Diabetic Ketoacidosis (DKA) Clinical Pathway Emergency Department | Children's Hospital of Philadelphia As the name says, this screen is used to graph and plot any parameter. DKA can develop within 24 hours and is potentially life threatening, requiring prompt recognition and therapeutic intervention. www.cdc.gov/diabetes/statistics/prev/national/. reduced air entry, coarse crackles) to screen for evidence of pneumonia. 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. However, this leads to confusion. 2. Several environments may be suitable for your classroom. Open the patients airwayusing ahead-tiltchin-lift manoeuvre: 1. A pre-briefing session is conducted prior to the start of the simulation scenario. A collection of data interpretation guides to help you learn how to interpret various laboratory and radiology investigations. Askhow the patient is feeling as this may provide some useful information about their current symptoms. She is lethargic and slightly confused but can intermittently respond to questions. She was taken to the Emergency Department from her soccer game because she complained of nausea, extreme fatigue, mild disorientation, and blurred vision toward the end of the soccer match. 2 0 obj <> - PSA Question Pack: https://geekymedics.com/psa-question-bank/ 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). Other details are also important, including descriptions regarding patient language skill, social history, socioeconomic history, family history, religious practices or beliefs pertinent to treatment, and descriptive signs and symptoms. Simulation in Healthcare4(4):232-236, Winter 2009. Strategies of high-performing paramedic educational programs. An oxygen mask is also demonstrated as an alternative device, as these early trainees had mostly not yet seen any of these devices. Trainee will correlate the underlying pathophysiology with symptoms and signs as exhibited by the simulation session. Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. 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. Stage 1: Initial assessment of acutely unwell pregnant woman and diagnosis of DKA. Debriefing If any obstruction is encountered, remove the tube and try the left nostril. PDF Medicine Simulation Scenario Diabetic Ketoacidosis: An Emergency During an immersive simulation, its imperative the group uses critical-thinking skills and group collaboration independently. Medical simulation technology is a powerful tool for training physicians but papers dealing with DKA simulators are scarce. As with the animated lecture, the simulation is strongly dependent on a focused case study. These simulation sessions seem to work because the medical students do have prior knowledge. Immersive simulations are mentally exhausting because they create an intense and stressful atmosphere requiring the learner to work outside their comfort zone. Recognize the signs and symptoms of a patient presenting with diabetic ketoacidosis. Trainee will recognize the need for therapy and suggest an appropriate therapy in a simulated environment. Immersive Simulations Similar to a ward round, where the instructor would say: Come and listen to this patient with an aortic stenosis. It was developed for anesthesiology resident physicians with some background knowledge and experience caring for critically ill patients. If an infection is suspected, IV antibioticsshould be administered as soon as possible. Diabetic ketoacidosis; Simulation training; Medical students. Diabetic Ketoacidosis in the Obstetric Population: A Simulation 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. The students worked on the underlying physiology during a week long PBL session and are therefore familiar with the theoretical aspects of DKA. We ask the trainee why the blood pressure is so low or heart rate is so high, and how we should treat it. A fixed-rate intravenous insulin infusion should be commenced initially to suppress ketogenesis, reduce blood glucose levels and address electrolyte disturbances. Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. Perform urinalysis and send the urine for culture if urinary tract infection is suspected. The students mentioned that they did not obtain the maximum value from the simulation session under these circumstances. 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. Capillary refill timemay be prolonged if the patient is hypovolaemic. 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Rosens Emergency Medicine: Concepts and Clinical Practice. Development of simulation scenarios for an adolescent patient with diabetic ketoacidosis. Advance the airway until it lies within the pharynx. It should only be inserted in unconscious patients as it is otherwise poorly tolerated and may induce gagging and aspiration. PBL was introduced at our institution in 1995. 2010;49:578586. In this manner, the students have to apply their knowledge at the appropriate points during the progression of the scenario. Prehosp Emerg Care. Using your thumbs, slightly open the mouth by downward displacement of the chin. A blood glucose level may already be available from earlier investigations (e.g. TikTok: https://www.tiktok.com/@geekymedics It involves a facilitating instructor, a small learner group and conceptual aspects of environmental and manikin staging to provide sensory cues. Properly interpret a venous blood gas (VBG) and basic metabolic panel in a patient presenting with diabetic ketoacidosis. 2017 May 29;9(5):e1286. Typically potassium levels should be maintained between 4.0 5.5 mmol/L and close monitoring is required. In the final 10 minutes, we show how the patient has a good recovery after fluid replacement. Trainee will get to know how professionals behave during management of a critically ill patient. Simulation-based medical education: An ethical imperative. In some cases, normal saline with additional potassium is required to prevent overcorrection of serum potassium levels which would otherwise result in hypokalaemia. Questionswhich may need to be considered include: The next team of doctors on shift should bemade awareof any patient in their department who hasrecently deteriorated. 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. Clearlydocument your ABCDE assessment, including history, examination, observations, investigations, interventions, and the patients response. 2007. - Over 3000 Free MCQs: https://geekyquiz.com/ Conclusions This technical report describes the design and implementation of a simulation scenario on DKA for emergency medicine trainees. Data Description All the product records are stored at /user/spark/dataset/retail_db/products All the category records are stored at /user/spark/dataset /ret. Cureus is on a mission to change the long-standing paradigm of medical publishing, where submitting research can be costly, complex and time-consuming. Trainee will describe the changes in vital signs, the major metabolic, fluid, and electrolyte. Trainee will improve their understanding of clinical practice through reflective assessment of actual cases during the prior PBL sessions. Terms of Use. The relationship between sleep, fatigue and patient and provider safety. Its absolutely necessary to follow all immersive simulations with a positive, emotionally safe and nonjudgmental debriefing environment. In an animated lecture, its important that the student group have an instructor so they can ask direct questions. We have spent many hours debating whether the small group format was a waste of time. Use blankets to re-warm patients who are mild to moderately hypothermic. Antibiotics should be prescribed in keeping with local guidelines. Assessment & Treatment of Five Diabetic Emergencies - JEMS Calculate the patients current fluid balance using their fluid balance chart (e.g. Ask for anotherclinicalmemberofstafftoassistyou if possible. Diabetic Ketoacidosis (DKA) Clinical Pathway Emergency Department 1 0 obj Initially, we used a blood pressure cuff to generate the blood pressure values. Make sure tore-assessthe patient after anyintervention. Pediatric Emergency Medicine Didactics and Simulation (PEMDAS 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. Highlight selected keywords in the article text. If the patient is suspected to have sufferedsignificanttraumawith potential spinal involvement, perform ajaw-thrustrather than a head-tilt chin-lift manoeuvre: 2. The students are in their basic science course. A comprehensive collection of medical revision notes that cover a broad range of clinical topics. 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. Another example: At one minute into the scenario, the patient becomes unresponsive and their breathing becomes shallow. PDF DKA Sim Scenario - ABCD (Diabetes Care) Ltd Manikin staging can provide strong cues. Schneider Sarver PA, Senczakowicz EA, Slovensky BM. Inspect for evidence of self-injection sites (e.g. If the patient loses consciousness and there are no signs of life on assessment, put out a crash call and commence CPR. Please try after some time. We now provide the students with handouts of the data to save time and provide consistency. #geekymedics #fyp #fypviral #studytok #medicalstudentuk #medtok #studytips #studytipsforstudents #medstudentuk #premed #medschoolfinals, Cardiovascular History Tips - DON'T FORGET these 3 things .
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