Similar to a ward round, where the instructor would say: Come and listen to this patient with an aortic stenosis. You may search for similar articles that contain these same keywords or you may 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. Conclusions This technical report describes the design and implementation of a simulation scenario on DKA for emergency medicine trainees. 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. Example: If the provider immediately evaluates blood glucose, then the reading will display 45 mg/dL. I assigned true to life parking codes, and added some extra parking for the superfluous US Express AI. Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. 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. We guide the group to suggest fluid. (1) The assessment of a diabetic patient is best taught as a. Ziv A, Wolpe PR, Small SD, et al. Acad Med. DKA can develop within 24 hours and is potentially life threatening, requiring prompt recognition and therapeutic intervention. - 2500+ OSCE Flashcards: https://geekymedics.com/osce-flashcards/ type 1 diabetes), Complete insulin insensitivity (e.g. This may produce better retention of the subject matter and help students adapt to emergency scenes before going into the field. We have spent many hours debating whether the small group format was a waste of time. 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]). 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). . Many of the preclinical students have never seen a real life clinical monitor or even an intravenous (IV) setup. An animated lecture may be described as a pseudo-simulation environment. Over the years, some groups happened to have the simulation session before the completion of the theoretical PBL session. Revisit history taking to explore relevant medical history and identify any precipitating factors for DKA. Seek senior helpif the patient shows no signs of improvement or if you have any concerns. This allows us to get in touch for more details if required. doi: 10.7759/cureus.1286. 2. 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. We ask the trainee why the blood pressure is so low or heart rate is so high, and how we should treat it. Consider any precipitating factors for the development of DKA and involve the diabetes team in the patients care. This simulation session therefore aims to make the case come alive, and show this known case in a clinical context. 1 Potassium losses occurring both before and during treatment of DKA must be replaced. Introduceyourselfto thepatientincluding yournameandrole. Please write a single word answer in lowercase (this is an anti-spam measure). A collection of free medical student quizzes to put your medical and surgical knowledge to the test! Stage 2: Emergency management of DKA and consideration of abnormal CTG. Open the patients mouth to ensure there is no foreign material that may be pushed into the larynx. 5. Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario 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. His Wife Gave Him CPR. Target Learner Groups A nasopharyngeal airway is a soft plastic tube with a bevel at one end and a flange at the other. Trainee will appropriately request assistance and use available resources. Finally, we summarize the course and give them time for questions. 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. The instructors role is to facilitate active learning through a combination of learning styles. Often, the learner group will be unaware of these behaviors, but the instructor can key into the first few comments made during the transition between rooms. We now provide the students with handouts of the data to save time and provide consistency. Several environments may be suitable for your classroom. Indeed, it is the only thing that ever has.". After the first voluntary session in 2006, feedback from the medical students indicated that they would like to receive this handout. Trainee will practice or observe good teamwork skills, both as a leader and a team player. The files are given in full in the web supplement (Appendix B, Supplemental Digital Content 2, https://links.lww.com/SIH/A2). However, this leads to confusion. Another example: At one minute into the scenario, the patient becomes unresponsive and their breathing becomes shallow. Search for Similar Articles 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). Keywords: diabetic ketoacidosis, simulation, expertise, emergency medicine Introduction Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes mellitus, most . We also show them IV bags containing saline and Ringers lactate, as well as show them IV infusion sets. DY{Qb"(EgN$QI*%XN1F""0a5 TikTok: https://www.tiktok.com/@geekymedics 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 . Facebook: http://www.facebook.com/geekymedics The students have acquired all the applicable theoretical knowledge of the case during the previous multiday PBL sessions. Section snippets . Should any changes be made to the current management of their underlying condition(s)? Review the patientscurrent medicationsand check any regular medications areprescribed appropriately. Animated lectures, however, must work within the framework of a focused case study, which requires increased preparation time. There are several causes of DKA, which we remember by the "five I's". Margolis GS, Romer GA, Fernandez AR, et al. 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. Keyword Highlighting 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. #geekymedics #fyp #fypviral #studytok #medicalstudentuk #medtok #studytips #studytipsforstudents #medstudentuk #premed #medschoolfinals, Cardiovascular History Tips - DON'T FORGET these 3 things . A collection of surgery revision notes covering key surgical topics. 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. The normal reference range for fasting plasma glucose is 4.0 5.8 mmol/l. Causes: Any situation arising in a diabetic that requires increased insulin without that demand being met can result in DKA. Inspect for evidence of self-injection sites (e.g. 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). Simulation Scenario for Anesthesia Providers Clark Obr, MD*, Anthony Mueller, MD *Corresponding author: clark-obr@uiowa.edu Abstract Introduction: This simulation on diabetic ketoacidosis (DKA) in . unilateral coarse crackles may be present if the patient has pneumonia which may have been the precipitant for DKA). The Pratcice Clearlydocument your ABCDE assessment, including history, examination, observations, investigations, interventions, and the patients response. Marx JA, Hockberger RS, Walls RM. 2 The evaluation of potassium deficits is complicated by potassium exit from . 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. 3. Facilitator to ask how often to measure BMs See ourdocumentation guidesfor more details. Available from: [, NICE guidelines. Please try again soon. Instagram: https://instagram.com/geekymedics You should have another member of the clinical team aiding you in your ABCDE assessment, such a nurse, who can perform observations, take samples to the lab and catheterise if appropriate. 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Advance the airway until it lies within the pharynx. Insert the airway bevel-end first, vertically along the floor of the nose with a slight twisting action. They should introduce the student group to the environment, assign roles for each learner and guide the decision-making process. Urinary tract infections are a common DKA precipitant. 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.. 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. 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. If the patient is confused you might be able to get a collateral history from staff or family members as appropriate. His Heart Stopped On a Treadmill. These simulation sessions seem to work because the medical students do have prior knowledge. As this is an interactive discussion session, any needed debriefing and/or explanation is given during the sessions. 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. Antibiotics should be prescribed in keeping with local guidelines. A pre-briefing session is conducted prior to the start of the simulation scenario. Healthcare Students' Psychological Well-Being in a Diabetic Ketoacidosis Simulation. Circulating nurse in the emergency room (ER). This is particularly important for core . After initial insulin therapy has reduced plasma blood glucose levels (e.g. We found it more important to have the students full attention so that they could concentrate on concepts and not on menial tasks such as recording data.
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