Using the arterial line, the scenario becomes much more dynamic. By joining Cureus, you agree to our Circulating nurse in the emergency room (ER). Diabetic Ketoacidosis (DKA) | Acute Management | ABCDE Surgical dressings and imitation blood can support medical history. - Examples 05:45 diagnosis of DKA Trigger 3, ABG show acidosis and high BM and normal potassium. Laschinger S, Medves J, Pulling C, et al. An oxygen mask is also demonstrated as an alternative device, as these early trainees had mostly not yet seen any of these devices. She began experiencing progressively worsening thirst, increased appetite, and excessively increased urination. 1 0 obj 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. - Severity 05:32 See ourCXR interpretation guidefor more details. 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). Moses Lake (WA) Fire Department Gets $3.3M Grant for more Firefighters, Woman Who Crashed into Responders, Killing PA Firefighter, Gets Prison, Three Apparent Gas Explosions at San Bernardino (CA) Mountain Homes, Enid (OK) Fire Department Begins SWAT Medic Program to Assist Police, FDNY EMS Providers Win COVID-19-Linked Free Speech Lawsuit, Coronavirus Origins Still a Mystery Three Years into Pandemic. Chapters: This is a 25-year-old woman with a medical history of diabetes medicated with 40 units insulin per day. Airway adjuncts are often helpful and in some cases essential to maintain a patients airway. This may produce better retention of the subject matter and help students adapt to emergency scenes before going into the field. Intubation lubricants can mimic drooling. 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. Assess the patients pulse and blood pressure: Inspect the patient from the end of the bed: they may appear drowsy, confused and/or clammy/pale. Scenarios. Given 6 to 8 back-to-back sessions, it is critical that every session starts and ends on time! The normal reference range for fasting plasma glucose is 4.0 5.8 mmol/l. An animated lecture may be described as a pseudo-simulation environment. The facilitator guides the group only when necessary. The lecture allows for understanding of concepts prior to action, and instructor feedback is immediate. Diabetic ketoacidosis (DKA) is a common, potentially lethal disease. NPAs are typically better tolerated in patients who are partly or fully conscious compared to oropharyngeal airways. may email you for journal alerts and information, but is committed A collection of anatomy notes covering the key anatomy concepts that medical students need to learn. For more information, please refer to our Privacy Policy. confusion, coma), All critically unwell patients should have. Finally, we summarize the course and give them time for questions. Many of the preclinical students have never seen a real life clinical monitor or even an intravenous (IV) setup. I assigned true to life parking codes, and added some extra parking for the superfluous US Express AI. 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. In this case scenario, dehydration is one of the most serious immediate issues. The students worked on the underlying physiology during a week long PBL session and are therefore familiar with the theoretical aspects of DKA. The trainees have had background knowledge of biochemistry because they had completed the PBL case. 1. For instance, one of the questions is: Why is Tiffany dehydrated? There are several possible reasons and mechanisms (as outlined in Appendix B, fourth 15 minutes, Supplemental Digital Content 2, https://links.lww.com/SIH/A2), which the students can mention. Weight, Height: Not given, normal appearing (as per simulator) but has lost 20 lbs recently. If the patient isunconsciousorunresponsive, start thebasic life support(BLS)algorithmas per resuscitation guidelines. (1), The assessment of a diabetic patient is best taught as a case-based simulation. Are any further assessments or interventions required? Acad Med. It may be necessary toexposethe patient during your assessment: remember to prioritise patient dignity and conservation of body heat. The optimal number of simulation participants is four to seven individuals, depending on the case study objectives. Initially, we used a blood pressure cuff to generate the blood pressure values. 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. 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. For example, you could develop a diabetic scenario in which the prehospital provider encounters an altered patient with incomprehensible speech. A patient with Type I diabetes will often have symptoms related to blood sugar imbalances that appear abruptly with polydipsia, polyuria, polyphagia and rapid weight loss. 1 Potassium losses occurring both before and during treatment of DKA must be replaced. A collection of data interpretation guides to help you learn how to interpret various laboratory and radiology investigations. modify the keyword list to augment your search. 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. PDF Medicine Simulation Scenario Diabetic Ketoacidosis: An Emergency - Cureus >> Patterson PD, Weaver M, Frank R, et al. www.cdc.gov/diabetes/statistics/prev/national/. 3. Seek senior helpif the patient shows no signs of improvement or if you have any concerns. - Medical Finals Question Pack: https://geekymedics.com/medical-student-finals-questions/ Consider any precipitating factors for the development of DKA and involve the diabetes team in the patients care. Standardized patient as the voice of the simulator (or the simulation operator may play this role). 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. Inspect theairwayfor obviousobstruction. PDF Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario 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. 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. Tilt the forehead back whilst lifting the chin forwards to extend the neck. type 1 diabetes) Complete insulin insensitivity (e.g. Extremities: mild cyanosis, no clubbing or edema (verbalized by instructors); pulses equal, and symmetrical (elucidated by trainees). If the patient has COPD and a history of CO2retention you should switch to aventuri maskas soon as possible andtitrate oxygen appropriately. 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. Typically potassium levels should be maintained between 4.0 5.5 mmol/L and close monitoring is required. Keyword Highlighting 34 - Diabetic Ketoacidosis in Pregnancy | Obgyn Key You can check out our guide to using SOCRATES here: https://geekymedics.com/the-socrates-acronym-in-history-taking/ 2 0 obj 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. See ourintravenous cannulation guidefor more details. The HFS-DKA simulation teaching consisted of pre-briefing (an hour), running simulation (30 minutes) and debriefing (an hour) for the high-fidelity simulator using the Lardeal SIM man . This leads to hyperglycaemia, osmotic diuresis, and dehydration. The relationship between sleep, fatigue and patient and provider safety. However, this leads to confusion. There are several causes of DKA, which we remember by the "five I's". Diabetic ketoacidosis simulator: a new learning tool for a life Medical Simulation Scenarios are text documents outlining the various details of a simulation - everything from patient simulator settings to debriefing notes. The instructors never expect the trainees to exhibit full understanding of pathophysiology and skills in the treatment but do give them a few important points to understand the diagnosis and initial treatment of the patients with DKA. Trigger 4, Pathway 1l of saline required over 1hour and insulin infusion need prescribing and making up in 50ml syringe. If you have any scenarios you would be willing to share with the simulation community, please forward them . This article originally appeared in March 2011 JEMS as Diabetes Demonstration: Simulation-based learning works best., Simulation Training Ideal for Diabetic Patients, CMS Begins Reprocessing Retroactive Payments, Documents Detail EMTs Failure to Aid Tyre Nichols, New Course Lets Bystanders Be the Help Until Help Arrives, All Paramedic Recruits in New Castle County (DE) Obtain NRP Certification, International Prehospital Medicine Institute Literature Review, March 2023. We guide the group to suggest fluid. She had developed nausea, extreme fatigue, mild disorientation, and blurred vision toward the end of the soccer match. Please try again soon. Adds true to life parking codes and extra parking for AI. type 1 diabetes), Complete insulin insensitivity (e.g. #geekymedics #fyp #fypviral #studytok #medicalstudentuk #medtok #studytips #studytipsforstudents #medstudentuk #premed #medschoolfinals, Cardiovascular History Tips - DON'T FORGET these 3 things . You may be trying to access this site from a secured browser on the server. Instructors should write a case study for the simulation before the session. Twitter: http://www.twitter.com/geekymedics Catheterisethe patient to closelymonitor urine outputto guide fluid resuscitation and need for escalation. She is lethargic and slightly confused but can intermittently respond to questions. dq-]gX4 `L'u7myx) rpjf0z,.y`VMyx-&Ju`U0 A nasopharyngeal airway is a soft plastic tube with a bevel at one end and a flange at the other. After initial insulin therapy has reduced plasma blood glucose levels (e.g. After entering the environment, the student doesnt have the option of leaving the simulation until the learning objectives and performance measures are achieved. SimMan Nursing Scenarios Software - laerdal.com 2. 2011;15:108109. Performing an ECG should not delay the emergency management of DKA. If the patient is suspected to have sufferedsignificanttraumawith potential spinal involvement, perform ajaw-thrustrather than a head-tilt chin-lift manoeuvre: 2. (1) According to Centers for Disease Control and Prevention (CDC), 223,619 deaths were attributed to diabetes in 2005. Patients with DKA require fluid resuscitation to restore circulatory volume, clear ketones, correct electrolyte abnormalities and increase renal perfusion. LYqC+pJ&6X4onfBT#?=R}.p8N3+Dk,P4tIgWB}-L'=8;_G >,K#.e89XnG'B~NtR PBL was introduced at our institution in 1995. 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. 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. Environment & Manikin Testing a diabetes keotacidosis simulation in critical care nursing: A The students are in their first year. Geeky Medics accepts no liability for loss of any kind incurred as a result of reliance upon the information provided in this video. It involves a facilitating instructor, a small learner group and conceptual aspects of environmental and manikin staging to provide sensory cues. See ourhistory taking guidesfor more details. 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). A collection of communication skills guides, for common OSCE scenarios, including history taking and information giving. 5. Revisit history taking to explore relevant medical history and identify any precipitating factors for DKA. 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]..