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Please enable scripts and reload this page. Simulation Scenario for Anesthesia Providers Clark Obr, MD*, Anthony Mueller, MD *Corresponding author: clark-obr@uiowa.edu Abstract Introduction: This simulation on diabetic ketoacidosis (DKA) in . doi: 10.7759/cureus.1286. 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. 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. Please try after some time. SimMan offers you the ability to provide simulation education to challenge and test your students clinical and decision-making skills during realistic patient care scenarios. However, this turned out to be too slow, took too much time, and could not continuously demonstrate the direction of changes. The following scenarios are available for download and are designed to meet your multi-disciplinary nursing needs. Inspect theairwayfor obviousobstruction. If the patient is suspected to have sufferedsignificanttraumawith potential spinal involvement, perform ajaw-thrustrather than a head-tilt chin-lift manoeuvre: 2. 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. This may produce better retention of the subject matter and help students adapt to emergency scenes before going into the field. 3. and Trigger 4, Pathway 1l of saline required over 1hour and insulin infusion need prescribing and making up in 50ml syringe. Check out our other awesome clinical skills resources including: Terms of Use. Works with Traffic 2005, but . Simulation provides a safe environment where learning is enhanced through the deliberate practice of skills and controlled management of a variety of clinical encounters. If the patient is conscious, sit themuprightas this can also help with oxygenation. Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario Cureus. Review the patientscurrent medicationsand check any regular medications areprescribed appropriately. Measure the patients capillary blood glucose and ketone levels to confirm the diagnosis and guide the management of DKA. After the first voluntary session in 2006, feedback from the medical students indicated that they would like to receive this handout. - Medical Finals Question Pack: https://geekymedics.com/medical-student-finals-questions/ 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. Section snippets . unilateral coarse crackles may be present if the patient has pneumonia which may have been the precipitant for DKA). <> Diabetic ketoacidosis (DKA) is a common, potentially lethal disease. - Introduction 00:00 A patient presenting with altered level of consciousness and a blood sugar level below 80 mg/dL should be considered hypoglycemic, and treatment modalities should be consistent with those for a diabetic patient. If the patient isunconsciousorunresponsive, start thebasic life support(BLS)algorithmas per resuscitation guidelines. - Site 01:12 Both external and internal potassium balances are disturbed during the development and treatment of DKA. During an immersive simulation, its imperative the group uses critical-thinking skills and group collaboration independently. Data is temporarily unavailable. - Timing 03:23 General: Moaning, asking what has happening to her. If the patientloses consciousnessand there areno signs of lifeon assessment, put out acrash callandcommence CPR. The simulation session is also hosted as an interactive session. - Over 3000 Free MCQs: https://geekyquiz.com/ She tends to drink sugar containing fluids (soda) when she is thirsty, and she eats fast foods (cream-filled muffins) when she is hungry. 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)? See our blood glucose measurement guide for more details. 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. Stage 2: Emergency management of DKA and consideration of abnormal CTG. 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). 1-6. Alert a senior immediately if you have any concerns about the consciousness level of a patient. 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. Emergency medical services workLife characteristics contribute to clinically significant excessive daytime sleepiness. Search for Similar Articles #geekymedics #fyp #fypviral #studytok #medicalstudentuk #medtok #studytips #studytipsforstudents #medstudentuk #premed #medschoolfinals, Cardiovascular History Tips - DON'T FORGET these 3 things . Open the patients mouth to ensure there is no foreign material that may be pushed into the larynx. 4. Management of diabetic ketoacidosis in adults. Trainee will recognize the need for therapy and suggest an appropriate therapy in a simulated environment. There are just a few more things to do. However, this leads to confusion. Keyword Highlighting This style also doesnt mimic an actual scene, and a student may feel that treatment modalities and skills are performed at a slower rate than real-world applications. 2009;13:505511. Refer to your local guidelines which should provide a clear protocol for the management of DKA. Extremities: mild cyanosis, no clubbing or edema (verbalized by instructors); pulses equal, and symmetrical (elucidated by trainees). Therefore, we have to emphasize the importance of airway, breathing, and circulation in the very sick patient in any clinical setting. - Severity 05:32 Deteriorationshould be recognised quickly and acted upon immediately. % They have had no clinical exposure or any clinical experience. Before trainees arrival into the simulation area, the simulator is already preprogrammed for DKA. Weight, Height: Not given, normal appearing (as per simulator) but has lost 20 lbs recently. See Table 4 for a suggested standardized script. Insert the airway bevel-end first, vertically along the floor of the nose with a slight twisting action. See ourdocumentation guidesfor more details. Each PBL case typically goes over 23 days, affording the students periods to find information for the case. Much time was wasted explaining why it did not matter. may email you for journal alerts and information, but is committed Initially, we used a blood pressure cuff to generate the blood pressure values. The student group is given a short introduction into a closed simulation environment. 5. Invasive monitors, including a left radial intraarterial and a right subclavian IV catheter, were placed. In other words, they do not have clinical experience, but they have clinical knowledge. - Exacerbating & relieving factors 05:12 The optimal number of simulation participants is four to seven individuals, depending on the case study objectives. Prehosp Emerg Care. The DKA simulation incorporates cue recognition, analysis of cues, generation of solutions, nursing interventions, and evaluation of outcomes, including effective communication and psychosocial concerns. Diabetic ketoacidosis; Simulation training; Medical students. 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. You may be trying to access this site from a secured browser on the server. Heart: S1 and S2 within normal limits; no S3/S4 or murmurs, normal rate and rhythm. You should have another member of the clinical team aiding you in your ABCDE assessment, such a nurse, who can perform observations, take samples to the lab and catheterise if appropriate. Refer to your local guidelines for further details. Seek senior helpif the patient shows no signs of improvement or if you have any concerns. Virtual patient simulation (VPS) is an interactive computer simulation that recreates real-world scenarios with the objectives of training, education, and assessment for health care providers [].Virtual simulation has been used extensively to adapt nursing education to the COVID-19 pandemic context [], such as social distancing and/or confinement. Circulating nurse in the emergency room (ER). Available from: [, NICE guidelines. A pre-briefing session is conducted prior to the start of the simulation scenario. This session provides additional clinical support material for the theoretical PBL session. Inspect for evidence of self-injection sites (e.g. 1 Potassium losses occurring both before and during treatment of DKA must be replaced. Case-based education adds a real-world aspect to the learning environment. In the final 10 minutes, we show how the patient has a good recovery after fluid replacement. The facilitator guides the group only when necessary. Depending on scenario complexity, team dynamic and treatment modalities, this simulation may take 1020 minutes. 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. 1. 3. Geeky Medics accepts no liability for loss of any kind incurred as a result of reliance upon the information provided in this video. She does not take this regularly. Askhow the patient is feeling as this may provide some useful information about their current symptoms. 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. 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. Trainee will improve their understanding of clinical practice through reflective assessment of actual cases during the prior PBL sessions. The objective is to give as many visual and tactile cues concerning the patient condition and background as possible. Revisit history taking to explore relevant medical history and identify any precipitating factors for DKA. 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 main purpose of the simulation is to draw a line from the theoretical, boring biochemistry to the clinical manifestations. a simulation training session designed to acquaint emergency medicine residents with the presentation and management of diabetic ketoacidosis (DKA) through the use of simulation. On arrival to the ER, standard monitors (electrocardiogram [ECG] and pulse oximetry [SpO2]) and end-tidal carbon dioxide (ETCO2) concentration were placed, and the patient was given oxygen by nasal cannulae. 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. endobj 2011;15:108109. 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. cloudy urine may indicate urinary tract infection). An integral part of a PBL session is for trainees to be able to navigate through huge literature bases. Trainee will recognize and interpret the clinical signs and symptoms and the typical history of a patient with DKA, as well as understand the major causative factors of DKA. Prehosp Emerg Care. This is a 25-year-old woman with a medical history of diabetes medicated with 40 units insulin per day. 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. In some cases, normal saline with additional potassium is required to prevent overcorrection of serum potassium levels which would otherwise result in hypokalaemia. LYqC+pJ&6X4onfBT#?=R}.p8N3+Dk,P4tIgWB}-L'=8;_G >,K#.e89XnG'B~NtR There are several causes of DKA, which we remember by the "five I's". The choice of fluid type, rate of administration and volume should be tailored to the individual patient based upon their vital signs and electrolytes. This video demonstrates how to use the SOCRATES acronym when taking a history of pain or other symptoms. Scenarios. Tilt the forehead back whilst lifting the chin forwards to extend the neck. In the first, the authors expanded the National Registrys Longitudinal EMT Attributes and Demographic (LEADS) study by resurveying 1,600 EMS workers about their sleepiness while at work. Instagram: https://instagram.com/geekymedics We give the history of the patient to the trainees. See ourfluid prescribing guidefor more details onresuscitation fluids. She began experiencing progressively worsening thirst, increased appetite, and excessively increased urination. 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].. Recognize the signs and symptoms of a patient presenting with diabetic ketoacidosis. 2010;49:578586. 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. Lets discuss your options. Interactive lecture/discussion with use of monitors that show the vital signs of the simulated patient on manikin. She had developed nausea, extreme fatigue, mild disorientation, and blurred vision toward the end of the soccer match. One of the key differences with the immersive simulation is that the instructor is absent from the simulation environment. 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. Available from: [. Stage 1: Initial assessment of acutely unwell pregnant woman and diagnosis of DKA. They should introduce the student group to the environment, assign roles for each learner and guide the decision-making process. <> By joining Cureus, you agree to our Catheterisethe patient to closelymonitor urine outputto guide fluid resuscitation and need for escalation. Trainee will appropriately request assistance and use available resources. It involves working through the following steps: Each stage of the ABCDE approach involvesclinicalassessment,investigationsandinterventions. An oxygen mask is also demonstrated as an alternative device, as these early trainees had mostly not yet seen any of these devices. Patients with DKA require fluid resuscitation to restore circulatory volume, clear ketones, correct electrolyte abnormalities and increase renal perfusion. 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. As a next step, we will let one of the trainees talk to the patient, and prompt to ask medical questions such as previous medical issues or recent drug use for them to practice asking questions to generate a differential diagnosis (in this case, other causes for confusion). - 150+ PDF OSCE Checklists: https://geekymedics.com/pdf-osce-checklists/ The scenario would include an if-then algorithm. cellulitis). I assigned true to life parking codes, and added some extra parking for the superfluous US Express AI. 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). 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. 2017 May 29;9(5):e1286. 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. We used the Medical Education Technologies Inc. (METI) Human Patient Stimulator (HPS, METI Sarasoto, Fl). The learning environment should closely mimic real-world applications. Using the arterial line, the scenario becomes much more dynamic. 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. His Heart Stopped On a Treadmill. Trainee will increase knowledge of professional behaviors during the simulation. Simulation-based medical education: An ethical imperative. x]o ]?9kgq~:)?hE )R6!up}\<8||\]}Y~;xp~yQ$#4~djX&{n_m-]^K1/~/AD Hv 99evs,;8}8zwnhFxV.kf-V^? 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. Well done, youve now stabilised the patient and theyre doing much better. The required potassium replacement varies greatly. Conclusion In this manner, the students have to apply their knowledge at the appropriate points during the progression of the scenario. Manikin staging can provide strong cues. your express consent.
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