Help files (English)
Contents
1. QRS Basic rhythm Extrasyst Basic Rhythm Enter the Basic rhythm by pulling down the Basic rhythm list box and select the desired type If your selection is correct the selection will appear in the answer field above the list box Extrasystole Enter the Extrasystole by pulling down the Extrasyst list box and select the desired type If your selection is correct the selection will appear in the answer field above the list box Next By clicking this button you can see the answer and a new rhythm will be presented after a few seconds Using Next will reduce your score Hint By clicking on this button the characteristics of the running rhythm will be presented Your score will not be affected If no Basic rhythm has been correctly selected the Hint will be for the Basic rhythm If a Basic rhythm has been correctly selected the Hint will be for the Extrasystole HeartSim 4000 Ver 1 1 Help OLaerdal Medical 1998 page 33 of 39 Time Time presented in the Rhythm section is the time used to recognize the current rhythm The program presents an accumulated score Pressing the Reset key will reset the score ECG Monitor Lead Speed Normal The on screen HeartScope ECG monitor shows the Running ECG rhythm ECG Size By clicking on this button you can toggle the ECG size between 1X default and 2X Display Speed By clicking on this button you can toggle between Normal approximately2. ALS MATIN iaa 3 ABE O Pe N 3 Mann rro leiiLo E A o o Pe 8 IV NE VUE TE CIN a e A E RO aarsonnesioep oan E 12 Run PISS CCT AITO punto E tic eecitaceot E E E E 13 Makers SC CHAIN socorro cod 14 SN PP II A II Saleaucanc 17 A o e no A 21 CPR T NE E E ance ona A natoucosadeneiiaeetenesmuaste 25 AB ER PO OOO ei A 27 ASA e A T E E 27 PONTONO as sp ccs o II E N 30 PCO RoCo MIO ass meiesit noel trastes aberrantes 33 IVI CO A A A ose poses ade 36 RUT EOS SUECA 39 HeartSim 4000 Ver 1 1 Help OLaerdal Medical 1998 page 2 of 39 Heart ALS training ALS Training ECG Rhythm selection Running Rhythm The Running Rhythm field shows the ECG that is currently running on the ECG monitor the Link and the Manikin At start up the system will always display a Sinus rhythm with HR 80 BP120 80 Artifacts Muscular T 50 80 Hz Sn fe vote sf ep va The Running Rhythm can be modified directly ORS Extrasystole Pull down the Extrasyst listbox and select an Extrasystole type from the list Lal with the Remote Control when there is no Waiting rhythm selected press one of the Extrasystole keys Pressing the key again will clear the Extrasyst selection except for the Unifocal PVC key which will toggle from lt Unifocal PVC gt to lt PVCs RonT gt to lt gt Available Extrasystole types vary with Basic Rhythm Heart Rate Increase or Decrease clicking on the HR UP Down buttons E Pl win the Re
3. All other functions on this page are identical to the ALS training page Note You can edit scenarios to follow local protocols with the addition of events you enter yourself To do this first go to the ALS Training page and select Edit Menu to add in your own events Once these are entered go to Make Scenario and include the new events in your scenario Note Be aware that you can have the Make Scenario page and the Run Scenario page running at the same time This eases the making and testing of scenarios since you can edit and run a scenario simultaneously HeartSim 4000 Ver 1 1 Help Laerdal Medical 1998 page 13 of 39 Heart Make ALS scenario Make ALS Scenario This is a graphical editing tool which allows you to make and edit scenarios that can be run under the Run Scenario and Run Sequence functions a Load Scenario Allows you to load and edit an existing scenario Selecting the default newFile will present a blank scenario with a blank Frame0 On the top of the scenario page the filename of the scenario currently being edited is displayed k Save Scenario Allows you to save a scenario Scenarios used by the HeartSim 4000 are saved in and must reside in the folder Heartsim4000 scenario H Laerdal Medical EE HeartSim4000 HeartSim4000 of J audio graphics help Images E report scenarios 1 3 temp 23 template HeartSim 4000 Ver 1 1 Help OLaerdal Medical 1998 page 14
4. Pulse This 1s an information window and confirms the strength of the pulse which is linked directly to the BP EMD PEA By clicking on this box the Pulse is switched off and Blood Pressure is set to 0 0 simulating EMD PEA Lak with the Remote Control press the EMD PEA Button Press the key again to deselect Manual Extrasyst By clicking on this button an Extrasystole of the selected type is immediately generated If no extrasystoles are selected as part of the running rhythm a unifocal PVC will be seen Lal with the Remote Control Press the Manual Extrasyst key Waiting Rhythm The Waiting rhythm section allows you to select all parameters of a rhythm before it is activated and to select a new rhythm that will be activated when a defibrillation shock is given Once a Waiting rhythm is selected the Remote Control can only adjust Extrasyst HR and BP for the Waiting rhythm as it has no control functions over the running rhythm any longer Artifacts Muscular 50 60Hz Su e ORS Basic Rhythm Wasting e ET JEE PAC 35 ane Wait lt Run E 7 20 80 z Actwate To select a Waiting rhythm when there is none selected select a Basic Rhythm or a QRS type HeartSim 4000 Ver 1 1 Help OLaerdal Medical 1998 page 4 of 39 QRS type Alters the type of waveform seen allowing you to present Infarct patterns etc Select a new QRS type by pulling down the QRS list box and select the desired type Available QRS types var
5. menus p gt By selecting any one of the above you can then click on any event within the drop down menu to log it Lal with the Remote Control select the desired menu box by pressing ABC Misc or Medication The selected box will become green to indicate Remote Control Focus Then use the corresponding Up Down keys to make the desired selection within a menu press the OK key to select it The Contents of these three event log menus are user definable via the button Certain Instructor entered events also give a visual display on the manikin picture AAs i ae Ei os fo YL r I Oxygen y TV line Suction HeartSim 4000 Ver 1 1 Help Laerdal Medical 1998 page 9 of 39 Intubation View Event Log El By clicking this button the manikin picture 1s replaced with the event log showing the most recent actions By clicking on the A the manikin picture returns ESO ais 0 00 00 Pause Restart Event Log Control The event log is timed and starts as soon as the ALS Training page is opened Elapsed time from the start of the session is displayed in the time display Clicking on the Pause button will pause the event log and stop the elapsed time The button now changes to Start By clicking on Start Event logging the elapsed timer will resume Clicking on the Restart button will clear the Event Log and the timing begins afresh Restart will also remove indicated Events
6. 25mm sec depending on screen size and resolution and Fast 50mm sec ECG draw speeds Display mode N This button allows you to select between sweep or scroll mode This function will only affect the on screen monitor display not the patient monitors At start up the display mode is sweep HeartSim 4000 Ver 1 1 Help Laerdal Medical 1998 page 34 of 39 Freeze Freeze By clicking on this button you freeze the ECG display on a 0 2 sec by 0 5 mV grid In sweep mode the ECG will be rearranged so that the most recent ECG is on the right edge of the display In Freeze mode Cursor Scroll and Zoom functions will become available By clicking on the Continue button the ECG returns to real time monitoring with a dynamic display Cursors The cursors can be used for measuring distances between relevant landmarks on the ECG The time difference between the two cursors will be displayed to the Right of the screen as will the heart rate Both cursors can be dragged and dropped using the mouse place the mouse pointer anywhere on the cursor to be moved click and hold down the left mouse button to drag the cursor to its new position When the cursors are repositioned the Time and Rate are updated The Time display shows the time between the two cursors The Rate display shows the corresponding Heart rate in Beats per Minute bpm Scroll var By moving the Horizontal scroll bar the past 20 seconds of ECG can be
7. has no Waiting rhythm This function has no effect on the Scenario execution of the Defibrillation Performed Event Clear Shock Count In the Defibrillation Performed Event you can set the event to be executed when a certain number of shocks are given The number of shocks are accumulative over the whole scenario so for instance 3 Shocks means 3 shocks given from Frame O where the Scenario started or from the Frame where the shock counter was reset You can use the function Clear Shock Count to reset the shock counter to zero in any Frame Kd l Pacing Enable Ignore Pacing Enable Ignore EJ Pacing Enable OF fo i so Cancel Pacing threshald m Pacing Ignored Pacing Enable Enables Pacing capture and allows you to set a Pacing threshold Pacing Ignored Disables Pacing Capture The Pacing Capture started and the Pacing with Capture events can not occur if Pacing Ignored is set HeartSim 4000 Ver 1 1 Help OLaerdal Medical 1998 page 18 of 39 This function allows you to set sounds Only one sound can be set in each frame Be aware that Breathing is also controlled by the blood pressure Setting Breathing with a non perfusing rhythm will have no effect This function allows you to set Airway obstructions You can obstruct the left and right airway independently Be aware that Airway obstruction controls are only active if the manikin head is in the backward position or if Jaw thrust is
8. reviewed The time of the ECG in the display is shown on the bottom of the ECG display window Zoom 1X Zoom bar Using the Zoom bar the size of the ECG on the display can be adjusted between 1X and 4X HeartSim 4000 Ver 1 1 Help Laerdal Medical 1998 page 35 of 39 a AN ean V fib recognition 7717 V fib Recognition The V Fib Recognition function will present different field recorded rhythms at random Your task is to identify which should be defibrillated and which should not About 50 of the rhythms are V Fib The rest are other rhythms For the purpose of the Recognition Module V Tachs with rate above 180 bpm should be defibrillated Click on the Yes button if the rhythm should be defibrillated Click on the No button if the rhythm should not be defibrillated should this rhythm be Defibrillated PA eee eae YES E Next By clicking this button you can reveal the rhythm and a new rhythm will be presented after a few seconds Using Next will affect the score Time Time presented in the Rhythm section is the time used to recognize the current rhythm Score The program presents an accumulated score Pressing the Reset key will reset the score HeartSim 4000 Ver 1 1 Help OLaerdal Medical 1998 page 36 of 39 ECG Monitor Lead Il Speed Normal The on screen HeartScope ECG monitor shows the Running ECG rhythm ECG Size By clicking on this button you can toggle the E
9. such as Intubation and IV line from the manikin picture Lah ith the Remote Control The Start Pause key will toggle Event logging On Off Remote Control Enable Disable nl y clicking on this button the input from the Remote Control unit is ignored This function 1s useful 1f another Skillmaster ALS Interactive Training System is being used in close proximity dl clicking on the button again the Remote Control unit is re activated HeartSim 4000 Ver 1 1 Help OLaerdal Medical 1998 page 10 of 39 Access Buttons The ALS Training Page contains a number of access buttons that on activation take you to another page or function Edit menus PI By clicking on this button you will go to the edit page for the Event Log menus This page allows you to create your own drop down menus see the Help function on this page for more information ef LL Print Event Log By clicking on this button you are able to print event logs either the current one or previously saved logs After having selected the desired log to print the log will be presented as a Print Preview page Print Click on the Print button 1in the Print Preview to select printer and print the log Save Event Log By clicking on this button you are able to save the current event log You can select a file name for the log this can be your students name course date or any combination you may wish to choose Click on save to initiat
10. CG size between 1X default and 2X Display Speed By clicking on this button you can toggle between Normal approximately 25mm sec depending on screen size and resolution and Fast SOmm sec ECG draw speeds Display mode N This button allows you to select between sweep or scroll mode This function will only affect the on screen monitor display not the patient monitors At start up the display mode is sweep Freeze Freeze By clicking on this button you freeze the ECG display on a 0 2 sec by 0 5 mV grid In sweep mode the ECG will be rearranged so that the most recent ECG is on the right edge of the display In Freeze mode Cursor Scroll and Zoom functions will become available By clicking on the Continue button the ECG returns to real time monitoring with a dynamic display HeartSim 4000 Ver 1 1 Help OLaerdal Medical 1998 page 37 of 39 Cursors The cursors can be used for measuring distances between relevant landmarks on the ECG The time difference between the two cursors will be displayed to the Right of the screen as will the heart rate Both cursors can be dragged and dropped using the mouse place the mouse pointer anywhere on the cursor to be moved click and hold down the left mouse button to drag the cursor to its new position When the cursors are repositioned the Time and Rate are updated The Time display shows the time between the two cursors The Rate display shows the corresponding Heart rate i
11. Scenario you want to run and click OK The scenario page will then start executing the scenario from Frame0 The Run Scenario page is almost identical to the ALS Training page All the controls of the ALS Training page are available and can be used to override the current frame of the Scenario Be aware that if the scenario changes frame it may again override the manual selections The Run Scenario page has Scenario controls instead of the Event Log Control on the ALS Training page Frame 1 ros 145 Pause Restart Scenario Control Frame name The name of the current frame is shown at the top of the scenario control Patient time The patient time is shown to the left below the frame name This time is counting down and is updated every 2 seconds Frame time Time spent in the current frame is shown to the right below the frame name This time is counting up and is updated every 2 seconds Pause Clicking on the Pause button will pause the scenario Patient time and frame time will be frozen and the scenario will not accept inputs which are done while the scenario is paused Event logging will also pause When the Start the Pause button changes to Start button is clicked scenario execution will resume Restart Clicking on the Restart button will restart the scenario from Frame0 The Event Log and the timing begins afresh Restart will also remove indicated Events such as Intubation and IV line from the manikin picture
12. acing Threshold field shows the Remote Control focus by becoming green 00 AAA the Pacing Threshold with the corresponding Up Down keys on the Remote Control To disable enable pacing toggle the Pacing Threshold key External Pacing is indicated with a pacing symbol IF on the manikin picture regardless of whether pacing is enabled or not ECG Monitor N The on screen monitor shows the Running ECG rhythm Display mode N This button allows you to select between sweep or scroll mode This function will only affect the on screen monitor display not the patient monitors At start up the display mode is sweep HeartSim 4000 Ver 1 1 Help Laerdal Medical 1998 page 7 of 39 Manikin Functions This part of the page allows you to select and alter the manikin functions sounds M Breathing Womit MMoaning Ainvay Obstruction ABC action Miscellaneous Medication Airway Obstruction By clicking on the on screen green boxes you can enable complete airway obstruction of one or both lungs allowing simulation of events such as foreign body obstruction tension pneumothorax etc By clicking on the box again the airway obstruction is removed Airway obstruction functions whether the manikin is intubated or not including left or right Main Bronchus intubation Sounds The manikin has an in built speaker and can respond at your prompt with a variety of sounds e Breathing When this box is ticked the manikin will make
13. acts By clicking the appropriate box Muscular and Electrical artifacts can be selected Clicking on the box again deselects the artifact Lavi me Remote Control Press the Artifact Button The first press will i Muscular Ww Muscular m 50 60 Hz press deselects all 7 Muscular p 50 60 Hz the next press will select 50 60 Hz L HeartSim 4000 Ver 1 1 Help OLaerdal Medical 1998 page 27 of 39 Extrasyst Rate min This allows you to vary the frequency of Extrasystoles if selected Extrasystoles occurs randomly at approximately the rate selected Click on the UP Down buttons S vary the rate Lal with the Remote Control Press the Extrasyst Rate Button the on screen field shows the Remote Control focus by becoming green Adjust the Extrasyst Rate with the corresponding UP Down keys on the Remote Control Manual Extrasyst By clicking on this button an Extrasystole of the selected type is immediately generated If no extrasystoles are selected as part of the running rhythm a unifocal PVC will be seen lwin the Remote Control Press the Manual Extrasyst key Waiting Rhythm The Waiting rhythm section allows you to select all parameters of a rhythm before it is activated Once a Waiting rhythm is selected the Remote Control can only adjust Extrasyst and HR for the Waiting rhythm as it has no control functions over the Running rhythm any longer Artifacts Extrasys Manual Ir Muscular 50 60 Hz Extras
14. as will the heart rate Both cursors can be dragged and dropped using the mouse place the mouse pointer anywhere on the cursor to be moved click and hold down the left mouse button to drag the cursor to its new position When the cursors are repositioned the Time and Rate are updated The Time display shows the time between the two cursors The Rate display shows the corresponding Heart rate in Beats per Minute bpm Lal with the Remote Control Press the Cursor key to select a cursor The Selected cursor will become a full line instead of a dotted line Use the OK key to toggle between cursors Use the Right and Left arrow keys to move the selected cursor 4 d Seront bar MA By moving the Horizontal scroll bar the past 20 seconds of ECG can be reviewed The time of the ECG in the display is shown on the bottom of the ECG display window Miwim the Remote Control Use the gray Right and Left arrow keys to move the scroll bar If one of the cursors is selected press the Cursor key to de select cursors and select scrollbar Zoom 1X Zoom bar Using the Zoom bar the size of the ECG on the display can be adjusted between 1X and 4X Lal with the Remote Control Use the gray Up Down arrow keys to move the scroll bar HeartSim 4000 Ver 1 1 Help OLaerdal Medical 1998 page 31 of 39 Remote Control Enable Disable i clicking on this button the input from the Remote Control unit is ignored This function is useful if an
15. ated and Pacing stopped has been performed for more than a set period of time in this frame You can set this time If pacing is started and stopped several times within the same Frame the time of the pacing sequences are accumulated ano ABC action ABC action AE azio Carmel Any of the ABC actions included actions added by the Edit Menu function can be programmed as events ABC actions that are preprogrammed in the Heartsim 4000 are language independent Intubation and IV line differ from the other events in that they do not have to happen in the same frame that the event is specified The scenario will remember that Intubation and IV line has occurred and the events will be true in any frame after the occurrence HeartSim 4000 Ver 1 1 Help OLaerdal Medical 1998 page 23 of 39 Any of the Misc actions included actions added by the Edit Menu function can be programmed as events Misc actions that are preprogrammed in the Heartsim 4000 are language independent Medication edicaton M Any of the Medications included medications added by the Edit Menu function can be programmed as events Medications that are preprogrammed in the HeartSim 4000 are language independent This function allows you to set events based on Patient time or Frame time time in the current frame Patient Time The Patient time 1s equal to or less than the set number of seconds Time in this Frame The time since t
16. breathing sounds By clicking on the box you can toggle breathing On Off ine Breathing key on the Remote Control will toggle breathing On Off At start up breathing will be on Breathing is automatically turned off if the blood pressure becomes zero e Vomit When this button is clicked or the Vomit key on the Remote Control is pressed the manikin will make a vomiting sound e Moaning When this button is clicked or the Moaning key on the Remote Control is pressed the manikin will make a moaning sound Actions on the Manikin During the running of a training scenario the HeartSim will detect indicate and log a number of actions performed on the manikin The manikin has built in sensors for the following actions e Airway opened Jaw thrust and or head tilt a Indicated by changing head position on the manikin picture HeartSim 4000 Ver 1 1 Help OLaerdal Medical 1998 page 8 of 39 F 1 rr U Fa b a a s a e i e Pulse check Carotid pulse check on either side eo Ventilations a The lung volume for the individual lungs is indicated in the lung display PF E a E TA e e Precordial Thump e e Chest compressions CA gt e Defibrillation detects shock of above 5 joules e Pacing detects external pacing Manual Logging of Events In addition to the sensorized input you can log additional events via the three event log _ ABL action Miscellaneous Medication
17. e frame by clicking on the border of the frame The frame border will be highlighted Click on the Delete Item button m and the whole frame will be deleted with all its connections Connections and other frame items can be deleted in the same manner Click on the item you want to delete it will be highlighted then click on the Delete Item button Actions To add or edit actions in a frame click on the desired Action Button then click on the action field of the frame that you want to edit edit the dialog that appears and click on the OK button the programmed action will now appear in the action field of the frame Available Actions Ej ECG and Blood pressure ECG and BloodPietsure Artifacts Exim i Rate mil Musca 50460 Hz a FT EMD PEA QAS Basie Ahethm Extiasyst HA AF Allows you to set the ECG and Blood pressure together with other ECG related parameters If the Extrasyst Rate is set to blank default Extrasystole Rate will not be changed from the previous state HeartSim 4000 Ver 1 1 Help OLaerdal Medical 1998 page 17 of 39 aA Defibrillation Dehbillation Enable Ignore Apples for Waiting Rhythm onk Does not affect Scena o Shock Deehaction Dehbellstion Ignored Defibrillation Enable Ignore This has the same function as in the HeartSim 4000 ALS page in that it will prevent the system changing to the Waiting rhythm when a defibrillatory shock 1s given The Scenario
18. e the save function and return automatically to the ALS Training page Run Scenario EN By clicking on this button you can select a Scenario made by the Make Scenaro function and run it as a standard training session See the Help page on the Run Scenario page Make Scenario f By clicking on this button you can prepare save and edit your own scenarios which you can later run in the Run Scenario function See the Help page on the Make Scenario page HeartSim 4000 Ver 1 1 Help Laerdal Medical 1998 page 11 of 39 Menu Editing The Edit Menu functions let you enter new items into the ABC action Miscellaneous and Medication list boxes The new items will appear in the Eventlog when selected List items which are included in the original installation of HeartSim 4000 can not be deleted Adding an item to a Menu New herr Add Delete Type inn the new item in the corresponding entry box Then click on the corresponding Add button The new item will appear in the list above Deleting an item from a Menu Intubatior MM Line Suction Oxygen Item to Delete Add Delete Select the item you want to delete in the list Then click on the corresponding Delete button The deleted item will be removed from the list HeartSim 4000 Ver 1 1 Help OLaerdal Medical 1998 page 12 of 39 Heart AAD Run ALS scenario Run ALS Scenario Run Scenario will start with a Open Scenario dialog Select the
19. ere the events are specified Example In this example Pulse checked will bring the scenario from Frame0 to Framel The pulse has to be checked again in Frame to bring the scenario back to Frame 0 Framel has no memory of the event also happening in Frame 0 Framebl pubs checked Frame Pulse checked To add or edit events in a frame click on the desired Events Button then click on the desired event field of the frame that you want to edit edit the dialog that appears and click on the OK button Pulse checked and Precordial Thump have no dialogs the programmed event will now appear in the selected event field of the frame Available Events Pulse checked When Pulse is checked on the manikin the event has occurred This event has no dialog and will be displayed directly into the event field HeartSim 4000 Ver 1 1 Help OLaerdal Medical 1998 page 21 of 39 E CPR performed CPR Ea CPA started E CPA perfomed accumulated for po Seconds This function allows you to set one of the following CPR related events CPR started Either compressions or ventilations are started on the manikin CPR stopped There is more than 5 seconds since the last compression ventilation on the manikin CPR performed CPR time between CPR stated and stopped has been performed for more than a set period of time in this frame You can set this time If CPR is started and stopped several times within
20. he scenario entered this frame is equal to the set number of seconds HeartSim 4000 Ver 1 1 Help OLaerdal Medical 1998 page 24 of 39 CPR training CPR Training This page allows you to assess an individuals CPR performance against set performance criteria The CPR log can be saved and printed When on this page the manikin ECG is always V fib Airway obstruction valves are controlled by the Neck Jaw position Ink oe Remote Control can not be used on this page Real time CPR view 1500 queen 1000 ao o o RA Qt om Sasi A0 eE EJ g E This section 1s a 20 seconds real time image of CPR performance There are two areas to the section the upper being ventilation and the lower chest compressions Recording will automatically start when CPR activity is started and will automatically stop when no CPR activity has been registered for 5 seconds A FP bol indicates a recording break The scroll bar gives access to the last 60 seconds of graphs Setting Protocol limits ce Both the ventilation and compression graphs have red and blue lines across the body of the graph to indicate the upper and lower limits of acceptable performance These indications are user definable so that you can set the limits in accordance with your local national or international resuscitation guidelines Simply place the mouse cursor on the arrow to be moved click and drag the arrow to the new setting The new setting will re
21. lections again HeartSim 4000 Ver 1 1 Help OLaerdal Medical 1998 page 29 of 39 ECG Monitor Lead Il Speed Norma The on screen HeartScope ECG monitor shows the Running ECG rhythm Size ECG Size By clicking on this button you can toggle the ECG size between 1X default and 2X Speed Display Speed By clicking on this button you can toggle between Normal approximately 25mm sec depending on screen size and resolution and Fast SOmm sec ECG draw speeds Display mode N This button allows you to select between sweep or scroll mode This function will only affect the on screen monitor display not the patient monitors At start up the display mode is sweep Freeze Freeze By clicking on this button you freeze the ECG display on a 0 2 sec by 0 5 mV grid In sweep mode the ECG will be rearranged so that the most recent ECG is on the right edge of the display In Freeze mode Cursor Scroll and Zoom functions will become available By clicking on the Continue button the ECG returns to real time monitoring with a dynamic display Lal with the Remote Control The Start Pause button will toggle Freeze On Off HeartSim 4000 Ver 1 1 Help OLaerdal Medical 1998 page 30 of 39 Mormal Cursors The cursors can be used for measuring distances between relevant landmarks on the ECG The time difference between the two cursors will be displayed to the Right of the screen
22. main in the system as the default setting HeartSim 4000 Ver 1 1 Help OLaerdal Medical 1998 page 25 of 39 Overview of CPR gt 2 2 tomo De 50 Mi Le 0 2 minutes 6 oll 0 k This section gives a 4 minute record of CPR and defibrillation Episodes of ventilation chest compressions and defibrillation are blocked together with a numerical record of ventilations compressions and shocks given within that block Recording Control 0 00 Pause Restart A 60 minute timer runs from the beginning of the session By clicking on Pause the recording is stopped and when start is clicked the recording starts again from where it was interrupted By clicking on Restart the clock is zeroed and recording begins again from zero Previous recordings will be lost unless they are saved with the CIMA Ea Print CPR log By clicking on this button you are able to print event logs either the current one or previously saved logs The printed log will give you summary information and give you graphical representation of the last 60 seconds CPR curves and previous 10 minutes CPR and defibrillation history After having selected the desired log to print the log will be presented as a Print Preview page Print Click on the Print button 1in the Print Preview to select printer and print the log Save CPR Log By clicking on this button you are able to save the curre
23. mote Control when there is no Waiting rhythm selected Press the HR Button the on screen HR field shows the Remote Control focus by becoming green 10 E Adjust the Heart Rate with the corresponding UP Down keys on the Remote Control Blood Pressure Increase or Decrease clicking on the BP UP Down buttons E vin the Remote Control when there is no Waiting rhythm selected Press the BP Button the on screen BP field shows the Remote Control focus by becoming green Adjust the Blood Pressure with the corresponding UP Down keys on the Remote Control HeartSim 4000 Ver 1 1 Help OLaerdal Medical 1998 page 3 of 39 Artifacts By clicking the appropriate box Muscular and Electrical artifacts can be selected Clicking on the box again deselects the artifact nk with the Remote Control Press the Artifact Button The first press will select Muscular Artifacts Artifacts lv Muscular 50 60 Hz T Muscular JW 50 60 Hz J the next press will select 50 60 Hz Jand the next press deselects all Extrasyst Rate min This allows you to vary the frequency of Extrasystoles 1f selected Extrasystoles occur randomly at approximately the rate selected Click on the UP Down buttons to vary the rate vin the Remote Control Press the Extrasyst Rate Button the on screen field shows the Remote Control focus by becoming green Adjust the Extrasyst Rate with the corresponding UP Down keys on the Remote Control
24. n Beats per Minute bpm Scroll var MA By moving the Horizontal scroll bar the past 20 seconds of ECG can be reviewed The time of the ECG in the display is shown on the bottom of the ECG display window Zoom 1X Zoom bar Using the Zoom bar the size of the ECG on the display can be adjusted between 1X and 4X HeartSim 4000 Ver 1 1 Help Laerdal Medical 1998 page 38 of 39 ean Run ECG sequence Run ECG Sequence Run ECG sequence will start with a Open Scenario dialog Select the Scenario you want to run and click OK The Run ECG Sequence page will then start executing the scenario from FrameO The Run ECG Sequence is almost identical to the ECG Simulator page All the controls of the ECG Simulator page are available and can be used to override the current frame of the Scenario Be aware that if the scenario changes frame it may again override the manual selections The Run ECG Sequence page has Scenario controls in addition to the controls of the ECG Simulator page 145 18 __Restat_ Frame name The name of the current frame is shown at the top of the scenario control Scenario Control Patient time The patient time is shown to the left below the frame name This time is counting down and is updated every 2 seconds Frame time Time spent in the current frame is shown to the right below the frame name This time is counting up and is updated every 2 seconds Restart Clicking on the Restart button will re
25. nt CPR log You can select a file name for the log this can be your students name course date or any combination you may wish to choose Click on Save to initiate the save function HeartSim 4000 Ver 1 1 Help OLaerdal Medical 1998 page 26 of 39 Sr ECG simulator ECG Simulator Rhythm Selection Running Rhythm The Running Rhythm field shows the ECG that is currently running on the ECG monitor At start up the system will always display Sinus rhythm HR 80 Artifacts Extrasy sunt Muscular 50 60 Hz Rate min Extrasyst ee M Wait lt gt Run wo o o ms a QRS Basic Rhythm Waiting 1 Al E E i erie The Running Rhythm can be modified directly Extrasystole Pull down the Extrasyst list box and select an Extrasystole type from the list Lal with the Remote Control when there is no Waiting rhythm selected press one of the Extrasystole keys Pressing the key again will clear the Extrasyst selection except for the Unifocal PVC key which will toggle from lt Unifocal PVC gt to lt PVCs RonT gt to lt gt Available Extrasystole types vary with Basic Rhythm Heart Rate Pull down the HR listbox and select the desired Heart Rate from the list Pl win the Remote Control when there is no Waiting rhythm selected Press the HR Button the on screen HR field shows the Remote Control focus by becoming green 0 Fes Adjust the Heart Rate with the corresponding UP Down keys on the Remote Control Artif
26. of 39 Print Scenario Print Help To print a Scenario select Print on the Menu bar and then Print Scenario Select print mode in the Select Print Mode dialog and click OK Select Print Mode E f Reduced size 1 page C Full size 2 pages Lancel Reduced size will print the whole scenario over one A4 Letter page Full size will print the scenario over 2 A4 Letter pages Frames Framebl 4 Sinus 80 1207 80 Moan Pulse checked A Frame represents a state in the scenario The upper large field of the frame the Actions field contains the name of the frame Frame0 and the state descriptions Frame 0 is always the start frame The 3 bottom fields are Event Fields which describe 3 events that will make the scenario go to another frame The state descriptions can be set by the various actions that you can put into a frame If an action is not specified in a frame the action will remain from the previous frame i e if the ECG rhythm is not changed in Framel then the ECG from the previous frame s will still be running Frame Oo Fg Pause When running the Scenario the Frame name together with Patient time and Frame time is displayed on the Run Scenario page HeartSim 4000 Ver 1 1 Help OLaerdal Medical 1998 page 15 of 39 Creating a Frame To create a frame click on the Create Frame button then click on the place where you want to place the frame The frame will automatically
27. other Skillmaster ALS Interactive Training System is being used in close proximity dl clicking on the button again the Remote Control unit is re enabled Access Buttons The ECG Training Page contains a number of access buttons that on activation take you to another page or function Rhythm Recognition 4 The Rhythm Recognition page will present rhythms at random from the HeartSim s rhythm library which contains over 2500 different rhythm combinations You must suggest Basic Rhythm and Extrasystole type The HeartSim will keep track of your score See Help in the Rhythm Recognition page for further information V fib Recognition The V fib Recognition page will present rhythms at random from a library of field recorded rhythms of which 50 are V fib You must then determine whether it is a V fib or not The HeartSim will keep track of your score See Help in the V fib Recognition page for further information Run ECG Sequence 99 By clicking on this button you run an ECG sequence made with the Make Scenario function See the Help page on the Run ECG Sequence page HeartSim 4000 Ver 1 1 Help OLaerdal Medical 1998 page 32 of 39 ECG Recognition The ECG Recognition function will present rhythms at random from the rhythm library Your task is to identify the Basic Rhythm and any Extrasystoles When both selections are answered correctly a new rhythm will be presented after a few seconds Rhythm
28. performed or if Intubation is selected HeartSim 4000 Ver 1 1 Help OLaerdal Medical 1998 page 19 of 39 7 EA Patient time Set Patient time to ein feo Seconds C Subtract from Patient time Cancel This function allows you to set add to or subtract from the patient time The patient time is counted down in every frame of the scenario It will count down and stop at 0 You can use the value of the patient time as an event to move to another frame Frame 1 0o Fo Pause When running the Scenario the Patient time is displayed as the leftmost time information in the Frame section Example In this example the Patient time is set to 90 seconds in Frame0 If no CPR is given the patient will go from V fibr to Asystole in 90 seconds If CPR is started the patient is given 15 more seconds and for every 10 seconds of CPR given the patient is given back 15 seconds in Patient time Frame ACV Abr O00 Patient time 90 sec CPR stated PatTimecD Frames Patient time 15 sec CPRIds PatTimez0 Frarme Ac spztole 00D HeartSim 4000 Ver 1 1 Help OLaerdal Medical 1998 page 20 of 39 Events Each frame can have 3 events that will bring the scenario to an other frame Unspecified event fields will never occur even if they are connected Unconnected Event fields which are specified will connect back to the current frame With exception from Intubation and IV Line all events has to happen in the frame wh
29. receive a name which will be displayed in the actions field Note that the frame names do not indicate order of execution They are reference names for programming only Connecting Frames You can only have one connection from each Event filed You can have multiple connections to a Frame To connect frames first click on the Connect Frames button Frames can now be connected in 3 different ways 1 Connection with a line click the mouse down in the Event Field you want to connect drag the mouse to the Action Field you want to connect to and release the mouse button 2 Connecting through a node click the mouse down in the Event Field you want to connect drag the mouse outside the frame and release the mouse button select the frame you want to connect to from the connection dialog Framed ES Cancel 3 Connecting back to the current frame Frame click the mouse down in the Event Field you want to connect drag the mouse to the Action Field of the same frame and release the mouse button HeartSim 4000 Ver 1 1 Help Laerdal Medical 1998 page 16 of 39 Moving Frames To move a frame click on the Select Frame button D Click on the border of the frame you want to move drag it to where you want it to be placed and release the mouse button Deleting Frames Connections and Frame Items To delete a frame click on the Select Frame button D Select the Whol
30. st the Heart Rate with the corresponding Up Down keys on the Remote by becoming green Control Blood Pressure Pull down the BP listbox and select the desired Blood Pressure from the list vin the Remote Control Press the BP Button the on screen BP field shows the Remote Control focus by becoming green Adjust the Blood Pressure with the corresponding Up Down keys on the Remote Control HeartSim 4000 Ver 1 1 Help OLaerdal Medical 1998 page 5 of 39 Activating the Waiting Rhythm There are three ways of activating the waiting rhythm Wait gt Run Cae y clicking on the Activate button or pressing the Activate key on the Remote Control the Waiting rhythm is becomes the Running rhythm and the Waiting rhythm section is cleared Wait lt gt Run a clicking on the Paroxysmal button or pressing the Paroxysmal key on the Remote Control the Waiting rhythm is exchanged for the Running rhythm The previous Running rhythm can be re activated by clicking on the paroxysmal button again El defibrillation shock to the manikin will also activate the Waiting rhythm see below Defibrillation This function allows you to activate or disable the ignore shock function At start up defibrillation is enabled Defibrillation Enabled y Click to ignore With the defibrillation button Enabled a defibrillation shock of 5 joules or more will convert the Running rhythm to the Waiting rhythm providing a Waiting rhythm has been selec
31. start the scenario from Frame0 All other functions on this page are identical to the ECG Simulator page Note Be aware that you can have the Make Scenario page and the Run ECG Sequence page running at the same time This eases the making and testing of sequences since you can edit and run a sequence simultaneously HeartSim 4000 Ver 1 1 Help OLaerdal Medical 1998 page 39 of 39
32. ted Defibrillation Ignored amp Click to Enable By clicking on this button the Ignore shock function will become active All defibrillation shocks will be ignored and the running rhythm maintained Lal with the Remote Control Press the Ignore Shock key to toggle Defibrillation Enabled or Ignored Cardioversion will only occur when a Waiting rhythm is available To achieve cardio version it is essential that a waiting rhythm is selected this is the rhythm that will become active on cardioversion A Defibrillation shock is indicated with a defibrillation symbol ib the manikin picture regardless of whether defibrillation is enabled or not HeartSim 4000 Ver 1 1 Help OLaerdal Medical 1998 page 6 of 39 Pacing This function allows you to enable or disable the pacing function and to alter the pacing threshold At start up Pacing is enabled and the pacing threshold is set to 80 mA Pacing Pacing Threshold mA Enabled thes Click to ignore al When Pacing is Enabled the HeartSim will detect pacing pulses on the manikin If they are above the set Pacing Threshold level capture will be seen Clicking on the Pacing Threshold Up or Down buttons alters the pacing threshold for external pacing Paci a d Pacing Threshold mA Click to Enable al By selecting Ignore Pacing all external pacing stimuli will be ignored Ink with the Remote Control Press the Pacing Threshold key the on screen P
33. the same Frame the time of the CPR sequences are accumulated Sl Precordial Thump When a Precordial thump is performed on the manikin the event has occurred This event has no dialog and will be displayed directly into the event field La Defibrillation performed x Defibrillation performed ph E Shocks Delivered OK Cancel This function allows you to set the event to be executed when a certain number of shocks are given The number of shocks are accumulative over the whole scenario so for instance 3 Shocks means 3 shocks given from Frame O where the Scenario started or from the Frame where the shock counter was reset You can use the function Clear Shock Count to reset the shock counter in any Frame HeartSim 4000 Ver 1 1 Help OLaerdal Medical 1998 page 22 of 39 Kd Pacing performed Pacing Ea Pacing cated O Pacing Capture Hopped aa Pacing Capture etarted Pacing with Capture accumulated foi fo Seconds This function allows you to set one of the following Pacing related events Pacing started Pacing is performed on the manikin Capture may not necessarily occur Pacing capture started Pacing is performed on the manikin with a current level over the set threshold This event can not happen if pacing is disabled Se also the Pacing Enable Ignore action Pacing capture stopped Pacing capture has occurred and has now stopped Pacing with capture for Pacing time between Pacing Capture st
34. y with the Basic Rhythm Selecting a QRS type when there was no Waiting rhythm selected will give a new Waiting rhythm with the same Basic rhythm as the Running rhythm with default HR and BP and no Extrasystoles Lal with the Remote Control Press the QRS key repeatedly until the desired QRS type is displayed Basic Rhythm Select a new Basic rhythm by pulling down the Basic Rhythm list box and select the desired type The Waiting rhythm will appear with default HR and BP and no Extrasystoles Lal with the Remote Control Press the desired Basic Rhythm key WORE fine Fi If V Fib or Pacemaker rhythms are selected the HR Up Down keys on the Remote Control can be used to select the desired type of V Fib or Pacemaker rhythms This is indicted with the Remote Control Focus being moved to the Basic Rhythm field when the HR key is pressed on the Remote Control Extrasystole Pull down the Extrasyst listbox and select an Extrasystole type from the list LL ith the Remote Control press one of the Extrasystole keys Pressing the key again will clear the Extrasyst selection except for the Unifocal PVC key which will toggle from lt Unifocal PVC gt to lt PVCs RonT gt to lt gt Available Extrasystole types vary with Basic Rhythm Heart Rate Pull down the HR listbox and select the desired Heart Rate from the list vin the Remote Control Press the HR Button the on screen HR field shows the Remote Control focus ra Adju
35. ype from the list Lak with the Remote Control press one of the Extrasystole keys Pressing the key of the selected Extrasystole will clear the Extrasyst selection except for the Unifocal PVC key which will toggle from lt Unifocal PVC gt to lt PVCs RonT gt to lt gt Available Extrasystole types vary with the type of Basic Rhythm Heart Rate Pull down the HR listbox and select the desired Heart Rate from the list Ind ith the Remote Control Press the HR Button the on screen HR field shows the Remote Control focus by becoming green a Then adjust the Heart Rate with the corresponding Up Down keys on the Remote Control Activating the Waiting Rhythm There are two ways of activating the waiting rhythm Wait gt Run pen y clicking on the Activate button or pressing the Activate key on the Remote Control the Waiting rhythm is becomes the Running rhythm and the Waiting rhythm section is cleared Wait lt gt Run ara clicking on the Paroxysmal button or pressing the Paroxysmal key on the Remote Control the Waiting rhythm is exchanged for the Running rhythm The previous Running rhythm can be re activated by clicking on the paroxysmal button again Hide Rhythm Selections Clicking on this button will remove the rhythm selections section from the screen Rhythm selections will then have to be done from the remote control without visible feedback to the operator Clicking the Show button will display the rhythm se
36. yst i aie Wait lt gt Run Running es roa ORS Basic Rhythm Extrasyst Wait gt Run Waiting B Y fa flatt Unifocal PE BET Activate To select a Waiting rhythm when there is none selected select a Basic Rhythm or a QRS type QRS type Alters the type of waveform seen allowing you to present Infarct patterns etc Select a new QRS type by pulling down the QRS list box and select the desired type Available QRS types vary with the Basic Rhythm Selecting a QRS type when there was no Waiting rhythm selected will give a new Waiting rhythm with the same Basic rhythm as the Running rhythm with default HR and BP and no Extrasystoles Lal with the Remote Control Press the QRS key repeatedly until the desired QRS type is displayed Basic Rhythm Select a new Basic rhythm by pulling down the Basic Rhythm list box and select the desired type The Waiting rhythm will appear with default HR and BP and no Extrasystoles HeartSim 4000 Ver 1 1 Help OLaerdal Medical 1998 page 28 of 39 Lal with the Remote Control Press the desired Basic Rhythm key ME fine If V fib or Pacemaker rhythms are selected the HR Up Down keys on the Remote Control can be used to select the desired type of V fib or Pacemaker rhythms This is indicted with the Remote Control Focus being moved to the Basic Rhythm field when the HR key is pressed on the Remote Control Extrasystole Pull down the Extrasyst list box and select an Extrasystole t
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