Intubation lubricants can mimic drooling. The scenario would include an if-then algorithm. The Simulation Laboratory session follows after a completed PBL session, and is aimed at making the case come alive, while providing a clinical perspective to preclinical students. JEMS. DOI 10.7759/cureus.1286. 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. The DKA simulation incorporates cue recognition, analysis of cues, generation of solutions, nursing interventions, and evaluation of outcomes, including effective communication and psychosocial concerns. Join the Geeky Medics community: 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). 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. In the context of DKA, a patients consciousness level may be reduced. Reprints: Koichiro Nandate, MD, PhD, Department of Anesthesiology, Milton S. Hershey Medical Center, Pennsylvania State University College of Medicine, 500 University Drive Box 850, Hershey, PA 17033 (e-mail: [emailprotected]). The instructor can also gauge the direction the debriefing session should follow or be alerted to possible problems or conflicts in treatment opinions. If the patient has clinical signs ofanaphylaxis(e.g. Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare, Get new journal Tables of Contents sent right to your email inbox, SIH_13_4_2018_08_03_KOBAYASHI_17-00153_SDC5.tif; [Other] (3.04 MB), SIH_4_4_2009_10_29_NANDATE_200199_SDC2.doc; [Word] (68 KB), SIH_4_4_2009_10_29_NANDATE_200199_SDC3.doc; [Word] (29 KB), SIH_4_4_2009_10_29_NANDATE_200199_SDC4.doc; [Word] (40 KB), Simulation of Diabetic Ketoacidosis for Cellular and Molecular Basics of Medical Practice, Articles in PubMed by Koichiro Nandate, MD, PhD, Articles in Google Scholar by Koichiro Nandate, MD, PhD, Other articles in this journal by Koichiro Nandate, MD, PhD, Privacy Policy (Updated December 15, 2022). In this case scenario, dehydration is one of the most serious immediate issues. - Over 3000 Free MCQs: https://geekyquiz.com/ confusion, coma), All critically unwell patients should have. The Theory Refer to your local guidelines for further details. Circulating nurse in the emergency room (ER). The reason for inserting the airway upside down initially is to reduce the risk of pushing the tongue backwards and worsening airway obstruction. The simulation experience serves to give substance to the theoretical words and concepts that the students encountered during the PBL sessions. Medical simulation technology is a powerful tool for training physicians but papers dealing with DKA simulators are scarce. See ourintravenous cannulation guidefor more details. Ketones show 5.5. Trainee will appropriately request assistance and use available resources. We combined both to indicate the continuity of the curriculum, and the building on prior knowledge. Wolters Kluwer Health In this section, we have to help the trainee to institute definitive therapy based on the underlying biochemical abnormalities. As individuals with uncontrolled type I . Lets discuss your options. A collection of free medical student quizzes to put your medical and surgical knowledge to the test! This video demonstrates how to use the SOCRATES acronym when taking a history of pain or other symptoms. Works with Traffic 2005, but . If the patient is conscious, sit themuprightas this can also help with oxygenation. ABG, venepuncture). unilateral coarse crackles may be present if the patient has pneumonia which may have been the precipitant for DKA). Stage 1: Initial assessment of acutely unwell pregnant woman and diagnosis of DKA. The Pratcice See Table 4 for a suggested standardized script. Weight, Height: Not given, normal appearing (as per simulator) but has lost 20 lbs recently. 2007. opioids, sedatives, anxiolytics, insulin, oral hypoglycaemic medications). The use of case-based simulation, although more complicated and time consuming for the instructor, immerses the students in the subject matter. Please enable scripts and reload this page. The files are given in full in the web supplement (Appendix B, Supplemental Digital Content 2, https://links.lww.com/SIH/A2). 3. 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. 3. Indeed, it is the only thing that ever has.". Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario Cureus. Laschinger S, Medves J, Pulling C, et al. Collectblood testsafter cannulating the patient including: An ECG should be performed to screen for cardiac pathology such as arrhythmias which may be precipitated by electrolyte abnormalities (e.g. We used the Medical Education Technologies Inc. (METI) Human Patient Stimulator (HPS, METI Sarasoto, Fl). A nasopharyngeal airway is a soft plastic tube with a bevel at one end and a flange at the other. I assigned true to life parking codes, and added some extra parking for the superfluous US Express AI. Instead, instructors should combine case- and simulation-based techniques when teaching diabetic assessment. angioedema, rash) commence appropriate treatment as discussed in ouranaphylaxis guide. Open the patients airwayusing ahead-tiltchin-lift manoeuvre: 1. We try to provide sufficient realism.. your express consent. The faculty member/course coordinator of Simulation Design It should only be inserted in unconscious patients as it is otherwise poorly tolerated and may induce gagging and aspiration. Introduceyourselfto thepatientincluding yournameandrole. 2. As this is a PBL session, the trainees are not given any references. Published August 2015. Simulation-based medical education: An ethical imperative. Askhow the patient is feeling as this may provide some useful information about their current symptoms. These simulation sessions seem to work because the medical students do have prior knowledge. 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. Each clinical case scenario allows you to work through history taking, investigations, diagnosis and management. 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. In an animated lecture, its important that the student group have an instructor so they can ask direct questions. Make sure thepatientsnotes,observationchartandprescriptionchartare easily accessible. The trainees have had background knowledge of biochemistry because they had completed the PBL case. Environment & Manikin Available from: [. 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. Maintain head-tilt chin-lift or jaw thrust and assess the patency of the patients airway by looking, listening and feeling for signs of breathing. A pre-briefing session is conducted prior to the start of the simulation scenario. Surgical dressings and imitation blood can support medical history. An integral part of a PBL session is for trainees to be able to navigate through huge literature bases. Given such a small group, the students indicated that they feel more involved than they would with a larger group (eg, the whole class.) 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. The Theory Terms of Use. doi: 10.7759/cureus.1286. Acad Med. Geeky Medics accepts no liability for loss of any kind incurred as a result of reliance upon the information provided in this video. She does not take this regularly. Over the years, some groups happened to have the simulation session before the completion of the theoretical PBL session. Adds true to life parking codes and extra parking for AI. Geeky Medics accepts no liability for loss of any kind incurred as a result of reliance upon the information provided in this video. She Died the Next Day. In the first, the authors expanded the National Registrys Longitudinal EMT Attributes and Demographic (LEADS) study by resurveying 1,600 EMS workers about their sleepiness while at work. 4. 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. >> Fernandez AR, Mac Crawford J, Pennell ML, et al. Introduceyourselfto whoever has requested a review of the patient andlistencarefullyto their handover. (1) The assessment of a diabetic patient is best taught as a. If the patientloses consciousnessand there areno signs of lifeon assessment, put out acrash callandcommence CPR. His Heart Stopped On a Treadmill. Keyword Highlighting A collection of anatomy notes covering the key anatomy concepts that medical students need to learn. Consider active re-warming techniques in patients with severe hypothermia. - Medical Finals Question Pack: https://geekymedics.com/medical-student-finals-questions/ Topic: Abdominal TraumaTitle: Motorcycle CrashTarget: Senior Emergency Residents / Trauma TeamAuthor / Institution: Tim Chaplin, Alison Archibaldclick here to download, Topic: Adrenal CrisisTarget: Senior Emergency Residents / Trauma TeamAuthor / Institution: Anonclick here to download, Topic: AnaphylaxisTarget: Internal MedicineAuthor / Institute: Jim Boseovski / Queen's Universityclick here to download, Topic: AnaphylaxisTitle: Anaphylaxis In An InpatientTarget: PGY1Author / Institution: Alison Rodger, Babar Haroon / Dalhousie Universityclick here to download, Topic: AnaphylaxisTitle: Bee Sting In An 8 Month OldAuthor / Institution: Katie Gordon / University of Maryland School of Medicineclick here to download, Topic: ApneaTitle: Drowning In A 3 Year OldAuthor / Institution: Katie Gordon / University of Maryland School of Medicineclick here to download, Topic: Asthmatic Protocol for EDTitle: Branching Scenario: 3 Treatment Routine ER - Pediatric PatientTargets: Emergency Department Staff and Respiratory Therapy StudentsAuthor / Instituation: Carl Rod, MS, RRT, RCP, Rose State College RT Clinical Simulation Labclick here to download, Topic: Atrial FibrillationTarget: Internal MedicineAuthor / Institute: Jim Boseovski / Queen's Universityclick here to download plus chart documents here, Topic: Bidirectional Ventricular Tachycardia from Digoxin ToxicityTarget: Senior Emergency Residents / Trauma TeamAuthor / Institution: Anonclick here to download, Topic: BradicadiaTitle: Bradycardic Arrest - Carotid Sinus MassTarget: PGY1Author / Institution: Babar Haroon / Dalhousie Universityclick here to download, Topic: BurnTitle: Cigarette FireTarget: Senior Emergency Residents / Trauma TeamAuthor / Institution: Tim Chaplin, Alison Archibaldclick here to download, Topic: BurnTitle: Meth Lab Explosion Target: Senior Emergency Residents / Trauma TeamAuthor / Institution: Tim Chaplin, Alison Archibaldclick here to download, Topic: Cardiac ArrestTarget: Inter-professional Team TrainingAuthor / Institution: Alim Nagji, Krista Dowhos / Joseph Brant Hospitalclick here to download, Topic: Chest and Abdominal TraumaTitle: Auto AccidentTarget: Senior Emergency Residents / Trauma TeamAuthor / Institution: Tim Chaplin, Alison Archibaldclick here to download, Topic: CHF (Congestive Heart Failure)Target: Internal MedicineAuthor / Institute: Jim Boseovski / Queen's Universityclick here to download, Topic: Communication, Interpersonal Skills, Mediating Conflict Title: Managing Family Members with Different Views Target: ICU FellowsAuthor / Institution: Ryan Fink, Miko Enomoto / OHSUclick here to download, Topic: Crohns FlareTitle: Complicated CrohnsTarget: PGY1Author / Institution:Allen Tran / Dalhousie Universityclick here to download, Topic: Delirious, Combative / Violent Patient Management Title: DeliriumTarget: ICU FellowsAuthor / Institution: Ryan Fink, Miko Enomoto / OHSUclick here to download, Topic: Delivering Bad NewsTitle: Delivering Bad News after a StrokeTarget: ICU FellowsAuthor / Institution: Ryan Fink, Miko Enomoto / OHSUclick here to download, Topic: Difficult AirwayTitle: Ace Inhibitor AngioedemaTarget: Mid - Senior Emergency ResidentsAuthor / Institution: Anonclick here to download, Topic: Difficult AirwayTitle: Difficult / Failed AirwayTarget: Mid - Senior Emergency ResidentsAuthor / Institution: Anonclick here to download, Topic: Disclosure of an Adverse EventTitle: Retained Guidewire from a Central LineTarget: ICU FellowsAuthor / Institution: Ryan Fink / OHSUclick here to download, Topic: DKA (Diabetic Ketoacidosis)Target: Internal MedicineAuthor / Institute: Jim Boseovski / Queen's Universityclick here to download, Topic: DKATarget: PGY1Author / Institution: Allen Tran, Babar Haroon / Dalhousie Universityclick here to download, Topic: Dyspnea (Shortness of Breath)Title: Acute Pulmonary Edema requiring intubationTarget: Senior Emergency ResidentsAuthor / Institution: Anonclick here to download, Topic: Dyspnea (Shortness of Breath)Title: Severe Asthma requiring intubationTarget: Senior Emergency ResidentsAuthor / Institution: Anonclick here to download, Topic: Electrical StormTarget: Internal MedicineAuthor / Institute: Jim Boseovski / Queen's Universityclick here to download plus chart documents here, Topic: Emergent Med-Surg ResponseTitle: MET/RRT ResponseTargets: Response Teams, House Staff and Respiratory Therapy StudentsAuthor / Instituation: Carl Rod, MS, RRT, RCP, Rose State College RT Clinical Simulation Labclick here to download, Topic: EtOH WithdrawalTitle: EtOH Withdrawal SiezureTarget: PGY1Author / Institution: Allen Tran, Babar Haroon / Dalhousie Universityclick here to download, Topic: Febrile NeutropeniaTarget: Internal MedicineAuthor / Institute: Jim Boseovski / Queen's Universityclick here to download, Topic: Head TraumaTitle: Four Storey FallTarget: Senior Emergency Residents / Trauma TeamAuthor / Institution: Tim Chaplin, Alison Archibaldclick here to download, Topic: Head TraumaTitle: Hit by MotorboatTarget: Senior Emergency Residents / Trauma TeamAuthor / Institution: Tim Chaplin, Alison Archibaldclick here to download, Topic: HypertensionTitle: Aortic DissectionTarget: Senior Emergency ResidentsAuthor / Institution: Anonclick here to download, Topic: HypertensionTitle: Autonomic DysreflexiaTarget: Senior Emergency ResidentsAuthor / Institution: Anonclick here to download, Topic: Hypertensive EmergencyTarget: Internal MedicineAuthor / Institute: Jim Boseovski / Queen's Universityclick here to download, Topic: Hypertensive EmergencyTitle: Diastolic Danger Hypertensive Urgency / EmergencyTarget: PGY1Author / Institution: Hailey Hobbs, Babar Haroon / Dalhousie Universityclick here to download, Topic: HypoxiaTarget: Inter-professional Team TrainingAuthor / Institution: Devin Sydorclick here to download, Topic: Inferior StemiTarget: Internal MedicineAuthor / Institute: Jim Boseovski / Queen's Universityclick here to download, Topic: Labor and delivery, postpartum hemorrhageTitle: Normal Delivery with PPHTarget: Maternal - Child Course - Nursing EducationAuthor / Institution: Kelly McMunnclick here to download, Topic: PEA Arrest (pulseless electrical activity)Target: Internal MedicineAuthor / Institute: Jim Boseovski / Queen's Universityclick here to download, Topic: Pelvic FractureTarget: Senior Emergency Residents / Trauma TeamAuthor / Institution: Anonclick here to download, Topic: Penetrating Thoracic TraumaTarget: Senior Emergency Residents / Trauma TeamAuthor / Institution: Anonclick here to download, Topic: PneumoniaTarget: Internal MedicineAuthor / Institute: Jim Boseovski / Queen's Universityclick here to download, Topic: PneumoniaTitle: Community Acquired PneumoniaTarget: PGY1Author / Institution: Iain Arseneau, Babar Haroon / Dalhousie Universityclick here to download, Topic: Pulmonary EmbolismTarget: Internal MedicineAuthor / Institute: Jim Boseovski / Queen's Universityclick here to download, Topic: Ruptured Ectopic PregnancyTarget: Senior Emergency Residents / Trauma TeamAuthor / Institution: Anonclick here to download, Topic: SepsisTarget: PGY1Author / Institution: Allen Tran / Dalhousie Universityclick here to download, Topic: SepsisTitle: Sepsis - Crohn's IntraabdominalTarget: Mid - Senior Emergency ResidentsAuthor / Institution: Anonclick here to download, Topic: SepsisTitle: Sepsis - DKA and PneumoniaTarget: Mid - Senior Emergency ResidentsAuthor / Institution: Anonclick here to download, Topic: SepsisTitle: Sepsis - Febrile NeutropeniaTarget: Mid - Senior Emergency ResidentsAuthor / Institution: Anonclick here to download, Topic: ShockTitle: Blunt Trauma Causing a High Spinal Cord Injury with Neurogenic ShockTarget: Senior Emergency Residents / Trauma TeamAuthor / Institution: Tim Chaplin, Alison Archibaldclick here to download, Topic: ShockTitle: Hemorrhagic Shock in an Elderly Pedestrian stuck by a VehicleTarget: Senior Emergency Residents / Trauma TeamAuthor / Institution: Tim Chaplin, Alison Archibaldclick here to download, Topic: ShockTitle: Penetrating Chest Trauma Causing Obstructive ShockTarget: Senior Emergency Residents / Trauma TeamAuthor / Institution: Tim Chaplin, Alison Archibaldclick here to download, Topic: Snake BiteTarget: ER residentsAuthor / Institution: Katie Gordon / University of Maryland School of Medicineclick here to download, Topic: Status AsthmaticusTarget: PGY1Author / Institution: Unknownclick here to download, Topic: Status Epilepticus - Apnea Post-BenzodiazepinesTitle: Seven month old with Status EpilepticusTarget: Pediatric ResidentsAuthor / Institution: Keith Gregoireclick here to download, Topic: StrokeTarget: PGY1Author / Institution: Allen Tran / Dalhousie Universityclick here to download, Topic: Subdural Hemorrhage Title: SDH and DOACTarget: PGY1Author / Institution: Allen Tran / Dalhousie Universityclick here to download, Topic: Syncope / TorsadesTitle: Syncope / Torsades in the setting of acquired prolonged QTTarget: PGY1Author / Institution:Tasha Kulai, Babar Haroon / Dalhousie Universityclick here to download, Topic: Tachycardia Rapid AFTarget: PGY1Author / Institution: Allen Tran, Babar Haroon / Dalhousie Universityclick here to download, Topic: Toxic Shock SyndromeTarget: Senior Emergency Residents / Trauma TeamAuthor / Institution: Anonclick here to download, Topic: Toxicology - Bupivicaine OverdoseTarget: Senior Emergency ResidentsAuthor / Institution: Queens Universityclick here to download, Topic: Toxicology - 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