We try to provide sufficient realism.. 2011;15:108109. Search for Similar Articles . The use of a simulated, evolving case scenario was an effective method of exposing nursing students to complex patient care. Her medical, social, and family histories are not clear at the time of admission to the emergency department. The teaching of diabetic assessment and management, like many other medical emergencies, lends itself well to case-based simulation. Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. 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. 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. 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. Strategies of high-performing paramedic educational programs. Antibiotics should be prescribed in keeping with local guidelines. 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. Initially, we required the students to write down the vital signs. - 700+ OSCE Stations: https://geekymedics.com/osce-stations/ Highlight selected keywords in the article text. Recognize the signs and symptoms of a patient presenting with diabetic ketoacidosis. ABG, venepuncture). She does not take this regularly. Keywords: diabetic ketoacidosis, simulation, expertise, emergency medicine Introduction Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes mellitus, most . 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. The choice of fluid type, rate of administration and volume should be tailored to the individual patient based upon their vital signs and electrolytes. They have had no clinical exposure or any clinical experience. By joining Cureus, you agree to our The following scenarios are available for download and are designed to meet your multi-disciplinary nursing needs. Insert the airway bevel-end first, vertically along the floor of the nose with a slight twisting action. Ketones show 5.5. She Died the Next Day. This typically involves the use of anon-rebreathe maskwith an oxygen flow rate of15L. An animated lecture may be described as a pseudo-simulation environment. Despite this increased calorie intake, she noticed an unexplained 20 lbs weight loss. In the meantime, you can perform some basic airway manoeuvres to help maintain the airway whilst awaiting senior input. A collection of communication skills guides, for common OSCE scenarios, including history taking and information giving. 2003;78:783788. Generaltipsfor applying anABCDEapproachin an emergency setting include: Acute scenarios typically begin with abriefhandoverfrom a member of thenursing staffincluding thepatients name,age,backgroundand thereasonthereviewhas been requested. Scenario in a Nutshell Diabetic ketoacidosis (DKA) in pregnancy. Competency-based medical education has seen widespread adoption in the field along with ongoing work in the areas of . <> She tends to drink sugar containing fluids (soda) when she is thirsty, and she eats fast foods (cream-filled muffins) when she is hungry. 2010;49:578586. If an obstruction is visible within the airway, use afingersweeporsuctionto remove it. 3. Performing an ECG should not delay the emergency management of DKA. Each PBL case typically goes over 23 days, affording the students periods to find information for the case. Section snippets . In some cases, normal saline with additional potassium is required to prevent overcorrection of serum potassium levels which would otherwise result in hypokalaemia. Schneider Sarver PA, Senczakowicz EA, Slovensky BM. If the patientloses consciousnessand there areno signs of lifeon assessment, put out acrash callandcommence CPR. 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. DO NOT perform any examination or procedure on patients based purely on the content of these videos. A collection of free medical student quizzes to put your medical and surgical knowledge to the test! Geeky Medics accepts no liability for loss of any kind incurred as a result of reliance upon the information provided in this video. A collection of surgery revision notes covering key surgical topics. - PSA Question Pack: https://geekymedics.com/psa-question-bank/ % Geeky Medics accepts no liability for loss of any kind incurred as a result of reliance upon the information provided in this video. Subscribe to our newsletter to be the first to know about our latest content: https://geekymedics.com/newsletter/ 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. 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 . 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). Trainee will practice or observe good teamwork skills, both as a leader and a team player. An oxygen mask is also demonstrated as an alternative device, as these early trainees had mostly not yet seen any of these devices. JEMS. 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. 1. Capillary refill timemay be prolonged if the patient is hypovolaemic. can be reemphasized, and the effects of fluid therapy demonstrated. 1. Many of the preclinical students have never seen a real life clinical monitor or even an intravenous (IV) setup. 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. 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].. 5. J Nurs Educ. Prehosp Emerg Care. Facebook: http://www.facebook.com/geekymedics The instructor should have visual access via one-way windows or cameras. Does the patient need a referral toHDU/ICU? However, this leads to confusion. Makeup may be used to depict gender, hollow eyes and cheeks, produce pallor or display bruises and scars. If any obstruction is encountered, remove the tube and try the left nostril. 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. 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. If an infection is suspected, IV antibioticsshould be administered as soon as possible. Make sure to re-assess the patient after any intervention. There are just a few more things to do. 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. Introduceyourselfto whoever has requested a review of the patient andlistencarefullyto their handover. your express consent. 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. Trainee will increase knowledge of professional behaviors during the simulation. A nasopharyngeal airway is a soft plastic tube with a bevel at one end and a flange at the other. 4 0 obj Trainee will improve their understanding of clinical practice through reflective assessment of actual cases during the prior PBL sessions. To read Pages full Research Review column, visit www.jems.com/patient-care. Case-based simulation should include two to three broad-focus objectives, as well as 1020 specific performance measures that the student should accomplish. 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. 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). 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. We also show them IV bags containing saline and Ringers lactate, as well as show them IV infusion sets. The validity of the HFS-DKA scenario was verified by a certified diabetes nurse educator, a registered nurse, and a clinical nurse educator. Each performance measure is separated into cognitive, behavioral or technical categories. A fixed-rate intravenous insulin infusion should be commenced initially to suppress ketogenesis, reduce blood glucose levels and address electrolyte disturbances. 1. In the simulated environment, trainees will ask questions on how to interpret the data that they observe on the monitors and interpretation of clinical signs and symptoms on the manikin. Development of simulation scenarios for an adolescent patient with diabetic ketoacidosis. x]o ]?9kgq~:)?hE )R6!up}\<8||\]}Y~;xp~yQ$#4~djX&{n_m-]^K1/~/AD Hv 99evs,;8}8zwnhFxV.kf-V^? MassBay EMS Program Integrates Training for Dogs, Heat Waves Are Killing More LA Homeless People. Trainee will be respectful to others and their views during the PBL session. 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. - Geeky Medics OSCE App: https://geekymedics.com/geeky-medics-app/ 1-6. After initial insulin therapy has reduced plasma blood glucose levels (e.g. Reduced urine output (oliguria) is typically defined as less than 0.5ml/kg/hour in an adult. The students are in their first year. The main goal is to establish a safe learning environment for the learner [9, 13 . Trainee will appropriately request assistance and use available resources. 1) Please read through this document as it will help you prepare for your upcoming simulation on DKA. Emergency medical services workLife characteristics contribute to clinically significant excessive daytime sleepiness. Example: If the provider immediately evaluates blood glucose, then the reading will display 45 mg/dL. 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. We now provide the students with handouts of the data to save time and provide consistency. Trainee will recognize the need for therapy and suggest an appropriate therapy in a simulated environment. unilateral coarse crackles may be present if the patient has pneumonia which may have been the precipitant for DKA). angioedema, rash) commence appropriate treatment as discussed in ouranaphylaxis guide. A number of key modifiers are described that allow for the adjustment of case . From the Department of Anesthesiology, Pennsylvania State University College of Medicine, Hershey, PA. Dr. Murray is on the Speakers Bureau of METI, Sarasota, FL. Both external and internal potassium balances are disturbed during the development and treatment of DKA. Virtual patient simulation (VPS) is an interactive computer simulation that recreates real-world scenarios with the objectives of training, education, and assessment for health care providers [].Virtual simulation has been used extensively to adapt nursing education to the COVID-19 pandemic context [], such as social distancing and/or confinement. 3. Check out our other awesome clinical skills resources including: DKA can be caused by either: Absolute insulin deficiency (e.g. 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). Supplemental digital content is available for this article. The objective is to give as many visual and tactile cues concerning the patient condition and background as possible.