Case-based simulation should include two to three broad-focus objectives, as well as 1020 specific performance measures that the student should accomplish. Each clinical case scenario allows you to work through history taking, investigations, diagnosis and management. Antibiotics should be prescribed in keeping with local guidelines. angioedema, rash) commence appropriate treatment as discussed in ouranaphylaxis guide. Trainee will practice or observe good teamwork skills, both as a leader and a team player. We have 18 to 20 PBL groups for an hour each in the week after their PBL DKA session. Environment & Manikin
In some cases, normal saline with additional potassium is required to prevent overcorrection of serum potassium levels which would otherwise result in hypokalaemia. Problems are addressed as they are identified and the patient is re-assessed regularly to monitor their response to treatment. - 150+ PDF OSCE Checklists: https://geekymedics.com/pdf-osce-checklists/ If the patient is confused you might be able to get a collateral history from staff or family members as appropriate. 2008;6:278302. Given such a small group, the students indicated that they feel more involved than they would with a larger group (eg, the whole class.) 1. Inspect theairwayfor obviousobstruction. 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. Makeup may be used to depict gender, hollow eyes and cheeks, produce pallor or display bruises and scars. 2011;15:108109. Intubation lubricants can mimic drooling. 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. Refer to your local guidelines which should provide a clear protocol for the management of DKA. 2017 May 29;9(5):e1286. Revisit history taking to explore relevant medical history and identify any precipitating factors for DKA. 6. As the name says, this screen is used to graph and plot any parameter. The consequences (low blood pressure, high heart rate, central nervous system status, etc.) 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. 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! endobj
His Wife Gave Him CPR. 3. These simulation sessions seem to work because the medical students do have prior knowledge. Measure the patients capillary blood glucose and ketone levels to confirm the diagnosis and guide the management of DKA. Keyword Highlighting
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. Scenario in a Nutshell Diabetic ketoacidosis (DKA) in pregnancy. An hour was . 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. 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). <>
cellulitis). 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. Int J Evid Based Healthc. KDCA, Ronald Reagan Washington National Airport, DC. The facilitator guides the group only when necessary. Does the patient need reviewing by a specialist? Glycosuria leads to urinary losses of potassium through osmotic diuresis. Capillary refill timemay be prolonged if the patient is hypovolaemic. Clearlydocument your ABCDE assessment, including history, examination, observations, investigations, interventions, and the patients response. Manikin staging can provide strong cues. 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. Stage 2: Emergency management of DKA and consideration of abnormal CTG. An oxygen mask is also demonstrated as an alternative device, as these early trainees had mostly not yet seen any of these devices. 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. 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. 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.) Conclusion: Our DKA simulator is a new tool whose objective is the training in a severe, frequent and complex situation, and can be used to improve the approach made by the junior physicians to the real diabetic . In the final 10 minutes, we show how the patient has a good recovery after fluid replacement. Performing an ECG should not delay the emergency management of DKA. Heart: S1 and S2 within normal limits; no S3/S4 or murmurs, normal rate and rhythm. Deteriorationshould be recognised quickly and acted upon immediately. As individuals with uncontrolled type I . Geeky Medics accepts no liability for loss of any kind incurred as a result of reliance upon the information provided in this video. You might also be interested in our awesome bank of 700+ OSCE Stations. In the meantime, you should re-assess and maintain the patients airway. 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. 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). DO NOT perform any examination or procedure on patients based purely on the content of these videos. Her medical, social, and family histories are not clear at the time of admission to the emergency department. The optimal number of simulation participants is four to seven individuals, depending on the case study objectives. 2. Ziv A, Wolpe PR, Small SD, et al. Initially, we required the students to write down the vital signs. Similar to a ward round, where the instructor would say: Come and listen to this patient with an aortic stenosis. For similar reasons, we do not believe a videotaped session will keep the students attention as much as these live simulator sessions. Below is a collection of donated scenarios for you to use or modify. Inspect the urine currently in the catheter bag and note its appearance (e.g. I assigned true to life parking codes, and added some extra parking for the superfluous US Express AI. As this is a PBL session, the trainees are not given any references. See Table 4 for a suggested standardized script. tall tented T waves in hyperkalaemia). The Simulation Laboratory session follows after a completed PBL session, and is aimed at making the case come alive, while providing a clinical perspective to preclinical students. It involves a facilitating instructor, a small learner group and conceptual aspects of environmental and manikin staging to provide sensory cues. The researchers found that long shift hours (24hrs), working overtime and marital/relationship stress were strongly correlated. The addition of a fluid infusion containing some potassium allows insulin therapy to continue to suppress ketogenesis and normalise plasma pH whilst preventing the development of hypokalaemia. 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. Trainee will be respectful to others and their views during the PBL session. 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. 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. She Died the Next Day. Each performance measure is separated into cognitive, behavioral or technical categories. See our blood glucose measurement guide for more details. 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. >> Fernandez AR, Mac Crawford J, Pennell ML, et al. DY{Qb"(EgN$QI*%XN1F""0a5 In this manner, the students have to apply their knowledge at the appropriate points during the progression of the scenario. <>>>
diagnosis of DKA Trigger 3, ABG show acidosis and high BM and normal potassium. confusion, coma), All critically unwell patients should have. The DKA simulation incorporates cue recognition, analysis of cues, generation of solutions, nursing interventions, and evaluation of outcomes, including effective communication and psychosocial concerns. We try to provide sufficient realism.. Urinary tract infections are a common DKA precipitant. Well done, youve now stabilised the patient and theyre doing much better. The main goal is to establish a safe learning environment for the learner [9, 13 . Categories: Emergency Medicine, Medical Education Keywords: diabetic ketoacidosis, simulation, expertise, emergency medicine . Much time was wasted explaining why it did not matter. 2009;13:505511. (1), The assessment of a diabetic patient is best taught as a case-based simulation. 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. This field is for validation purposes and should be left unchanged. 3. Search for Similar Articles
The Theory
The students mentioned that they did not obtain the maximum value from the simulation session under these circumstances. 2 0 obj
An individual student can get an immediate answer to a question, the facilitator can see puzzled expressions on faces, and the PBL group could get answers that they could not get during their prior PBL group discussions. Groups of fewer than four students dont allow for optimal collaboration. She tends to drink sugar containing fluids (soda) when she is thirsty, and she eats fast foods (cream-filled muffins) when she is hungry. DO NOT perform any examination or procedure on patients based purely on the content of these videos. 2011;15:108109. 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. Check out our other awesome clinical skills resources including: Prehosp Emerg Care. 1. Therefore, the same file is also sent to the participants before the session. A comprehensive collection of OSCE guides to common clinical procedures, including step-by-step images of key steps, video demonstrations and PDF mark schemes. We are looking for declaration of DKA and request for pathway. The file explaining the session is sent to instructors 1 week before the sessions. With your index and other fingers placed behind the angle of the mandible, apply steady upwards and forward pressure to lift the mandible. Please note that by doing so you agree to be added to our monthly email newsletter distribution list. Diabetic ketoacidosis (DKA) is a common, potentially lethal disease. She began experiencing progressively worsening thirst, increased appetite, and excessively increased urination. When erroneous treatment is delivered, the instructor can end the 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 . 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. vD0
x@FFJ{m[ 3//Oh|JR7! Medical simulation technology is a powerful tool for training physicians but papers dealing with DKA simulators are scarce. 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. 2010;49:578586. If the patient has COPD and a history of CO2retention you should switch to aventuri maskas soon as possible andtitrate oxygen appropriately. Subscribe to our newsletter to be the first to know about our latest content: https://geekymedics.com/newsletter/ 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. 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. Cureus is on a mission to change the long-standing paradigm of medical publishing, where submitting research can be costly, complex and time-consuming. insulin-dependent type 2 diabetes), Altered consciousness (e.g. From the Department of Anesthesiology, Pennsylvania State University College of Medicine, Hershey, PA. Dr. Murray is on the Speakers Bureau of METI, Sarasota, FL. - PSA Question Pack: https://geekymedics.com/psa-question-bank/ In the meantime, you can perform some basic airway manoeuvres to help maintain the airway whilst awaiting senior input. The students worked on the underlying physiology during a week long PBL session and are therefore familiar with the theoretical aspects of DKA. Trainee will increase knowledge of professional behaviors during the simulation. The relationship between sleep, fatigue and patient and provider safety. - Severity 05:32 The use of a simulated, evolving case scenario was an effective method of exposing nursing students to complex patient care. 3 0 obj
Are any further assessments or interventions required? In this section, we have to help the trainee to institute definitive therapy based on the underlying biochemical abnormalities. 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. may email you for journal alerts and information, but is committed
As this is an interactive discussion session, any needed debriefing and/or explanation is given during the sessions. The trainees have had background knowledge of biochemistry because they had completed the PBL case. The Theory
The student group is given a short introduction into a closed simulation environment. 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. Trainee will describe the changes in vital signs, the major metabolic, fluid, and electrolyte. This allows the learner group to make a psychological break from the patient and environment while beginning the reflection process. 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. endobj
In an animated lecture, its important that the student group have an instructor so they can ask direct questions. The use of case-based simulation, although more complicated and time consuming for the instructor, immerses the students in the subject matter. If the patient isunconsciousorunresponsive, start thebasic life support(BLS)algorithmas per resuscitation guidelines. 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. A collection of anatomy notes covering the key anatomy concepts that medical students need to learn. The required potassium replacement varies greatly. Could we not just do this as a large group session to all 160 students (versus 20 1-hour sessions to groups of eight students)? Before trainees arrival into the simulation area, the simulator is already preprogrammed for DKA. 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. We guide the group to suggest fluid. 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. The main purpose of the simulation is to draw a line from the theoretical, boring biochemistry to the clinical manifestations. 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). Stage 1: Initial assessment of acutely unwell pregnant woman and diagnosis of DKA. Finally, we summarize the course and give them time for questions. A collection of surgery revision notes covering key surgical topics. Trainee will learn to collaborate with peers to decide on appropriate interventions, tests, and therapy. Cureus 9(5): e1286. 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. Alert a senior immediately if you have any concerns about the consciousness level of a patient. Emergency medical services workLife characteristics contribute to clinically significant excessive daytime sleepiness.