If you have any scenarios you would be willing to share with the simulation community, please forward them to me. A collection of surgery revision notes covering key surgical topics. This leads to hyperglycaemia, osmotic diuresis, and dehydration. Scenarios. Properly interpret a venous blood gas (VBG) and basic metabolic panel in a patient presenting with diabetic ketoacidosis. Perform urinalysis and send the urine for culture if urinary tract infection is suspected. Hypothermia may be present if the patient has been unconscious and exposed for some time. 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. 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. Available if the trainee asks: arterial blood gas, glucose, electrolytes, BUN and plasma osmolality (please see last section of Appendix B, Supplemental Digital Content 2, https://links.lww.com/SIH/A2, for values). Causes: Any situation arising in a diabetic that requires increased insulin without that demand being met can result in DKA. Strategies of high-performing paramedic educational programs. 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. For instance, one of the questions is: Why is Tiffany dehydrated? There are several possible reasons and mechanisms (as outlined in Appendix B, fourth 15 minutes, Supplemental Digital Content 2, https://links.lww.com/SIH/A2), which the students can mention. 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. Just place the BR2_KDCA file into your addons scenery folder: C:\\Program Files\\Microsoft Games\\Microsoft Flight Simulator X\\Addon Scenery\\Scenery. endobj DKA can develop within 24 hours and is potentially life threatening, requiring prompt recognition and therapeutic intervention. In this case scenario, dehydration is one of the most serious immediate issues. Available from: [. VbQuX#R M21 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. angioedema, rash) commence appropriate treatment as discussed in ouranaphylaxis guide. Many of the preclinical students have never seen a real life clinical monitor or even an intravenous (IV) setup. A fixed-rate intravenous insulin infusion should be commenced initially to suppress ketogenesis, reduce blood glucose levels and address electrolyte disturbances. may email you for journal alerts and information, but is committed Please try after some time. 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. Available from: [, NICE guidelines. Instructors should write a case study for the simulation before the session. Tilt the forehead back whilst lifting the chin forwards to extend the neck. type 1 diabetes), Complete insulin insensitivity (e.g. <>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 595.32 841.92] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> In keeping with the case study, as a treatment marker is reached, the instructor should place emphasis on physiological, pharmacological, environmental and psychosocial issues. Geeky Medics accepts no liability for loss of any kind incurred as a result of reliance upon the information provided in this video. - Radiation 02:45 The normal reference range for fasting plasma glucose is 4.0 5.8 mmol/l. As individuals with uncontrolled type I . PBL was introduced at our institution in 1995. A collection of communication skills guides, for common OSCE scenarios, including history taking and information giving. You may be trying to access this site from a secured browser on the server. It may be necessary toexposethe patient during your assessment: remember to prioritise patient dignity and conservation of body heat. The learning environment should closely mimic real-world applications. The use of a simulated, evolving case scenario was an effective method of exposing nursing students to complex patient care. The students are in their first year. This is a 25-year-old woman with a medical history of diabetes medicated with 40 units insulin per day. 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. 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 . Invasive monitors, including a left radial intraarterial and a right subclavian IV catheter, were placed. Recognize the signs and symptoms of a patient presenting with diabetic ketoacidosis. Her medical, social, and family histories are not clear at the time of admission to the emergency department. We also show them IV bags containing saline and Ringers lactate, as well as show them IV infusion sets. Does the patient need a referral toHDU/ICU? 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. PA EMT Said COVID Patient Didnt Need to Go to the Hospital. 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). 1-6. Simulation-based medical education: An ethical imperative. Antibiotics should be prescribed in keeping with local guidelines. Observe and discuss the effects of therapy in a mathematically modeled physiological simulator. The patient synopsis should include such standard aspects as age, sex, ethnicity, medical history, medications and allergies. 2009;13:505511. DOI 10.7759/cureus.1286. Refer to your local guidelines for further details. A traditional classroom lecture format allows for student participation but limits the instructors ability to create realistic situations. However, this leads to confusion. Make sure thepatientsnotes,observationchartandprescriptionchartare easily accessible. Open the patients mouth to ensure there is no foreign material that may be pushed into the larynx. This allows us to get in touch for more details if required. Blood sugar issues in the Type II diabetic will have a gradual onset, with diagnosis generally resulting from routine laboratory exams.(1). Trainee will practice or observe good teamwork skills, both as a leader and a team player. The simulation experience serves to give substance to the theoretical words and concepts that the students encountered during the PBL sessions. %PDF-1.5 With your index and other fingers placed behind the angle of the mandible, apply steady upwards and forward pressure to lift the mandible. Place one hand on the patients forehead and the other under the chin. Your message has been successfully sent to your colleague. I assigned true to life parking codes, and added some extra parking for the superfluous US Express AI. (1), The assessment of a diabetic patient is best taught as a case-based simulation. - Geeky Medics OSCE App: https://geekymedics.com/geeky-medics-app/ Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario Cureus. Ask for anotherclinicalmemberofstafftoassistyou if possible. 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. Trainee will recognize the need for therapy and suggest an appropriate therapy in a simulated environment. Trainee will describe the changes in vital signs, the major metabolic, fluid, and electrolyte. In other words, they do not have clinical experience, but they have clinical knowledge. The students are in their first year. For more information, please refer to our Privacy Policy. A well-staged environment allows for greater student buy-in. We have 18 to 20 PBL groups for an hour each in the week after their PBL DKA session. Makeup may be used to depict gender, hollow eyes and cheeks, produce pallor or display bruises and scars. 3. Instagram: https://instagram.com/geekymedics Inspect for evidence of infection on the skin (e.g. 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 Insert the airway bevel-end first, vertically along the floor of the nose with a slight twisting action. In the context of DKA, a patients consciousness level may be reduced. You could also ask a student to smear a small amount of acetone on a piece of glass to see how volatile it is, helping them understand why its being exhaled by the DKA patient. 3. We do not use passive visualizing materials such as videotapes or DVD other than vital signs shown on the monitors. 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. Revisit history taking to explore relevant medical history and identify any precipitating factors for DKA. - Character 02:14 Cureus is on a mission to change the long-standing paradigm of medical publishing, where submitting research can be costly, complex and time-consuming. Despite this increased calorie intake, she noticed an unexplained 20 lbs weight loss. 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. The students worked on the underlying physiology during a week long PBL session and are therefore familiar with the theoretical aspects of DKA. This is particularly important for core cases and low-frequency, high-stakes procedures and encounters. 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). dq-]gX4 `L'u7myx) rpjf0z,.y`VMyx-&Ju`U0 After initial insulin therapy has reduced plasma blood glucose levels (e.g. The file explaining the session is sent to instructors 1 week before the sessions. Make sure to re-assess the patient after any intervention. Works with Traffic 2005, but . 2. unilateral coarse crackles may be present if the patient has pneumonia which may have been the precipitant for DKA). Well done, youve now stabilised the patient and theyre doing much better. The choice of fluid type, rate of administration and volume should be tailored to the individual patient based upon their vital signs and electrolytes. Data Description All the product records are stored at /user/spark/dataset/retail_db/products All the category records are stored at /user/spark/dataset /ret. Diabetes UK with the Joint British Diabetes Societies Inpatient Care Group. Assess the patients level of consciousness using the AVPU scale: If a more detailed assessment of the patients level of consciousness is required, use the Glasgow Coma Scale (GCS). 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. An hour was . Please enable scripts and reload this page. The instructions to the facilitators suggest a series of structured, sequential questions to the students (starting at one end, involving each student in turn, and repeatedly cycling around the group.) 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). A pre-briefing session is conducted prior to the start of the simulation scenario. The trainees have had background knowledge of biochemistry because they had completed the PBL case. The 60 minutes training time consists of four 15-minute sections divided as follows. 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. Facebook: http://www.facebook.com/geekymedics We now provide the students with handouts of the data to save time and provide consistency. A comprehensive collection of medical revision notes that cover a broad range of clinical topics. The main goal is to establish a safe learning environment for the learner [9, 13 . - PSA Question Pack: https://geekymedics.com/psa-question-bank/ Introduceyourselfto thepatientincluding yournameandrole. 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. - Timing 03:23 Administer oxygen to all critically unwell patients during yourinitialassessment. The facilitator guides the group only when necessary. 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. Please try again soon. This is an important period, as this is where the students see the theoretical concept (metabolic acidosis), come to life as for instance large tidal volumes. (1) According to Centers for Disease Control and Prevention (CDC), 223,619 deaths were attributed to diabetes in 2005. Prehosp Emerg Care. Its best, however, to allow the student group to continue so theyre able to evaluate their decision-making processes during debriefing. - Site 01:12 Adds true to life parking codes and extra parking for AI. If fever is present, make sure to consider co-existing infection. 2. tall tented T waves in hyperkalaemia). Trainee will appropriately request assistance and use available resources. Therefore, the same file is also sent to the participants before the session. DO NOT perform any examination or procedure on patients based purely on the content of these videos. stream After entering the environment, the student doesnt have the option of leaving the simulation until the learning objectives and performance measures are achieved.
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