Tilt the forehead back whilst lifting the chin forwards to extend the neck. In this section, we have to help the trainee to institute definitive therapy based on the underlying biochemical abnormalities. 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). 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. In an animated lecture, its important that the student group have an instructor so they can ask direct questions. 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. 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. Initially, we used a blood pressure cuff to generate the blood pressure values. 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. The facilitator guides the group only when necessary. Manikin staging can provide strong cues. Should any changes be made to the current management of their underlying condition(s)? See ourdocumentation guidesfor more details. Emergency medical services workLife characteristics contribute to clinically significant excessive daytime sleepiness. Trainee will describe the changes in vital signs, the major metabolic, fluid, and electrolyte. We have 18 to 20 PBL groups for an hour each in the week after their PBL DKA session. Instead, instructors should combine case- and simulation-based techniques when teaching diabetic assessment. 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. The patient synopsis should include such standard aspects as age, sex, ethnicity, medical history, medications and allergies. After entering the environment, the student doesnt have the option of leaving the simulation until the learning objectives and performance measures are achieved. Simulation Scenario. The validity of the HFS-DKA scenario was verified by a certified diabetes nurse educator, a registered nurse, and a clinical nurse educator. 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Twitter: http://www.twitter.com/geekymedics 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. Each PBL case typically goes over 23 days, affording the students periods to find information for the case. A nasopharyngeal airway is a soft plastic tube with a bevel at one end and a flange at the other. J Nurs Educ. An integral part of a PBL session is for trainees to be able to navigate through huge literature bases. Categories: Emergency Medicine, Medical Education Keywords: diabetic ketoacidosis, simulation, expertise, emergency medicine . Prehosp Emerg Care. A collection of interactive medical and surgical clinical case scenarios to put your diagnostic and management skills to the test. vD0 x@FFJ{m[ 3//Oh|JR7! A debriefing section with pre-established questions allows the instructor to review the main focus and performance measures with the student group. 4. 2 0 obj See ourfluid prescribing guidefor more details onresuscitation fluids. type 1 diabetes), Complete insulin insensitivity (e.g. The instructors role is to facilitate active learning through a combination of learning styles. Does the patient need a referral toHDU/ICU? They have had no clinical exposure or any clinical experience. The lecture allows for understanding of concepts prior to action, and instructor feedback is immediate. 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). As with the animated lecture, the simulation is strongly dependent on a focused case study. Patients with DKA require fluid resuscitation to restore circulatory volume, clear ketones, correct electrolyte abnormalities and increase renal perfusion. 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. Keyword Highlighting - Geeky Medics OSCE App: https://geekymedics.com/geeky-medics-app/ In this case scenario, dehydration is one of the most serious immediate issues. This is particularly important for core cases and low-frequency, high-stakes procedures and encounters. During an immersive simulation, its imperative the group uses critical-thinking skills and group collaboration independently. <> In keeping with the case study, as a treatment marker is reached, the instructor should place emphasis on physiological, pharmacological, environmental and psychosocial issues. In this manner, the students have to apply their knowledge at the appropriate points during the progression of the scenario. On the basis of the feedback from the students, they indicated that they believed the small group sessions are better. 2003;78:783788. 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. Simulation provides a safe environment where learning is enhanced through the deliberate practice of skills and controlled management of a variety of clinical encounters. We then start the DKA state. See Appendix D, Supplemental Digital Content 4, https://links.lww.com/SIH/A4. The file explaining the session is sent to instructors 1 week before the sessions. 5. 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. Trainee will increase knowledge of professional behaviors during the simulation. 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 . Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario Cureus. It should only be inserted in unconscious patients as it is otherwise poorly tolerated and may induce gagging and aspiration. Make sure thepatientsnotes,observationchartandprescriptionchartare easily accessible. 2. Facebook: http://www.facebook.com/geekymedics The 60 minutes training time consists of four 15-minute sections divided as follows. A collection of free medical student quizzes to put your medical and surgical knowledge to the test! opioids, sedatives, anxiolytics, insulin, oral hypoglycaemic medications). Works with Traffic 2005, but . Scenarios. The students are in their first year. Extremities: mild cyanosis, no clubbing or edema (verbalized by instructors); pulses equal, and symmetrical (elucidated by trainees). cloudy urine may indicate urinary tract infection). If the patient has COPD and a history of CO2retention you should switch to aventuri maskas soon as possible andtitrate oxygen appropriately. 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. The main goal is to establish a safe learning environment for the learner [9, 13 . Several environments may be suitable for your classroom. Environment & Manikin - Over 3000 Free MCQs: https://geekyquiz.com/ 3. Observe and discuss the effects of therapy in a mathematically modeled physiological simulator. With your index and other fingers placed behind the angle of the mandible, apply steady upwards and forward pressure to lift the mandible. There are just a few more things to do. Rosens Emergency Medicine: Concepts and Clinical Practice. The student group is given a short introduction into a closed simulation environment. cellulitis). GRAPH. If any obstruction is encountered, remove the tube and try the left nostril. The consequences (low blood pressure, high heart rate, central nervous system status, etc.) Open the patients airwayusing ahead-tiltchin-lift manoeuvre: 1. She Died the Next Day. General: Moaning, asking what has happening to her. Subscribe to our newsletter to be the first to know about our latest content: https://geekymedics.com/newsletter/ 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. Highlight selected keywords in the article text. 1. Its important to train and educate students of prehospital care on key indicators of a diabetic emergency. Example: If the provider immediately evaluates blood glucose, then the reading will display 45 mg/dL. 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). - 2500+ OSCE Flashcards: https://geekymedics.com/osce-flashcards/ The instructors have to appreciate that the trainees participating in this simulation have not seen a diabetic patient in either a ward or ER, but that they have knowledge of the underlying physiology. 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. 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. Wolters Kluwer Health Chapters: A strong emphasis is placed on the focused, methodical examination of a specific medical problem and the decision-based treatment options available.