Prehosp Emerg Care. angioedema, rash) commence appropriate treatment as discussed in ouranaphylaxis guide. We guide the group to suggest fluid. Advance the airway until it lies within the pharynx. MassBay EMS Program Integrates Training for Dogs, Heat Waves Are Killing More LA Homeless People. Open the patients airwayusing ahead-tiltchin-lift manoeuvre: 1. Inspect the urine currently in the catheter bag and note its appearance (e.g. However, this turned out to be too slow, took too much time, and could not continuously demonstrate the direction of changes. 2010;49:578586. Problems are addressed as they are identified and the patient is re-assessed regularly to monitor their response to treatment. <> type 1 diabetes), Complete insulin insensitivity (e.g. After the first voluntary session in 2006, feedback from the medical students indicated that they would like to receive this handout. From the Department of Anesthesiology, Pennsylvania State University College of Medicine, Hershey, PA. Dr. Murray is on the Speakers Bureau of METI, Sarasota, FL. This field is for validation purposes and should be left unchanged. If an obstruction is visible within the airway, use afingersweeporsuctionto remove it. Trainee will appropriately request assistance and use available resources. 1-6. Conclusions This technical report describes the design and implementation of a simulation scenario on DKA for emergency medicine trainees. 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. Initially, we required the students to write down the vital signs. The teaching of diabetic assessment and management, like many other medical emergencies, lends itself well to case-based simulation. The file explaining the session is sent to instructors 1 week before the sessions. Margolis GS, Romer GA, Fernandez AR, et al. - Geeky Medics OSCE App: https://geekymedics.com/geeky-medics-app/ 1 Potassium losses occurring both before and during treatment of DKA must be replaced. If the patient loses consciousness and there are no signs of life on assessment, put out a crash call and commence CPR. Circulating nurse in the emergency room (ER). See ourintravenous cannulation guidefor more details. We are looking for declaration of DKA and request for pathway. Kymera Systems Inc | SCADA Online Demo Ignition 34 - Diabetic Ketoacidosis in Pregnancy | Obgyn Key Please write a single word answer in lowercase (this is an anti-spam measure). Initially, we used a blood pressure cuff to generate the blood pressure values. 2011;15:108109. The debriefing environment should be removed from the location where the simulation took place. Diabetic Ketoacidosis (DKA) Clinical Pathway Emergency Department Its absolutely necessary to follow all immersive simulations with a positive, emotionally safe and nonjudgmental debriefing environment. A comprehensive collection of medical revision notes that cover a broad range of clinical topics. Instagram: https://instagram.com/geekymedics Intubation lubricants can mimic drooling. A traditional classroom lecture format allows for student participation but limits the instructors ability to create realistic situations. Observe and discuss the effects of therapy in a mathematically modeled physiological simulator. A collection of anatomy notes covering the key anatomy concepts that medical students need to learn. . Centers for Disease Control and Prevention. Trainee will correlate the underlying pathophysiology with symptoms and signs as exhibited by the simulation session. Medical Simulation Scenarios are text documents outlining the various details of a simulation - everything from patient simulator settings to debriefing notes. His Heart Stopped On a Treadmill. 1. Ziv A, Wolpe PR, Small SD, et al. "Never doubt that a small group of thoughtful, committed citizens can change the world. The validity of the HFS-DKA scenario was verified by a certified diabetes nurse educator, a registered nurse, and a clinical nurse educator. Antibiotics should be prescribed in keeping with local guidelines. Instead, instructors should combine case- and simulation-based techniques when teaching diabetic assessment. Medical simulation technology is a powerful tool for training physicians but papers dealing with DKA simulators are scarce. Nandate, Koichiro MD, PhD; Abola, Ramon MD; Murray, W Bosseau MB; Whitfield, Carol PhD; Lang, Charles PhD; Sinz, Elizabeth MD. As individuals with uncontrolled type I . A number of key modifiers are described that allow for the adjustment of case . Scenario in a Nutshell Diabetic ketoacidosis (DKA) in pregnancy. It involves working through the following steps: Each stage of the ABCDE approach involvesclinicalassessment,investigationsandinterventions. Diabetes (type 1 and type 2) in children and young people: diagnosis and management. 3. Classroom Dynamics DO NOT perform any examination or procedure on patients based purely on the content of these videos. There are several causes of DKA, which we remember by the "five I's". Works with Traffic 2005, but . Data is temporarily unavailable. To read Pages full Research Review column, visit www.jems.com/patient-care. Development of simulation scenarios for an adolescent patient with diabetic ketoacidosis. Please note that by doing so you agree to be added to our monthly email newsletter distribution list. The students have acquired all the applicable theoretical knowledge of the case during the previous multiday PBL sessions. Well done, youve now stabilised the patient and theyre doing much better. 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! <>>> Respiratory Failure in the Course of Treatment of Diabetic Ketoacidosis We introduce the Simulation Laboratory and the Simulator, and demonstrate: pulses, eyes blinking, pupil constriction, gas moves in and out of mouth (place hand over mouth), chest moves up and down. 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. There are just a few more things to do. 2017 May 29;9(5):e1286. A blood glucose level may already be available from earlier investigations (e.g. Seek senior helpif the patient shows no signs of improvement or if you have any concerns. The facilitator guides the group only when necessary. . (1) The assessment of a diabetic patient is best taught as a. We now provide the students with handouts of the data to save time and provide consistency. Inspect theairwayfor obviousobstruction. This leads to hyperglycaemia, osmotic diuresis, and dehydration. The scenario would include an if-then algorithm. 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 They should introduce the student group to the environment, assign roles for each learner and guide the decision-making process. Its important to train and educate students of prehospital care on key indicators of a diabetic emergency. Use an effectiveSBARR handoverto communicate the key information effectively to other medical staff. 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. A collection of communication skills guides, for common OSCE scenarios, including history taking and information giving. PA EMT Said COVID Patient Didnt Need to Go to the NYC Unions Demand Reinstatement, Back Pay for Workers Fired for Refusing President Biden to End COVID-19 Emergencies on May 11. Pediatric Emergency Medicine Didactics and Simulation (PEMDAS The normal reference range for fasting plasma glucose is 4.0 5.8 mmol/l. An integral part of a PBL session is for trainees to be able to navigate through huge literature bases. Diabetic ketoacidosis (DKA) is a common, potentially lethal disease. Groups of fewer than four students dont allow for optimal collaboration. Consider any precipitating factors for the development of DKA and involve the diabetes team in the patients care. You may search for similar articles that contain these same keywords or you may (1), The assessment of a diabetic patient is best taught as a case-based simulation. Emergency medical services workLife characteristics contribute to clinically significant excessive daytime sleepiness. 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. In the meantime, you can perform some basic airway manoeuvres to help maintain the airway whilst awaiting senior input. 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 . The instructor should have visual access via one-way windows or cameras. to maintaining your privacy and will not share your personal information without It involves a facilitating instructor, a small learner group and conceptual aspects of environmental and manikin staging to provide sensory cues. Clearlydocument your ABCDE assessment, including history, examination, observations, investigations, interventions, and the patients response. stream 5. Rosens Emergency Medicine: Concepts and Clinical Practice. A comprehensive collection of clinical examination OSCE guides that include step-by-step images of key steps, video demonstrations and PDF mark schemes. Place one hand on the patients forehead and the other under the chin. A chest X-ray should not delay the emergency management of DKA. The students are in their first year. General: Moaning, asking what has happening to her. 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. Invasive monitors, including a left radial intraarterial and a right subclavian IV catheter, were placed. The optimal number of simulation participants is four to seven individuals, depending on the case study objectives. Deteriorationshould be recognised quickly and acted upon immediately. 4. Stage 1: Initial assessment of acutely unwell pregnant woman and diagnosis of DKA. endobj 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. Privacy Policy If the patient is conscious, sit themuprightas this can also help with oxygenation. The use of a simulated, evolving case scenario was an effective method of exposing nursing students to complex patient care. A well-staged environment allows for greater student buy-in. PDF DKA Sim Scenario - ABCD (Diabetes Care) Ltd Revisit history taking to explore relevant medical history and identify any precipitating factors for DKA. Given 6 to 8 back-to-back sessions, it is critical that every session starts and ends on time! Indeed, it is the only thing that ever has.". Review the patients drug chart for medications which may cause a reduced level of consciousness (e.g. 1 0 obj Extremities: mild cyanosis, no clubbing or edema (verbalized by instructors); pulses equal, and symmetrical (elucidated by trainees). If any obstruction is encountered, remove the tube and try the left nostril. We also show them IV bags containing saline and Ringers lactate, as well as show them IV infusion sets. The students are in their basic science course. Yes: if the patient can talk, their airway is patent and you can move on to the assessment of breathing. 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. Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario During the debriefing process that follows the simulation, well-balanced performance measures will guide feedback toward accomplished tasks and may illustrate existing decision-making, behavioral or technical skill deficits. Despite this increased calorie intake, she noticed an unexplained 20 lbs weight loss. A debriefing section with pre-established questions allows the instructor to review the main focus and performance measures with the student group. Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario When erroneous treatment is delivered, the instructor can end the simulation. Diabetic ketoacidosis simulator: a new learning tool for a life 6. We then start the DKA state. See Appendix D, Supplemental Digital Content 4, https://links.lww.com/SIH/A4. PDF Medicine Simulation Scenario Diabetic Ketoacidosis: An Emergency Hypothermia may be present if the patient has been unconscious and exposed for some time. In an animated lecture, its important that the student group have an instructor so they can ask direct questions. Finally, we summarize the course and give them time for questions. Insert the airway bevel-end first, vertically along the floor of the nose with a slight twisting action. Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario The learning environment should closely mimic real-world applications. - 150+ PDF OSCE Checklists: https://geekymedics.com/pdf-osce-checklists/ - Associated symptoms 03:04 Its best, however, to allow the student group to continue so theyre able to evaluate their decision-making processes during debriefing. 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.
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