Trainee will correlate the underlying pathophysiology with symptoms and signs as exhibited by the simulation session. 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]). It was developed for anesthesiology resident physicians with some background knowledge and experience caring for critically ill patients. Interactive lecture/discussion with use of monitors that show the vital signs of the simulated patient on manikin. - Radiation 02:45 The students have acquired all the applicable theoretical knowledge of the case during the previous multiday PBL sessions. Simulation in Healthcare4(4):232-236, Winter 2009. unilateral coarse crackles may be present if the patient has pneumonia which may have been the precipitant for DKA). 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. Check out our other awesome clinical skills resources including: Nandate, Koichiro MD, PhD; Abola, Ramon MD; Murray, W Bosseau MB; Whitfield, Carol PhD; Lang, Charles PhD; Sinz, Elizabeth MD. doi: 10.7759/cureus.1286. may email you for journal alerts and information, but is committed 2. Available from: [, NICE guidelines. It may be necessary toexposethe patient during your assessment: remember to prioritise patient dignity and conservation of body heat. We used the Medical Education Technologies Inc. (METI) Human Patient Stimulator (HPS, METI Sarasoto, Fl). Trainee will practice or observe good teamwork skills, both as a leader and a team player. 3. Privacy Policy Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. An oropharyngeal airway is a curved plastic tube with a flange on one end that sits between the tongue and hard palate to relieve soft palate obstruction. We guide the group to suggest fluid. Collectblood testsafter cannulating the patient including: An ECG should be performed to screen for cardiac pathology such as arrhythmias which may be precipitated by electrolyte abnormalities (e.g. The consequences (low blood pressure, high heart rate, central nervous system status, etc.) After entering the environment, the student doesnt have the option of leaving the simulation until the learning objectives and performance measures are achieved. - Site 01:12 - Over 3000 Free MCQs: https://geekyquiz.com/ JEMS. - 2500+ OSCE Flashcards: https://geekymedics.com/osce-flashcards/ Margolis GS, Romer GA, Fernandez AR, et al. Note that if-thens must also include negative patient outcomes for when the provider doesnt take appropriate action. 2010;49:578586. Abdomen: The abdominal examination reveals diffuse mild epigastric tenderness to deep palpitation but neither rebound tenderness nor guarding (result of examination given by patient or by instructor). A strong emphasis is placed on the focused, methodical examination of a specific medical problem and the decision-based treatment options available. endobj 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. VbQuX#R M21 As individuals with uncontrolled type I . See ourfluid prescribing guidefor more details onresuscitation fluids. 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. This is particularly important for core cases and low-frequency, high-stakes procedures and encounters. The instructors role is to facilitate active learning through a combination of learning styles. SimMan Nursing Scenarios Software. Case-based simulation should include two to three broad-focus objectives, as well as 1020 specific performance measures that the student should accomplish. The immersive simulation is performed when the instructor feels comfortable with the acquired knowledge and skill base presented in the animated lecture or when the student group has sufficient practical experience to apply the cognitive, behavioral and technical skills outlined in the case scenario. Capillary refill timemay be prolonged if the patient is hypovolaemic. For example, you could develop a diabetic scenario in which the prehospital provider encounters an altered patient with incomprehensible speech. Using SOCRATES in History Taking | OSCE | Communication Skills, Diabetic Ketoacidosis (DKA) | Acute Management | ABCDE. Ketones show 5.5. Administer oxygen to all critically unwell patients during yourinitialassessment. Alert a senior immediately if you have any concerns about the consciousness level of a patient. 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. Clearly communicate how often would you like the patients observations relayed to you by other staff members. 2007. Competency-based medical education has seen widespread adoption in the field along with ongoing work in the areas of . Use washable, non-toxic paints to imitate various body emissions. The student group is given a short introduction into a closed simulation environment. An oxygen mask is also demonstrated as an alternative device, as these early trainees had mostly not yet seen any of these devices. DOWNLOAD Diabetic Ketoacidosis By the end of this scenario, the learner will be able to: 1. She Died the Next Day. Refer to your local guidelines for further details. The facilitator guides the group only when necessary. 1-6. Trainee will describe the changes in vital signs, the major metabolic, fluid, and electrolyte. Keywords: diabetic ketoacidosis, simulation, expertise, emergency medicine Introduction Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes mellitus, most . We ask the trainee why the blood pressure is so low or heart rate is so high, and how we should treat it. This leads to hyperglycaemia, osmotic diuresis, and dehydration. 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. Join the Geeky Medics community: As this is an interactive discussion session, any needed debriefing and/or explanation is given during the sessions. Open the patients airwayusing ahead-tiltchin-lift manoeuvre: 1. In the meantime, you can perform some basic airway manoeuvres to help maintain the airway whilst awaiting senior input. 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! 2 0 obj insulin-dependent type 2 diabetes), Altered consciousness (e.g. Immersive simulations are mentally exhausting because they create an intense and stressful atmosphere requiring the learner to work outside their comfort zone. A collection of interactive medical and surgical clinical case scenarios to put your diagnostic and management skills to the test. We give the history of the patient to the trainees. A collection of communication skills guides, for common OSCE scenarios, including history taking and information giving. This allows the learner group to make a psychological break from the patient and environment while beginning the reflection process. Two abstracts related to sleepiness in the EMS workforce were presented at the National Association of EMS Physicians symposium in January. <> Groups of more than seven may struggle with meeting objectives due to insufficient functional rolls. Initially, we required the students to write down the vital signs. This is particularly important for core . Using the arterial line, the scenario becomes much more dynamic. The learning environment should closely mimic real-world applications. Review the patientsoxygen saturation(SpO2): Auscultate the chest to screen for evidence of respiratory pathology (e.g. - Geeky Medics OSCE App: https://geekymedics.com/geeky-medics-app/ Inspect the urine currently in the catheter bag and note its appearance (e.g. There are several causes of DKA, which we remember by the "five I's". PA EMT Said COVID Patient Didnt Need to Go to the Hospital. A list of the requirements (monitors, props, and others) is given in Tables 2 and 3, as well as in the web supplement (Appendix C, Supplemental Digital Content 3, https://links.lww.com/SIH/A3). Review the patients drug chart for medications which may cause a reduced level of consciousness (e.g. - Exacerbating & relieving factors 05:12 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. Int J Evid Based Healthc. The students worked on the underlying physiology during a week long PBL session and are therefore familiar with the theoretical aspects of DKA. Stage 2: Emergency management of DKA and consideration of abnormal CTG. Marx JA, Hockberger RS, Walls RM. Askhow the patient is feeling as this may provide some useful information about their current symptoms. If the patient is confused you might be able to get a collateral history from staff or family members as appropriate. The students are in their basic science course. Initially, we had a white board available, but the temptation (and habits) were just too strong, and the simulator sessions tended to become one way lectures, rather than an interactive, 2 way discussion.. type 1 diabetes), Complete insulin insensitivity (e.g. - Associated symptoms 03:04 The instructor should have visual access via one-way windows or cameras. Simulation Scenario. It was Typically potassium levels should be maintained between 4.0 5.5 mmol/L and close monitoring is required. 2009;13:505511. This allows us to get in touch for more details if required. Hypothermia may be present if the patient has been unconscious and exposed for some time. The Theory 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. The students are in their first year. Forty percent of respondents reported excessive daytime sleepiness. If you have any scenarios you would be willing to share with the simulation community, please forward them to me. Introduceyourselfto thepatientincluding yournameandrole. Its important to train and educate students of prehospital care on key indicators of a diabetic emergency. Categories: Emergency Medicine, Medical Education Keywords: diabetic ketoacidosis, simulation, expertise, emergency medicine . The main purpose of the simulation is to draw a line from the theoretical, boring biochemistry to the clinical manifestations. Circulating nurse in the emergency room (ER). 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). A debriefing section with pre-established questions allows the instructor to review the main focus and performance measures with the student group. Much time was wasted explaining why it did not matter. <>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 595.32 841.92] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> a simulation training session designed to acquaint emergency medicine residents with the presentation and management of diabetic ketoacidosis (DKA) through the use of simulation. 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. This guide provides an overview of the recognition and immediate management of diabetic ketoacidosis (DKA)using an ABCDE approach. 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. The students mentioned that they did not obtain the maximum value from the simulation session under these circumstances. Extremities: mild cyanosis, no clubbing or edema (verbalized by instructors); pulses equal, and symmetrical (elucidated by trainees). The validity of the HFS-DKA scenario was verified by a certified diabetes nurse educator, a registered nurse, and a clinical nurse educator. Each performance measure is separated into cognitive, behavioral or technical categories. vD0 x@FFJ{m[ 3//Oh|JR7! Available from: [. DKA can be caused by either: Absolute insulin deficiency (e.g. DO NOT perform any examination or procedure on patients based purely on the content of these videos. 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. General: Moaning, asking what has happening to her. 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. Make sure to re-assess the patient after any intervention. >> Patterson PD, Weaver M, Frank R, et al. (1) According to Centers for Disease Control and Prevention (CDC), 223,619 deaths were attributed to diabetes in 2005. Standardized patient as the voice of the simulator (or the simulation operator may play this role). As with the animated lecture, the simulation is strongly dependent on a focused case study. 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). - Examples 05:45 Simulation-based medical education: An ethical imperative. Inspect for evidence of self-injection sites (e.g. Using your thumbs, slightly open the mouth by downward displacement of the chin. These simulation sessions seem to work because the medical students do have prior knowledge. 2003;78:783788. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journals Web site (www.simulationinhealthcare.com). Does the patient need reviewing by a specialist? We do not use passive visualizing materials such as videotapes or DVD other than vital signs shown on the monitors. See Table 4 for a suggested standardized script. 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. Manikin staging can provide strong cues. Deteriorationshould be recognised quickly and acted upon immediately. endobj type 1 diabetes) Complete insulin insensitivity (e.g. It involves working through the following steps: Each stage of the ABCDE approach involvesclinicalassessment,investigationsandinterventions. If the patientloses consciousnessand there areno signs of lifeon assessment, put out acrash callandcommence CPR. Diabetic ketoacidosis (DKA) is a common, potentially lethal disease. - PSA Question Pack: https://geekymedics.com/psa-question-bank/ Instructors should write a case study for the simulation before the session. endobj 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. TikTok: https://www.tiktok.com/@geekymedics 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. If an obstruction is visible within the airway, use afingersweeporsuctionto remove it. Should any changes be made to the current management of their underlying condition(s)? Environment & Manikin (1) The assessment of a diabetic patient is best taught as a. 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. areas of lipohypertrophy) if it is unclear if the patient is diabetic. Cureus 9(5): e1286. 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. Tilt the forehead back whilst lifting the chin forwards to extend the neck. cloudy urine may indicate urinary tract infection). The learning objectives follow the American College of Graduate Medical Education (ACGME) Core Compentencies. Given 6 to 8 back-to-back sessions, it is critical that every session starts and ends on time! To read Pages full Research Review column, visit www.jems.com/patient-care. Mosby:Philadelphia. KDCA, Ronald Reagan Washington National Airport, DC. Discuss the patients current clinical condition with aseniorclinicianusing anSBARR style handover. She had developed nausea, extreme fatigue, mild disorientation, and blurred vision toward the end of the soccer match. 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 required potassium replacement varies greatly. Check the patency of the patients right nostril and if required (depending on the model of NPA) insert a safety pin through the flange of the NPA. You may be trying to access this site from a secured browser on the server. stream tall tented T waves in hyperkalaemia). They should introduce the student group to the environment, assign roles for each learner and guide the decision-making process. The debriefing environment should be removed from the location where the simulation took place. 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. Target Learner Groups 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.

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