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If the patient loses consciousness and there are no signs of life on assessment, put out a crash call and commence CPR. Development of simulation scenarios for an adolescent patient with diabetic ketoacidosis. 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. - PSA Question Pack: https://geekymedics.com/psa-question-bank/ Check out our other awesome clinical skills resources including: 2017 May 29;9(5):e1286. insulin-dependent type 2 diabetes), Altered consciousness (e.g. 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). 2 The evaluation of potassium deficits is complicated by potassium exit from . Initially, we used a blood pressure cuff to generate the blood pressure values. Many of the preclinical students have never seen a real life clinical monitor or even an intravenous (IV) setup. Cureus 9(5): e1286. Data is temporarily unavailable. Diabetic ketoacidosis; Simulation training; Medical students. NPAs should not be used in patients who may have sustained a skull base fracture, due to the small but life-threatening risk of entering the cranial vault with the NPA. - Over 3000 Free MCQs: https://geekyquiz.com/ If the patient has clinical signs ofanaphylaxis(e.g. Trainee will practice or observe good teamwork skills, both as a leader and a team player. 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. Surgical dressings and imitation blood can support medical history. dq-]gX4 `L'u7myx) rpjf0z,.y`VMyx-&Ju`U0 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. Yes: if the patient can talk, their airway is patent and you can move on to the assessment of breathing. The consequences (low blood pressure, high heart rate, central nervous system status, etc.) His Heart Stopped On a Treadmill. We do not use passive visualizing materials such as videotapes or DVD other than vital signs shown on the monitors. The students mentioned that they did not obtain the maximum value from the simulation session under these circumstances. You could also ask a student to smear a small amount of acetone on a piece of glass to see how volatile it is, helping them understand why its being exhaled by the DKA patient. Antibiotics should be prescribed in keeping with local guidelines. 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. Animated lectures, however, must work within the framework of a focused case study, which requires increased preparation time. The impetus for creating and implementing the high-fidelity diabetic ketoacidosis (DKA) simulation was based on a needs assessment and reviewing of undergraduate nursing students' examination statistics in a second semester medical-surgical course. Perform urinalysis and send the urine for culture if urinary tract infection is suspected. Several environments may be suitable for your classroom. type 1 diabetes) Complete insulin insensitivity (e.g. If foreign material is present, attempt removal using suction. Insert the airway bevel-end first, vertically along the floor of the nose with a slight twisting action. 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. doi: 10.7759/cureus.1286. This guide provides an overview of the recognition and immediate management of diabetic ketoacidosis (DKA)using an ABCDE approach. Facilitator to ask how often to measure BMs 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. At the end of the previous section, the trainee can make the diagnosis of DKA but has not confirmed it yet. Review the patientsoxygen saturation(SpO2): Auscultate the chest to screen for evidence of respiratory pathology (e.g. Available from: [. We are looking for declaration of DKA and request for pathway. Prehosp Emerg Care. Simulation in Healthcare4(4):232-236, Winter 2009. Trainee will learn to collaborate with peers to decide on appropriate interventions, tests, and therapy. The required potassium replacement varies greatly. Geeky Medics accepts no liability for loss of any kind incurred as a result of reliance upon the information provided in this video. Geeky Medics accepts no liability for loss of any kind incurred as a result of reliance upon the information provided in this video. Strategies of high-performing paramedic educational programs. Stage 3: Ongoing management and monitoring of DKA 1 hour after initiation of treatment. COVID-19 Screening in the Pediatric Emergency Department. modify the keyword list to augment your search. Inspect for evidence of self-injection sites (e.g. Target Learner Groups 2008;6:278302. Available from: [, NICE guidelines. 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. After initial insulin therapy has reduced plasma blood glucose levels (e.g. PA EMT Said COVID Patient Didnt Need to Go to the Hospital. - Radiation 02:45 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. oral fluids, intravenous fluids, urine output, drain output, stool output, vomiting) to inform resuscitation efforts. Given such a small group, the students indicated that they feel more involved than they would with a larger group (eg, the whole class.) For similar reasons, we do not believe a videotaped session will keep the students attention as much as these live simulator sessions. Patients with DKA require fluid resuscitation to restore circulatory volume, clear ketones, correct electrolyte abnormalities and increase renal perfusion. This leads to hyperglycaemia, osmotic diuresis, and dehydration. DY{Qb"(EgN$QI*%XN1F""0a5 Performing an ECG should not delay the emergency management of DKA. Diabetic ketoacidosis (DKA) is a common, potentially lethal disease. Trainee will increase knowledge of professional behaviors during the simulation. DO NOT perform any examination or procedure on patients based purely on the content of these videos. This is a 25-year-old woman with a medical history of diabetes medicated with 40 units insulin per day. Clearly communicate how often would you like the patients observations relayed to you by other staff members. Rosens Emergency Medicine: Concepts and Clinical Practice. The student group should be encouraged to collaborate on management options and to perform skills. The main purpose of the simulation is to draw a line from the theoretical, boring biochemistry to the clinical manifestations. See our blood glucose measurement guide for more details. 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. Centers for Disease Control and Prevention. The students are in their first year. Interactive lecture/discussion with use of monitors that show the vital signs of the simulated patient on manikin. %PDF-1.5 Finally, we summarize the course and give them time for questions. It involves a facilitating instructor, a small learner group and conceptual aspects of environmental and manikin staging to provide sensory cues. In an animated lecture, its important that the student group have an instructor so they can ask direct questions. In the final 10 minutes, we show how the patient has a good recovery after fluid replacement. 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. You can plot as many parameters as you want and can choose to display either Historical data or have the graphs update as often as new data comes in and view them in Real-time. 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). DO NOT perform any examination or procedure on patients based purely on the content of these videos. Trainee will correlate the underlying pathophysiology with symptoms and signs as exhibited by the simulation session. 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). DKA can be caused by either: Absolute insulin deficiency (e.g. A GCS of 8 or below warrants urgent expert help from an anaesthetist. Effectiveness of simulation on health profession students knowledge, skills, confidence and satisfaction. 5. This is a combination of the modified traditional lecture within scenario-based learning. See ourhistory taking guidesfor more details. We ask the trainee why the blood pressure is so low or heart rate is so high, and how we should treat it. Mosby:Philadelphia. Adds true to life parking codes and extra parking for AI. Medical Simulation Scenarios are text documents outlining the various details of a simulation - everything from patient simulator settings to debriefing notes. Immersive simulations are mentally exhausting because they create an intense and stressful atmosphere requiring the learner to work outside their comfort zone. 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). A comprehensive collection of clinical examination OSCE guides that include step-by-step images of key steps, video demonstrations and PDF mark schemes. 2. After entering the environment, the student doesnt have the option of leaving the simulation until the learning objectives and performance measures are achieved. #geekymedics #fyp #fypviral #studytok #medicalstudentuk #medtok #studytips #studytipsforstudents #medstudentuk #premed #medschoolfinals #shorts, Cardiovascular Exam Tips - DON'T FORGET these 3 things , Watch this video to find out the most COMMONLY FORGOTTEN components of the cardiovascular history! Save this video to help prepare for your upcoming OSCEs and dont forget to follow Geeky Medics! Introduceyourselfto whoever has requested a review of the patient andlistencarefullyto their handover. You may be trying to access this site from a secured browser on the server. DKA can develop within 24 hours and is potentially life threatening, requiring prompt recognition and therapeutic intervention. They have had no clinical exposure or any clinical experience. 1 Potassium losses occurring both before and during treatment of DKA must be replaced. The students are in their basic science course. 3. The facilitator guides the group only when necessary. Discuss the patients current clinical condition with aseniorclinicianusing anSBARR style handover. Place one hand on the patients forehead and the other under the chin. A debriefing section with pre-established questions allows the instructor to review the main focus and performance measures with the student group. The normal reference range for fasting plasma glucose is 4.0 5.8 mmol/l. Open the patients airwayusing ahead-tiltchin-lift manoeuvre: 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.