Simulation Scenario for Anesthesia Providers Clark Obr, MD*, Anthony Mueller, MD . Available if the trainee asks: arterial blood gas, glucose, electrolytes, BUN and plasma osmolality (please see last section of Appendix B, Supplemental Digital Content 2, https://links.lww.com/SIH/A2, for values). 2007. Therefore, we should not have to take much time on this issue, but we have to focus on the relationship between the biochemistry and clinical signs and symptoms by asking why the patient is dehydrated, why acidosis develops, why respiration is rapid and deep (Kussmaul) respirations, and what the rationale for inpatient treatment is. 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. Measure the patients capillary blood glucose and ketone levels to confirm the diagnosis and guide the management of DKA. Groups of more than seven may struggle with meeting objectives due to insufficient functional rolls. The learning objectives follow the American College of Graduate Medical Education (ACGME) Core Compentencies. We have spent many hours debating whether the small group format was a waste of time. Urinary tract infections are a common DKA precipitant. However, this leads to confusion. The students have acquired all the applicable theoretical knowledge of the case during the previous multiday PBL sessions. Trainee will increase knowledge of professional behaviors during the simulation. Marx JA, Hockberger RS, Walls RM. In the final 10 minutes, we show how the patient has a good recovery after fluid replacement. - 2500+ OSCE Flashcards: https://geekymedics.com/osce-flashcards/ The students are in their first year. A pre-briefing session is conducted prior to the start of the simulation scenario. 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. Using the arterial line, the scenario becomes much more dynamic. a simulation training session designed to acquaint emergency medicine residents with the presentation and management of diabetic ketoacidosis (DKA) through the use of simulation. Mosby:Philadelphia. #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! Simulation in Healthcare4(4):232-236, Winter 2009. DKA can be caused by either: Absolute insulin deficiency (e.g. . The Pratcice
J Nurs Educ. - Associated symptoms 03:04 The simulation session is also hosted as an interactive session. confusion, coma), All critically unwell patients should have. TheABCDEapproach can be used to perform a systematic assessment of a critically unwell patient. This session provides additional clinical support material for the theoretical PBL session. If fever is present, make sure to consider co-existing infection. Each clinical case scenario allows you to work through history taking, investigations, diagnosis and management. Your message has been successfully sent to your colleague. A number of key modifiers are described that allow for the adjustment of case . 2011;15:108109. Seek senior helpif the patient shows no signs of improvement or if you have any concerns. - Character 02:14 Initially, we required the students to write down the vital signs. Abdomen: The abdominal examination reveals diffuse mild epigastric tenderness to deep palpitation but neither rebound tenderness nor guarding (result of examination given by patient or by instructor). Open the patients mouth to ensure there is no foreign material that may be pushed into the larynx. NPAs are typically better tolerated in patients who are partly or fully conscious compared to oropharyngeal airways. GRAPH. Trainee will learn to collaborate with peers to decide on appropriate interventions, tests, and therapy. 4 0 obj
2011;15:108109. Interactive lecture/discussion with use of monitors that show the vital signs of the simulated patient on manikin. A collection of communication skills guides, for common OSCE scenarios, including history taking and information giving. 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). endobj
This video demonstrates how to use the SOCRATES acronym when taking a history of pain or other symptoms. Available from: [, NICE guidelines. Diabetic ketoacidosis (DKA) is a common, potentially lethal disease. It was Make sure to re-assess the patient after any intervention. Hypothermia may be present if the patient has been unconscious and exposed for some time. When a group treatment decision is made that would be contraindicated or harmful to the patient, the instructor can redirect the learner group while maintaining an atmosphere inclined toward independent thinking. The students are in their basic science course. Cureus is on a mission to change the long-standing paradigm of medical publishing, where submitting research can be costly, complex and time-consuming. Introduceyourselfto thepatientincluding yournameandrole. An events progression section should include patient status changes, as well as a time/treatment continuum that incorporates if-then event progressions. Scenarios. Review the patients drug chart for medications which may cause a reduced level of consciousness (e.g. Both external and internal potassium balances are disturbed during the development and treatment of DKA. Performing an ECG should not delay the emergency management of DKA. The instructors have to appreciate that the trainees participating in this simulation have not seen a diabetic patient in either a ward or ER, but that they have knowledge of the underlying physiology. DKA can develop within 24 hours and is potentially life threatening, requiring prompt recognition and therapeutic intervention. 4. type 1 diabetes), Complete insulin insensitivity (e.g. See ourCXR interpretation guidefor more details. They have had no clinical exposure or any clinical experience. 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. Does the patient need a referral toHDU/ICU? 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. 1 Potassium losses occurring both before and during treatment of DKA must be replaced. }HyEf,#$/JSRU9+CF6k\'/z+i`[
5JudK*Zly^g%[jCK)H[)Y=Qp0/r9o9HW_zF}pTzI~'|q.~:=Y T 9w! As this is a PBL session, the trainees are not given any references. The normal reference range for fasting plasma glucose is 4.0 5.8 mmol/l. Similar to a ward round, where the instructor would say: Come and listen to this patient with an aortic stenosis. An oxygen mask is also demonstrated as an alternative device, as these early trainees had mostly not yet seen any of these devices. This is particularly important for core cases and low-frequency, high-stakes procedures and encounters. 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. If you'd like to support us and get something great in return, check out our awesome products: You don't need to tell us which article this feedback relates to, as we automatically capture that information for you. opioids, sedatives, anxiolytics, insulin, oral hypoglycaemic medications). A nasopharyngeal airway is a soft plastic tube with a bevel at one end and a flange at the other. Use washable, non-toxic paints to imitate various body emissions. Much time was wasted explaining why it did not matter. Inspect the urine currently in the catheter bag and note its appearance (e.g. As a next step, we will let one of the trainees talk to the patient, and prompt to ask medical questions such as previous medical issues or recent drug use for them to practice asking questions to generate a differential diagnosis (in this case, other causes for confusion). You may need further help or advice from a senior staff member and you shouldnot delay seeking help if you have concerns about your patient. unilateral coarse crackles may be present if the patient has pneumonia which may have been the precipitant for DKA). The instructors role is to facilitate active learning through a combination of learning styles. Before trainees arrival into the simulation area, the simulator is already preprogrammed for DKA. Subscribe to our newsletter to be the first to know about our latest content: https://geekymedics.com/newsletter/ <>>>
The faculty member/course coordinator of Simulation Design Manikin staging can provide strong cues. 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. There are several causes of DKA, which we remember by the "five I's". Please enable scripts and reload this page. The lecture allows for understanding of concepts prior to action, and instructor feedback is immediate. In the meantime, you can perform some basic airway manoeuvres to help maintain the airway whilst awaiting senior input. Conclusion
Animated Lecture
Trainee will be respectful to others and their views during the PBL session. Trainee will recognize the need for therapy and suggest an appropriate therapy in a simulated environment. The use of simulation-based instruction enables a student to learn at their own pace and allows them to repeat sequential steps to gain confidence and proficiency. The scenario would include an if-then algorithm. The learning environment should closely mimic real-world applications. Two abstracts related to sleepiness in the EMS workforce were presented at the National Association of EMS Physicians symposium in January. Geeky Medics accepts no liability for loss of any kind incurred as a result of reliance upon the information provided in this video. The main purpose of the simulation is to draw a line from the theoretical, boring biochemistry to the clinical manifestations. 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. Join the Geeky Medics community: This simulation session therefore aims to make the case come alive, and show this known case in a clinical context. Her medical, social, and family histories are not clear at the time of admission to the emergency department. dq-]gX4
`L'u7myx) rpjf0z,.y`VMyx-&Ju`U0 Does the patient need reviewing by a specialist? At the end of the previous section, the trainee can make the diagnosis of DKA but has not confirmed it yet. Instead, instructors should combine case- and simulation-based techniques when teaching diabetic assessment. <>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 595.32 841.92] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>>
2 The evaluation of potassium deficits is complicated by potassium exit from . When erroneous treatment is delivered, the instructor can end the simulation. For more information, please refer to our Privacy Policy. 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. 2. The researchers found that long shift hours (24hrs), working overtime and marital/relationship stress were strongly correlated. The objective is to give as many visual and tactile cues concerning the patient condition and background as possible. Wolters Kluwer Health
The facilitator guides the group only when necessary. Rosens Emergency Medicine: Concepts and Clinical Practice. 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. Stage 3: Ongoing management and monitoring of DKA 1 hour after initiation of treatment. After the first voluntary session in 2006, feedback from the medical students indicated that they would like to receive this handout. This is an important period, as this is where the students see the theoretical concept (metabolic acidosis), come to life as for instance large tidal volumes. 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. Our simulated patient is a 25-year-old woman, Tiffany, who has been taken to the Emergency Department from her soccer game by her boyfriend, Adam. Its important to train and educate students of prehospital care on key indicators of a diabetic emergency. Revisit history taking to explore relevant medical history and identify any precipitating factors for DKA. Laschinger S, Medves J, Pulling C, et al. reduced air entry, coarse crackles) to screen for evidence of pneumonia. DO NOT perform any examination or procedure on patients based purely on the content of these videos. your express consent. Keywords: diabetic ketoacidosis, simulation, expertise, emergency medicine Introduction Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes mellitus, most commonly occurring in patients with type I diabetes. You might also be interested in our awesome bank of 700+ OSCE Stations. Highlight selected keywords in the article text. Antibiotics should be prescribed in keeping with local guidelines. The Theory
Medical Simulation Scenarios are text documents outlining the various details of a simulation - everything from patient simulator settings to debriefing notes. 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. It involves a facilitating instructor, a small learner group and conceptual aspects of environmental and manikin staging to provide sensory cues. Ask for anotherclinicalmemberofstafftoassistyou if possible. Introduceyourselfto whoever has requested a review of the patient andlistencarefullyto their handover. (1) The assessment of a diabetic patient is best taught as a. For example, you could develop a diabetic scenario in which the prehospital provider encounters an altered patient with incomprehensible speech. 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 Makeup may be used to depict gender, hollow eyes and cheeks, produce pallor or display bruises and scars. Instagram: https://instagram.com/geekymedics Keyword Highlighting
They should introduce the student group to the environment, assign roles for each learner and guide the decision-making process. x]o ]?9kgq~:)?hE
)R6!up}\<8||\]}Y~;xp~yQ$#4~djX&{n_m-]^K1/~/AD Hv 99evs,;8}8zwnhFxV.kf-V^? If an infection is suspected, IV antibioticsshould be administered as soon as possible. In this case scenario, dehydration is one of the most serious immediate issues. 2008;6:278302. 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]). She does not take this regularly. #geekymedics #fyp #fypviral #studytok #medicalstudentuk #medtok #studytips #studytipsforstudents #medstudentuk #premed #medschoolfinals, Cardiovascular History Tips - DON'T FORGET these 3 things . See Table 4 for a suggested standardized script. Refer to your local guidelines for further details. Virtual patient simulation (VPS) is an interactive computer simulation that recreates real-world scenarios with the objectives of training, education, and assessment for health care providers [].Virtual simulation has been used extensively to adapt nursing education to the COVID-19 pandemic context [], such as social distancing and/or confinement. 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. areas of lipohypertrophy) if it is unclear if the patient is diabetic. We believe it is important to have active, participatory learning by having conversations with the trainees in the form of questions and answers. Many of the preclinical students have never seen a real life clinical monitor or even an intravenous (IV) setup. 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. Given 6 to 8 back-to-back sessions, it is critical that every session starts and ends on time! JEMS. They have had no clinical exposure or any clinical experience. This allows us to get in touch for more details if required. 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. Should any changes be made to the current management of their underlying condition(s)? Centers for Disease Control and Prevention. A list of the requirements (monitors, props, and others) is given in Tables 2 and 3, as well as in the web supplement (Appendix C, Supplemental Digital Content 3, https://links.lww.com/SIH/A3). A comprehensive collection of clinical examination OSCE guides that include step-by-step images of key steps, video demonstrations and PDF mark schemes. SimMan Nursing Scenarios Software. 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. Categories: Emergency Medicine, Medical Education Keywords: diabetic ketoacidosis, simulation, expertise, emergency medicine . We also show them IV bags containing saline and Ringers lactate, as well as show them IV infusion sets. If the provider starts an IV and gives dextrose, then the patients alertness will increase, respirations will normalize and repeated blood glucose will read 210 mg/dL over a two-minute interval. 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. 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. However, this turned out to be too slow, took too much time, and could not continuously demonstrate the direction of changes. The relationship between sleep, fatigue and patient and provider safety. This is a 25-year-old woman with a medical history of diabetes medicated with 40 units insulin per day. She tends to drink sugar containing fluids (soda) when she is thirsty, and she eats fast foods (cream-filled muffins) when she is hungry. An animated lecture may be described as a pseudo-simulation environment. Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario Cureus. One advantage to the animated lecture style is the ability to introduce treatment options in a methodically guided approach thats in conjunction with simultaneous environmental stimulus. Refer to your local guidelines which should provide a clear protocol for the management of DKA. Each performance measure is separated into cognitive, behavioral or technical categories. 3 0 obj
We give the history of the patient to the trainees. If foreign material is present, attempt removal using suction. Extremities: mild cyanosis, no clubbing or edema (verbalized by instructors); pulses equal, and symmetrical (elucidated by trainees). 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. Advance the airway until it lies within the pharynx. If the patient isunconsciousorunresponsive, start thebasic life support(BLS)algorithmas per resuscitation guidelines. In keeping with the case study, as a treatment marker is reached, the instructor should place emphasis on physiological, pharmacological, environmental and psychosocial issues. Terms of Use. Trainee will get to know how professionals behave during management of a critically ill patient. The 60 minutes training time consists of four 15-minute sections divided as follows. This guide provides an overview of the recognition and immediate management of diabetic ketoacidosis (DKA)using an ABCDE approach. 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). The choice of fluid type, rate of administration and volume should be tailored to the individual patient based upon their vital signs and electrolytes. 1. Healthcare Students' Psychological Well-Being in a Diabetic Ketoacidosis Simulation. Capillary refill timemay be prolonged if the patient is hypovolaemic. 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). Place one hand on the patients forehead and the other under the chin. The use of case-based simulation, although more complicated and time consuming for the instructor, immerses the students in the subject matter. In the meantime, you should re-assess and maintain the patients airway. In other words, they do not have clinical experience, but they have clinical knowledge. type 1 diabetes) Complete insulin insensitivity (e.g. We have been presenting Simulation Laboratory sessions to our preclinical medical students (first and second years). Works with Traffic 2005, but . 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 . Observe and discuss the effects of therapy in a mathematically modeled physiological simulator. Cureus 9(5): e1286. We then start the DKA state. See Appendix D, Supplemental Digital Content 4, https://links.lww.com/SIH/A4. tall tented T waves in hyperkalaemia). 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. Simulation Scenario for Anesthesia Providers Clark Obr, MD*, Anthony Mueller, MD *Corresponding author: clark-obr@uiowa.edu Abstract Introduction: This simulation on diabetic ketoacidosis (DKA) in . Immersive simulations are mentally exhausting because they create an intense and stressful atmosphere requiring the learner to work outside their comfort zone. Are any further assessments or interventions required? Please try again soon. Prehosp Emerg Care. His Heart Stopped On a Treadmill. 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. 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. 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. From the Department of Anesthesiology, Pennsylvania State University College of Medicine, Hershey, PA. Dr. Murray is on the Speakers Bureau of METI, Sarasota, FL.
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