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DKA can develop within 24 hours and is potentially life threatening, requiring prompt recognition and therapeutic intervention. PBL was introduced at our institution in 1995. 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). Does the patient need a referral toHDU/ICU? 2009;13:505511. Therefore, the same file is also sent to the participants before the session. 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. An hour was . 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. Revisit history taking to explore relevant medical history and identify any precipitating factors for DKA. 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. Scenarios. cloudy urine may indicate urinary tract infection). endobj We also show them IV bags containing saline and Ringers lactate, as well as show them IV infusion sets. Instead, instructors should combine case- and simulation-based techniques when teaching diabetic assessment. Insert the airway bevel-end first, vertically along the floor of the nose with a slight twisting action. Inspect for evidence of self-injection sites (e.g. There are just a few more things to do. The instructor should have visual access via one-way windows or cameras. - 150+ PDF OSCE Checklists: https://geekymedics.com/pdf-osce-checklists/ Published August 2015. In the meantime, you can perform some basic airway manoeuvres to help maintain the airway whilst awaiting senior input. Refer to your local guidelines for further details. A patient presenting with altered level of consciousness and a blood sugar level below 80 mg/dL should be considered hypoglycemic, and treatment modalities should be consistent with those for a diabetic patient. Hypothermia may be present if the patient has been unconscious and exposed for some time. Place one hand on the patients forehead and the other under the chin. Your message has been successfully sent to your colleague. Stage 2: Emergency management of DKA and consideration of abnormal CTG. If the patient isunconsciousorunresponsive, start thebasic life support(BLS)algorithmas per resuscitation guidelines. Problems are addressed as they are identified and the patient is re-assessed regularly to monitor their response to treatment. Inspect the urine currently in the catheter bag and note its appearance (e.g. Data Description All the product records are stored at /user/spark/dataset/retail_db/products All the category records are stored at /user/spark/dataset /ret. The normal reference range for fasting plasma glucose is 4.0 5.8 mmol/l. Over the years, some groups happened to have the simulation session before the completion of the theoretical PBL session. Catheterisethe patient to closelymonitor urine outputto guide fluid resuscitation and need for escalation. Margolis GS, Romer GA, Fernandez AR, et al. Wolters Kluwer Health The following scenarios are available for download and are designed to meet your multi-disciplinary nursing needs. Advance the airway until it lies within the pharynx. Make sure thepatientsnotes,observationchartandprescriptionchartare easily accessible. We believe it is important to have active, participatory learning by having conversations with the trainees in the form of questions and answers. She tends to drink sugar containing fluids (soda) when she is thirsty, and she eats fast foods (cream-filled muffins) when she is hungry. Target Learner Groups A fixed-rate intravenous insulin infusion should be commenced initially to suppress ketogenesis, reduce blood glucose levels and address electrolyte disturbances. You may be asked to review a patient with DKA due to confusion, reduced level of consciousness, tachycardia, hypotension and/or vomiting. However, this turned out to be too slow, took too much time, and could not continuously demonstrate the direction of changes. - Timing 03:23 Measure the patients capillary blood glucose and ketone levels to confirm the diagnosis and guide the management of DKA. You may be trying to access this site from a secured browser on the server. As this is an interactive discussion session, any needed debriefing and/or explanation is given during the sessions. In this section, we have to guide them as to what they should do first for the patient in this critical condition (ie, treat the A, B, Cs of airway, breathing, and circulation) before we can confirm the diagnosis. If the patientloses consciousnessand there areno signs of lifeon assessment, put out acrash callandcommence CPR. Terms of Use. 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. The main purpose of the simulation is to draw a line from the theoretical, boring biochemistry to the clinical manifestations. 1. Her medical, social, and family histories are not clear at the time of admission to the emergency department. On the basis of the feedback from the students, they indicated that they believed the small group sessions are better. DOWNLOAD Diabetic Ketoacidosis By the end of this scenario, the learner will be able to: 1. 2. - Site 01:12 Tilt the forehead back whilst lifting the chin forwards to extend the neck. A simulation training session is described designed to acquaint emergency medicine residents with the presentation and management of diabetic ketoacidosis through the use of simulation. Generaltipsfor applying anABCDEapproachin an emergency setting include: Acute scenarios typically begin with abriefhandoverfrom a member of thenursing staffincluding thepatients name,age,backgroundand thereasonthereviewhas been requested. Prehosp Emerg Care. As with the animated lecture, the simulation is strongly dependent on a focused case study. 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 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). Refer to your local guidelines which should provide a clear protocol for the management of DKA. Scenario in a Nutshell Diabetic ketoacidosis (DKA) in pregnancy. The researchers found that long shift hours (24hrs), working overtime and marital/relationship stress were strongly correlated. - 2500+ OSCE Flashcards: https://geekymedics.com/osce-flashcards/ His Wife Gave Him CPR. A comprehensive collection of clinical examination OSCE guides that include step-by-step images of key steps, video demonstrations and PDF mark schemes. 3. Cureus 9(5): e1286. Use blankets to re-warm patients who are mild to moderately hypothermic. Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario 1-6. 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. Diabetes (type 1 and type 2) in children and young people: diagnosis and management. The choice of fluid type, rate of administration and volume should be tailored to the individual patient based upon their vital signs and electrolytes. Initially, we required the students to write down the vital signs. 2003;78:783788. See ourfluid prescribing guidefor more details onresuscitation fluids. unilateral coarse crackles may be present if the patient has pneumonia which may have been the precipitant for DKA). - Introduction 00:00 The scenario would include an if-then algorithm. Antibiotics should be prescribed in keeping with local guidelines. Case-based education adds a real-world aspect to the learning environment. 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). JEMS. Trainee will get to know how professionals behave during management of a critically ill patient. 3. Inspect for evidence of infection on the skin (e.g. Simulation Scenario for Anesthesia Providers Clark Obr, MD*, Anthony Mueller, MD . - Over 3000 Free MCQs: https://geekyquiz.com/ 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. 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. The instructors role is to facilitate active learning through a combination of learning styles. Medical Simulation Scenarios are text documents outlining the various details of a simulation - everything from patient simulator settings to debriefing notes. Simulation Scenario. 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. vD0 x@FFJ{m[ 3//Oh|JR7! The simulation experience serves to give substance to the theoretical words and concepts that the students encountered during the PBL sessions. Immersive Simulations Much time was wasted explaining why it did not matter. The learning environment should closely mimic real-world applications. 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 . The faculty member/course coordinator of Simulation Design In keeping with the case study, as a treatment marker is reached, the instructor should place emphasis on physiological, pharmacological, environmental and psychosocial issues. Available from: [, NICE guidelines. Prehosp Emerg Care. 4. Many of the preclinical students have never seen a real life clinical monitor or even an intravenous (IV) setup. From the Department of Anesthesiology, Pennsylvania State University College of Medicine, Hershey, PA. Dr. Murray is on the Speakers Bureau of METI, Sarasota, FL. We then start the DKA state. See Appendix D, Supplemental Digital Content 4, https://links.lww.com/SIH/A4. A debriefing section with pre-established questions allows the instructor to review the main focus and performance measures with the student group. 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. 3. 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. Emergency medical services workLife characteristics contribute to clinically significant excessive daytime sleepiness. The student group is given a short introduction into a closed simulation environment. See Table 4 for a suggested standardized script. 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). The use of a simulated, evolving case scenario was an effective method of exposing nursing students to complex patient care. opioids, sedatives, anxiolytics, insulin, oral hypoglycaemic medications). The students are in their first year. Subscribe to our newsletter to be the first to know about our latest content: https://geekymedics.com/newsletter/ For more information, please refer to our Privacy Policy. The addition of a fluid infusion containing some potassium allows insulin therapy to continue to suppress ketogenesis and normalise plasma pH whilst preventing the development of hypokalaemia. Askhow the patient is feeling as this may provide some useful information about their current symptoms. VbQuX#R M21 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. This is particularly important for core cases and low-frequency, high-stakes procedures and encounters. 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. 3. Heart: S1 and S2 within normal limits; no S3/S4 or murmurs, normal rate and rhythm. Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. The Theory Causes: Any situation arising in a diabetic that requires increased insulin without that demand being met can result in DKA. endobj Marx JA, Hockberger RS, Walls RM. An oxygen mask is also demonstrated as an alternative device, as these early trainees had mostly not yet seen any of these devices. The students mentioned that they did not obtain the maximum value from the simulation session under these circumstances. The use of case-based simulation, although more complicated and time consuming for the instructor, immerses the students in the subject matter. These simulation sessions seem to work because the medical students do have prior knowledge. It involves a facilitating instructor, a small learner group and conceptual aspects of environmental and manikin staging to provide sensory cues. 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. Clearly communicate how often would you like the patients observations relayed to you by other staff members. confusion, coma), All critically unwell patients should have. The instructions to the facilitators suggest a series of structured, sequential questions to the students (starting at one end, involving each student in turn, and repeatedly cycling around the group.) Consider any precipitating factors for the development of DKA and involve the diabetes team in the patients care. Given such a small group, the students indicated that they feel more involved than they would with a larger group (eg, the whole class.) 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). It may be necessary toexposethe patient during your assessment: remember to prioritise patient dignity and conservation of body heat. 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. After entering the environment, the student doesnt have the option of leaving the simulation until the learning objectives and performance measures are achieved. Anesthetic Management Using the Oxygen Reserve Index for Tracheal Resection and Tracheal End-to-E A Scoping Review of the Impact of COVID-19 on Kidney Transplant Patients in the United States, Alabama College of Osteopathic Medicine Research, Baylor Scott & White Medical Center Department of Neurosurgery, California Institute of Behavioral Neurosciences & Psychology, Contemporary Reviews in Neurology and Neurosurgery, DMIMS School of Epidemiology and Public Health, Simulation, Biodesign, & Innovation In Medical Education, The Florida Medical Student Research Publications, University of Florida-Jacksonville Neurosurgery, VCOM Clinical, Biomedical, and Educational Research, American Red Cross Scientific Advisory Council, Canadian Association of Radiation Oncology, International Liaison Committee on Resuscitation, International Pediatric Simulation Society, Medical Society of Delaware Academic Channel, Society for Healthcare & Research Development, Surgically Targeted Radiation Therapy for Brain Tumors: Clinical Case Review, Clinical and Economic Benefits of Autologous Epidermal Grafting, Defining Health in the Era of Value-Based Care, Optimization Strategies for Organ Donation and Utilization, MR-Guided Radiation Therapy: Clinical Applications & Experiences, Multiple Brain Metastases: Exceptional Outcomes from Stereotactic Radiosurgery, Proton Therapy: Advanced Applications for the Most Challenging Cases, Radiation Therapy as a Modality to Create Abscopal Effects: Current and Future Practices, Clinical Applications and Benefits Using Closed-Incision Negative Pressure Therapy for Incision and Surrounding Soft Tissue Management, Negative Pressure Wound Therapy with Instillation, NPWT with Instillation and Dwell: Clinical Results in Cleansing and Removal of Infectious Material with Novel Dressings. 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. Stage 3: Ongoing management and monitoring of DKA 1 hour after initiation of treatment. If the patient loses consciousness and there are no signs of life on assessment, put out a crash call and commence CPR. If foreign material is present, attempt removal using suction. 5. 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. 2007. can be reemphasized, and the effects of fluid therapy demonstrated. The debriefing environment should be removed from the location where the simulation took place. angioedema, rash) commence appropriate treatment as discussed in ouranaphylaxis guide. 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. 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). An animated lecture may be described as a pseudo-simulation environment. Are any further assessments or interventions required? We do not use passive visualizing materials such as videotapes or DVD other than vital signs shown on the monitors. Capillary refill timemay be prolonged if the patient is hypovolaemic. Download: http://teamworkmatters.ocbmedia.com/media/DKA-Simulation-Scenario.docx Categories: 5th Year MBChB paeds scenario, Emergency Department, Human Factors, Interprofessional / multidisciplinary, Non-technical skills, Paediatrics, Postgraduate / newly qualified, Undergraduate / pre-registration Rating Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario Cureus. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journals Web site (www.simulationinhealthcare.com). There are several causes of DKA, which we remember by the "five I's". This field is for validation purposes and should be left unchanged. 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. The students are in their first year. Medical Simulation Scenarios are text documents outlining the various details of a simulation - everything from patient simulator settings to debriefing notes.Below is a collection of donated scenarios for you to use or modify. This video demonstrates how to use the SOCRATES acronym when taking a history of pain or other symptoms. DO NOT perform any examination or procedure on patients based purely on the content of these videos. The patient synopsis should include such standard aspects as age, sex, ethnicity, medical history, medications and allergies. We have spent many hours debating whether the small group format was a waste of time. type 1 diabetes), Complete insulin insensitivity (e.g. In the context of DKA, a patients consciousness level may be reduced. modify the keyword list to augment your search. . Reduced urine output (oliguria) is typically defined as less than 0.5ml/kg/hour in an adult. This allows the learner group to make a psychological break from the patient and environment while beginning the reflection process. 1 Potassium losses occurring both before and during treatment of DKA must be replaced. Perform urinalysis and send the urine for culture if urinary tract infection is suspected. 1. LYqC+pJ&6X4onfBT#?=R}.p8N3+Dk,P4tIgWB}-L'=8;_G >,K#.e89XnG'B~NtR Healthcare Students' Psychological Well-Being in a Diabetic Ketoacidosis Simulation. endobj Moses Lake (WA) Fire Department Gets $3.3M Grant for more Firefighters, Woman Who Crashed into Responders, Killing PA Firefighter, Gets Prison, Three Apparent Gas Explosions at San Bernardino (CA) Mountain Homes, Enid (OK) Fire Department Begins SWAT Medic Program to Assist Police, FDNY EMS Providers Win COVID-19-Linked Free Speech Lawsuit, Coronavirus Origins Still a Mystery Three Years into Pandemic. Blood sugar issues in the Type II diabetic will have a gradual onset, with diagnosis generally resulting from routine laboratory exams.(1). A collection of interactive medical and surgical clinical case scenarios to put your diagnostic and management skills to the test. Airway adjuncts are often helpful and in some cases essential to maintain a patients airway. Acad Med. As individuals with uncontrolled type I . Given 6 to 8 back-to-back sessions, it is critical that every session starts and ends on time! Invasive monitors, including a left radial intraarterial and a right subclavian IV catheter, were placed. 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). . If you have any scenarios you would be willing to share with the simulation community, please forward them to me. A collection of data interpretation guides to help you learn how to interpret various laboratory and radiology investigations. Facilitator to ask how often to measure BMs J Nurs Educ. The facilitator guides the group only when necessary. TheABCDEapproach can be used to perform a systematic assessment of a critically unwell patient. - 700+ OSCE Stations: https://geekymedics.com/osce-stations/ 2010;49:578586. See ourCXR interpretation guidefor more details. 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. Centers for Disease Control and Prevention. You can check out our guide to using SOCRATES here: https://geekymedics.com/the-socrates-acronym-in-history-taking/ Often, the learner group will be unaware of these behaviors, but the instructor can key into the first few comments made during the transition between rooms. Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. - Examples 05:45 This leads to hyperglycaemia, osmotic diuresis, and dehydration. These are not learning objectives in this program. In this case scenario, dehydration is one of the most serious immediate issues. <>>> The patient was placed in the supine position and was a little confused as well as drowsy but at times had a good verbal response (Glasgow Coma Scale 15/15). Environment & Manikin Performing an ECG should not delay the emergency management of DKA. Make sure to re-assess the patient after any intervention. Its best, however, to allow the student group to continue so theyre able to evaluate their decision-making processes during debriefing. 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. Simulation provides a safe environment where learning is enhanced through the deliberate practice of skills and controlled management of a variety of clinical encounters. One of the key differences with the immersive simulation is that the instructor is absent from the simulation environment. 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. Classroom Dynamics The relationship between sleep, fatigue and patient and provider safety. The 60 minutes training time consists of four 15-minute sections divided as follows. 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. Regardless of the underlying cause of airway obstruction, seekimmediate expert supportfrom an anaesthetist and the emergency medical team (often referred to as the crash team). The students are in their basic science course. www.cdc.gov/diabetes/statistics/prev/national/. Instructors should write a case study for the simulation before the session. Below is a collection of donated scenarios for you to use or modify. 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. Each performance measure is separated into cognitive, behavioral or technical categories. Strategies of high-performing paramedic educational programs. Insert at least onewide-bore intravenous cannula(14G or 16G) and take blood tests as discussed below. 1 0 obj The main goal is to establish a safe learning environment for the learner [9, 13 . Using SOCRATES in History Taking | OSCE | Communication Skills, Diabetic Ketoacidosis (DKA) | Acute Management | ABCDE. Ketones show 5.5. Trainee will correlate the underlying pathophysiology with symptoms and signs as exhibited by the simulation session. Trainee will practice or observe good teamwork skills, both as a leader and a team player. <> 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. 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.