Diabetic Ketoacidosis (DKA) Clinical Pathway Emergency Department | Children's Hospital of Philadelphia <>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 595.32 841.92] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> opioids, sedatives, anxiolytics, insulin, oral hypoglycaemic medications). Physician working in the emergency department. It was developed for anesthesiology resident physicians with some background knowledge and experience caring for critically ill patients. She had developed nausea, extreme fatigue, mild disorientation, and blurred vision toward the end of the soccer match. Make sure tore-assessthe patient after anyintervention. Simulation of Diabetic Ketoacidosis for Cellular and Molecul J Nurs Educ. 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. A fixed-rate intravenous insulin infusion should be commenced initially to suppress ketogenesis, reduce blood glucose levels and address electrolyte disturbances. On arrival to the ER, standard monitors (electrocardiogram [ECG] and pulse oximetry [SpO2]) and end-tidal carbon dioxide (ETCO2) concentration were placed, and the patient was given oxygen by nasal cannulae. 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). Geeky Medics accepts no liability for loss of any kind incurred as a result of reliance upon the information provided in this video. If the patient loses consciousness and there are no signs of life on assessment, put out a crash call and commence CPR. Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. Medical Simulation Scenarios are text documents outlining the various details of a simulation - everything from patient simulator settings to debriefing notes. Make sure to re-assess the patient after any intervention. unilateral coarse crackles may be present if the patient has pneumonia which may have been the precipitant for DKA). Supplemental digital content is available for this article. Twitter: http://www.twitter.com/geekymedics 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. In other words, they do not have clinical experience, but they have clinical knowledge. This style also doesnt mimic an actual scene, and a student may feel that treatment modalities and skills are performed at a slower rate than real-world applications. Yes: if the patient can talk, their airway is patent and you can move on to the assessment of breathing. PDF Medicine Simulation Scenario Diabetic Ketoacidosis: An Emergency - Cureus Environment & Manikin Example: If the provider immediately evaluates blood glucose, then the reading will display 45 mg/dL. Simulation Scenario for Anesthesia Providers Clark Obr, MD*, Anthony Mueller, MD . The student group should be encouraged to collaborate on management options and to perform skills. Pediatric Emergency Medicine Didactics and Simulation (PEMDAS As individuals with uncontrolled type I . 3 0 obj The relationship between sleep, fatigue and patient and provider safety. As the name says, this screen is used to graph and plot any parameter. Review the patientscurrent medicationsand check any regular medications areprescribed appropriately. DKA can be caused by either: Absolute insulin deficiency (e.g. Effectiveness of simulation on health profession students knowledge, skills, confidence and satisfaction. If any obstruction is encountered, remove the tube and try the left nostril. TheABCDEapproach can be used to perform a systematic assessment of a critically unwell patient. Development of simulation scenarios for an adolescent patient with diabetic ketoacidosis. 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). If the patientloses consciousnessand there areno signs of lifeon assessment, put out acrash callandcommence CPR. 1 Potassium losses occurring both before and during treatment of DKA must be replaced. LYqC+pJ&6X4onfBT#?=R}.p8N3+Dk,P4tIgWB}-L'=8;_G >,K#.e89XnG'B~NtR 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. COVID-19 Screening in the Pediatric Emergency Department. Immersive Simulations 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. There are just a few more things to do. Trainee will be respectful to others and their views during the PBL session. stream 1-6. Strategies of high-performing paramedic educational programs. 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. The file explaining the session is sent to instructors 1 week before the sessions. If the patient is confused you might be able to get a collateral history from staff or family members as appropriate. The use of a simulated, evolving case scenario was an effective method of exposing nursing students to complex patient care. Available from: [. Using SOCRATES in History Taking | OSCE | Communication Skills, Diabetic Ketoacidosis (DKA) | Acute Management | ABCDE. We have been presenting Simulation Laboratory sessions to our preclinical medical students (first and second years). Introduceyourselfto thepatientincluding yournameandrole. Alert a senior immediately if you have any concerns about the consciousness level of a patient. Glycosuria leads to urinary losses of potassium through osmotic diuresis. 3. If the patient has clinical signs ofanaphylaxis(e.g. This leads to hyperglycaemia, osmotic diuresis, and dehydration. 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. cloudy urine may indicate urinary tract infection). 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. - Timing 03:23 See ourintravenous cannulation guidefor more details. An animated lecture may be described as a pseudo-simulation environment. You should have another member of the clinical team aiding you in your ABCDE assessment, such a nurse, who can perform observations, take samples to the lab and catheterise if appropriate. DY{Qb"(EgN$QI*%XN1F""0a5 In the final 10 minutes, we show how the patient has a good recovery after fluid replacement. This guide has been created to assist students in preparing for emergencysimulationsessionsas part of their training,it is not intended to be relied upon for patient care. Some error has occurred while processing your request. Adds true to life parking codes and extra parking for AI. vD0 x@FFJ{m[ 3//Oh|JR7! It may be necessary toexposethe patient during your assessment: remember to prioritise patient dignity and conservation of body heat. The trainees have had background knowledge of biochemistry because they had completed the PBL case. Intubation lubricants can mimic drooling. Terms of Use. 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). *=NdL/c2XSJn8:I Jb8'.8>N*[L .hxw6afq40DX3c~>abt'Q,8y(BZu(vKBTufIR. Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario 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. 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 . A collection of data interpretation guides to help you learn how to interpret various laboratory and radiology investigations. During an immersive simulation, its imperative the group uses critical-thinking skills and group collaboration independently. 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 . Refer to your local guidelines for further details. Clearlydocument your ABCDE assessment, including history, examination, observations, investigations, interventions, and the patients response. A traditional classroom lecture format allows for student participation but limits the instructors ability to create realistic situations. Calculate the patients current fluid balance using their fluid balance chart (e.g. Your message has been successfully sent to your colleague. Just place the BR2_KDCA file into your addons scenery folder: C:\\Program Files\\Microsoft Games\\Microsoft Flight Simulator X\\Addon Scenery\\Scenery.
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