- Examples 05:45 If the patient has clinical signs ofanaphylaxis(e.g. Diabetic Ketoacidosis in the Obstetric Population: A Simulation x]o ]?9kgq~:)?hE )R6!up}\<8||\]}Y~;xp~yQ$#4~djX&{n_m-]^K1/~/AD Hv 99evs,;8}8zwnhFxV.kf-V^? Instagram: https://instagram.com/geekymedics In this manner, the students have to apply their knowledge at the appropriate points during the progression of the scenario. 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. 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. You may be asked to review a patient with DKA due to confusion, reduced level of consciousness, tachycardia, hypotension and/or vomiting. Section snippets . We have spent many hours debating whether the small group format was a waste of time. The following scenarios are available for download and are designed to meet your multi-disciplinary nursing needs. Endocrine - thesimbook.com The teaching of diabetic assessment and management, like many other medical emergencies, lends itself well to case-based simulation. Refer to your local guidelines for further details. 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. endobj %PDF-1.5 Each clinical case scenario allows you to work through history taking, investigations, diagnosis and management. TikTok: https://www.tiktok.com/@geekymedics A pre-briefing session is conducted prior to the start of the simulation scenario. It involves a facilitating instructor, a small learner group and conceptual aspects of environmental and manikin staging to provide sensory cues. Cureus 9(5): e1286. 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! Example: If the provider immediately evaluates blood glucose, then the reading will display 45 mg/dL. A fixed-rate intravenous insulin infusion should be commenced initially to suppress ketogenesis, reduce blood glucose levels and address electrolyte disturbances. Keywords: diabetic ketoacidosis, simulation, expertise, emergency medicine Introduction Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes mellitus, most . This simulation session therefore aims to make the case come alive, and show this known case in a clinical context. . Cureus is on a mission to change the long-standing paradigm of medical publishing, where submitting research can be costly, complex and time-consuming. Several environments may be suitable for your classroom. A chest X-ray should not delay the emergency management of DKA. Another example: At one minute into the scenario, the patient becomes unresponsive and their breathing becomes shallow. Observe and discuss the effects of therapy in a mathematically modeled physiological simulator. Geeky Medics accepts no liability for loss of any kind incurred as a result of reliance upon the information provided in this video. 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). The student group should be encouraged to collaborate on management options and to perform skills. The DKA simulation incorporates cue recognition, analysis of cues, generation of solutions, nursing interventions, and evaluation of outcomes, including effective communication and psychosocial concerns. (1) According to Centers for Disease Control and Prevention (CDC), 223,619 deaths were attributed to diabetes in 2005. a simulation training session designed to acquaint emergency medicine residents with the presentation and management of diabetic ketoacidosis (DKA) through the use of simulation. Groups of fewer than four students dont allow for optimal collaboration. Introduceyourselfto whoever has requested a review of the patient andlistencarefullyto their handover. See our blood glucose measurement guide for more details. 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. As the name says, this screen is used to graph and plot any parameter. Chapters: Diabetes (type 1 and type 2) in children and young people: diagnosis and management. We ask the trainee why the blood pressure is so low or heart rate is so high, and how we should treat it. She Died the Next Day. 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). However, this turned out to be too slow, took too much time, and could not continuously demonstrate the direction of changes. 1-6. 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.. With your index and other fingers placed behind the angle of the mandible, apply steady upwards and forward pressure to lift the mandible. Available from: [, NICE guidelines. Manikin staging can provide strong cues. Animated Lecture Extremities: mild cyanosis, no clubbing or edema (verbalized by instructors); pulses equal, and symmetrical (elucidated by trainees). insulin-dependent type 2 diabetes), Altered consciousness (e.g. Debriefing Facebook: http://www.facebook.com/geekymedics areas of lipohypertrophy) if it is unclear if the patient is diabetic. Facilitator to ask how often to measure BMs 3. We combined both to indicate the continuity of the curriculum, and the building on prior knowledge. Perform urinalysis and send the urine for culture if urinary tract infection is suspected. Pediatric Emergency Medicine Didactics and Simulation (PEMDAS 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. The optimal number of simulation participants is four to seven individuals, depending on the case study objectives. 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. 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. Just place the BR2_KDCA file into your addons scenery folder: C:\\Program Files\\Microsoft Games\\Microsoft Flight Simulator X\\Addon Scenery\\Scenery. Patients with DKA require fluid resuscitation to restore circulatory volume, clear ketones, correct electrolyte abnormalities and increase renal perfusion. Int J Evid Based Healthc. Teaching nursing management of diabetic ketoacidosis: a description of 2010;49:578586. We used the Medical Education Technologies Inc. (METI) Human Patient Stimulator (HPS, METI Sarasoto, Fl). It involves working through the following steps: Each stage of the ABCDE approach involvesclinicalassessment,investigationsandinterventions. 2011;15:108109. We guide the group to suggest fluid. Calculate the patients current fluid balance using their fluid balance chart (e.g. Research Watch Box:Sleep, Fatigue & SafetyBy David Page, MS, NREMT-P - Character 02:14 Open the patients mouth to ensure there is no foreign material that may be pushed into the larynx. 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. Trainee will increase knowledge of professional behaviors during the simulation. ABG, venepuncture). Environment & Manikin The diabetes with DKA clinical pathway is a detailed plan of the course of care for pediatric patients seen in the emergency department with diabetic ketoacidosis. It should only be inserted in unconscious patients as it is otherwise poorly tolerated and may induce gagging and aspiration. We have 18 to 20 PBL groups for an hour each in the week after their PBL DKA session. 2003;78:783788. Scenarios thesimtech You can check out our guide to using SOCRATES here: https://geekymedics.com/the-socrates-acronym-in-history-taking/ The simulation experience serves to give substance to the theoretical words and concepts that the students encountered during the PBL sessions. 2. When erroneous treatment is delivered, the instructor can end the simulation. DY{Qb"(EgN$QI*%XN1F""0a5 cloudy urine may indicate urinary tract infection). angioedema, rash) commence appropriate treatment as discussed in ouranaphylaxis guide. PDF Adult Type I Diabetic Ketoacidosis Pre-simulation Preparation Student #geekymedics #fyp #fypviral #studytok #medicalstudentuk #medtok #studytips #studytipsforstudents #medstudentuk #premed #medschoolfinals #shorts, Cardiovascular Exam Tips - DON'T FORGET these 3 things , Watch this video to find out the most COMMONLY FORGOTTEN components of the cardiovascular history! Save this video to help prepare for your upcoming OSCEs and dont forget to follow Geeky Medics! The choice of fluid type, rate of administration and volume should be tailored to the individual patient based upon their vital signs and electrolytes. 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. Case-based education adds a real-world aspect to the learning environment. 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. The students have acquired all the applicable theoretical knowledge of the case during the previous multiday PBL sessions. 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. A strong emphasis is placed on the focused, methodical examination of a specific medical problem and the decision-based treatment options available. 3. DO NOT perform any examination or procedure on patients based purely on the content of these videos. After the first voluntary session in 2006, feedback from the medical students indicated that they would like to receive this handout. Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. endobj Trainee will improve their understanding of clinical practice through reflective assessment of actual cases during the prior PBL sessions. Diabetic Ketoacidosis in the Obstetric Population: A Simulation You may search for similar articles that contain these same keywords or you may 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. 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 . This is particularly important for core . 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. A collection of data interpretation guides to help you learn how to interpret various laboratory and radiology investigations. 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. 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. Alert a senior immediately if you have any concerns about the consciousness level of a patient. and An hour was . However, this leads to confusion. www.cdc.gov/diabetes/statistics/prev/national/. 34 - Diabetic Ketoacidosis in Pregnancy | Obgyn Key Terms of Use. Surgical dressings and imitation blood can support medical history. Other details are also important, including descriptions regarding patient language skill, social history, socioeconomic history, family history, religious practices or beliefs pertinent to treatment, and descriptive signs and symptoms. 1 Potassium losses occurring both before and during treatment of DKA must be replaced. The learning environment should closely mimic real-world applications. 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.
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