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. 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. Other details are also important, including descriptions regarding patient language skill, social history, socioeconomic history, family history, religious practices or beliefs pertinent to treatment, and descriptive signs and symptoms. 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. Anesthetic Management Using the Oxygen Reserve Index for Tracheal Resection and Tracheal End-to-E A Scoping Review of the Impact of COVID-19 on Kidney Transplant Patients in the United States, Alabama College of Osteopathic Medicine Research, Baylor Scott & White Medical Center Department of Neurosurgery, California Institute of Behavioral Neurosciences & Psychology, Contemporary Reviews in Neurology and Neurosurgery, DMIMS School of Epidemiology and Public Health, Simulation, Biodesign, & Innovation In Medical Education, The Florida Medical Student Research Publications, University of Florida-Jacksonville Neurosurgery, VCOM Clinical, Biomedical, and Educational Research, American Red Cross Scientific Advisory Council, Canadian Association of Radiation Oncology, International Liaison Committee on Resuscitation, International Pediatric Simulation Society, Medical Society of Delaware Academic Channel, Society for Healthcare & Research Development, Surgically Targeted Radiation Therapy for Brain Tumors: Clinical Case Review, Clinical and Economic Benefits of Autologous Epidermal Grafting, Defining Health in the Era of Value-Based Care, Optimization Strategies for Organ Donation and Utilization, MR-Guided Radiation Therapy: Clinical Applications & Experiences, Multiple Brain Metastases: Exceptional Outcomes from Stereotactic Radiosurgery, Proton Therapy: Advanced Applications for the Most Challenging Cases, Radiation Therapy as a Modality to Create Abscopal Effects: Current and Future Practices, Clinical Applications and Benefits Using Closed-Incision Negative Pressure Therapy for Incision and Surrounding Soft Tissue Management, Negative Pressure Wound Therapy with Instillation, NPWT with Instillation and Dwell: Clinical Results in Cleansing and Removal of Infectious Material with Novel Dressings. In the final 10 minutes, we show how the patient has a good recovery after fluid replacement. A collection of interactive medical and surgical clinical case scenarios to put your diagnostic and management skills to the test. Trainee will learn to collaborate with peers to decide on appropriate interventions, tests, and therapy. We ask the trainee why the blood pressure is so low or heart rate is so high, and how we should treat it. Inspect for evidence of self-injection sites (e.g. This is particularly important for core cases and low-frequency, high-stakes procedures and encounters. - 2500+ OSCE Flashcards: https://geekymedics.com/osce-flashcards/ We do not use passive visualizing materials such as videotapes or DVD other than vital signs shown on the monitors. If foreign material is present, attempt removal using suction. The scenario would include an if-then algorithm. In this manner, the students have to apply their knowledge at the appropriate points during the progression of the scenario. KDCA, Ronald Reagan Washington National Airport, DC. cellulitis). If the patient is conscious, sit themuprightas this can also help with oxygenation. We try to provide sufficient realism.. The learning objectives follow the American College of Graduate Medical Education (ACGME) Core Compentencies. 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. Re-assessthe patient using theABCDE approachto identify any changes in their clinical condition and assess the effectiveness of your previous interventions. It was developed for anesthesiology resident physicians with some background knowledge and experience caring for critically ill patients. DIABETIC KETOACIDOSIS MODULE: ENDOCRINOLOGY / METABOLIC TARGET: ALL PAEDIATRIC TRAINEES;NURSING STAFF BACKGROUND: DKA occurs when a relative or absolute lack of insulin leads to the inability to metabolise glucose. Please note that by doing so you agree to be added to our monthly email newsletter distribution list. Diabetes (type 1 and type 2) in children and young people: diagnosis and management. Immersive simulations are mentally exhausting because they create an intense and stressful atmosphere requiring the learner to work outside their comfort zone. Geeky Medics accepts no liability for loss of any kind incurred as a result of reliance upon the information provided in this video. - Exacerbating & relieving factors 05:12 1. opioids, sedatives, anxiolytics, insulin, oral hypoglycaemic medications). Trainee will correlate the underlying pathophysiology with symptoms and signs as exhibited by the simulation session. 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. confusion, coma), All critically unwell patients should have. Review the patientsoxygen saturation(SpO2): Auscultate the chest to screen for evidence of respiratory pathology (e.g. SimMan Nursing Scenarios Software. We give the history of the patient to the trainees. The patient synopsis should include such standard aspects as age, sex, ethnicity, medical history, medications and allergies. The students are in their basic science course. Use blankets to re-warm patients who are mild to moderately hypothermic. Urinary tract infections are a common DKA precipitant. 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. By joining Cureus, you agree to our Make sure thepatientsnotes,observationchartandprescriptionchartare easily accessible. The main purpose of the simulation is to draw a line from the theoretical, boring biochemistry to the clinical manifestations. If you have any scenarios you would be willing to share with the simulation community, please forward them . 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. Development of simulation scenarios for an adolescent patient with diabetic ketoacidosis. However, this leads to confusion. In the meantime, you can perform some basic airway manoeuvres to help maintain the airway whilst awaiting senior input. reduced air entry, coarse crackles) to screen for evidence of pneumonia. Make sure tore-assessthe patient after anyintervention. After initial insulin therapy has reduced plasma blood glucose levels (e.g. - Geeky Medics OSCE App: https://geekymedics.com/geeky-medics-app/ We do have a wig that we place on the patient, but we do not try for full realism. For instance, if we mimicked the noise and traffic of a real emergency department, this would constitute excessive realism, and become a distraction to beginner medical students. 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. Diabetic ketoacidosis (DKA) is a common, potentially lethal disease. Introduceyourselfto whoever has requested a review of the patient andlistencarefullyto their handover. <> 1-6. General: Moaning, asking what has happening to her. On the basis of the feedback from the students, they indicated that they believed the small group sessions are better. 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. It should only be inserted in unconscious patients as it is otherwise poorly tolerated and may induce gagging and aspiration. Supplemental digital content is available for this article. A collection of surgery revision notes covering key surgical topics. 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 used the Medical Education Technologies Inc. (METI) Human Patient Stimulator (HPS, METI Sarasoto, Fl). 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. Typically potassium levels should be maintained between 4.0 5.5 mmol/L and close monitoring is required. To read Pages full Research Review column, visit www.jems.com/patient-care. The simulation session is also hosted as an interactive session. This leads to hyperglycaemia, osmotic diuresis, and dehydration. 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 was taken to the Emergency Department from her soccer game because she complained of nausea, extreme fatigue, mild disorientation, and blurred vision toward the end of the soccer match. www.cdc.gov/diabetes/statistics/prev/national/. The student group should be encouraged to collaborate on management options and to perform skills. Clinical Simulation in Nursing, Volume 39, 2020, pp. PA EMT Said COVID Patient Didnt Need to Go to the Hospital. Please try after some time. Refer to your local guidelines which should provide a clear protocol for the management of DKA. 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. Causes: Any situation arising in a diabetic that requires increased insulin without that demand being met can result in DKA. Case-based education adds a real-world aspect to the learning environment. Diabetic Ketoacidosis (DKA) Clinical Pathway Emergency Department | Children's Hospital of Philadelphia See ourintravenous cannulation guidefor more details. - Site 01:12 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. Measure the patients capillary blood glucose and ketone levels to confirm the diagnosis and guide the management of DKA. - 700+ OSCE Stations: https://geekymedics.com/osce-stations/ Facebook: http://www.facebook.com/geekymedics Laschinger S, Medves J, Pulling C, et al. If an obstruction is visible within the airway, use afingersweeporsuctionto remove it. 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. 2 The evaluation of potassium deficits is complicated by potassium exit from . Physician working in the emergency department. In this section, we have to guide them as to what they should do first for the patient in this critical condition (ie, treat the A, B, Cs of airway, breathing, and circulation) before we can confirm the diagnosis. 2003;78:783788. Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. Review the patients drug chart for medications which may cause a reduced level of consciousness (e.g. She began experiencing progressively worsening thirst, increased appetite, and excessively increased urination. 2009;13:505511. Deteriorationshould be recognised quickly and acted upon immediately. - Introduction 00:00 5. ABG, venepuncture). unilateral coarse crackles may be present if the patient has pneumonia which may have been the precipitant for DKA). A GCS of 8 or below warrants urgent expert help from an anaesthetist. Insert at least onewide-bore intravenous cannula(14G or 16G) and take blood tests as discussed below. Review thepatients notes,chartsandrecent investigation results. With your index and other fingers placed behind the angle of the mandible, apply steady upwards and forward pressure to lift the mandible. 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]). Lets discuss your options. The main goal is to establish a safe learning environment for the learner [9, 13 . An animated lecture may be described as a pseudo-simulation environment. The instructor should have visual access via one-way windows or cameras. % Similar to a ward round, where the instructor would say: Come and listen to this patient with an aortic stenosis. 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. Both external and internal potassium balances are disturbed during the development and treatment of DKA. 3. Scenarios. See ourhistory taking guidesfor more details. His Wife Gave Him CPR. Case-based simulation should include two to three broad-focus objectives, as well as 1020 specific performance measures that the student should accomplish. 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. Its absolutely necessary to follow all immersive simulations with a positive, emotionally safe and nonjudgmental debriefing environment. The debriefing environment should be removed from the location where the simulation took place. 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. DKA can develop within 24 hours and is potentially life threatening, requiring prompt recognition and therapeutic intervention. The questionnaire for the assessment of the session is given in full in the web-based supplement (Appendix A, Supplemental Digital Content 1, https://links.lww.com/SIH/A1). However, this turned out to be too slow, took too much time, and could not continuously demonstrate the direction of changes. Another example: At one minute into the scenario, the patient becomes unresponsive and their breathing becomes shallow. As this is a PBL session, the trainees are not given any references. The 60 minutes training time consists of four 15-minute sections divided as follows. An hour was . She is lethargic and slightly confused but can intermittently respond to questions. In this case scenario, dehydration is one of the most serious immediate issues. Research Watch Box:Sleep, Fatigue & SafetyBy David Page, MS, NREMT-P Ketones show 5.5. As the name says, this screen is used to graph and plot any parameter. 2. 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. The relationship between sleep, fatigue and patient and provider safety. In an animated lecture, its important that the student group have an instructor so they can ask direct questions. Trainee will increase knowledge of professional behaviors during the simulation. Just place the BR2_KDCA file into your addons scenery folder: C:\\Program Files\\Microsoft Games\\Microsoft Flight Simulator X\\Addon Scenery\\Scenery. Please enable scripts and reload this page. Trainee will describe the changes in vital signs, the major metabolic, fluid, and electrolyte. 2) Complete the assigned suggested readings 3) Complete the presimulation preparation virtual simulation game (Instructor will provide link) 4) Once you have completed reading this document and prepared for your simulation, please: a. This is particularly important for core . The choice of fluid type, rate of administration and volume should be tailored to the individual patient based upon their vital signs and electrolytes. 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). Indeed, it is the only thing that ever has.". 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. to maintaining your privacy and will not share your personal information without DO NOT perform any examination or procedure on patients based purely on the content of these videos. J Nurs Educ. The validity of the HFS-DKA scenario was verified by a certified diabetes nurse educator, a registered nurse, and a clinical nurse educator. 3 0 obj Simulation Scenario for Anesthesia Providers Clark Obr, MD*, Anthony Mueller, MD . Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. 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. Askhow the patient is feeling as this may provide some useful information about their current symptoms. A number of key modifiers are described that allow for the adjustment of case . 1. Depending on scenario complexity, team dynamic and treatment modalities, this simulation may take 1020 minutes. Margolis GS, Romer GA, Fernandez AR, et al. The use of case-based simulation, although more complicated and time consuming for the instructor, immerses the students in the subject matter. Scenario in a Nutshell Diabetic ketoacidosis (DKA) in pregnancy. PBL was introduced at our institution in 1995. It may be necessary toexposethe patient during your assessment: remember to prioritise patient dignity and conservation of body heat. Recognize the signs and symptoms of a patient presenting with diabetic ketoacidosis. Keywords: diabetic ketoacidosis, simulation, expertise, emergency medicine Introduction Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes mellitus, most . Its important to train and educate students of prehospital care on key indicators of a diabetic emergency. In some cases, normal saline with additional potassium is required to prevent overcorrection of serum potassium levels which would otherwise result in hypokalaemia. 2008;6:278302. Section snippets . Using the arterial line, the scenario becomes much more dynamic. Simulation-based medical education: An ethical imperative. 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. Subscribe to our newsletter to be the first to know about our latest content: https://geekymedics.com/newsletter/ There are just a few more things to do. Many of the preclinical students have never seen a real life clinical monitor or even an intravenous (IV) setup. Download: http://teamworkmatters.ocbmedia.com/media/DKA-Simulation-Scenario.docx Categories: 5th Year MBChB paeds scenario, Emergency Department, Human Factors, Interprofessional / multidisciplinary, Non-technical skills, Paediatrics, Postgraduate / newly qualified, Undergraduate / pre-registration Rating Privacy Policy Each performance measure is separated into cognitive, behavioral or technical categories. She Died the Next Day. Note that if-thens must also include negative patient outcomes for when the provider doesnt take appropriate action. 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. Cureus is on a mission to change the long-standing paradigm of medical publishing, where submitting research can be costly, complex and time-consuming. Vital Signs: BP, 90/30 mm Hg (ECG shows normal sinus rhythm); central venous pressure, 0 to 2 cm H. Lungs: All lung fields are clear to auscultation without wheeze or rhonchi, and the respiratory pattern is typical of Kussmaul breathing, ie, large deep tidal volumes and increased respiratory rate. 2011;15:108109. Airway adjuncts are often helpful and in some cases essential to maintain a patients airway. Ziv A, Wolpe PR, Small SD, et al. COVID-19 Screening in the Pediatric Emergency Department. The instructions to the facilitators suggest a series of structured, sequential questions to the students (starting at one end, involving each student in turn, and repeatedly cycling around the group.) A collection of anatomy notes covering the key anatomy concepts that medical students need to learn. The use of simulation-based instruction enables a student to learn at their own pace and allows them to repeat sequential steps to gain confidence and proficiency. Rosens Emergency Medicine: Concepts and Clinical Practice. Competency-based medical education has seen widespread adoption in the field along with ongoing work in the areas of . Acad Med. Therefore, we have to emphasize the importance of airway, breathing, and circulation in the very sick patient in any clinical setting. 4. You may be trying to access this site from a secured browser on the server. Therefore, the same file is also sent to the participants before the session. TikTok: https://www.tiktok.com/@geekymedics Alert a senior immediately if you have any concerns about the consciousness level of a patient. Insert the airway bevel-end first, vertically along the floor of the nose with a slight twisting action. Available if the trainee asks: arterial blood gas, glucose, electrolytes, BUN and plasma osmolality (please see last section of Appendix B, Supplemental Digital Content 2, https://links.lww.com/SIH/A2, for values). #geekymedics #fyp #fypviral #studytok #medicalstudentuk #medtok #studytips #studytipsforstudents #medstudentuk #premed #medschoolfinals, Cardiovascular History Tips - DON'T FORGET these 3 things . "Never doubt that a small group of thoughtful, committed citizens can change the world. This guide provides an overview of the recognition and immediate management of diabetic ketoacidosis (DKA)using an ABCDE approach. After entering the environment, the student doesnt have the option of leaving the simulation until the learning objectives and performance measures are achieved. A comprehensive collection of medical revision notes that cover a broad range of clinical topics. A collection of communication skills guides, for common OSCE scenarios, including history taking and information giving. In keeping with the case study, as a treatment marker is reached, the instructor should place emphasis on physiological, pharmacological, environmental and psychosocial issues. Open the patients mouth to ensure there is no foreign material that may be pushed into the larynx. This video demonstrates how to use the SOCRATES acronym when taking a history of pain or other symptoms. 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.
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