However, this leads to confusion. The Theory - Severity 05:32 <> The researchers found that long shift hours (24hrs), working overtime and marital/relationship stress were strongly correlated. On the basis of the feedback from the students, they indicated that they believed the small group sessions are better. After initial insulin therapy has reduced plasma blood glucose levels (e.g. The learning environment should closely mimic real-world applications. Trainee will appropriately request assistance and use available resources. Her medical, social, and family histories are not clear at the time of admission to the emergency department. Animated Lecture A strong emphasis is placed on the focused, methodical examination of a specific medical problem and the decision-based treatment options available. Diabetes UK with the Joint British Diabetes Societies Inpatient Care Group. 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. TheABCDEapproach can be used to perform a systematic assessment of a critically unwell patient. If an obstruction is visible within the airway, use afingersweeporsuctionto remove it. As a next step, we will let one of the trainees talk to the patient, and prompt to ask medical questions such as previous medical issues or recent drug use for them to practice asking questions to generate a differential diagnosis (in this case, other causes for confusion). reduced air entry, coarse crackles) to screen for evidence of pneumonia. Note that if-thens must also include negative patient outcomes for when the provider doesnt take appropriate action. DONT FORGET these 3 key components of the cardiovascular exam for your upcoming OSCEs Save this video to watch later and dont forget to follow Geeky Medics! 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. 2010;49:578586. Manikin staging can provide strong cues. 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. 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. 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. See ourdocumentation guidesfor more details. Target Learner Groups (1) According to Centers for Disease Control and Prevention (CDC), 223,619 deaths were attributed to diabetes in 2005. Makeup may be used to depict gender, hollow eyes and cheeks, produce pallor or display bruises and scars. Furthermore, we demonstrate and explain the basic parameters (ECG, SpO2, BP, capnography), using an interactive format of questions and answers, and encourage the group to observe the normal values. Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. Does the patient need a referral toHDU/ICU? A fixed-rate intravenous insulin infusion should be commenced initially to suppress ketogenesis, reduce blood glucose levels and address electrolyte disturbances. However, this turned out to be too slow, took too much time, and could not continuously demonstrate the direction of changes. 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. Its absolutely necessary to follow all immersive simulations with a positive, emotionally safe and nonjudgmental debriefing environment. To read Pages full Research Review column, visit www.jems.com/patient-care. Make sure thepatientsnotes,observationchartandprescriptionchartare easily accessible. Prehosp Emerg Care. Does the patient need reviewing by a specialist? Physician working in the emergency department. Review the patients drug chart for medications which may cause a reduced level of consciousness (e.g. The simulation experience serves to give substance to the theoretical words and concepts that the students encountered during the PBL sessions. We have been presenting Simulation Laboratory sessions to our preclinical medical students (first and second years). - 2500+ OSCE Flashcards: https://geekymedics.com/osce-flashcards/ The instructor can also gauge the direction the debriefing session should follow or be alerted to possible problems or conflicts in treatment opinions. We then start the DKA state. See Appendix D, Supplemental Digital Content 4, https://links.lww.com/SIH/A4. 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. 1) Please read through this document as it will help you prepare for your upcoming simulation on DKA. 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. We have spent many hours debating whether the small group format was a waste of time. 2. A collection of anatomy notes covering the key anatomy concepts that medical students need to learn. 34 - Diabetic Ketoacidosis in Pregnancy | Obgyn Key vD0 x@FFJ{m[ 3//Oh|JR7! Rosens Emergency Medicine: Concepts and Clinical Practice. Weight, Height: Not given, normal appearing (as per simulator) but has lost 20 lbs recently. 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. Keyword Highlighting These simulation sessions seem to work because the medical students do have prior knowledge. Trainee will get to know how professionals behave during management of a critically ill patient. It may be necessary toexposethe patient during your assessment: remember to prioritise patient dignity and conservation of body heat. 5. 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. In other words, they do not have clinical experience, but they have clinical knowledge. Reduced urine output (oliguria) is typically defined as less than 0.5ml/kg/hour in an adult. endobj Use an effectiveSBARR handoverto communicate the key information effectively to other medical staff. Nandate, Koichiro MD, PhD; Abola, Ramon MD; Murray, W Bosseau MB; Whitfield, Carol PhD; Lang, Charles PhD; Sinz, Elizabeth MD. If foreign material is present, attempt removal using suction. Available from: [. Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario. - PDF The impetus for creating and implementing the high-fidelity diabetic ketoacidosis (DKA) simulation was based on a needs assessment and reviewing of undergraduate nursing students' examination statistics in a second semester medical-surgical course. The objective is to give as many visual and tactile cues concerning the patient condition and background as possible. Invasive monitors, including a left radial intraarterial and a right subclavian IV catheter, were placed. Review the patientsoxygen saturation(SpO2): Auscultate the chest to screen for evidence of respiratory pathology (e.g. In some cases, normal saline with additional potassium is required to prevent overcorrection of serum potassium levels which would otherwise result in hypokalaemia. Therefore, the same file is also sent to the participants before the session. This session provides additional clinical support material for the theoretical PBL session. JEMS. After the first voluntary session in 2006, feedback from the medical students indicated that they would like to receive this handout. Example: If the provider immediately evaluates blood glucose, then the reading will display 45 mg/dL. COVID-19 Screening in the Pediatric Emergency Department. The Theory Search for Similar Articles unilateral coarse crackles may be present if the patient has pneumonia which may have been the precipitant for DKA). See ourintravenous cannulation guidefor more details. Well done, youve now stabilised the patient and theyre doing much better. Refer to your local guidelines for further details. The normal reference range for fasting plasma glucose is 4.0 5.8 mmol/l. Instead, instructors should combine case- and simulation-based techniques when teaching diabetic assessment. Yes: if the patient can talk, their airway is patent and you can move on to the assessment of breathing. She tends to drink sugar containing fluids (soda) when she is thirsty, and she eats fast foods (cream-filled muffins) when she is hungry. Strategies of high-performing paramedic educational programs. Review the patientscurrent medicationsand check any regular medications areprescribed appropriately. 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. }HyEf,#$/JSRU9+CF6k\'/z+i`[ 5JudK*Zly^g%[jCK)H[)Y=Qp0/r9o9HW_zF}pTzI~'|q.~:=Y T 9w! Use washable, non-toxic paints to imitate various body emissions. 2017 May 29;9(5):e1286. The simulation session is also hosted as an interactive session. Properly interpret a venous blood gas (VBG) and basic metabolic panel in a patient presenting with diabetic ketoacidosis. www.cdc.gov/diabetes/statistics/prev/national/. DKA can develop within 24 hours and is potentially life threatening, requiring prompt recognition and therapeutic intervention. LYqC+pJ&6X4onfBT#?=R}.p8N3+Dk,P4tIgWB}-L'=8;_G >,K#.e89XnG'B~NtR In the context of DKA, a patients consciousness level may be reduced. confusion, coma), All critically unwell patients should have. Diabetic Ketoacidosis in the Obstetric Population: A Simulation 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. This typically involves the use of anon-rebreathe maskwith an oxygen flow rate of15L. When erroneous treatment is delivered, the instructor can end the simulation. - Radiation 02:45 As this is a PBL session, the trainees are not given any references. The following scenarios are available for download and are designed to meet your multi-disciplinary nursing needs. Medical Simulation Scenarios are text documents outlining the various details of a simulation - everything from patient simulator settings to debriefing notes.Below is a collection of donated scenarios for you to use or modify. An individual student can get an immediate answer to a question, the facilitator can see puzzled expressions on faces, and the PBL group could get answers that they could not get during their prior PBL group discussions. ABG, venepuncture). Typically potassium levels should be maintained between 4.0 5.5 mmol/L and close monitoring is required. 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 . They should introduce the student group to the environment, assign roles for each learner and guide the decision-making process. 1. Environment & Manikin The trainees have had background knowledge of biochemistry because they had completed the PBL case. During an immersive simulation, its imperative the group uses critical-thinking skills and group collaboration independently. PA EMT Said COVID Patient Didnt Need to Go to the Hospital. 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. areas of lipohypertrophy) if it is unclear if the patient is diabetic. See Table 4 for a suggested standardized script. We try to provide sufficient realism.. A comprehensive collection of OSCE guides to common clinical procedures, including step-by-step images of key steps, video demonstrations and PDF mark schemes. The addition of a fluid infusion containing some potassium allows insulin therapy to continue to suppress ketogenesis and normalise plasma pH whilst preventing the development of hypokalaemia. Diabetic ketoacidosis; Simulation training; Medical students. #geekymedics #fyp #fypviral #studytok #medicalstudentuk #medtok #studytips #studytipsforstudents #medstudentuk #premed #medschoolfinals, Cardiovascular History Tips - DON'T FORGET these 3 things . You may be trying to access this site from a secured browser on the server. Case-based simulation should include two to three broad-focus objectives, as well as 1020 specific performance measures that the student should accomplish. Medical Simulation Scenarios are text documents outlining the various details of a simulation - everything from patient simulator settings to debriefing notes. Despite this increased calorie intake, she noticed an unexplained 20 lbs weight loss. In the meantime, you can perform some basic airway manoeuvres to help maintain the airway whilst awaiting senior input. oral fluids, intravenous fluids, urine output, drain output, stool output, vomiting) to inform resuscitation efforts. 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). She does not take this regularly. Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario Kymera Systems Inc | SCADA Online Demo Ignition Ketones show 5.5. 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. This simulation session therefore aims to make the case come alive, and show this known case in a clinical context. The students are in their first year. 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. - Exacerbating & relieving factors 05:12 There are just a few more things to do. An integral part of a PBL session is for trainees to be able to navigate through huge literature bases. Advance the airway until it lies within the pharynx. Twitter: http://www.twitter.com/geekymedics If the patientloses consciousnessand there areno signs of lifeon assessment, put out acrash callandcommence CPR. stream Interactive lecture/discussion with use of monitors that show the vital signs of the simulated patient on manikin. Trigger 4, Pathway 1l of saline required over 1hour and insulin infusion need prescribing and making up in 50ml syringe. In this case scenario, dehydration is one of the most serious immediate issues. Trainee will correlate the underlying pathophysiology with symptoms and signs as exhibited by the simulation session. 4. 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.
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