Peds DKA ESCAPE ROOM

Pediatric Escape Room

DKA

start

Introduction

The purpose of this activity is to create a fun and interactive way to test and/or learn about Pediatric DKA.

Abby is a 5 year old child, who is brought in by mom to our ED after being seen at the pediatrician office yesterday for nausea and vomiting over the last two days. He was sent home with Zofran ODT, but mother is concerned as she is still vomiting with Zofran. Per mother they are constantly wanting to drink water and get up to urinate very frequently. NO previous medical hx.

+ info

Rooms

Complete each test to beat the game: there is no other way to escape!

Room 1

Room 2

Room 3

Final Room

Room 4

Room 5

Test 1

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Icebreaker question: Which presenting symptoms are often present with DKA?

Nausea & vomiting, dry skin, increased thirst, weakness, tachycardia, urinary frequency

Nausea & vomiting, bradycardia, hypertension

Test 1

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You're doing great. Next question:What ESI level would you give this patient?

ESI 3

ESI 2

ESI 4

Room 1

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You're almost there.Based off of the Pediatric Assessment Triangle (PAT), what more do you want to know about this child in triage?

How much they have been urinating each time?

What they ate last and when?

How do they appear? (interactiveness, are they talking ?) How's their breathing? How's their color?

How long have they been sick for?

Rooms

Complete each test to beat the game: there is no other way to escape!

Room 2

Room 1

Room 3

Room 5

Final Room

Room 4

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Room 2

Watch this video:The child is breathing oddly, view video below and select the correct statement.

Kussmaul breathing is related to respiratory acidosis.

Kussmaul breathing is due to metabolic acidosis, it is the body compensating for the build up of acids.

Kussmaul breathing is caused from a metabolic alkalosis, it is the body's attempt of blowing off bicarbonate.

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What further diagnostic tests would you anticipate the provider to order confirming DKA?

Betahydroxy, venous blood gas, anion gap, serum glucose

CBC, PT/INR, BMET

urine analysis for ketones

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You are almost there! The ED provider orders two IVs, along with IV fluid boluses, insulin, potassium replacement and antiemetics. What do you anticipate needing to start ASAP on this patient once the IV is established?

Insulin drip

Antibiotics

IV fluid bolus

DKA Review!

Rooms

Complete each test to beat the game: there is no other way to escape!

Room 1

Room 2

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Room 4

Room 5

Final Room

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The provider orders an EKG for Peter. The EKG below appears normal. TRUE or FALSE?

False

True

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What is abnormal about Peter's EKG?

prolonged QT interval

Nothing, it appears normal.

1st degree AV block

Inverted T wave, prominenet U wave

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Which lab result is likely causing this abnormal EKG?

Rooms

Complete each test to beat the game: there is no other way to escape!

Room 1

Room 2

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Room 4

Room 5

Final Room

Tip: write down the answer

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Test 4

All of the orders are placed, insulin has arrived and you grabbed NS and KCl replacement. Organize the steps in order of how they should per protocol be completed.

A. Start potassium replacement

B. Start IV fluid bolus at 20mL/kg

C. Start insulin drip ONLY if potassium is > 3.3

D. Ensure you have two working IVs at minimum

E. Verify potassium level

continue

Solución

Solution

You must enter the solution from the previous page to gain access

Enter the answer in the correct order

3/3

Per protocol what maintenance IVF should we anticipate?

D5W

D5 1/2 NS

LR

NS with 20mEq KCl

Rooms

Complete each test to beat the game: there is no other way to escape!

Room 1

Room 2

Room 3

Room 4

Room 5

Final Room

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Turn up the volume:Your patient has recieved their IV fluid bolus, and maintenance with KCL is infusing as ordered. The insulin drip is so be started, what should we do next?

Select here

Select here

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Well done!Your BMET results are back: Na - 132 , K- 3.2, Bicarb- 16, Cl- 100, Glucose- 302 What should you do next?

Select here

Select here

Select here

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3/3

You're almost there, press play!Now that your glucose has fallen below 300. What should you do now?

Respuesta incorrecta

Select here

Respuesta incorrecta

Select here

Respuesta correcta

Select here

Respuesta incorrecta

Select here

Rooms

Complete each test to beat the game: there is no other way to escape!

Room 1

Room 2

Room 3

Final Room

Room 5

Room 4

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Room 6

Surely you know the answer to this question:Select the correct statement below as it relates to DKA.

Start your insulin drip asap, as soon as it arrives to the ED.

Priorities of resusciation in DKA: HYDRATION first, potassium replacement, and then insulin replacement.

You do not need to worry about starting a dextrose containing solution as the blood glucose levels drop, pediatric patients tolerate glucose drops much better than adults.

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Room 6

Pediatric patients with DKA are not at risk for developing cerebral edema during resusciation with IV fluids.

True

False

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Room 6

You're almost there! Select the correct photo below as it relates to resolution of DKA.

Completed

Congratulations, you have successfully completed the escape room!

Start over?

Oh oh!

That answer is not correct...

But don't lose your balance, continue on your way and try again!

back

Upon examination in the ED, Peter's vitals are: HR 145, RR 32, BP 91/60, temp. 38.5, SpO2 95% on RA.

genial.ly

Current Vitals

HR - 145 BP 90/62 RR - 35 SPO2 - 96% - RA Temp. 37.4C

• GCS 14, disoriented x1
• vomiting in triage chair
• mother in triage

1- D

2- B

3 - E

4 - A

5 - C