriate treatment as discussed in ouranaphylaxis guide. Terms of Use. Trainee will increase knowledge of professional behaviors during the simulation. 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. 2017 May 29;9(5):e1286. We do not use passive visualizing materials such as videotapes or DVD other than vital signs shown on the monitors. She does not take this regularly. Emergency medical services workLife characteristics contribute to clinically significant excessive daytime sleepiness. The HFS-DKA simulation teaching consisted of pre-briefing (an hour), running simulation (30 minutes) and debriefing (an hour) for the high-fidelity simulator using the Lardeal SIM man . Cureus 9(5): e1286. 2. 1. Simulation Scenario. It should only be inserted in unconscious patients as it is otherwise poorly tolerated and may induce gagging and aspiration. With your index and other fingers placed behind the angle of the mandible, apply steady upwards and forward pressure to lift the mandible. TikTok: https://www.tiktok.com/@geekymedics This guide provides an overview of the recognition and immediate management of diabetic ketoacidosis (DKA)using an ABCDE approach. Instructors should write a case study for the simulation before the session. Check out our other awesome clinical skills resources including: The facilitator guides the group only when necessary. You can check out our guide to using SOCRATES here: https://geekymedics.com/the-socrates-acronym-in-history-taking/ A collection of free medical student quizzes to put your medical and surgical knowledge to the test! - PSA Question Pack: https://geekymedics.com/psa-question-bank/ A nasopharyngeal airway is a soft plastic tube with a bevel at one end and a flange at the other. 1. Below is a collection of donated scenarios for you to use or modify. In this case scenario, dehydration is one of the most serious immediate issues. 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. 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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. Your message has been successfully sent to your colleague. Review the patientscurrent medicationsand check any regular medications areprescribed appropriately. vD0 x@FFJ{m[ 3//Oh|JR7! If fever is present, make sure to consider co-existing infection. If an infection is suspected, IV antibioticsshould be administered as soon as possible. The main goal is to establish a safe learning environment for the learner [9, 13 . - Associated symptoms 03:04 opioids, sedatives, anxiolytics, insulin, oral hypoglycaemic medications). This video demonstrates how to use the SOCRATES acronym when taking a history of pain or other symptoms. In this section, we have to guide them as to what they should do first for the patient in this critical condition (ie, treat the A, B, Cs of airway, breathing, and circulation) before we can confirm the diagnosis. Nandate, Koichiro MD, PhD; Abola, Ramon MD; Murray, W Bosseau MB; Whitfield, Carol PhD; Lang, Charles PhD; Sinz, Elizabeth MD. This is particularly important for core . We are looking for declaration of DKA and request for pathway. Healthcare Students' Psychological Well-Being in a Diabetic Ketoacidosis Simulation. Make sure tore-assessthe patient after anyintervention. Refer to your local guidelines for further details. For similar reasons, we do not believe a videotaped session will keep the students attention as much as these live simulator sessions. 1-6. Over the years, some groups happened to have the simulation session before the completion of the theoretical PBL session. 3. If the patient isunconsciousorunresponsive, start thebasic life support(BLS)algorithmas per resuscitation guidelines. Given 6 to 8 back-to-back sessions, it is critical that every session starts and ends on time! ABG, venepuncture). The objective is to give as many visual and tactile cues concerning the patient condition and background as possible. We have been presenting Simulation Laboratory sessions to our preclinical medical students (first and second years). 3 0 obj The 60 minutes training time consists of four 15-minute sections divided as follows. As with the animated lecture, the simulation is strongly dependent on a focused case study. Ask for anotherclinicalmemberofstafftoassistyou if possible. Check the patency of the patients right nostril and if required (depending on the model of NPA) insert a safety pin through the flange of the NPA. 2008;6:278302. 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. Please write a single word answer in lowercase (this is an anti-spam measure). <> 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. your express consent. Insert at least onewide-bore intravenous cannula(14G or 16G) and take blood tests as discussed below. During an immersive simulation, its imperative the group uses critical-thinking skills and group collaboration independently. If the patient is confused you might be able to get a collateral history from staff or family members as appropriate. 1. The students have acquired all the applicable theoretical knowledge of the case during the previous multiday PBL sessions. <>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 595.32 841.92] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> Properly interpret a venous blood gas (VBG) and basic metabolic panel in a patient presenting with diabetic ketoacidosis. The students are in their basic science course. 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