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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). At the end of the previous section, the trainee can make the diagnosis of DKA but has not confirmed it yet. The optimal number of simulation participants is four to seven individuals, depending on the case study objectives. 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. On the basis of the feedback from the students, they indicated that they believed the small group sessions are better. 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. Int J Evid Based Healthc. Supplemental digital content is available for this article. Medical simulation technology is a powerful tool for training physicians but papers dealing with DKA simulators are scarce. This guide provides an overview of the recognition and immediate management of diabetic ketoacidosis (DKA)using an ABCDE approach. Categories: Emergency Medicine, Medical Education Keywords: diabetic ketoacidosis, simulation, expertise, emergency medicine . The lecture allows for understanding of concepts prior to action, and instructor feedback is immediate. There are several causes of DKA, which we remember by the "five I's". Does the patient need reviewing by a specialist? The validity of the HFS-DKA scenario was verified by a certified diabetes nurse educator, a registered nurse, and a clinical nurse educator. Perform urinalysis and send the urine for culture if urinary tract infection is suspected. Consider any precipitating factors for the development of DKA and involve the diabetes team in the patients care. Conclusion: Our DKA simulator is a new tool whose objective is the training in a severe, frequent and complex situation, and can be used to improve the approach made by the junior physicians to the real diabetic . 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. After the initial treatment is initiated, by showing a simulated urine and blood, and by getting them to smell ketones, we can enable the trainee to confirm the diagnosis of DKA. Emergency medical services workLife characteristics contribute to clinically significant excessive daytime sleepiness. It was This is a 25-year-old woman with a medical history of diabetes medicated with 40 units insulin per day. Refer to your local guidelines for further details. www.cdc.gov/diabetes/statistics/prev/national/. 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].. These simulation sessions seem to work because the medical students do have prior knowledge. For example, you could develop a diabetic scenario in which the prehospital provider encounters an altered patient with incomprehensible speech. The student group is given a short introduction into a closed simulation environment. 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). The teaching of diabetic assessment and management, like many other medical emergencies, lends itself well to case-based simulation. In an animated lecture, its important that the student group have an instructor so they can ask direct questions. From the Department of Anesthesiology, Pennsylvania State University College of Medicine, Hershey, PA. Dr. Murray is on the Speakers Bureau of METI, Sarasota, FL. A well-staged environment allows for greater student buy-in. "Never doubt that a small group of thoughtful, committed citizens can change the world. SimMan offers you the ability to provide simulation education to challenge and test your students clinical and decision-making skills during realistic patient care scenarios. diagnosis of DKA Trigger 3, ABG show acidosis and high BM and normal potassium. The simulation session is also hosted as an interactive session. Please enable scripts and reload this page. Immersive simulations are mentally exhausting because they create an intense and stressful atmosphere requiring the learner to work outside their comfort zone. Its best, however, to allow the student group to continue so theyre able to evaluate their decision-making processes during debriefing. We are looking for declaration of DKA and request for pathway. Diabetic Ketoacidosis (DKA) Clinical Pathway Emergency Department | Children's Hospital of Philadelphia 4 0 obj 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. Animated Lecture 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. Refer to your local guidelines which should provide a clear protocol for the management of DKA. . Weight, Height: Not given, normal appearing (as per simulator) but has lost 20 lbs recently. 1) Please read through this document as it will help you prepare for your upcoming simulation on DKA. Revisit history taking to explore relevant medical history and identify any precipitating factors for DKA. It involves a facilitating instructor, a small learner group and conceptual aspects of environmental and manikin staging to provide sensory cues. 2009;13:505511. 2011;15:108109. On arrival to the ER, standard monitors (electrocardiogram [ECG] and pulse oximetry [SpO2]) and end-tidal carbon dioxide (ETCO2) concentration were placed, and the patient was given oxygen by nasal cannulae. Facilitator to ask how often to measure BMs Heart: S1 and S2 within normal limits; no S3/S4 or murmurs, normal rate and rhythm. Please try again soon. Works with Traffic 2005, but . %PDF-1.5 Make sure tore-assessthe patient after anyintervention. In this section, we have to help the trainee to institute definitive therapy based on the underlying biochemical abnormalities. Generaltipsfor applying anABCDEapproachin an emergency setting include: Acute scenarios typically begin with abriefhandoverfrom a member of thenursing staffincluding thepatients name,age,backgroundand thereasonthereviewhas been requested. Inspect the urine currently in the catheter bag and note its appearance (e.g. 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)? In the final 10 minutes, we show how the patient has a good recovery after fluid replacement. 1. 3. NPAs are typically better tolerated in patients who are partly or fully conscious compared to oropharyngeal airways. In the meantime, you can perform some basic airway manoeuvres to help maintain the airway whilst awaiting senior input. A traditional classroom lecture format allows for student participation but limits the instructors ability to create realistic situations. cellulitis). Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. Trainee will correlate the underlying pathophysiology with symptoms and signs as exhibited by the simulation session. PBL in our institution is implemented as a small group (n 68 students) self study session with a facilitator, who incrementally discloses further information about the patient. If the patient is suspected to have sufferedsignificanttraumawith potential spinal involvement, perform ajaw-thrustrather than a head-tilt chin-lift manoeuvre: 2. The DKA simulation incorporates cue recognition, analysis of cues, generation of solutions, nursing interventions, and evaluation of outcomes, including effective communication and psychosocial concerns. Note that if-thens must also include negative patient outcomes for when the provider doesnt take appropriate action. A collection of data interpretation guides to help you learn how to interpret various laboratory and radiology investigations. DO NOT perform any examination or procedure on patients based purely on the content of these videos. The students mentioned that they did not obtain the maximum value from the simulation session under these circumstances. Circulating nurse in the emergency room (ER). Competency-based medical education has seen widespread adoption in the field along with ongoing work in the areas of . For similar reasons, we do not believe a videotaped session will keep the students attention as much as these live simulator sessions. DKA can develop within 24 hours and is potentially life threatening, requiring prompt recognition and therapeutic intervention. DO NOT perform any examination or procedure on patients based purely on the content of these videos.
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