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. 2017 May 29;9(5):e1286. Just place the BR2_KDCA file into your addons scenery folder: C:\\Program Files\\Microsoft Games\\Microsoft Flight Simulator X\\Addon Scenery\\Scenery. Interactive lecture/discussion with use of monitors that show the vital signs of the simulated patient on manikin. A well-staged environment allows for greater student buy-in. 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. Using SOCRATES in History Taking | OSCE | Communication Skills, Diabetic Ketoacidosis (DKA) | Acute Management | ABCDE. Conclusions This technical report describes the design and implementation of a simulation scenario on DKA for emergency medicine trainees. Simulation provides a safe environment where learning is enhanced through the deliberate practice of skills and controlled management of a variety of clinical encounters. 2011;15:108109. A fixed-rate intravenous insulin infusion should be commenced initially to suppress ketogenesis, reduce blood glucose levels and address electrolyte disturbances. A comprehensive collection of medical revision notes that cover a broad range of clinical topics. The objective is to give as many visual and tactile cues concerning the patient condition and background as possible. reduced air entry, coarse crackles) to screen for evidence of pneumonia. Observe and discuss the effects of therapy in a mathematically modeled physiological simulator. General: Moaning, asking what has happening to her. 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. 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. This guide provides an overview of the recognition and immediate management of diabetic ketoacidosis (DKA)using an ABCDE approach. The student group is given a short introduction into a closed simulation environment. Moses Lake (WA) Fire Department Gets $3.3M Grant for more Firefighters, Woman Who Crashed into Responders, Killing PA Firefighter, Gets Prison, Three Apparent Gas Explosions at San Bernardino (CA) Mountain Homes, Enid (OK) Fire Department Begins SWAT Medic Program to Assist Police, FDNY EMS Providers Win COVID-19-Linked Free Speech Lawsuit, Coronavirus Origins Still a Mystery Three Years into Pandemic. Initially, we used a blood pressure cuff to generate the blood pressure values. Seek senior helpif the patient shows no signs of improvement or if you have any concerns. This allows the learner group to make a psychological break from the patient and environment while beginning the reflection process. Glycosuria leads to urinary losses of potassium through osmotic diuresis. Conclusion 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. Does the patient need reviewing by a specialist? A nasopharyngeal airway is a soft plastic tube with a bevel at one end and a flange at the other. 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. For more information, please refer to our Privacy Policy. 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. A collection of interactive medical and surgical clinical case scenarios to put your diagnostic and management skills to the test. Manikin staging can provide strong cues. Alert a senior immediately if you have any concerns about the consciousness level of a patient. Weight, Height: Not given, normal appearing (as per simulator) but has lost 20 lbs recently. Simulation Scenario for Anesthesia Providers Clark Obr, MD*, Anthony Mueller, MD . 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. Finally, we summarize the course and give them time for questions. Immersive Simulations % 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. Its best, however, to allow the student group to continue so theyre able to evaluate their decision-making processes during debriefing. A chest X-ray should not delay the emergency management of DKA. Trainee will describe the changes in vital signs, the major metabolic, fluid, and electrolyte. Facilitator to ask how often to measure BMs 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. #geekymedics #fyp #fypviral #studytok #medicalstudentuk #medtok #studytips #studytipsforstudents #medstudentuk #premed #medschoolfinals #shorts, Cardiovascular Exam Tips - DON'T FORGET these 3 things , Watch this video to find out the most COMMONLY FORGOTTEN components of the cardiovascular history! Save this video to help prepare for your upcoming OSCEs and dont forget to follow Geeky Medics! 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].. Note that if-thens must also include negative patient outcomes for when the provider doesnt take appropriate action. 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. The Pratcice GRAPH. 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). During an immersive simulation, its imperative the group uses critical-thinking skills and group collaboration independently. Please try again soon. YouTube Video VVVram5yRUhROGJRUW1sZk5kQVFDXzV3LjMxakdNallNcng0, YouTube Video VVVram5yRUhROGJRUW1sZk5kQVFDXzV3LkJPVjVZMzBKczY4, YouTube Video VVVram5yRUhROGJRUW1sZk5kQVFDXzV3LkxEM2VkQzB2NTBr, Start typing to see results or hit ESC to close, Deep Vein Thrombosis (DVT) Examination OSCE Guide, Pre-hospital Advanced Life Support (ALS) OSCE Guide, Adult Choking (Basic Life Support) OSCE Guide, Paediatric Intravenous Cannulation OSCE Guide, Intrauterine System (Mirena) Counselling OSCE guide, Geeky Medics OSCE Book | Clinical Examination, Paediatric Gastro-oesophageal Reflux Disease, A Career as a GP with Special Interest with Dr Fiona Mosgrove, Absolute insulin deficiency (e.g. This may produce better retention of the subject matter and help students adapt to emergency scenes before going into the field. *=NdL/c2XSJn8:I Jb8'.8>N*[L .hxw6afq40DX3c~>abt'Q,8y(BZu(vKBTufIR. Supplemental digital content is available for this article. Several environments may be suitable for your classroom. diagnosis of DKA Trigger 3, ABG show acidosis and high BM and normal potassium. Stage 1: Initial assessment of acutely unwell pregnant woman and diagnosis of DKA. The patient was placed in the supine position and was a little confused as well as drowsy but at times had a good verbal response (Glasgow Coma Scale 15/15). 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. - Severity 05:32 A pre-briefing session is conducted prior to the start of the simulation scenario. modify the keyword list to augment your search. If an infection is suspected, IV antibioticsshould be administered as soon as possible. See our blood glucose measurement guide for more details. areas of lipohypertrophy) if it is unclear if the patient is diabetic. Trainee will practice or observe good teamwork skills, both as a leader and a team player. Given 6 to 8 back-to-back sessions, it is critical that every session starts and ends on time! This field is for validation purposes and should be left unchanged. Make sure thepatientsnotes,observationchartandprescriptionchartare easily accessible. JEMS. The students have acquired all the applicable theoretical knowledge of the case during the previous multiday PBL sessions. 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. Simulation in Healthcare4(4):232-236, Winter 2009. Well done, youve now stabilised the patient and theyre doing much better. can be reemphasized, and the effects of fluid therapy demonstrated. However, this turned out to be too slow, took too much time, and could not continuously demonstrate the direction of changes. Join the Geeky Medics community: Consider active re-warming techniques in patients with severe hypothermia. 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. Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. Perform urinalysis and send the urine for culture if urinary tract infection is suspected. 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. The lecture allows for understanding of concepts prior to action, and instructor feedback is immediate. 2003;78:783788. The validity of the HFS-DKA scenario was verified by a certified diabetes nurse educator, a registered nurse, and a clinical nurse educator. A comprehensive collection of OSCE guides to common clinical procedures, including step-by-step images of key steps, video demonstrations and PDF mark schemes. Diabetes mellitus affects nearly 7.8% of the U.S. population, with approximately 510% of this group affected by Type I and 9095% by Type II.1 Diabetes is the most common type of endocrine disease and was the seventh leading underlying cause of death listed on death certificates in 2006. Immersive simulations are mentally exhausting because they create an intense and stressful atmosphere requiring the learner to work outside their comfort zone. 1. We try to provide sufficient realism.. We believe it is important to have active, participatory learning by having conversations with the trainees in the form of questions and answers. Antibiotics should be prescribed in keeping with local guidelines. 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. Clearlydocument your ABCDE assessment, including history, examination, observations, investigations, interventions, and the patients response. The DKA simulation incorporates cue recognition, analysis of cues, generation of solutions, nursing interventions, and evaluation of outcomes, including effective communication and psychosocial concerns. 2. Published August 2015. Stage 3: Ongoing management and monitoring of DKA 1 hour after initiation of treatment. Revisit history taking to explore relevant medical history and identify any precipitating factors for 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. doi: 10.7759/cureus.1286. This video demonstrates how to use the SOCRATES acronym when taking a history of pain or other symptoms. stream Simulation-based medical education: An ethical imperative. LYqC+pJ&6X4onfBT#?=R}.p8N3+Dk,P4tIgWB}-L'=8;_G >,K#.e89XnG'B~NtR Depending on scenario complexity, team dynamic and treatment modalities, this simulation may take 1020 minutes. Wolters Kluwer Health Twitter: http://www.twitter.com/geekymedics Emergency medical services workLife characteristics contribute to clinically significant excessive daytime sleepiness. Stage 2: Emergency management of DKA and consideration of abnormal CTG. Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario 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. Hypothermia may be present if the patient has been unconscious and exposed for some time. Works with Traffic 2005, but . Open the patients airwayusing ahead-tiltchin-lift manoeuvre: 1. An hour was . You can check out our guide to using SOCRATES here: https://geekymedics.com/the-socrates-acronym-in-history-taking/ vD0 x@FFJ{m[ 3//Oh|JR7! Please enable scripts and reload this page. By joining Cureus, you agree to our Physician working in the emergency department. A collection of free medical student quizzes to put your medical and surgical knowledge to the test! 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.