Simulation-based medical education: An ethical imperative. Trainee will improve their understanding of clinical practice through reflective assessment of actual cases during the prior PBL sessions. A well-staged environment allows for greater student buy-in. Schneider Sarver PA, Senczakowicz EA, Slovensky BM. The students are in their first year. Endocrine - thesimbook.com It should only be inserted in unconscious patients as it is otherwise poorly tolerated and may induce gagging and aspiration. 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. Over the years, some groups happened to have the simulation session before the completion of the theoretical PBL session. SimMan Nursing Scenarios Software - laerdal.com Simulation Scenario. With your index and other fingers placed behind the angle of the mandible, apply steady upwards and forward pressure to lift the mandible. Join the Geeky Medics community: Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario. - PDF Forty percent of respondents reported excessive daytime sleepiness. 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. Trainee will increase knowledge of professional behaviors during the simulation. endobj If the patient isunconsciousorunresponsive, start thebasic life support(BLS)algorithmas per resuscitation guidelines. If the patient has COPD and a history of CO2retention you should switch to aventuri maskas soon as possible andtitrate oxygen appropriately. Circulating nurse in the emergency room (ER). Airway adjuncts are often helpful and in some cases essential to maintain a patients airway. 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). 2007. Given 6 to 8 back-to-back sessions, it is critical that every session starts and ends on time! - Site 01:12 Instructors should write a case study for the simulation before the session. 5. The students are in their first year. Ziv A, Wolpe PR, Small SD, et al. Assessment & Treatment of Five Diabetic Emergencies - JEMS Animated lectures, however, must work within the framework of a focused case study, which requires increased preparation time. 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. Recognize the signs and symptoms of a patient presenting with diabetic ketoacidosis. DKA can develop within 24 hours and is potentially life threatening, requiring prompt recognition and therapeutic intervention. Another example: At one minute into the scenario, the patient becomes unresponsive and their breathing becomes shallow. The Theory From the Department of Anesthesiology, Pennsylvania State University College of Medicine, Hershey, PA. Dr. Murray is on the Speakers Bureau of METI, Sarasota, FL. In some cases, normal saline with additional potassium is required to prevent overcorrection of serum potassium levels which would otherwise result in hypokalaemia. Manikin staging can provide strong cues. 4. Each performance measure is separated into cognitive, behavioral or technical categories. She tends to drink sugar containing fluids (soda) when she is thirsty, and she eats fast foods (cream-filled muffins) when she is hungry. 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. When erroneous treatment is delivered, the instructor can end the simulation. Abstract Introduction: This simulation on diabetic ketoacidosis (DKA) in the obstetric population presents learners with one of the more commonly encountered etiologies of critical illness in the pregnant patient. Furthermore, we demonstrate and explain the basic parameters (ECG, SpO2, BP, capnography), using an interactive format of questions and answers, and encourage the group to observe the normal values. Geeky Medics accepts no liability for loss of any kind incurred as a result of reliance upon the information provided in this video. They should introduce the student group to the environment, assign roles for each learner and guide the decision-making process. We used the Medical Education Technologies Inc. (METI) Human Patient Stimulator (HPS, METI Sarasoto, Fl). See ourfluid prescribing guidefor more details onresuscitation fluids. A pre-briefing session is conducted prior to the start of the simulation scenario. The learning objectives follow the American College of Graduate Medical Education (ACGME) Core Compentencies. 2. Make sure tore-assessthe patient after anyintervention. In the final 10 minutes, we show how the patient has a good recovery after fluid replacement. #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! 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. The choice of fluid type, rate of administration and volume should be tailored to the individual patient based upon their vital signs and electrolytes. Geeky Medics accepts no liability for loss of any kind incurred as a result of reliance upon the information provided in this video. 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. Please enable scripts and reload this page. TheABCDEapproach can be used to perform a systematic assessment of a critically unwell patient. Using the arterial line, the scenario becomes much more dynamic. Immersive Simulations 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. Use an effectiveSBARR handoverto communicate the key information effectively to other medical staff. However, this turned out to be too slow, took too much time, and could not continuously demonstrate the direction of changes. 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. Inspect the urine currently in the catheter bag and note its appearance (e.g. A collection of interactive medical and surgical clinical case scenarios to put your diagnostic and management skills to the test. Clinical Simulation in Nursing, Volume 39, 2020, pp. We give the history of the patient to the trainees. >> Patterson PD, Weaver M, Frank R, et al. 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. Inspect theairwayfor obviousobstruction. Cureus is on a mission to change the long-standing paradigm of medical publishing, where submitting research can be costly, complex and time-consuming. 3. - Associated symptoms 03:04 Many of the preclinical students have never seen a real life clinical monitor or even an intravenous (IV) setup. Diabetic ketoacidosis (DKA) is a common, potentially lethal disease. One advantage to the animated lecture style is the ability to introduce treatment options in a methodically guided approach thats in conjunction with simultaneous environmental stimulus. Typically potassium levels should be maintained between 4.0 5.5 mmol/L and close monitoring is required. The simulation experience serves to give substance to the theoretical words and concepts that the students encountered during the PBL sessions. "Never doubt that a small group of thoughtful, committed citizens can change the world. confusion, coma), All critically unwell patients should have. Therefore, the same file is also sent to the participants before the session. At the end of the previous section, the trainee can make the diagnosis of DKA but has not confirmed it yet. These simulation sessions seem to work because the medical students do have prior knowledge. Target Learner Groups *=NdL/c2XSJn8:I Jb8'.8>N*[L .hxw6afq40DX3c~>abt'Q,8y(BZu(vKBTufIR. If you have any scenarios you would be willing to share with the simulation community, please forward them . 2008;6:278302. Available from: [, NICE guidelines. 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. Prehosp Emerg Care. Management of diabetic ketoacidosis in adults. Introduceyourselfto whoever has requested a review of the patient andlistencarefullyto their handover. 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. If an infection is suspected, IV antibioticsshould be administered as soon as possible. Simulation Training Ideal for Diabetic Patients - JEMS This allows the learner group to make a psychological break from the patient and environment while beginning the reflection process. Interactive lecture/discussion with use of monitors that show the vital signs of the simulated patient on manikin. The Theory Trainee will recognize the need for therapy and suggest an appropriate therapy in a simulated environment. Scenario in a Nutshell Diabetic ketoacidosis (DKA) in pregnancy. 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. 3. These are not learning objectives in this program. A traditional classroom lecture format allows for student participation but limits the instructors ability to create realistic situations. To read Pages full Research Review column, visit www.jems.com/patient-care. Trainee will get to know how professionals behave during management of a critically ill patient. Refer to your local guidelines for further details. 3. Terms of Use. 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].. - Severity 05:32 Laschinger S, Medves J, Pulling C, et al. Make sure to re-assess the patient after any intervention. type 1 diabetes) Complete insulin insensitivity (e.g. The relationship between sleep, fatigue and patient and provider safety. Geeky Medics accepts no liability for loss of any kind incurred as a result of reliance upon the information provided in this video. Alert a senior immediately if you have any concerns about the consciousness level of a patient. Chapters: We do not use passive visualizing materials such as videotapes or DVD other than vital signs shown on the monitors. His Wife Gave Him CPR. stream Administer oxygen to all critically unwell patients during yourinitialassessment. Antibiotics should be prescribed in keeping with local guidelines. unilateral coarse crackles may be present if the patient has pneumonia which may have been the precipitant for DKA). PDF Diabetic Ketoacidosis in the Obstetric Population: A Simulation If you have any scenarios you would be willing to share with the simulation community, please forward them to me. Makeup may be used to depict gender, hollow eyes and cheeks, produce pallor or display bruises and scars. PBL was introduced at our institution in 1995. Diabetic Ketoacidosis (DKA) Clinical Pathway Emergency Department | Children's Hospital of Philadelphia type 1 diabetes), Complete insulin insensitivity (e.g. Prior to starting the scenario, the instructor should introduce a short summary of the case study and ask open-ended questions regarding the management direction. Problems are addressed as they are identified and the patient is re-assessed regularly to monitor their response to treatment. 4. 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. Review the patientsoxygen saturation(SpO2): Auscultate the chest to screen for evidence of respiratory pathology (e.g. As this is an interactive discussion session, any needed debriefing and/or explanation is given during the sessions. 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. Reprints: Koichiro Nandate, MD, PhD, Department of Anesthesiology, Milton S. Hershey Medical Center, Pennsylvania State University College of Medicine, 500 University Drive Box 850, Hershey, PA 17033 (e-mail: [emailprotected]). 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. The optimal number of simulation participants is four to seven individuals, depending on the case study objectives. a simulation training session designed to acquaint emergency medicine residents with the presentation and management of diabetic ketoacidosis (DKA) through the use of simulation. 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. Patients with DKA require fluid resuscitation to restore circulatory volume, clear ketones, correct electrolyte abnormalities and increase renal perfusion. . Both external and internal potassium balances are disturbed during the development and treatment of DKA. Review thepatients notes,chartsandrecent investigation results. - Examples 05:45 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. The students have acquired all the applicable theoretical knowledge of the case during the previous multiday PBL sessions. It was Depending on scenario complexity, team dynamic and treatment modalities, this simulation may take 1020 minutes. Before trainees arrival into the simulation area, the simulator is already preprogrammed for DKA. 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. Capillary refill timemay be prolonged if the patient is hypovolaemic. Assess the patients pulse and blood pressure: Inspect the patient from the end of the bed: they may appear drowsy, confused and/or clammy/pale. Diabetic Ketoacidosis (DKA) | Acute Management | ABCDE This is particularly important for core cases and low-frequency, high-stakes procedures and encounters. In the meantime, you should re-assess and maintain the patients airway. On the basis of the feedback from the students, they indicated that they believed the small group sessions are better. The instructor should have visual access via one-way windows or cameras. She does not take this regularly. - Geeky Medics OSCE App: https://geekymedics.com/geeky-medics-app/ Adds true to life parking codes and extra parking for AI. (1) According to Centers for Disease Control and Prevention (CDC), 223,619 deaths were attributed to diabetes in 2005. We have 18 to 20 PBL groups for an hour each in the week after their PBL DKA session. A collection of free medical student quizzes to put your medical and surgical knowledge to the test! PDF Medicine Simulation Scenario Diabetic Ketoacidosis: An Emergency Discuss the patients current clinical condition with aseniorclinicianusing anSBARR style handover. As this is a PBL session, the trainees are not given any references. x]o ]?9kgq~:)?hE )R6!up}\<8||\]}Y~;xp~yQ$#4~djX&{n_m-]^K1/~/AD Hv 99evs,;8}8zwnhFxV.kf-V^? An integral part of a PBL session is for trainees to be able to navigate through huge literature bases. doi: 10.7759/cureus.1286. Acad Med. If foreign material is present, attempt removal using suction. Please write a single word answer in lowercase (this is an anti-spam measure). We guide the group to suggest fluid. 2. 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). This article originally appeared in March 2011 JEMS as Diabetes Demonstration: Simulation-based learning works best., Simulation Training Ideal for Diabetic Patients, CMS Begins Reprocessing Retroactive Payments, Documents Detail EMTs Failure to Aid Tyre Nichols, New Course Lets Bystanders Be the Help Until Help Arrives, All Paramedic Recruits in New Castle County (DE) Obtain NRP Certification, International Prehospital Medicine Institute Literature Review, March 2023. Trainee will learn to collaborate with peers to decide on appropriate interventions, tests, and therapy. Note that if-thens must also include negative patient outcomes for when the provider doesnt take appropriate action. Prehosp Emerg Care. For example, you could develop a diabetic scenario in which the prehospital provider encounters an altered patient with incomprehensible speech. The lecture allows for understanding of concepts prior to action, and instructor feedback is immediate. Available from: [. %PDF-1.5 This video demonstrates how to use the SOCRATES acronym when taking a history of pain or other symptoms. The Pratcice The main goal is to establish a safe learning environment for the learner [9, 13 . His Heart Stopped On a Treadmill. Diabetic Ketoacidosis in the Obstetric Population: A Simulation If an obstruction is visible within the airway, use afingersweeporsuctionto remove it. The student group is given a short introduction into a closed simulation environment. COVID-19 Screening in the Pediatric Emergency Department. A chest X-ray should not delay the emergency management of DKA. diagnosis of DKA Trigger 3, ABG show acidosis and high BM and normal potassium. The required potassium replacement varies greatly. 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. Physician working in the emergency department. VbQuX#R M21 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. Marx JA, Hockberger RS, Walls RM. They have had no clinical exposure or any clinical experience. - 700+ OSCE Stations: https://geekymedics.com/osce-stations/ 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. 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. 2003;78:783788. Pediatric Emergency Medicine Didactics and Simulation (PEMDAS 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 . Scenarios. Its absolutely necessary to follow all immersive simulations with a positive, emotionally safe and nonjudgmental debriefing environment. Diabetes mellitus affects nearly 7.8% of the U.S. population, with approximately 510% of this group affected by Type I and 9095% by Type II.1 Diabetes is the most common type of endocrine disease and was the seventh leading underlying cause of death listed on death certificates in 2006. GRAPH. Urinary tract infections are a common DKA precipitant. We have spent many hours debating whether the small group format was a waste of time. 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)?