Administer oxygen to all critically unwell patients during yourinitialassessment. Keywords: diabetic ketoacidosis, simulation, expertise, emergency medicine Introduction Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes mellitus, most commonly occurring in patients with type I diabetes. PDF Adult Type I Diabetic Ketoacidosis Pre-simulation Preparation Student 2007. Creating a Simulation Experience to Promote Clinical Judgment Groups of more than seven may struggle with meeting objectives due to insufficient functional rolls. }HyEf,#$/JSRU9+CF6k\'/z+i`[ 5JudK*Zly^g%[jCK)H[)Y=Qp0/r9o9HW_zF}pTzI~'|q.~:=Y T 9w! 2. Pediatric Emergency Medicine Didactics and Simulation (PEMDAS Introduceyourselfto thepatientincluding yournameandrole. (1) According to Centers for Disease Control and Prevention (CDC), 223,619 deaths were attributed to diabetes in 2005. >> Patterson PD, Weaver M, Frank R, et al. Antibiotics should be prescribed in keeping with local guidelines. The students are in their first year. reduced air entry, coarse crackles) to screen for evidence of pneumonia. Effectiveness of simulation on health profession students knowledge, skills, confidence and satisfaction. This guide provides an overview of the recognition and immediate management of diabetic ketoacidosis (DKA)using an ABCDE approach. 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). Reduced urine output (oliguria) is typically defined as less than 0.5ml/kg/hour in an adult. Schneider Sarver PA, Senczakowicz EA, Slovensky BM. 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 Diabetic ketoacidosis (DKA) is a life-threatening complication of diabetes mellitus, most common in patients with type 1 diabetes in particular due to a deficiency or absence of insulin [1].. Research Watch Box:Sleep, Fatigue & SafetyBy David Page, MS, NREMT-P Ketones show 5.5. Rosens Emergency Medicine: Concepts and Clinical Practice. See ourCXR interpretation guidefor more details. your express consent. DKA can develop within 24 hours and is potentially life threatening, requiring prompt recognition and therapeutic intervention. Measure the patients capillary blood glucose and ketone levels to confirm the diagnosis and guide the management of DKA. A chest X-ray should not delay the emergency management of DKA. x]o ]?9kgq~:)?hE )R6!up}\<8||\]}Y~;xp~yQ$#4~djX&{n_m-]^K1/~/AD Hv 99evs,;8}8zwnhFxV.kf-V^? His Wife Gave Him CPR. Refer to your local guidelines for further details. If you have any scenarios you would be willing to share with the simulation community, please forward them to me. Kymera Systems Inc | SCADA Online Demo Ignition endobj With your index and other fingers placed behind the angle of the mandible, apply steady upwards and forward pressure to lift the mandible. The students are in their first year. DONT FORGET these 3 key components of the cardiovascular exam for your upcoming OSCEs Save this video to watch later and dont forget to follow Geeky Medics! 3. Standardized patient as the voice of the simulator (or the simulation operator may play this role). Please try after some time. See ourfluid prescribing guidefor more details onresuscitation fluids. Its absolutely necessary to follow all immersive simulations with a positive, emotionally safe and nonjudgmental debriefing environment. In this manner, the students have to apply their knowledge at the appropriate points during the progression of the scenario. Initially, we used a blood pressure cuff to generate the blood pressure values. MassBay EMS Program Integrates Training for Dogs, Heat Waves Are Killing More LA Homeless People. Medical simulation technology is a powerful tool for training physicians but papers dealing with DKA simulators are scarce. The files are given in full in the web supplement (Appendix B, Supplemental Digital Content 2, https://links.lww.com/SIH/A2). She is lethargic and slightly confused but can intermittently respond to questions. The researchers found that long shift hours (24hrs), working overtime and marital/relationship stress were strongly correlated. Scenario in a Nutshell Diabetic ketoacidosis (DKA) in pregnancy. Simulation Scenario for Anesthesia Providers Clark Obr, MD*, Anthony Mueller, MD . Re-assessthe patient using theABCDE approachto identify any changes in their clinical condition and assess the effectiveness of your previous interventions. %PDF-1.5 Performing an ECG should not delay the emergency management of DKA. #geekymedics #fyp #fypviral #studytok #medicalstudentuk #medtok #studytips #studytipsforstudents #medstudentuk #premed #medschoolfinals #shorts, Cardiovascular Exam Tips - DON'T FORGET these 3 things , Watch this video to find out the most COMMONLY FORGOTTEN components of the cardiovascular history! Save this video to help prepare for your upcoming OSCEs and dont forget to follow Geeky Medics! 2008;6:278302. SimMan Nursing Scenarios Software - laerdal.com This typically involves the use of anon-rebreathe maskwith an oxygen flow rate of15L. Should any changes be made to the current management of their underlying condition(s)? The debriefing environment should be removed from the location where the simulation took place. Assess the patients pulse and blood pressure: Inspect the patient from the end of the bed: they may appear drowsy, confused and/or clammy/pale. 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. Catheterisethe patient to closelymonitor urine outputto guide fluid resuscitation and need for escalation. When erroneous treatment is delivered, the instructor can end the simulation. Some manikin models support a variety of human functions, such as capillary and facial cyanosis, facial sweating, foley catheter and IV placement, blood pressure generation, cardiac rhythms and abnormalities, defibrillation, cardioversion, external pacing and vital sign generation. Askhow the patient is feeling as this may provide some useful information about their current symptoms. Finally, we summarize the course and give them time for questions. We have been presenting Simulation Laboratory sessions to our preclinical medical students (first and second years). Manikin staging can provide strong cues. Stage 3: Ongoing management and monitoring of DKA 1 hour after initiation of treatment. Forty percent of respondents reported excessive daytime sleepiness. 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). We ask the trainee why the blood pressure is so low or heart rate is so high, and how we should treat it. 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 required potassium replacement varies greatly. Conclusions This technical report describes the design and implementation of a simulation scenario on DKA for emergency medicine trainees. Stage 2: Emergency management of DKA and consideration of abnormal CTG. Problems are addressed as they are identified and the patient is re-assessed regularly to monitor their response to treatment. Using the arterial line, the scenario becomes much more dynamic. Advance the airway until it lies within the pharynx. The relationship between sleep, fatigue and patient and provider safety. This video demonstrates how to use the SOCRATES acronym when taking a history of pain or other symptoms. Trainee will be respectful to others and their views during the PBL session. Invasive monitors, including a left radial intraarterial and a right subclavian IV catheter, were placed. Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. A collection of data interpretation guides to help you learn how to interpret various laboratory and radiology investigations. If the patientloses consciousnessand there areno signs of lifeon assessment, put out acrash callandcommence CPR. 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 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). 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. 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. Are any further assessments or interventions required? doi: 10.7759/cureus.1286. She had developed nausea, extreme fatigue, mild disorientation, and blurred vision toward the end of the soccer match. For similar reasons, we do not believe a videotaped session will keep the students attention as much as these live simulator sessions. The student group should be encouraged to collaborate on management options and to perform skills. See ourintravenous cannulation guidefor more details. Emergency medical services workLife characteristics contribute to clinically significant excessive daytime sleepiness. A traditional classroom lecture format allows for student participation but limits the instructors ability to create realistic situations. 1 Potassium losses occurring both before and during treatment of DKA must be replaced. 34 - Diabetic Ketoacidosis in Pregnancy | Obgyn Key DKA can develop within 24 hours and is potentially life threatening, requiring prompt recognition and therapeutic intervention. 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. 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.. Data is temporarily unavailable. Twitter: http://www.twitter.com/geekymedics NPAs are typically better tolerated in patients who are partly or fully conscious compared to oropharyngeal airways. This is a combination of the modified traditional lecture within scenario-based learning. This is a 25-year-old woman with a medical history of diabetes medicated with 40 units insulin per day. The learning objectives follow the American College of Graduate Medical Education (ACGME) Core Compentencies. 3. insulin-dependent type 2 diabetes), Altered consciousness (e.g. Animated Lecture Testing a diabetes keotacidosis simulation in critical care nursing: A In keeping with the case study, as a treatment marker is reached, the instructor should place emphasis on physiological, pharmacological, environmental and psychosocial issues. Immersive Simulations We do not use passive visualizing materials such as videotapes or DVD other than vital signs shown on the monitors. It was We have 18 to 20 PBL groups for an hour each in the week after their PBL DKA session. Inspect theairwayfor obviousobstruction. In other words, they do not have clinical experience, but they have clinical knowledge. confusion, coma), All critically unwell patients should have. cloudy urine may indicate urinary tract infection). The objective is to give as many visual and tactile cues concerning the patient condition and background as possible. Seek senior helpif the patient shows no signs of improvement or if you have any concerns. Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. General: Moaning, asking what has happening to her. The consequences (low blood pressure, high heart rate, central nervous system status, etc.) 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. 3. On the basis of the feedback from the students, they indicated that they believed the small group sessions are better. - Associated symptoms 03:04 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 - 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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. Groups of fewer than four students dont allow for optimal collaboration. 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. Each PBL case typically goes over 23 days, affording the students periods to find information for the case. Subscribe to our newsletter to be the first to know about our latest content: https://geekymedics.com/newsletter/ A pre-briefing session is conducted prior to the start of the simulation scenario. You can check out our guide to using SOCRATES here: https://geekymedics.com/the-socrates-acronym-in-history-taking/ YouTube Video VVVram5yRUhROGJRUW1sZk5kQVFDXzV3LjMxakdNallNcng0, YouTube Video VVVram5yRUhROGJRUW1sZk5kQVFDXzV3LkJPVjVZMzBKczY4, YouTube Video VVVram5yRUhROGJRUW1sZk5kQVFDXzV3LkxEM2VkQzB2NTBr, Start typing to see results or hit ESC to close, Deep Vein Thrombosis (DVT) Examination OSCE Guide, Pre-hospital Advanced Life Support (ALS) OSCE Guide, Adult Choking (Basic Life Support) OSCE Guide, Paediatric Intravenous Cannulation OSCE Guide, Intrauterine System (Mirena) Counselling OSCE guide, Geeky Medics OSCE Book | Clinical Examination, Paediatric Gastro-oesophageal Reflux Disease, A Career as a GP with Special Interest with Dr Fiona Mosgrove, Absolute insulin deficiency (e.g. 2. NPAs should not be used in patients who may have sustained a skull base fracture, due to the small but life-threatening risk of entering the cranial vault with the NPA. Review the patients drug chart for medications which may cause a reduced level of consciousness (e.g. The normal reference range for fasting plasma glucose is 4.0 5.8 mmol/l. Discuss the patients current clinical condition with aseniorclinicianusing anSBARR style handover. The validity of the HFS-DKA scenario was verified by a certified diabetes nurse educator, a registered nurse, and a clinical nurse educator. Stage 1: Initial assessment of acutely unwell pregnant woman and diagnosis of DKA. Circulating nurse in the emergency room (ER). If an infection is suspected, IV antibioticsshould be administered as soon as possible. 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. As a next step, we will let one of the trainees talk to the patient, and prompt to ask medical questions such as previous medical issues or recent drug use for them to practice asking questions to generate a differential diagnosis (in this case, other causes for confusion). The DKA simulation incorporates cue recognition, analysis of cues, generation of solutions, nursing interventions, and evaluation of outcomes, including effective communication and psychosocial concerns. Trainee will recognize the need for therapy and suggest an appropriate therapy in a simulated environment. - Over 3000 Free MCQs: https://geekyquiz.com/ You may search for similar articles that contain these same keywords or you may Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. Use washable, non-toxic paints to imitate various body emissions. Despite this increased calorie intake, she noticed an unexplained 20 lbs weight loss. Blood sugar issues in the Type II diabetic will have a gradual onset, with diagnosis generally resulting from routine laboratory exams.(1). 1. However, this turned out to be too slow, took too much time, and could not continuously demonstrate the direction of changes. Respiratory Failure in the Course of Treatment of Diabetic Ketoacidosis areas of lipohypertrophy) if it is unclear if the patient is diabetic. 2011;15:108109. Check out our NEW & IMPROVED quiz platform at geekyquiz.com, To be the first to know about our latest videos, subscribe to our YouTube channel . The students worked on the underlying physiology during a week long PBL session and are therefore familiar with the theoretical aspects of DKA. Causes: Any situation arising in a diabetic that requires increased insulin without that demand being met can result in DKA. Airway adjuncts are often helpful and in some cases essential to maintain a patients airway. 1) Please read through this document as it will help you prepare for your upcoming simulation on DKA. Make sure thepatientsnotes,observationchartandprescriptionchartare easily accessible. Review the patientsoxygen saturation(SpO2): Auscultate the chest to screen for evidence of respiratory pathology (e.g. 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.