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If the patient is confused you might be able to get a collateral history from staff or family members as appropriate. Properly interpret a venous blood gas (VBG) and basic metabolic panel in a patient presenting with diabetic ketoacidosis. % www.cdc.gov/diabetes/statistics/prev/national/. Clearly communicate how often would you like the patients observations relayed to you by other staff members. If an obstruction is visible within the airway, use afingersweeporsuctionto remove it. - Over 3000 Free MCQs: https://geekyquiz.com/ Simulation provides a safe environment where learning is enhanced through the deliberate practice of skills and controlled management of a variety of clinical encounters. Research Watch Box:Sleep, Fatigue & SafetyBy David Page, MS, NREMT-P The 60 minutes training time consists of four 15-minute sections divided as follows. Target Learner Groups Therefore, the session is divided into four sections of 15 minutes each, so that the facilitator is constantly aware of being on time (or not), even after the first 15 minutes period. 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. Acad Med. We then start the DKA state. See Appendix D, Supplemental Digital Content 4, https://links.lww.com/SIH/A4. Invasive monitors, including a left radial intraarterial and a right subclavian IV catheter, were placed. Does the patient need a referral toHDU/ICU? TikTok: https://www.tiktok.com/@geekymedics I assigned true to life parking codes, and added some extra parking for the superfluous US Express AI. The facilitator guides the group only when necessary. 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. PA EMT Said COVID Patient Didnt Need to Go to the NYC Unions Demand Reinstatement, Back Pay for Workers Fired for Refusing President Biden to End COVID-19 Emergencies on May 11. The students are in their basic science course. 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. A comprehensive collection of OSCE guides to common clinical procedures, including step-by-step images of key steps, video demonstrations and PDF mark schemes. 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). Capillary refill timemay be prolonged if the patient is hypovolaemic. Therefore, we have to emphasize the importance of airway, breathing, and circulation in the very sick patient in any clinical setting. Diabetic Ketoacidosis in the Obstetric Population: A Simulation KDCA for FSX - Fly Away Simulation She tends to drink sugar containing fluids (soda) when she is thirsty, and she eats fast foods (cream-filled muffins) when she is hungry. Twitter: http://www.twitter.com/geekymedics Indeed, it is the only thing that ever has.". Wolters Kluwer Health Use washable, non-toxic paints to imitate various body emissions. Diabetic ketoacidosis simulator: a new learning tool for a life The reason for inserting the airway upside down initially is to reduce the risk of pushing the tongue backwards and worsening airway obstruction. Given such a small group, the students indicated that they feel more involved than they would with a larger group (eg, the whole class.) She had developed nausea, extreme fatigue, mild disorientation, and blurred vision toward the end of the soccer match. You may be asked to review a patient with DKA due to confusion, reduced level of consciousness, tachycardia, hypotension and/or vomiting. Alert a senior immediately if you have any concerns about the consciousness level of a patient. We used the Medical Education Technologies Inc. (METI) Human Patient Stimulator (HPS, METI Sarasoto, Fl). We combined both to indicate the continuity of the curriculum, and the building on prior knowledge. Given 6 to 8 back-to-back sessions, it is critical that every session starts and ends on time! The use of a simulated, evolving case scenario was an effective method of exposing nursing students to complex patient care. Another example: At one minute into the scenario, the patient becomes unresponsive and their breathing becomes shallow. Animated Lecture General: Moaning, asking what has happening to her. You may search for similar articles that contain these same keywords or you may Physician working in the emergency department. 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. They have had no clinical exposure or any clinical experience. Adds true to life parking codes and extra parking for AI. Laschinger S, Medves J, Pulling C, et al. PDF Adult Type I Diabetic Ketoacidosis Pre-simulation Preparation Student A GCS of 8 or below warrants urgent expert help from an anaesthetist. They should introduce the student group to the environment, assign roles for each learner and guide the decision-making process. 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.. Refer to your local guidelines for further details. If the patient isunconsciousorunresponsive, start thebasic life support(BLS)algorithmas per resuscitation guidelines. Please enable scripts and reload this page. In other words, they do not have clinical experience, but they have clinical knowledge. Published August 2015. Schneider Sarver PA, Senczakowicz EA, Slovensky BM. 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. Experience has shown that the more experienced the provider, the more detailed the environmental and manikin staging should be, because providers are trained to take in and interpret visual cues as indicators of patient status. Catheterisethe patient to closelymonitor urine outputto guide fluid resuscitation and need for escalation. Despite this increased calorie intake, she noticed an unexplained 20 lbs weight loss. Int J Evid Based Healthc. Please write a single word answer in lowercase (this is an anti-spam measure). Review thepatients notes,chartsandrecent investigation results. oral fluids, intravenous fluids, urine output, drain output, stool output, vomiting) to inform resuscitation efforts. Simulation Scenario for Anesthesia Providers Clark Obr, MD*, Anthony Mueller, MD . Its important to train and educate students of prehospital care on key indicators of a diabetic emergency. >> Patterson PD, Weaver M, Frank R, et al. Refer to your local guidelines which should provide a clear protocol for the management of DKA. cellulitis). 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]). Privacy Policy A collection of interactive medical and surgical clinical case scenarios to put your diagnostic and management skills to the test. Check the patency of the patients right nostril and if required (depending on the model of NPA) insert a safety pin through the flange of the NPA. 5. Extremities: mild cyanosis, no clubbing or edema (verbalized by instructors); pulses equal, and symmetrical (elucidated by trainees). KDCA, Ronald Reagan Washington National Airport, DC. 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. . 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. endobj 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. <> 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 - Hydrofluoric Acid BurnsTarget: Senior Emergency ResidentsAuthor / Institution: Queens Universityclick here to download, Topic: Toxicology - OrganophosphatesTarget: Senior Emergency ResidentsAuthor / Institution: Queens Universityclick here to download, Topic: Upper GastrointestinalI BleedTarget: Internal MedicineAuthor / Institute: Jim Boseovski / Queen's Universityclick here to download, Topic: Upper Gastrointestinal BleedingTitle: GI BleedTarget: PGY1Author / Institution: Babar Haroon / Dalhousie Universityclick here to download, Topic: Viral bronchiolitis in infants requiring intubationTitle: Apnea in the infant with RSV bronchiolitisTarget: Pediatric ResidentsAuthor / Institution: Mike Storrclick here to download.
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