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). Simulation provides a safe environment where learning is enhanced through the deliberate practice of skills and controlled management of a variety of clinical encounters. The relationship between sleep, fatigue and patient and provider safety. Immersive simulations are mentally exhausting because they create an intense and stressful atmosphere requiring the learner to work outside their comfort zone. 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. If the patient has COPD and a history of CO2retention you should switch to aventuri maskas soon as possible andtitrate oxygen appropriately. Problems are addressed as they are identified and the patient is re-assessed regularly to monitor their response to treatment. Weight, Height: Not given, normal appearing (as per simulator) but has lost 20 lbs recently. On the basis of the feedback from the students, they indicated that they believed the small group sessions are better. See ourintravenous cannulation guidefor more details. The learning objectives follow the American College of Graduate Medical Education (ACGME) Core Compentencies. endobj Trainee will recognize and interpret the clinical signs and symptoms and the typical history of a patient with DKA, as well as understand the major causative factors of DKA. Trainee will be respectful to others and their views during the PBL session. This session provides additional clinical support material for the theoretical PBL session. Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. 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. Review thepatients notes,chartsandrecent investigation results. 4. Feel the slow and tardy pulse, we consider these PBL sessions as an example of a Look here, see this use of a full human simulator in the hierarchy of learning strategies with a full human simulator (Table 1). 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 integral part of a PBL session is for trainees to be able to navigate through huge literature bases. to maintaining your privacy and will not share your personal information without The main purpose of the simulation is to draw a line from the theoretical, boring biochemistry to the clinical manifestations. They have had no clinical exposure or any clinical experience. 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.. Prehosp Emerg Care. However, this leads to confusion. 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. A simulation training session is described designed to acquaint emergency medicine residents with the presentation and management of diabetic ketoacidosis through the use of simulation. unilateral coarse crackles may be present if the patient has pneumonia which may have been the precipitant for DKA). The lecture allows for understanding of concepts prior to action, and instructor feedback is immediate. This allows us to get in touch for more details if required. 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. Heart: S1 and S2 within normal limits; no S3/S4 or murmurs, normal rate and rhythm. If an obstruction is visible within the airway, use afingersweeporsuctionto remove it. can be reemphasized, and the effects of fluid therapy demonstrated. 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. stream Margolis GS, Romer GA, Fernandez AR, et al. Ketones show 5.5. 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. Instead, instructors should combine case- and simulation-based techniques when teaching diabetic assessment. 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 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. Conclusions This technical report describes the design and implementation of a simulation scenario on DKA for emergency medicine trainees. Supplemental digital content is available for this article. The students have acquired all the applicable theoretical knowledge of the case during the previous multiday PBL sessions. 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. Please write a single word answer in lowercase (this is an anti-spam measure). 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. Groups of fewer than four students dont allow for optimal collaboration. Review the patientscurrent medicationsand check any regular medications areprescribed appropriately. A collection of surgery revision notes covering key surgical topics. Indeed, it is the only thing that ever has.". 2008;6:278302. - Severity 05:32 If you have any scenarios you would be willing to share with the simulation community, please forward them to me. Introduceyourselfto thepatientincluding yournameandrole. An oxygen mask is also demonstrated as an alternative device, as these early trainees had mostly not yet seen any of these devices. It should only be inserted in unconscious patients as it is otherwise poorly tolerated and may induce gagging and aspiration. - Character 02:14 Animated Lecture YouTube Video VVVram5yRUhROGJRUW1sZk5kQVFDXzV3LjMxakdNallNcng0, YouTube Video VVVram5yRUhROGJRUW1sZk5kQVFDXzV3LkJPVjVZMzBKczY4, YouTube Video VVVram5yRUhROGJRUW1sZk5kQVFDXzV3LkxEM2VkQzB2NTBr, Start typing to see results or hit ESC to close, Deep Vein Thrombosis (DVT) Examination OSCE Guide, Pre-hospital Advanced Life Support (ALS) OSCE Guide, Adult Choking (Basic Life Support) OSCE Guide, Paediatric Intravenous Cannulation OSCE Guide, Intrauterine System (Mirena) Counselling OSCE guide, Geeky Medics OSCE Book | Clinical Examination, Paediatric Gastro-oesophageal Reflux Disease, A Career as a GP with Special Interest with Dr Fiona Mosgrove, Absolute insulin deficiency (e.g. Note that if-thens must also include negative patient outcomes for when the provider doesnt take appropriate action. *=NdL/c2XSJn8:I Jb8'.8>N*[L .hxw6afq40DX3c~>abt'Q,8y(BZu(vKBTufIR. 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. 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. Conclusion 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! As this is a value-added session that demonstrates new concepts, such as the vital signs on a clinical monitor, there are no assessment instruments to measure gaining of understanding. 3. Trainee will appropriately request assistance and use available resources. 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. 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. Invasive monitors, including a left radial intraarterial and a right subclavian IV catheter, were placed. Join the Geeky Medics community: (1) According to Centers for Disease Control and Prevention (CDC), 223,619 deaths were attributed to diabetes in 2005. We used the Medical Education Technologies Inc. (METI) Human Patient Stimulator (HPS, METI Sarasoto, Fl). Intubation lubricants can mimic drooling. 6. areas of lipohypertrophy) if it is unclear if the patient is diabetic. 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. Trainee will get to know how professionals behave during management of a critically ill patient. Advance the airway until it lies within the pharynx. Diabetic Ketoacidosis (DKA) Clinical Pathway Emergency Department | Children's Hospital of Philadelphia 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. The instructions to the facilitators suggest a series of structured, sequential questions to the students (starting at one end, involving each student in turn, and repeatedly cycling around the group.) The students are in their first year. The student group is given a short introduction into a closed simulation environment. Could we not just do this as a large group session to all 160 students (versus 20 1-hour sessions to groups of eight students)? doi: 10.7759/cureus.1286. This is a combination of the modified traditional lecture within scenario-based learning. Available from: [, NICE guidelines. Askhow the patient is feeling as this may provide some useful information about their current symptoms. We now provide the students with handouts of the data to save time and provide consistency. These simulation sessions seem to work because the medical students do have prior knowledge. You may be asked to review a patient with DKA due to confusion, reduced level of consciousness, tachycardia, hypotension and/or vomiting. Depending on scenario complexity, team dynamic and treatment modalities, this simulation may take 1020 minutes. She had developed nausea, extreme fatigue, mild disorientation, and blurred vision toward the end of the soccer match. Using SOCRATES in History Taking | OSCE | Communication Skills, Diabetic Ketoacidosis (DKA) | Acute Management | ABCDE. 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. Check out our NEW & IMPROVED quiz platform at geekyquiz.com, To be the first to know about our latest videos, subscribe to our YouTube channel . We have spent many hours debating whether the small group format was a waste of time. 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.