endobj A fixed-rate intravenous insulin infusion should be commenced initially to suppress ketogenesis, reduce blood glucose levels and address electrolyte disturbances. The use of case-based simulation, although more complicated and time consuming for the instructor, immerses the students in the subject matter. Simulation Scenario for Anesthesia Providers Clark Obr, MD*, Anthony Mueller, MD . Some error has occurred while processing your request. The consequences (low blood pressure, high heart rate, central nervous system status, etc.) The debriefing environment should be removed from the location where the simulation took place. Diabetic ketoacidosis; Simulation training; Medical students. Rosens Emergency Medicine: Concepts and Clinical Practice. It was They have had no clinical exposure or any clinical experience. to below 12 mmol/L) an infusion containing normal saline and 5% dextrose is typically commenced to prevent the development of hypoglycaemia, whilst allowing insulin therapy to continue to suppress ketogenesis and reduce serum electrolyte concentrations. Search for Similar Articles See ourintravenous cannulation guidefor more details. 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. Discuss the patients current clinical condition with aseniorclinicianusing anSBARR style handover. Terms of Use. A traditional classroom lecture format allows for student participation but limits the instructors ability to create realistic situations. Trainee will get to know how professionals behave during management of a critically ill patient. If fever is present, make sure to consider co-existing infection. TheABCDEapproach can be used to perform a systematic assessment of a critically unwell patient. 3. Review the patientscurrent medicationsand check any regular medications areprescribed appropriately. 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. Heart: S1 and S2 within normal limits; no S3/S4 or murmurs, normal rate and rhythm. Diabetic Ketoacidosis in the Obstetric Population: A Simulation Instructors should write a case study for the simulation before the session. type 1 diabetes), Complete insulin insensitivity (e.g. - Radiation 02:45 angioedema, rash) commence appropriate treatment as discussed in ouranaphylaxis guide. There are several causes of DKA, which we remember by the "five I's". Using your thumbs, slightly open the mouth by downward displacement of the chin. <>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI] >>/MediaBox[ 0 0 595.32 841.92] /Contents 4 0 R/Group<>/Tabs/S/StructParents 0>> If the patient is conscious, sit themuprightas this can also help with oxygenation. Her medical, social, and family histories are not clear at the time of admission to the emergency department. NPAs are typically better tolerated in patients who are partly or fully conscious compared to oropharyngeal airways. We do not use passive visualizing materials such as videotapes or DVD other than vital signs shown on the monitors. If the patientloses consciousnessand there areno signs of lifeon assessment, put out acrash callandcommence CPR. 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. Evenly balancing performance measures will ensure the student has the opportunity to critically think through patient treatment and to practice new or support previously learned behaviors and technical skills. Emergency medical services workLife characteristics contribute to clinically significant excessive daytime sleepiness. Its absolutely necessary to follow all immersive simulations with a positive, emotionally safe and nonjudgmental debriefing environment. confusion, coma), All critically unwell patients should have. An animated lecture may be described as a pseudo-simulation environment. As this is an interactive discussion session, any needed debriefing and/or explanation is given during the sessions. Subscribe to our newsletter to be the first to know about our latest content: https://geekymedics.com/newsletter/ If the patient isunconsciousorunresponsive, start thebasic life support(BLS)algorithmas per resuscitation guidelines. Intubation lubricants can mimic drooling. 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. Over the years, some groups happened to have the simulation session before the completion of the theoretical PBL session. 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. Healthcare Students' Psychological Well-Being in a Diabetic Ketoacidosis Simulation. We have spent many hours debating whether the small group format was a waste of time. The learning objectives follow the American College of Graduate Medical Education (ACGME) Core Compentencies. Make sure to re-assess the patient after any intervention. Medical Simulation Scenarios are text documents outlining the various details of a simulation - everything from patient simulator settings to debriefing notes. Geeky Medics accepts no liability for loss of any kind incurred as a result of reliance upon the information provided in this video. The scenario would include an if-then algorithm. Inspect theairwayfor obviousobstruction. Calculate the patients current fluid balance using their fluid balance chart (e.g. Section snippets . DO NOT perform any examination or procedure on patients based purely on the content of these videos. Lets discuss your options. PDF Diabetic Ketoacidosis in the Obstetric Population: A Simulation Given 6 to 8 back-to-back sessions, it is critical that every session starts and ends on time! Research Watch Box:Sleep, Fatigue & SafetyBy David Page, MS, NREMT-P The authors of the second study reported that poor sleep quality (60% of respondents) and extreme fatigue (55% of respondents) are independently associated with safety risks on the job. Many of the preclinical students have never seen a real life clinical monitor or even an intravenous (IV) setup. Simulation student Scenario- DKA-Peds.docx - DIABETIC Available if the trainee asks: arterial blood gas, glucose, electrolytes, BUN and plasma osmolality (please see last section of Appendix B, Supplemental Digital Content 2, https://links.lww.com/SIH/A2, for values). Please try again soon. 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. 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. 2. 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. Always adhere to medical school/local hospital guidelines when performing examinations or clinical procedures. The file explaining the session is sent to instructors 1 week before the sessions. Simulation Training Ideal for Diabetic Patients - JEMS Problems are addressed as they are identified and the patient is re-assessed regularly to monitor their response to treatment. 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). 3. 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. 3. This field is for validation purposes and should be left unchanged. We believe it is important to have active, participatory learning by having conversations with the trainees in the form of questions and answers. Airway adjuncts are often helpful and in some cases essential to maintain a patients airway. Make sure thepatientsnotes,observationchartandprescriptionchartare easily accessible. 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 . - Examples 05:45 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. Performing an ECG should not delay the emergency management of DKA. Inspect for evidence of self-injection sites (e.g. The students are in their basic science course. Int J Evid Based Healthc. 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. This is particularly important for core cases and low-frequency, high-stakes procedures and encounters. Forty percent of respondents reported excessive daytime sleepiness. In this manner, the students have to apply their knowledge at the appropriate points during the progression of the scenario. J Nurs Educ. The files are given in full in the web supplement (Appendix B, Supplemental Digital Content 2, https://links.lww.com/SIH/A2). Geeky Medics accepts no liability for loss of any kind incurred as a result of reliance upon the information provided in this video. Highlight selected keywords in the article text. Simulation provides a safe environment where learning is enhanced through the deliberate practice of skills and controlled management of a variety of clinical encounters. A collection of surgery revision notes covering key surgical topics. 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. Blood sugar issues in the Type II diabetic will have a gradual onset, with diagnosis generally resulting from routine laboratory exams.(1). Inspect the urine currently in the catheter bag and note its appearance (e.g. Its best, however, to allow the student group to continue so theyre able to evaluate their decision-making processes during debriefing. Scenarios thesimtech <> Trainee will improve their understanding of clinical practice through reflective assessment of actual cases during the prior PBL sessions. diagnosis of DKA Trigger 3, ABG show acidosis and high BM and normal potassium. Development of simulation scenarios for an adolescent patient with diabetic ketoacidosis. You may be asked to review a patient with DKA due to confusion, reduced level of consciousness, tachycardia, hypotension and/or vomiting. Makeup may be used to depict gender, hollow eyes and cheeks, produce pallor or display bruises and scars. >> Fernandez AR, Mac Crawford J, Pennell ML, et al. Consider any precipitating factors for the development of DKA and involve the diabetes team in the patients care. (1) The assessment of a diabetic patient is best taught as a. An hour was . Observe and discuss the effects of therapy in a mathematically modeled physiological simulator. Simulation of Diabetic Ketoacidosis for Cellular and Molecul type 1 diabetes) Complete insulin insensitivity (e.g. A collection of free medical student quizzes to put your medical and surgical knowledge to the test! After initial insulin therapy has reduced plasma blood glucose levels (e.g. It may be necessary toexposethe patient during your assessment: remember to prioritise patient dignity and conservation of body heat. Recognize the signs and symptoms of a patient presenting with diabetic ketoacidosis. 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. to maintaining your privacy and will not share your personal information without Trainee will describe the changes in vital signs, the major metabolic, fluid, and electrolyte. - Site 01:12 This simulation session therefore aims to make the case come alive, and show this known case in a clinical context. You can check out our guide to using SOCRATES here: https://geekymedics.com/the-socrates-acronym-in-history-taking/ endobj Should any changes be made to the current management of their underlying condition(s)? 4 0 obj Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario Measure the patients capillary blood glucose and ketone levels to confirm the diagnosis and guide the management of DKA. The relationship between sleep, fatigue and patient and provider safety. Pediatric Emergency Medicine Didactics and Simulation (PEMDAS - Onset 01:48 Immersive simulations are mentally exhausting because they create an intense and stressful atmosphere requiring the learner to work outside their comfort zone. - PSA Question Pack: https://geekymedics.com/psa-question-bank/ Therefore, we should not have to take much time on this issue, but we have to focus on the relationship between the biochemistry and clinical signs and symptoms by asking why the patient is dehydrated, why acidosis develops, why respiration is rapid and deep (Kussmaul) respirations, and what the rationale for inpatient treatment is. The students have acquired all the applicable theoretical knowledge of the case during the previous multiday PBL sessions. Open the patients airwayusing ahead-tiltchin-lift manoeuvre: 1. DY{Qb"(EgN$QI*%XN1F""0a5 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. By joining Cureus, you agree to our 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. Several environments may be suitable for your classroom. This is a 25-year-old woman with a medical history of diabetes medicated with 40 units insulin per day. Diabetic Ketoacidosis in the Obstetric Population: A Simulation If an obstruction is visible within the airway, use afingersweeporsuctionto remove it. 2009;13:505511. We combined both to indicate the continuity of the curriculum, and the building on prior knowledge. It involves a facilitating instructor, a small learner group and conceptual aspects of environmental and manikin staging to provide sensory cues. VbQuX#R M21 When erroneous treatment is delivered, the instructor can end the simulation. Centers for Disease Control and Prevention. Note that if-thens must also include negative patient outcomes for when the provider doesnt take appropriate action. Invasive monitors, including a left radial intraarterial and a right subclavian IV catheter, were placed. The diabetes with DKA clinical pathway is a detailed plan of the course of care for pediatric patients seen in the emergency department with diabetic ketoacidosis. Trainee will appropriately request assistance and use available resources. 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. The teaching of diabetic assessment and management, like many other medical emergencies, lends itself well to case-based simulation. Data is temporarily unavailable. A number of key modifiers are described that allow for the adjustment of case . Diabetic Ketoacidosis: An Emergency Medicine Simulation Scenario If you have any scenarios you would be willing to share with the simulation community, please forward them . and cloudy urine may indicate urinary tract infection). This guide provides an overview of the recognition and immediate management of diabetic ketoacidosis (DKA)using an ABCDE approach. 4. However, this leads to confusion. The reason for inserting the airway upside down initially is to reduce the risk of pushing the tongue backwards and worsening airway obstruction. 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). Paediatric DKA | Simulation Education }HyEf,#$/JSRU9+CF6k\'/z+i`[ 5JudK*Zly^g%[jCK)H[)Y=Qp0/r9o9HW_zF}pTzI~'|q.~:=Y T 9w! 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). Schneider Sarver PA, Senczakowicz EA, Slovensky BM. Clearly communicate how often would you like the patients observations relayed to you by other staff members. Use blankets to re-warm patients who are mild to moderately hypothermic. Privacy Policy We ask the trainee why the blood pressure is so low or heart rate is so high, and how we should treat it. 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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