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. Introduceyourselfto whoever has requested a review of the patient andlistencarefullyto their handover. Each performance measure is separated into cognitive, behavioral or technical categories. Nandate, Koichiro MD, PhD; Abola, Ramon MD; Murray, W Bosseau MB; Whitfield, Carol PhD; Lang, Charles PhD; Sinz, Elizabeth MD. You can plot as many parameters as you want and can choose to display either Historical data or have the graphs update as often as new data comes in and view them in Real-time. Invasive monitors, including a left radial intraarterial and a right subclavian IV catheter, were placed. <> Trigger 4, Pathway 1l of saline required over 1hour and insulin infusion need prescribing and making up in 50ml syringe. 2 0 obj We are looking for declaration of DKA and request for pathway. Healthcare Students' Psychological Well-Being in a Diabetic Ketoacidosis Simulation. We do not use passive visualizing materials such as videotapes or DVD other than vital signs shown on the monitors. We believe it is important to have active, participatory learning by having conversations with the trainees in the form of questions and answers. They should introduce the student group to the environment, assign roles for each learner and guide the decision-making process. Observe and discuss the effects of therapy in a mathematically modeled physiological simulator. Schneider Sarver PA, Senczakowicz EA, Slovensky BM. your express consent. As this is an interactive discussion session, any needed debriefing and/or explanation is given during the sessions. Surgical dressings and imitation blood can support medical history. 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. Askhow the patient is feeling as this may provide some useful information about their current symptoms. The students are in their first year. 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. %PDF-1.5 Finally, we summarize the course and give them time for questions. 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). 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. An oxygen mask is also demonstrated as an alternative device, as these early trainees had mostly not yet seen any of these devices. >> Fernandez AR, Mac Crawford J, Pennell ML, et al. Its absolutely necessary to follow all immersive simulations with a positive, emotionally safe and nonjudgmental debriefing environment. The patient synopsis should include such standard aspects as age, sex, ethnicity, medical history, medications and allergies. We used the Medical Education Technologies Inc. (METI) Human Patient Stimulator (HPS, METI Sarasoto, Fl). 1-6. The debriefing environment should be removed from the location where the simulation took place. Trainee will improve their understanding of clinical practice through reflective assessment of actual cases during the prior PBL sessions. - 150+ PDF OSCE Checklists: https://geekymedics.com/pdf-osce-checklists/ 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. This is a 25-year-old woman with a medical history of diabetes medicated with 40 units insulin per day. unilateral coarse crackles may be present if the patient has pneumonia which may have been the precipitant for DKA). The teaching of diabetic assessment and management, like many other medical emergencies, lends itself well to case-based simulation. Facilitator to ask how often to measure BMs For similar reasons, we do not believe a videotaped session will keep the students attention as much as these live simulator sessions. Your message has been successfully sent to your colleague. Diabetes UK with the Joint British Diabetes Societies Inpatient Care Group. If the patient has COPD and a history of CO2retention you should switch to aventuri maskas soon as possible andtitrate oxygen appropriately. 3. Data is temporarily unavailable. vD0 x@FFJ{m[ 3//Oh|JR7! After entering the environment, the student doesnt have the option of leaving the simulation until the learning objectives and performance measures are achieved. 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. One of the key differences with the immersive simulation is that the instructor is absent from the simulation environment. 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. We have spent many hours debating whether the small group format was a waste of time. In this case scenario, dehydration is one of the most serious immediate issues. See ourintravenous cannulation guidefor more details. If the patient loses consciousness and there are no signs of life on assessment, put out a crash call and commence CPR. to below 12 mmol/L) an infusion containing normal saline and 5% dextrose is typically commenced to prevent the development of hypoglycaemia, whilst allowing insulin therapy to continue to suppress ketogenesis and reduce serum electrolyte concentrations. Two abstracts related to sleepiness in the EMS workforce were presented at the National Association of EMS Physicians symposium in January. opioids, sedatives, anxiolytics, insulin, oral hypoglycaemic medications). If the patient isunconsciousorunresponsive, start thebasic life support(BLS)algorithmas per resuscitation guidelines. 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. This leads to hyperglycaemia, osmotic diuresis, and dehydration. If any obstruction is encountered, remove the tube and try the left nostril. 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. 1 0 obj She Died the Next Day. >> Patterson PD, Weaver M, Frank R, et al. Trainee will be respectful to others and their views during the PBL session. - Medical Finals Question Pack: https://geekymedics.com/medical-student-finals-questions/ "Never doubt that a small group of thoughtful, committed citizens can change the world. 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. angioedema, rash) commence appropriate treatment as discussed in ouranaphylaxis guide. Refer to your local guidelines for further details. General: Moaning, asking what has happening to her. A collection of data interpretation guides to help you learn how to interpret various laboratory and radiology investigations. Centers for Disease Control and Prevention. 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. 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When erroneous treatment is delivered, the instructor can end the simulation. Evenly balancing performance measures will ensure the student has the opportunity to critically think through patient treatment and to practice new or support previously learned behaviors and technical skills. - Associated symptoms 03:04 Administer oxygen to all critically unwell patients during yourinitialassessment. 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)? Hypothermia may be present if the patient has been unconscious and exposed for some time. Competency-based medical education has seen widespread adoption in the field along with ongoing work in the areas of . . If foreign material is present, attempt removal using suction. Margolis GS, Romer GA, Fernandez AR, et al. The validity of the HFS-DKA scenario was verified by a certified diabetes nurse educator, a registered nurse, and a clinical nurse educator. Instagram: https://instagram.com/geekymedics 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. 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. A blood glucose level may already be available from earlier investigations (e.g. Open the patients airwayusing ahead-tiltchin-lift manoeuvre: 1. You may be trying to access this site from a secured browser on the server. Revisit history taking to explore relevant medical history and identify any precipitating factors for DKA. You can check out our guide to using SOCRATES here: https://geekymedics.com/the-socrates-acronym-in-history-taking/ A nasopharyngeal airway is a soft plastic tube with a bevel at one end and a flange at the other. 3. See our blood glucose measurement guide for more details. 4. 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. Therefore, we have to emphasize the importance of airway, breathing, and circulation in the very sick patient in any clinical setting. The relationship between sleep, fatigue and patient and provider safety. Please try after some time. 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. For diabetic assessment involving DKA, staging may include the use of a container with a small amount of acetone placed near the manikin because many students may not know what acetone smells like but will expect to smell something. Make sure thepatientsnotes,observationchartandprescriptionchartare easily accessible. dq-]gX4 `L'u7myx) rpjf0z,.y`VMyx-&Ju`U0 Adds true to life parking codes and extra parking for AI. Groups of fewer than four students dont allow for optimal collaboration. cloudy urine may indicate urinary tract infection). 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. *=NdL/c2XSJn8:I Jb8'.8>N*[L .hxw6afq40DX3c~>abt'Q,8y(BZu(vKBTufIR. Trainee will correlate the underlying pathophysiology with symptoms and signs as exhibited by the simulation session. Just place the BR2_KDCA file into your addons scenery folder: C:\\Program Files\\Microsoft Games\\Microsoft Flight Simulator X\\Addon Scenery\\Scenery. <>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 595.32 841.92] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> We ask the trainee why the blood pressure is so low or heart rate is so high, and how we should treat it. Heart: S1 and S2 within normal limits; no S3/S4 or murmurs, normal rate and rhythm. This simulation session therefore aims to make the case come alive, and show this known case in a clinical context. . % 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. 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). Properly interpret a venous blood gas (VBG) and basic metabolic panel in a patient presenting with diabetic ketoacidosis. 2010;49:578586. Keyword Highlighting Conclusion Geeky Medics accepts no liability for loss of any kind incurred as a result of reliance upon the information provided in this video. The consequences (low blood pressure, high heart rate, central nervous system status, etc.) I assigned true to life parking codes, and added some extra parking for the superfluous US Express AI. Below is a collection of donated scenarios for you to use or modify. 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. She began experiencing progressively worsening thirst, increased appetite, and excessively increased urination. Alert a senior immediately if you have any concerns about the consciousness level of a patient. Ziv A, Wolpe PR, Small SD, et al. Insert at least onewide-bore intravenous cannula(14G or 16G) and take blood tests as discussed below. Its best, however, to allow the student group to continue so theyre able to evaluate their decision-making processes during debriefing. As this is a PBL session, the trainees are not given any references. Groups of more than seven may struggle with meeting objectives due to insufficient functional rolls. Initially, we used a blood pressure cuff to generate the blood pressure values. Are any further assessments or interventions required? Therefore, the session is divided into four sections of 15 minutes each, so that the facilitator is constantly aware of being on time (or not), even after the first 15 minutes period. This allows the learner group to make a psychological break from the patient and environment while beginning the reflection process. In other words, they do not have clinical experience, but they have clinical knowledge. Development of simulation scenarios for an adolescent patient with diabetic ketoacidosis. In an animated lecture, its important that the student group have an instructor so they can ask direct questions. Diabetic Ketoacidosis (DKA) Clinical Pathway Emergency Department | Children's Hospital of Philadelphia 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. Consider active re-warming techniques in patients with severe hypothermia. The students are in their basic science course. 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. The use of a simulated, evolving case scenario was an effective method of exposing nursing students to complex patient care. It may be necessary toexposethe patient during your assessment: remember to prioritise patient dignity and conservation of body heat. Facebook: http://www.facebook.com/geekymedics The Pratcice An integral part of a PBL session is for trainees to be able to navigate through huge literature bases. - Examples 05:45 Does the patient need reviewing by a specialist? Place one hand on the patients forehead and the other under the chin.
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