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. This leads to hyperglycaemia, osmotic diuresis, and dehydration. There are just a few more things to do. Instead, instructors should combine case- and simulation-based techniques when teaching diabetic assessment. If the patient is suspected to have sufferedsignificanttraumawith potential spinal involvement, perform ajaw-thrustrather than a head-tilt chin-lift manoeuvre: 2. 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. Simulation in Healthcare4(4):232-236, Winter 2009. Diabetic Ketoacidosis (DKA) | Acute Management | ABCDE The relationship between sleep, fatigue and patient and provider safety. Revisit history taking to explore relevant medical history and identify any precipitating factors for DKA. Groups of fewer than four students dont allow for optimal collaboration. You can check out our guide to using SOCRATES here: https://geekymedics.com/the-socrates-acronym-in-history-taking/ Initially, we required the students to write down the vital signs. Circulating nurse in the emergency room (ER). TikTok: https://www.tiktok.com/@geekymedics This field is for validation purposes and should be left unchanged. General: Moaning, asking what has happening to her. The student group should be encouraged to collaborate on management options and to perform skills. PDF Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario Please try after some time. During an immersive simulation, its imperative the group uses critical-thinking skills and group collaboration independently. Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario Cureus. In the final 10 minutes, we show how the patient has a good recovery after fluid replacement. Over the years, some groups happened to have the simulation session before the completion of the theoretical PBL session. 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. 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 %PDF-1.5
A collection of interactive medical and surgical clinical case scenarios to put your diagnostic and management skills to the test. In keeping with the case study, as a treatment marker is reached, the instructor should place emphasis on physiological, pharmacological, environmental and psychosocial issues. 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. Diabetes UK with the Joint British Diabetes Societies Inpatient Care Group. In the meantime, you should re-assess and maintain the patients airway. An oxygen mask is also demonstrated as an alternative device, as these early trainees had mostly not yet seen any of these devices. Works with Traffic 2005, but . We do not use passive visualizing materials such as videotapes or DVD other than vital signs shown on the monitors. The simulation experience serves to give substance to the theoretical words and concepts that the students encountered during the PBL sessions. It may be necessary toexposethe patient during your assessment: remember to prioritise patient dignity and conservation of body heat. Example: If the provider immediately evaluates blood glucose, then the reading will display 45 mg/dL. Should any changes be made to the current management of their underlying condition(s)? 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. - Site 01:12 The facilitator guides the group only when necessary. Calculate the patients current fluid balance using their fluid balance chart (e.g. 3. 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. The teaching of diabetic assessment and management, like many other medical emergencies, lends itself well to case-based simulation. Section snippets . Inspect for evidence of self-injection sites (e.g. Much time was wasted explaining why it did not matter. Management of diabetic ketoacidosis in adults. Subscribe to our newsletter to be the first to know about our latest content: https://geekymedics.com/newsletter/ This allows us to get in touch for more details if required. 5. 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. Acad Med. The file explaining the session is sent to instructors 1 week before the sessions. This video demonstrates how to use the SOCRATES acronym when taking a history of pain or other symptoms. Conclusion
This allows the learner group to make a psychological break from the patient and environment while beginning the reflection process. The 60 minutes training time consists of four 15-minute sections divided as follows. MassBay EMS Program Integrates Training for Dogs, Heat Waves Are Killing More LA Homeless People. %
This is particularly important for core cases and low-frequency, high-stakes procedures and encounters. The simulators do not have rock steady vital sign values, and the students were unsure as to write down 121 or 122 mm Hg as the systolic blood pressure. A debriefing section with pre-established questions allows the instructor to review the main focus and performance measures with the student group. Stage 3: Ongoing management and monitoring of DKA 1 hour after initiation of treatment. A collection of data interpretation guides to help you learn how to interpret various laboratory and radiology investigations. Askhow the patient is feeling as this may provide some useful information about their current symptoms. Refer to your local guidelines for further details. The immersive simulation is performed when the instructor feels comfortable with the acquired knowledge and skill base presented in the animated lecture or when the student group has sufficient practical experience to apply the cognitive, behavioral and technical skills outlined in the case scenario. The normal reference range for fasting plasma glucose is 4.0 5.8 mmol/l. 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. Trainee will correlate the underlying pathophysiology with symptoms and signs as exhibited by the simulation session. Competency-based medical education has seen widespread adoption in the field along with ongoing work in the areas of . Both external and internal potassium balances are disturbed during the development and treatment of DKA. Geeky Medics accepts no liability for loss of any kind incurred as a result of reliance upon the information provided in this video. We give the history of the patient to the trainees. After initial insulin therapy has reduced plasma blood glucose levels (e.g. Debriefing
Are any further assessments or interventions required? - PSA Question Pack: https://geekymedics.com/psa-question-bank/ The reason for inserting the airway upside down initially is to reduce the risk of pushing the tongue backwards and worsening airway obstruction. endobj
A comprehensive collection of medical revision notes that cover a broad range of clinical topics. Insert the oropharyngeal airway in the upside-down position until you reach the junction of the hard and soft palate, at which point you should rotate it 180. 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). On the basis of the feedback from the students, they indicated that they believed the small group sessions are better. 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. Diabetic Ketoacidosis (DKA) Clinical Pathway Emergency Department Physician working in the emergency department. Clinical Simulation in Nursing, Volume 39, 2020, pp. Environment & Manikin
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. Anesthetic Management Using the Oxygen Reserve Index for Tracheal Resection and Tracheal End-to-E A Scoping Review of the Impact of COVID-19 on Kidney Transplant Patients in the United States, Alabama College of Osteopathic Medicine Research, Baylor Scott & White Medical Center Department of Neurosurgery, California Institute of Behavioral Neurosciences & Psychology, Contemporary Reviews in Neurology and Neurosurgery, DMIMS School of Epidemiology and Public Health, Simulation, Biodesign, & Innovation In Medical Education, The Florida Medical Student Research Publications, University of Florida-Jacksonville Neurosurgery, VCOM Clinical, Biomedical, and Educational Research, American Red Cross Scientific Advisory Council, Canadian Association of Radiation Oncology, International Liaison Committee on Resuscitation, International Pediatric Simulation Society, Medical Society of Delaware Academic Channel, Society for Healthcare & Research Development, Surgically Targeted Radiation Therapy for Brain Tumors: Clinical Case Review, Clinical and Economic Benefits of Autologous Epidermal Grafting, Defining Health in the Era of Value-Based Care, Optimization Strategies for Organ Donation and Utilization, MR-Guided Radiation Therapy: Clinical Applications & Experiences, Multiple Brain Metastases: Exceptional Outcomes from Stereotactic Radiosurgery, Proton Therapy: Advanced Applications for the Most Challenging Cases, Radiation Therapy as a Modality to Create Abscopal Effects: Current and Future Practices, Clinical Applications and Benefits Using Closed-Incision Negative Pressure Therapy for Incision and Surrounding Soft Tissue Management, Negative Pressure Wound Therapy with Instillation, NPWT with Instillation and Dwell: Clinical Results in Cleansing and Removal of Infectious Material with Novel Dressings. Mosby:Philadelphia. Perform urinalysis and send the urine for culture if urinary tract infection is suspected. 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. oral fluids, intravenous fluids, urine output, drain output, stool output, vomiting) to inform resuscitation efforts. Many of the preclinical students have never seen a real life clinical monitor or even an intravenous (IV) setup. Ketones show 5.5. Some manikin models support a variety of human functions, such as capillary and facial cyanosis, facial sweating, foley catheter and IV placement, blood pressure generation, cardiac rhythms and abnormalities, defibrillation, cardioversion, external pacing and vital sign generation. This environment doesnt allow the student to identify presentation cues, be active in their own learning or apply their skills without endangering the lives of patients.(2). 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". <>
An hour was . If the patient is confused you might be able to get a collateral history from staff or family members as appropriate. The Theory
PDF Diabetic Ketoacidosis in the Obstetric Population: A Simulation type 1 diabetes) Complete insulin insensitivity (e.g. 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. A comprehensive collection of clinical examination OSCE guides that include step-by-step images of key steps, video demonstrations and PDF mark schemes. Each PBL case typically goes over 23 days, affording the students periods to find information for the case. For similar reasons, we do not believe a videotaped session will keep the students attention as much as these live simulator sessions.