pinellas county arrests mugshots
dka simulation scenario
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. Development of simulation scenarios for an adolescent patient with diabetic ketoacidosis. Given 6 to 8 back-to-back sessions, it is critical that every session starts and ends on time! can be reemphasized, and the effects of fluid therapy demonstrated. 2003;78:783788. stream Please try after some time. 3. Simulation-based medical education: An ethical imperative. We are looking for declaration of DKA and request for pathway. If you have any scenarios you would be willing to share with the simulation community, please forward them . 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. We then start the DKA state. See Appendix D, Supplemental Digital Content 4, https://links.lww.com/SIH/A4. Scenarios. Cureus 9(5): e1286. Antibiotics should be prescribed in keeping with local guidelines. Trainee will correlate the underlying pathophysiology with symptoms and signs as exhibited by the simulation session. 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.. 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. SimMan Nursing Scenarios Software. The required potassium replacement varies greatly. Insert at least onewide-bore intravenous cannula(14G or 16G) and take blood tests as discussed below. For more information, please refer to our Privacy Policy. Review the patientscurrent medicationsand check any regular medications areprescribed appropriately. We do not use passive visualizing materials such as videotapes or DVD other than vital signs shown on the monitors. 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). Use an effectiveSBARR handoverto communicate the key information effectively to other medical staff. A collection of free medical student quizzes to put your medical and surgical knowledge to the test! Centers for Disease Control and Prevention. We have been presenting Simulation Laboratory sessions to our preclinical medical students (first and second years). Revisit history taking to explore relevant medical history and identify any precipitating factors for DKA. 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. Management of diabetic ketoacidosis in adults. From the Department of Anesthesiology, Pennsylvania State University College of Medicine, Hershey, PA. Dr. Murray is on the Speakers Bureau of METI, Sarasota, FL. One of the key differences with the immersive simulation is that the instructor is absent from the simulation environment. Nandate, Koichiro MD, PhD; Abola, Ramon MD; Murray, W Bosseau MB; Whitfield, Carol PhD; Lang, Charles PhD; Sinz, Elizabeth MD. Wolters Kluwer Health Initially, we required the students to write down the vital signs. 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 patient synopsis should include such standard aspects as age, sex, ethnicity, medical history, medications and allergies. The simulation experience serves to give substance to the theoretical words and concepts that the students encountered during the PBL sessions. They have had no clinical exposure or any clinical experience. Groups of more than seven may struggle with meeting objectives due to insufficient functional rolls. A collection of communication skills guides, for common OSCE scenarios, including history taking and information giving. After entering the environment, the student doesnt have the option of leaving the simulation until the learning objectives and performance measures are achieved. - PSA Question Pack: https://geekymedics.com/psa-question-bank/ Search for Similar Articles Int J Evid Based Healthc. See ourfluid prescribing guidefor more details onresuscitation fluids. Clearly communicate how often would you like the patients observations relayed to you by other staff members. Ziv A, Wolpe PR, Small SD, et al. 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. After initial insulin therapy has reduced plasma blood glucose levels (e.g. Available from: [. A nasopharyngeal airway is a soft plastic tube with a bevel at one end and a flange at the other. The trainees have had background knowledge of biochemistry because they had completed the PBL case. We give the history of the patient to the trainees. This allows the learner group to make a psychological break from the patient and environment while beginning the reflection process. - Geeky Medics OSCE App: https://geekymedics.com/geeky-medics-app/ "Never doubt that a small group of thoughtful, committed citizens can change the world. Simulation Scenario for Anesthesia Providers Clark Obr, MD*, Anthony Mueller, MD . You might also be interested in our awesome bank of 700+ OSCE Stations. Another example: At one minute into the scenario, the patient becomes unresponsive and their breathing becomes shallow. Make sure tore-assessthe patient after anyintervention. If the patient isunconsciousorunresponsive, start thebasic life support(BLS)algorithmas per resuscitation guidelines. Given such a small group, the students indicated that they feel more involved than they would with a larger group (eg, the whole class.) If the patient loses consciousness and there are no signs of life on assessment, put out a crash call and commence CPR. Terms of Use. However, this leads to confusion. >> Fernandez AR, Mac Crawford J, Pennell ML, et al. - Medical Finals Question Pack: https://geekymedics.com/medical-student-finals-questions/ A number of key modifiers are described that allow for the adjustment of case . 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. Immersive simulations are mentally exhausting because they create an intense and stressful atmosphere requiring the learner to work outside their comfort zone. Moses Lake (WA) Fire Department Gets $3.3M Grant for more Firefighters, Woman Who Crashed into Responders, Killing PA Firefighter, Gets Prison, Three Apparent Gas Explosions at San Bernardino (CA) Mountain Homes, Enid (OK) Fire Department Begins SWAT Medic Program to Assist Police, FDNY EMS Providers Win COVID-19-Linked Free Speech Lawsuit, Coronavirus Origins Still a Mystery Three Years into Pandemic. This session provides additional clinical support material for the theoretical PBL session. Cureus is on a mission to change the long-standing paradigm of medical publishing, where submitting research can be costly, complex and time-consuming. On the basis of the feedback from the students, they indicated that they believed the small group sessions are better. 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. Refer to your local guidelines for further details. One advantage to the animated lecture style is the ability to introduce treatment options in a methodically guided approach thats in conjunction with simultaneous environmental stimulus. An animated lecture may be described as a pseudo-simulation environment. In this case scenario, dehydration is one of the most serious immediate issues. Consider active re-warming techniques in patients with severe hypothermia. The students worked on the underlying physiology during a week long PBL session and are therefore familiar with the theoretical aspects of DKA. Highlight selected keywords in the article text. 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. This typically involves the use of anon-rebreathe maskwith an oxygen flow rate of15L. The facilitator guides the group only when necessary. Catheterisethe patient to closelymonitor urine outputto guide fluid resuscitation and need for escalation. In the final 10 minutes, we show how the patient has a good recovery after fluid replacement. 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). If the patient is confused you might be able to get a collateral history from staff or family members as appropriate. 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). Please enable scripts and reload this page. PBL in our institution is implemented as a small group (n 68 students) self study session with a facilitator, who incrementally discloses further information about the patient. 3 0 obj In the meantime, you should re-assess and maintain the patients airway. 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). This guide provides an overview of the recognition and immediate management of diabetic ketoacidosis (DKA)using an ABCDE approach. 1. 3. 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). The instructor should have visual access via one-way windows or cameras. When erroneous treatment is delivered, the instructor can end the simulation. Data Description All the product records are stored at /user/spark/dataset/retail_db/products All the category records are stored at /user/spark/dataset /ret. Ketones show 5.5. Glycosuria leads to urinary losses of potassium through osmotic diuresis. This video demonstrates how to use the SOCRATES acronym when taking a history of pain or other symptoms. Many of the preclinical students have never seen a real life clinical monitor or even an intravenous (IV) setup. 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. PA EMT Said COVID Patient Didnt Need to Go to the Hospital. She Died the Next Day. Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario Cureus. and Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. - Radiation 02:45 In the meantime, you can perform some basic airway manoeuvres to help maintain the airway whilst awaiting senior input. your express consent. Surgical dressings and imitation blood can support medical history. 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. The students are in their basic science course. Classroom Dynamics Mosby:Philadelphia. 1 0 obj modify the keyword list to augment your search. Environment & Manikin type 1 diabetes), Complete insulin insensitivity (e.g. We guide the group to suggest fluid. unilateral coarse crackles may be present if the patient has pneumonia which may have been the precipitant for DKA). (1), The assessment of a diabetic patient is best taught as a case-based simulation. A comprehensive collection of medical revision notes that cover a broad range of clinical topics. Facilitator to ask how often to measure BMs <>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 595.32 841.92] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> DKA can develop within 24 hours and is potentially life threatening, requiring prompt recognition and therapeutic intervention. You may be asked to review a patient with DKA due to confusion, reduced level of consciousness, tachycardia, hypotension and/or vomiting. 2010;49:578586. JEMS. In other words, they do not have clinical experience, but they have clinical knowledge. Adds true to life parking codes and extra parking for AI. Case-based simulation should include two to three broad-focus objectives, as well as 1020 specific performance measures that the student should accomplish. This allows us to get in touch for more details if required. For similar reasons, we do not believe a videotaped session will keep the students attention as much as these live simulator sessions. See ourdocumentation guidesfor more details. Recognize the signs and symptoms of a patient presenting with diabetic ketoacidosis. Inspect theairwayfor obviousobstruction. Keyword Highlighting We try to provide sufficient realism.. 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. 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 optimal number of simulation participants is four to seven individuals, depending on the case study objectives. They have had no clinical exposure or any clinical experience. Animated lectures, however, must work within the framework of a focused case study, which requires increased preparation time. 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. 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. 2008;6:278302. Performing an ECG should not delay the emergency management of DKA. 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. A collection of surgery revision notes covering key surgical topics. Debriefing The students mentioned that they did not obtain the maximum value from the simulation session under these circumstances. 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. Therefore, the session is divided into four sections of 15 minutes each, so that the facilitator is constantly aware of being on time (or not), even after the first 15 minutes period. 3. Diabetes UK with the Joint British Diabetes Societies Inpatient Care Group. 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. - Character 02:14 Medical Simulation Scenarios are text documents outlining the various details of a simulation - everything from patient simulator settings to debriefing notes. For diabetic assessment involving DKA, staging may include the use of a container with a small amount of acetone placed near the manikin because many students may not know what acetone smells like but will expect to smell something. We used the Medical Education Technologies Inc. (METI) Human Patient Stimulator (HPS, METI Sarasoto, Fl). See Table 4 for a suggested standardized script. A collection of anatomy notes covering the key anatomy concepts that medical students need to learn. These are not learning objectives in this program. Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. If the patientloses consciousnessand there areno signs of lifeon assessment, put out acrash callandcommence CPR. Make sure to re-assess the patient after any intervention. 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. This is particularly important for core cases and low-frequency, high-stakes procedures and encounters. Using the arterial line, the scenario becomes much more dynamic. She began experiencing progressively worsening thirst, increased appetite, and excessively increased urination. doi: 10.7759/cureus.1286. As this is an interactive discussion session, any needed debriefing and/or explanation is given during the sessions. 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. Example: If the provider immediately evaluates blood glucose, then the reading will display 45 mg/dL. Effectiveness of simulation on health profession students knowledge, skills, confidence and satisfaction. Vital Signs: BP, 90/30 mm Hg (ECG shows normal sinus rhythm); central venous pressure, 0 to 2 cm H. Lungs: All lung fields are clear to auscultation without wheeze or rhonchi, and the respiratory pattern is typical of Kussmaul breathing, ie, large deep tidal volumes and increased respiratory rate. 2 0 obj An oxygen mask is also demonstrated as an alternative device, as these early trainees had mostly not yet seen any of these devices. Using SOCRATES in History Taking | OSCE | Communication Skills, Diabetic Ketoacidosis (DKA) | Acute Management | ABCDE. Clinical Simulation in Nursing, Volume 39, 2020, pp. - Introduction 00:00 Trainee will get to know how professionals behave during management of a critically ill patient. Note that if-thens must also include negative patient outcomes for when the provider doesnt take appropriate action. 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. DOWNLOAD Diabetic Ketoacidosis By the end of this scenario, the learner will be able to: 1. DIABETIC KETOACIDOSIS MODULE: ENDOCRINOLOGY / METABOLIC TARGET: ALL PAEDIATRIC TRAINEES;NURSING STAFF BACKGROUND: DKA occurs when a relative or absolute lack of insulin leads to the inability to metabolise glucose. Trainee will be respectful to others and their views during the PBL session. It should only be inserted in unconscious patients as it is otherwise poorly tolerated and may induce gagging and aspiration. Typically potassium levels should be maintained between 4.0 5.5 mmol/L and close monitoring is required. A collection of interactive medical and surgical clinical case scenarios to put your diagnostic and management skills to the test. 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. Forty percent of respondents reported excessive daytime sleepiness. General: Moaning, asking what has happening to her. - Site 01:12 TikTok: https://www.tiktok.com/@geekymedics A debriefing section with pre-established questions allows the instructor to review the main focus and performance measures with the student group. Heart: S1 and S2 within normal limits; no S3/S4 or murmurs, normal rate and rhythm. A GCS of 8 or below warrants urgent expert help from an anaesthetist. Does the patient need a referral toHDU/ICU? Below is a collection of donated scenarios for you to use or modify. It was developed for anesthesiology resident physicians with some background knowledge and experience caring for critically ill patients. Stage 1: Initial assessment of acutely unwell pregnant woman and diagnosis of DKA. Immersive Simulations DKA can be caused by either: Absolute insulin deficiency (e.g. to maintaining your privacy and will not share your personal information without However, this turned out to be too slow, took too much time, and could not continuously demonstrate the direction of changes. She was taken to the Emergency Department from her soccer game because she complained of nausea, extreme fatigue, mild disorientation, and blurred vision toward the end of the soccer match. There are actually two sets of educational objectives: the first set is for the theoretical PBL sessions, and the 2nd set is for the Simulation Session. This simulation session therefore aims to make the case come alive, and show this known case in a clinical context. 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). Well done, youve now stabilised the patient and theyre doing much better. 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. Diabetes (type 1 and type 2) in children and young people: diagnosis and management. The normal reference range for fasting plasma glucose is 4.0 5.8 mmol/l. Several environments may be suitable for your classroom. 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. Make sure thepatientsnotes,observationchartandprescriptionchartare easily accessible. At the end of the previous section, the trainee can make the diagnosis of DKA but has not confirmed it yet. 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. Open the patients mouth to ensure there is no foreign material that may be pushed into the larynx. Trainee will be able to apply skills of communication with the simulated patient in a semiacute crisis to get sufficient important information for a final diagnosis. Indeed, it is the only thing that ever has.". The students are in their basic science course. Works with Traffic 2005, but . Consider any precipitating factors for the development of DKA and involve the diabetes team in the patients care. Makeup may be used to depict gender, hollow eyes and cheeks, produce pallor or display bruises and scars. Just place the BR2_KDCA file into your addons scenery folder: C:\\Program Files\\Microsoft Games\\Microsoft Flight Simulator X\\Addon Scenery\\Scenery. As this is a PBL session, the trainees are not given any references. 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. Stage 3: Ongoing management and monitoring of DKA 1 hour after initiation of treatment. You may be trying to access this site from a secured browser on the server. 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. They should introduce the student group to the environment, assign roles for each learner and guide the decision-making process. 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]). We also show them IV bags containing saline and Ringers lactate, as well as show them IV infusion sets. 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. The Theory She is lethargic and slightly confused but can intermittently respond to questions. The main goal is to establish a safe learning environment for the learner [9, 13 . cellulitis). PBL was introduced at our institution in 1995. Circulating nurse in the emergency room (ER). Conclusions This technical report describes the design and implementation of a simulation scenario on DKA for emergency medicine trainees. MassBay EMS Program Integrates Training for Dogs, Heat Waves Are Killing More LA Homeless People. In this section, we have to help the trainee to institute definitive therapy based on the underlying biochemical abnormalities. Privacy Policy If an obstruction is visible within the airway, use afingersweeporsuctionto remove it. An hour was . - 2500+ OSCE Flashcards: https://geekymedics.com/osce-flashcards/ Animated Lecture NPAs are typically better tolerated in patients who are partly or fully conscious compared to oropharyngeal airways. If fever is present, make sure to consider co-existing infection. Subscribe to our newsletter to be the first to know about our latest content: https://geekymedics.com/newsletter/ Research Watch Box:Sleep, Fatigue & SafetyBy David Page, MS, NREMT-P A strong emphasis is placed on the focused, methodical examination of a specific medical problem and the decision-based treatment options available. Use blankets to re-warm patients who are mild to moderately hypothermic. Virtual patient simulation (VPS) is an interactive computer simulation that recreates real-world scenarios with the objectives of training, education, and assessment for health care providers [].Virtual simulation has been used extensively to adapt nursing education to the COVID-19 pandemic context [], such as social distancing and/or confinement. angioedema, rash) commence appropriate treatment as discussed in ouranaphylaxis guide. Measure the patients capillary blood glucose and ketone levels to confirm the diagnosis and guide the management of DKA. Introduceyourselfto thepatientincluding yournameandrole. Inspect for evidence of infection on the skin (e.g. This may produce better retention of the subject matter and help students adapt to emergency scenes before going into the field. The student group is given a short introduction into a closed simulation environment.