We used the Medical Education Technologies Inc. (METI) Human Patient Stimulator (HPS, METI Sarasoto, Fl). Works with Traffic 2005, but . Patients with DKA require fluid resuscitation to restore circulatory volume, clear ketones, correct electrolyte abnormalities and increase renal perfusion. Mosby:Philadelphia. The simulation session is also hosted as an interactive session. LYqC+pJ&6X4onfBT#?=R}.p8N3+Dk,P4tIgWB}-L'=8;_G >,K#.e89XnG'B~NtR 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. Often, the learner group will be unaware of these behaviors, but the instructor can key into the first few comments made during the transition between rooms. Introduceyourselfto whoever has requested a review of the patient andlistencarefullyto their handover. The researchers found that long shift hours (24hrs), working overtime and marital/relationship stress were strongly correlated. If you have any scenarios you would be willing to share with the simulation community, please forward them to me. 1. Makeup may be used to depict gender, hollow eyes and cheeks, produce pallor or display bruises and scars. See ourCXR interpretation guidefor more details. Privacy Policy We do not use passive visualizing materials such as videotapes or DVD other than vital signs shown on the monitors. Properly interpret a venous blood gas (VBG) and basic metabolic panel in a patient presenting with diabetic ketoacidosis. JEMS. The Pratcice See ourdocumentation guidesfor more details. Simulation-based medical education: An ethical imperative. Margolis GS, Romer GA, Fernandez AR, et al. Published August 2015. The following scenarios are available for download and are designed to meet your multi-disciplinary nursing needs. We give the history of the patient to the trainees. The patient synopsis should include such standard aspects as age, sex, ethnicity, medical history, medications and allergies. 2. Classroom Dynamics Acad Med. During an immersive simulation, its imperative the group uses critical-thinking skills and group collaboration independently. For example, if a student is to run a diabetic emergency in an extended living facility, the room should be staged with the appropriate bed, linens and medical equipment, and include personal artifacts and memorabilia normally found in such environments. Cureus is on a mission to change the long-standing paradigm of medical publishing, where submitting research can be costly, complex and time-consuming. 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. In the context of DKA, a patients consciousness level may be reduced. COVID-19 Screening in the Pediatric Emergency Department. Alert a senior immediately if you have any concerns about the consciousness level of a patient. 2 The evaluation of potassium deficits is complicated by potassium exit from . The student group is given a short introduction into a closed simulation environment. 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. Case-based education adds a real-world aspect to the learning environment. 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. dq-]gX4 `L'u7myx) rpjf0z,.y`VMyx-&Ju`U0 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. 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. 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. 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 Emergency medical services workLife characteristics contribute to clinically significant excessive daytime sleepiness. 2. Refer to your local guidelines for further details. Simulation in Healthcare4(4):232-236, Winter 2009. Given such a small group, the students indicated that they feel more involved than they would with a larger group (eg, the whole class.) An animated lecture may be described as a pseudo-simulation environment. Ask for anotherclinicalmemberofstafftoassistyou if possible. It should only be inserted in unconscious patients as it is otherwise poorly tolerated and may induce gagging and aspiration. Scenarios. 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. After the first voluntary session in 2006, feedback from the medical students indicated that they would like to receive this handout. 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. Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes mellitus, most common in patients with type 1 diabetes in particular due to a deficiency or absence of insulin [1].. <> 3. 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. We are looking for declaration of DKA and request for pathway. Several environments may be suitable for your classroom. cloudy urine may indicate urinary tract infection). Stage 3: Ongoing management and monitoring of DKA 1 hour after initiation of treatment. This typically involves the use of anon-rebreathe maskwith an oxygen flow rate of15L. The 60 minutes training time consists of four 15-minute sections divided as follows. 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. 1-6. This video demonstrates how to use the SOCRATES acronym when taking a history of pain or other symptoms. Revisit history taking to explore relevant medical history and identify any precipitating factors for DKA. You can check out our guide to using SOCRATES here: https://geekymedics.com/the-socrates-acronym-in-history-taking/ Facebook: http://www.facebook.com/geekymedics It involves working through the following steps: Each stage of the ABCDE approach involvesclinicalassessment,investigationsandinterventions. Example: If the provider immediately evaluates blood glucose, then the reading will display 45 mg/dL. Laschinger S, Medves J, Pulling C, et al. Groups of fewer than four students dont allow for optimal collaboration. Trainee will increase knowledge of professional behaviors during the simulation. Administer oxygen to all critically unwell patients during yourinitialassessment. The Theory Physician working in the emergency department. It involves a facilitating instructor, a small learner group and conceptual aspects of environmental and manikin staging to provide sensory cues. Using your thumbs, slightly open the mouth by downward displacement of the chin. However, this leads to confusion. Immersive simulations are mentally exhausting because they create an intense and stressful atmosphere requiring the learner to work outside their comfort zone. Trainee will describe the changes in vital signs, the major metabolic, fluid, and electrolyte. 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). 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. Some error has occurred while processing your request. Review the patientsoxygen saturation(SpO2): Auscultate the chest to screen for evidence of respiratory pathology (e.g. They have had no clinical exposure or any clinical experience. 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. 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. You may search for similar articles that contain these same keywords or you may 2008;6:278302. SimMan Nursing Scenarios Software. Problems are addressed as they are identified and the patient is re-assessed regularly to monitor their response to treatment. In other words, they do not have clinical experience, but they have clinical knowledge. >> Fernandez AR, Mac Crawford J, Pennell ML, et al. Trainee will improve their understanding of clinical practice through reflective assessment of actual cases during the prior PBL sessions. A blood glucose level may already be available from earlier investigations (e.g. Use washable, non-toxic paints to imitate various body emissions. 2. Inspect theairwayfor obviousobstruction. insulin-dependent type 2 diabetes) Symptoms Typical symptoms of DKA include: Palpitations Nausea Vomiting Sweating Thirst Weight loss Leg cramps Clinical signs Typical clinical signs of DKA include: Tachycardia Hypotension This field is for validation purposes and should be left unchanged. DKA can develop within 24 hours and is potentially life threatening, requiring prompt recognition and therapeutic intervention. A comprehensive collection of OSCE guides to common clinical procedures, including step-by-step images of key steps, video demonstrations and PDF mark schemes. 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. 2) Complete the assigned suggested readings 3) Complete the presimulation preparation virtual simulation game (Instructor will provide link) 4) Once you have completed reading this document and prepared for your simulation, please: a. Simulation Scenario. 3. - 2500+ OSCE Flashcards: https://geekymedics.com/osce-flashcards/ PA EMT Said COVID Patient Didnt Need to Go to the Hospital. - Introduction 00:00 After entering the environment, the student doesnt have the option of leaving the simulation until the learning objectives and performance measures are achieved. A well-staged environment allows for greater student buy-in. For example, you could develop a diabetic scenario in which the prehospital provider encounters an altered patient with incomprehensible speech. Should any changes be made to the current management of their underlying condition(s)? An events progression section should include patient status changes, as well as a time/treatment continuum that incorporates if-then event progressions. Its best, however, to allow the student group to continue so theyre able to evaluate their decision-making processes during debriefing. Centers for Disease Control and Prevention. Urinary tract infections are a common DKA precipitant. This is particularly important for core cases and low-frequency, high-stakes procedures and encounters. The students are in their first year. Below is a collection of donated scenarios for you to use or modify. The students worked on the underlying physiology during a week long PBL session and are therefore familiar with the theoretical aspects of DKA. - 150+ PDF OSCE Checklists: https://geekymedics.com/pdf-osce-checklists/ Review thepatients notes,chartsandrecent investigation results. The students are in their basic science course. Clearly communicate how often would you like the patients observations relayed to you by other staff members. - Exacerbating & relieving factors 05:12 Our simulated patient is a 25-year-old woman, Tiffany, who has been taken to the Emergency Department from her soccer game by her boyfriend, Adam. reduced air entry, coarse crackles) to screen for evidence of pneumonia. Forty percent of respondents reported excessive daytime sleepiness. Observe and discuss the effects of therapy in a mathematically modeled physiological simulator. 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. This allows the learner group to make a psychological break from the patient and environment while beginning the reflection process. See Table 4 for a suggested standardized script. Chapters: "Never doubt that a small group of thoughtful, committed citizens can change the world. Each PBL case typically goes over 23 days, affording the students periods to find information for the case. Hypothermia may be present if the patient has been unconscious and exposed for some time. Discuss the patients current clinical condition with aseniorclinicianusing anSBARR style handover. Please note that by doing so you agree to be added to our monthly email newsletter distribution list. 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. It may be necessary toexposethe patient during your assessment: remember to prioritise patient dignity and conservation of body heat. Trainee will practice or observe good teamwork skills, both as a leader and a team player. Simulation provides a safe environment where learning is enhanced through the deliberate practice of skills and controlled management of a variety of clinical encounters. A collection of communication skills guides, for common OSCE scenarios, including history taking and information giving. unilateral coarse crackles may be present if the patient has pneumonia which may have been the precipitant for DKA). Trainee will learn to collaborate with peers to decide on appropriate interventions, tests, and therapy. 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). We have spent many hours debating whether the small group format was a waste of time. opioids, sedatives, anxiolytics, insulin, oral hypoglycaemic medications). 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. Simulation provides a safe environment where learning is enhanced through the deliberate practice of skills and controlled management of a variety of clinical encounters. Intubation lubricants can mimic drooling. 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. This leads to hyperglycaemia, osmotic diuresis, and dehydration. 4. Debriefing Its absolutely necessary to follow all immersive simulations with a positive, emotionally safe and nonjudgmental debriefing environment. The consequences (low blood pressure, high heart rate, central nervous system status, etc.) You may be asked to review a patient with DKA due to confusion, reduced level of consciousness, tachycardia, hypotension and/or vomiting. diagnosis of DKA Trigger 3, ABG show acidosis and high BM and normal potassium. A collection of data interpretation guides to help you learn how to interpret various laboratory and radiology investigations. This is a combination of the modified traditional lecture within scenario-based learning. TheABCDEapproach can be used to perform a systematic assessment of a critically unwell patient. Assess the patients level of consciousness using the AVPU scale: If a more detailed assessment of the patients level of consciousness is required, use the Glasgow Coma Scale (GCS). Keyword Highlighting Yes: if the patient can talk, their airway is patent and you can move on to the assessment of breathing. GRAPH. 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. 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 style also doesnt mimic an actual scene, and a student may feel that treatment modalities and skills are performed at a slower rate than real-world applications. - Geeky Medics OSCE App: https://geekymedics.com/geeky-medics-app/ One of the key differences with the immersive simulation is that the instructor is absent from the simulation environment. They have had no clinical exposure or any clinical experience. Review the patients drug chart for medications which may cause a reduced level of consciousness (e.g. Trigger 4, Pathway 1l of saline required over 1hour and insulin infusion need prescribing and making up in 50ml syringe. In the meantime, you can perform some basic airway manoeuvres to help maintain the airway whilst awaiting senior input. A strong emphasis is placed on the focused, methodical examination of a specific medical problem and the decision-based treatment options available. Depending on scenario complexity, team dynamic and treatment modalities, this simulation may take 1020 minutes.
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