If the patient is unconscious or unresponsive, start the basic life support (BLS) algorithm as per resuscitation guidelines. pH: low in the context of DKA due to the presence of acidic ketones. Monitoring/Labs. Acute scenarios typically begin with a brief handover from a member of the nursing staff including the patient’s name, age, background and the reason the review has been requested.. Introduction. If foreign material is present, attempt removal using suction. This is on top of a history of untreated hypertension. Typically potassium levels should be maintained between 4.0 – 5.5 mmol/L and close monitoring is required. Decrease glucose 50-100 mg/dL per hour; Order 2 bag system, D 0 and D 10 with electrolytes; Begin dextrose when the patient’s glucose is ; 300 mg/dL or decrease in POC glucose > 100 mg/dL per hour. Using your thumbs, slightly open the mouth by downward displacement of the chin. Inspect the urine currently in the catheter bag and note its appearance (e.g. This is due to the variation in the pathology of the condition. Below are tips to help the facilitator conduct the simulation. The patient will initially demonstrate compensated shock requiring aggressive resuscitation. Bonus cases are inspired by learning objectives from: coronial inquiries and subsequent recommendations. areas of lipohypertrophy) if it is unclear if the patient is diabetic. 1. Upon arrival back from the CT scan (which confirms the diagnosis of Type A aortic dissection) the patient is altered and in shock. A bolus of rapid-acting insulin should be administered subcutaneously based on the results of the fingerstick test 1-2 hours before discontinuation of intravenous insulin. Introduce yourself to the patient including your name and role. 2. 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. Consider active re-warming techniques in patients with severe hypothermia. You may need further help or advice from a senior staff member and you should not delay seeking help if you have concerns about your patient. Simulation Scenario Leadership: Triage/Prioritization (Part 1) Overview Title: Triage/Prioritization (Part 1 of 2) Concept: Leadership Target Group: Second Year Nursing Students To cite this reference: Serfling, J. Quiz. Introduce yourself to whoever has requested a review of the patient and listen carefully to their handover.. Interaction. Patient clinically deteriorates as the drug reaches peak effects, requiring IV fluids, atropine, calcium, glucagon, multi-dose vasopressors, high dose insulin, and a discussion around potential salvage therapies. Methods. Possible diagnosis: DKA/HHNK Regular Insulin drip per protocol. After initial insulin therapy has reduced plasma blood glucose levels (e.g. He collapsed in the police car and therefore they came to the ED. If the patient has COPD and a history of CO2 retention you should switch to a venturi mask as soon as possible and titrate oxygen appropriately. Place one hand on the patient’s forehead and the other under the chin. HCO 3-: low in the context of DKA due to metabolic acidosis. Consider any precipitating factors for the development of DKA and involve the diabetes team in the patient’s care. Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario. If fever is present, make sure to consider co-existing infection. Fill in your details below or click an icon to log in: Email (required) (Address never made public) Name (required) Website. This typically involves the use of a non-rebreathe mask with an oxygen flow rate of 15L. Dr. Evtushevski is an Emergency Medicine resident at the University of British Columbia, Vancouver Island Site. About CISL. A 68-year old man with COPD requiring home oxygen presents with respiratory failure. Use blankets to re-warm patients who are mild to moderately hypothermic. Peer-reviewed simulation cases for Emergency Medicine programs available in FOAMed spirit. The normal reference range for fasting plasma glucose is 4.0 – 5.8 mmol/l. Simulation scenario; Leadership: Triage/prioritization (part 1 of 2). In compliance with the criteria to meet the standards, a needs assessment was performed to provide evidence of the need for the DKA simulation-based experience. He is hypoxic, hypercarbic and agitated and will require intubation. If you'd like to support us and get something great in return, check out our OSCE Checklist Booklet containing over 100 OSCE checklists in PDF format. Refer to your local guidelines which should provide a clear protocol for the management of DKA. Check out our brand new medical MCQ quiz platform at https://geekyquiz.com. The choice of fluid type, rate of administration and volume should be tailored to the individual patient based upon their vital signs and electrolytes. The simulated scenario is delivered to pairs of final year students in the simulation suite at the Universityof Aberdeen. 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°. Deterioration should be recognised quickly and acted upon immediately. The team leader must troubleshoot the high ventilation pressures until they find and treat a tension pneumothorax. 3. Simulation Canada enables and supports research, development and innovation in the field of simulation for health professions education and health system improvement. A man with tight foreskin. Inspect for evidence of self-injection sites (e.g. Check the patency of the patient’s right nostril and if required (depending on the model of NPA) insert a safety pin through the flange of the NPA. You can access many of the applications that were listed on the eCommons portal by adding them to your "My Applications" block in your MyHMS dashboard. DKA precipitated by a respiratory infection). See our fluid prescribing guide for more details on resuscitation fluids. 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. Make sure to re-assess the patient after any intervention. 9 Specifically, it has been shown that simulation is a strong method by which to teach management of patients for which rapid interventions are required. Please see the CISL News and Events page to view the video. 3. See our CXR interpretation guide for more details. cellulitis). A collection of free medical student quizzes to put your medical and surgical knowledge to the test! Collect blood tests after cannulating the patient including: An ECG should be performed to screen for cardiac pathology such as arrhythmias which may be precipitated by electrolyte abnormalities (e.g. A fixed-rate intravenous insulin infusion should be commenced initially to suppress ketogenesis, reduce blood glucose levels and address electrolyte disturbances. ABG, venepuncture). Diabetes (type 1 and type 2) in children and young people: diagnosis and management. 10 This simulation is fully presented in the simulation case file (). Simulation Toolkit. Alert a senior immediately if you have any concerns about the consciousness level of a patient. unilateral coarse crackles may be present if the patient has pneumonia which may have been the precipitant for DKA). Each clinical case scenario allows you to work through history taking, investigations, diagnosis and management. The actual sample was 73, although due to incomplete surveys, the final sample size was … Information for research of yearly salaries, wage level, bonus and compensation data comparison. Airway adjuncts are often helpful and in some cases essential to maintain a patient’s airway. Measure the patient’s capillary blood glucose and ketone levels to confirm the diagnosis and guide the management of DKA. Both his parents are healthcare workers with possible COVID-19 exposures. Simulation and TEL scenario - seizure.pdf 1.15 MB. A collection of interactive medical and surgical clinical case scenarios to put your diagnostic and management skills to the test. We've also just launched an OSCE Flashcard Collection which contains over 800 cards. Initial steps. Clearly communicate how often would you like the patient’s observations relayed to you by other staff members. Transition from intravenous to subcutaneous insulin administration should begin. In the meantime, you can perform some basic airway manoeuvres to help maintain the airway whilst awaiting senior input. reduced air entry, coarse crackles) to screen for evidence of pneumonia. He has been started on an insulin drip and has received one amp of bicarb. In report you learn that his blood glucose on arrival was 780. oral fluids, intravenous fluids, urine output, drain output, stool output, vomiting) to inform resuscitation efforts. The ABCDE approach can be used to perform a systematic assessment of a critically unwell patient. confusion, coma), All critically unwell patients should have. opioids, sedatives, anxiolytics, insulin, oral hypoglycaemic medications). A chest X-ray should not delay the emergency management of DKA. You are commenting using your WordPress.com account. After this initial phase, findings of severe head injury will become apparent. In the context of DKA, a patient’s consciousness level may be reduced. ( Log Out / Change ) You are commenting using your Twitter … & Warren, D.(2012). insulin-dependent type 2 diabetes), Altered consciousness (e.g. ( Log Out / Change ) You are commenting using your Google account. NPAs are typically better tolerated in patients who are partly or fully conscious compared to oropharyngeal airways. Dissociative-dosed ketamine and BiPAP can facilitate pre-oxygenation. Advance the airway until it lies within the pharynx. Available from: [.