Effectiveness of simulation on health profession students knowledge, skills, confidence and satisfaction. COVID-19 Screening in the Pediatric Emergency Department. Ketones show 5.5. Open the patients mouth to ensure there is no foreign material that may be pushed into the larynx. 4. You might also be interested in our awesome bank of 700+ OSCE Stations. The Theory
NPAs should not be used in patients who may have sustained a skull base fracture, due to the small but life-threatening risk of entering the cranial vault with the NPA. The HFS-DKA simulation teaching consisted of pre-briefing (an hour), running simulation (30 minutes) and debriefing (an hour) for the high-fidelity simulator using the Lardeal SIM man . In this manner, the students have to apply their knowledge at the appropriate points during the progression of the scenario. 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. The file explaining the session is sent to instructors 1 week before the sessions. This field is for validation purposes and should be left unchanged. Administer oxygen to all critically unwell patients during yourinitialassessment. An hour was . . Mosby:Philadelphia. This leads to hyperglycaemia, osmotic diuresis, and dehydration. Typically potassium levels should be maintained between 4.0 5.5 mmol/L and close monitoring is required. We believe it is important to have active, participatory learning by having conversations with the trainees in the form of questions and answers. Please try again soon. This video demonstrates how to use the SOCRATES acronym when taking a history of pain or other symptoms. Insert the airway bevel-end first, vertically along the floor of the nose with a slight twisting action. The reason for inserting the airway upside down initially is to reduce the risk of pushing the tongue backwards and worsening airway obstruction. This simulation session therefore aims to make the case come alive, and show this known case in a clinical context. Instagram: https://instagram.com/geekymedics Healthcare Students' Psychological Well-Being in a Diabetic Ketoacidosis Simulation. unilateral coarse crackles may be present if the patient has pneumonia which may have been the precipitant for DKA). Diabetes (type 1 and type 2) in children and young people: diagnosis and management. - Severity 05:32 Re-assessthe patient using theABCDE approachto identify any changes in their clinical condition and assess the effectiveness of your previous interventions. Marx JA, Hockberger RS, Walls RM. *=NdL/c2XSJn8:I Jb8'.8>N*[L .hxw6afq40DX3c~>abt'Q,8y(BZu(vKBTufIR. A list of the requirements (monitors, props, and others) is given in Tables 2 and 3, as well as in the web supplement (Appendix C, Supplemental Digital Content 3, https://links.lww.com/SIH/A3). DO NOT perform any examination or procedure on patients based purely on the content of these videos. DKA can be caused by either: Absolute insulin deficiency (e.g. Debriefing
Management of diabetic ketoacidosis in adults. Emergency medical services workLife characteristics contribute to clinically significant excessive daytime sleepiness. Trainee will recognize the need for therapy and suggest an appropriate therapy in a simulated environment. In keeping with the case study, as a treatment marker is reached, the instructor should place emphasis on physiological, pharmacological, environmental and psychosocial issues. Manikin staging can provide strong cues. In other words, they do not have clinical experience, but they have clinical knowledge. I assigned true to life parking codes, and added some extra parking for the superfluous US Express AI. 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. 2. 2010;49:578586. Supplemental digital content is available for this article. 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. Wolters Kluwer Health
Please write a single word answer in lowercase (this is an anti-spam measure). We have spent many hours debating whether the small group format was a waste of time. SimMan Nursing Scenarios Software. During an immersive simulation, its imperative the group uses critical-thinking skills and group collaboration independently. 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. 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. DY{Qb"(EgN$QI*%XN1F""0a5 2. 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. Intubation lubricants can mimic drooling. endobj
Geeky Medics accepts no liability for loss of any kind incurred as a result of reliance upon the information provided in this video. If the patient is confused you might be able to get a collateral history from staff or family members as appropriate. %PDF-1.5
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The main goal is to establish a safe learning environment for the learner [9, 13 . 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. The learning environment should closely mimic real-world applications. After initial insulin therapy has reduced plasma blood glucose levels (e.g. Medical Simulation Scenarios are text documents outlining the various details of a simulation - everything from patient simulator settings to debriefing notes. Inspect for evidence of infection on the skin (e.g. Its absolutely necessary to follow all immersive simulations with a positive, emotionally safe and nonjudgmental debriefing environment. Revisit history taking to explore relevant medical history and identify any precipitating factors for DKA. Please note that by doing so you agree to be added to our monthly email newsletter distribution list. 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. A debriefing section with pre-established questions allows the instructor to review the main focus and performance measures with the student group. 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. A collection of communication skills guides, for common OSCE scenarios, including history taking and information giving. 2007. Trainee will correlate the underlying pathophysiology with symptoms and signs as exhibited by the simulation session. vD0
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3. DO NOT perform any examination or procedure on patients based purely on the content of these videos. Hypothermia may be present if the patient has been unconscious and exposed for some time. Problems are addressed as they are identified and the patient is re-assessed regularly to monitor their response to treatment. You can check out our guide to using SOCRATES here: https://geekymedics.com/the-socrates-acronym-in-history-taking/ 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). Development of simulation scenarios for an adolescent patient with diabetic ketoacidosis. (1) According to Centers for Disease Control and Prevention (CDC), 223,619 deaths were attributed to diabetes in 2005. Join the Geeky Medics community: Glycosuria leads to urinary losses of potassium through osmotic diuresis. After the first voluntary session in 2006, feedback from the medical students indicated that they would like to receive this handout. The trainees have had background knowledge of biochemistry because they had completed the PBL case. www.cdc.gov/diabetes/statistics/prev/national/. 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. NPAs are typically better tolerated in patients who are partly or fully conscious compared to oropharyngeal airways. 1-6. Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. For example, you could develop a diabetic scenario in which the prehospital provider encounters an altered patient with incomprehensible speech. - Examples 05:45 We ask the trainee why the blood pressure is so low or heart rate is so high, and how we should treat it. Highlight selected keywords in the article text. She tends to drink sugar containing fluids (soda) when she is thirsty, and she eats fast foods (cream-filled muffins) when she is hungry. KDCA, Ronald Reagan Washington National Airport, DC. The students are in their basic science course. - 150+ PDF OSCE Checklists: https://geekymedics.com/pdf-osce-checklists/ Groups of fewer than four students dont allow for optimal collaboration. The Pratcice
Prehosp Emerg Care. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journals Web site (www.simulationinhealthcare.com). 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. If the provider starts an IV and gives dextrose, then the patients alertness will increase, respirations will normalize and repeated blood glucose will read 210 mg/dL over a two-minute interval. Its important to train and educate students of prehospital care on key indicators of a diabetic emergency. The instructors role is to facilitate active learning through a combination of learning styles. It should only be inserted in unconscious patients as it is otherwise poorly tolerated and may induce gagging and aspiration. (1), The assessment of a diabetic patient is best taught as a case-based simulation. We have 18 to 20 PBL groups for an hour each in the week after their PBL DKA session. 4. His Heart Stopped On a Treadmill. 1) Please read through this document as it will help you prepare for your upcoming simulation on DKA. %
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. Review the patients drug chart for medications which may cause a reduced level of consciousness (e.g. 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. DO NOT perform any examination or procedure on patients based purely on the content of these videos. The files are given in full in the web supplement (Appendix B, Supplemental Digital Content 2, https://links.lww.com/SIH/A2). Inspect the urine currently in the catheter bag and note its appearance (e.g. If you have any scenarios you would be willing to share with the simulation community, please forward them . VbQuX#R M21 In this section, we have to help the trainee to institute definitive therapy based on the underlying biochemical abnormalities. Note that if-thens must also include negative patient outcomes for when the provider doesnt take appropriate action. 4. Works with Traffic 2005, but . Clinical Simulation in Nursing, Volume 39, 2020, pp. We now provide the students with handouts of the data to save time and provide consistency. Circulating nurse in the emergency room (ER). Cureus is on a mission to change the long-standing paradigm of medical publishing, where submitting research can be costly, complex and time-consuming. 3. With your index and other fingers placed behind the angle of the mandible, apply steady upwards and forward pressure to lift the mandible. The scenario would include an if-then algorithm. Some error has occurred while processing your request. Refer to your local guidelines for further details. Use an effectiveSBARR handoverto communicate the key information effectively to other medical staff. 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. - Geeky Medics OSCE App: https://geekymedics.com/geeky-medics-app/ Heart: S1 and S2 within normal limits; no S3/S4 or murmurs, normal rate and rhythm. Consider any precipitating factors for the development of DKA and involve the diabetes team in the patients care. A nasopharyngeal airway is a soft plastic tube with a bevel at one end and a flange at the other. She is lethargic and slightly confused but can intermittently respond to questions. 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. GRAPH. 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]). Simulation Scenario. Classroom Dynamics
This typically involves the use of anon-rebreathe maskwith an oxygen flow rate of15L. Immersive simulations are mentally exhausting because they create an intense and stressful atmosphere requiring the learner to work outside their comfort zone. Initially, we used a blood pressure cuff to generate the blood pressure values. Case-based simulation should include two to three broad-focus objectives, as well as 1020 specific performance measures that the student should accomplish. Rosens Emergency Medicine: Concepts and Clinical Practice. Trainee will practice or observe good teamwork skills, both as a leader and a team player. In this case scenario, dehydration is one of the most serious immediate issues. Are any further assessments or interventions required? Refer to your local guidelines which should provide a clear protocol for the management of DKA. Observe and discuss the effects of therapy in a mathematically modeled physiological simulator. Urinary tract infections are a common DKA precipitant. Categories: Emergency Medicine, Medical Education Keywords: diabetic ketoacidosis, simulation, expertise, emergency medicine . ABG, venepuncture). This allows us to get in touch for more details if required. If you have any scenarios you would be willing to share with the simulation community, please forward them to me. Over the years, some groups happened to have the simulation session before the completion of the theoretical PBL session. Stage 3: Ongoing management and monitoring of DKA 1 hour after initiation of treatment. The diabetes with DKA clinical pathway is a detailed plan of the course of care for pediatric patients seen in the emergency department with diabetic ketoacidosis. 1. If foreign material is present, attempt removal using suction. Cureus 9(5): e1286. Finally, we summarize the course and give them time for questions. A collection of anatomy notes covering the key anatomy concepts that medical students need to learn. Your message has been successfully sent to your colleague. Trainee will appropriately request assistance and use available resources. Causes: Any situation arising in a diabetic that requires increased insulin without that demand being met can result in DKA. They have had no clinical exposure or any clinical experience. endobj
Animated Lecture
- Timing 03:23 angioedema, rash) commence appropriate treatment as discussed in ouranaphylaxis guide. (1) The assessment of a diabetic patient is best taught as a. The immersive simulation is performed when the instructor feels comfortable with the acquired knowledge and skill base presented in the animated lecture or when the student group has sufficient practical experience to apply the cognitive, behavioral and technical skills outlined in the case scenario. See ourdocumentation guidesfor more details. 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. 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. The students have acquired all the applicable theoretical knowledge of the case during the previous multiday PBL sessions. your express consent. Given 6 to 8 back-to-back sessions, it is critical that every session starts and ends on time! Trainee will improve their understanding of clinical practice through reflective assessment of actual cases during the prior PBL sessions. doi: 10.7759/cureus.1286. confusion, coma), All critically unwell patients should have. The choice of fluid type, rate of administration and volume should be tailored to the individual patient based upon their vital signs and electrolytes. The faculty member/course coordinator of Simulation Design 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. 2. Facebook: http://www.facebook.com/geekymedics See ourCXR interpretation guidefor more details. Review the patientscurrent medicationsand check any regular medications areprescribed appropriately. The students mentioned that they did not obtain the maximum value from the simulation session under these circumstances. 3. It may be necessary toexposethe patient during your assessment: remember to prioritise patient dignity and conservation of body heat. If the patient has COPD and a history of CO2retention you should switch to aventuri maskas soon as possible andtitrate oxygen appropriately. These are not learning objectives in this program. Simulation provides a safe environment where learning is enhanced through the deliberate practice of skills and controlled management of a variety of clinical encounters. Trainee will learn to collaborate with peers to decide on appropriate interventions, tests, and therapy. Invasive monitors, including a left radial intraarterial and a right subclavian IV catheter, were placed. The consequences (low blood pressure, high heart rate, central nervous system status, etc.) Weight, Height: Not given, normal appearing (as per simulator) but has lost 20 lbs recently. Place one hand on the patients forehead and the other under the chin. Capillary refill timemay be prolonged if the patient is hypovolaemic. - Onset 01:48 3 0 obj
The Theory
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. A fixed-rate intravenous insulin infusion should be commenced initially to suppress ketogenesis, reduce blood glucose levels and address electrolyte disturbances. The facilitator guides the group only when necessary. Keywords: diabetic ketoacidosis, simulation, expertise, emergency medicine Introduction Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes mellitus, most commonly occurring in patients with type I diabetes. Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. We have been presenting Simulation Laboratory sessions to our preclinical medical students (first and second years). The required potassium replacement varies greatly. - Site 01:12 As this is a PBL session, the trainees are not given any references. 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. Extremities: mild cyanosis, no clubbing or edema (verbalized by instructors); pulses equal, and symmetrical (elucidated by trainees). A chest X-ray should not delay the emergency management of DKA. 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)? Please enable scripts and reload this page. Make sure tore-assessthe patient after anyintervention. - Associated symptoms 03:04 You could also ask a student to smear a small amount of acetone on a piece of glass to see how volatile it is, helping them understand why its being exhaled by the DKA patient. reduced air entry, coarse crackles) to screen for evidence of pneumonia. 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.
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