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Handoff: Patient with DKA

Hand off a complex patient with resolving DKA to the night-team resident, ensuring they know what to watch for.

  1. 1
    Briefing
  2. 2
    Simulation
  3. 3
    Feedback

How This Works

This is an interactive phone call simulation. You'll speak with Dr. Evans in a realistic clinical communication scenario.

1. Start Call

Click "Start Call" when you're ready. Speak naturally as you would on a real call.

2. Have the Conversation

10 minutes to complete the call. The AI responds in real-time to what you say.

3. Get Feedback

End the call when finished. You'll receive AI-powered feedback on your communication.

💡 Tip: Speak clearly and at a natural pace. If you need a moment to think, it's okay to pause briefly - just as you would in a real conversation.

Briefing Details

Your Patient List for Handoff

Your Objective

You are the day-team resident finishing your shift. You need to call the on-call night resident, Dr. Evans, to hand off your sickest patient, a young woman with Diabetic Ketoacidosis (DKA). Use the I-PASS framework to guide your handoff. Your goal is to provide a clear, concise, and complete picture of the patient, including specific tasks and contingency plans for the night.

Patient: Maria Rodriguez, 24F

  • MRN: 456789
  • Room: 512
  • Code Status: Full Code
  • Allergies: NKDA
  • Problem List: Type 1 Diabetes Mellitus, Diabetic Ketoacidosis

Hospital Course & Data

History: 24F with T1DM presented to ED 12 hours ago with nausea, vomiting, and abdominal pain after missing several doses of her insulin. Found to be in DKA.

Pertinent Labs on Admission:

  • Glucose: 550 mg/dL
  • Bicarb: 8 mEq/L
  • Anion Gap: 28
  • Beta-hydroxybutyrate: 6.8 mmol/L
  • Potassium (K): 3.2 mEq/L

Current Status: She has received aggressive IV fluids and has been on an insulin drip for 10 hours. She is feeling much better. Her anion gap just closed on the last lab draw (1 hour ago).

Most Recent Labs (1 hour ago):

  • Glucose: 180 mg/dL
  • Bicarb: 20 mEq/L
  • Anion Gap: 11
  • Potassium (K): 4.1 mEq/L

Overnight Plan & Watch-Outs

The main task for tonight is to transition her from the IV insulin drip to subcutaneous (SQ) insulin and start her on a clear liquid diet.

Key Tasks for Night Team:
  1. Give first dose of long-acting SQ insulin (Lantus).
  2. CRITICAL: Continue the insulin drip for 1-2 hours *after* the SQ dose is given to prevent the anion gap from re-opening.
  3. Once drip is off, start hourly fingerstick glucose checks.
  4. Re-check basic metabolic panel (BMP) 4 hours after stopping the drip to ensure gap remains closed and K is stable.
Anticipatory Guidance: The biggest risk during this transition is hypoglycemia. Be clear about what glucose level should trigger the hypoglycemia protocol.

Learning Objectives

Optional prep details

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Optional Pre-Call Knowledge Check

Optional self-check before you start

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After completing this scenario, you will be able to:

  • Structure a verbal handoff for a medically complex patient using the I-PASS framework.
  • Synthesize patient data to provide a concise yet comprehensive summary of a patient with resolving DKA.
  • Formulate specific action items and contingency plans (anticipatory guidance) for the oncoming provider.

When managing a patient with resolving DKA, what is a critical criterion that must be met *before* stopping the insulin infusion?

While a DKA patient's anion gap is closing, which of the following is the most important 'if/then' contingency to communicate in a handoff?

Which of the following correctly lists the core components of the I-PASS handoff framework?