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noelle s554.100

1. Newborn HAL 554 555 V Noele 554 555 GaumardUI controls one simulator at a time To switch between NOELLE and Newborn first exit the GaumardUl software and reconnect the communications cable to the simulator you wish to control Each profile stores an independent library of customizable palettes scenarios and options settings Changes made to items in one profile do not affect items stored in others The Quick Start profile was created in conjunction with experienced healthcare instructors and working medical professionals The Quick Start NOELLE profile contains prebuilt labor scenarios for birth simulation and post partum complications It serves a convenient starting point and it can be customized to fit most simulation objectives e Quick Start NOELLE Contains a total of twelve labor scenarios e NOELLE Advanced Contains fourteen linear scenarios twenty two labor scenarios and one branched scenario e Quick Start Newborn contains a total of eleven scenarios Select a profile and click Load to continue For more information on the items included on the Quick Start profiles navigate to Page 116 To change profiles from inside the GaumardUI environment click Profiles from the File menu Profiles are used to organize and protect software settings As you begin to customize NOELLE it will become clear how profiles can best serve your needs For ex
2. Call for help stat page physician Wait indefinitely 168 User Guide NOELLE 554 100 Newborn Flowcharts Quick Start Newborn Alice s Baby Asphyxia Beth s Dona s Baby Cynthia s Baby Elaine s Baby Gloria s Baby Helen s Irene s Baby EA Francine s Baby NOELLE 554 100 User Guide 169 Gaumard Newborn HAL Alice s Baby Healthy baby 170 User Guide NOELLE S554 100 Apply suction and O2 Wait Indefinitely for actions Gaumard eon in Jators for Health Care Education Asphyxia SIT Baby has an asphyxia attack and the providers need to give ventilations to help bring back the vitals to a healthy state Apply suction and O2 Wait indefinitely for actions Ventilate and perform chest compressions Wait indefinitely for actions NOELLE 554 100 User Guide 171 Gaumard Newborn HAL Simulators for Health Care Education Beth s Donna s Baby Baby is born with a mild asphyxia that needs attention Once ventilations are started the baby s vitals go to a healthy state Begin PPV Wait Indefinitely for action 172 User Guide NOELLE 554 100 Gaumard Newborn HAL ee ere Cynthia s Baby Male infant with central cyanosis limp flaccid and requires i
3. Custom Numerical Parameters on Monitor s Ew Load Hematocrit Glucose mg dl update Enter the amount to be displayed in the virtual monitors and click update Remove ae Have the student or provider close one of the parameters currently displayed by the virtual monitor by clicking on the button of the value to be removed and selecting Close Now the new custom number has a display slot NOELLE 554 100 User Guide 93 Click on the button and select Other Choose the value to display AeMRaen ee i Time Glucose Do the same for as many new values as preferred for display The figure below shows three new values Glucose level hematocrit and TSH levels along the bottom of the display Delete any parameter by clicking Remove Custom Numerical Parameters on Monitor s Glucose sam annaa Hematocrit 52 ja e Tma ALL Glucose Save any list of added custom numbers by clicking on the Save button After clicking this button the Save As window is displayed fsm x lt Orr profiles Custom Numbers v 5 Search Custom Numbers p Organize v New folder J v A Favorites Name Date modified Type og Libraries A Homegroup jE Computer a Network File name Glucose Hematocrit v Save as type Custom Scalars files csc X a Hide Folders Save Canc
4. Slowly pull the birth canal insert towards you When the urine catheter tube is visible detach from the birth canal insert Finally after removing the urine catheter tube gently remove the birth Canal insert Place birth canal insert into polythene bag and ensure the bag covers the Velcro on the outer wall of the insert as shown in picture NOELLE 554 100 User Guide 193 While first inserting the plastic bag through the birth canal opening on the mannequin gently position the birth canal insert with the approximate final alignment to the opening Push the birth canal insert into position Place your hands on the lower half of the insert with your fingers holding the bag in place Steady the front of the insert with your thumbs Without removing the plastic orient the birth Canal insert so that it is properly aligned with the opening on the lower torso of the mannequin Gently begin to remove the polythene bag with one hand while holding the insert in place with the other as pictured below It is easier to start at the top then work down the sides towards the bottom Place one hand towards the bottom of the birth canal insert when pulling out the bottom portion of the polythene bag 194 User Guide NOELLE 554 100 With the birth canal insert in place pull the post partum hemorrhage tube through the hole in the bottom of the birth canal insert as shown in the picture This is to
5. 48 User Guide NOELLE S554 100 Labor The most advanced method of controlling the NOELLE birthing system is to build a Labor Scenario which is a sequence of Palette Items with delay periods corresponding to a labor curve Gaumard Time Info ma hk al ROA LOA Save Labor Labor duration 30 gt min warp Factor 1 4 approx 30 min 8 Labor Control a Dystocia Contraction Response Delivery Position C Enable Smart Labor 10 lt sec izi ON OFF C Enable Contraction Response eech Gl e aor Breech wr Loe C Descend only with contractons ration 9 E O speech speechhitais fi check ROT LOT deWery e Ka edt Pause Run Reset Alice Labor Time 00 00 00 o_o rr DESCENT 3 Ss BS Bas Ge Be Ge en es Gs Be ee Be ee ee ee lS GE G9 6 GS GE GES BS GS ass Lj tt FH Palette ttem He E BROBessstsntststtonwaus The sections that follow describe in detail the function of the various controls found in the Labor page Click on the Save Labor button to save the current configuration of the descent curve Labor Control Dystocia L_ Enable Smart Labor L0 2 sec ON _ Descend only with contractions Pause Run Station NOELLE 554 100 User Guide 49 The window shown below opens Use this window to input relevant information about the scenario for future reference You must enter the Mothers name which will become the name of the scenari
6. Providers p en E o e Emergency Reported Airway Log CPR The colored vertical bars on either side of the log text box will match the color that is coded to the chosen provider On the Log Page image above Chris is the active provider so the vertical bars are turquoise Notice that Patricia who has a green colored button is not the active provider While there is an active provider every time a Provider Action or Evaluation log entry is created it will have the name of the provider prefixed to it as follows 00 07 41 Chris Action Check for pulses radial To deactivate this feature deselect the active provider and return to general logging click the Team button and the vertical bars will return to neutral color All provider buttons can be edited or deleted by right clicking them and selecting an option from the menu that appears The session info area contains the Session Title and Facilitator fields at the top of the page At the beginning of each training session the session title and facilitator fields can be filled in and the information contained in them is stored with the text file when the log is saved or printed Session Title Simulation 101 Facilitator Randy Pausch Providers Caj m D e Emergency Reported Airway Breathing Circulation 76 User Guide NOELLE 554 100 The Evaluation panel always visible at the bottom of the GaumardUl window allows the fa
7. Adapter Wireless Network Connection Controller IP Wireless Network Connection Loopback no network Connected to The controller IP shown is the static IP address previously configured BS Noele 574 575 Virtual Monitor Setup Select the number of monitors that will be used with this manikin Also you can name each monitor with an appropiate description Adapter Wireless Network Connection vi lt refresh Controler IP 10 0 0 1 C All sensors always ON Port 8001 lt findaval Connected to Connect Click Connect and take note of the controller IP address and port number This information will be used on the following steps The status icon will read connecting until the Gaumard Monitor software is configured Activate the Gaumard Monitors software on the Virtual monitor computer 6 Click on the menu labeled V located on the upper left corner and click Monitor Selection Noelle Monitor Selection WiFi Ethernet RF Controller Check for Updates Help About Exit 7 From the Monitor Selection menu select the applicable simulator screen and click OK to save the settings Pediatric Hal 5 Year 2 Noelle Pediatric Hal 1 Year Noelle and Newborn Hal Newborn Hal Noelle and Premie Hal Monitors distribution pT Premie Hal a Return to the V menu and select Comm setup option to access the TCP Comm Setup window lf the communication
8. Add node button Quick Launch Details Palette Scenario Labor Lab Speech Log Lab Clear Load Sa ponses Go to Normal Scenario E E store NOELLE 554 100 User Guide 43 Click the node s identifier number to edit the node properties Enter a name for the node and description then click Save Node Properties Unique Identifier 1 Name start Bradycardia Description Click Add Item to add palette items or Add Scenario to add full scenarios to this node S In this example the following nodes are created 1 Start Bradycardia 2 Deteriorate 3 Interventions 4 Atropine 5 Epinephrine 6 Dopamine and 7 Pace Each node is programmed with palettes that simulate the effect described 44 User Guide NOELLE 8554 100 A path refers to the trajectory from one node to another after the last palette in a node expires Click on the Time Limit icon to modify the Go To point for the default path Path Go to point Configure the countdown timer and the go to point for the default path Click OK to save After the last palette expires the scenario will move on to the node as indicated by the arrow Set Time Limit 59 59 Max Go to Deteriorate os Node 1 is now configured to continue to Node 2 as indicated by the path s time limit hd Start Bradycardia SS gt Bradycardia 00 00 RR 10
9. Al Number of copies 1 HH Selection Curent Page E Pages 1 3 Collate ry ig l Enter either a single page number or a single 1 2 3 page range For example 5 12 80 User Guide NOELLE 554 100 Each evaluation is based on an evaluation template Facilitators can create new evaluation templates to tailor specific assessments Template design and creation is done in the evaluation form edit mode To enter the edit mode toggle the Go To button located on the top right of the evaluation form window In edit mode enter the name of the evaluation template in the Evaluation Name field Evaluation Form Load template save cear akte Evaluation Name Vacuum Delivery On Site Reviewer Evaluation Name Vacuum Delivery On Site Reviewer Category man doin dion oe Select the Question with answer region category type and enter the category information title To save the changes click OK Category Options 1 Select Category Type Question with answer region Multiple choice Yes No Multiple choice Disagree Neither Agree or Disagree Agree Multiple choice Unacceptable Poor Average Good Perfect 2 Category Information Problem Description Evaluation Name Vacuum Delivery On Site Reviewer Category 1 Problem description NOELLE 554 100 User Guide 81 Click Add to include another categor
10. Palette alice02 Details ContractionFreq 4 min ContractionDurat 40 sec Contraction Response Speech Epidural Contraction Response Speech Aahh Applied 00 00 Palette alice03 Details RR 23 OSat 97 ContractionFreq 3 min ContractionDurat 70 sec Contraction Contraction Response Speech Ouch Contraction Response Speech Epidural Applied 00 00 Palette alice04 Details HR 70 RR 19 u IKII ii gt No pain controlled patient 00 00 41 00 00 42 00 00 55 00 00 57 00 00 58 00 01 07 00 01 08 00 01 11 Contraction Response Decrease HR BP RR 9 during contraction Contraction Response Decrease HR BP RR 9 during contraction Applied 00 00 Palette alice02 Details ContractionFreq 4 min ContractionDurat 40 sec Contraction Response Speech Epidural Increase HR BP RR 12 during contraction Contraction Response Decrease HR BP RR 9 during contraction Contraction Response Speech Aahh Increase HR BP RR 12 during contraction Contraction Response Decrease HR BP RR 9 during contraction Applied 00 00 Palette alice03 Details RR 23 OSat 97 ContractionFreq 3 min ContractionDurat 70 sec Contraction i i gt The descent curve represents the position of the fetal head relative to the ischial spines in centimeters from 5 cm to 10 cm station The user can manipulate this curve by clicking over a point on
11. Quick Launch Details Palette Scenario Labor Lab Speech Log Legend Gear Settings LoadPaletteItem Saveas PaletteItem o of Breathing Resp Pattern ix Respiratory Rate OSat _ breaths min change change EtCO2 mmHg Inspiratory Time change Circulation Rhythm Heart Rate Blood Pressure beats min change Systolic Diastolic mmHg change Other Temperature C Seizures Hemorrhage Uterine Pres Uterine Hemorrhage i a i Gis es es el Vital controls are divided in several categories For each vital control on the details tab there is a corresponding entry on the Status Panel displaying real time information Additional controls can be accessed by clicking on the vertical tab located on the left of the screen Controls on the details tab vary from simulator to simulator GaumardUI will automatically detect features and upgrades installed on the simulator and display the corresponding controls Set the changes on the available fields and use the Apply panel located at the bottom of the Details tab area to submit GaumardUI only sends updated vital information to the simulator settings not specified will remain unchanged Outlined below are common control behaviors NOELLE 554 100 User Guide 21 Click or tap slider control to quickly adjust numerical values using the track pad Alternatively use the keyboard
12. READ AND UNDERSTAND THE FORE GOING AND THAT YOU AGREE TO BE BOUND BY ITS TERMS AND CONDITIONS YOU ALSO AGREE THAT THIS AGREEMENT IS THE COMPLETE AND EXCLUSIVE STATEMENT OF AGREEMENT BETWEEN THE PARTIES AND SUPERSEDES ALL PROPOSED OR PRIOR AGREEMENTS ORAL OR WRITTEN AND ANY OTHER COMMUNICATIONS BETWEEN THE PARTIES RELATING TO THE LICENSE DESCRIBED HEREIN 6 User Guide NOELLE 554 100 Care and Cautions NOELLE 554 100 User Guide 7 Overall Warnings Remember that damage caused by misuse is not covered by your warranty It is critical to understand and comply with the following guidelines Do not attempt to intubate without lubricating the airway adjunct with silicone lubricant provided Failure to do so will make intubation very difficult and is likely to result in damage When simulating drug administration via endotracheal tube providers must use an empty syringe Passing liquids into the trachea or esophagus may cause internal damage Mouth to mouth resuscitation without a barrier device is not recommended as it will contaminate the airway Treat the simulator with the same precautions that would be used with a real patient Always keep clear of the birthing mechanism while the system is on Never operate the birthing mechanism without the tummy cover in place Only use Gaumard s provided simulated blood Any other simulated blood containing Sugar or any additive may cause blockage and or interrup
13. The wireless connection allows the GaumardUl control software to send vital signs information to the Gaumard Monitors software To verify the wireless ad hoc connection click on the wireless icon located on the task tray To troubleshoot connection issues please go to page 183 Currently connected to Unidentified network EEEE Ss IBS SESS SSS SSS SSSSLS SSSSse PSSST SSSsss fs No Internet access EEEE EEEE EEEE EEEE EEEE EEEE EEEE ii i i i 5 Wireless Network Connection 2 Sass ssanen ssaass sssass sssacssaesss ssssss gt GaumardNet Conrected i S EFM OFSE EA gaumard Other Network Open Network and Shanng Center Continue to the next section to begin working with the GaumardUI control software and the f pi s ete G a 2 54PM simulator After the wireless connection is established double click or tap the Gaumard Monitors icon on the virtual monitor s home screen NOELLE 554 100 User Guide 15 Working with GaumarduI 16 User Guide NOELLE 554 100 Initializing the simulator After reading the care and cautions information included with the system components power on control laptop computer and double click the GaumardUl icon The simulator selection menu is shown Select the simulator connected to the communication module and click start The simulator will power on in approximately 30 seconds GaumardUI Version 1 29 13 0 F ih m 3 z Gavi Lare Ci
14. Wait Indefinitely for action Administer Epinephrine Wait Indefinitely for action 176 User Guide NOELLE 554 100 a Newborn HAL fiando Sor Heath Cave Eckocation Helen s Irene s Baby This baby is born with a severe asphyxia that has to be treated immediately After ventilations and EPI have been given the baby s vitals go towards a good outcome Begin PPV Compressions and Epinephrine Wait Indefinitely for actions NOELLE 554 100 User Guide 177 i Newborn HAL Gaumard Simulators for Health Care Education MAS Meconium Aspiration Syndrome Apply suction intubate and supply 100 O2 Wait Indefinitely for actions 178 User Guide NOELLE S554 100 4 i Newborn HAL Gaumard E20 Simulators for Health Care Education RDS E Newborn with mild Respiratory Distress Syndrome gets a pneumothorax after oxygen is given Administer Oxygen Wait indefinitely for action Apply needle aspiration Wait Indefinitely for action NOELLE 554 100 User Guide 179 A Caunmard Newborn HAL Simulators for Health Care Educatior TIN i Transient Tachypnea of the Newborn Apply suction and deliver O2 Wait Indefinitely for action 180 User Guide NOELLE 8554 100 Tips on Creat
15. a a z He i return all stations and arcs to factory defaults Make sure the labor curve covers all the points from 5 to 5 if both rotations are desired Also notice that the rotations are somewhat exaggerated this is done because the head swivels a couple of degrees separately from the alignment of the torso The torso is the portion of the baby that s being rotated by the motor so the head lags behind by a small amount Both of these arrows allow the instructor to rotate the baby to any desired position while the delivery is in progress NOELLE 554 100 User Guide 53 Delivery Position Rotate baby Q ao _ Breech C Check ROT LOT delivery 2 Breech Use this control when planning a breech delivery When selected it disables the motor rotation Check ROT LOT delivery this control limits the release mechanism to trigger only when the neonate s shoulders are positioned vertically If the shoulders are not aligned vertically the mechanism will not release The only way to detach the baby then is by manually clicking on the Release Baby button Enable Smart Labor this option allows you to run all non speech palettes in real time You can specify for how long the palettes will run in real time The software defaults to ten seconds Labor Control Enable Smart Labor dio sec z C Descend only with contractions Pause Run Reset When the Smart
16. such as NIBP and Thermometer are equipped with a STAT control that will allow the facilitator to activate readings on the virtual monitors from the controller software 92 User Guide NOELLE 554 100 Another way to control the sensors is to go to Monitors Sensors This option brings up a floating window that can be viewed from any of the tabs in GUI It can also remain opened as the users work in different scenarios The sensors dialog box will look like the example below Sensors Light blue buttons indicate that a particular sensor is turned on and dark blue buttons indicate that a sensor is turned off In the example above all the sensors are turned on except the thermometer and the ABP cannula File sharing is only available when using the Gaumard vital signs monitor To use this tool you must first locate the GaumardUI folder on the desktop of the tablet Make sure you enable it for file sharing This can be done by doing a right click over the folder selecting Properties and then enable sharing Add to this folder any kind of files that you wish to share with your students or providers The File Sharing Setup menu is used to manage shared files Custom numbers Configuration Files in the Gaumard_UI folder will be listed on the Available Files panel located on the left To share a file click on the Add button in the middle of the screen Enter a context n
17. 0 and that she is EE z F currently 39 weeks pregnant she has had 0 spontaneous Organize Tamm tenio E G abortions 0 elective abortions and 1 living children O00 gt Wir Favorites Name Type She has been currently using no medications of any L Chris scz SCZ File gt J Libraries gt e amp Homegroup gt i Computer c6 l Make a selection and click Export The oa Save As window is then displayed iH E Save As i gO 3 gt Libraries Documents gt OO awe Filename Alicia m File name y Scenario Files scz X Browse to the location where the palette scenario or patient files have been saved and open it They are automatically brought into the GaumardUl Make sure that you have the correct file type selected File name Scenario Files scz Branched Scenarios bsz Labor Scenarios Isz Palette Items plt Profiles pfz You can export palettes scenarios branched or linear and model patients After selecting the kind of file to be exported the following dialog box is displayed Once the files are saved on to the flash drive plug the drive to the computer where the files will be imported From the Gaumardul select import from the file menu Navigate to the location where the file was saved on the flash drive and click open GaumardUI will copy the scenario to the computer during the import process You can exit t
18. 1 On Network and Sharing Center and select Set up a new connection or network Change adapter settings ENG2 PC Internet Change advanced sharing This computer settings View your active networks You are currently not connected to any networks Change your networking settings i Set up a new connection or network Set up a wireless broadband dial up ad hoc or VPN connection or set up w Connect to a network 2 Select Set up a wireless ad hoc computer to computer network and click Next to continue ae k Y Set Up a Connection or Network a i Choose a connection option ES Set up a new network Configure a new router or access point D er connect to a wireless network to a hidden network or create a new wireless profile a toa ee eis Set up ad VPN c Jey Setup a dial up connection lt 4 onnect to the Intern sing 3 3 The next screen provides some information about the ad hoc connection click Next r G oy Set Up an Ad Hoc Set up a wireless ad hoc network An ad hoc network sometimes called a computer to computer network is a temporary network used for sharing files presentations or an Internet connection among multiple computers and devices Computers and devices in ad hoc networks must be within 30 feet of each other If you re currently connected to a wireless network you might be disconnected when you set up this network mera NOELLE 554 100 User
19. Cord Prolapse helps her into a wheel chair and takes Faye is a 34 yr old gravida 1 25 weeks gestation She began cramping about 3 hours ago and decided to drive herself to the hospital She began leaking clear fluid on the way An admitting clerk her to L amp D Labor duration 20 minutes S amp S Prolapsed cord is protruding from the vaginal opening V E reveals double footling breech partially into vagina S i ia a amp P t Admit place bed in deep trendelenburg position cover extruded cord with warm NS gauze Culture placenta and send to lab Notify Priest for emotional care document according to facility requirements 144 User Guide NOELLE S554 100 Noelle 574 575 Labor Scenario Gaumard Frances Simulators for Health Care Education Prolapsed Cord Frances is admitted into a small town hospital due to regular contractions 4 minutes apart and bloody show She labors without problems for about 4 hours and then the fetus starts to brady down after SROM A V E reveals a prolapsed coed in the vagina Labor duration 20 minutes Scenario duration 22 27 minutes NOELLE 554 100 User Guide 145 Noelle 574 575 Labor Scenario Gaumard Frances Simulators for Health Care Education Prolapsed Cord 7m
20. Details page Change NOELLE s vital signs and symptoms instantly by clicking to select a Palette Item and clicking the NOW button Alternatively create a gradual transition in physiological state with one of the other Apply buttons Palette Items can be sorted with the View buttons found on the right side of the page Editing existing Palette Items is simply a matter of selecting the item you wish to modify and clicking the Edit button You will be automatically be taken to the Details page and the settings that comprise the selected Palette Item will be displayed Change them as desired and click the Save as Palette Item button Many of the functions related to Palette Items are also available by clicking the second mouse button usually the right button while the pointer is positioned over an Item Note that when using the tablet computer this is best done by holding the stylus button while tapping the screen For more information on customizing the Palette see the Tips on Palette Item and Scenario Creation section of the Appendix at the end of this guide NOELLE 554 100 User Guide 25 Lab Laboratory tests are helpful tools for evaluating the health of a patient To simulate this process the Lab Tab allows the facilitator to create laboratory reports to aid providers during simulation Once a laboratory test is created the facilitator can display the results on the Virtual Monitor window for the provide
21. Eclamptic Seizure lx Gear on Name Eclamptic Seizure 78 User Guide NOELLE 554 100 To save the finished evaluation as digital document select Microsoft XPS Document writer and click Print It is recommended that documents are first saved as XPS files before being printed into hard copies Select Printer Microsoft XPS Document Writer 4 F Status ead Preferences Location Comment Page Range All Selection Current Page Pages Save the file as G J Documents Evaluations v 4 Organize v New folder Evaluations Libraries Ea Documents M Music i Pictures E Videos No items match your search Ke Favorites Documents library E e Foke jE Computer a E File name Eclamptic Seizure Session 3 xps Save as type XPS Document xps z Hide Folders uru NOELLE 554 100 User Guide 79 If a print device is connected to the tablet first select and open the evaluation document saved in the previous step gt Evaluations g Organize v Open v Share with v Print E mail Burn New fold Fr Favorites Documents library Evaluations Libraries Documents z4 Eclamptic Seizure Session 3 xps Ctrl O Cirl S Print Ctrl P Properties Alt Enter Exit Alt F4 meN iptic Seizu On Site Reviewer James C Date 08 08 2011 Select the printer device from the list box and click print Select Printer F Find Printer
22. G2 35 weeks Previous U S revealed a low lying placenta and this is the 5 time in 11 weeks she been admitted for bleeding This time the bleeding is is heavier and is not resolving Her OB is on the way to the hospital bimanual palpation shows the uterus to be soft and non tender Labor duration 15 minutes Monitor FHR and Vaginal bleeding Wait time 3 min Bleeding increases and fetal trace becomes a concern Wait time 2 min Fetal strip worsens prep for c section Wait time 2 min 154 User Guide NOELLE 8554 100 Gaumard Simulators for Health Care Education Noelle S574 575 Labor Scenario Haley Peripartum Hemorrhage Previa y Move to OR to deliver baby Wait indefinitely Requires PRBCs Wait time 2 20 min NOELLE 554 100 User Guide 155 Gaumard Simulators for Health Care Education Noelle S574 575 Labor Scenario India Peripartum Hemorrhage Abruptio India is a 19 yr old gravida 2 37 weeks She arrives at hospital with her husband who says she fell down the stairs and she has been cramping and bleeding for about an hour During admitting interview husband answers all the questions and India doesn t make eye contact The nurse palpates uterus initiates fetal monitoring and starts a pad count Labor duration 25 minutes 156 Us
23. HR 45 2nd deg AVB Speech 1 00 01 complaint Feel dizzy vr Additem Add Scenario Copy Remove Add path gt NOELLE 554 100 User Guide 45 Key events allow the facilitator to select from multiple paths within a node to alter the trajectory of the scenario To add a key event to a node first click the Add path button to add an alternate path and then click the key event Edit button 2 Deteriorate encanta is 3 ooo gt 3 Edit C gt Wat 02 00 No changes are made to manikin aloa Delete Speech 1 00 01 confusion What happened cS Cardo Drop 01 00 HR 15 BP 10 OSat 5 ee pes Copy Additem Add Scenano 2 Copy Remove Add path L Use the Edit Path window to name sort and create key events First type a name for the action and then click Add Edit Path Key events Selected Rename Delete Action Linked Action Defibrillation Shock Joules Cardioversion Shock After the action is added to the Key Events list assign the node that this action will move the scenario to using the Go to menu Click OK to save changes Edit Path Key events E Selected Rename Delete Action os Linked Action Defibrillation Shock Joules Cardioversion Shock Joules Non Sync Shock Joules External Pacing 1 Start Bradycardia 2 Deteriorate Eval 3 Inter
24. Labor is activated the window circled in red below is displayed U a ina i E za m E a _ i a a ee es eee ee 10 0 12 0 14 0 16 0 18 0 20 0 220 240 2 Hide the message by clicking the Hide button or Stop that palette from running in real time otherwise the message will display for ten seconds The number in red indicates how many seconds are left before switching back to warped speed The name of the palette being applied in real time is also shown in this dialog box Descend only with contractions If checked this option configures the motor to descend ONLY when there is a contraction 54 User Guide NOELLE S554 100 Run Begins a labor and initializes the birthing mechanism The red bar on the left of the labor screen turns green when labor scenario is running Warning Do not initialize the birthing mechanism until reading Working with NOELLE and Care and Cautions sections of this guide for important information on preparing NOELLE for delivery Labor Control _ Enable Smart Labor dio s z C Descend only with contractions Pause Run Reset Pause This button pauses the labor Reset This button will reset the motor to the initial position and also reset the labor scenario to its initial conditions The reset button is enabled only when a labor is paused If a labor is running this button will be grayed out To troubleshoot the motor mechanism navi
25. Maria is a 30 yr old multip 27 weeks She has an 11 yr old and has been trying for more children She has had 2 miscarriages in the last 4 years and she lost both due to an incompetent cervix This time a McDonalds suture was placed 14 weeks Fluid Kimberly is a 27 yr old multip 42 Runs for approximately 30 minutes In this scenario patient has an AFE and resuscitation efforts are in vain Fetus is delivered via perimortem C section Runs for approximately 35 minutes Patient starts having contractions and is given SQ Terbutaline to stop contractions She begins to have unfavorable reactions to the drug and contractions break through about 30 minutes later Another dose of Terbutaline is given and her reaction is worse and contractions break through yet again Eventually she s given Procardia which resolves the contractions and does not give adverse reactions A run for approximately 15 minutes and it is a tocolysis emergency Patient has reaction to overmedication of magnesium sulfate Model Newborn The physiologic cyanosis model adjusts vital signs and skin color in response to ventilation effectiveness Set the physiological modeling state to deteriorate and monitor the provider s intervention effectiveness using the CPR monitor window The model speed can be controlled through the Model warp factor which goes from 1 to 5 1 representing real time Details Palette Lab Model Scenario Log Gauma
26. Scenario pSirbatent 1 Actve i Transitin Stage 2 stage3 Patient Information 11 05 2010 15 02 12 11 05 2010 15 02 12 11 05 2010 15 02 12 11 05 2010 15 02 12 11 05 2010 15 02 12 11 05 2010 15 02 12 11 05 2010 15 02 14 11 05 2010 15 02 14 11 05 2010 15 02 14 11 05 2010 15 02 14 Alice is a 24 year old female weighing 170 pounds W Gain NA Her significant other is Mike Her OB history shows a gravida of 2 a term of 1 a preterm of 0 and that she is currently 39 weeks pregnant she has had 0 spontaneous abortions 0 elective abortions and 1 living children She has had prenatal care She has been currently using no medications of any kind Her medical records shows she has no previous history Maternal Info Respiratory status Cardiac status Pain Bleeding Membranes Dilation Station Other 11 05 2010 15 02 14 Her treatment history includes NO Fetal Info Decreased No fetal movement Other The preset labor scenarios are only found in the Quick Start NOELLE or NOELLE Advanced profiles There are no factory preset scenarios in the Default Profile Labor duration This is the time of the delivery being simulated from stage one to stage three Warp Factor By increasing this number the labor duration will be shortened so that the labor can be simulated faster An approximation of th
27. So by starting with a complete state NOELLE s condition will always be the same when the scenario starts regardless of what he was doing previously Likewise the transition duration of the first step in the scenario should be zero indicating that changes are applied immediately There is one point that can cause confusion and warrants further explanation It is an extension of the above discussion of partial states The issue is best illustrated through the following example Suppose that you are creating a Palette Item to start your scenario In this case you have decided that the patient will be apneic The question is How should the lung sounds be set Most people s first inclination is to set the lung sounds to none This is incorrect despite apnea Obviously no lung sounds should be heard during apnea but since you have already set respiratory rate to zero none will be Sounds are synchronized to the breathing cycle What you are really setting here when you choose a lung sound is the condition of the lungs given respiratory drive That is if the patient s respiratory rate were changed from zero what sound would be heard Assuming that the lungs themselves are normal in this scenario you would choose normal for the lung sound setting Then as the scenario progresses if the patient starts breathing there will be no need to set the lung sound again It will already be set The same principle applies to the heart soun
28. Use the scenario quick launch window to start scenarios with a single click The Quick Launch window displays all the scenarios saved in the current profile Quick Launch Details Palette Scenario Labor Lab Speech Log Scenario After the scenario button is clicked GaumardUI will automatically start the scenario Becca delivered precipitously and has retained gt Becca Sedation secundes Name Transition Description 00 00 Delivery 00 40 instructor to reset birthing motor 02 00 sedate for bimanual exploration Wait Indefinitely ae remove placental fragments Becca 3 00 30 postpartum 36 User Guide NOELLE S554 100 Before starting a scenario first match the position of the birthing baby on the birthing mechanism with the software by clicking on the corresponding labor position radio button Before using the labor quick launch feature for the first time go to page 101 for important information on preparing NOELLE for delivery After the position icon matches the baby s position inside the abdomen click on the labor scenario to start Labor Scenario ROA LOA ROT LoT a LOP GaumardUl will automatically start the labor scenario and switch to the labor tab itals eeu ree 3 speech vi Check ROT LOT delivery b p cae to Alyssa Labor Time 00 01 29 rT DESCENT B 3 ALT ATT PUTT TTT SHUT EET SHTML DATA NOELLE 8554 10
29. Use this section to select specific details about the medical history of the patient e Treatment History Use this section to check off any treatment histories that apply e Labor type Other Use this field to enter specific text regarding the labor Entries may include notes such as Postpartum Hemorrhage or Preterm Labor e Stage Information this section contains a total of five tabs Each tab corresponds to a labor stage Use each tab to describe specific details about the patient during each stage of labor e Post Partum Scenario You can link a labor scenario to a postpartum scenario This allows the software to automatically start the post partum scenario upon delivery of the fetus and completion of the labor scenario To view the Stage information while a labor is in progress click on the label for the corresponding labor stage Refer to Page 116 for more information 50 User Guide NOELLE 554 100 To load a labor scenario click the Load Labor button on the Labor tab and the Load screen will open Labor Control Dystocta ON OFF Station 9g All the previously saved files will appear on the left hand side text box A single click over a name displays the patient information for that labor scenario To see the details for each stage select each tab on the right hand side individually L_ Enable Smart Labor DA sec b2 _ Descend only with contractions Pause Run RE Load Labor
30. Virtual Monitors Selected Item dt Delete 30 User Guide NOELLE 554 100 On the Gaumard Monitors window an exclamation icon notifies the provider a file is ready for access Click the NOELLE drop down menu to select the available lab report Noelle Ask for The lab report will open using the system s default application Lab 01 jal range Cholesterol LDL Cholesterol Lipid Panel Female Variable Normal Range L 35 00 85 00 3 0 00 4 40 Lipid Panel Both Variable Hormal Range Cholesterol mg dl LOL Cholesterol mg dl 0 00 129 00 Triglycerides mg dl 30 00 200 00 Once the report is sent the letter Y will be present on the Sent column Use the Stop Sharing button on the right panel to remove any items on the Gaumard Monitor file list Lab Reports n Template Description a ae Healthy 2 OB Blood test Healthy Levels View Healthy Neonate Blood test Healthy Levels Sort by Color Metabolic Panel Session 1 PEER rE 7 aay terol LDL Cholesterol Y Selected Item nel _ Above norm i ipii CBC DIFF High levels Neonate Blood test High levels CBC DIFF Simulation 1 OB Blood test Session 2 PPT Session 2 Lipid Panel Session 4 An editable copy of the lab report is also copied onto the Gaumard_UI folder on the tablet s home screen For information on how to access other files from the Gaumard Monitor screen navigate to page 92 NOELLE S554
31. access the learning resources One copy of the software may be made for backup purposes You may not network this Software or allow multiple users unless you purchased a multi user workstation license Sharing this Software with other individuals or allowing other individuals to view the contents of this Software is in violation of this license 2 Copyright The Software is owned by Gaumard and protected by United States copyright laws and international treaty provisions Therefore you must treat this Software like any other copyrighted material You may not make this Software or copies thereof available in any manner or form or use copy or transfer the Software in whole or in part except as provided herein 3 Other Restrictions You may not rent or lease this Software to any other party You may not alter merge modify adapt reverse engineer decompile or disassemble the software or disclose the contents of this Software to any other party 4 Electronic Transmission of Software If you received the Software by electronic transmission or by Internet delivery by installation of the Software you acknowledge that you have read and understand this license agreement and agree to be bound by its terms and conditions 5 Term of Agreement The term of this Agreement and the license granted to you pursuant hereto shall commence upon installation of this Software This Agreement and the license granted herein may otherwise be terminated by Gau
32. and receiving To change volume at simulator s end change the tablet s microphone gain To change volume on the tablet use the speaker volume control e See troubleshooting section in the manual for more info NOELLE 8554 100 User Guide 71 Log The Log page allows the facilitator Instructor or tablet operator to keep track of every event during a session It automatically creates an entry whenever a detected event occurs as well as every change in the condition of the patient In addition the facilitator can enter observed provider actions to the log with a simple click Details Palette Lab Scenario Labor Speech Log Gaumard Session Title Facilitator fe Providers __ i een Emergency Reported Airway Call for assistance Medication Drug Dose Units Route ex a Administer Log CPR 00 02 45 Chris Action Call for assistance 00 02 52 Chris Action Call for assistance additional staffing 00 03 12 Patricia Action Shoulder dystocia 00 03 20 Chris Action Shoulder dystocia Suprapubic pressure 00 03 30 Chris Action Shoulder dystocia McRoberts maneuver 00 03 37 Patricia Action Shoulder dystocia McRoberts maneuver 00 03 52 Patricia Evaluation Care Provided Satisfactory 00 04 02 Chris Action Manage bleeding The Log page consists of four different areas from bottom to top the text log provider action buttons
33. by the facilitator via either the Palette or Details page 4 Choose auto response settings based on the scenario content and the objectives As you ve seen auto responses can be used to free the facilitators attention They also enhance realism by presenting instant reactions to the care providers On the other hand sometimes it is not possible or desirable to determine the responses before the simulation begins Different environments and applications call for different settings Loosely structured teaching and practice is usually best done with the auto response settings in Prompt mode Responses must be triggered by a vigilant facilitator Though it is slower and requires more attention the benefit of Prompt over other modes is that the simulation can be allowed to go in any direction and it will be possible to choose the response on a case by case basis Tightly structured teaching and assessment requires a higher degree of automation For such applications most facilitators choose Auto mode for the auto response settings The key issue is standardized timing of symptom presentation A consistent repeatable simulation is essential for fair assessment of that care provider in relation to others and for the broader interpretation of results in the context of training validation studies When in doubt it is best to choose Prompt mode in which the facilitator will be given direct control of the responses as events are detected 182 Us
34. care Cynthia is a 31 year old gravida 3 1 at 41 weeks She weighs 170 lbs Donna is a 20 year old gravida 4 2 at 31 weeks She weighs 180 los She has had one elective abortion She has had prenatal care NOELLE 554 100 Runs for 30 minutes Labor progresses normally and fetal heart tones remain within normal limits The normal male infant earns good APGAR scores Runs for 20 minutes Labor progresses normally and fetal heart tones remain within normal limits The normal infant earns good APGAR scores Runs for 30 minutes Labor progresses normally and fetal heart tones remain within normal limits The baby earns good APGAR scores Runs for 20 minutes Labor progresses normally and fetal heart tones remain within normal limits The normal infant earns good APGAR scores Runs for 10 minutes Fetal descent is rapid Fetal baseline is maintained at 150 Nuchal chord is evident and moderate bleeding is noted immediately following delivery from a second degree perineal laceration The normal female infant is limp dusky and does not cry spontaneously Baby is hypothermic and tachypneic Runs for 30 minutes Labor progresses normally and fetal heart tone baseline remains within normal limits Patient is unable to fully crown Vacuum extractor is required to deliver the head Shoulder dystocia is encountered and McRobert s and suprapubic pressure maneuvers are required Male infant is centrally cyanotic limp an
35. cet IESE AEAEE Pe eas aa ease eee te eed ee he ene ee ees 26 SCENO Scat cease th cance ieee aes E a a 32 LADO gama ener Nasne tn et ne oe NE ne ee eee oan mee Ie Peeve een ne E er ee eee eve ere ere en Tene 49 Model ING WOU moisis sacra carne raacasaaclue teatateronaitageathe souedetecenias ek eheeeaneenpetsapideendaaieatee 69 Evaluation F OW caret a a aia 77 MOUS rea E E E Te NCE reno Te PIES 84 Working WiN NOELLE aint id cesta ve viccstueiacedvestacetvestaicevestaaeeasteateee 98 PM sate ate ae et let a tale Adee pete tala eee heals healer eee edduale math 99 PROG UMC ssas ea a aa E a a 99 CFG AO aa a A ats a tueammanenne Sema saesesuata terse 99 SUC TIC Sia ces araceecccaenaeceewtatcecaueuennestnsnesausaname a anaes 101 OVSEC E ua aieatant ones valdeate eamneenauau sam ae eatenathc wea SO 112 Blais GeO ERC A EEEIEE EA ESETET AEAEE er Ney eee tr nC ert werent Pree EA EE en OAIE er earn veer nee 112 WOKING Wilh NCW DORN 2 22 E 113 AIWA seca ta eal shat wm ce uit A a E A 114 Breat lasts tess cece ster a at et ela ecient cinder bala suc dale a sade tains deta ist ato sed cinta a 114 NG Gast crete tese scsi cinastase esate te aioe acti tae ania trea ranula vest cate tte set aoatea enact oataguiee aaa ite 114 Craon tase erase te aiogcnita acts ice taster tea aba esadcaie atu uaeteountea eesti oaingusee acne ea ite 114 CEPA a paced c anata os iehiete E E E a 114 SYSTEMIC ioa E S EE E 114 Eil EITE A ENIE ENA BEIN EINE A ETETE TEA ATENT AEE setae im bat
36. e Simulation transport case for electronic products e Prepare for OB emergencies evaluate and report on training and clinical outcomes e Full size NOELLE maternal and neonatal birthing simulator with eclampsia and hemorrhage capabilities e Mobility allows training to be in L D and postpartum units e Build team and technical competencies e Maternal vital signs monitor e Fetal heart tones and neonatal vital signs monitor e Set up and run OB emergency simulations for shoulder dystocia postpartum hemorrhage eclampsia umbilical cord prolapse breech vaginal delivery operative vaginal delivery neonatal resuscitation IV arms for meds fluids Intubatable airway with chest rise Removable stomach cover Chest compressions and ventilations are measured and logged Programmable eclampsia Advanced birthing mechanism Programmable postpartum hemorrhage Birthing fetus with placentas and umbilical cords e Full term intubatable newborn with cyanosis and umbilical pulse e Chest compressions and ventilations are measured and logged e Realistic heart and lung sounds e Realistic crying SIMULATED VITAL SIGNS MONITOR e Single large 23 inch touchscreen monitor with desktop controller and wireless communication to laptop e FCC IC CE Certifications e One year warranty extend to three years e Installation and training available Terminology Apply In the context of a simulation to apply settings is to send details of t
37. intravenous infusions as well as for drawing fluids Warning Do not attempt to fill IV system without the drain connector in place Always leave the drain port connected when injecting fluids into the system Use only Gaumard s provided simulated blood Any other simulated blood brand containing sugar or any additive may cause blockage and or interruption of the vasculature system Always purge the system with 70 isopropyl alcohol solution at the end of every simulation 1 First locate the fill syringe with tubing and the drain tube with pinch clamp Fill the syringe with the desired fluid water or simulated blood NOELLE 554 100 User Guide 99 2 Connect the syringe with tubing to one port and the drain tube with clamp to the other port as shown 3 Leave the drain tube clamp opened and depress the syringe until all air has been pushed from the IV system and fluid runs from the drain 4 To simulate a patient with no accessible peripheral IV sites connect only the syringe Pull the plunger to create suction which will collapse the veins Disconnect the syringe tube from the arm port while maintaining suction The port will seal and the veins will remain collapsed 100 User Guide NOELLE 554 100 2 Lubricate the head and shoulders of the fetus Obstetrics e Ball point pens ink and markers permanently stain the birth canal insert e Do not wrap this or any other Gaumard product
38. no chest rise at all while damage the baby is released If user is not pulling the baby it means breathing that Force Sensor is offset See the Calibration Wizard section inside User s Manual and reset the force sensor to its default value Reset to Default Force button NOELLE s delivery baby is Wrong force sensor reading Try manual Release from button located on the left hand site corner disengaged prematurely under Delivery tab If baby releases then calibrate Force Sensor See the Calibration Wizard section inside User s Manual and reset the force sensor to its default value Reset to Default Force button NOELLE s delivery baby _ Dystocia is ON When Dystocia On button is checked the baby is not released until does not release at delivery checking Dystocia Off end when user is pulling the baby Motor is disoriented Reset the delivery motor by going to Setup Options menu NOELLE Features tab and then click on Labor Motor under Reset tab If delivery mechanism is at the very beginning ina way that it is compressing the rubber boots the grinding noise won t go away for a minute or so Should that be the case either let it go it won t break or simply move motor forward a few turns and then reset Initial fetus position was not specified Lock the baby into the birthing mechanism and manually turn the on the software baby
39. of mind frontal headache 3 tibial edema and 4 DTRs with 2 beats clonus are noted Labor duration 40 minutes NOELLE 554 100 User Guide 125 As G d Noelle Labor Scenario alta PONE Francine Cesarean Delivery 31m Francine is a 19 year old female gravida 2 1 at 37 weeks She weighs 145 lbs She has had prenatal care She has STD Herpes Labor duration 10 minutes 126 User Guide NOELLE S554 100 Noelle Labor Scenario Gloria Cord Prolapse Gaumard simulators for Health Care Educatior Gloria is a 34 years old gravida 1 0 at 25 weeks She weighs 190 lbs She has had prenatal care Labor duration 10 minutes NOELLE 554 100 User Guide 127 Noelle Labor Scenario Helen Hemorrhage Gaumard Simulators for Health Care Education Helen is a 25 year old gravida 1 0 at 35 weeks She weighs 180 lbs She has had prenatal care Labor duration 30 minutes 128 User Guide NOELLE S554 100 As Noelle Labor Scenario Gaumard irene Simulators for Health Care Education Cesarean Delivery Irene is a 19 year old gravida 2 0 at 29 weeks She has had one spontaneous abortion Labor duration 45 minutes Admit patient Routine labs notify HCP of admission and status Set up delivery table and infant warmer co
40. option Open Volume Mixer Playback devices Recording devices Sounds Volume control options Pe ie al 1 1 4 201 3 The sound properties window and recording tab are displayed Right click the microphone option and select properties Select a recording device below to modify its settings Microphone Realtek High Definition Audio Default Device MANIN Configure Speech Recognition Disable Show Disabled Devices v Show Disconnected Devices Properties Set Default M Properties From the microphone properties sub menu select the Levels tab Use the microphone control to decrease and increase the recording volume For an additional increase in recording volume use the microphone boost control Microphone Boost Microphone boost increases volume and saturation which can decrease overall clarity For optimal clarity adjust the microphone volume to 100 and the microphone boost to 10 Click OK to save the changes to the volumes on the microphone properties menu Click OK to close the Sound properties window Select a recording device below to modify its settings Microphone Realtek High Definition Audio Default Device pp Set Default v NOELLE 554 100 User Guide 185 7 It might be necessary to re adjust the microphone settings to accommodate environment noise Connecting to the Gaumard Monitors To establish a connection between the Gaum
41. position the hemorrhage tube in the correct location The birth canal insert is now ready for normal use Warranty EXCLUSIVE ONE YEAR LIMITED WARRANTY Gaumard warrants that if the accompanying Gaumard product proves to be defective in material or workmanship within one year from the date on which the product is shipped from Gaumard to the customer Gaumard will at Gaumard s option repair or replace the Gaumard product This limited warranty covers all defects in material and workmanship in the Gaumard product except 1 Damage resulting from accident misuse abuse neglect or unintended use of the Gaumard product 2 Damage resulting from failure to properly maintain the Gaumard product in accordance with Gaumard product instructions including failure to property clean the Gaumard product and 3 Damage resulting from a repair or attempted repair of the Gaumard product by anyone other than Gaumard or a Gaumard representative This one year limited warranty is the sole and exclusive warranty provided by Gaumard for the accompanying Gaumard product and Gaumard hereby explicitly disclaims the implied warranties of merchantability satisfactory quality and fitness for a particular purpose Except for the limited obligations specifically set forth in this one year limited warranty Gaumard will not be liable for any direct indirect special incidental or consequential damages whether based on contract tort or any other legal theor
42. select Administer Immediately the heart rate of the Newborn should rise and the dose on board should start diminishing over time The dose should be enough to increase the heart rate a small percentage in order to help the oxygen delivery in the system therefore helping improve the neonate with proper ventilation Reset By selecting Reset the oxygen flow and the epinephrine dose onboard will be eliminated NOELLE 554 100 User Guide 69 NOELLE has over 90 pre recorded expressions which can be initiated with a single click on the Speech page The collection of speech and other sounds was chosen to cover a wide range of simulated emergencies petals Palette unt Scenario tabon iiaaha Lon Complaint Elephant on Co on manen E Swollen all sa ve seen a jons mutono 4 4 S ege Previous a Worst RSET peee eane Used cocaine For ease of use NOELLE s expressions are divided into categories complaints history description confusion reply location occurrence urgency effect and numbers These categories are labeled in blue on the speech page Any of the speech items listed on the Speech page can be incorporated into labor and post partum scenarios Streaming audio makes simulation even more realistic It allows the facilitator to hear everything the providers are disc
43. team logging buttons and session info This is the large panel at the bottom of the Log Page containing all of the time stamped text entries Every event that occurs in a session is recorded as an entry in the Text Log The types of entries recorded by the log are categorized as follows Actions Applied Changes Detected Events Evaluations Speech and Notes 00 02 45 Chris Action Call for assistance 00 02 52 Chris Action Call for assistance additional staffing 00 03 12 Patricia Action Shoulder dystocia 00 03 20 Chris Action Shoulder dystocia Suprapubic pressure 00 03 30 Chris Action Shoulder dystocia McRoberts maneuver 00 03 37 Patricia Action Shoulder dystocia McRoberts maneuver 00 03 52 Patricia Evaluation Care Provided Satisfactory 00 04 02 Chris Action Manage bleeding Actions The term actions refers to tasks performed by one or more of the providers on the manikin during the session The facilitator can quickly log actions from the Provider Actions section of the log page To assign the entry to a particular provider or to the team in general the instructor may utilize the Team Logging feature The following is an example of an unassigned Action entry 00 07 24 Action Assess responsiveness Applied Changes An Applied log entry occurs automatically every time a change is applied to the physiological condition of the manikin In other words each time changes are applied
44. the abdominal cover the fetus and the inflatable cushion Place the lubricated fetus onto the lubricated inflatable cushion and snap the lubricated abdominal cover into place Inflate the cushion lifting the fetus anteriorly Inflate the cushion at the base of the pelvic cavity to position fetus 108 User Guide NOELLE 554 100 Confirm the breech position and attempt to manually turn the fetus within the uterus by trans abdominal manipulation Breech Birth Breech birth occurs when either the buttocks or lower extremities of the fetus are the presenting part There are three types of breech birth frank complete and incomplete or footling e Frank breech occurs when the buttocks are the presenting part and the legs of the fetus are extended up toward the baby s head e Complete breech occurs when the buttocks are the presenting part and the baby s legs are flexed along the lower torso e Footling or incomplete breech occurs when one or both of the legs are the presenting part There are many differences in labor between the breech presentation and the vertex presentation During the descent the posterior hip encounters the pelvic floor and internal rotation takes place allowing the anterior hip to move beneath the pubic arch The anterior hip then delivers followed by the posterior hip the legs and the feet External rotation allows the shoulders to move into the maternal pelvis and internal rotation allo
45. to either ROA LOA LOP and ROP Then synchronize the baby s position in the womb with the labor position icon located on the labor tab page 101 NOELLE s delivery Select Quick Start Scenarios when starting the software mechanism doesn t come to To change profiles from within the GaumardUI Go to File Profile menu and then select Modeled Scenarios its initial position when using the Reset button under the Labor tab or it makes a grinding noise when reaching the end of the rails Pre built scenarios do Volume not set to user s criterion Every sound has a volume control Adjust the volume control located cannot be loaded on the status panel to reach the desired level A sound is absent or is not Cyanosis intensity not set to user s Set Cyanosis level to a desired level by playing with the Set Max heard at desired volume criterion cyanosis level control level 184 User Guide NOELLE 554 100 Microphone Boost Windows 7 Use the instructions below to increase the streaming audio volume The Headset must be connected to the tablet in order to adjust the microphone volume properties In addition adjust the recording control on the headset s physical control to high 1 Right click on the speaker icon located on the bottom right corner of the laptop s taskbar 6 15 AM SS 1 Pe i ll 1 4 2011 2 The speaker menu is displayed Click on the recording devices
46. to manually type a numerical value Breathing Resp Pattern Respiratory Rate 56 breaths mi change aspiratory Time ulation Rhythm eart Rate b Upper Airway Sound Resp Pattern nor none espiratory Rate stridor inspiratory breaths min stridor expiratory O change stridor biphasic Click on the feature control button to enable blue or disable black features such as hemorrhage chest rise and crying Then click Apply to submit the change For more information about the simulator s features navigate to the Working with NOELLE Newborn section of this guide After the settings are selected in the details area changes are submitted using any of the apply buttons located near the bottom of the page Please note that settings not specified will remain unchanged a ae Click the NOW button to change the simulators condition instantly Alternatively click a trending time to gradually increase or decrease to the numerical value specified e g heart rate blood pressure in the time allotted The right most button can be customized to any transition time by clicking the part of the button labeled Edit Some settings are applied immediately such as cardiac rhythm and breathing pattern while numerical settings such as heart rate and respiratory rate can trend 22 User Guide NOELLE 554 100 As transitions are applied the trend countdown is dis
47. 0 User Guide 37 A powerful way to supplement the labor feature is to load factory preset scenarios To locate and load these scenarios follow the steps below While operating under a Quick Start Profile go to the Scenario tab and Click on Load Scenario Details Palette Scenario Lab Labor Speech Log Gaumard Go to Branching A Select the desired scenario and click on Load Load Scenario Scenarios Haley Heidi postpartum Inez postpartum Jani PPH Scenario Description Kelly resuscitation June suffers PPH following svd Kimberly c_s of healthy baby boy Maria PTL After loading the desired scenario click the Play button and watch the vital signs adjust according to the specifications of each palette Details Palette Scenario Lab Labor Speech Log Gaumard June suffers PPH following svd of healthy baby boy June PPH Name Description O gt sune 3_1 early signs of hemorrhage Wait Indefinitely allow time for instructor to place PPH kit in Noelle simulator June 3_1 1 hemorrhaging increase Pit give methergine cath bimanual exploration Bimanual fundal massage Give Cytotec rectally June 3_1 2 fundus firms up June 4 recovering Properties Ma rots 38 User Guide NOELLE 8554 100 First create the palette items to be used in the scenario To do so go to the Details tab and change the controls that best des
48. 100 User Guide 31 Scenarios The most advanced method of controlling the system is to build a Scenario a sequence of Palette Items and delay periods Scenarios can be linear or branching as covered in the following section Think of a scenario as a playlist of palette items Consistent with this analogy scenario controls at the bottom of the page look and behave just like traditional and software based media players Scenarios let the facilitator automate most of the changes to the simulators s condition so their attention can remain on the providers actions The scenario system can also provide standardization of the patient s presentation of symptoms For fair assessment of providers and any research application such standardization is key For tips on planning and creating scenarios go to page 181 NOELLE linear scenarios simulate pre partum and postpartum events Scenarios that incorporate the labor mechanism are loaded using the Labor tab page 49 In the example below the simulation exercise begins during the admission process and continues onto the delivery when the scenario reaches the last item on the list Linear scenarios consist of palette items added in sequence with specific transition times as shown in the figure below Details Palette Scenario Lab Labor Speech Log Gaumard lear Save Scenario Scenario Auto Responses CL Candice is 19 yr old multip Approxi
49. 8 yr old 38 weeks ad mitted by her physician for preeclamp sia She is started on Magnesium sulfate per protocol induced with pitocin and her membranes are ruptured Light meconium staining is noted following AROM Baby is pronounced dead after 20 minutes of resuscitation Runs for approximately 60 minutes Upon induction of pitosin and rupture of membranes instructor should tell participants to switch audio output on fetal monitors to FSE tones NOELLE 554 100 User Guide 65 Patient Name Cord Prolapse Faye Faye is a 34 year old gravida 1 0 25 Runs for approximately 20 minutes Pro weeks gestation She had been lapsed cord is protruding into the vaginal involved with a married man and this opening Faye is put into deep Trendelen unexpected and unwanted pregnancy burg position There is no palpable cord caused a great deal of stress in her life pulsation and FHTs are not audible with After much emotional upheaval she Doppler Upon VE fetus presents as decided to have the baby The affair double footling breech and is already ended and she is no longer involved partially into birth canal Therefore baby with the father of the baby None of has to be delivered vaginally Fetus is non her family or friends are aware of the pregnancy She began cramping about 3 hours ago and decided to drive herself to the hospital when she began leaking clear fluid An admitting clerk helps her into a wheelchai
50. Dilation Active modules report light blue and inactive modules report black If there is a specific module that fails to respond please contact customer support ensure that the module that is unresponsive is not specific to an Add On feature that is not installed on your simulator Selected Consumables and Replacements Parts Selected Parts List Contact Gaumard Scientific for a complete list of consumables and replacement parts and their prices C Consumables R Replacements A Accessories U Upgrades M Factory Repair ONLY Item ID Name Type Description 555 100 001 R2 A C Virtual Monitor All in one computer 555 100 004L D Lower Left Arm Skin Cover Lower left arm skin cover 555 100 004L L Lower Left Arm Skin Cover Lower left arm skin cover 555 100 004L M Lower Left Arm Skin Cover M Lower left arm skin cover 555 100 004R D Lower Right Arm Skin Cover M Lower right arm skin cover 555 100 004R L Lower Right Arm Skin Cover M Lower right arm skin cover 555 100 004R M Lower Right Arm Skin Cover M Lower right arm skin cover S555 100 007 D C Section Abdominal Cover G NOELLE stomach cover for C Section Exercises dark color S555 100 007 L C Section Abdominal Cover C NOELLE stomach cover for C Section Exercises light color S555 100 007 M C Section Abdominal Cover C NOELLE stomach cover for C Section Exercises medium color 555 100 040 M Articulating baby R Articulating birthing fetus NOELLE 554 100 User Guide 191
51. E 1001 255 0 0 0 GaumardNet Tablet 2 Newborn 0 0 2 255 0 0 0 GaumardNet HAL Virtual Monitor 0 0 3 255 0 0 0 GaumardNet Computer Tou can get P pring payed sutomabcally if your network supports this capabdity r YOu ned bo ask your nehverk ackranisi ater for the appropriate F settings Obtain an IP address automatically the folowing IP address IP address Default gabermay Obie DAS gerne acres slona My Use the folowing DHS server addresses Preferred ONS server Validate settings upon ent Example of IP addresses that will NOT communicate with each other Tablet 1 1 0 10 1 VM Computer 1 0 0 3 Tablet 1 50 0 10 1 VM Computer 1 0 10 3 Tablet 1 10 10 10 1 VM Computer 10 10 10 1 7 Click once in the subnet mask field to auto populate the correct address Leave all other fields blank and click OK to save the changes and return to the Network and Sharing Center window Tou can get IP pring ayre auvtomatcally if your network supperts this capabdity Otherwise you mped to ask your network administrator for the aporocoriate F settings Obtain an P address automatically Use the folowing IP address IP address Sunet mask CONFIGURING THE WIRELESS AD HOC NETWORK After each computer is configured with a unique static IP address follow the steps below to create the ad hoc wireless network The following steps are performed identically on the GaumardUl tablet and the virtual monitor computer
52. ELLE 554 100 User Guide 13 Follow the steps below to connect the communication module to the simulator and the laptop computer GaumardUI controls only one simulator at a time To switch between NOELLE and Newborn first exit the GaumardUI software and reconnect the communications cable to the simulator you wish to control Warning Do not connect the simulator to Ethernet cards LAN networks or unauthorized diagnostic equipment Doing so may cause damage to the system 1 Connect the communication cable to the USB communication module 2 Connect the USB communication module to an available USB port and power on the laptop computer 3 Connect the communication cable to the communications port located on the simulator s right side 14 User Guide NOELLE 8554 100 Virtual Monitor The mobile virtual monitor system works with GaumardUI to display the vital signs of NOELLE birthing baby and Newborn Refer to the manufacturers documentation included with the virtual monitor system components for important safety installation and start up information before turning on the computer for the first time VIRTUAL MONITOR WIRELESS The Gaumard Monitors software is now ready to receive vital signs information CONNECTIVITY ee generated by the GaumardUI control The control laptop and the all in one virtual software monitor computer automatically establish an ad hoc wireless connection at startup
53. Guide 187 1 In the Network name SSID field type GaumardNet Network names are case sensitive and must be typed identically on all the computers that will belong to this ad hoc network Give your network a name and choose security options Network name GaumardNet Security type No authentication Open Help me choose Security key Hide characters 2 Ensure the security type is No authentication Checkmark Save this network then click Next Give your network a name and choose security options Network name GaumardNet Security type No authentication Open Help me choose Security key Hide characters 7 Save this network If the system warns of another network with the same name simply power down any other computer configured with the same network name during this step and try again 4 Windows will advise if the network is successfully completed by displaying a ready message and a summary of the network s properties Click Close and restart the computer The GaumardNet network is ready to use This network will appear in the list of wireless networks and will stay active until everyone disconnects from it Give the network name and security key if any to people you want to connect to this network Wireless network name GaumardNet Network security key unsecured 188 User Guide NOELLE 554 100 VERIFYING THE AD HOC WIRELESS CONNECTION Window 7 s
54. H Amniotic Embolism Fluid India is a 19 yr old gravida 2 37 Runs for approximately 25 minutes This weeks She arrives at hospital with her scenario is a suspected spousal abuse husband who says she fell down the case Patient has a central abruption of the stairs and she has been cramping and placenta Instructor must fill hemorrhage kit bleeding for about an hour During with fluids before running the scenario admitting interview husband answers all the questions and India doesn t make eye contact The nurse palpates uterus initiates fetal monitoring and starts a pad count Inez is a 27 yr old primip 35 weeks Runs for approximately 18 minutes This She arrives at hospital one evening scenario involves a precipitous delivery with crying and doubled over in pain She heavy bleeding due to placental abruption is admitted to a birthing room and the Abruption was brought on by use of alcohol nurse notices bright red blood on Inez s and cocaine Instructor must fill hemor panties She is having very intense rhage kit with fluids before running the and close contractions scenario Janie is a 23 yr old G 2 38 weeks Runs for approximately 25 minutes Even She has experienced several bleeding though patient suffers heavy blood loss episodes due to a low lying placenta blood products are not to be used so She has been counseled about thejalternative methods must be found potential for postpartum hemorrhage Instructor must fi
55. Item ID 555 100 048 555 100 060 555 100 062 555 100 081 555 100 087 555 100 207 555 100 310 555 100 EXW 555 100 INST 192 User Guide Name Adult IV Filling Kit Simulator Transport Case Shipping Cardboard Box Silicone Oil Wireless Streaming Audio Headset Laptop PC Wireless keypads Two Year Warranty In Service Training NOELLE 554 100 Extended Type Description A R R R R R A A Fluid dispensing syringe with filling tube Soft storage and transport case with wheels Box dimensions 60 x20 x30 for simulators with soft case S 555 100 080 Simulated Blood Concentrate C R Oil based Silicone lubricant GUI Software included Extra pack of five wireless keypads Extended warranty for years Two AND Three Day of in service training and installation Replacing Common Consumable and Replacement Parts Follow the instructions below to replace the birth canal You may also use the steps below in case the birth canal has to be removed temporarily to adapt the episiotomy kit 1 Insert your left hand at the 9 o clock position between the lower torso and the birth canal insert Slowly push inward Warning Do not pull the birth canal to remove 2 Repeat instructions in step 1 with right hand at the 3 o clock position 3 Push inward on the birth canal insert Then place your thumbs on the top of the birth canal insert and push downward
56. L amp D in active labor She had a previous elective AB as a result of incest at age 13 She now lives with her boyfriend and his mother who are both with her at the hospital Her prenatal visits have been irregular due to transportation issues She is leaking light meconium fluid and she vomits as she is undressing Labor duration 25 minutes Scenario duration 30 minutes Attach EFM Notice variables turn patient e Wait time 3 30 min tie Check resolution of variables Goto labor Bianca Wait time 1 45 min 134 User Guide NOELLE 554 100 Noelle 574 575 Labor Scenario Gaumard Bianca Simulators for Health Care Education ee Variations on Normal NOELLE 554 100 User Guide 135 Noelle S 574 575 Labor Scenario Gaumard Candice Simulators for Health Care Education 7 Shoulder Dystocia Candice is a 19 r old multip She her boyfriend and their 3 yr daughter are homeless living in a car She has not seen a doctor and believes that she is about 8 months pregnant Her water broke yesterday and she is leaking moderately thick meconium fluid An ultrasound is performed to determine position and gestational age Labor duration 15 minutes Full scenario duration 23 25 minutes S amp S Complains of tenderness in abdomen finds ctx very painful Admit to birt
57. NOELLE Maternal and Neonatal Birthing Simulator 0554 100 Gaumard Simulators for Health Care Education User Guide 12 5 1 NOELLE is an interactive educational system developed to assist Gaumard Scientific Company 2012 a certified instructor It is not a substitute for a comprehensive All Rights Reserved understanding of the subject matter and not intended for clinical decision making www Gaumard com 2 User Guide NOELLE S554 100 Contents CONIENIS aa ee ees 3 End User License Agreement ccsecceseecseeceseceneeenseonsesenesenseoneesens 5 r 1g le Ie Or 0 0 q lt n es rs ns ee ee a 7 Overal UAT a savas anaasiew ease ausiee etna ania paul aieean Nea a ase anes se eS 8 Getting Starnes E a 10 IVONI EWN aana T E T en cts tc ssenatentora yaaa ece a suk mata 11 TENNOU V oera ce acts ead Becca ten a Wer olain tPA Net han eal ated eas alata iam NonDa Rats 11 EgupmMment S6 UP nrinn 12 HE GNSS MY ca lento cee ee Detect e a E aE 13 NOELLE POWE cero U 0 amet ene eee eee el en eee eee en meee eee ere 13 Newbon POwer SUDDIY morerei e vasdoceedebracsencaduatniolesh sex intandetraneerdaieaiodss 13 COMMON COMPUTE aieia a eae ha eee enedanivsict del needa bertelnne desea tents 13 MUAMO O eea a ae acines 14 Working WHR GaumardU accra 16 mitiaizing UAC IMU AL O nnes a a a et cis 17 TTR EFA Mir eI tel Iiae aa ate ences ene S 19 Py aN eat elec ass ates gsc ens ca pees eet cee eee ene ee ees 21 E 2 ester
58. Perform c section delivery infant repair incision Wait indefinitely 146 User Guide NOELLE 554 100 a ma Gaumard Simulators for Health Care Education Noelle S574 575 Labor Scenario Gabriella Uterine Rupture 25 minutes Gabriella is a young Hispanic woman who presents at a small hospital just across the Mexican border She appears to be in late pregnancy and in active labor As the nurse helps her to bed she notices a midline abdominal scar Gabriella has had one prvious child in Mexico but shares no more information Labor duration 15 minutes Scenario duration S amp S Patient feels pain with ctx S amp S Vaginal bleeding extreme Pain pale diaphoretic Turn patient on side give O2 incresae IV rate Hit emergency button Rush patient to OR prep transfer to ER for emergency c section Wait time 3 min Notify nursery personnel NOELLE 8554 100 User Guide 147 M Gaumard Simulators for Health Care Education Noelle 574 575 Labor Scenario Gabriella Uterine Rupture 148 User Guide NOELLE 554 100 Repair anterior wall During surgery notice anterior uterine wall dehiscence Wait time 2 min dehiscence close abdomen Uterus double sutured and bleeding co
59. SE OF THE SOFTWARE OR WRITTEN MATERIALS IN TERMS OF CORRECTNESS ACCURACY RELIABILITY CURRENTNESS OR OTHERWISE AND THE ENTIRE RISK AS TO THE RESULTS AND PERFORMANCE OF THE SOFTWARE IS ASSUMED BY YOU IF THE SOFTWARE OR WRITTEN MATERIALS ARE DEFECTIVE YOU AND NOT GAUMARD OR ITS DEALERS DISTRIBUTORS AGENTS OR EMPLOYEES ASSUME THE ENTIRE COST OF ALL NECESSARY SERVICING REPAIR OR CORRECTION OTHER THAN EXPRESSLY DESCRIBED ABOVE C NEITHER GAUMARD NOR ANYONE ELSE WHO HAS BEEN INVOLVED IN THE CREATION PRODUCTION OR DELIVERY OF THIS PRODUCT SHALL BE LIABLE FOR ANY DIRECT INDIRECT CONSEQUENTIAL OR INCIDENTAL DAMAGES INCLUDING DAMAGES FOR LOSS OF BUSINESS PROFITS BUSINESS INTERRUPTION LOSS OF BUSINESS INFORMATION AND THE LIKE ARISING OUT OF THE USE OR INABILITY TO USE SUCH PRODUCT OR RELATED TO THIS AGREEMENT EVEN IF GAUMARD HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH DAMAGES GAUMARD SHALL NOT BE LIABLE TO YOU FOR ANY INDIRECT SPECIAL INCIDENTAL OR CONSEQUENTIAL DAMAGES OR LOST PROFITS ARISING OUT OF OR RELATED TO THIS AGREEMENT OR YOUR USE OF THE SOFTWARE AND OR THE RELATED DOCUMENTATION EVEN IF GAUMARD HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH DAMAGES IN NO EVENT SHALL GAUMARD S LIABILITY HERE UNDER IF ANY EXCEED THE PURCHASE PRICE PAID BY YOU FOR THE SOFTWARE ALL RIGHTS NOT EXPRESSLY GRANTED IN THIS LICENSE AGREEMENT ARE RESERVED BY GAUMARD ACKNOWLEDGMENT BY INSTALLATION OF THIS SOFTWARE YOU ACKNOWLEDGE THAT YOU HAVE
60. There will be one actuation of the locking mechanism when the articulating baby is inserted which is normal Warning Never operate the birthing mechanism without the tummy cover in place 1 Position the baby so that its face is upward anterior Connect the baby to the birthing mechanism while the manikin is ON so that the electromechanical mechanism allows the baby to be locked into place 2 Once the baby is connected and locked onto the mechanism position the baby to its initial birthing position The user has the choice of ROP LOP ROA LOA 7 Umbilical cord can be wrapped around the neck demonstrating a nuchal cord 102 User Guide NOELLE S554 100 3 On the labor tab select the fetal position that matches the birthing baby s initial position on the simulator Mute Listen Talk pace LO Be Y LOT delivery gt kop edit Lop prox 60 min B Several prebuilt labor scenarios are included in the Quick Start NOELLE Profile Click the Load Labor button to load a labor scenario Tip Navigate to File gt Profile from the menu bar to quickly change between profiles Labor Control E Enable Smart Labor 10 sec on amp Only descend during contractions ge la On the Load Labor Scenario window select the Alice labor from and click Load 11 05 2010 16 02 12 11 05 2010 16 02 12 11 05 2010 16 02 12 The labor process is started from
61. These fragments are attached to the body of the placenta with Velcro You may reverse one or both fragments causing one or both to birth with the placenta or remain affixed to the uterine wall Students must carefully inspect the birthed placenta to make sure it is complete and that no fragments remain internally If retained fragments are noted the student must retrieve them using a gloved hand under appropriate sterile conditions Postpartum Activity After delivery the uterus normally contracts reducing postpartum bleeding Under certain conditions contraction does not occur and hemorrhaging may continue Postpartum hemorrhaging can be simulated with the Noelle system via use of the 48 hour uterus Use the following steps to set the Noelle simulator for postpartum hemorrhage scenarios 1 Place the white Styrofoam block between the rails of the birth mechanism 110 User Guide NOELLE 554 100 Secure the uterus on the Styrofoam Velcro attachment to prevent it from moving or shifting Then insert the distal end of the uterus inside the cervix Warning Always ensure that the distal end of the uterus is inserted through the cervical opening of the birth canal until the cervix closes around the built in recess Failure to do so could result in liquid accumulating in the pelvic cavity and damage to the birthing mechanism Connect the center hose to the air pressure port and then the lateral hose to the uterine he
62. a brief description Also select a color that represents the palette s condition Green for healthy red for critical yellow for care required and blue for other Then click Save Save as Palette Item Palette Item Name Resting Palette Item Description H Normal Vitals Color Healthy O Critical Care Required O Other 2 After creating all your palettes go to the Scenario tab Gaumard ea 3 Click on the Add to Scenario button Select a single palette or enable Multi to select multiple palettes at the same time Specify a transition time for the palette and click Add NOELLE 554 100 User Guide 39 4 From the add menu you may also choose the Wait item which causes a delay of a specified duration or a Wait Indefinitely item which causes the scenario to pause until the facilitator manually advances to the next item Q mut min sec 59 59 Max Add Palette Item Item Description Normal Vitals 5 Repeat the previous step to add more palettes wait times speech or labs Details Palette Lab Scenario Labor Speech Log Gaumard Gear Load Scenario Save Scenario Scenario Auto Responses Cria Alice suffers from allergies before the labor Alice Allergy begins Name Transition Description O gt Start State 00 20 Asthma Sinus respiratory allergy 04 00 wheezing difficulty exhaling tongue edema Closed a
63. ained below e Off The software does not respond to the electric therapy e Prompt The software detects the electrical therapy and prompts the facilitator before applying the changes configured in the Settings section e Auto The software automatically detects the electrical therapy and compares it to a threshold selected by the provider If the threshold is met the vitals will automatically change to the parameters specified on the Settings section Each type of electrical therapy has a unique set of default parameters For example the default response to a Defibrillation Shock applies the following vital sign parameter changes NSR 75 bpm BP 120 80 Click on the palette button to program a specific palette item as the auto response Defibrillation Shock O Prompt p ae gt Setting at Joules 200 O Shocks convert to NSR 75 bpm BP 120 80 The Load Palette Item window is displayed Select the desired palette and click Load Load Palette Item Healthy Resting Q rac Item Description normal vitals The desired palette is now displayed in the Setting section Defibrillation Shock off Prompt Auto Setting The auto response is now configured to automatically apply the Healthy Resting palette if a Defibrillation shock of 200 Joules or greater is detected NOELLE 554 100 User Guide 91 Monitors T
64. ajector may bend the motor arm and cause damage to the birthing mechanism As labor progresses the manikin will detect manipulations performed on the fetus by the care providers Activity on the fetus prompts the Activity on Fetus window to appear on the tablet screen providing the instructor with feedback on pulling force uterine contractions torque on the baby twisting force and shoulder position The instructor can evaluate the providers in terms of pulling in or out of sync with uterine contractions The labor activity is a beneficial tool for the instructor as excessive forces applied to the fetus by care providers during delivery can lead to brachial plexus injuries All of these values will be given in real time and they will be recorded by the graphical interface for further analysis Peak Force measurement of how hard the provider is pulling the fetus Can be displayed in lbs or Newton Uterine Activity contractions generated by NOELLE Peak Torque measurement of the torque induced as the provider rotates the fetus negative readings represent counter clockwise rotation and positive values represent clockwise rotation Cardinal Movement the angular position of the baby is measured in degrees taking into account that O degrees corresponds to the fetus facing upwards with the shoulders horizontal Export Data to Desktop exports labor force data to an Excel file Use the data to make graphs to stud
65. ame on the pop up menu and click OK The shared file will appear on the right list box Remove individual files by using the remove button on the right File Sharing Setup The files on this list will be accessible from the patient menu on the vital sign monitor The Context Name will be the name displayed Shared Files File Context Name Quiz rtf Quiz X ay bmp X Ray Chest Hematology rtf Blood Test Remove A yellow icon will be shown on the top left of the screen once a file is shared This will inform the provider that a file is available for viewing X Ray Chest Click on the NOELLE button to bring down the selection of available files Once a file is selected it will automatically open on the Gaumard Monitor screen Use the custom numbers tool to add a new parameter such as glucose level or platelet count to NOELLE s virtual monitor CPR File Setup AN Monitors Help Sensors File sharing Custom numbers Configuration On clicking the Custom numbers option the following window is displayed Custom Numerical Parameters on Monitor s Click Add to enter a new parameter for display in the virtual monitor This dialog box is displayed Custom Numerical Parameters on Monitor s Name Units Enter the name and units of the new parameter and click OK The new parameter is displayed Several custom numbers may be entered at a time
66. ample e It may be appropriate to assign one profile to each user of your NOELLE system e Others may choose to create a profile dedicated to a specific academic course which might be taught by multiple instructors e For the most detailed exercises it is sometimes useful to devote an entire profile to one particular subject area or even one particular scenario To create a user made profile click on the New Profile button on the right panel Manage Enter a name for the new profile followed by a description NOELLE 554 100 User Guide 17 To include scenarios and palettes from other profiles click the applicable check box For security enable PIN protection which will require a user to enter a four digit key before loading the protected profile Finally click Create to save the new profile To import and export profiles navigate to Page 85 Create New Profile Profile Name Winter Session Profile Description Include contents O of Default Profile Copy current Include contents OR O ie O of Quick Start Noele 554 555 18 User Guide NOELLE S 554 100 The Environment The GaumardUI environment is used by the facilitator as the simulation command center In addition to managing the simulator s functionality and vital signs the facilitator can evaluate student performance and act as the simulator s voice This powerful combination of tools provides the facilitator w
67. and her glucose Decels now have late characteristics She tolerance test GTT is borderline Anjis given SQ Terbutaline and fetal baseline ultrasound a few days ago estimated drops to 90 She is intubated and very current fetal weight at 3800 to 4000 difficult to ventilate Patient develops VFib grams Kelly s physician feels that her and then arrests Baby is removed by cervix is favorable so he has recom emergency C Section Kelly remains on a mended an elective induction ventilator Baby is limp and unresponsive and requires resuscitation and suffers repetitive seizure activity NOELLE 554 100 User Guide 67 Preterm Labor E Preterm Labor 68 User Guide Amniotic Embolism NOELLE 554 100 weeks She began having contractions at home and now they are becoming stronger She is excited to be finally going into labor By the time the nurse completes admission Kimberly is requesting pain meds as her labor is progressing quickly Madonna is a 41 year old multip 31 weeks She has experienced difficult pregnancies in the past and has one Downs Syndrome baby so she is very apprehensive An early U S and genetic studies showed this baby to be a normal female She has had several episodes of preterm contractions that resolved with LLP bed rest and oral hydration She began contracting again 3 hours ago and again tried LLP bed rest and oral hydration but the contractions have continued amp become stronger
68. ard Virtual Monitor software and GaumardUI both computers must be connected to the same network ad hoc network The section below describes in detail how to configure the ad hoc wireless settings and establish a connection between the Gaumard computer systems Follow the guide when troubleshooting connection issues Vital sign information is sent and updated from the GaumardUI software via Wi Fi ad hoc network connection and not from the simulator or the RF communication module PROCEDURE OVERVIEW FOR EACH COMPUTER e Configuring Static IP addresses e Configuring the Network SSID name e Verifying the ad hoc connection Perform the steps below to assign a static IP addresses to the Gaumard Virtual Monitor computer and the GaumardUI tablet Please note that each computer requires a unique static IP address 1 Locate the wireless connection icon on the bottom right corner of the computer screen 8 15 AM 1 4 2011 _ _ a atl D 2 Click the wireless icon and select Open Network and Sharing Center from the options on the menu Open Network and Sharing Center 1 40 PM a a a lal atl ths 186 User Guide NOELLE 554 100 3 In the Network and Sharing Center window click Change adapter settings from the left hand panel Control Panel Home View your basic networ Manage wireless networks ke Change adapter settin nge adapter settings ENG2 PC Change advanced sharing This computer settings Vi
69. avigate to the bottom of the page to Save the new template Hel Edit Lab Results Template Name E id Panel Description Cholesterol HDL LDL Triglycerides Category Single Entry pet se Variable HDL Cholesterol mg dL 35 00 85 00 Cholesterold HDL Ratio 0 00 4 40 Lipid Panel Male Variable Normal Range HDL Cholesterol mg dL 29 00 71 00 Cholesterol HDL Ratio Ratio 0 00 4 90 Lipid Panel Both Variable Normal Range Cholesterol mg dL 0 00 199 00 LDL Cholesterol mg dL 0 00 129 00 Triglycerides mg dL 30 00 200 00 Allowed value range is displayed in Value column It won t be visible when entering data Once a new format is created it will be listed on the Lab Format section at the bottom of the Lab tab Use the buttons on the left panel to edit or delete lab formats Lab Template Template Description CBC DIFF Platelets Differential Lipid Panel Cholesterol HDL LDL Triglycerides Metabolic Panel Anion Gap Albumin Alkaline Phos Calcium Choride Neonate Blood test For newborn and premie 28 User Guide NOELLE 554 100 Details Palette Lab Scenario Labor Speech Log Lab Reports fs Template Description The Edit Lab Report window is used to prepare new lab report First select a Lab Template from the drop down menu Edit Lab Report Lab Template Lipid Panel CBC DIFF Templa
70. button on the Labor tab This action unlocks the baby allowing students to pull the baby through the birth canal Cesarean Delivery Cesarean birth is the delivery of the fetus through an abdominal and uterine incision A Cesarean delivery also called a C section may be performed as a result of breech presentation pre term or dysfunctional labor fetal distress prolapsed umbilical cord placenta previa placental abruption or a variety of other abnormalities Demonstrate a C section using NOELLE by unfastening the snaps just above the pubic bone and birthing the baby between the tummy cover and the pubic bone An optional abdominal cover is available if the Instructor wishes to demonstrate midline or bikini incisions Delivery mechanism fully retracted and inflatable cushion inserted NOELLE C section delivery using abdominal cover with bikini incision P N 8575 029 Warning Do not enable the motorized birthing mechanism while performing this exercise Prolapse of the Umbilical Cord Prolapse of the umbilical cord is a dangerous complication which involves the presence of the umbilical cord in the birth canal in front of the presenting fetal part This condition may occur as a result of breech presentation transverse lies a small fetus an overly long cord a placenta placed low in the uterus or other abnormalities If the cord is observed in the birth canal ahead of the presenting part gloved fi
71. cation indicator shows the status of the link between the computer and the simulator The indicator is clear when no attempts to communicate with the simulator are being made for example when the wired communication module is not connected to the computer or the if system is in STAND BY mode The battery status indicator updates as the backup battery in the simulator is used The exclamation mark indicator is shown when there is no communication with the simulator and the program cannot retrieve battery information from the simulator eb ae The volume levels for sound features on the simulator are adjusted on the Status Panel Click on the volume level indicator next to each sound level to adjust The standby button is located on the bottom right corner of the GaumardUI software Use the standby mode to save backup battery power between exercises The simulator will establish a connection less than one minute after resuming from standby The connection bars will confirm the link between the controller computer and the simulator The wired communication module must be connected when resuming from stand by 20 User Guide NOELLE 554 100 Details From the Details tab facilitators can manually control the simulator s vitals enable disable features and create palette items later used to build scenarios Changing controls directly from the details page is the simplest form of control available to the facilitator
72. cilitator to insert standard evaluations or other relevant notes into the log The stylus device and hand writing recognition technology makes annotation in real time rapid and convenient Evaluation z 7 Power of Patricia agiia Unsatisfactory Satisfactory Note lt Add to log Standard evaluations satisfactory or not are given context by their position in the log relative to detected and observed provider actions The following example illustrates this idea 00 03 12 Patricia Action Shoulder dystocia 00 03 20 Chris Action Shoulder dystocia Suprapubic pressure 00 03 30 Chris Action Shoulder dystocia McRoberts maneuver 00 03 37 Patricia Action Shoulder dystocia McRoberts maneuver 00 03 52 Patricia Evaluation Care Provided Satisfactory The evaluation panel is part of the team logging system described previously When a particular provider is selected log entries generated via the Evaluation panel will be prefaced with the provider s name For more information on Team Logging see the previous section of this guide on Logging Evaluation Form The evaluation tool assists facilitators in reporting and assessing provider interaction using a questionnaire form A completed evaluation form can then be stored as a digital document or printed for distribution Facilitator Several evaluation templates are built in to GaumardUI s evaluation tool Each template includes a set of mult
73. cribe the condition to be simulated Not every field has to be populated in order to save a palette item Details Palette Lab Scenario Labor Speech Log A Airway Upper Airway Sound normal Laryngospasm Breathing Resp Pattern normal Left Lung Sound normal Right Lung Sound normal Respiratory Rate breaths min OSat Etco2 ratory Tan mm Inspiratory Time 33 change piratory Time 33 foe ieee Circulation Rhythm Sinus lx Heart Rate Blood Pressure Absent Pulses Heart Sound go beats min Systolic Diastolic Radial Right normal change mmHg oe 114 J 80 O change Radial Left Sinus Arrhythmia Other Temperature 1 F Seizures none Eyes State 20 blinks min Pupils L Enable Rxn Time sec Hemorrhage Uterine Pres Enable Rxn Apply When operating in automatic mode if inconsistent combinations or vitals are selected the model does not adjust to the specified values The model is based on accurate physiologic principles and therefore choosing a combination of vitals that is inconstant with these principles will not deliver the appointed results 1 Save your palette s by clicking on the Save as Palette Item button on the upper right side of the page Assign a name to the Palette Item and specify
74. d Scientific 14700 SW 136 Street Miami FL 33196 5691 USA Office hours Monday Friday 8 30am 4 30pm EST GMT 4 Summer Time Gaumard Scientific Company 2012 All rights reserved Gaumard NOELLE HAL are trademarks of Gaumard Scientific Company Inc Patented Other Patents Pending Always dispose of this product and its components in compliance with local laws and regulations C 196 User Guide NOELLE 554 100
75. d and other settings 2 Include notes to guide the facilitator during the simulation It is common for scenario designers especially those who act as facilitators to neglect the importance of notes in the scenario They think that they will remember the learning objectives patient history and other details at the time they are ready to conduct the simulation They usually don t especially when revisiting a scenario months after creating it When you add Wait and Wait Indefinitely steps to a scenario you have an opportunity to edit the item description Use this description field to hold notes to the facilitator Typically scenario designers put notes there to indicate what the provider s or facilitator should be doing at that point Further when saving the scenario you may edit the scenario description This is the best place to put patient history and any other longer notes and instructions 3 Assume that providers will do the right thing NOELLE 554 100 User Guide 181 Usually you should create a scenario with the assumption that the providers will perform correctly As long as they do the scenario can simply be allowed to continue Naturally you must be prepared for what might happen to NOELLE when providers deviate from expectations The consequences of such deviations can sometimes be included in the scenario punctuated by Wait Indefinitely items In other cases the simulation will require more direct control
76. d flaccid and requires immediate resuscitation Stat CXR reveals a fractured right clavicle and right pneumothorax Runs for 20 minutes Labor progresses quickly and breech is delivered by the nurse Meconium is noted The preterm female baby cries weakly with stimulation but color and tone are poor She is transferred to the nursery for stabilization and continuing care Scenario Name Labor Type Preeclampsia Cesarean Delivery Cord Prolapse Cesarean Delivery History Elaine is a 23 year old gravida 1 0 at 37 weeks She weighs 140 los She has had prenatal care She complains of mind frontal headache 3 tibial edema and 4 DTRs with 2 beats clonus are noted Francine is a 19 year old female gravida 2 1 at 37 weeks She weighs 145 lbs She has had prenatal care She has SID Herpes Gloria is a 34 years old gravida 1 0 at 25 weeks She weighs 190 los She has had prenatal care Helen is a 25 year old gravida 1 0 at 35 weeks She weighs 180 los She has had prenatal care Irene is a 19 year old gravida 2 0 at 29 weeks She has had one spontaneous abortion Runs for 40 minutes Progressive cervical change and fetal descent are noted during 9 hour induction Fetal descent continues with little active pushing FHTs show decreased variability and mild to moderate decelerations Delivery is accompanied with outlet forceps Female infant is dusky limp and does not breathe spontaneously at delivery Mecon
77. e Labor duration will be given in parenthesis In this way a two hour labor can be simulated in five minutes as an example Time Information Labor duration 30 min Warp Fator approx 30 min NOELLE 554 100 User Guide 51 Labor Time This timer represents the time on the labor curve ime ormaton Save Labor Load Labor Labor duration 30 min Warp Factor 21 3 approx 1 min Labor Control Dystocia Contraction Response Delivery Position C Enable Smart Labor j10 A sec 2 ON OFF Enable Contraction Response eh Q a C Descend only with contractions ion 9 Oman Oaa gt C Bree Station 9 gt C Check ROT LOT delivery w Lot Rop edit Lop O Pause Run Rese l NOELLE s birthing mechanism can be preset to four different initial configurations if a regular vertex delivery is desired These conditions are ROA LOA LOP and ROP It is very important that once the motor has been reset the instructor selects the desired delivery configuration in the software Then the baby has to be connected representing this state Select the initial position for the baby Make sure it represents the position at which the baby was inserted inside NOELLE I PUTT 5 4 3 2 1 0 1 2 3 4 5 6 7 8 9 PUTT 52 User Guide NOELLE 554 100 Each of these states has a different rotation program that will represent the internal rotation and the external rotation The rota
78. e drug list and display the best match if any 74 User Guide NOELLE 554 100 After a drug has been selected the action of clicking on the dose text field the units and route fields with the default values for that particular drug are filled automatically Medication Units Route Drug Dose I The facilitator then enters the dose and clicks on the Administered button prompting the event to be recorded in the log Following the example suppose the dose entered was 6 00 05 43 Action Medication Administered Adenosine 6 mg IVP The Team Logging feature allows the facilitator to designate which member of the team performed a particular action The Team Logging section is right above the Provider Actions section on the Log page Session Title Providers Team b Emergency Reported mn Before beginning a session the facilitator can add the names of all providers in the team to the team log This is done by clicking on the Add button and filling in the Add Provider name field Edit Provider NOELLE 554 100 User Guide 75 As shown in the Log Page image a colored button is inserted onto the Team Logging region for the provider just added The software allows up to six different providers each with a corresponding button to be entered Each time one of the provider buttons is clicked the indicated person becomes the active provider in the evaluation window Session Title
79. e is a 31 year old gravida 3 1 at 41 5 7 weeks Her physician stripped her membranes yesterday and she began contracting during the night She is admitted in active labor Runs for approximately 30 minutes Simulates 8 hour labor without complications resulting in SVD over intact perineum Baby is vigorous and earns good APGARS Runs for approximately 30 minutes Simulates normal labor and delivery of grand multip resulting in shorter labor duration Runs for approximately 18 22 minutes Following ROM nurse must support fetal head to prevent explosive delivery Patient has retained secundes therefore bimanual exam is required Safety Note Instructor is required to reset motor before allowing learner to perform bimanual exam Runs for approximately 30 minutes La3 25 Note To run full scenario load Bianca at Admit from scenario tab Instructor has to set up fetus with Nuchal chord prior to running scenario Full scenario runs for approximately 23 25 minutes Dystocia drill runs for 15 min Labor progresses normally for about 6 hours but after 45 minutes of pushing patient is unable to bring vertex to perineum A vacuum extractor is necessary to bring the head to the perineum Patient is still unable to deliver McRobert s suprapubic pressure Woods and Rubin maneuvers fail Baby is finally delivered using Gaskin maneuver Note To run full scenario load Candice Admit from scenario tab To run dystocia drill o
80. eatures Activation codes are unique to the simulator s serial number Before entering a code go to the Environment tab and set the connection mode to FIXED then enter the simulator s serial number e MOES Enter the MOES activation code to enable the MOES Standard curriculum profile Noelle Features Noelle s Add Ons add even more fidelity to your simulation MOES 90 User Guide NOELLE 554 100 The Non Scenario Automatic Response feature allows the facilitator to set preprogrammed responses to electrical therapy events When the electrical therapy Is detected auto responses can automatically load a specific palette item or prompt the facilitator before making preprogrammed changes to the simulator s vital signs Non scenario response settings only detect electrical therapy administered when a scenario is not in progress For information on how to configure auto responses for scenarios go to page Error Bookmark not defined To activate the virtual shock panel go to page 88 Warning Do not defibrillate or pace the simulator with real medical equipment Display warning when non shockable cardac rhythm is shocked Defibrillation Shock ardioversion Shock Non Sync Shock w Prompt Promot S Prompt Q R E Auto Th Auto 33 Auto 3h Setting Setting x Shocks Shocks yp convert to NSR ip convert to NSR 75 bpm BP 120 80 120 80 The behavior of each auto response option is expl
81. ectly from the Evaluation panel or by right clicking on the text log at any time by the facilitator Note entries display each and every character the facilitator types into the text box The following is an example of a Note entry 00 10 10 Note provider took too long to assess patient The Provider Actions section refers to the collection of buttons in the middle of the log page These buttons permit the facilitator to accurately and quickly track common provider actions Emergency Reported Airway Breathing Circulation i 2 vi Attachelectrodes Gheckforpuises Interpret rhythm Estabishiv Cyanosis Openairway Extubate gt Medication Gu headin Log CPR The buttons are categorized into five groups Emergency Reported Airway Breathing Circulation and Medication Any time the facilitator clicks one of the buttons a time stamped log entry is generated documenting the action For example if the Assess responsiveness button is clicked when the session clock reads 00 07 24 the following entry is automatically generated 00 07 24 Action Assess Responsiveness Special Buttons Some provider action buttons are accompanied by a special option button The first special button lets the facilitator be a log actions in more detail For example if the button Assess breathing is clicked the following
82. el 94 User Guide NOELLE S554 100 Type a file name and click Save You can load any of the pre saved combination of custom numbers by clicking on the Load button The Monitors gt Configuration menu is used to verify or configure the connection status between GaumardUI and the Gaumard Monitors software ES Newborn HAL Virtual Monitor Setup Select the number of monitors that wil be used with this manikin Also you can name each monitor with an appropiate description O All sensors always ON except tor Swan Ganz Adapter Controller IP 10 0 1 1 Port 8001 Connected to 10 0 1 2 To properly configure this window and the virtual monitors software refer to the Appendix on page 186 Compression and ventilation data is displayed at the CPR bottom of the window as CPR is performed by the provider GaumardUI features a CPR performance evaluator and trainer From the menu bar click on CPR and 0 10 20 30 select Evaluator to access the CPR Evaluator i Compression Data 306 Ventilation Data window Rate Ct LC Rate PIP 96 0 3 00 00 0 0 I E PEEP 0 08 57 TEE Evaluator Too Many Compressions 42 Too Many Ventilations 8 Options L 3 OK 11 H 28 L 0 OK 0 H 8 Chest compressions will not provide feedback to the instructor if the cardiac rhythm is set to a healthy state and ventilations will only be Rate Rate of compressions in
83. em When clicked a second time the scenario is stopped immediately For example if the currently playing item has a transition of 1 00 minute and the Stop button is pressed when it has 0 10 seconds left the scenario will be halted at the end the transition i e in 10 seconds If the Stop button is clicked again within those remaining 10 seconds the scenario stops immediately f l p The Next button advances the indicator to the next item on the scenario regardless if the scenario is playing paused or stopped It can also be used to move the indicator to select an item before playing it Similar to the Next button the Previous button returns the indicator to the previous item in the scenario i The Reset button stops the scenario immediately and returns the indicator to the first item in the scenario g 34 User Guide NOELLE 8554 100 The scenario auto responses feature assists facilitators in automating electrical therapy responses during a scenario First click on the shock panel icon located near the top right of the screen to access the virtual Shock Pace panel If the shock panel button is not displayed go to Setup gt Options gt General and checkmark Show defibrillation cardioversion panel E Click on the Scenario Auto Responses button to access and configure the auto response feature Quick Launch Details Palette Scenario Model Lab Log Healthy baby Al
84. enario Gaumard Simulators for Health Care taucation Beth Variations on Normal Beth is a 16 year old gravida 2 0 at 37 weeks She has had one elective abortion She has had prenatal care Labor duration 10 minutes Speech bathroom blood coming out baby is coming bathroom _ 122 User Guide NOELLE 8554 100 M Gaumard Simulators for Health Care Education i Noelle Labor Scenario Cynthia Shoulder Dystocia Cynthia is a 31 year old gravida 3 1 at 41 weeks She weighs 170 Ibs Labor duration 30 minutes Admit patient Routine labs notify HCP of admission and status Set up delivery table and infant warmer configure bed for delivery Perform Suprapubic pressure McRoberts Woods and Rubin maneuvers Alleviate Dystocia with Gaskin maneuver NOELLE 554 100 User Guide 123 As G d Noelle Labor Scenario aumar Simulators for Health Care Educatior Donna Breech Donna is a 20 year old gravida 4 2 at 31 weeks She weighs 180 Ibs She has had one elective abortion She has had prenatal care Labor duration 20 minutes 124 User Guide NOELLE 8554 100 4 g Noelle Labor Scenario Pn A Elaine i Preeclampsia Elaine is a 23 year old gravida 1 0 at 37 weeks She weighs 140 Ibs She has had prenatal care She complains
85. entry is created NOELLE 554 100 User Guide 73 00 01 28 Action Assess breathing On the other hand if the button next to Ventilate is clicked a list of additional options appears The facilitator can be more specific and choose for example look listen feel Breathing Breathing look listen feel abdominal auscultation axillary auscultation and the following entry is added 00 01 28 Action Ventilate look listen feel The second special button gt allows pre programming common responses to specific actions For example the facilitator can pre program normal respiratory sounds and re enable the lungs when the provider performs a needle decompression Airway Response When the extubate button is the following entry is created 00 01 28 Action Extubate cough Medications The Medications section allows for quick and easy logging of drug administration including dosage and route The software comes preloaded with a set of commonly used drugs Each of these drugs has a default dosage unit and a default route for administration which can be overwritten by just typing over it For example Adenosine has the default dosage unit of mg and the default route is IVP intravenous push In order to enter an administered dose 6 mg of adenosine via IVP the facilitator need only enter the text ad which prompts the software to automatically search th
86. er Guide NOELLE S554 100 Noelle 574 575 Labor Scenario Gaumard Inez Simulators for Health Care Education i Peripartum Hemorrhage Abruption Inez is a 27 yr old primip 35 weeks She arrives at hospital one evening crying and doubled over in pain She is admitted to a birthing room and the nurse notices bright red blood on Inez s panties She is having very intense and close contractions Labor duration 10 minutes Scenario duration 18 minutes Reset birthing motor and attach PP uterus Wait time 3 min NOELLE 554 100 User Guide 157 Noelle 574 575 Labor Scenario Gaumard Inez Simulators for Health Care Education Peripartum Hemorrhage Abruption AA Administer Pitocin manage bleeding and massage fundus Wait time 3 min 158 User Guide NOELLE 8554 100 Gaumard Simulators for Health Care Education Noelle S574 575 Labor Scenario Janie Peripartum Hemorrhage PPH Janie is a 23 yr old G 2 38 weeks She has experienced several bleeding episodes due to a low lying placenta She has been counseled about the potential for postpartum hemorrhage Her religious beliefs prohibit the administration of any blood products Labor duration 15 minutes Scenario duration 25 minutes Reset delivery motor and insert pos
87. er Guide NOELLE 554 100 Troubleshooting General Troubleshooting Guide Use the following table to find causes and solutions to a number of possible problems Communication never gets established or is lost Battery is discharged If NOELLE s backup battery is completely discharged connect the charger and wait 20 minutes to power on the simulator Leave the simulator connected while in use blinking communication indicator is consistently red NOELLE should always be plugged in while being operated The birth mechanism is power intensive and will drain the battery quickly Newborn must be plugged in to the charger during use Communication Module is not Perform a full shutdown of the tablet detected Disconnected power plug NOELLE s internal battery is used for transportation Always use NOELLE connected to the charger Communication module RJ 45 Cable Both simulators operate using a wired connection Connect the wired is not connected to the simulator communication module to the simulator and restart GaumardUI All others Close the GaumardUI software and unplug the USB communication module for at least 5 seconds then plug it back in Restart the software and wait for initialization Sound quality while Sound is too low or too loud Sound volume at PC side is managed from PC s volume control streaming is poor Simulator sound volume is managed from PC s Microphone gain control Adjust microph
88. er for at least five seconds then plug it back in and restart the software is displayed when Is the communication indicator panel See solution above in section making reference to blinking com consistently yellow munication indicator is consistently yellow Chest compressions are not Is the respiratory rate set to O Set respiration rate to zero properly detected or not min Chest compressions are only detected at all detected when the respiratory rate is set to 0 per minute 0 min NOELLE 554 100 User Guide 183 Otherwise they are ignored Simulator is not connected Verify connection to the simulator All others See Calibration Wizard section inside User s Manual Newborn artificial Simulator is not connected Verify connection to the simulator ventilations are not properly detected or not detected at All others See Calibration Wizard section inside User s Manual all Simulator not running Simulator must be powered on and respiratory rate set at 0 Newborn simulator s chest Incorrect respiratory settings Respiration rate and inspiration percentage must be higher than 0 does not rise with artificial If problem persist shut down the simulator and restart the tablet ventilation e g BVM Turn on the system then verify connection battery and lung settings Newborn s Low chest rise Wrong force sensor reading When baby is pulled with more than 35 Ibs of force to avoid or
89. eral episodes of preterm contractions that resolved with LLP bed rest This time the bed rest and oral hydration are not resolving the contractions in fact they seem to be getting worse Labor duration 35 minutes Perform SSE to determine cervical status give Terbutaline SQ for tocolysis S amp S Patient is anxious and shaky she says her heart is racing Reassure patient about effects of beta mimetic drugs Give second dose of SQ Terbutaline for cessation of breakthrough ctx S amp S Patient is anxious and shaky Palpitations tachycardia and PVCs result from second dose of SQ Terbutaline Discontinue Terbutaline give 300ml IV bolus replace tocolytic drug with Procardia S amp S no adverse reaction to Procardia NOELLE 554 100 User Guide 167 i Noelle S574 575 Labor Scenario Gaumard Maria Simulators for Health Care Education Preterm Labor Maria is a 30 yr old multip 27 weeks She has an 11 yr old and has been trying for more children She has had 2 miscarriages in the last 4 years and she lost both due to an incompetent cervix This time a McDonalds suture was placed 14 weeks Labor duration 15 minutes Give IV bolus apply EFM Wait time 5 min Ctx subside administer mag sulfate skip forward 24 hrs Wait indefinitely
90. es E N EAE tag 115 NOELLE 8554 100 User Guide 3 POO CIGD ciare cane ccsncetctensennetaveccesterecneccapccate scrucenstasceseecareceeaas 116 FaGlory Preset abOr Scenarios eenia a 117 TP ORG le atNIG SCENO Sta sivassdagiel at iea alec tendutatnateand A 181 TRO MONE SOO UIA unie te Seca atenndanei eatin auantanenctiaaanuennitaisaialntdatel 183 selected Consumables and Replacements Parts ccccssscccccssseeccesseeeceeseeseenseesseaes 191 MM Eg UN AEE atelectasis teste T I T od Saale olen caatate atlases tats 195 G0 9 1 LIS AU nee ene cae ae OY Ee ee en eT ere nT ee ene eee eee ee ee 196 4 User Guide NOELLE 554 100 End User License Agreement This is a legal agreement between you the end user and Gaumard Scientific Company Inc Gaumard This software is protected by copyright laws and remains the sole property of Gaumard By installing the GaumardUI simulation the Software media you agree to be bound by the terms of this agreement If you do not agree to the terms of this agreement promptly return the uninstalled media and accompanying items to Gaumard at the address indicated below 1 Grant of License Gaumard hereby grants to you an individual or institution the right to install and activate the Software on one computer for use with one Code Blue Ill Interactive patient simulator system The software may also be installed on any number of other computers at the same institution so that students may
91. est compressions or artificial ventilations depending on what you are calibrating Calibration Chest Compressions The values from the last compressions user calibration are shown below Press START and do 5 7 correct chest compressions one at a time SS following the text cue l Finish The facilitator should follow the text cue on the screen to perform just ONE compression or ventilation at a time until prompted for the next one For example if calibrating chest compressions The wizard prompts you with a 1 Perform one correct chest compression A green filled oval indicates that the chest compression was successfully recorded The wizard prompts you with a 2 5 Perform a second correct chest compression 6 A green filled oval indicates that the chest compression was successfully recorded 7 Continue the same process to finish the calibration At the end of the calibrating session the wizard shows the average peak depth and duration values for the procedure If you feel you performed the procedures correctly click the Save button Otherwise press the Back button to repeat the calibration Notice that you can go back abort or cancel at any time during the procedure Use the factory settings menu to restore sensors to the factory calibration A factory reset will over ride any calibrations performed by the facilitator Make sure that when you are restor
92. et the tolerance and intensity of both chest compressions and ventilations The first option Once a Palette is applied load to Details Tab is useful for facilitators who want to keep track of the latest parameters that were updated using the Details Tab If the motor is not moving properly through the track during a labor remove the baby and click Reset Labor Motor The motor will move down the track and calibrate the proper starting position Options Environment General Noelle Features Log Othersse EENE E e Set the threshold for the labor force display To read more about the labor force display go to Page 61 F na monitor for maternal vitals and fetal F ETAL MO N ITO R PAP E R S P E E D E Use AV System Start AV Automatically on Scenario Start Output Log Events to Windows Log Use this feature to adjust the speed of the fetal monitor paper on the FHR monitor screen Link Respiration sensor to ECG Leads sensors GaumardUl is capable of interfacing with a number of third party A V recording systems Checkmark the Use AV System to display the AV drop down as shown on page 97 NOELLE 554 100 User Guide 89 You can display Gaumard Monitors using one monitor To do so select the checkbox use single monitor for maternal vitals and fetal traces When you enable this checkbox the Maternal Vitals Fetal Monitor control is shown in the GUI These controls enable y
93. ew your active networks Change your networking setti Set up a new connec Click on the Wireless Network Connection icon to select it and then click Change settings of this connection on the menu panel The Properties window for the connection will be shown twor k and Internet Network Connec tions gt Wireless Network Connection 2 Not connected trolld x i Intel R WiFi Link 5300 AGN Select Internet Protocol Version 4 TCP IPv4 to highlight it and click Properties H Wireless Network Connection 2 Properties Connect using EP Intel R Wifi Link 5300 AGN Configure This connection uses the following items o Client for Microsoft Networks dE Virtual PC Network Filter Driver Zi QoS Packet Scheduler 2 File and Printer Sharing for Microsoft Networks Intemet Protocol Version 6 TCP IP v6 Sed Intemet Protocol Version 4 TCP IP v4 wi Link Layer Topology Discovery Mapper IO Driver wi Link Layer Topology Discovery Responder Transmission Control Protocol Intemet Protocol The default wide area network protocol that provides communication across diverse interconnected networks Uninstall 6 Configure both computers with static IP addresses and subnet masks following the IP address convention below Each computer in the ad hoc network must be configured with the same first three octets and only differ on the last Computer IP SSID Network address Name Tablet 1 NOELL
94. for simulations and is therefore considered a consumable item Cephalic Newborn displays central and peripheral cyanosis at various intensities healthy mild and severe Systemic Intramuscular Injection sites are located on both deltoids and quadriceps for placement and technique exercises rao 9 The Virtual Signs Monitor simulates a vital signs monitor attached to Newborn The vital signs are synchronized through a wireless network between the facilitator s tablet and the computer running the monitor Each trace can be customized independently of each other users can set alarms time scales boundaries and grid options In addition it allows the facilitator to display lab reports x rays and other files on the virtual monitor screen for use by the provider 17 03 57 NOELLE 554 100 User Guide 115 Appendix 116 User Guide NOELLE 554 100 Factory Preset Labor Scenarios mise rin on Fs eae rin on eam rin on me Stam EA eee ec Favene Sosa A EA C Senseo NOELLE 8554 100 User Guide 117 Noelle Labor Scenario Alice Normal Gaumard Simulators for Health Care Education Alice is a 24 year old female weighing 170 pounds Her OB history shows a gravida of 2 and a term of 1 She is currently 39 weeks pregnant and has one living child She has had prenatal care She has not been using medications of any kind Labor du
95. ft with a clean slate to either rebuild or to completely change the scenario The stages shown in colored blocks under the timeline are also dependent on the descent curve The blocks representing different stages of labor change size as the points on the descent curve are moved Click on each stage label to view the details This information was assigned when the scenario was created c Stage Information Maternal Info Respratory status Cardiac status Pain Bleeding Sd Membranes P E A SSS Fetal Info Decreased No fetal movement Other NOELLE 554 100 User Guide 59 Release Baby This button activates the release mechanism on the baby which allows either the providers to disengage the baby or the instructor to connect the baby Time Information ROA LOA Save Labor Load Labor Labor duration 30 min Warp Factor 21 gt approx 1 min Labor Control Dystocia Contraction Response Delivery Position Enable Smart Labor 10 ls 2 O ON OFF gi ae Response Rotate baby Q O ROT LoT C Descend only with contractions 4 z i A pai y Station O speech speech vitals E Check ROT LOT delivery 2 Pause Run Reset ROP edit Labor Time 00 28 50 SALT ETAT aT After clicking on the Release Baby button as shown below the system will take a few seconds to send the release commands to the simulator Once the baby is plugged into the motor arm the locking mechanism act
96. g Do not overfill the reservoir To start the bleeding go to the Details tab and click the Hemorrhage feature icon to the active status Blue Then click the Apply NOW button to submit the change and start the hemorrhage Hemorrhage O Uterine Hemorrhage Uterine Pres 30 To stop the hemorrhage click the control icon to black disabled and then click apply NOW If the uterus insert is connected to the uterine hemorrhage fluid port inside the abdomen activate the Uterine Hemorrhage option to start bleeding from the Cervix 2 Hemorrhage Uterine Hemorrhage Uterine Pres 30 6 GaumarduUl includes several built in labors preprogrammed with post partum hemorrhage activity For more information go to page 62 for more information NOELLE 554 100 User Guide 111 Episiotomy Repair To perform episiotomy repair exercises remove the birth canal used during delivery and snap in the episiotomy holder into place Finally snap the episiotomy insert into the holder Use a 000 size suture and small curved needle to repair the surgical incision or repair For replacement episiotomy inserts part number information go to page 191 IM sites for placement exercises are located on both deltoids and quadriceps Warning Do not inject fluids into the IM sites NOELLE is outfitted with a convulsion mechanism that can be used in conjunction with scenarios preeclampsia for exam
97. gate to page 183 The dystocia controls will be activated only if the last point on the descent curve is lower than the dystocia threshold set on the Options or on the Dystocia Control Box Dystocia can be used during any scenario by switching the control on in the Dystocia control box When the dystocia is set to On and the labor starts the warp factors for labor and perinatal monitor will change to real time warp factor 1 as the descent curve passes the preset dystocia threshold While in dystocia mode a Turtle Sign will occur with each uterine contraction The dystocia controls are disabled when the last point on the descent curve is less than the indicated dystocia station In the example below dystocia controls are disabled because the last point is less than seven the current dystocia station Labor Control i Contraction Response Delivery Position Enable Smart Labor 10 H se9 on ik aa ar O Q Rot e Breech Only descend duri tracti a a A i Reset Pause Run Reset Alyssa Labor Time 00 00 00 NOELLE 554 100 User Guide 55 In the example below shoulder dystocia and turtle signs begin station 10 Labor Control Dystocia Contraction Response aa boat oi Nr E Enable Smart Labor 10 sec a ON 0 Enable Contraction Response an rf 5 j j ree a E baie sn 0E speech
98. h excessive force in contrast to the birthing mechanism s linear trajector may bend the motor arm and cause damage to the birthing mechanism The student or instructor may help the fetal head and shoulders through the vulva just as in real life However the fetus will automatically unlock only after the vertical progress bar reaches Stage 3 of the delivery process The automatic unlock process is indicated by the Releasing status After the delivery is complete click the reset button to return the delivery mechanism to the initial position Warning Do not turn off the simulator until the birthing mechanism has fully retracted to its initial position Time Informati Save Labor Load Labor Labor durati Labor Control Dystocia i i i 220 240 26 0 280 30 0 min Enable Smart Labor 10 e a ON OFF Only descend during contractions PF Pause Run R Click the Release Button to manually disengage the baby 15 30 0 min DATA 104 User Guide NOELLE 554 100 Vacuum Assisted Delivery Vacuum assisted delivery is a technique for the management of arrest during the second stage of labor Criteria for successful delivery include 1 cervical dilation is complete 2 cephalic presentation is confirmed 3 the fetal head is no more than 1 5 palpable above the pubic bone 4 effective uterine contractions continue 5 maternal expulsive efforts continue A soft skin scalp cover for the articulating baby
99. has not been established please enter the IP address and port number selected on the controlling computer GaumardUl Hal Enter the IP and port selected on the controlling computer Controller IP 0 0 0 0 Port 8001 9 Input the Controller IP address and port number as previously noted on GaumardUl s Virtual Monitor Setup window NOELLE 554 100 User Guide 189 Monitor selection NOELLE If the communication has not been established please enter the IP address and port number selected on the controling computer GaumardUI E Port 8001 p Connect Noelle Enter the IP and port selected on the controlling computer Controller IP 10 0 0 1 Monitor Selection NOELLE and Newborn HAL If the communication has not been established please enter the IP address and port number selected on the controling computer GaumardUI Noelle Enter the IP and port selected on the controlling computer Controller IP 10 0 0 1 Port 8001 Newborn Enter the IP and port selected on the controlling computer Controller IP 10 0 0 2 C Port 8001 If the communication has not been established please enter the IP address and port number selected on the controlling computer GaumardUI Noelle eg i Enter the IP and port selected on the controlling computer Controller IP 10 0 0 1 E Port 8001 11 On GaumardUl s Virtual Monitor Setup window the connection status will al
100. he patient s condition to the simulator itself When settings are successfully applied NOELLE s condition should match that shown on the Status panel GaumardUI the Gaumard User Interface software application used to control the simulator and evaluate care providers Facilitator the person conducting the simulation an instructor or lab staff member Palette Item Any full or partial set of physiological parameters saved together under a single name Profile a unique GaumardUI configuration including custom palettes scenarios and options Each profile acts as a separate program whereby changes made to one profile have no effect on the others Provider a person participating in the simulation as a healthcare provider Scenario a saved sequence of physiological states which flow like a play list Scenarios provide a level of automation that unburdens the facilitator and allows standardized presentation of symptoms Scenario Item a Palette Item that is part of a scenario Scenario Items may also represent a fixed delay period Wait or a pause Wait Indefinitely NOELLE 554 100 User Guide 11 Equipment Set up 12 User Guide NOELLE 554 100 Leg Assembly Follow the steps below to install the lower legs Always remove the lower legs when transporting NOELLE inside the protective case 1 Remove the fixed bolts from the knee joints using the hexagonal wrench included 2 Posit
101. he optional Virtual Signs Monitor computer simulates a vital signs monitor attached to the patient The vital signs information is sent through the Wi Fi wireless network from the facilitator s tablet to the computer running the Gaumard Virtual Monitor software File Setup Monitors Sensors Status ol File sharing ABC Mo i Custom numbers Configuration ii a a Use the Monitors drop down menu to enable disable sensors on the virtual monitor screen share files program custom scalars and configure the connection between the GaumardUI and Gaumard Virtual Monitor software For detailed instructions on how to configure and connect the Gaumard Vital Signs Monitors go to 186 This tool allows you disable any of the waveforms present in the vital signs monitor Newborn HAL MOES User Interface SN J0000001 QUICK START NOELLE File Setup Monitors CPR Help Status of Sma spozprobe Appearan File sharing ECG Leads Skin Color Custom numbers Resp Monitor N Thermometer Configuration Airway NIBP Cuff Crying m Airway C ABP cannula Breathing 3 C h Resp Pattern AA Breathing paaa Respiratory R AIL ON Rate 40 bpm In 20 ob All OFF change Window Jers Select any of the waves that you will like to display and select ON If you want to turn any of them off click OFF The vital signs monitor defaults to All On Some sensors
102. he software at any time by going to File Exit or by clicking on the x button at the top right corner of the user interface NOELLE 554 100 User Guide 85 Monitors A V Help Options Auto Responses Use the calibration window to calibrate features and to reset sensors the simulator Calibration Calibration Wizard Welcome to the Manikin s calibration wizard Proceed only after you have reviewed the calibration section in the user manual Please select the function you would like to calibrate Chest Compressions Artificial Ventilation COMPRESSIONS ARTIFICIAL VENTILATIONS This tool helps you calibrate the chest compressions and the artificial ventilations to your specific criteria That is you will be telling the system what a correct chest compression is and or what a correct artificial ventilation is Providers will be evaluated by the system based on this criteria The chest compressions and ventilations are calibrated the same way After making a selection this dialog box is displayed 86 User Guide NOELLE S554 100 Calibration Chest Compressions Please select the type of calibration you would like to do Normal Calibration You will be asked to ms G perform based on your criteria Providers 3 will be evaluated based on that criteria Never calibrated Click next to proceed with the calibration The software will now ask you to perform a number of correct ch
103. hing room administer medication change position to relive variables Turn patient LLP to resolve variables Wait time 2 30 min Check that variables have resolved Wait time 3 min Go to Labor Candice Wait time 2 min 136 User Guide NOELLE 554 100 Noelle S574 575 Labor Scenario Gaumard Candice Simulators for Health Care Education Shoulder Dystocia Perform Suprapubic pressure McRoberts Woods and Rubin maneuvers Alleviate Dystocia with Gaskin maneuver Titrate pitocin to maitain uterine contractions give Tylenol for pain antibiotic therapy NOELLE 554 100 User Guide 137 G d Noelle 574 575 Labor Scenario wy ih Charlotte Simulators for Health Care Education Shoulder Dystocia Charlotte is a 31 yr old gravida 3 1 41 5 7 weeks Her physician stripped her membranes yesterday and she began contracting during the night She is admitted in active labor Labor duration 40 minutes 138 User Guide NOELLE 554 100 Noelle 8574 575 Labor Scenario Gaumard Dana Simulators for Health Care Education Breech Presentation Dana is a 24 yr old multip 29 weeks who was admitted because she began contracting Upon V E physician discovers that
104. ice s Baby During a wait indefinitely palette the auto response feature will advance the scenario to the next palette item in response to the following interventions External Pacing Defibrillation Shock During shockable rhythms only Cardioversion Shock Non sync Shock Scenario Alice s Baby automatic responses settings Display warning when non shockable cardiac rhythm is shocked External Pacing Defibrillation Shock Cardioversion Shock Non Sync Shock Prompt Prompt A Prompt A Prompt nes Auto J Auto j SN Auto i SSN Auto i SSN Setting Setting Setting Setting at at at 8 E Joules 4E Joules 4 5 Joules Shocks Shocks Shocks advance to next advance to next advance to next scenario item only scenario item only scenario item only when at WAIT when at WAIT when at WAIT The three auto response detection modes are defined below e Off The software does not respond to the electric therapy e Prompt The software detects the electrical therapy and prompts the facilitator if the scenario should proceed to the next palette e Auto The software detects the electrical therapy and compares it to the joules or shock threshold configured by the facilitator If the electrical therapy is equal to or greater than the threshold specified the scenario will automatically continue without prompting the facilitator NOELLE 554 100 User Guide 35
105. in Electrical defibrilation Wait time 1 min Administer resuscitation per ACLS protocols Inspect placenta following delivery administer Pitocin to promote uterine ctx Full resuscitation Wait indefinitely Give blood products for DIC management stabilize patient transfer to ICU 164 User Guide NOELLE S554 100 Noelle S574 575 Labor Scenario Gaumard Kimberly Simulators for Health Care Education AFE Kimberly is a 27 yr old multip 42 weeks She began having contractions at home and now they are becoming stronger She is excited to be finally going into labor By the time the nurse completes admission Kimberly is requesting pain meds as her labor is progressing quickly Labor duration 25 minutes Scenario duration 30 minutes NOELLE 554 100 User Guide 165 Noelle 574 575 Labor Scenario Gaumard Kimberly oImutaw re Or ean are tcaucanon AFE Begin CPR Wait time 4 min Deliver baby perimortum c s Wait time 3 min 166 User Guide NOELLE 8554 100 Noelle 574 575 Labor Scenario Gaumard Madonna Simulators for Health Care Education Preterm Labor Madonna is a 41 yr old multip 31 weeks She has experienced difficult pregnancies and has one Downs Syndrome baby She has had sev
106. in newsprint e The birth canal insert can be cleaning by wiping with a mild solution of soap and water After cleaning dust with talcum powder e Store the unit in a cool dry place e After exercise is completed DO NOT leave birthing baby in contact with the birth canal 3 e Always lubricate the birth canal prior to delivery 1 Lubricate the fetal head and shoulders plus the inside of the birth canal insert using the silicone oil provided Warning Always lubricate the fetus and the birth canal before every delivery Failure to do so will result in damage to the birthing mechanism and the birth canal 4 Attach placenta to either side of the abdominal wall Orienting the Velcro patches in parallel causes segments of the placenta to be retained if secundes are reversed orienting them at right angles causes the placenta to release with modest traction NOELLE 554 100 User Guide 101 5 Attach the umbilical cord to the baby route the LOCKING MECHANISM cord SO it does not bind in the mechanism and Fe ec em eee eee ee attach the placenta to the pelvic cavity using the The birthing mechanism arm attaches and locks into the Velcro fastener Note that the fetus has 2 fetus attachment port The motor arm low voltage cable receptacles at the perineum into which the feeds power to the locking mechanism and fetal heart matching pins located on the birthing mechanism tones speaker inside the fetus are inserted
107. ing Scenarios As described previously Palette items represent complete or partial groups of settings that have been stored as a single item We learned how applying partial states will hold constant all settings that are left unspecified Not only does it take time to customize the palette but a very large palette becomes difficult to navigate So it is desirable to minimize the number of Palette Items in each Profile To accomplish this an experienced facilitator tries to create items that are as generally applicable as possible and can thus be applied to a wide range of scenarios The key is to only include in your Palette Items the settings that are directly related to the physiological event represented by that Palette Item After reading the Details Palette and Scenarios sections of this guide it should be clear how to build a scenario You may have already tried building your own or modifying some of the factory presets The following four guidelines will refine your ability to build the best possible scenarios 1 How will the scenario begin The first thing to consider is the initial condition of the patient Create a Palette Item to describe this condition Make sure that this first step in the scenario is a complete state That is indicate some selection for each and every available setting on the Details page Remember that only the settings you specify will cause a change in NOELLE and all other settings will remain constant
108. ing the sensors to the factory settings that no one is practicing chest compressions or ventilations Any of these actions may interfere with the reset Each time that one of these sensors is clicked a message will appear at the bottom left of the screen notifying the user of the status of the reset OK or TRY AGAIN Should the sensor not respond please refer to the troubleshooting guide or contact Customer Support At the end of calibrating a function the Calibration Wizard resets the simulator for the changes to take effect and displays the message Done If the wizard displays the message Can t reset it simply means that the new calibration values will take effect next time you start the software If the changes need to take immediate effect simply close the GaumardUI software wait one minute for the simulator to turn off and then start the GaumardUI software again The options below are specific to the NOELLE simulator Remove the birthing baby from the birthing mechanism before continuing Reset Force sensor Reset the force sensor if the labor activity is displaying incorrect force readings First remove the baby from the birthing arm and allow the motor arm to remain free for 30 seconds While the birthing arm is free click reset the force sensor button to record the current state as zero force Reset Uterine Pressure Disconnect the uterus from the pressure port and click reset to restore the calibrat
109. ion the lower legs and insert the bolts Use the two provided hexagonal wrenches to secure the knee bolts Do not over tighten NOELLE Power Supply Connect the power adapter labeled NOELLE to the power input located on NOELLE s right side NOELLE is equipped with an internal backup battery to maintain functionality in the event the power adapter is unplugged or the simulator is requires transportation from one room to another Always operate NOELLE with the power supply connected The backup battery level is displayed on the GaumardUI status panel For more information about the battery indicator refer to page 20 Warning Do not store the simulator with a discharged battery Re charge the system at least once every 3 months if the simulator is not being used otherwise permanent loss of Capacity might occur Newborn Power Supply Connect the power adapter labeled Newborn to the power input located on Newborn s right side Always operate Newborn with the power supply connected Newborn is not equipped with an internal battery Control Computer The laptop computer is the simulators control center Startup and control commands are sent from the Gaumard control software GaumardUl to the simulator using the wired communication module shown in the next section Review all manufacturer warnings and procedural information included with the laptop s documentation before continuing NO
110. ion to factory default Reset Labor Motor Recalibrate the position of the birthing mechanism on the track Always remove the birthing baby prior to recalibrating the birthing mechanism position NOELLE 554 100 User Guide 87 Click the Options menu to enable or disable and customize the behavior of GaumardUl s features Monitors Help To connect to a specific simulator select the FIXED option and enter the simulator s serial number in the text box Establishing a FIXED connection is required before entering the activation codes for the simulators add ons features and detecting hardware upgrades If you cannot find the serial number first connect to the simulator using GENERIC and then press on the button that says Can t find Serial Number and follow the instructions Options GENERIC Find and establish a connection with Noelle Please switch to FIXED once connected FIXED The software will enable controls for features available on your simulator FIXED Noelle Setup Enter the Serial Number from the Noelle simulator that THIS computer will control SN on RF Module M 0000001 Can t find Serial Number _ 88 User Guide NOELLE S554 100 This tab allows the facilitator to e Enable auto saving of the log e Save your current log report e Enable stand by warning e Select units SI or English e Enable electrical therapy shock pane
111. iple choice questions related to the type of assessment being performed To begin select an evaluation template from the Load Template dropdown New templates created in the edit mode will also be listed Evaluation Form Load template x Save Clear Delete Go To Evaluation Mode Breech Vaginal Delivery E Evaluation Nar EAE Forceps Delivery On Site Reviey Postpartum Hemorrhage Shoulder Dystocia Category Enter the name of the facilitator performing the review in the On Site Reviewer field NOELLE 554 100 User Guide 77 Evaluation Form Load template Eclamptic Seizure lx dear Print GoToEditMode Evaluation Name Eclamptic Seizure On Site Reviewer James C Date 08 08 2011 1 Problems Identified Complete the form by first entering the written response in the Problems Identified field and selecting the applicable multiple choice responses throughout 1 Problems Identified Eclamptic Seizure 2 Provider Tasks and Performance Calls for additional help Nursing or Physician Calls for anesthesia Providers turn or assist in turning patient to side during seizure Inserts tongue blade into mouth Places supplemental oxygen on patient Places pulse oximeter on patient Once the evaluation is completed click the Print button located at the top right corner of the screen
112. irway 00 00 all difficult airway actuators on Wait Indefinitely a Hold in current state until action is taken Resting 01 00 Normal Vitals ee w a m cee 6 Begin the scenario by pressing play Watch the vital signs adjust according to the specifications of each palette item One can manipulate the scenario items with the Selected Item group of buttons on the right side of the page Most of these functions are also available by right clicking on scenario items When using the stylus hold the stylus button and tap the screen to do a right click 40 User Guide NOELLE 8554 100 To automatically transition from a linear scenario to a labor scenario add a Go to labor palette at the end of the list From the drop down select the labor that will begin at the end of this scenario and click add Add Palette Item Palette File Lab nts mn sec a PA ma A 59 59 Max Item Description a Select labor scenario from the aoa pulldown menu below ireneo4 Transition ireneo1 ireneo ireneOS irene06 respiratory allergy Resting i Alice ace Wait Alicia Wait Indefinitely Amy speech Beth Cynthia Danna Elaine A Gloria Upon reaching the Go to Labor palette the software will automatically begin the labor scenario named Alice Name Transition Description Start State 00 20 Asthma Sinus respiratory allergy 04 00 wheezing difficulty exhaling tongue edema Closed ai
113. is provided for vacuum assisted deliveries Warning The soft skin scalp cover is to be used during the process of a vacuum delivery only Do not allow the head to rest against the cervix during non simulation times If pressure is left on the cervix from the scalp cover for lengthy times both pieces will be damaged Always remove and store the soft skin after simulation is complete Vacuum assisted delivery may be practiced with the NOELLE simulator using a vacuum cup available from a number of suppliers Vacuum assist device attaches to fetal scalp between fontanelles Await the next contraction that may be simulated by asking NOELLE to bear down and have the student apply steady traction perpendicular to the plane of the cup Some vacuum assisted delivery devices are equipped with a means for measuring the amount of traction which may be on the order of about fifteen pounds The software will also give the instructor a graph that indicates applied force as the delivery mechanism is equipped with a strain gauge The student must stop traction when the simulated contraction ceases Repeat this procedure of waiting for the simulated contraction and providing traction during the contraction if and only if the fetus is moving down the birth canal with each contraction Leopold Maneuver To perform Leopold Maneuvers retract the birthing mechanism fully and remove the articulating birthing baby Place the elevating cushi
114. ith an indispensable tool for simulation training and testing The Status panel is visible along the left edge of the GUI window at all times Backup battery level information signal strength volume levels and vitals are displayed in real time Vital sign parameters such as heart rate blood pressure and respiratory rate are highlighted in yellow while undergoing change Click the arrow to expand the viewer and access status entries for Other Uterine Activity and Fetal Heart rate Some status panel entries may not be visible depending on the simulator s hardware configuration Expanded Panel Status ool W Prat Status saat Battery apc More DES Expand Signal Strength 3 Cont ee min Breath ing AA Breathing PNE Cont Duration 40 sec Resp Pattern Ml a ani 23 om naa Ate 2 Rate 13 bpm In 33 o unlina Rate 13 bpm In 33 O2 Sat 98 0 Prob 0 Size FHR tCO2 40 mmHg cain O2 5at 98 FHR Baseline 139 bpm m Variability EtCO2 40 mmHg Circulation z Cardiac Rhythm Accel Decel Intensity Circulation ae Cardiac Rhythm Heart Rate 70 bpm tare 120 80 mmHg Variable Parameter 5 Heart Rate BO bpm undergoing Other Blood Pressure enange Temperature 37 5 C 120 80 mmHg Other Temperature 37 5 C Seizures Hemorrhage Uterine Hemorrhage UP O Active inactive feature indicator NOELLE 554 100 User Guide 19 The communi
115. ithout prior authorization 2 Upon receiving authorization from Gaumard send the Gaumard product along with copies of 1 the original bill of sale or receipt and 2 this limited warranty document to Gaumard at 14700 SW 136 Street Miami FL 33196 5691 USA 3 If the necessary repairs to the Gaumard product are covered by this limited warranty then the first purchaser will pay only the incidental expenses associated with the repair including any shipping handling and related costs for sending the product to Gaumard and for sending the product back to the first purchaser However if the repairs are not covered by this limited warranty then the first purchaser will be liable for all repair costs in addition to costs of shipping and handling In addition to the standard one year of coverage the following support plans are available e Two Year Extension covers second and third years e Call for pricing USA only NOELLE 554 100 User Guide 195 Gaumard Simulators for Health Care Education Contact Us E mail Technical Support support gaumard com E mail Sales and Customer Service sales gaumard com Phone Toll free in the USA 800 882 6655 Worldwide 01 805 971 3790 Fax 305 667 6085 Before contacting Tech Support you must 1 Have the simulator s Serial Number located in the left leg under the IM site 2 Access to the simulator and the control computer if troubleshooting is needed Post Gaumar
116. ium is noted and a small amount is observed below vocal cords Baby is suctioned and is eventually transferred to NICU for continued observation Runs for 10 minutes Delivery of male infant is accomplished through a low transverse uterine incision The infant exhibits good tone and cries spontaneously at delivery peripheral Runs for 10 minutes Gloria arrives at the hospital with ruptured membranes and an obviously prolapsed cord Profound fetal bradycardia is noted Delivery occurs almost immediately after the patient is moved to the delivery room C amp S is obtained and sent to pathology The male infant is placed on infant warmer His earns APGAR score Runs for 30 minutes FHT remain WNL Midline episiotomy is performed and the delivery is spontaneous The placenta delivers but is not intact Bimanual uterine exploration removes small amount of placental tissue The male infant is pale and flaccid He is covered with vernix and blood Neonatal resuscitation is begun immediately Runs for 45 minutes Sterile speculum exam indicates a shortened cervix with a cerclage in place Fluid is noted in the vaginal vault and ferning is positive Breakthrough contractions reveals cervical occur and sterile speculum change Cerclage is removed Fetal heart tones remain stable throughout the short labor Spon taneous delivery occurs The female infant born earns good APGARs NOELLE 554 100 User Guide 63 Patient Name Al
117. l The shock panel is a floating window used for simulating electrical therapy It can also be used in conjunction with auto responses For more information go to page 86 Options Auto Save E Enable Log Auto Save _ Auto save every 10 E etaaigeal Session Timer E Reset session timer once scenario is started Electrical therapy Panel Show defibrillation cardioversion pacer panel Stand by warning A Warn the first time trying to apply settings when system is on Stand By mode Units International System SI Imperial If the Electrical therapy panel is enabled a new conirol will be accessible from the top right of the screen w FAY RET en Tak Gaumard Legend Oo of Use this control to bring focus to the floating shock pace control window At any moment the shock pace window can be moved or closed while remaining accessible by clicking the button above Environment General NoeleFeatures Log Other Assign a color code for each of the log entry Reset categories and click OK to save Labor Force Display Dra a In this tab you can 0 44 ium N 89 155 e Select the number of desired compressions per minute Fetal Monitor Paper Speed e Specify the compression ventilation ratio O aen 2a ae Select number of ventilations per minute if the Only Ventilations button is selected The tolerances tab is used to s
118. l About GaumardUI Check for Updates and Diagnostics Instruction Manual allows you to view a soft copy of the entire simulator help manual NOELLE 554 100 User Guide 97 Working with NOELLE 9 r Guide NOELLE 554 100 Airway management techniques can be practiced on NOELLE including BVM nasal oral intubation and suctioning Endotracheal tubes NG tubes and LMAs can be used Procedure Recommended Device Size Intubation Blade size Miller 4 or MAC 3 5 LMA Size 4 Nasal Intubation 8 mm outer diameter max Oral Intubation ETT Fr7or75 Warning Do not introduce liquids when performing nasal and oral intubation Doing so can permanently damage the system Always lubricate tubing airway and nasal opening prior to performing any nasal or oral intubation Breathing Software controlled breathing patterns Kussmaul s Cheyne Stokes Biot s Apneustic apnea and normal The airway contains nominal landmarks permitting either BVM or intubation exercises including the use of a LMA The trachea extends to the bronchi and lungs Use a normal size adult BVM which will seal around the mouth and nose The ribs have normal anatomic landmarks and the lungs permit an adequate chest rise Normal CPR procedures can be followed with aid of GaumardUI s CPR trainer Circulation Palpable bilateral radial pulses are blood pressure dependent NOELLE has a bilateral IV training arms that can be used for bolus or
119. l signs palettes simulate the response to z dopamine Time limit Go to node 3 after 1 minute 7 Pace Vital signs simulate the effect of pacing Scenario ends Vital signs simulate the effect of pacing Vital signs simulate the effect of pacing Scenario ends ends opine A Linked action automatically triggers a key event when virtual electrical therapy is detected To add a linked action first open the Edit Path window Warning Do not apply electrical therapy using real medical equipement NOELLE 8554 100 User Guide 47 Click the Linked Action radio button and select from Defibrillation Shock Cardioversion Shock Non Sync Shock or External Pacing Then set the parameters for response to either joules or number of shocks Linked Action Electrical Therapy Defibrillation Shock Cardioversion Shock O Non Sync Shock External Pacing E Joules Joules 7 Joules ma Go to ok Cancel Specify the Go To node the linked action will move the scenario to and click the Add to insert the electrical therapy into the Key Events Click OK to save the changes To apply electrical therapy use the virtual shock panel ee Initial assessment i sfc ened 2 VFib 1 00 00 V fib E Effective shock delivered i fey CI E Adenosine SD IV Push A Cy Additem Add scenario copy Remove addpath gt amen F
120. ll hemorrhage kit with Her religious beliefs prohibit the fluids before running the scenario administration of any blood products June is a 31 year old who is about to Full scenario runs approximately for 22 25 deliver her 5th baby She has had a minutes PPH runs for 8 10 minutes Labor normal pregnancy and plans natural and delivery progress uneventfully Heavy childbirth and breastfeeding Her bleeding begins immediately upon delivery husband and oldest daughter attended of placenta Uterus remains atonic despite the CBE refresher course and she has Fundal massage and rapid pitosin infusion arranged for the 11 year old to attend Patient s BP drops to 80 50 and uterus the delivery begins to clamp down following Cytotec rectal insertion Note Running full scenario requires retraction of motor mechanism and insertion of PPH kit following delivery To run PPH only load June PPH from the scenario tab Kelly is a 34 year old gravida 5 2 38 Runs approximately for 35 40 minutes weeks She is scheduled for an Shortly following SROM Kelly begins induction due to problems with her last having mild variable decels that are pregnancy That baby weighed almost associated with contractions Over the next 10 pounds and she had experienced a few minutes variables become more severe shoulder dystocia with the severe Kelly vomits and begins gasping delivery She has gained 43 pounds then suddenly becomes unresponsive with this pregnancy
121. ly to the manikin without user intervention The voice activation threshold can be adjusted The Mic Threshold is used to adjust how sensitive the microphone is to the user s voice The higher the threshold the less sensitive the microphone is and vice versa For instance if the threshold is set to high users must speak loudly for the microphone to detect the audio Voice Recorder The instructor is able to record his her own speech phrases at any time Once the instructor clicks on the Rec button the software automatically starts capturing everything that is said into the microphone Voice Recorder nee stop Press Stop to finish recording Use the Enter Audio Name window to name the speech phrase Enter Audio Name Enter a name and click OK The phrase will now be accessible under the Prerecorded Speech menu Prerecorded Speech On this section the instructor is able to play any of the custom phrases by either typing on the text box or clicking on the menu option Once a phrase is selected it can be played as the manikin s voice or deleted Prerecorded Speech I m scared My head hurts My name is More If the instructor wishes to play any of the Simulator s prerecorded speech phrases he will need to click on the More button located on the bottom right corner of the Speech page e At any time the user can change the sound volume for sending
122. manual fundal massage Give Cytotec rectally June 3_1 2 fundus firms up June 4 recovering gt Ee pent semnar NOELLE 554 100 User Guide 33 Scenarios are controls are located at bottom of the Scenario page The same way a music player plays songs the Scenario plays palette items Intuitively the facilitator can play stop pause skip or repeat items as appropriate The Scenario Position Indicator points to the current item and shows the current status of the scenario The following paragraphs describe in detail the behavior of each button and indicator An unfilled triangle means that the scenario is stopped When the Play button is clicked the item pointed by the indicator is be played A rapidly blinking triangle means that the scenario is playing the item to which the indicator is pointing A slowly blinking triangle means that the scenario is paused at P the item to which the indicator is pointing Plays the item to which the scenario position indicator is pointing This button has to states play or pause 7 i j Pauses the scenario This state of the play button is m only active when the scenario is playing It is disabled when a Wait indefinitely item is playing because in such case the scenario is already paused l The Stop button has 2 behaviors depending on when it is clicked When clicked once the Stop button halts the scenario at the end of the currently playing it
123. mard in the event that you are in breach of any provision of this Agreement In the event of termination you agree to immediately return this Software accompanying items and any copies thereof to Gaumard 6 LIMITED WARRANTY A THE CD ROM MEDIA THE MEDIA WHICH CONTAINS THIS SOFTWARE IS WARRANTED FOR A PERIOD OF 30 DAYS FROM THE DATE OF PURCHASE TO BE FREE FROM DEFECTS IN MATERIAL AND WORKMANSHIP ELECTRONIC TRANSMISSION IS WARRANTED TO BE FREE FROM DEFECTS AT THE MOMENT OF TRANSMISSION YOUR SOLE AND EXCLUSIVE REMEDY AND GAUMARD S SOLE LIABILITY IS TO REPLACE THE DEFECTIVE MEDIA OR TO REPEAT THE ELECTRONIC TRANSMISSION PROVIDED THAT YOU NOTIFY GAUMARD IN WRITING OF SUCH DEFECT OR DEFECTIVE TRANSMISSION AND RETURN THE DEFECTIVE MEDIA IF ANY DURING THE 30 DAY WARRANTY PERIOD NOELLE 554 100 User Guide 5 B EXCEPT AND TO THE EXTENT EXPRESSLY PROVIDED IN PARAGRAPH A THE SOFTWARE AND ACCOMPANYING WRITTEN MATERIALS ARE PROVIDED ON AN AS IS BASIS WITHOUT ANY WARRANTIES OF ANY KIND INCLUDING BUT NOT LIMITED TO ANY IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR ANY PARTICULAR PURPOSE NO ORAL OR WRITTEN INFORMATION OR ADVICE GIVEN BY GAUMARD ITS DEALERS DISTRIBUTORS AGENTS OR EMPLOYEES SHALL CREATE A WARRANTY OR IN ANY WAY INCREASE THE SCOPE OF THIS WARRANTY AND YOU MAY NOT RELY ON ANY SUCH INFORMATION OR ADVICE GAUMARD DOES NOT WARRANT GUARANTEE OR MAKE ANY REPRESENTATIONS REGARDING THE USE OR THE RESULTS OF U
124. mately 8 Candice admit months pregnant No PNC Ruptured gt 24 hrs Meconium Variables Probable chorioamnionitis more Name Transition Description gt candice 1 00 00 Admission Wait 02 30 Turn patient LLP Candice 1 1 00 00 Labor 1 03 00 check that variables resolve 01 00 Labor 2 02 00 continue routine care Candice While operating in the NOELLE Advanced profile go to the Scenario tab and Click on Load Scenario On the Newborn software load the Quick Start Profile Details Palette Scenario Lab Labor Speech Log Gaumard i Save Scenario Scenario Auto Responses ey 32 User Guide NOELLE 554 100 Select the desired scenario and click on Load Scenarios Haley Heidi postpartum Inez postpartum Janie PPH enh Scenario Description Kelly resuscitation June suffers PFPH following svd Kimberly c_s of healthy baby boy Maria PTL E After loading the desired scenario click the Play button and watch the vital signs adjust according to the specifications of each palette Details Palette Scenario Lab Labor Speech Log Gaumard m n pen June suffers PPH following svd of healthy baby boy June PPH Name Description es June 3_1 early signs of hemorrhage Wait Indefinitely allow time for instructor to place PPH kit in Noelle simulator June 3_1 1 hemorrhaging increase Pit give methergine cath bimanual exploration Bi
125. mmediate resuscitation No spontaneous movement of right arm is noted Stat CXR reveals a fractured right clavicle and right pneumothorax Perform ventilations and needle decompression Wait Indefinitely for actions Perform fluid resuscitation Wait Indefinitely for action NOELLE 554 100 User Guide 173 Newborn HAL Gaumard ae Simulators for Health Care Education Elaine s Baby This baby is born with moderate asphyxia and will require CPR and oxygen to bring the vitals to a healthy state Administer 100 O2 with bagging Wait Indefinitely for actions 174 User Guide NOELLE 554 100 Newborn HAL Gaumard i Simulators for Health Care Education Francines s Baby This baby was born through a C Section and is responsive but needs some attention after a while all vitals go to a healthy state Warm baby apply suction and administer O2 Wait Indefinitely for actions NOELLE 554 100 User Guide 175 Dauman Newborn HAL Siroulators for Health Care Education Gloria s Baby This baby is born with mild asphyxia but no matter how good the interventions are this disastrous intrapartum complication results in neonatal death Begin PPV Wait Indefinitely for action Begin PPV and chest compressions
126. morrhage fluid port inside the abdomen Use bimanual massage to shrink the boggy uterus into a smaller and firmer condition Adjust the uterine pressure using the control in the Details tab or a palette item Uterine pressure settings are also programmable into both linear and branching scenarios Uterine Pres 60 5o emorrhage terine Hemorrhage Hemorrhaging Simulate cervix or birth canal hemorrhage complications with real fluid Follow the steps below to fill the hemorrhage fluid reservoir and start the hemorrhage Warning Prior to starting an exercise always position the simulator so the post partum hemorrhage fluid will flow away from the birth canal and the simulator itself Do not allow post partum hemorrhage fluid to puddle beneath the simulator or reach the lower back panel Failure to do so will result in damage to the simulator The hemorrhage fluid reservoir fill port is located behind the right knee Using the PPH Fill Kit Syringe fill the PPH reservoir with water or diluted Gaumard simulated blood mix The hemorrhage reservoir has a maximum capacity of 850 mL or approximately 15 fill kit syringes Warning Only use Gaumard provided simulated blood Any other simulated blood brand containing sugar or any additive may cause blockage and or interruption of the vasculature system At the end of every simulation always flush the system with distilled water to prevent cloggin
127. n with a severe asphyxia that has to be treated immediately after ventilations and EPI have been given the baby s vitals go towards a good outcome OOMS Meconium aspiration syndrome ROS Newborn with mild Respiratory Distress OOO mo Transient Tachypnea of the Newborn Francine s Baby Helen s Irene s Baby 42 User Guide NOELLE S554 100 Unlike linear scenarios which progress from one palette to the next the interactive branching scenario controls allow the facilitator to change the scenario s trajectory in response to provider actions To access the Branching window click the Go to Branching Scenario button on the Scenario tab Details Palette Lab Scenario Speech Log Gaumard The top panel buttons are used to clear load and save a scenario or to switch from branching to linear scenarios Click Load Scenario to access the preprogrammed branched scenarios in the Quick Start Profile The basic process of creating a new branching scenario is the following e Add nodes e Add palettes or scenarios to each node e Add paths to nodes that require provider action e Create key events to alter the progress and trajectory of the nodes within the scenario A branching scenario consists of several Nodes Each node is preconfigured to run a normal scenario or a series of palettes simulating a specific condition or effect To add nodes click the
128. nfigure bed for delivery NOELLE 554 100 User Guide 129 Scenario Name Labor Type pe eh seon emre sehen Eme Pecos oo peee me fr fon e C mare pe ara amare armon freer marge paeme 130 User Guide NOELLE 8554 100 Noelle 574 575 Labor Scenario Gaumard Alyssa Simulators for Health Care Education Normal Labor Alyssa is a 23 yr old primip at term Her health is generally good and she has experienced no prenatal complications She wishes to receive no medications and will have the CNM attending her delivery Labor duration 30 minutes NOELLE 554 100 User Guide 131 Noelle 574 575 Labor Scenario Angela Normal Labor Gaumard Simulators for Health Care Education Angela is a 31 yr old grand multip term She tells the triage nurse that even though she has had few contractions she came in because she has a history of rapid labors Her general health is good and she has had no problems during this pregnancy V E shows the cervix to be paper thin and Angela is admitted to birthing room Labor duration 30 minutes S amp S Comfortable excited about delivery Perform V E admit patient to BR initiate continuous EFM S amp S feeling pain remo a eee eae ee Urge to push strong Notify patie ano
129. ng episodes during pregnancy and is known to have a low lying placenta She arrives in L amp D complaining of abdominal cramps and has bright red vaginal bleeding Labor duration 30 minutes Labor duration 35 45 Is scenario Branching e Se NOELLE S554 100 User Guide 151 Noelle S574 575 Labor Scenario Gaumard Heidi Simulators for Health Care Education Peripartum Hemorrhage Previa Deliver placenta Wait time 1 min Sedate and perform bimanual exploration Wait time 2 30 min Give pitocin fundal massage Wait time 1 30 min 152 User Guide NOELLE 8554 100 Noelle S 574 575 Labor Scenario Gaumard Heidi Simulators for Health Care Educatior Peripartum Hemorrhage Previa i Deliver and inspect placenta Wait time 1 min Sedate and perform bimanual exploration Wait time 2 30 min Increase pitocin fundal massage give Cytotec rectally Wait time 1 10 min Does bleeding stop Does bleeding NO stop YES Insert Bakri balloon Wait time 1 min NOELLE 554 100 User Guide 153 Noelle 574 575 Labor Scenario Gaumard Haley Simulators for Health Care Education F Peripartum Hemorrhage Previa Haley is a 33yr old
130. ngers should be inserted and the presenting part lifted off the cord to relieve pressure from the cord This procedure must be maintained until the prolapse has been resolved either by termination of the compression of the cord or until delivery of the fetus by C section Placenta Previa Placenta previa is a condition in which the placenta is in the lower half of the uterus located near to or covering the cervical os There are three types of placenta previa Total partial and marginal e Total placenta previa is when the placenta completely covers the cervical os e Partial placenta previa is when the cervical os is partially covered by the placenta e Marginal placenta previa is when the edge of the placenta extends to the internal os where the uterus opens into the vaginal canal NOELLE 554 100 User Guide 107 To simulate placenta previa with NOELLE place the placenta in the desired position to simulate the condition with the maternal side against the uterine wall or the cervical os Then position the fetus within the uterine cavity with the presenting part closest to the placenta External Version Version may be attempted by the care provider to rotate the fetus from a breech position into one permitting normal vertex presentation To practice version remove the abdominal cover and the fetus retract the delivery mechanism fully and insert the inflatable cushion Thoroughly lubricate the inside surface of
131. nly load Candice from labor tab Scenario minutes shoulder McRoberts pressure runs for approximately 40 Baby is delivered after basic dystocia maneuvers such as and stiff arm suprapubic Breech Presentation Dana Is a 24 yr old multip 29 weeks who was admitted because she began contracting Upon V E physician discovers that she is 4 5cm with bulging membranes She was given Terbutaline subQ and then transported to the regional medical center Breech Presentation Demaris is a young Hispanic teen who has received prenatal care in the Adolescent OB clinic She kept the Runs for approximately 45 minutes Instructor must set up baby for double footling breech delivery To skip resolution of contractions portion of scenario it is suggested that the instructor warp to around 20 minute mark on the timeline Runs for approximately 30 minutes Frank breech position has been confirmed by real time U S Patient refuses Cesarean pregnancy a secret as long as was delivery Pinard maneuver must be utilized possible and did not attend any to bring the legs down MLE is performed childbirth classes Her plan is to return and baby is delivered to high school while her mother cares for the baby The baby s father will not accept any responsibility and does not wish to be involved The ER is notified that EMS is about 4 Runs for approximately 20 minutes minutes away with a 19 year old instructor must
132. ntrolled Wait time 3 min Gaumard Simulators for Health Care Education Noelle 574 575 Labor Scenario Gail Uterine Rupture Gail is a 29 year old primip 35 weeks She was admitted to L amp D from the ER after being involved in car accident Both she and her husband Alan were seriously injured and she is on a backboard wearing a c collar to stabilize the spine Her right humerus is fractured and seat belt marks are visible across the abdomen Labor duration 18 20 minutes Establish EFM await cervical x ray results Wait time 1 45 min Remove collar and backboard Wait time 4 00 min Call for emergency c s Wait time 40 sec NOELLE 554 100 User Guide 149 Gaumard Simulators for Health Care Educatior Noelle S574 575 Labor Scenario Gail Uterine Rupture lt p Physically place Noelle on ventilator Prep for c s Wait time 1 30 min Begin c s procedure Wait time 1 min 150 User Guide NOELLE S554 100 Deliver Baby repair uterus Wait indefinitely Gaumard Simulators for Health Care Education Noelle 574 575 Labor Scenario Heidi Peripartum Hemorrhage Previa minutes Heidi is a 25 yr old primip 35 weeks She has experienced several mild bleedi
133. nts recorded in the software log Enabling the AV Link displays the following A V menu Ga u mard ators for Health Care Education GaumardUI Version 1 20 8 0 Firmware 1 25 Copyright 2011 Gaumard Scientific Co www gaumard com Click Start AV to enable the Audio Video messages OK in the log system GaumardUI also permits automatic sending of a Start Record message to the A V Unit If updates are not available the Install button is disabled and the following dialog box is displayed Because itis possible to extend a simulation 0 session beyond the last step in a scenario the DIAGNOSTICS Stop Recording message oeo oo aree EE automatically stop option Use the diagnostics window to test and diagnose For more information go to the Appendix e GaumardUI Version 1 24 11 0 Diagnostics Info SN JO000001 File ais voice E Umbilical O Cyanosis C pee Clicking on A V Setup displays the following dialog Se teats nai Haai a box This menu permits sending Start and Stop oci Oks messages to the recorder as well as displaying the na connection status In order to set up the connection ee on the A V System side please consult your A V O Ventilation System s documentation A V Link Information AV Link Information Adapter Local Area Connection Controler IP 192 168 1 159 Connected to Help The help menu has four options Instruction Manua
134. o All the remaining information can be left blank as it is optional Save Labor Scenario Labor type Other Mother Alice Age 24 Height Stage Information Weight 170 Weight gain Sa Latent s1 Active S1 Transition Stage 2 stage3 Significant Other Mike Maternal Info Respiratory status OB History Cardiac status Gravida 0 Spont Abortions Pain Bleeding Membranes Dilation Station C Alcohol C Tobacco C Illegal Drug Use Other Term 0 Elective Abortions Preterm 1 Living Children Gestational Age Prenatal care C Rx Drugs C Allergies C Anemia C Diabetes C Heart Disease C Hytertension Fetal Info C Tuberculosis Group B Strep C Infectious Diseases C Decreased No fetal movement O STI C Previous C S C PROM PPROM Other Treatment History None 02 AROM IV Started Amino Infusion Post Partum Scenario none FSE IV Pain Meds Epidural O Save Translation and Rotation Parameters The Save Labor Scenario dialog box is divided into the various sections listed below e Mother you can enter specific information about the mother including age height weight among others The only field that must be completed is the name of the Mother e OB History
135. o the mouth and airway The nasogastric intubation feature is used for placement techniques only Fluids cannot be inserted through nasogastric tubes as internal damage will result Breathing Control the breathing and lung sounds synchronized with selectable breathing patterns Use a BVM which will seal around the mouth and nose The ribs have normal anatomic landmarks and the lungs permit an adequate chest rise Normal CPR procedures can be followed with aid of GaumardUI s CPR trainer Cardiac Newborn is equipped with several realistic heart sounds which are tied to heart rates and selectable rhythms Circulation Newborn s software controlled umbilical pulse is blood pressure and heart rate dependent To install or the umbilical cord first turn the simulator off by clicking on File Exit on the GaumardUI software or set the manikin on STAND BY mode The replacement of the umbilical cords should also be done while the manikin is turned off or set on STAND BY mode 114 User Guide NOELLE S554 100 Warning Do not remove or install umbilical cord while Newborn is in ON Newborn s umbilical cord can be catheterized or injected with up to 2ccs To fill the umbilical cord with fluid inject any of the three blood vessels with 2 cc of water using the fill syringe For catheterization use a 6 Fr urethral round tip catheter lubricated with silicon oil The umbilical cord can be trimmed or clipped
136. on Clock resets the clock back to zero It does not have any effect on the transition time remaining on a scenario it does not reset the vital signs or clear out loaded scenarios The facilitator can also reset the session clock by clicking on the Session button next to the session time Clocks Transition remaining 00 00 00 06 04 52 This option allows you to save all the information recorded in the log page as a text file Clicking on it brings up the Save As dialog box eee Organize v New folder a gt J Favorites Name Date modified Type No items match your search gt a Libraries a Homegroup gt jE Computer gt Gia Network 4 m File name Report 1 Save as type Text files b a Hide Folders Select the desired name and path and click Save The shortcut key for saving a report is Ctrl S For a sample report look at the figure below rmn R ee File Edit Format View Help 02 11 2011 01 38 12 Session Facilitator Providers Team Alice is a 24 year old female weighing 170 pounds W Gain NA Her significant other is Mike Her OB history shows a gravida of 2 a term of 1 a preterm of 0 and that she is currently 39 weeks pregnant she has had 0 spontaneous abortions 0 elective abortions and 1 living children She has had prenatal care She has been currently using no medications of any kind Her medical records sho
137. on within the birthing torso Route the inflation bulb outside NOELLE through any space open on the left side Place the birthing baby in the elevating cushion in the vertex breech or transverse positions Install the tummy cover Inflate the elevating cushion until the fetus can be felt under the abdomen cover Warning Do not enable the motorized birthing mechanism while performing this exercise Placing elevating pillow within simulator Place fetus onto elevating pillow and lift fetus anteriorly using the squeeze bulb NOELLE 554 100 User Guide 105 Set abdominal cover into place Lift fetus anteriorly using squeeze bulb until it can be felt under the cover Shoulder Dystocia Shoulder dystocia is a dangerous condition defined in the NOELLE Guide as the arrest of delivery of the fetal body after the successful delivery of the fetal head It may be characterized by the so called turtle sign wherein the fetal head moves forward and then retracts 106 User Guide NOELLE 554 100 During dystocia the fetal shoulders become wedged behind the symphysis pubis NOELLE may be used to practice the resolution of dystocia using episiotomy techniques the McRoberts maneuver suprapubic pressure posterior arm sweep or elbow knee delivery The McRobert s maneuver causes pelvic tilt that helps release the fetal shoulder from behind the pubic bone Suprapubic pressure may al
138. one gain until simulator voice level equals user s voice intensity Always talk as close as possible to the microphone in order to improve quality Using a headset is recommended Respiration and other undesirable Since simulator s microphone has high sensitivity in order to capture sounds are heard by instructor the voice of providers it also captures all surrounded noises on or around the simulator This is normal and it is not a malfunction Simulator is set to Generic Make sure to select multiple simulator environment Setup Options Environment menu Setup gt Options gt Environment tab and enter the Serial Number of the simulator you are using Warning Streaming audio is disabled in generic mode simulator is checked Streaming audio does not The backup battery on the simulator Plug charger into the simulator Verify LED light on charger indicates work tab is not displayed is depleted charging status NOELLE should always be plugged in while being operated The birth mechanism is power intensive and will drain the backup battery quickly Reconnect Newborn to the charger GaumardUl has set the Wired communication module is not Connect the communication module to any USB port power mode to STAND BY connected automatically Wired communication Wired communication is module not Close the software and try disconnecting the communication module module not found message identified by the comput
139. onvulsing in the bathroom According to relatives she is 81 2 months pregnant with her first baby She has been on an IV during transport and her BP is 180 120 Labor duration 20 S amp S Responsive only to pain with groans Vaginal bleeding S amp S Suffers tonic clonic seizure prolonged fetal bradycardia results Stat page on call OB attending Give Magnesium sulfate bonus Employ safety measures during seizure give another Magnesium sulfate bonus Prep for precipitous delivery following tetanic ctx Hang pitocin infusion following placental delivery to encourage uterine contraction NOELLE 554 100 User Guide 141 y Noelle 574 575 Labor Scenario 4 Gaumard Eleanor iia cai ak Variations on Normal 142 User Guide NOELLE 8554 100 Noelle 574 575 Labor Scenario Gaumard Erin Simulators for Health Care Education Preeclampsia Erin is a 28 yr old 38 weeks admitted by her physician for preeclampsia She is stared on Magnesium sulfate per protocol induced with pitocin and her membranes are ruptured Light meconium staining is noted following AROM Labor duration 60 minuntes NOELLE 554 100 User Guide 143 4 l Gaumard Im ula oO fealth Care Education Noelle S574 575 Labor Scenario Faye
140. ou to change the display on the vital signs monitor The following options are specific to the Newborn control software Configure Newborn features available in the Newborn software e Pulse Set pulse strengths for normal BP 60 40 COTO Serre E Once a Palette is applied load to Details Tab Enter the activation code to enable upgrade features Activation codes are unique to the simulator s serial number Before entering a code go to the Environment tab and set the connection mode to FIXED then enter the simulator s serial number E Use AV System C Start AV Automatically on Scenario Start C Output Log Events to Windows Log F Use single monitor for maternal vitals and fetal traces e Virtual Monitor Enable the Monitors menu option to configure the virtual monitor connection For more information on connecting the virtual monitors go to page 186 e MOES Enter the MOES activation code to enable the MOES Standard curriculum profile Select FM to display the fetal monitor and Options MV for maternal vitals You can also have both screens auto change from one to the other To do so select the box labeled auto flip and specify how often you will like the switch to take place Environment NEWBORN HAL s Add Ons add ewen more fidelity to your simulation NEWBORN HAL Virtual Monitor Use Newborn Hal Virtual Vital Signs Monitor Enter the activation code to enable upgrade f
141. place C collar on NOELLE pregnant postictal patient named cimulator before beginning scenario Eleanor Her aunt found her con puring delivery patient has tonic clonic vulsing in the bathroom and called 911 ceizure followed by tetanic contractions The aunt told the EMS providers that Fetal baseline drops to approximately 60 Eleanor was 81 2 months pregnant with bom SVD occurs very quickly Infant is her first baby and that it was a difficult cyanotic and limp and no respiratory effort family situation She added thatlics evident Eleanor had just moved in with them and had not yet seen a doctor The paramedic reports to the ER physician by radio that the patient is responsive only to pain Her initial blood pressure is 180 120 The EMS crew applies a C collar and move her onto a backboard for transport The para medic initiates ECG monitoring and does a genital exam before they move her She notes a small amount of vaginal bleeding The crew moves her to the ambulance and the paramedic starts an IV of LR and initiates oxygen 10L by non rebreather mask She monitors the ECG and VS during transport and also tilts the backboard about 15 to the left with a blanket roll to decrease vena caval compression Eleanor has no further seizure activity during transport but her BP remains consistently 180 110 The ER notifies L amp D about the patient and asks that an OB nurse come to the ER to assist o 7 Erin is a 2
142. plate and description sent status or colors Details Palette Lab Scenario Labor Speech Log Lab Reports Name Template Healthy 2 OB Blood test Neonate Blood test Metabolic Panel Description Healthy Levels Healthy Levels Session 1 Session 4 Simulation 1 High levels High levels Session 2 Session 2 Select a lab report and click the Preview button on the right panel to view the report on the facilitators screen From the Lab Preview window the facilitator can print as well as send the report to the virtual monitor computer To make changes click Close and then edit Lab Preview Lab 01 11 36am Above normal range Cholesterol LDL Cholesterol HDL Cholesterol mg dL 35 00 85 00 Cholesterold HDL Ratio 0 00 4 40 0 00 199 00 0 00 129 00 30 00 200 00 The preview window also allows the printing of results for distribution and archiving To make changes click Close and then edit Begin by selecting the report from the lab reports list Sent sapere tat View Sort by Color Selected Item Lab Reports Namie Template Healthy 2 OB Blood test Healthy Levels Healthy Neonate Blood test Healthy Levels Metabolic Panel Session 1 Labos tipid Panel Above normal range Cholesterol LDL Cholesterol CBC DIFF High levels High levels Simulation 1 Session 2 Session 2 Session 4 Description Click the Send to Monitor button to transfer the lab report to the
143. played in the Clocks panel at the bottom of the GaumardUI window If there is already an ongoing transition at the moment you click an Apply button it will stop and a new transition will begin from the current physiological state Tae TTI T a g L Transition remaining 00 00 00 Session 17 31 21 N When cardiac rhythm is maintained at Ventricular Tachycardia for one minute the following prompt dialog box will be displayed Ventricular Tachycardia x i minute has passed since the patient is in Ventricular tachycardia A do you wish to degrade to Ventricular fibrillation Click NO to re check the Cardiac Rhythm in one minute Click CANCEL to stop checking every minute the Cardiac Rhythm Cancel Click Yes to degrade the cardiac rhythm to ventricular fibrillation Click No to maintain the cardiac rhythm and recheck after 1 more minute Click Cancel to stop the software from checking the cardiac rhythm every minute Click on the UA FHR vertical tab to access uterine activity and Fetal Heart Rate controls A UA lt Click button to generate spontaneous contraction with current parameters TOCO Contraction Intensity 8 Contraction Frequency min Contraction Duration sec No Contractions C O mild R Resting Tone mmHg Moderate g Strong Coupling Probability Size WPC mmHg V lt Select FHR pat
144. ple ures Hemorrhage Uter O Uterine Hemorrhage 112 User Guide NOELLE 8554 100 Vital Signs Monitor The vital signs monitor simulates a vital signs monitor attached to the simulated patient The vital signs are synchronized through a wireless network between the facilitator s tablet and the computer running the monitor You can customize each trace independently of each other users can set alarms time scales boundaries and grid options mtot i J Turn On FHR Beep ver re a For information on how to setup Gaumard Monitors with GUI please refer to the Appendix The Micro system is an all in one debriefing and simulator control solution for facilitators working in a lab or mobile environment The system combines GaumardUI and powerful audio video recording software in one control laptop Working with Newborn NOELLE 554 100 User Guide 113 Airway Newborn s airway can be intubated orally using LMA or endotracheal tubes and nasally using a nasogastric tube Procedure Recommended Device Size Intubation Blade size Miller O LMA Size 1 Nasal Intubation 8 Fr catheter ETT 3 0 no cuff 6 Fr suction Oral Intubation catheter Warning Always lubricate tubing airway and nasal opening prior to performing any nasal or oral intubation Failure to do so will make intubation very difficult and is likely to result in damage Do not place silicone oil directly int
145. r and takes her to L amp D Frances is admitted into a small town hospital due to regular contractions 4 minutes apart and bloody show She labors without problems for about 4 Runs for approximately 22 27 minutes Instructor must set up prolapse cord prior to beginning scenario Instructor may disconnect NOELLE simulator from power hours and then the fetus starts to brady down after SROM A V E reveals a prolapsed coed in the vagina Cord Prolapse outlet and continue running scenario while transferring the NOELLE birthing simulator to the OR Gabriella Uterine Rupture Gabriella is a young Hispanic woman who presents to a small hospital just across the Mexican border She is alone and speaks little English Her nurse Is fluent in Spanish but Gabriella is very quiet and gives little information Runs for approximately 25 minutes Shortly after admission patient clutches her abdomen and fetal baseline bradys down to the 80s Patient becomes very pale and diaphoretic BP drops to 80 60 and pulse is 120 She suffers heavy vaginal bleeding Patient is rushed for emergency C Section Baby is limp and severely depressed needs to be intubated and ventilated Uterine Rupture Gail is a 29 year old primip 35 weeks She was admitted to L amp D from the ER after being involved in car acci dent Both she and her husband Alan were seriously injured and she is ona backboard wearing a c collar to Stabilize the
146. r to utilize Details Palette Lab Scenario Labor Speech Log Gaumard Lab Reports Template Description sent zeate mew tab Lab Template Template Description CBC DIFF Platelets Differential Lipid Panel Cholesterol HDL LDL Triglycerides Metabolic Panel Anion Gap Albumin Alkaline Phos Calcium Choride Neonate Blood test For newborn and premie OB Blood test Noelle The Gaumard Virtual monitors must be connected before using the file sharing feature To verify the connection navigate to PAGE 94 To begin navigate to the bottom of the tab and click on the New Template button on the right panel Description Platelets Differential Selected Item Cholesterol HDL LDL Triglycerides Anion Gap Albumin Alkaline Phos Calcium Choride For newborn and premie 26 User Guide NOELLE 554 100 The Edit Lab Results Template window is used to create templates that will be later used to create lab reports Enter a name for the lab template followed by a description He Edit Lab Results Template Description Category Single Entry add Remove Rename Insert A add Delete Allowed value range is displayed in Value column It won t be visible when entering data Categories are used to group a series of tests in a lab report From the Category box click Add to name and create a category Then click OK to save the new category HE Edi
147. ration 30 minutes Admit patient Routine labs notify HCP of admission and status Set up delivery table and infant warmer configure bed for delivery 118 User Guide NOELLE 554 100 Noelle Labor Scenario Alicia Variations on Normal Gaumard Simulators for Health Care Education Alicia is a 24 year old gravida 2 1 at 39 weeks She weighs 160 pounds She has had prenatal care She has not been using medications of any kind Labor duration 20 minutes NOELLE 554 100 User Guide 119 Noelle Labor Scenario Amy Variations on Normal Gaumard Simulators for Health Care Education Amy is 19 years and she weighs 160 lbs Her OB history shows a gravida of 1 She is currently 40 weeks pregnant She enters LD accompanied by her mother Labor duration 30 minutes 120 User Guide NOELLE 554 100 Noelle Labor Scenario Angelica Variations on Normal Gaumard Simulators for Health Care Education Angelica is a 31 year old gravida 5 3 at 41 weeks She weighs 160 lbs She has experienced no prenatal complications and has a history of fast labors Labor duration 20 minutes NOELLE 554 100 User Guide 121 As Noelle Labor Sc
148. rd Physiological Modeling State Model rate a s PAUSE physiological oxygenation modeling Modeled Therapy Improve Gain J Oxygen IMPROVE adequate oxygen perfusion breathing DETERIORATE compromised oxygen perfusion apnea 0 Limin Epinephrine 0 0 Elmo Healthy Mild Cyanosis Severe Cyanosis dose onboard 0 CPR Monitor Effective RCD Min Ventilation Range 30 COMPRESSION Pause Model will pause at the current state Improve Model trend to a healthy state Once the model reaches the complete Healthy state the model will go to Pause mode Deteriorate Model will trend to a severe cyanotic state If ventilations given to the neonate are of correct depth and between 40 and 60 per minute the vital signs will improve Otherwise they will continue to deteriorate The facilitator can quickly jump to any of the three points in the state of the model Healthy Pedi is pink with adequate oxygenation Mild Cyanosis Pedi is bluish and vital signs are starting to deteriorate Severe Cyanosis Pedi is blue apneic and vital signs are rapidly worsening Improve Gain Moving this slider will help increase or decrease the cyanotic response to ventilations Oxygen By selecting an oxygen rate the baby will improve faster with proper ventilation Flow On must be selected to activate the oxygen response Epinephrine Select the desired epinephrine dose and then
149. re to do so could result in liquid accumulating in the pelvic cavity and damage to the birthing mechanism Always position the simulator so post partum hemorrhage fluid flows away from the birth canal and the simulator itself Do not allow post partum hemorrhage fluid to puddle beneath the simulator or reach the lower back At the end of every simulation always flush the system with distilled water to prevent clogging To prevent staining or molding always clean NOELLE using diluted soap and water Remove the birth canal and clean thoroughly Always lubricate the fetus and the birth canal before every delivery Failure to do so will result in damage to the birthing mechanism and the birth canal Do not pull the baby upward in contrast to the birthing mechanism s linear trajectory Doing so can bend the motor arm and cause damage to the birthing mechanism NOELLE 554 100 User Guide 9 Getting Started 10 User Guide NOELLE 8554 100 Overview The NOELLE S554 100 is a comprehensive package of simulator technology scenario based training and performance measurement and debriefing tools designed e Display up to 8 numeric values including HR ABP RR CO2 SpO2 temperature NIBP and time e Select up to 5 dynamic waveforms including ECG II ABP respiration CO2 and pulse oximetry e Fetal Heart Rate monitor to build competencies needed to help manage OB emergencies OTHER j HIGHLIGHTS
150. real time reported if the respiration rate is set to zero Ct Compression time Average length of each compression in seconds The CPR evaluator feature provides real time feedback on the providers compression and ventilation performance last compression performed VENTILATION DATA LC Last Compression Time elapsed since the Rate Ventilation rate in real time PIP approx Peak Inspiratory Pressure 0 10 a Ti Time Inspiration I E Inspiratory Expiratory Ratio Compression Data 26 Ventilation Data ae a walie PEEP approx Positive end expiratory I E PEEP pressure 1 0 6 14 12 LV Last Ventilation Time elapsed since the Too Many Compressions 242 Too Many Ventilations 9 last ventilation performed L 9 OK 129 H 104 L 0 OK 0 H 9 Eon TRAINER ihe provider perlormance indicator Doxes arc eet desrei on the right The V ventilation and C compression The CPR trainer features generates a visual queue of box fill color changes between the following states the compression to ventilation ratio programmed in the CPR Options menu When the Trainer button is clicked the V ventilations and C compressions box e Grey No intervention borders blink to indicate the correct reference CPR was detected rate e Yellow Compression was too shallow Ventilation was too weak e Green Compression ventila
151. rway 00 00 all difficult airway actuators on Wait Indefinitely eae Hold in current state until action is taken Resting 01 00 Normal Vitals gt cototabor ee Warning Prepare the simulator for delivery before using a linear scenario that automatically transitions to a labor scenario NOELLE 554 100 User Guide 41 These scenarios in the Quick Start Newborn profile when the Newborn software is activated There are eleven linear scenarios Scenario Name Alice s Baby Healthy baby Baby has an asphyxia attack and the providers need to give ventilations to help bring back a the vitals to a healthy state Baby is born with a mild asphyxia that needs attention Once ventilations start the baby s vitals go to a healthy state Scenario Description Beth s Donna s Baby Male infant with central cyanosis limp flaccid and requires immediate resuscitation No Cynthia s Baby spontaneous movement of right arm is noted Stat CXR reveals a fractured right clavicle and right pneumothorax foes This baby is born with moderate asphyxia and will require CPR and oxygen to bring the Panes BAY vitals to a healthy state This baby was born through a C Section and is responsive but need some attention after a while all vitals go to a healthy state Goras Bab This baby is born with mild asphyxia but no matter how good the interventions are this y disastrous intrapartum complication results in neonatal death This baby is bor
152. s 132 User Guide NOELLE S554 100 la Noelle 574 575 Labor Scenario Gaumard Becca AE R HEE A papa E Variations on Normal Becca is a young pregnant teen who is living on the streets She is a heavy smoker and drug user She was seen twice in the Adolescent Clinic and referred to Social Services but she only saw the social worker once and did not go to the follow up appointment Labor duration 18 22 minutes S amp S Patient is screaming and uncooperative Prep for precipitous delivery support fetal head to prevent explosive delivery check for nuchal cord if possible check for intact placenta at delivery S amp S SROM followed by Becca pushing hard Program swithces to scenario tab automatically Stat Page anesthesia for sedation bimanual Instructor to reset birthing motor exploration for retained sedate for bimanual exploration secundes collect labs for tox Wait time 2 40 min screen Use of Bimanual uterine massage and pitocin to maintain contractions Remove placental fragments Wait indefinitely NOELLE 554 100 User Guide 133 G qd Noelle 574 575 Labor Scenario ansaid Bianca Simulators for Health Care Education Variations on Normal Bianca is a 16 yr old 38 weeks who shows up in
153. s A collection of palette items are included in the quick start profile Click the Load Palette button to load a prebuilt palette item Select a palette item from the list and click Load Finally click apply to submit the changes Legend on of A 5 Breathing Resp Pattern normal im U A Respiratory Rate OSat _ 29 breaths min 98 change change EtCo2 mmHg Inspiratory Time 33 40 a change To create a Palette Item adjust the vital parameters and features on the Details tab and click the Save as Palette Item button near the top of the page Save as Palette Item Palette Item Name Healthy Palette Item Description Normal Vital Signs Color Healthy Care Required 24 User Guide NOELLE 554 100 Palette The second level of control is the Palette tab page Each item on the Palette represents a complete or partial physiological state The Palette page displays all of the Palette Items in the active profile Each profile has its own separately customizable Palette Create Palette Items with the Details page as described previously Details Palette Scenario Lab Labor Speech Log Description admissi Transitional Labor Second stage Delivery Stage 1 Active Stage Transition Apply Palette Items using the buttons at the bottom of the page exactly as changes to NOELLE s condition are applied on the
154. s twice to secure the birthing baby a clicking noise can be heard coming from inside the baby The user then must hold the baby until the noise stops and make sure that it is locked by pulling the baby to check that it is held fast For more information on preparing the simulator for delivery navigate to page 101 Follow the guidelines below when releasing the baby from the birthing mechanism To troubleshoot any additional issues please navigate to page 183 If shoulder dystocia turned OFF e The release mechanism is automatically actuated ten times in Oone second intervals once vertical progress bar reaches STAGE 3 e The baby has descended more than 80 of its entire translation baby s head is out and user pulls the baby with more than three pounds of force e By pressing the Release Baby button inside the Labor tab If shoulder dystocia is turned on e When user pulls the baby with more than 35 Ibs the baby is released as a safety feature in order to avoid damage e By pressing the Release Baby button inside the Labor tab 60 User Guide NOELLE S554 100 e Allow at least 30 seconds after the baby has been initially locked before trying to release it e The labor progress line reaches Stage 3 and dystocia is turned off Warning Guide the baby out of the birth canal by gently pulling in line with the birthing mechanism Pulling the baby upward or downward in contrast to the birthing mechanism s linear tr
155. she is 4 5cm with bulging membranes She was given Terbutaline subQ and then transported to the regional medical center Labor duration 45 minutes NOELLE 554 100 User Guide 139 Noelle 574 575 Labor Scenario Gaumard Simulators for Health Care Education Demaris Breech Presentation Demaris is a young Hispanic teen who has received prenatal care in the Adolescent OB clinic She kept the pregnancy a secret as long as was possible and did not attend any childbirth classes Her plan is to return to high school while her mother cares for the baby The baby s father will not accept any responsibility and does not wish to be involved Labor duration 30 minutes Admit patient Routine labs notify HCP of admission and status Order real time U S to determine fetal position S amp S Agitated uncooperative FHTs are above the umbilicus Attempt to get patient consent for c s transfer patient to OR for delivery insert FSE on fetal buttocks S amp S Patient and mother vehemently refuse to consent to C S AROM 140 User Guide NOELLE 554 100 Gaumard Simulators for Health Care Education Noelle 574 575 Labor Scenario Eleanor Variations on Normal minutes Elenor is a 19 yr old post ictal patient being transferred to the ER by EMS She was found c
156. so display connected Noele 574 575 Virtual Monitor Setup Select the number of monitors that will be used with this manikin Also you can name each monitor with an appropiate description O Al sensors aways ON i except tor Swan Ganz Adapter Wireless Network Connection Controler IP 10 0 0 1 Port 8001 Connected to 10 0 0 3 Stop Diagnostics The Diagnostics window can be accessed by going to the Help menu and selecting Diagnostics This window is very useful for troubleshooting because it gives the user feedback on all of the working modules inside the simulator The user can click on the button that says Check All Modules and the software checks which modules are responding 190 User Guide NOELLE 554 100 GaumardUI Version 1 24 11 0 Diagnostics Info SN J0000001 File Audio Mechanical Other Legend Throat voice Umbilical cyanosis C Active Heart Breathing cyanosis P Inactive Lung Front Upper Left Check Modules Lung Front Upper Right Check sone Pressure Compression Compressor Ventilation Also check individual modules by clicking on the module to highlight Notice that the name of the module is displayed on the right column Now click on the Check Single Module button Other Legend J ECG ECcG2 Active Module Trachea Intubation Inactive selected Check Modules Eyelids Right Pupil Dilation Left Pupil
157. so release the fetal shoulder To demonstrate shoulder dystocia place the fetal baby in the ROA position Activate the delivery mechanism moving the fetus down the birth canal until the fetal head is delivered Simulate dystocia by clicking the Turn ON Dystocia button on the Labor Tab Once the dystocia mode is active the fetal traces will automatically convert to real time mode and with each subsequent contraction there will be a Turtle Sign Students must use the various maneuvers including fetal manipulation to deliver the baby Once the students perform all of the appropriate maneuvers required by the instructor the dystocia mode can be deactivated by clicking on the Turn OFF Dystocia button Once the dystocia mode is off the fetal traces and labor warp factor will adjust to the previous settings and the labor will continue resulting in delivery of the baby lt is very important that the students are aware of the Turtle Signs If for any reason the students fail to recognize the proper corrective procedures required the labor can be stopped completely and set up again The instructor can then add an unsatisfactory note to the log of the providers actions Normally the fetus is retained by the delivery mechanism so that it can be rotated but not delivered The facilitator can either turn off the dystocia mode to allow the baby to be delivered in the normal fashion or press the Release Baby
158. speech vitals gt Check ROT LOT delivery nop Gm ud Pause Run Reset Labor Time 00 00 00 LUT Mimin T TTT The contraction response feature makes your labor simulation more realistic When enabled this feature can automatically make changes to the maternal vital signs or add ee palettes during the contraction Contraction Response Enable Contraction Response There are two kinds of patients that you can simulate Pain controlled patients and patients with uncontrolled pain The changes made are different depending on the selection speech or speech vitals Maternal Vital Signs Audio Palettes Changes Simulates a think I m having patient that is contractions pain controlled No Changes Ouch Ahhh Please need Simulates a Increase HR something forthe patient that is BP and RR pain Please NOT pain give me an controlled epidural Speech vitals The changes are applied only during the length of the contraction At the end of a contraction the maternal vital signs if changed adjust back to the previous setting 56 User Guide NOELLE 8554 100 When a contraction response is applied the changes are recorded in the Log page Pain controlled patient 00 00 44 00 00 56 00 00 59 00 01 11 00 01 12 00 01 21 00 01 30 00 01 33 s Contraction Response Speech Contractions gt Applied 00 00
159. spine Her right humerus is fractured and seat belt marks are visible across the abdomen Runs for approximately 181 20 minutes Use file sharing feature to display pictures of C spine x ray as patient was involved in car crash Haley Peripartum Hemorrhage Previa Haley is a 33yr old G2 35 weeks Previous U S revealed a low lying placenta and this is the 5 time in 11 weeks she been admitted for bleeding This time the bleeding is is heavier and is not resolving Her OB is on the way to the hospital bimanual palpation shows the uterus to be soft and non tender Runs for approximately 15 minutes Instructor must set up for partial placenta previa Instructor must fill hemorrhage kit with fluids before running the scenario Runs for 35 45 minutes This scenario utilizes a vaginal delivery even though there is a low lying placenta Instructor has option to run a linear or a branching postpartum section of the scenario Instructor must fill hemorrhage kit with fluids before running the scenario Peripartum Hemorrhage Previa Heidi is a 25 yr old primip 35 weeks She has experienced several mild bleeding episodes during pregnancy and is known to have a low lying placenta She arrives in L amp D complaining of abdominal cramps and has bright red vaginal bleeding 66 User Guide NOELLE 554 100 Peripartum Hemorrhage Peripartum Hemorrhage Abruption Peripartum Hemorrhage PPH Peripartum Hemorrhage PP
160. t Lab Results Template Name Lipid Panel Description Cholesterol HDL LDL Triglycerides Category Single Entry i Remove Rename insert a v add Delete EIS Category Name Lipid Panel Female Comment Use the Single Entry menu to add a test under the category previously created Edit Lab Results Template Name Liquid Panel Description Cholesterol HDL LDL Triglycerides Category Single Entry add l Remove Rename insert A l Yy Lipid Panel Female Variable NOELLE 554 100 User Guide 27 Use the Add Edit Entry menu to customize the different parameters on a specific test Begin by providing the name of the test unit and decimal precision The Normal Range will be displayed on the lab report for the provider to use as guide while reading the results Meanwhile the Allowed Range restricts the minimum and maximum value a facilitator can input as a test result Once the test entry is configured click OK to add the new test Ei Add Insert Entry Name HDL Cholesterol Unit Precision 2 Normal Range Minimum 35 00 Maximum Allowed Range Minimum Maximum etd Repeat the process to add more tests and categories using the Category and Single Entry menu Please note that individual items can be moved deleted or modified after they are created After all the tests are entered n
161. tat sedation bimanual exploration and massage Increase Pitocin give Methergine straight cath administer Cytotec rectally Transition time 3 min Discontinue massage as the uterus bagins to firm up following Cytotec dosing Gaumard Simulators for Health Care Education Noelle 574 575 Labor Scenario Kelly Amniotic Fluid Embolism 35 40 minutes Kelly is a 34 yr old gravida 5 2 38 weeks She is scheduled for induction as her last baby weighed almost 10lbs and she experienced a severe shoulder dystocia with that delivery She has gained 43lbs with this pregnancy and her GTT is borderline Labor duration 25 minutes Scenario duration S amp S sudden onset of pain following ROM asks for epidural S amp S Patient says she is having trouble breathing vomits suddenly becomes non responsive Rush to OR for emergency c section Intubate ventilate stat page anesthesia and NICU personnel Turn patient LLP to resolve variables put O2 mask on patient discontinue Pitocin Give SQ Terbutaline to reduce ctx NOELLE 554 100 User Guide 163 Noelle S574 575 Labor Scenario Gaumard Kelly Simulators for Health Care Educatior Amniotic Fluid Embolism Perform emergency C section Wait time 3 m
162. te Description Metabolic Panel Neonate Blood test OB Blood test PPT Report Name Prothrombin Time Provide a Report Name Report Time and Description In addition select a condition color tag for the lab report on the right panel Color tags aid the sorting of lab reports on the report list window Edit Lab Report Lab Template Lipid Panel Cholesterol HDL LDL Triglycerides Color Healthy Critical Care O Other Report Name Lab 01 Report Time 11 15am Description Above normal range Cholesterol LDL Cholesterol Input the results of the tests on the Value column Values above the normal range specified will be displayed in bold Include any comments associated with the test performed Finally click Save from the top right menu to create the lab report Description Above normal range Cholesterol LDL Cholesterol Lipid Panel Female Variable Normal Range HDL Cholesterol mg dL 35 00 85 00 Cholesterold HDL Ratio 0 00 4 40 5 Care required Lipid Panel Male Variable Normal Range HDL Cholesterol mg dL 29 00 71 00 Cholesterol HDL Ratio Ratio 0 00 4 90 Lipid Panel Both Variable Normal Range Cholesterol mg dL 0 00 199 00 LDL Cholesterol mg dL 0 00 129 00 Triglycerides mg dL 30 00 200 00 NOELLE 554 100 User Guide 29 The newly created lab report will be listed on the Lab Reports list Lab reports can be sorted by name tem
163. tern and dick button to generate spontanerous FHR change FHR Baseline bpm Variability Accel Decel Intensity vi Episodic Changes i Periodic Changes Variable Changes UA The instructor can generate a uterine contraction at any time by clicking the UA button the contraction will have the same duration and intensity settings applied on the status viewer FHR Generate a fetal heart rate acceleration or deceleration at any time by selecting one of the options in the drop box below the button and then clinking on the button FHR lt Select FHR pattern and click button to generate spontanerous FHR change Prolonged Accel longed Decel NOELLE 554 100 User Guide 23 A Palette item stores several vital parameters in a single container Use palette items to quickly change multiple parameters at once For example a facilitator may choose to create a palette item that stores all the vital parameters of a healthy patient Then at any moment in the simulation quickly return to a healthy state by loading the palette item Palette items are also used to build scenarios as covered on page 32 As part of the scenario building process a facilitator will first create a series of individual palette items which represent physiological states The scenario feature then automates the loading of palettes in succession to simulate patient recovery or complication
164. the evaluation template design is complete click Save at the top of the window Evaluation Form Load template lx Save Gear Delete Evaluation Name Vacuum Deliveryl On Site Reviewer Category Multiple Choice Entry 6 Finally select the new template from the Load template drop down to use the completed evaluation form Evaluation Form Load template l Save Clear Delete Breech Vaginal Delivery Edamptic Seizure Forceps Delivery On Site Reviey Postpartum Hemorrhage Shoulder Dystocia Evaluation Nan Category Umbilical Cord Prolapse Multiple Choice Entry 6 Vacuum Delivery NOELLE 554 100 User Guide 83 Menus Setup Monitors Help Profile New Session Reset Session Clock Sawe Report Print Report Import This option allows you to change your current profile The profiles dialog box displays the available profiles A software restart is not necessary to switch between profiles Clicking New Session in the file menu will e Clear any loaded playing scenario e Clear any loaded playing palette e Reset vital signs to normal values e Clear out log page e Restart the session clock The session clock is located at the bottom of the dialog box Clocks Transition remaining 00 00 00 The shortcut key for staring a new session is Ctrl N 84 User Guide NOELLE S554 100 Clicking on Reset Sessi
165. the labor control panel Increase the Warp Factor to simulate a 30 minute labor in a fraction of the time Warning Always place the tummy cover on the birthing cavity prior to starting the labor mechanism Click the Run to begin the labor process Details Palette Scer Load Labor Labor Control Dystocia Contraction E Enable Smart Labor 10 H sec le A ON OFF E Enable Co E Only descend during contractions Pause Run eset Time Information Labor duration 30 Save Labor Station 4 The labor mechanism will descend as indicated by the green vertical progress bar and descent curve ee W speecn i Pause Run Reset Alice SS E E OE 20 40 60 60 100 120 140 160 5 4 3 2 1 0 1 2 3 4 5 6 7 9 10 11 12 13 14 15 During delivery fetal heart tones can be heard by placing the bell of a conventional stethoscope on the abdomen Move it around until the tones are clearly heard Tones are supplied via a small speaker located in the fetus The first few centimeters of movement normally take about half the total delivery time The baby rotates internally as it moves forward after the head is delivered and before the shoulders are delivered NOELLE 554 100 User Guide 103 The fetus is turning and the head is crowning Warning Guide the baby out of the birth canal by gently pulling in line with the birthing mechanism Pulling the baby wit
166. the line and dragging it to the desired location on the grid In order to add more points right click on the line between existing points and select Add Point To remove points right click over the point and select Remove Point Pause Run 5 4 3 2 a ae eee esd earl feed ee A E E a a Es a i 0 1 2 3 2 5 6 7 8 3 5 4 3 2 1 0 1 2 3 4 5 Ss ae as aa J Remove Point NOELLE 554 100 User Guide 57 The time line is where Palette Items are added to build the labor scenario As the time indicator line passes over each point the corresponding Palette Item is implemented To add a palette item right click on the time line and select Add Palette This will open a window with all the palette items available in the current profile Add 22 59 kes Item Description Transitional Labor Once the point has been added you can touch it with the stylus and drag it to the desired location on the time line Double click over the point to bring up a window displaying the properties of the Palette Item represented by the point 58 User Guide NOELLE 554 100 To remove or edit a palette item from the time line right click over the point and select the desired option The user can remove all palette items at once by pressing the Clear button located to the left of the timeline When all palette items are removed the user is le
167. tion was performed correctly e Red Compression was too deep Ventilation was too strong NOELLE 554 100 User Guide 95 By default the trainer is configured to blink the reference borders at a 30 2 compression to ventilation ratio To change the ratio navigate to the menu bar and click the CPR dropdown and CPR Options Options Environment General Hal Add Ons Hal Pulses CPR Options Pacing Shock Tolerances Log Ventilations are too shallow Waveform peaks do not reach the green zone ventilations and Compressions 100 Compressions per minute Compression Ventilation Ratio J30 2 Only Ventilations 12 Ventilations per minute Compressions are too shallow Waveforms mostly do Ventilations are too strong Waveform peaks exceed not reach the green zone Compression indicator is the green zone yellow Ventilation was performed correctly Waveform peak Compressions are too deep Waveforms mostly is inside the green zone exceed the green zone Compression indicator is red Compressions are performed correctly Waveform peaks are mostly inside the green zone 96 User Guide NOELLE S554 100 A V ABOUT GUI This window gives you the version of the software you GaumardUl is capable of interfacing with a number of are currently using and also the firmware version third party A V recording systems that enable the capture of Audio and Video interlaced with the eve
168. tion is also dependent on the labor curve Notice that the internal rotation marked as 1 on the diagram above will be calculated between the stations 5 and 1 and the external rotation marked as 2 on the diagram will be calculated between the stations 3 and 5 If by any chance a labor curve is designed in such a way that the first point of the curve is below 1 the internal rotation will not be calculated The rotations may be edited by the instructor Click on the Edit button at the bottom of the head rotation selection box to expand the fields The first two rows allow you to set where in the delivery curve the two rotations occur The software will not allow an overlap of the rotations the stations specified for Rotation 2 will always be values greater than those specified for Rotation 1 further down the curve Each head position has two pairs of fields one pair each for Rotation 1 and Rotation 2 The provider can set the arc of the rotation to be as shallow or complete as desired Please remember that the zero point in the arc will always be at the top of the head position rotation box between ROA and LOA D b z E a 3 These settings will be retained until either altered again or the Reset button is pressed Reset will Rotate baby 8 O 65 SO al a i W a a iB gt 195 75 gi un v i Ww i z 4 i v 5 un lt gt v H
169. tion of the vasculature sysiem The use of needles larger than 22 gauge will reduce the lifetime of the lower arms skin and veins When the arm veins require replacement contact Gaumard to arrange for a lower arm exchange For a small fee we will deliver reconditioned and warrantied lower arm assemblies to your facility After receiving the replacement arms use the same box and the enclosed shipping label to return the old arms to Gaumard For international and express service additional fees may be charged Refer to the Consumables and Replacement Parts section of this guide and contact customer service for more information 8 User Guide NOELLE 554 100 Vein tubing contains latex which may cause allergic reactions Users allergic or sensitive to latex should avoid contact Discontinue use of this product and seek medical attention if an allergic reaction occurs Store NOELLE in a cool dry place Extended storage above 85 degrees Fahrenheit 29 Celsius will cause the simulator to soften and slowly warp It is acceptable to operate NOELLE at an ambient temperature of 95 degrees Fahrenheit 35 Celsius Do not store the simulator with a discharged battery It is good practice to re charge the battery at the end of every simulation session In addition make sure the battery is re charged at least once every 6 months even if the simulator is not being used otherwise permanent loss of capacity might occur beca
170. to the manikin from the Details page the Palette page or from a Scenario a log entry similar to the following is created 00 04 01 Applied 00 30 Details Rhythm Sinus Cardiac event 0 HR 80 72 User Guide NOELLE 554 100 Detected Events Each time one of the various sensors within the manikin detects a provider action it is automatically logged as a Detected entry These actions include intubation BP cuff placement artificial ventilations chest compressions and electrical therapy pacing defibrillation cardioversion inappropriate shock The following example shows a detected log entry after a provider attempts to defibrillate 00 03 26 Detected defibrillation Shock 2 300 Joules Evaluations Evaluations are added by the facilitator clicking on the Satisfactory or Unsatisfactory buttons on the Evaluation panel The Evaluation panel is present at the bottom of the screen next to the clocks panel and is accessible at all times Team Logging allows the facilitator to evaluate individual providers with a single click For example if provider Chris performed a procedure satisfactorily the Evaluation entry would be 00 07 43 Chris Evaluation Care Provided SATISFACTORY Speech When the facilitator makes NOELLE speak by pressing buttons on the Speech page an entry into the text log is automatically generated 00 18 10 Speech Urgency Don t touch me Notes Notes can be entered dir
171. tpartum uterus Wait time 3 min NOELLE 554 100 User Guide 159 M z Noelle 574 575 Labor Scenario Gaumard gt Janie Simulators for Health Care Education Peripartum Hemorrhage PPH ad Massage fundus to stem bleeding Wait time 1 min Administer hemabate 250mcg IM stat Wait time 2 min Administer Lomotil 2 tabs for nausea Wait time 35 sec 160 User Guide NOELLE 554 100 Noelle S 574 575 Labor Scenario June Peripartum Hemorrhage PPH Gaumard Simulators for Health Care Education June is a 31 yr old multip about to have her 5 baby She has had a normal pregnancy and she is planning natural childbirth She enters the hospital in active labor The family is very excited as they know this baby is a boy Labor duration 15 minutes Scenario duration 22 25 minutes S amp S Abdominal and low back pain with ctx S amp S Patient looking pale early signs of hemorrhage NOELLE 554 100 User Guide 161 4 i Gaumard Simulators for Health Care Education Noelle 574 575 Labor Scenario June Peripartum Hemorrhage PPH 162 User Guide NOELLE S554 100 y Place PPH kit inside Noelle simulator Wait indefinitely Massage fundus page anesthesia for s
172. use of self discharge The simulator should be cleaned with a cloth dampened with diluted liquid dishwashing soap If medical adhesives remain on the skin clean with alcohol wipes DO NOT USE GOO GONE as the citric acid in the formula will cause pitting of the various materials comprising your simulator NOELLE is splash proof but not water proof Do not submerge or allow water to enter the interior of the simulator Do not expose the tablet computer to water or excessive dust NOELLE will only power on when connected to the power supply NEVER disconnect the communications module while the GaumardUI software is running The software will halt and the module may be damaged Ball point pens ink and markers permanently stain the birth canal insert Do not wrap this or any other Gaumard product in newsprint The birth canal insert can be cleaning by wiping with a mild solution of soap and water After cleaning dust with talcum powder After exercise is completed DO NOT leave birthing baby in contact with the birth canal POST PARTUM HEMORRHAGE CHECK LIST AND WARNINGS Use only Gaumard s provided simulated blood Any other simulated blood brand containing sugar or any additive may cause blockage and or interruption of the vasculature system Always ensure that the distal end of the uterus is inserted through the cervical opening of the birth canal until the cervix closes around the built in recess Failu
173. ussing around the simulator At the same time the facilitator can interact as the patients voice for the provider t The instructor will also be able to record his own speech phrases that can be used at any given time or within a scenario The streaming audio controls can be accessed by clicking on the More button in the lower right corner of the Speech tab 70 User Guide NOELLE 554 100 Please verify that the simulator is connected by serial number on the Setup gt Options gt Environment FIXED field to access the more button Streaming Voice Controls This button opens a new dialog box that is available to the user at all times Selections on that dialog box include Mute Listen and Talk Select Mute to stop the communication Listen to hear what providers are saying or Talk to speak to the providers as the manikin s voice Prerecorded Speech My head hurts My name is Mute Listen and Talk controls are always available on the top right corner of the user interface Streaming Voice Output G Gain Mute Listen Talk Push toTalk Voice Activation Headset Required __ Gaumard Voice Recorder ree Stop It is recommended that the instructor uses a headset to improve sound quality The headset also allows the user to use the Voice Activation so that at any time the instructor wishes to speak it is sent direct
174. ventions 5 Epinephrine 6 Dopamine 8 Pace Previous End 46 User Guide NOELLE 554 100 In the example below node 2 is configured with four alternate paths Once the provider performs any one of the actions listed as key events the facilitator will checkmark the key event to alter the trajectory of the node sequence 2 Deteriorate oe Wait 02 00 No changes are made to manikin E Atropine Speech 1 00 01 confusion What happened Cardio Drop 01 00 HR 15 BP 10 OSat 5 2 Co AddItem Add Scenario co M P 2o b lt ajam B Node Bp Node ome O Deserpion Start Node vital signs palettes simulate bradycardia Go to bradycardia node 2 Vital signs palettes deteriorate the patients condition by 15 Care provider has 4 options Each option key event moves the scenario to the node specified If no action i is taken the scenario will move to node 3 at the end of Deteriorate the time limit Atropine Epinephrine Dopamine Pace Node 4 Node 5 Node 6 Node 7 Wait indefinitely vital signs are on hold Provider is to intervene ee Intervention p Keyevent event Atropine Epinephrine Dopamine Pace Node 4 Node 5 Node 6 Node 7 Atropine Now vital signs palettes simulate the response to atropine Time limit Go to node 3 after 1 minute eyinechane Node vital signs palettes simulate the response to eee epinephrine Time limit Go to node 3 after 1 minute Donam Node vita
175. ws she has no previous history Her treatment history includes NO 00 00 12 Applied 00 00 Palette alice01 Details HR 75 RR 21 Temp 37 1 ContractionFreq 6 min ContractionDurat 30 sec FHRSpont non reactive 00 01 00 Applied 00 00 Palette alice02 Details ContractionFreq 4 min ContractionDurat 40 sec 00 01 16 Applied 00 00 Palette alice03 Details RR 23 OSat 97 ContractionFregq 3 min ContractionDurat 70 sec ContractionInt 60 mmHg FHRPeriodic early decels 00 01 37 Applied 00 00 Palette alice04 Details HR 70 RR 19 This option allows you to print a text file containing all the information in the log for the latest session Clicking on Print Report brings up the Print dialog box The shortcut key for this option is Ctrl P Export File Type Mi M E Last modified a ici 11 05 2010 15 02 12 11 05 2010 15 02 12 11 05 2010 15 02 12 11 05 2010 15 02 12 11 05 2010 15 02 12 11 05 2010 15 02 12 This tool allows the import of palettes scenarios or modeling patients that may have been created on another tablet PC 11 05 2010 15 02 14 11 05 2010 15 02 14 When Import is clicked the Open dialog box is displayed Description Alice is a 24 year old female weighing 170 pounds Her Open companion s name is Mike QCHer OB history shows a gO Di gt Fih Drive uae aa gravida of 2 a term of 1 a preterm of
176. ws the shoulders to deliver Downward traction allows the delivery of the anterior shoulder with a finger inserted into the birth canal to free the arm Upward traction allows the posterior shoulder to deliver and the posterior arm is freed in the same manner After the delivery of the shoulders the fetal head delivers in a flexed or heads up position Although it is possible for a vaginal delivery of breech presentations once a breech presentation has been confirmed a Cesarean is often performed to lower the risk of infant mortality due to cord prolapse or birth asphyxia To simulate breech presentations with the NOELLE retract the birthing mechanism fully remove the cover in the fetal head insert the birthing mechanism into the fetal head and place the fetal legs in either an extended position to simulate footling delivery or retract the legs for a frank delivery Remove plug in fetal head for breech delivery The Pinard or leg flip maneuver frees one leg then another The fetal arms may also require a similar maneuver during delivery NOELLE 554 100 User Guide 109 The fetal arms are delivered and the fetus rotated anteriorly to birth the head Placenta Delivery The placenta supplied with NOELLE may be positioned so that it births spontaneously or requires either modest cord traction or manual removal In addition note that the placenta is designed with two removable placental fragments
177. y Select the Multiple choice category type enter the category information title and click OK Category Options 1 Select Category Type Question with answer region Multiple choice Yes No Multiple choice Disagree Neither Agree or Disagree Agree Multiple choice Unacceptable Poor Average Good Perfect 2 Category Information Highlight the Provider tasks and performance category and then click Add from the Multiple Choice Entry menu On Site Reviewer Category Multiple Choice Entry 2 1 Problem Description 2 Provider Tasks and performance Enter the multiple choice information in the entry fields Category Multiple Choice Entry 2 Add Remove tosert de p add Delete arse PJ 1 Problem Description 2 Provider Tasks and performance Physician Provider introduces themselves to the patient 82 User Guide NOELLE 554 100 Repeat the previous steps to add more categories questions and multiple choice options Category Multiple Choice Entry 2 Ada Remove insert A ie aa set A How would you rate teamwork during this delivery emergency 5 Communication Overall Communication Rating Orient new members SBAR Transparent thinking Directed communication Closed loop communication 6 Situational Awareness Overall Situational Awareness Rating After
178. y regardless of whether Gaumard has been advised of the possibilities of such damages Some jurisdictions do not allow disclaimers of implied warranties or the exclusion or limitation of consequential damages so the above disclaimers and exclusions may not apply and the first purchaser may have other legal rights This limited warranty applies only to the first purchaser of the product and is not transferable Any subsequent purchasers or users of the product acquire the product as is and this limited warranty does not apply This limited warranty applies only to the products manufactured and produced by Gaumard This limited warranty does not apply to any products provided along with the Gaumard product that are manufactured by third parties For example third party products such as computers desktop laptop tablet or handheld and monitors standard or touch screen are not covered by this limited warranty Gaumard does not provide any warranty express or implied with respect to any third party products Defects in third party products are covered exclusively by the warranty if any provided by the third party Any waiver or amendment of this warranty must be in writing and signed by an officer of Gaumard In the event of a perceived defect in material or workmanship of the Gaumard product the first purchaser must 1 Contact Gaumard and request authorization to return the Gaumard product Do NOT return the Gaumard product to Gaumard w
179. y trends and performance patterns Slider The slider at the bottom of this screen lets you rewind the strip to see the previous graph data Activity on fetus Activity started 00 22 26 Export Data to Desktop HH i H H Peak Force 62 sE r ne Uterine Activity wtons mmH Se TH Peak Torque 2 NOELLE 554 100 User Guide 61 NOELLE has a total of thirty six factory preset labor scenarios which were designed in conjunction with healthcare professionals The scenarios are divided into two separate profiles Below is information on the scenarios available under the quick start and NOELLE Advanced scenarios Variations Normal B l Variations Normal Variations Normal T o 62 User Guide Variations Normal Shoulder Dystocia Normal History Alice is a 24 year old gravida 2 1 at 39 weeks She weighs 170 She has had prenatal care She has not been using medications of any kind pounds Alicia is a 24 year old gravida 2 1 at 39 weeks She weighs 160 pounds She has had prenatal care She has not been using medications of any kind Amy is 19 years old 1 0 at 40 weeks She weighs 160 Ibs Angelica is a 31 year old gravida 5 3 at 41 weeks She weighs 160 los She has experienced no prenatal complications and has a history of fast labors Beth is a 16 year old gravida 2 0 at 37 weeks She has had one elective abortion She has had prenatal
180. yssa Normal Labor Normal Labor Variations Normal Angela Becca on Variations Normal Bianca Shoulder Dystocia Candice Charlotte Shoulder Dystocia 64 User Guide NOELLE 554 100 Alyssa is a 23 year old primip at term She has received prenatal care in a multidisciplinary practice Her general health is good and she has experienced no prenatal complications She wants to have an unmedicated natural birth Angela is a 31 year old grand multip Even though she has had only a few contractions she came in anyway because she has a history of rapid labors Becca is a young pregnant teen who is living on the streets She is a heavy smoker and drug user She was seen twice in the Adolescent Clinic and referred to Social Services but she only saw the social worker once and did not go to the follow up appointment The extremely precipitous delivery and patient s agitated state should point participants to order tox screen to check for illicit drug use Bianca is a 16 year old gravida 2 1 She had an elective abortion at age 13 She lives with her 17 year old boyfriend and has no contact with her family She has been inconsistent with appointments at the teen clinic due to transportation issues Candice is a 19 year old multip She and her boyfriend and 3 year old daughter are homeless and currently living in a car She has not seen a doctor but believes that she is about 8 months pregnant Charlott
181. ystems do not automatically connect at startup To establish a connection to the ad hoc wireless network navigate to the wireless icon located at the bottom right corner of the screen select the ad hoc network name and click connect Because the computers are connecting to each other both systems must be powered on Currently commected tec Unaden titted network No Internet acoes Wireless Neha Connection 2 a Open Network and Sharing Center CONNECTING GAUMARDUI TO THE GAUMARD MONITORS SOFTWARE GaumardUI sends all the vital signs information to the Gaumard Monitor software over the wireless ad hoc connection configured in the previous section Follow the guide below to establish the connection between the programs CAUTION To avoid connection issues always establish the ad hoc wireless connection between the computers before activating the GaumardUI and Gaumard Monitors program 1 On the tablet computer start the GaumardUl software and navigate to Monitors gt Configuration Sensors File sharing Custom numbers 2 In the NOELLE Virtual Monitor Setup window access the Adapter dropdown menu and select Wireless Network Connection If the adapter is inaccessible click the stop button first ES Noelle 574 575 Virtual Monitor Setup Select the number of monitors that will be used with this manikin Also you can name each monitor with an appropiate description O All sensors always ON

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