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Hypothermia may be present if the patient has been unconscious and exposed for some time. In some cases, normal saline with additional potassium is required to prevent overcorrection of serum potassium levels which would otherwise result in hypokalaemia. This typically involves the use of anon-rebreathe maskwith an oxygen flow rate of15L. DKA can develop within 24 hours and is potentially life threatening, requiring prompt recognition and therapeutic intervention. Clinical Simulation in Nursing, Volume 39, 2020, pp. Deteriorationshould be recognised quickly and acted upon immediately. Review the patientsoxygen saturation(SpO2): Auscultate the chest to screen for evidence of respiratory pathology (e.g. 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. . Each PBL case typically goes over 23 days, affording the students periods to find information for the case. Conclusion: Our DKA simulator is a new tool whose objective is the training in a severe, frequent and complex situation, and can be used to improve the approach made by the junior physicians to the real diabetic . Simulation provides a safe environment where learning is enhanced through the deliberate practice of skills and controlled management of a variety of clinical encounters. 3 0 obj Prehosp Emerg Care. Each clinical case scenario allows you to work through history taking, investigations, diagnosis and management. Subscribe to our newsletter to be the first to know about our latest content: https://geekymedics.com/newsletter/ NPAs are typically better tolerated in patients who are partly or fully conscious compared to oropharyngeal airways. 2011;15:108109. The file explaining the session is sent to instructors 1 week before the sessions. J Nurs Educ. 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. Use blankets to re-warm patients who are mild to moderately hypothermic. In this section, we have to help the trainee to institute definitive therapy based on the underlying biochemical abnormalities. - Examples 05:45 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. She had developed nausea, extreme fatigue, mild disorientation, and blurred vision toward the end of the soccer match. General: Moaning, asking what has happening to her. Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario The consequences (low blood pressure, high heart rate, central nervous system status, etc.) This guide provides an overview of the recognition and immediate management of diabetic ketoacidosis (DKA)using an ABCDE approach. 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. If the patientloses consciousnessand there areno signs of lifeon assessment, put out acrash callandcommence CPR. (1), The assessment of a diabetic patient is best taught as a case-based simulation. Her medical, social, and family histories are not clear at the time of admission to the emergency department. 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. This leads to hyperglycaemia, osmotic diuresis, and dehydration. Int J Evid Based Healthc. We have been presenting Simulation Laboratory sessions to our preclinical medical students (first and second years). After the first voluntary session in 2006, feedback from the medical students indicated that they would like to receive this handout. x]o ]?9kgq~:)?hE )R6!up}\<8||\]}Y~;xp~yQ$#4~djX&{n_m-]^K1/~/AD Hv 99evs,;8}8zwnhFxV.kf-V^? A simulation training session is described designed to acquaint emergency medicine residents with the presentation and management of diabetic ketoacidosis through the use of simulation. It involves a facilitating instructor, a small learner group and conceptual aspects of environmental and manikin staging to provide sensory cues. Trigger 4, Pathway 1l of saline required over 1hour and insulin infusion need prescribing and making up in 50ml syringe. An animated lecture may be described as a pseudo-simulation environment. Because of the early stage (first year) of their medical careers, they have not yet seen vital sign monitoring, or patients, so these clinical aspects are introduced and emphasized. Animated Lecture A hyperglycemic patient may present with tachypnea, which often presents as Kussmauls respirations, tachycardia, orthostatic blood pressure changes and other signs of dehydration and diabetic ketoacidosis (DKA). . Observe and discuss the effects of therapy in a mathematically modeled physiological simulator. 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). Blood sugar issues in the Type II diabetic will have a gradual onset, with diagnosis generally resulting from routine laboratory exams.(1). We ask the trainee why the blood pressure is so low or heart rate is so high, and how we should treat it. LYqC+pJ&6X4onfBT#?=R}.p8N3+Dk,P4tIgWB}-L'=8;_G >,K#.e89XnG'B~NtR Debriefing Refer to your local guidelines for further details. modify the keyword list to augment your search. A pre-briefing session is conducted prior to the start of the simulation scenario. opioids, sedatives, anxiolytics, insulin, oral hypoglycaemic medications). This field is for validation purposes and should be left unchanged. A collection of interactive medical and surgical clinical case scenarios to put your diagnostic and management skills to the test. Acad Med. Healthcare Students' Psychological Well-Being in a Diabetic Ketoacidosis Simulation. 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. A fixed-rate intravenous insulin infusion should be commenced initially to suppress ketogenesis, reduce blood glucose levels and address electrolyte disturbances. 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. Its absolutely necessary to follow all immersive simulations with a positive, emotionally safe and nonjudgmental debriefing environment. Inspect for evidence of infection on the skin (e.g. Prehosp Emerg Care. 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. 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. Trainee will recognize the need for therapy and suggest an appropriate therapy in a simulated environment. Case-based education adds a real-world aspect to the learning environment. 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. If the patient loses consciousness and there are no signs of life on assessment, put out a crash call and commence CPR. Groups of fewer than four students dont allow for optimal collaboration. 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. Make sure thepatientsnotes,observationchartandprescriptionchartare easily accessible. TheABCDEapproach can be used to perform a systematic assessment of a critically unwell patient. 2008;6:278302. 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. 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.) 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. - Onset 01:48 "Never doubt that a small group of thoughtful, committed citizens can change the world. 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. The following scenarios are available for download and are designed to meet your multi-disciplinary nursing needs. Recognize the signs and symptoms of a patient presenting with diabetic ketoacidosis. She tends to drink sugar containing fluids (soda) when she is thirsty, and she eats fast foods (cream-filled muffins) when she is hungry. In the meantime, you can perform some basic airway manoeuvres to help maintain the airway whilst awaiting senior input. Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. 1. Ask for anotherclinicalmemberofstafftoassistyou if possible. Place one hand on the patients forehead and the other under the chin. The use of a simulated, evolving case scenario was an effective method of exposing nursing students to complex patient care. Intubation lubricants can mimic drooling. An events progression section should include patient status changes, as well as a time/treatment continuum that incorporates if-then event progressions. We are adding to their theoretical knowledge by introducing them to physical objects, dynamic moving vital sign signals, and a moving, breathing simulated patient to make the case come alive. Make sure tore-assessthe patient after anyintervention. Problems are addressed as they are identified and the patient is re-assessed regularly to monitor their response to treatment. 2 The evaluation of potassium deficits is complicated by potassium exit from . It involves working through the following steps: Each stage of the ABCDE approach involvesclinicalassessment,investigationsandinterventions. Immersive Simulations >> Patterson PD, Weaver M, Frank R, et al. 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. DOI 10.7759/cureus.1286. 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). The instructors never expect the trainees to exhibit full understanding of pathophysiology and skills in the treatment but do give them a few important points to understand the diagnosis and initial treatment of the patients with DKA. areas of lipohypertrophy) if it is unclear if the patient is diabetic. Note that if-thens must also include negative patient outcomes for when the provider doesnt take appropriate action. 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 . DY{Qb"(EgN$QI*%XN1F""0a5 Schneider Sarver PA, Senczakowicz EA, Slovensky BM. Are any further assessments or interventions required? Open the patients airwayusing ahead-tiltchin-lift manoeuvre: 1. Diabetes (type 1 and type 2) in children and young people: diagnosis and management. Facilitator to ask how often to measure BMs Despite this increased calorie intake, she noticed an unexplained 20 lbs weight loss. 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. A traditional classroom lecture format allows for student participation but limits the instructors ability to create realistic situations. Chapters: The relationship between sleep, fatigue and patient and provider safety. The faculty member/course coordinator of Simulation Design - Timing 03:23 Environment & Manikin 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].. In the meantime, you should re-assess and maintain the patients airway. a simulation training session designed to acquaint emergency medicine residents with the presentation and management of diabetic ketoacidosis (DKA) through the use of simulation. 2. 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Please note that by doing so you agree to be added to our monthly email newsletter distribution list. A chest X-ray should not delay the emergency management of DKA. 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. and Revisit history taking to explore relevant medical history and identify any precipitating factors for DKA. doi: 10.7759/cureus.1286. 3. The students are in their basic science course. If the patient has COPD and a history of CO2retention you should switch to aventuri maskas soon as possible andtitrate oxygen appropriately. The student group is given a short introduction into a closed simulation environment. PA EMT Said COVID Patient Didnt Need to Go to the Hospital. 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. Insert at least onewide-bore intravenous cannula(14G or 16G) and take blood tests as discussed below. Published August 2015. 2010;49:578586. Typically potassium levels should be maintained between 4.0 5.5 mmol/L and close monitoring is required. I assigned true to life parking codes, and added some extra parking for the superfluous US Express AI. 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. }HyEf,#$/JSRU9+CF6k\'/z+i`[ 5JudK*Zly^g%[jCK)H[)Y=Qp0/r9o9HW_zF}pTzI~'|q.~:=Y T 9w! Scenarios. The trainees have had background knowledge of biochemistry because they had completed the PBL case. Keywords: diabetic ketoacidosis, simulation, expertise, emergency medicine Introduction Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes mellitus, most . 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. Administer oxygen to all critically unwell patients during yourinitialassessment.