She reports polyuria, polydipsia today and has developed vomiting and abdominal pain.
Her blood sugar reads high, ketones are 6.
MAJOR LEARNING THEME IDENTIFIED: MAKE THE EXPERIENCE AS PLEASANT AS POSSIBLE
There is always a child who screams on a commercial flight. The combination of being sleep deprived in a new environment which is crowded, noisy and pressurised understandably upsets even the most resilient of children. Being a patient in the emergency department can be a lot like this.
In this scenario, I played the role of the 15 year old Justin Bieber fan presenting in DKA with new onset Type 1 diabetes. The nursing staff showed a calm and caring approach whilst also recognising that they were dealing with a sick patient, calling early for medical help. The nursing team also showed ‘behaviour management’ of a difficult parent who was notably distressed by the situation.
During the debrief, we discussed how overwhelming it can be to be a patient especially when lots of events are occurring simultaneously, for example during this scenario at one stage the patient was lying down with one person auscultating the chest, another establishing IV access and the third taking a blood sugar sample.
We discussed how we can minimise this by performing one task at a time and maintaining clear communication with patient and parent.
This is particularly crucial for first presentations of diabetes because these children will need repeated bloods as an inpatient, followed by a lifetime of blood sugar testing, insulin injections and outpatient clinics.
Getting it ‘wrong’ the first time can have a devastating effect on this trust relationship and so making the experience as pleasant as possible from the offset is vital.