dka simulation scenario

3. Insert the airway bevel-end first, vertically along the floor of the nose with a slight twisting action. The students have acquired all the applicable theoretical knowledge of the case during the previous multiday PBL sessions. Trainee will recognize the need for therapy and suggest an appropriate therapy in a simulated environment. For similar reasons, we do not believe a videotaped session will keep the students attention as much as these live simulator sessions. Abstract 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. The Theory During an immersive simulation, its imperative the group uses critical-thinking skills and group collaboration independently. Development of simulation scenarios for an adolescent patient with diabetic ketoacidosis. 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. We introduce the Simulation Laboratory and the Simulator, and demonstrate: pulses, eyes blinking, pupil constriction, gas moves in and out of mouth (place hand over mouth), chest moves up and down. In the simulated environment, trainees will ask questions on how to interpret the data that they observe on the monitors and interpretation of clinical signs and symptoms on the manikin. Subscribe to our newsletter to be the first to know about our latest content: https://geekymedics.com/newsletter/ If the patient has COPD and a history of CO2retention you should switch to aventuri maskas soon as possible andtitrate oxygen appropriately. tall tented T waves in hyperkalaemia). Could we not just do this as a large group session to all 160 students (versus 20 1-hour sessions to groups of eight students)? Seek senior helpif the patient shows no signs of improvement or if you have any concerns. Inspect theairwayfor obviousobstruction. Simulation Scenario for Anesthesia Providers Clark Obr, MD*, Anthony Mueller, MD . Capillary refill timemay be prolonged if the patient is hypovolaemic. There are actually two sets of educational objectives: the first set is for the theoretical PBL sessions, and the 2nd set is for the Simulation Session. Diabetes mellitus affects nearly 7.8% of the U.S. population, with approximately 510% of this group affected by Type I and 9095% by Type II.1 Diabetes is the most common type of endocrine disease and was the seventh leading underlying cause of death listed on death certificates in 2006. x]o ]?9kgq~:)?hE )R6!up}\<8||\]}Y~;xp~yQ$#4~djX&{n_m-]^K1/~/AD Hv 99evs,;8}8zwnhFxV.kf-V^? During the debriefing process that follows the simulation, well-balanced performance measures will guide feedback toward accomplished tasks and may illustrate existing decision-making, behavioral or technical skill deficits. The instructor can also gauge the direction the debriefing session should follow or be alerted to possible problems or conflicts in treatment opinions. The optimal number of simulation participants is four to seven individuals, depending on the case study objectives. It may be necessary toexposethe patient during your assessment: remember to prioritise patient dignity and conservation of body heat. Supplemental digital content is available for this article. Trainee will increase knowledge of professional behaviors during the simulation. DOWNLOAD Diabetic Ketoacidosis By the end of this scenario, the learner will be able to: 1. A collection of communication skills guides, for common OSCE scenarios, including history taking and information giving. Revisit history taking to explore relevant medical history and identify any precipitating factors for DKA. - Medical Finals Question Pack: https://geekymedics.com/medical-student-finals-questions/ Well done, youve now stabilised the patient and theyre doing much better. Does the patient need reviewing by a specialist? An animated lecture may be described as a pseudo-simulation environment. (1) The assessment of a diabetic patient is best taught as a. (1) According to Centers for Disease Control and Prevention (CDC), 223,619 deaths were attributed to diabetes in 2005. The teaching of diabetic assessment and management, like many other medical emergencies, lends itself well to case-based simulation. See our blood glucose measurement guide for more details. The files are given in full in the web supplement (Appendix B, Supplemental Digital Content 2, https://links.lww.com/SIH/A2). Introduction: Diabetic ketoacidosis (DKA) is a life-threatening illness which classically presents with polyuria, polydipsia, and polyphagia that can rapidly progress to severe dehydration and altered mental status from cerebral edema. You might also be interested in our awesome bank of 700+ OSCE Stations. If the patient has clinical signs ofanaphylaxis(e.g. An individual student can get an immediate answer to a question, the facilitator can see puzzled expressions on faces, and the PBL group could get answers that they could not get during their prior PBL group discussions. For instance, one of the questions is: Why is Tiffany dehydrated? There are several possible reasons and mechanisms (as outlined in Appendix B, fourth 15 minutes, Supplemental Digital Content 2, https://links.lww.com/SIH/A2), which the students can mention. Keyword Highlighting Ziv A, Wolpe PR, Small SD, et al. Vital Signs: BP, 90/30 mm Hg (ECG shows normal sinus rhythm); central venous pressure, 0 to 2 cm H. Lungs: All lung fields are clear to auscultation without wheeze or rhonchi, and the respiratory pattern is typical of Kussmaul breathing, ie, large deep tidal volumes and increased respiratory rate. 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. Yes: if the patient can talk, their airway is patent and you can move on to the assessment of breathing. A pre-briefing session is conducted prior to the start of the simulation scenario. We give the history of the patient to the trainees. A chest X-ray should not delay the emergency management of DKA. Consider active re-warming techniques in patients with severe hypothermia. 3. A strong emphasis is placed on the focused, methodical examination of a specific medical problem and the decision-based treatment options available. TikTok: https://www.tiktok.com/@geekymedics Assess the patients level of consciousness using the AVPU scale: If a more detailed assessment of the patients level of consciousness is required, use the Glasgow Coma Scale (GCS). For example, you could develop a diabetic scenario in which the prehospital provider encounters an altered patient with incomprehensible speech. 3. 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). However, this turned out to be too slow, took too much time, and could not continuously demonstrate the direction of changes. Check out our other awesome clinical skills resources including: Forty percent of respondents reported excessive daytime sleepiness. 1 Potassium losses occurring both before and during treatment of DKA must be replaced. Given 6 to 8 back-to-back sessions, it is critical that every session starts and ends on time! 2017 May 29;9(5):e1286. Weight, Height: Not given, normal appearing (as per simulator) but has lost 20 lbs recently. Scenario in a Nutshell Diabetic ketoacidosis (DKA) in pregnancy. Medical Simulation Scenarios are text documents outlining the various details of a simulation - everything from patient simulator settings to debriefing notes. 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. Deteriorationshould be recognised quickly and acted upon immediately. insulin-dependent type 2 diabetes), Altered consciousness (e.g. - Timing 03:23 opioids, sedatives, anxiolytics, insulin, oral hypoglycaemic medications). We have 18 to 20 PBL groups for an hour each in the week after their PBL DKA session. MassBay EMS Program Integrates Training for Dogs, Heat Waves Are Killing More LA Homeless People. The instructor should have visual access via one-way windows or cameras. TheABCDEapproach can be used to perform a systematic assessment of a critically unwell patient. If the patient isunconsciousorunresponsive, start thebasic life support(BLS)algorithmas per resuscitation guidelines. The DKA simulation incorporates cue recognition, analysis of cues, generation of solutions, nursing interventions, and evaluation of outcomes, including effective communication and psychosocial concerns. See ourintravenous cannulation guidefor more details. 2011;15:108109. Virtual patient simulation (VPS) is an interactive computer simulation that recreates real-world scenarios with the objectives of training, education, and assessment for health care providers [].Virtual simulation has been used extensively to adapt nursing education to the COVID-19 pandemic context [], such as social distancing and/or confinement. 2009;13:505511. An hour was . A number of key modifiers are described that allow for the adjustment of case . Immersive Simulations Keywords: diabetic ketoacidosis, simulation, expertise, emergency medicine Introduction Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes mellitus, most . Make sure thepatientsnotes,observationchartandprescriptionchartare easily accessible. This is a combination of the modified traditional lecture within scenario-based learning. These are not learning objectives in this program. 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). This is particularly important for core cases and low-frequency, high-stakes procedures and encounters. Measure the patients capillary blood glucose and ketone levels to confirm the diagnosis and guide the management of DKA. As this is a PBL session, the trainees are not given any references. A debriefing section with pre-established questions allows the instructor to review the main focus and performance measures with the student group. Properly interpret a venous blood gas (VBG) and basic metabolic panel in a patient presenting with diabetic ketoacidosis. A comprehensive collection of clinical examination OSCE guides that include step-by-step images of key steps, video demonstrations and PDF mark schemes. Refer to your local guidelines which should provide a clear protocol for the management of DKA. We try to provide sufficient realism.. This may produce better retention of the subject matter and help students adapt to emergency scenes before going into the field. Management of diabetic ketoacidosis in adults. }HyEf,#$/JSRU9+CF6k\'/z+i`[ 5JudK*Zly^g%[jCK)H[)Y=Qp0/r9o9HW_zF}pTzI~'|q.~:=Y T 9w! Re-assessthe patient using theABCDE approachto identify any changes in their clinical condition and assess the effectiveness of your previous interventions. A list of the requirements (monitors, props, and others) is given in Tables 2 and 3, as well as in the web supplement (Appendix C, Supplemental Digital Content 3, https://links.lww.com/SIH/A3). a simulation training session designed to acquaint emergency medicine residents with the presentation and management of diabetic ketoacidosis (DKA) through the use of simulation. The main goal is to establish a safe learning environment for the learner [9, 13 . Consider any precipitating factors for the development of DKA and involve the diabetes team in the patients care. Cureus is on a mission to change the long-standing paradigm of medical publishing, where submitting research can be costly, complex and time-consuming. The students mentioned that they did not obtain the maximum value from the simulation session under these circumstances. His Wife Gave Him CPR. Refer to your local guidelines for further details. Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. There are several causes of DKA, which we remember by the "five I's". Discuss the patients current clinical condition with aseniorclinicianusing anSBARR style handover. Note that if-thens must also include negative patient outcomes for when the provider doesnt take appropriate action. Alert a senior immediately if you have any concerns about the consciousness level of a patient. type 1 diabetes) Complete insulin insensitivity (e.g. Because of the early stage (first year) of their medical careers, they have not yet seen vital sign monitoring, or patients, so these clinical aspects are introduced and emphasized. stream If the patient loses consciousness and there are no signs of life on assessment, put out a crash call and commence CPR. cloudy urine may indicate urinary tract infection). Before trainees arrival into the simulation area, the simulator is already preprogrammed for DKA. The use of simulation-based instruction enables a student to learn at their own pace and allows them to repeat sequential steps to gain confidence and proficiency. This is an important period, as this is where the students see the theoretical concept (metabolic acidosis), come to life as for instance large tidal volumes. Makeup may be used to depict gender, hollow eyes and cheeks, produce pallor or display bruises and scars. Prior to starting the scenario, the instructor should introduce a short summary of the case study and ask open-ended questions regarding the management direction. It involves working through the following steps: Each stage of the ABCDE approach involvesclinicalassessment,investigationsandinterventions. 2 The evaluation of potassium deficits is complicated by potassium exit from . - Site 01:12 Animated lectures, however, must work within the framework of a focused case study, which requires increased preparation time. - 2500+ OSCE Flashcards: https://geekymedics.com/osce-flashcards/ Centers for Disease Control and Prevention. Diabetic Ketoacidosis (DKA) Clinical Pathway Emergency Department | Children's Hospital of Philadelphia - 150+ PDF OSCE Checklists: https://geekymedics.com/pdf-osce-checklists/ Its best, however, to allow the student group to continue so theyre able to evaluate their decision-making processes during debriefing. <>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 595.32 841.92] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> General: Moaning, asking what has happening to her. With your index and other fingers placed behind the angle of the mandible, apply steady upwards and forward pressure to lift the mandible. unilateral coarse crackles may be present if the patient has pneumonia which may have been the precipitant for DKA). She tends to drink sugar containing fluids (soda) when she is thirsty, and she eats fast foods (cream-filled muffins) when she is hungry. insulin-dependent type 2 diabetes) Symptoms Typical symptoms of DKA include: Palpitations Nausea Vomiting Sweating Thirst Weight loss Leg cramps Clinical signs Typical clinical signs of DKA include: Tachycardia Hypotension 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. Initially, we used a blood pressure cuff to generate the blood pressure values. We do point out the blood pressure (BP) cuff, but these medical students in their first year do not really need to know how the BP values are generated, they need to understand the origin and therapy for the low blood pressure. Administer oxygen to all critically unwell patients during yourinitialassessment. 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. We demonstrate to the trainees the significant changes on the monitors by asking them to point out any changes on the simulator (clinical examination) and the vital signs (monitor parameters). confusion, coma), All critically unwell patients should have. Two abstracts related to sleepiness in the EMS workforce were presented at the National Association of EMS Physicians symposium in January. Trainee will describe the changes in vital signs, the major metabolic, fluid, and electrolyte. In keeping with the case study, as a treatment marker is reached, the instructor should place emphasis on physiological, pharmacological, environmental and psychosocial issues. Therefore, we have to emphasize the importance of airway, breathing, and circulation in the very sick patient in any clinical setting. Strategies of high-performing paramedic educational programs. As the name says, this screen is used to graph and plot any parameter. An oropharyngeal airway is a curved plastic tube with a flange on one end that sits between the tongue and hard palate to relieve soft palate obstruction. This video demonstrates how to use the SOCRATES acronym when taking a history of pain or other symptoms. The instructors role is to facilitate active learning through a combination of learning styles. On the basis of the feedback from the students, they indicated that they believed the small group sessions are better. An integral part of a PBL session is for trainees to be able to navigate through huge literature bases. The immersive simulation is performed when the instructor feels comfortable with the acquired knowledge and skill base presented in the animated lecture or when the student group has sufficient practical experience to apply the cognitive, behavioral and technical skills outlined in the case scenario. 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. 1. Much time was wasted explaining why it did not matter. The following scenarios are available for download and are designed to meet your multi-disciplinary nursing needs. Problems are addressed as they are identified and the patient is re-assessed regularly to monitor their response to treatment. In this case scenario, dehydration is one of the most serious immediate issues. She had developed nausea, extreme fatigue, mild disorientation, and blurred vision toward the end of the soccer match. Acad Med. The impetus for creating and implementing the high-fidelity diabetic ketoacidosis (DKA) simulation was based on a needs assessment and reviewing of undergraduate nursing students' examination statistics in a second semester medical-surgical course. 2 0 obj We used the Medical Education Technologies Inc. (METI) Human Patient Stimulator (HPS, METI Sarasoto, Fl). reduced air entry, coarse crackles) to screen for evidence of pneumonia. 2. Simulation provides a safe environment where learning is enhanced through the deliberate practice of skills and controlled management of a variety of clinical encounters. Insert at least onewide-bore intravenous cannula(14G or 16G) and take blood tests as discussed below. Over the years, some groups happened to have the simulation session before the completion of the theoretical PBL session. Review the patientscurrent medicationsand check any regular medications areprescribed appropriately. If the patient is suspected to have sufferedsignificanttraumawith potential spinal involvement, perform ajaw-thrustrather than a head-tilt chin-lift manoeuvre: 2. Join the Geeky Medics community: The debriefing environment should be removed from the location where the simulation took place. 2008;6:278302. 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. Manikin staging can provide strong cues. Prehosp Emerg Care. The questionnaire for the assessment of the session is given in full in the web-based supplement (Appendix A, Supplemental Digital Content 1, https://links.lww.com/SIH/A1). After initial insulin therapy has reduced plasma blood glucose levels (e.g. 3. It was developed for anesthesiology resident physicians with some background knowledge and experience caring for critically ill patients. 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. 4 0 obj Wolters Kluwer Health Just place the BR2_KDCA file into your addons scenery folder: C:\\Program Files\\Microsoft Games\\Microsoft Flight Simulator X\\Addon Scenery\\Scenery. Simulation Scenario. 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. If any obstruction is encountered, remove the tube and try the left nostril. Reduced urine output (oliguria) is typically defined as less than 0.5ml/kg/hour in an adult. We do have a wig that we place on the patient, but we do not try for full realism. For instance, if we mimicked the noise and traffic of a real emergency department, this would constitute excessive realism, and become a distraction to beginner medical students. 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 researchers found that long shift hours (24hrs), working overtime and marital/relationship stress were strongly correlated. Interactive lecture/discussion with use of monitors that show the vital signs of the simulated patient on manikin. A comprehensive collection of OSCE guides to common clinical procedures, including step-by-step images of key steps, video demonstrations and PDF mark schemes. We have been presenting Simulation Laboratory sessions to our preclinical medical students (first and second years). 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. If you have any scenarios you would be willing to share with the simulation community, please forward them . As this is an interactive discussion session, any needed debriefing and/or explanation is given during the sessions. Airway adjuncts are often helpful and in some cases essential to maintain a patients airway. Review the patients drug chart for medications which may cause a reduced level of consciousness (e.g. His Heart Stopped On a Treadmill. We also show them IV bags containing saline and Ringers lactate, as well as show them IV infusion sets. Urinary tract infections are a common DKA precipitant. Hypothermia may be present if the patient has been unconscious and exposed for some time. Geeky Medics accepts no liability for loss of any kind incurred as a result of reliance upon the information provided in this video. Make sure to re-assess the patient after any intervention. Open the patients airwayusing ahead-tiltchin-lift manoeuvre: 1. Twitter: http://www.twitter.com/geekymedics >> Patterson PD, Weaver M, Frank R, et al. Both external and internal potassium balances are disturbed during the development and treatment of DKA. In this manner, the students have to apply their knowledge at the appropriate points during the progression of the scenario. *=NdL/c2XSJn8:I Jb8'.8>N*[L .hxw6afq40DX3c~>abt'Q,8y(BZu(vKBTufIR. 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 . The simulators do not have rock steady vital sign values, and the students were unsure as to write down 121 or 122 mm Hg as the systolic blood pressure. PBL in our institution is implemented as a small group (n 68 students) self study session with a facilitator, who incrementally discloses further information about the patient. 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. The Theory 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 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. Should any changes be made to the current management of their underlying condition(s)? Some error has occurred while processing your request. 1) Please read through this document as it will help you prepare for your upcoming simulation on DKA. Prehosp Emerg Care. 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. Environment & Manikin A collection of surgery revision notes covering key surgical topics. Trainee will practice or observe good teamwork skills, both as a leader and a team player. The faculty member/course coordinator of Simulation Design We combined both to indicate the continuity of the curriculum, and the building on prior knowledge. Introduceyourselfto thepatientincluding yournameandrole. <> The normal reference range for fasting plasma glucose is 4.0 5.8 mmol/l. 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. When erroneous treatment is delivered, the instructor can end the simulation. See Table 4 for a suggested standardized script. She began experiencing progressively worsening thirst, increased appetite, and excessively increased urination. You may need further help or advice from a senior staff member and you shouldnot delay seeking help if you have concerns about your patient. PA EMT Said COVID Patient Didnt Need to Go to the Hospital. Each clinical case scenario allows you to work through history taking, investigations, diagnosis and management. GRAPH. Introduction: Diabetic ketoacidosis (DKA) is a life-threatening illness which classically presents with polyuria, polydipsia, and polyphagia that can rapidly progress to severe dehydration and altered mental status from cerebral edema. ABG, venepuncture). They have had no clinical exposure or any clinical experience. Terms of Use. Conclusion 2010;49:578586. Conclusion: Our DKA simulator is a new tool whose objective is the training in a severe, frequent and complex situation, and can be used to improve the approach made by the junior physicians to the real diabetic . 2. As with the animated lecture, the simulation is strongly dependent on a focused case study. Privacy Policy We do not use passive visualizing materials such as videotapes or DVD other than vital signs shown on the monitors. 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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