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). Refer to your local guidelines which should provide a clear protocol for the management of DKA. Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. Many of the preclinical students have never seen a real life clinical monitor or even an intravenous (IV) setup. Prehosp Emerg Care. From the Department of Anesthesiology, Pennsylvania State University College of Medicine, Hershey, PA. Dr. Murray is on the Speakers Bureau of METI, Sarasota, FL. Please note that by doing so you agree to be added to our monthly email newsletter distribution list. Invasive monitors, including a left radial intraarterial and a right subclavian IV catheter, were placed. - Exacerbating & relieving factors 05:12 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. Keyword Highlighting GRAPH. - Radiation 02:45 She had developed nausea, extreme fatigue, mild disorientation, and blurred vision toward the end of the soccer match. Collectblood testsafter cannulating the patient including: An ECG should be performed to screen for cardiac pathology such as arrhythmias which may be precipitated by electrolyte abnormalities (e.g. A comprehensive collection of OSCE guides to common clinical procedures, including step-by-step images of key steps, video demonstrations and PDF mark schemes. We then start the DKA state. See Appendix D, Supplemental Digital Content 4, https://links.lww.com/SIH/A4. We now provide the students with handouts of the data to save time and provide consistency. Available from: [, NICE guidelines. Regardless of the underlying cause of airway obstruction, seekimmediate expert supportfrom an anaesthetist and the emergency medical team (often referred to as the crash team). Prehosp Emerg Care. - Timing 03:23 Margolis GS, Romer GA, Fernandez AR, et al. Seek senior helpif the patient shows no signs of improvement or if you have any concerns. The required potassium replacement varies greatly. diagnosis of DKA Trigger 3, ABG show acidosis and high BM and normal potassium. Refer to your local guidelines for further details. Therefore, we have to emphasize the importance of airway, breathing, and circulation in the very sick patient in any clinical setting. ABG, venepuncture). 2. modify the keyword list to augment your search. Int J Evid Based Healthc. Stage 2: Emergency management of DKA and consideration of abnormal CTG. 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.. The learning environment should closely mimic real-world applications. 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. In keeping with the case study, as a treatment marker is reached, the instructor should place emphasis on physiological, pharmacological, environmental and psychosocial issues. Diabetic Ketoacidosis (DKA) Clinical Pathway Emergency Department | Children's Hospital of Philadelphia We have been presenting Simulation Laboratory sessions to our preclinical medical students (first and second years). Insert at least onewide-bore intravenous cannula(14G or 16G) and take blood tests as discussed below. Download: http://teamworkmatters.ocbmedia.com/media/DKA-Simulation-Scenario.docx Categories: 5th Year MBChB paeds scenario, Emergency Department, Human Factors, Interprofessional / multidisciplinary, Non-technical skills, Paediatrics, Postgraduate / newly qualified, Undergraduate / pre-registration Rating If the patient loses consciousness and there are no signs of life on assessment, put out a crash call and commence CPR. 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. DO NOT perform any examination or procedure on patients based purely on the content of these videos. Clinical Simulation in Nursing, Volume 39, 2020, pp. - 700+ OSCE Stations: https://geekymedics.com/osce-stations/ We believe it is important to have active, participatory learning by having conversations with the trainees in the form of questions and answers. www.cdc.gov/diabetes/statistics/prev/national/. 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. Blood sugar issues in the Type II diabetic will have a gradual onset, with diagnosis generally resulting from routine laboratory exams.(1). Indeed, it is the only thing that ever has.". Trainee will get to know how professionals behave during management of a critically ill patient. 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. Competency-based medical education has seen widespread adoption in the field along with ongoing work in the areas of . Weight, Height: Not given, normal appearing (as per simulator) but has lost 20 lbs recently. 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. Simulation provides a safe environment where learning is enhanced through the deliberate practice of skills and controlled management of a variety of clinical encounters. 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). You can plot as many parameters as you want and can choose to display either Historical data or have the graphs update as often as new data comes in and view them in Real-time. The learning objectives follow the American College of Graduate Medical Education (ACGME) Core Compentencies. Strategies of high-performing paramedic educational programs. 1. 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). A traditional classroom lecture format allows for student participation but limits the instructors ability to create realistic situations. 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. When a group treatment decision is made that would be contraindicated or harmful to the patient, the instructor can redirect the learner group while maintaining an atmosphere inclined toward independent thinking. Standardized patient as the voice of the simulator (or the simulation operator may play this role). If the patient is suspected to have sufferedsignificanttraumawith potential spinal involvement, perform ajaw-thrustrather than a head-tilt chin-lift manoeuvre: 2. She tends to drink sugar containing fluids (soda) when she is thirsty, and she eats fast foods (cream-filled muffins) when she is hungry. Alert a senior immediately if you have any concerns about the consciousness level of a patient. Properly interpret a venous blood gas (VBG) and basic metabolic panel in a patient presenting with diabetic ketoacidosis. A GCS of 8 or below warrants urgent expert help from an anaesthetist. A nasopharyngeal airway is a soft plastic tube with a bevel at one end and a flange at the other. Hypothermia may be present if the patient has been unconscious and exposed for some time. Animated lectures, however, must work within the framework of a focused case study, which requires increased preparation time. - Examples 05:45 Please write a single word answer in lowercase (this is an anti-spam measure). Urinary tract infections are a common DKA precipitant. TheABCDEapproach can be used to perform a systematic assessment of a critically unwell patient. Recognize the signs and symptoms of a patient presenting with diabetic ketoacidosis. 2003;78:783788. 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. - Over 3000 Free MCQs: https://geekyquiz.com/ The students worked on the underlying physiology during a week long PBL session and are therefore familiar with the theoretical aspects of DKA. . DKA can develop within 24 hours and is potentially life threatening, requiring prompt recognition and therapeutic intervention. DOWNLOAD Diabetic Ketoacidosis By the end of this scenario, the learner will be able to: 1. Use blankets to re-warm patients who are mild to moderately hypothermic. The students are in their first year. Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare, Get new journal Tables of Contents sent right to your email inbox, SIH_13_4_2018_08_03_KOBAYASHI_17-00153_SDC5.tif; [Other] (3.04 MB), SIH_4_4_2009_10_29_NANDATE_200199_SDC2.doc; [Word] (68 KB), SIH_4_4_2009_10_29_NANDATE_200199_SDC3.doc; [Word] (29 KB), SIH_4_4_2009_10_29_NANDATE_200199_SDC4.doc; [Word] (40 KB), Simulation of Diabetic Ketoacidosis for Cellular and Molecular Basics of Medical Practice, Articles in PubMed by Koichiro Nandate, MD, PhD, Articles in Google Scholar by Koichiro Nandate, MD, PhD, Other articles in this journal by Koichiro Nandate, MD, PhD, Privacy Policy (Updated December 15, 2022). 2 The evaluation of potassium deficits is complicated by potassium exit from . Consider any precipitating factors for the development of DKA and involve the diabetes team in the patients care. The normal reference range for fasting plasma glucose is 4.0 5.8 mmol/l. For instance, one of the questions is: Why is Tiffany dehydrated? There are several possible reasons and mechanisms (as outlined in Appendix B, fourth 15 minutes, Supplemental Digital Content 2, https://links.lww.com/SIH/A2), which the students can mention. Make sure to re-assess the patient after any intervention. angioedema, rash) commence appropriate treatment as discussed in ouranaphylaxis guide. Scenario in a Nutshell Diabetic ketoacidosis (DKA) in pregnancy. Facilitator to ask how often to measure BMs Centers for Disease Control and Prevention. If the patient isunconsciousorunresponsive, start thebasic life support(BLS)algorithmas per resuscitation guidelines. 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. (1) The assessment of a diabetic patient is best taught as a. 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. 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. A well-staged environment allows for greater student buy-in. The main purpose of the simulation is to draw a line from the theoretical, boring biochemistry to the clinical manifestations. 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]). 2011;15:108109. Diabetic ketoacidosis; Simulation training; Medical students. Several environments may be suitable for your classroom. Topic: Abdominal TraumaTitle: Motorcycle CrashTarget: Senior Emergency Residents / Trauma TeamAuthor / Institution: Tim Chaplin, Alison Archibaldclick here to download, Topic: Adrenal CrisisTarget: Senior Emergency Residents / Trauma TeamAuthor / Institution: Anonclick here to download, Topic: AnaphylaxisTarget: Internal MedicineAuthor / Institute: Jim Boseovski / Queen's Universityclick here to download, Topic: AnaphylaxisTitle: Anaphylaxis In An InpatientTarget: PGY1Author / Institution: Alison Rodger, Babar Haroon / Dalhousie Universityclick here to download, Topic: AnaphylaxisTitle: Bee Sting In An 8 Month OldAuthor / Institution: Katie Gordon / University of Maryland School of Medicineclick here to download, Topic: ApneaTitle: Drowning In A 3 Year OldAuthor / Institution: Katie Gordon / University of Maryland School of Medicineclick here to download, Topic: Asthmatic Protocol for EDTitle: Branching Scenario: 3 Treatment Routine ER - Pediatric PatientTargets: Emergency Department Staff and Respiratory Therapy StudentsAuthor / Instituation: Carl Rod, MS, RRT, RCP, Rose State College RT Clinical Simulation Labclick here to download, Topic: Atrial FibrillationTarget: Internal MedicineAuthor / Institute: Jim Boseovski / Queen's Universityclick here to download plus chart documents here, Topic: Bidirectional Ventricular Tachycardia from Digoxin ToxicityTarget: Senior Emergency Residents / Trauma TeamAuthor / Institution: Anonclick here to download, Topic: BradicadiaTitle: Bradycardic Arrest - Carotid Sinus MassTarget: PGY1Author / Institution: Babar Haroon / Dalhousie Universityclick here to download, Topic: BurnTitle: Cigarette FireTarget: Senior Emergency Residents / Trauma TeamAuthor / Institution: Tim Chaplin, Alison Archibaldclick here to download, Topic: BurnTitle: Meth Lab Explosion Target: Senior Emergency Residents / Trauma TeamAuthor / Institution: Tim Chaplin, Alison Archibaldclick here to download, Topic: Cardiac ArrestTarget: Inter-professional Team TrainingAuthor / Institution: Alim Nagji, Krista Dowhos / Joseph Brant Hospitalclick here to download, Topic: Chest and Abdominal TraumaTitle: Auto AccidentTarget: Senior Emergency Residents / Trauma TeamAuthor / Institution: Tim Chaplin, Alison Archibaldclick here to download, Topic: CHF (Congestive Heart Failure)Target: Internal MedicineAuthor / Institute: Jim Boseovski / Queen's Universityclick here to download, Topic: Communication, Interpersonal Skills, Mediating Conflict Title: Managing Family Members with Different Views Target: ICU FellowsAuthor / Institution: Ryan Fink, Miko Enomoto / OHSUclick here to download, Topic: Crohns FlareTitle: Complicated CrohnsTarget: PGY1Author / Institution:Allen Tran / Dalhousie Universityclick here to download, Topic: Delirious, Combative / Violent Patient Management Title: DeliriumTarget: ICU FellowsAuthor / Institution: Ryan Fink, Miko Enomoto / OHSUclick here to download, Topic: Delivering Bad NewsTitle: Delivering Bad News after a StrokeTarget: ICU FellowsAuthor / Institution: Ryan Fink, Miko Enomoto / OHSUclick here to download, Topic: Difficult AirwayTitle: Ace Inhibitor AngioedemaTarget: Mid - Senior Emergency ResidentsAuthor / Institution: Anonclick here to download, Topic: Difficult AirwayTitle: Difficult / Failed AirwayTarget: Mid - Senior Emergency ResidentsAuthor / Institution: Anonclick here to download, Topic: Disclosure of an Adverse EventTitle: Retained Guidewire from a Central LineTarget: ICU FellowsAuthor / Institution: Ryan Fink / OHSUclick here to download, Topic: DKA (Diabetic Ketoacidosis)Target: Internal MedicineAuthor / Institute: Jim Boseovski / Queen's Universityclick here to download, Topic: DKATarget: PGY1Author / Institution: Allen Tran, Babar Haroon / Dalhousie Universityclick here to download, Topic: Dyspnea (Shortness of Breath)Title: Acute Pulmonary Edema requiring intubationTarget: Senior Emergency ResidentsAuthor / Institution: Anonclick here to download, Topic: Dyspnea (Shortness of Breath)Title: Severe Asthma requiring intubationTarget: Senior Emergency ResidentsAuthor / Institution: Anonclick here to download, Topic: Electrical StormTarget: Internal MedicineAuthor / Institute: Jim Boseovski / Queen's Universityclick here to download plus chart documents here, Topic: Emergent Med-Surg ResponseTitle: MET/RRT ResponseTargets: Response Teams, House Staff and Respiratory Therapy StudentsAuthor / Instituation: Carl Rod, MS, RRT, RCP, Rose State College RT Clinical Simulation Labclick here to download, Topic: EtOH WithdrawalTitle: EtOH Withdrawal SiezureTarget: PGY1Author / Institution: Allen Tran, Babar Haroon / Dalhousie Universityclick here to download, Topic: Febrile NeutropeniaTarget: Internal MedicineAuthor / Institute: Jim Boseovski / Queen's Universityclick here to download, Topic: Head TraumaTitle: Four Storey FallTarget: Senior Emergency Residents / Trauma TeamAuthor / Institution: Tim Chaplin, Alison Archibaldclick here to download, Topic: Head TraumaTitle: Hit by MotorboatTarget: Senior Emergency Residents / Trauma TeamAuthor / Institution: Tim Chaplin, Alison Archibaldclick here to download, Topic: HypertensionTitle: Aortic DissectionTarget: Senior Emergency ResidentsAuthor / Institution: Anonclick here to download, Topic: HypertensionTitle: Autonomic DysreflexiaTarget: Senior Emergency ResidentsAuthor / Institution: Anonclick here to download, Topic: Hypertensive EmergencyTarget: Internal MedicineAuthor / Institute: Jim Boseovski / Queen's Universityclick here to download, Topic: Hypertensive EmergencyTitle: Diastolic Danger Hypertensive Urgency / EmergencyTarget: PGY1Author / Institution: Hailey Hobbs, Babar Haroon / Dalhousie Universityclick here to download, Topic: HypoxiaTarget: Inter-professional Team TrainingAuthor / Institution: Devin Sydorclick here to download, Topic: Inferior StemiTarget: Internal MedicineAuthor / Institute: Jim Boseovski / Queen's Universityclick here to download, Topic: Labor and delivery, postpartum hemorrhageTitle: Normal Delivery with PPHTarget: Maternal - Child Course - Nursing EducationAuthor / Institution: Kelly McMunnclick here to download, Topic: PEA Arrest (pulseless electrical activity)Target: Internal MedicineAuthor / Institute: Jim Boseovski / Queen's Universityclick here to download, Topic: Pelvic FractureTarget: Senior Emergency Residents / Trauma TeamAuthor / Institution: Anonclick here to download, Topic: Penetrating Thoracic TraumaTarget: Senior Emergency Residents / Trauma TeamAuthor / Institution: Anonclick here to download, Topic: PneumoniaTarget: Internal MedicineAuthor / Institute: Jim Boseovski / Queen's Universityclick here to download, Topic: PneumoniaTitle: Community Acquired PneumoniaTarget: PGY1Author / Institution: Iain Arseneau, Babar Haroon / Dalhousie Universityclick here to download, Topic: Pulmonary EmbolismTarget: Internal MedicineAuthor / Institute: Jim Boseovski / Queen's Universityclick here to download, Topic: Ruptured Ectopic PregnancyTarget: Senior Emergency Residents / Trauma TeamAuthor / Institution: Anonclick here to download, Topic: SepsisTarget: PGY1Author / Institution: Allen Tran / Dalhousie Universityclick here to download, Topic: SepsisTitle: Sepsis - Crohn's IntraabdominalTarget: Mid - Senior Emergency ResidentsAuthor / Institution: Anonclick here to download, Topic: SepsisTitle: Sepsis - DKA and PneumoniaTarget: Mid - Senior Emergency ResidentsAuthor / Institution: Anonclick here to download, Topic: SepsisTitle: Sepsis - Febrile NeutropeniaTarget: Mid - Senior Emergency ResidentsAuthor / Institution: Anonclick here to download, Topic: ShockTitle: Blunt Trauma Causing a High Spinal Cord Injury with Neurogenic ShockTarget: Senior Emergency Residents / Trauma TeamAuthor / Institution: Tim Chaplin, Alison Archibaldclick here to download, Topic: ShockTitle: Hemorrhagic Shock in an Elderly Pedestrian stuck by a VehicleTarget: Senior Emergency Residents / Trauma TeamAuthor / Institution: Tim Chaplin, Alison Archibaldclick here to download, Topic: ShockTitle: Penetrating Chest Trauma Causing Obstructive ShockTarget: Senior Emergency Residents / Trauma TeamAuthor / Institution: Tim Chaplin, Alison Archibaldclick here to download, Topic: Snake BiteTarget: ER residentsAuthor / Institution: Katie Gordon / University of Maryland School of Medicineclick here to download, Topic: Status AsthmaticusTarget: PGY1Author / Institution: Unknownclick here to download, Topic: Status Epilepticus - Apnea Post-BenzodiazepinesTitle: Seven month old with Status EpilepticusTarget: Pediatric ResidentsAuthor / Institution: Keith Gregoireclick here to download, Topic: StrokeTarget: PGY1Author / Institution: Allen Tran / Dalhousie Universityclick here to download, Topic: Subdural Hemorrhage Title: SDH and DOACTarget: PGY1Author / Institution: Allen Tran / Dalhousie Universityclick here to download, Topic: Syncope / TorsadesTitle: Syncope / Torsades in the setting of acquired prolonged QTTarget: PGY1Author / Institution:Tasha Kulai, Babar Haroon / Dalhousie Universityclick here to download, Topic: Tachycardia Rapid AFTarget: PGY1Author / Institution: Allen Tran, Babar Haroon / Dalhousie Universityclick here to download, Topic: Toxic Shock SyndromeTarget: Senior Emergency Residents / Trauma TeamAuthor / Institution: Anonclick here to download, Topic: Toxicology - Bupivicaine OverdoseTarget: Senior Emergency ResidentsAuthor / Institution: Queens Universityclick here to download, Topic: Toxicology - Hydrofluoric Acid BurnsTarget: Senior Emergency ResidentsAuthor / Institution: Queens Universityclick here to download, Topic: Toxicology - OrganophosphatesTarget: Senior Emergency ResidentsAuthor / Institution: Queens Universityclick here to download, Topic: Upper GastrointestinalI BleedTarget: Internal MedicineAuthor / Institute: Jim Boseovski / Queen's Universityclick here to download, Topic: Upper Gastrointestinal BleedingTitle: GI BleedTarget: PGY1Author / Institution: Babar Haroon / Dalhousie Universityclick here to download, Topic: Viral bronchiolitis in infants requiring intubationTitle: Apnea in the infant with RSV bronchiolitisTarget: Pediatric ResidentsAuthor / Institution: Mike Storrclick here to download. We try to provide sufficient realism.. This article originally appeared in March 2011 JEMS as Diabetes Demonstration: Simulation-based learning works best., Simulation Training Ideal for Diabetic Patients, CMS Begins Reprocessing Retroactive Payments, Documents Detail EMTs Failure to Aid Tyre Nichols, New Course Lets Bystanders Be the Help Until Help Arrives, All Paramedic Recruits in New Castle County (DE) Obtain NRP Certification, International Prehospital Medicine Institute Literature Review, March 2023. MassBay EMS Program Integrates Training for Dogs, Heat Waves Are Killing More LA Homeless People. type 1 diabetes) Complete insulin insensitivity (e.g. In the context of DKA, a patients consciousness level may be reduced. 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 . 4. - Medical Finals Question Pack: https://geekymedics.com/medical-student-finals-questions/ 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. 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. Using SOCRATES in History Taking | OSCE | Communication Skills, Diabetic Ketoacidosis (DKA) | Acute Management | ABCDE. Open the patients airwayusing ahead-tiltchin-lift manoeuvre: 1. Schneider Sarver PA, Senczakowicz EA, Slovensky BM. Typically potassium levels should be maintained between 4.0 5.5 mmol/L and close monitoring is required. Trainee will practice or observe good teamwork skills, both as a leader and a team player. You might also be interested in our awesome bank of 700+ OSCE Stations. 1) Please read through this document as it will help you prepare for your upcoming simulation on DKA. By joining Cureus, you agree to our Trainee will increase knowledge of professional behaviors during the simulation. 3. In the meantime, you should re-assess and maintain the patients airway. 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.
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