This guide provides an overview of the recognition and immediate management of diabetic ketoacidosis (DKA)using an ABCDE approach. Feel the slow and tardy pulse, we consider these PBL sessions as an example of a Look here, see this use of a full human simulator in the hierarchy of learning strategies with a full human simulator (Table 1). If you have any scenarios you would be willing to share with the simulation community, please forward them . . - Over 3000 Free MCQs: https://geekyquiz.com/ 1. Each PBL case typically goes over 23 days, affording the students periods to find information for the case. type 1 diabetes), Complete insulin insensitivity (e.g. The students are in their basic science course. vD0 x@FFJ{m[ 3//Oh|JR7! The use of a simulated, evolving case scenario was an effective method of exposing nursing students to complex patient care. Review the patients drug chart for medications which may cause a reduced level of consciousness (e.g. If foreign material is present, attempt removal using suction. Please try again soon. Diabetic Ketoacidosis (DKA) Clinical Pathway Emergency Department | Children's Hospital of Philadelphia Trainee will practice or observe good teamwork skills, both as a leader and a team player. 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. As the name says, this screen is used to graph and plot any parameter. Note that if-thens must also include negative patient outcomes for when the provider doesnt take appropriate action. It involves working through the following steps: Each stage of the ABCDE approach involvesclinicalassessment,investigationsandinterventions. If the patient is suspected to have sufferedsignificanttraumawith potential spinal involvement, perform ajaw-thrustrather than a head-tilt chin-lift manoeuvre: 2. 2. 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. Consider any precipitating factors for the development of DKA and involve the diabetes team in the patients care. DO NOT perform any examination or procedure on patients based purely on the content of these videos. She does not take this regularly. reduced air entry, coarse crackles) to screen for evidence of pneumonia. The students have acquired all the applicable theoretical knowledge of the case during the previous multiday PBL sessions. Instructors should write a case study for the simulation before the session. 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. Review the patientscurrent medicationsand check any regular medications areprescribed appropriately. Does the patient need reviewing by a specialist? This video demonstrates how to use the SOCRATES acronym when taking a history of pain or other symptoms. Debriefing Data is temporarily unavailable. In this section, we have to help the trainee to institute definitive therapy based on the underlying biochemical abnormalities. Evenly balancing performance measures will ensure the student has the opportunity to critically think through patient treatment and to practice new or support previously learned behaviors and technical skills. Lets discuss your options. Insert the airway bevel-end first, vertically along the floor of the nose with a slight twisting action. The choice of fluid type, rate of administration and volume should be tailored to the individual patient based upon their vital signs and electrolytes. Diabetes UK with the Joint British Diabetes Societies Inpatient Care Group. A chest X-ray should not delay the emergency management of DKA. DO NOT perform any examination or procedure on patients based purely on the content of these videos. 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 have spent many hours debating whether the small group format was a waste of time. 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. 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. 2008;6:278302. 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. For example, you could develop a diabetic scenario in which the prehospital provider encounters an altered patient with incomprehensible speech. Case-based simulation should include two to three broad-focus objectives, as well as 1020 specific performance measures that the student should accomplish. The validity of the HFS-DKA scenario was verified by a certified diabetes nurse educator, a registered nurse, and a clinical nurse educator. Initially, we had a white board available, but the temptation (and habits) were just too strong, and the simulator sessions tended to become one way lectures, rather than an interactive, 2 way discussion.. 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. 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. Despite this increased calorie intake, she noticed an unexplained 20 lbs weight loss. Given such a small group, the students indicated that they feel more involved than they would with a larger group (eg, the whole class.) 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. We used the Medical Education Technologies Inc. (METI) Human Patient Stimulator (HPS, METI Sarasoto, Fl). Your message has been successfully sent to your colleague. - Geeky Medics OSCE App: https://geekymedics.com/geeky-medics-app/ MassBay EMS Program Integrates Training for Dogs, Heat Waves Are Killing More LA Homeless People. Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario Medical Simulation Scenarios are text documents outlining the various details of a simulation - everything from patient simulator settings to debriefing notes. The consequences (low blood pressure, high heart rate, central nervous system status, etc.) Stage 2: Emergency management of DKA and consideration of abnormal CTG. A comprehensive collection of medical revision notes that cover a broad range of clinical topics. modify the keyword list to augment your search. Administer oxygen to all critically unwell patients during yourinitialassessment. DKA can develop within 24 hours and is potentially life threatening, requiring prompt recognition and therapeutic intervention. This allows the learner group to make a psychological break from the patient and environment while beginning the reflection process. 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. Groups of fewer than four students dont allow for optimal collaboration. It was Strategies of high-performing paramedic educational programs. Immersive simulations are mentally exhausting because they create an intense and stressful atmosphere requiring the learner to work outside their comfort zone. They should be used in conjunction with the maneuvres mentioned above as the position of the head and neck need to be maintained to keep the airway aligned. Stage 1: Initial assessment of acutely unwell pregnant woman and diagnosis of DKA. It was developed for anesthesiology resident physicians with some background knowledge and experience caring for critically ill patients. 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. 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. The students are in their first year. 1) Please read through this document as it will help you prepare for your upcoming simulation on DKA. For diabetic assessment involving DKA, staging may include the use of a container with a small amount of acetone placed near the manikin because many students may not know what acetone smells like but will expect to smell something. Environment & Manikin 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. Wolters Kluwer Health The scenario would include an if-then algorithm. Pediatric Emergency Medicine Didactics and Simulation (PEMDAS The reason for inserting the airway upside down initially is to reduce the risk of pushing the tongue backwards and worsening airway obstruction. Trainee will learn to collaborate with peers to decide on appropriate interventions, tests, and therapy. Scenario in a Nutshell Diabetic ketoacidosis (DKA) in pregnancy. This session provides additional clinical support material for the theoretical PBL session. Much time was wasted explaining why it did not matter. Blood sugar issues in the Type II diabetic will have a gradual onset, with diagnosis generally resulting from routine laboratory exams.(1). Airway adjuncts are often helpful and in some cases essential to maintain a patients airway. We give the history of the patient to the trainees. to maintaining your privacy and will not share your personal information without TikTok: https://www.tiktok.com/@geekymedics Please write a single word answer in lowercase (this is an anti-spam measure). Supplemental digital content is available for this article. 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. Refer to your local guidelines which should provide a clear protocol for the management of DKA. dq-]gX4 `L'u7myx) rpjf0z,.y`VMyx-&Ju`U0 - Associated symptoms 03:04 endobj <>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 595.32 841.92] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> Perform urinalysis and send the urine for culture if urinary tract infection is suspected. A GCS of 8 or below warrants urgent expert help from an anaesthetist. Circulating nurse in the emergency room (ER). unilateral coarse crackles may be present if the patient has pneumonia which may have been the precipitant for DKA). In the meantime, you should re-assess and maintain the patients airway. Reduced urine output (oliguria) is typically defined as less than 0.5ml/kg/hour in an adult. This typically involves the use of anon-rebreathe maskwith an oxygen flow rate of15L. This field is for validation purposes and should be left unchanged. %PDF-1.5 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. Each performance measure is separated into cognitive, behavioral or technical categories. Simulation provides a safe environment where learning is enhanced through the deliberate practice of skills and controlled management of a variety of clinical encounters. Over the years, some groups happened to have the simulation session before the completion of the theoretical PBL session. It may be necessary toexposethe patient during your assessment: remember to prioritise patient dignity and conservation of body heat. The Theory Both external and internal potassium balances are disturbed during the development and treatment of DKA.