We also show them IV bags containing saline and Ringers lactate, as well as show them IV infusion sets. Simulation provides a safe environment where learning is enhanced through the deliberate practice of skills and controlled management of a variety of clinical encounters. Simulation-based medical education: An ethical imperative. 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. 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. 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Senior Emergency ResidentsAuthor / Institution: Anonclick here to download, Topic: Difficult AirwayTitle: Difficult / Failed AirwayTarget: Mid - Senior Emergency ResidentsAuthor / Institution: Anonclick here to download, Topic: Disclosure of an Adverse EventTitle: Retained Guidewire from a Central LineTarget: ICU FellowsAuthor / Institution: Ryan Fink / OHSUclick here to download, Topic: DKA (Diabetic Ketoacidosis)Target: Internal MedicineAuthor / Institute: Jim Boseovski / Queen's Universityclick here to download, Topic: DKATarget: PGY1Author / Institution: Allen Tran, Babar Haroon / Dalhousie Universityclick here to download, Topic: Dyspnea (Shortness of Breath)Title: Acute Pulmonary Edema requiring intubationTarget: Senior Emergency ResidentsAuthor / Institution: Anonclick here to download, Topic: Dyspnea (Shortness of Breath)Title: Severe Asthma requiring intubationTarget: Senior Emergency ResidentsAuthor / Institution: Anonclick here to download, Topic: Electrical StormTarget: Internal MedicineAuthor / Institute: Jim Boseovski / Queen's Universityclick here to download plus chart documents here, Topic: Emergent Med-Surg ResponseTitle: MET/RRT ResponseTargets: Response Teams, House Staff and Respiratory Therapy StudentsAuthor / Instituation: Carl Rod, MS, RRT, RCP, Rose State College RT Clinical Simulation Labclick here to download, Topic: EtOH WithdrawalTitle: EtOH Withdrawal SiezureTarget: PGY1Author / Institution: Allen Tran, Babar Haroon / Dalhousie Universityclick here to download, Topic: Febrile NeutropeniaTarget: Internal MedicineAuthor / Institute: Jim Boseovski / Queen's Universityclick here to download, Topic: Head TraumaTitle: Four Storey FallTarget: Senior Emergency Residents / Trauma TeamAuthor / Institution: Tim Chaplin, Alison Archibaldclick here to download, Topic: Head TraumaTitle: Hit by MotorboatTarget: Senior Emergency Residents / Trauma TeamAuthor / Institution: Tim Chaplin, Alison Archibaldclick here to download, Topic: HypertensionTitle: Aortic DissectionTarget: Senior Emergency ResidentsAuthor / Institution: Anonclick here to download, Topic: HypertensionTitle: Autonomic DysreflexiaTarget: Senior Emergency ResidentsAuthor / Institution: Anonclick here to download, Topic: Hypertensive EmergencyTarget: Internal MedicineAuthor / Institute: Jim Boseovski / Queen's Universityclick here to download, Topic: Hypertensive EmergencyTitle: Diastolic Danger Hypertensive Urgency / EmergencyTarget: PGY1Author / Institution: Hailey Hobbs, Babar Haroon / Dalhousie Universityclick here to download, Topic: HypoxiaTarget: Inter-professional Team TrainingAuthor / Institution: Devin Sydorclick here to download, Topic: Inferior StemiTarget: Internal MedicineAuthor / Institute: Jim Boseovski / Queen's Universityclick here to download, Topic: Labor and delivery, postpartum hemorrhageTitle: Normal Delivery with PPHTarget: Maternal - 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A fixed-rate intravenous insulin infusion should be commenced initially to suppress ketogenesis, reduce blood glucose levels and address electrolyte disturbances. 1 Potassium losses occurring both before and during treatment of DKA must be replaced. 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). Both external and internal potassium balances are disturbed during the development and treatment of DKA. 4. The teaching of diabetic assessment and management, like many other medical emergencies, lends itself well to case-based simulation. reduced air entry, coarse crackles) to screen for evidence of pneumonia. To read Pages full Research Review column, visit www.jems.com/patient-care. These simulation sessions seem to work because the medical students do have prior knowledge. <>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 595.32 841.92] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> your express consent. Simulation Scenario. 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. There are several causes of DKA, which we remember by the "five I's". The normal reference range for fasting plasma glucose is 4.0 5.8 mmol/l. Trainee will be respectful to others and their views during the PBL session. Mosby:Philadelphia. Search for Similar Articles 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. Privacy Policy Please enable scripts and reload this page. Pediatric Emergency Medicine Didactics and Simulation (PEMDAS Moses Lake (WA) Fire Department Gets $3.3M Grant for more Firefighters, Woman Who Crashed into Responders, Killing PA Firefighter, Gets Prison, Three Apparent Gas Explosions at San Bernardino (CA) Mountain Homes, Enid (OK) Fire Department Begins SWAT Medic Program to Assist Police, FDNY EMS Providers Win COVID-19-Linked Free Speech Lawsuit, Coronavirus Origins Still a Mystery Three Years into Pandemic. Research Watch Box:Sleep, Fatigue & SafetyBy David Page, MS, NREMT-P Trainee will recognize the need for therapy and suggest an appropriate therapy in a simulated environment. DOI 10.7759/cureus.1286. We have 18 to 20 PBL groups for an hour each in the week after their PBL DKA session. If an obstruction is visible within the airway, use afingersweeporsuctionto remove it. Trainee will describe the changes in vital signs, the major metabolic, fluid, and electrolyte. Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario 2 The evaluation of potassium deficits is complicated by potassium exit from . Instagram: https://instagram.com/geekymedics This is particularly important for core . Clinical Simulation in Nursing, Volume 39, 2020, pp. A collection of communication skills guides, for common OSCE scenarios, including history taking and information giving. cloudy urine may indicate urinary tract infection). Initially, we required the students to write down the vital signs. Available from: [, NICE guidelines. Introduceyourselfto thepatientincluding yournameandrole. NPAs should not be used in patients who may have sustained a skull base fracture, due to the small but life-threatening risk of entering the cranial vault with the NPA. <> Prehosp Emerg Care. 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. Margolis GS, Romer GA, Fernandez AR, et al. 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. Instructors should write a case study for the simulation before the session. Please note that by doing so you agree to be added to our monthly email newsletter distribution list. Refer to your local guidelines which should provide a clear protocol for the management of DKA. Strategies of high-performing paramedic educational programs. You may be trying to access this site from a secured browser on the server. 2010;49:578586. Conclusions This technical report describes the design and implementation of a simulation scenario on DKA for emergency medicine trainees. PDF DKA Sim Scenario - ABCD (Diabetes Care) Ltd See ourintravenous cannulation guidefor more details. 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. Use washable, non-toxic paints to imitate various body emissions. Just place the BR2_KDCA file into your addons scenery folder: C:\\Program Files\\Microsoft Games\\Microsoft Flight Simulator X\\Addon Scenery\\Scenery. Catheterisethe patient to closelymonitor urine outputto guide fluid resuscitation and need for escalation. may email you for journal alerts and information, but is committed Clearlydocument your ABCDE assessment, including history, examination, observations, investigations, interventions, and the patients response. 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. - Character 02:14 Data is temporarily unavailable. Revisit history taking to explore relevant medical history and identify any precipitating factors for DKA. 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). In the meantime, you can perform some basic airway manoeuvres to help maintain the airway whilst awaiting senior input. 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. They should introduce the student group to the environment, assign roles for each learner and guide the decision-making process. A collection of free medical student quizzes to put your medical and surgical knowledge to the test! Please write a single word answer in lowercase (this is an anti-spam measure). Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario Simulation of Diabetic Ketoacidosis for Cellular and Molecul 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. CCA 175 Real Time Exam Scenario 17 | JOIN Multiple DataFrames | Save as If the patient is confused you might be able to get a collateral history from staff or family members as appropriate. Are any further assessments or interventions required? As this is a PBL session, the trainees are not given any references. Manikin staging can provide strong cues. 3. . The students worked on the underlying physiology during a week long PBL session and are therefore familiar with the theoretical aspects of DKA. Diabetic ketoacidosis (DKA) is a common, potentially lethal disease. A comprehensive collection of OSCE guides to common clinical procedures, including step-by-step images of key steps, video demonstrations and PDF mark schemes. Cureus 9(5): e1286. 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. It should only be inserted in unconscious patients as it is otherwise poorly tolerated and may induce gagging and aspiration. This guide provides an overview of the recognition and immediate management of diabetic ketoacidosis (DKA)using an ABCDE approach. 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. Your message has been successfully sent to your colleague. *=NdL/c2XSJn8:I Jb8'.8>N*[L .hxw6afq40DX3c~>abt'Q,8y(BZu(vKBTufIR. Trainee will get to know how professionals behave during management of a critically ill patient. When erroneous treatment is delivered, the instructor can end the simulation. Trainee will improve their understanding of clinical practice through reflective assessment of actual cases during the prior PBL sessions. If any obstruction is encountered, remove the tube and try the left nostril. 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. ABG, venepuncture). She had developed nausea, extreme fatigue, mild disorientation, and blurred vision toward the end of the soccer match. An animated lecture may be described as a pseudo-simulation environment. - Examples 05:45 2. JEMS. The simulation session is also hosted as an interactive session. Simulation provides a safe environment where learning is enhanced through the deliberate practice of skills and controlled management of a variety of clinical encounters. type 1 diabetes), Complete insulin insensitivity (e.g. 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. - Exacerbating & relieving factors 05:12 Its absolutely necessary to follow all immersive simulations with a positive, emotionally safe and nonjudgmental debriefing environment. Endocrine - thesimbook.com (1), The assessment of a diabetic patient is best taught as a case-based simulation. The students have acquired all the applicable theoretical knowledge of the case during the previous multiday PBL sessions. Creating a Simulation Experience to Promote Clinical Judgment >> Patterson PD, Weaver M, Frank R, et al. 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. Int J Evid Based Healthc. Clearly communicate how often would you like the patients observations relayed to you by other staff members. We found it more important to have the students full attention so that they could concentrate on concepts and not on menial tasks such as recording data. www.cdc.gov/diabetes/statistics/prev/national/. In the meantime, you should re-assess and maintain the patients airway. See Table 4 for a suggested standardized script. Properly interpret a venous blood gas (VBG) and basic metabolic panel in a patient presenting with diabetic ketoacidosis.