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1. Epinephrine S ucchinylchaline Unpredicted results may occur if you select the same event in several frames 5 4 Program Menu The Program menu is located at the top left corner of File Edt view Heb I the Handler window 5 4 1 File Menu The File menu controls Windows system commands Ta Edit view He New Window New Window Opens a new handler window Good for New Handler copying frames from one handler to another ponds New Handler Clears the current view Load Handler Save Handler Print Handler Exit 5 4 2 Edit Menu Save Handler Loads an existing handler Print Handler Saves a handler Exit Prints a handler Exits the Handler Editor The Edit menu contains copy and paste functions View Help Copy Copies the selected item s to the clipboard Copy Paste Pastes the copied from the clipboard Paste Select All Selects all items Select All Edit Event Menus 6895 rev F Customizes the Event Menu for this scenario Edit Event Menus It is also possible to assign specific events to remote control keys See 4 6 for more information on customizing event menus OLaerdal Medical 2002 page 100 of 125 5 4 3 View Menu The View menu contains one item that opens a dialog Help listing used Events and Trends List Used Events and Trends Here is an example from a simple Handler Used Events and rends MedicHandler1 Events Trends Epinephrine Trend 5 4 4 Help Menu Th
2. File name Laerdal Medical 2002 Cursor 0 00 0 Minutes Help Close ij ek Fe E Hypaxiaz End esi Oesophageal Tube tnd E brief sympatkamimetic response tnd esl pneumath recovery tnd E pneumothorax tnd E rapid cardiac crump tnd E rapid desat tnd Files of type Trend Files tnd Cancel page 64 of 125 3 2 Save Trend To save a trend click the Save Trend Save in B trends button for the Save As dialog eo end Fader Es Hypoxia2 tnd Ej anaesthetised hypoxia tnd Ej Oesophageal Tube tnd type in a new file name or select an Es brief sympathomimetic response End E pneumath recovery tnd existing Trend name and click Save E coro Deterioration tnd E pneumathorax tnd E COPD Hypotension knd E rapid cardiac crump tnd Note Selecting an existing Trend name E hypoxi 2 tnd E rapid desat tnd from the Trends folder when saving will overwrite the selected Trend gt File name testname Save az type Trend Files trid Cancel 3 3 New Trend The New Trend Dl button loads a default flat line trend for editing 3 4 Editing Trends 3 4 1 Basic Editing Each trend curve has five points that can be moved up down and 3pU2 Trend left right to create a curve The starting point is zero and cannot be moved Trends are relative by default and will always use current system values when the t
3. The number of shocks is accumulative over the Scenario For example 3 Shocks means three shocks given from FrameO where the Scenario started or from the Frame where the shock counter was reset Use the Clear Shock Count function to reset the shock counter in any Frame 6895 rev F OLaerdal Medical 2002 page 92 of 125 In the following example it will take two shocks to convert the patient if performed within the first 45 seconds If not it will take three shocks within an additional 30 seconds otherwise the Manikin will convert to asystole Notice that one shock could be given within the first 45 seconds FrameO and the remaining 2 shocks could be given in the next 30 seconds Frame2 Framet AW Abr coarse OU U0 PR shocks FrameTime 45 Frame Frames AW Abr fine O Ut Bshocks FrameTime 30 A Sinus Unifocal PC 100 4 16 8 Pacing Performed Pacing Pacing started C Pacing Capture stopped C Pacing Capture started Cancel C Pacing with Capture accumulated for 60 Seconds The Pacing Performed Event button allows you to set one of the following Pacing related events e Pacing started Pacing is performed on the manikin Capture may not necessarily occur e Pacing capture started Pacing is performed on the manikin with a current level over the set threshold This event cannot happen if pacing is disabled See 4 15 5 for more information on the Pacing Enable
4. 6895 rev F Laerdal Medical 2002 El Application 3 ounds OF Cancel Apply page 41 of 125 2 6 6 Speaking Via a Microphone through the Manikin some PCs have the ability to directly output Microphone Controls microphone input through the speakers and headset output This may be cumbersome to set up and the volume gain may be lower than when you record and play sounds Activate Mic Monitoring The Microphone Controls dialog enables an easier way to use a microphone to speak directly through the Manikin s head speaker than by using the standard Windows Mixer It also provides more amplification of the microphone sound Under the Tools menu select the Microphone iride Controls option Enable microphone input by ticking the Activate Mic Monitoring tick box Mic In and Master Out levels can be adjusted Master Out controls the output level of all PC sounds The downside of this function is that it introduces a small delay in sound output This delay can be adjusted but if it is set too short the sound will be distorted Ticking the Use DirectSound tick box will on some PCs allow for shorter delays Try to adjust to the shortest delay your PC can handle 2 6 7 Auscultation Sounds At start up all auscultation sound will be Normal Lungs Heart To choose a different sound select the Normal Normal desired sound in the corresponding list box Systolic Murmu
5. No Chanae s TOF No Chanae TOF X No Chanae z Laerdal Medical 2002 Change Change Change Change Change Change Cancel page 85 of 125 4 15 12 Trends The Trends Action button allows you to start and stop a Trend from a Scenario Trends Start Trend E dit Start This Trend Stop All Others Stop Trend C Stop All Trends OF mue Cancel Start Time Set Duration There are two options for starting a trend 1 Start Trend starts the selected trend to run simultaneously with all other trends that may be running when the scenario enters this frame 2 Start This Trend Stop All Others starts the selected trend to run while stopping all others when the scenario enters this frame There are two options for stopping a trend as well 1 Selecting Stop Trend stops a specific Trend 2 Selecting Stop all Trends stops all active Trends Clicking the Edit button opens the Trend Editor Trend Editor allows you to specify the Start Time 300 and Duration of a Trend 250 Start Time defines how far into the programmed 200 trend the trend will be started For example this x En Trend will skip to the start position and start from there 100 At Duration defines how long the trend will run j U I I The default is that the trend starts from the beginning and continues until its last defined point Minutes ex
6. xml x Cancel Select the log you want to print choose a style template and click on Open A preview will be displayed in your default Internet browser Select to print from the browser See Appendix IV for more information regarding XML 2 9 1 5 Print Current Log Select Print Current Log to print the event log that is shown in the event log window Notice that this printout does not contain the additional info fields you enter when you save the log Select the Style Template and press OK Print Current Log A preview will be displayed in your default Internet browser Print the log from there Cancel 2 10 Manual Logging of Events 2 10 1 Entering Events Handling Event Lists Events that are not Register Events automatically registered by the ABC Action Miscellaneous Medication Edit manikin can be entered using E the three event lists Shift n The Cardiac and Airway remote control bottom Epi Lido Brytl Mag Procain rows give 10 different events for each remote control oy VE NTG MS The upper events work with the shift button pressed the lower without the shift button pressed 6895 rev F Laerdal Medical 2002 page 48 of 125 Pull down the list of events in the desired category by clicking the button Select the desired event The event is entered in the log when it is selected The events can be organized in folders Click on the sign to expand the f
7. Click Next 6895 rev F Laerdal Medical 2002 page 11 of 125 3 Alternatively and only recommended for expert users you can use Control Panel to install TCP IP You must have Windows CD or disks available In the Network setup Add Microsoft Dial up adapter Add Microsoft TCP IP protocol In this case select My computer is already set up for the Internet Do not show this wizard again when prompted by the Connection Wizard Multi User Installation Notes If you run a Windows 98 Me operating system you may be required to install the Laerdal SimMan software for each user who will be running Laerdal SimMan program This depends on the User Profiles settings in the Passwords Properties Dialog found in the Control Panel lf User Profiles is NOT turned on default SimMan is installed for all users Every user that logs into Windows will see the same programs lf User Profiles is turned on Laerdal SimMan software is installed only for the current user The users may see different programs installed on the system lt is recommended that you log into Windows rather than clicking cancel in the Windows log in window before installing the Laerdal SimMan software If you do not log in before installing you might get the following error message when you try to run the Laerdal SimMan program at a later time when you log in to Windows with a user name The Managed Software Installer failed to install the program associated
8. Comments Action button allows the addition of user entered comments in the Event Log to aid in evaluation of student performance 5 16 10 Set Trend Max Min Vital Signs mmHg Ma Change Mo Change 5 Change F Ma Change E No Change 4 Change mmHg No Gisrae No Change E Change mmHg No Change i No Change E Change aa BPM No Change 5 No Change E Change EPH No Change gt No Change 4 Change a canca mmHg Mo Change Mo Change a Change mmHg Mo Change E Mo Change B Change Tu The SimMan Trends Action button allows you to set parameter limits for vital signs Default limits are specified in the SimMan main program Options menu by selecting Trend Max Min Values These limits are overridden when set in a Scenario It is good practice to set the limits in scenarios to ensure they are set correctly Only the limits with the Change tick box ticked will be set the others remain unchanged 6895 rev F OLaerdal Medical 2002 page 111 of 125 6 SimMan Patient Monitor 6 1 Introduction The SimMan Patient Monitor emulates an ordinary patient monitor It is used to display vital signs parameters and waveforms for the student It is controlled by the instructor using the PC but will allow alarms to be set along with some customization using its touch sensitive screen This chapter focuses on use of the touch screen for setting alarms and performing other customiza
9. 1 4 2 Copy and Paste The SimMan SW supports copy and paste functions for large text fields such as entering a description when saving a scenario or entering a comment when saving a student log There are several ways to achieve copy and paste The simplest may be to use CTRL C to copy the selected text to the Windows clipboard and then use CTRL V to paste from the clipboard again to where the cursor is 1 4 3 Using keyboard to enter numbers When entering a number using the keyboard you must press the ENTER key to complete your change 6895 rev F Laerdal Medical 2002 page 27 of 125 1 5 Abbreviations 1 5 1 Monitor Parameters ECG Electro Cardio Gram HR SpO2 Heart rate calculated based on SpO2 CO Cardiac Output ABP Arterial Blood Pressure NIBP Non Invasive Blood Pressure SpO2 Pulse Oximetry C Temp Core Temperature Temp Core Temperature P Temp Peripheral Temperature TOF Train of 4 responses How many responses out of 4 TOF 96 Ratio between the strength of the fourth response and the first FI O2 Inspired Oxygen Fraction FI N20 Inspired Nitrous Oxide Fraction FI Anes Inspired Anesthetic Gas Fraction ET O2 End Tidal O2 CO2 End Tidal CO2 ET N20 End Tidal N2O ET Anes End Tidal Anesthetic Gas 2 SimMan Main Program 2 1 LogIn When starting the SimMan program the user must first log in This allows several users to share one computer and each have their individual setup and set of scenarios and trends A single
10. 6895 rev F Laerdal Medical 2002 page 75 of 125 The selected frames are marked with a blue border Frames Comment Correct step Start Trend IncreaseHA Start 0 0 Dur 10 0 Pulse checked or Intubation To copy the selected frames select Copy from the Edit menu and then select Paste See 4 2 2 You can also use standard Windows hotkeys CTRL C for copy and CTRL V for paste The copied cells are pasted at the top left of the drawing area and are selected and ready to be moved to the desired location You can also open a new Scenario Builder window and use the copy and paste functions to copy frames from one Scenario to another 4 12 Resizing Frames Click and drag the frame s right edge to resize the frame including Event fields horizontally Blood Pressure 120 80 Vital Sp z 38 LU 34 0 mmHg Temp 99 0 F Breathing Hate 10 CO Exhalation OFF Array Reset All Click and drag the frame s bottom edge to resize the frame but not the Event fields vertically Click and drag the frame s lower right corner to vertically and horizontally resize the frames simultaneously 6895 rev F OLaerdal Medical 2002 page 76 of 125 4 13 Connecting Frames Frame connections are drawn from an Event field in one frame to the Action field of another frame When an event occurs they specify the frame to which the Scenario moves You can have only one connection from ea
11. 8 Replace chest skin over torso and secure skin at the shoulders and both sides 9 Fill puncture marks on exterior of chest skin with modeling wax supplied in repair kit by applying firmly with fingertip while stretching skin H 3 Chest Drain Left Mid Axillary Site To replace chest tube insertion module 1 Remove skin at torso side and left shoulder 2 Remove chest tube insertion module from mid axillary side of manikin 3 Insert new chest drain module 4 Replace chest skin over torso and secure skin at the shoulders and both sides H 4 Breathing Bladder To replace bladder Remove skin at torso sides Lift out the chest plate Fold the lungs upward Remove foam part Disconnect bladder tubing from nipple on manifold block Connect new bladder to same nipple Replace foam lungs and chest plate Replace chest skin over torso and secure skin at the shoulders and both sides m cure 6895 rev F OLaerdal Medical 2002 page 21 of 125 H 5 IV Arm When excessive leaking occurs at the puncture sites a new vein and skin should be installed to reduce loss of fluid Ideally the skin and veins should be replaced near a sink To remove the arm 1 Remove deltoid pad from arm Disconnect the attachment hardware arm using a screwdriver 2 If replacing both skin and veins cut skin off and discard The thumb will detach with the skin new skins come Standard with thumb installed 3 If the skin is not damaged and yo
12. BP dia Ez s HR ce ce EE LE EE EE BR pu m EN EN EN Ex ES l EN E pr ES EN p m c E 2 12 Running Scenarios THE SCENARIO IS A MEANS OF PREPROGRAMMING CERTAIN AUTOMATIC RESPONSES FROM THE MANIKIN SCENARIOS ARE PROGRAMMED TO SET THE MANIKIN IN A CERTAIN CONDITION WITH AUTOMATIC CHANGES TO CONDITION BASED ON STUDENT ACTION OR THE LACK THERE OF A SCENARIO CAN BE STARTED BY SELECTING START SCENARIO FROM THE FILE MENU The Start Scenario dialog allows you to select a scenario and read its comments If someone send you a new scenario or you download it from the web it may contain new trends handlers or sounds When you run or edit the scenario all trends handlers and sounds used by the scenario will be copied to the logged in users profile But only if a trend handler or sound with the same name doesn t already exist If it already exists the existing one will be used instead oee chapter 4 for more information on building scenarios using the Scenario Editor 6895 rev F OLaerdal Medical 2002 page 58 of 125 Look in co scenarios den e Ea Comments Seer fee Ee we 1 New Folder ea Gesophageal Intubation sce Case history Male 26 years old Acute Appendicitis ate 3 hours aga i 1 need to debug sce a Rapid_sequence_Induction sce Is nauseous and has vomited Was in severe pain but n 1111ACLS bradvcardias sce ra Sedated awake _intubation sce has been given 75
13. Extrasystole Rate Select the desired extrasystole rate by clicking the Rate min Up Down buttons n With the Cardiac remote control press the ESR Up Down keys 6895 rev F OLaerdal Medical 2002 page 35 of 125 2 5 3 5 Heartrate HR Select the desired heartrate by pulling down the HR list box and selecting the desired rate Available heartrates vary with the basic rhythm ri With the Cardiac or Airway remote control press the HR Up down keys 2 5 3 6 Blood Pressure BP Blood pressure can be set as part of the ECG rhythm The advantage is that when the BP is set as part of the ECG rhythm it will change at the same time a Waiting Rhythm is activated To set the blood pressure tick the Set BP box and select thee desired blood pressure by pulling down the BP list box If Set BP is not ticked the BP will remain unaffected by the ECG selection as long as it is a perfusing rhythm Non perfusing rhythms include V fib Asystole Agonal and Ventr Standstill Also a PEA EMD condition will always set the BP to 0 0 See 2 5 6 for more information on setting Blood Pressure ri The remote controls only allow for Blood Pressure to be set directly 2 5 3 7 Activating the Rhythm After the rhythm has been edited clicking the OK button will move the new selection into the Running Waiting Rhythm Z Clicking Cancel will cancel the selections made and revert to the
14. Muscular 50 60 Hz WAS Basic Rhythm Extrasust HH Cancel EI The ECG Action button allows you to set the ECG and related parameters If the Extrasyst Rate is set to blank default Extrasystole Rate will not be changed from its previous state Note EMD PEA can be set from this Action Selecting EMD PEA will set the blood pressure to zero independently of the ECG rhythm and the blood pressure setting Selecting No EMD PEA will bring the blood pressure to the previous setting if the ECG is a perfusing rhythm 6895 rev F Laerdal Medical 2002 page 106 of 125 5 16 2 Blood Pressure Blood Pressure Systolic Diastolic Eorotkoff Yolume E E at T E BP The BP Action button allows you to set blood pressure Systolic and Diastolic rates independently and Korotkoff sound volume If the volume set lever is not moved sound volume is unaffected and indicated by to the lower right of the lever F AG If the volume is changed the level will be displayed as 0 to 10 Bi koro T Tick the Gap tick box to make an auscultation gap in the Korotkoff sound v Gap 5 16 3 Auscultation Sounds Auscultation Sounds X The Auscultation Sounds Action button allows you to select Right Lung Left Lung Heart and Bowel sounds in addition to sound volume Note Right and Left Lung sounds are set T B T 7 independently NoChange E uM If No change is selected the
15. Repetitions of sounds will continue Stop Sound even if the scenario changes frame Repeated sounds can be stopped in another frame by selecting Stop Sound I xi Cough Number Interval Cancel 6895 rev F Laerdal Medical 2002 page 84 of 125 Starting another sound in another frame overrides a previously programmed sound However the sound will not start until the one playing has completed 4 15 10 The Breathing Rate Action Breathing Rate Breathing Breathing Rate min CO Exhalation button can be set from 0 40 10 No Change breaths per minute in increments r DELE of two Output of CO in the exhaled air is also controlled from this function 4 15 11 Vital Signs Patient Monitor REM Vital Signs Temp The Vital Signs Action button allows you to set Patient Monitor parameters Only the parameters with the Change tick box ticked will be changed the others remain unchanged CO and Temperature scales are controlled by the SimMan settings 6895 rev F No Change s C02 mmHg No Chanae EF No Chanae 3 Perf Temp F No Change 3 co l min No Change CYP No Change E No Change ET 02 No Change e Change Change Change Change Change Change Change Change C Disable Fi N20 No Chanae d ET N20 No Chanae a FI Anaest No Change a ET Anaest
16. appear to inform you that all the scenario and trends that the user you are deleting may have written will also be deleted Pee The administrator can be given a new password Close but it must not be forgotten Note You cannot delete the administrator user 2 2 Chest Drain Manikin Enable Disable When starting SimMan for the first time after installing the software on a new PC you must tell the software which manikin version is connected to the PC Older SimMan manikins do not have chest drain functionality and require more air to fill the bladders used for pneumothorax decompression simulation You must specify whether or not your Manikin has chest drain functionality This setting is stored in the computer You can later change this setting through the Options menu See 2 14 4 The following dialog box will then appear Select the appropriate option Selecting With Chest Drain causes less air to be filled into the pneumothorax bladders This is the safest option if you are uncertain of the Manikin type Specify SimMan Manikin Type The new Siml an Manikin supports Chest Drain The old Manikin does not have this support The software needs to know which type of Manikin that rs or will be connected to this PC Please select the corect option For your Simbd an M anikin IF you are nat sure which type you have please select the first option Cancel C With Chest Drain 6895 rev F OLaerdal Medical 2002 p
17. performing a check in every frame This is how the scenario looks when using a medication handler The scenario starts the medication handler Once started the medication handler will start Trend1 each time Epinephrine is given no matter which frame the scenario is in The Medication Handler can be expanded to handle many drugs In addition you can start handlers that handle ABC and Miscellaneous Events 5 2 Startup Start Medic Handler MedicH andleri kie L d Frames Lo 1 1 Cd Medication handler MedicHandler1 Epinephrine Hm Start Trend Trendi Start 0 0 Dur 10 01 The Event Handler Editor is started from the Edit menu of SimMan s main program Select the type of handler you will edit create Then either start the handler to run from within a scenario see 2 13 or you can start it to run stand alone by selecting Start Handler from the File menu of SimMan s main program 6895 rev F Laerdal Medical 2002 page 98 of 125 5 3 Handler layout Layout of a Medication handler aerdal Medication Handler Editor File View Help EJ m 5I MedicHandlerl dhn Actions Epinephrine 7 Succ hinvichidline hd Actions Start Trend Trend Start 0 0 Dur 10 0 Start Trend Trende Start 0 0 Dur 10 0 Ansa Trismus OFF Larunges OFF Succhinylcholine The handlers look very much like scenarios but there are some obvious diffe
18. 1 Laerdal High Level Manikin Disinfectant solution Squeeze the solution out and allow the filling to air dry prior to reinsertion and storage Articulating parts will benefit from a light application of talcum powder prior to training sessions Powdering inside of chest skin with talcum powder decreases plastic sound Use on clean surface only AVOID FELT TIPPED MARKERS INK PENS ACETONE IODINE OR OTHER STAINING MEDICATIONS AND PLACING THE MANIKIN ON NEWSPRINT OR INKED LINES OF ANY KIND A general inspection should be conducted regularly Do not use the product if cables or tubings have signs of damage otore properly between teaching sessions If stored in hard cases disconnect cables and tubings and remove legs The different parts should be correctly positioned before closing the cases otudents should wash their hands prior to using the simulator and wear gloves when using the simulator Treat SimMan as you would a real patient Air filter in compressor should be replaced every two years Directions for replacement are part of the Technical Service manual A Technical Service manual is available for purchase using part number 381950 J Standards Approvals The product is CE marked and in compliance with essential requirements of council directive 89 336 EEC EMC directive 6895 rev F OLaerdal Medical 2002 page 23 of 125 K Parts Accessories List K 1 Accessories 1005146 Tubing Assy 40ft Comp
19. 6895 rev F OLaerdal Medical 2002 page 88 of 125 4 15 16 Add Miscellaneous Handler Miscellaneous Handler f Start Misc Handler f Stop Misc Handler Cancel The Miscellaneous Handler Action button allows you to start or stop a Miscellaneous Handler Only one Miscellaneous Handler can be active at one time If you start a new Miscellaneous Handler while another one is active the running Handler will automatically be stopped before the new one is started See chapter 5 for more information on Event Handlers Clicking the Edit button to starts the Miscellaneous Handler editor 4 16 Events A running scenario detects events caused by student s and internal events such as Time Events You may specify events the scenario will check for by placing them in a frame s Event fields When the running scenario reaches that frame and the event occurs the scenario will move to the frame connected to that event field With exception of Intubation and IV Line all events must happen in the frame where the events are specified Intubation and IV Line are remembered events meaning they are active until their opposing events Extubation and IV Line removed occur Example 1 In this example Pulse checked will move the scenario from FrameO to Frame1 The pulse must be checked again in Frame to bring the scenario back to Frame0 Frame1 has no memory of the fact that the Pulse
20. Anesthetic agent Log time Clear No change 6 4 3 NIBP Menu The NIBP Non Invasive BP menu has two additional menu items The monitor simulates a NIBP NIBP Options measurement by quickly increasing the numbers and then slowly decreasing them until the systolic and Start measu rement diastolic numbers are reached Change interval Note that during this process the actual cuff on Change upper limit SimMan s arm does not inflate Change lower limit Enable upper alarm Enable lower alarm Change color Change function Clear No change Selecting Start measurement starts an NIBP measurement Selecting Change interval allows you to change the intervals at which the monitor performs an automatic measurement 6 5 Alarms The SimMan Monitor alarm works by the numbers Once a limit is enabled the monitor continuously checks to see if the number exceeds that limit If a limit is exceeded three things happen 1 The alarm sounds from the pulse beeper of the link box Unless Disable alarm sounds is selected from the setup menu 6895 rev F Laerdal Medical 2002 page 116 of 126 2 The alarm window flashes a text message describing SpO2 Lower limit alarm the cause of the alarm 3 The exceeded limit is highlighted and starts flashing The student can then acknowledge the alarm by pressing SpO2 Lower limit alarm 1 56 the Alarm disable button The alarm is then temporarily disabled a
21. Audio Input on the SimMan Link l o l Vocal Sounds To activate vocal sounds on the manikin select the desired sound from the d Lough T Vocal Sounds pull down menu Cough 7 Vocal sound volume can be controlled using the lever adjacent to the Vocal Sounds selection menu Note Because the sound is generated by the computer s sound system you may also have to adjust its volume It is activated from the E symbol typically found in the lower right corner of the Windows screen Most Laptop computers also have a volume adjustment knob close to the sound output connector 6895 rev F OLaerdal Medical 2002 page 40 of 125 Moan ri With the Cardiac or Airway remote control press the desired sound key You can also assign sounds to the user definable keys on the remote control See 2 10 2 1 for more information on assigning sounds to the remote control Vomit Gough You can add your own vocal sounds to the vocal sound list C Program Files EL Laerdal Medical by copying wav files into the SimMan installation Ga SimMan Sounds folder When the SimMan program starts it will search for wav files in this folder and list their names in alphabetical order on the Vocal Sounds pull down menu See Appendix for more information on the SimMan data file structure 2 6 5 Adding New User Defined Vocal Sounds You can add new vocal sounds in two steps 1 Record the new vocal sounds using your
22. Change mmHg Yo Change ad No Change Change OF Ma Change Change Cancel Ma Chanae Change mmHg Mo Change B PH Ho Change B PH Ho Change Mo Change Change Change mmHg No Change Mo Change Change oo Nochanae Nochance NoChanae Nochance 3 NoChanae Noche NoChanae NoChance iota Noche Nochenae NoChance 3 No Chanae S NoChanae mmHg No Change Mo Change um 6895 rev F OLaerdal Medical 2002 page 81 of 125 The SimMan Trends Action button allows you to set parameter limits for vital signs Default limits are specified in the SimMan main program Options menu by selecting Trend Max Min Values These limits are overridden when set in a Scenario It is good practice to set the limits in scenarios to ensure they are set correctly Only the limits with the Change tick box ticked will be set the others remain unchanged 4 15 4 Clear Shock Count In the Defibrillation Performed event you can set the event for execution after a certain number of shocks The number of shocks is accumulative throughout the scenario For instance 3 Shocks means three shocks given from FrameO or from the frame where the shock counter was reset The function Clear Shock Count can be used to set the shock counter to zero in any frame C Framat Shack Count 0 The Clear Shock Count action goes direc
23. D 160 S D 60 70 90 100 70 Systolic max 300 normal normal absent S D S D Z Z lt gt 50 5 4 60 4 3 75 8 2 110 80 0 30 50Wide complex QRS 70 40 Systolic max 300 weak normal 6 lastolic max 210 weak absent 0 Narrow complex QRS ystolic max 300 normal normal iastolic max 210 weak absent Atrial Pacemaker 20 80 AV sequential pacemaker 120 80 Systolic max 300 normal normal pacing the atrium and the Diastolic max 210 weak ventricle A V interval absent 0 15sec Ventricular Pacemaker No 120 80 Systolic max 300 normal normal atrial activity Diastolic max 210 weak absent Ventricular Pacemaker 120 80 Systolic max 300 normal normal Atrial P rate 90 Diastolic max 210 weak absent 100 Ventricular Pacemaker 120 80 Systolic max 300 normal normal Atrial P rate 90 Diastolic max 210 weak absent Ventricular Pacemaker 120 80 Systolic max 300 normal normal Atrial fibrillation Paso marzo ea absent Loss of capture 120 80 Systolic max 300 normal normal absent page 125 of 125
24. E o Stomach Decompr ri With the Airway remote control press i 2 6 2 Spontaneous Breathing Ww w the Airway remote control press Spontaneous Breathing Rate can be adjusted from 0 to 40 breaths per minute To adjust the breathing rate use the Breathing Rate Up Down buttons Breathing Fate ot Apnea ri With the Cardiac or Airway remote control press the BR Up Down keys To stop spontaneous breathing click on Apnea Breathing will also automatically stop when BP is 0 0 both right and left lung compliance is active and when laryngospasm is activated ri With the Cardiac or Airway remote control press the Apnea key 2 6 3 Exhale CO The Manikin will exhale CO during spontaneous breathing or ventilation if v Coe Eshaled CO Exhaled is ticked ri With the Airway remote control toggle the Exhale CO key Through the Options menu it is possible to automatically disable exhaled CO2 two minutes after it is enabled The Exhale CO control is independent of the CO setting in the Monitor Controls Exhale CO2 turns the CO being exhaled through the manikin s airway on or off The amount of CO exhaled is always the same 2 6 4 Vocal Sounds Vocal sounds are generated by the computer s sound system For the vocal sounds to come from the manikin s head the sound out of the computer typically the speaker or head phone output must be connected to the
25. Ignore Action e Pacing capture stopped Pacing capture has occurred and has now stopped e Pacing with capture accumulated for Pacing has been performed for more than the period of time you have set in this frame If pacing is started and stopped several times within the same Frame the time of the pacing sequences is accumulated 6895 rev F Laerdal Medical 2002 page 93 of 125 4 16 9 ABC Action ABC action x ABC action The ABC Event button allows you to set any of the ABC actions Actions added by the Edit menu function can be programmed as events Intubation and IV Line differ from the other events in that they do not have to occur in the same Frame that the event is specified The scenario will remember that Intubation has occurred and the event will be true in any frame after the occurrence until Extubation occurs The same will be true for IV Line which will be remembered until IV Line Removed occurs Example In this somewhat complicated scenario we have a limited time to give the patient Epinephrine and get to Frame6 To give Epinephrine we must have either an IV Line or an ET tube While preparing Intubation or IV line time can be bought by performing CPR If no CPR is given the time will elapse and the patient will die Frame4 To do all this we will need more than three events in some frames The test for IV Line and Intubation is done in Framed and Framea2 while the actual
26. V This is a connection line Framed Frame Precod thump This is a node Pukechecked O To connect through a node Click in the Event field you want to connect nm A Drag the mouse outside the frame and release the amc Cancel mouse button to open the Connect to Frame dialog From the dialog select the desired connection frame and click OK 3 Connecting back to the current frame Connecting back to the current frame saves repetition of frames This one frame scenario will make the manikin moan at start up and again every time a shock is given Connection though a node and using the special loop back symbol are two ways for connecting a frame back to itself To connect using the loop back symbol A Click in the Event field you want to connect Drag the mouse to the Action Field of the same frame and release the mouse button The cursor will change shape when in connection mode i To change the cursor back to normal click the Select button 5s 4 14 Deleting Frames Connections and Frame Items To delete a frame click the Select frame button Ls Note Select frame is usually the default mode when no other function is selected Select the frame by clicking its border the selected frame is marked with a blue border and Frame i then clicking the Delete Item button The frame and its connections will be deleted You can also del
27. automatic responses to events Events are those listed in the SimMan window as ABC Action Miscellaneous and Medication events There is one Handler for each category Scenarios can perform the same task as Event Handlers but Event Handlers specialize in handling events By running the event handlers simultaneously with a running a scenario you can take event handling out of the scenario and let the scenario concentrate on the training The simplified scenario is easier to build and maintain If a scenario handles an event such as starting Frame a trend when a medication is given it must go to a new frame start the trend and then come back again Whine Epinephrine Frame Start Trend Trend Stark 0 0 Dur 10 0 However the event S r might happen in another fas frame causing it to perform the same check in every frame If you also want to check for several other events the scenario soon becomes long and Frame Start Trend Trend Start 0 0 0ur 10 0 cumbersome jmamelmes 0m s O Framel Framez2 pL Epinephrine Frame3 Start Trend Trend Start 0 0 0ur 10 0 fremelime m s Frame 6895 rev F OLaerdal Medical 2002 page 97 of 125 The event handlers are specialized in handling events They jump to another frame perform an action and jump back again Since they run simultaneously with the scenario it works as if the scenario were
28. checked event also happened in FrameQ Example 2 In this example performing either Intubation or IV Line Insertion in Frameo will move the scenario to Frame2 because Intubation and IV Line events are remembered Framet pubs checked Frame Pulse checked Frame O ntubation Frame intubation Framez Lo ee k 6895 rev F OLaerdal Medical 2002 page 89 of 125 4 16 1 Adding or Editing Events in a Frame Events us __ E Shacks Delivered i L ancel AB D efibrilla Click the Click the Event Edit the dialog and click OK The programmed desired field in the frame you Note Some events do not havea event will now Event want to edit dialog appear in the button frame s Event 4 16 2 Add Delete Event Fields In some cases more than three event fields are needed Click the right mouse button in any event field and select Add Event Output from the menu A new empty Event field is added to the right of the existing fields To delete an Event field click the right mouse button in the field you want to delete and select Delete Event Output from the menu Note It is not possible to have less than three event fields in a frame but there is no limit to how many may be added You can resize an event field by resizing the frame 4 16 3 Add Event Comment Add Event Comment allows you to add a comment in
29. computers sound recorder 2 Save the recorded sounds in the SimMan Sounds folder 1 To record new sounds Microphone Controls Connect a microphone to the microphone input on l Activate Microphone Amplifier your PC or use the built in microphone if your PC is equipped with one Under the Tools menu select the Microphone Controls option It is recommended that you Latency 250 ms adjust the microphone input level Mic in by dragging the lever to the maximum level that does not cause sound distortion Master Out From the Windows Start menu open the application under the folder Programs Applications Multimedia Sound Recorder in Win98 Programs Accessories Entertainment Sounds Recorder in Win2000 XP The Sound Recorder will appear Record the sound using the microphone and the Record and Stop keys on the Sound Recorder window 2 To save the recorded sound On the Sound Recorder window select Save As and save the recorded sound file under the following folder on your PC hard drive C Program Files Laerdal Medical SimMan Application Sounds Note This is the default SimMan location If you chose to install in a different location during the SimMan install the correct location on your PC will be relative to the location you chose The next time the SimMan program starts it will search for wav files in this folder and list them in alphabetical order in the Vocal Sounds pull down menu
30. corresponding sound is unaffected If the volume set levers are not moved sound volume will be unaffected and indicated by to the lower right of the lever If the volume is changed level will be displayed as 0 to 10 6895 rev F OLaerdal Medical 2002 page 107 of 125 5 16 4 Airway The Airway Action button allows you to set the state of all SimMan airway functions Ni Each function is identified with GR km a ToolTip when the mouse is moved over the button Each airway function has three states No change The function will remain as set in previous frames E Not Active The function will be cleared For instance Trismus off X Active This function will be set For instance Trismus on 5 16 4 1 Preset Buttons Reset All sets all functions to Not Active 2 Can t Intubate Can Ventilate will set Tongue Edema Pharyngeal Obstruction Cerv ROM and Stomach Decompr Cant Right and Left Lung compliance 5 16 5 Vocal Sounds The Vocal Sounds Action button allows you to select one of the manikin vocal sounds Yocal Sounds Start Sound The sound can be repeated several times at a selected interval Repetitions of sounds will continue Stop Sound even if the scenario changes frame Repeated sounds can be stopped in another frame by selecting Stop Sound I xi Cough Number Interval Cancel 6
31. difference between Events and Actions especially in the Scenario Builder Events Things that happen outside the control of a scenario and usually caused by student s are called Events The ABC Miscellaneous Medication Events in the main SimMan window are also ocenario Events There are also time Events caused by either of the two timers reaching a predetermined limit Actions In a scenario Actions are performed by the scenario For example changing a parameter value creating an airway complication and making vocal sounds are Actions performed by scenarios See 4 16 for more information on Events See 4 15 for more information on Actions 4 8 Frames A Frame represents a state in the scenario The frame s large upper field the Actions field Blood Pressure 120 80 contains the name of the frame Frame0 and Vital state descriptions Spe 38 LO 34 0 mmHg Frame0 is always the starting frame and will Temp 33 0 F always contain a default setup when New a Rate 10 CO2 Exhalation OFF 3 Reset All Scenario is selected Frame0 cannot be deleted but can be changed Pulse checked The scenario is constructed from a set of frames Each frame represents a state of the patient The Scenario can only operate in a single frame at any given time The scenario moves to other frames as events specified in the Events fields occur The Event fields are found along the bottom of Pulse checked
32. elapsed time is also displayed in the upper left corner of the _ 0 52 00 a a E Patient Monitor Clicking the Pause Event Log button pauses the Event Log and stops the elapsed gt IM 44 time Clicking the Restart Log button clears the Event Log and the time resets to zero gt uj Ss Restart will also remove indicated events such as Intubation and IV Line from the manikin picture You must answer Yes in a confirmation dialog before the log will restart Note Restart Log is different from Reset Patient on the Tools menu Reset Patient will restore SimMan and the Manikin picture to its original setting at start up 2 9 1 1 Adding Comments to the Event Log The instructor can add additional comments to the log by clicking the Event EEUE button IX 1 09 59 n a An Enter Comment dialog will appear Enter the UETTUN comments you want to appear in the log and click the Submit button Uncheck the Close on Submit box if you don t want this window to automatically close when you click Submit I Close on Submit Submit Close 2 9 1 2 Saving the Event Log To save the current event log to disk select Save Log from the File menu The Save As dialog will be displayed Save As fx Save inr Ej als E Ej g Event Logl htrnl ke Event Logl xml ej TestLagz xml Ei TestLag3 xml fe TestLags xml E TestLogSave xml r amp tudent infa F
33. for subcutaneous and intramuscular injections including right deltoid right thigh gluteal left thigh and ventro gluteal Using a 22 gauge or smaller needle increases the longevity of the skins 6895 rev F Laerdal Medical 2002 page 18 of 125 G 5 Blood Pressure Arm Blood pressure settings are controlled using the computer or remote control These settings are also linked to the ECG functionality so if you are changing the rhythm from a perfusing rhythm to a non perfusing rhythm this will also be reflected on the blood pressure settings which will be changed according to the new type of rhythm A non perfusing rhythm will also change breathing rate BR to zero When changing to a perfusing rhythm the blood pressure will remain at 0 0 until changed breathing rate can not be changed until blood pressure has been established G 6 Laerdal SimMan Software Using the computer user interface or the appropriate remote control the Laerdal oimMan Software allows the operator to select and control the following patient functions Breathing Respiratory Rate Heart Sounds Lung Sounds Bowel Sounds Vocal Sounds Patented Expert Difficult Airway functions Over 2 500 ECG rhythm variations systolic and Diastolic blood pressure values Pulses opO amp CO Temperature All data displayed on the Simulated Patient Monitor The remote controls are used as described below 1 Remote Primary cardiac functions and other miscellaneous items 2 R
34. from the walls of the room and noise from the environment Most important is the volume of the recorded sound If the volume is too low the playback volume will also be low SimMan only has limited sound volume gain If sounds are recorded at very high volume the recorder will have to clip the highest volume peaks which add a lot of noise The optimum is to record the sounds at the highest possible volume without the recorder ever having to clip To set the recording volume using the standard Windows volume control double click the speaker icon in the system tray found on the task bar Note The symbol may be temporarily hidden if you are running Windows XP unhide it by clicking the lt button The play control dialog will appear go to options properties and select to adjust the volume for recording Ensure that the microphone control is enabled When the microphone volume control displays select it and you are ready to go 6895 rev F Laerdal Medical 2002 page 122 of 125 A smart tip here is to go to the SimMan Tools menu and select Mic controls Select Activate Microphone Amplifier and deselect it again Now you can adjust the microphone recording volume by adjusting Mic in You cannot visualize the recorded volume of a sound using the Windows Sound recorder program We recommend using another program such as Goldwave www goldwave com but there are many other inexpensive programs Th
35. in the lists on the main T Check diuresis M SimMan window Unhide Unhides the event under the cursor if it is hidden Delete Deletes the event under the cursor Rename Renames the event under the cursor You can also rename an event by clicking to select it and then clicking on it again to type the new name Sort Sorts the selected event list alphabetically Alphabetically It is possible to copy events to and from folders Open the folder and use the mouse to drag and drop events into it To move an event rather than copying it hold down the shift button while dragging the event to the desired location The folder named System Events contains all events that originally came with the system This folder is hidden and undeletable and it is not possible to edit its content If you have deleted an original event from an event list and want it back you can copy it from this folder Make sure to click the OK button to save your changes 6895 rev F Laerdal Medical 2002 page 51 of 125 2 10 2 1 Assigning Events or Sounds to the Remote Control You can assign events or sounds to the lower row of keys green on each remote Two events can be assigned to each key one with the shift key pressed simultaneously and one without the shift key pressed Si a The two key rows are shown on the Edit menu screen DENN ORA HPA ani Combi Cric An event or sound is assigned to a remote control key by dragging the event s
36. in the lungs is indicated t on the user interface It is not an accurate indication of the amount of air in the r e lungs but a non quantified indication The heart animates every heartbeat Heart and Lung Animation can be turned on off individually in the Options menu by selecting or deselecting Heart Animation or Lung Animation 2 Monitor Controls 2 7 1 Basic Parameter Control Monitor Controls Monitor Controls controls and indicates status COs mmHg spo ez Temp C for COs SpO and Temperature These 3 m m pu parameters are only shown on the Patient Monitor Sal 88 ET 37 2 ET L E and do not affect any functions on the Manikin C05 kPa To adjust CO use the CO Up Down buttons 40 nl n E Mer With the Cardiac or Airway remote control press the CO Up Down SERIEN keys CO scale can be set to mmHg or kPa in the Options menu by selecting or deselecting CO2 in mmHG To adjust SpO use the SpO Up Down buttons Sp 2 100 X 1005 ri With the Cardiac or Airway remote control press the SpO Up Down keys Temp To adjust T he Temp Up D o adjust Temperature use the Temp Up Down buttons 352 is ri Temperature cannot be adjusted with the remote controls Temperature scale can be set to Celsius or Fahrenheit in the Options menu by selecting or deselecting Temp in Fahrenheit 6895 rev F OLaerdal Medi
37. is equal to the set number of seconds The scenarios have two timers 1 Patient timer This timer counts downwards It starts at zero when the scenario starts so it must be set to a value before use In addition to setting a specific value time can also be added or subtracted by the scenario See 4 15 13 for more information on Patient time You are free to use this timer as you choose The Patient timer can be used to count the seconds a critically ill patient has left to live Actions performed correctly by the students can add to the timer Time will be subtracted if actions performed by the student are dangerously wrong or if they bring the patient out of the critical state altogether The scenario can be programmed to make the patient beyond rescue if the student does not perform the correct action and the timer will reaches zero 2 Frame timer Time in this frame This timer counts upwards from zero when the running scenario changes from one frame to another This timer is intended to automatically change to another frame when the running scenario has stayed within the same frame for the specified amount of time The running scenario cannot change the frame timer other than by entering a new frame A scenario is allowed to go from one frame back to itself and the frame time will then be reset to zero 6895 rev F OLaerdal Medical 2002 page 96 of 125 5 Event Handlers 5 1 Overview The purpose of Event Handlers is to simplify
38. last successful COM port but if it does not get a reply it will display this message Abort will close SimMan Ignore continues without connecting to the external devices Retry makes the program try the same port SimMan Link not found SimMan Link could nat be Found at COM ports 1 3 The cause is probably aj The Link is not connected to any serial pork b The Link has nat been powered an Click Abort to terminate the SimMan program Click Retry to retry connecting to Link Click Ignore bo run SimMan program without connection to Link and Manikin Retry Ignore again If a connection is still not found an additional retry will make the program scan COM ports 1 through 9 In some cases other PC programs have occupied the COM port to which the SimMan is connected We have experienced problems with programs that are used to communicate with personal organizers The COM port may also be disabled if the IR port is enabled on a laptop These problems are program specific or hardware specific to some programs and some PCs Consult your program vendor or hardware vendor for solutions In other cases the SimMan main program has problems communicating with the SimMan host program This dialog will Possible causes appear Another program may be blocking the COM port SimMan Fatal Error SimMan could nok establish a connection with the SinMan host program Any synchronization software fe
39. not open Compressor Box when energized it contains high voltage The compressor should only be repaired by authorized personnel F 7 2 Option 2 Regulator Unit If you have purchased Laerdal SimMan with the Regulator Unit attach one end of the double lumen tube to the Air CO s out to Manikin outlet on the regulator and the other end to the right axillary side of the manikin Connect the Air in inlet to a wall air outlet or to a pressurized air canister 70 120 psi If simulated exhaled COs is desired connect the CO inlet to a pressurized CO canister 60 90 psi Jet ventilation TTJV requires a special connector available for purchase using part number 381201 SimMan amp AirMan Regulator Unit Air in 5 8 bar 70 120 psi CO in Shut off Air 60 90 psi Shut off CO 6895 rev F OLaerdal Medical 2002 page 15 of 125 SIMMAN CABLE HOSE CONNECTION GUIDE Dc IMPUT CABLE j Pabient Monitor Power CABLE ii rH EN GGG Wem i I I P TO MANIKIN 1 AISI 1 DATA CABLE ap o eX c0 SOURCE SOUHD TABLE i 1 TO MHIKIH I AIRCO 1 a ll 1 TO ca souRce i ooo COMMUNICATION Ta SOUND OUT PORTS PORT AIR SOURCE HEALI HOMHE JACE 6895 rev F OLaerdal Medical 2002 page 16 of 125 G Instructions For Use G 1 Airway Management Using the computer user interface or the appropriate remote control the following airwa
40. of its product s only if e Service repair readjustment or modification is carried out by Laerdal Medical or persons authorized by Laerdal Medical e Electrical installation of the room where the product is used complies with pertinent national requirements e Product is used in the proper manner in strict compliance with its directions for use Laerdal Medical shall not be liable under this warranty for incidental or consequential damages or in the event any unauthorized repairs or modifications have been made or attempted or when the product or any part thereof has been damaged by accident misuse or abuse This warranty does not cover batteries softpacks modules fuses normal wear and tear staining discoloration or other cosmetic irregularities that do not impede or degrade product performance Some states in the USA do not allow the exclusion or limitation of incidental or consequential damages so those limitations or exclusions may not apply to you There are no other express or implied warranties whether of merchant ability fitness or purpose or otherwise on the product its parts and accessories 6895 rev F Laerdal Medical 2002 page 2 of 125 B Cautions and Warnings Laerdal SimMan should be operated by trained persons Do not connect the product to a patient Use of a defibrillator for training purposes represents an operational hazard equivalent to use of a defibrillator on a real patient since it involves the
41. time an alarm will remain disabled when an alarm sounds and the Alarm disable button is pressed The default is two minutes selecting Set beeper volume allows you to set the volume for the High ECG SPOz2 beeper to High Medium or Low or to turn it off Medium Low V Off 6895 rev F OLaerdal Medical 2002 page 113 of 125 Selecting Save setup allows you to save up to five setups setup Configure the monitor as wanted and then select Save Setup from Setup the menu You can then select the setup under which you want the P configuration stored Setup3 Setup4 setups selecting Restore setup restores any of the saved setups selecting Reset to default resets the configuration to the default Selecting Help displays basic help Selecting Calibrate Touch Screen allows you to calibrate the screen since there may be some difference in the location you touch the screen and the location the monitor reads Choosing this menu starts the calibration Follow the on screen instructions 1 Press Calibrate 2 Touch the two points as requested 3 Press OK to finish the calibration 4 Press OK again on the message that notifies you that the new calibration data is stored in the Patient Monitor registry The calibration can also be started from the Patient Monitor menu in SimMan s main program 6 3 Waveform Fields 6 3 1 Modifying a Waveform When touching a waveform you will be given a me
42. user can also choose to log in as different usernames to have different setups for different situations e g anesthesiology emergency physicians nursing paramedicine difficult airway respiratory etc 2 1 1 Initial Log In The first time SimMan is started a new user must evem aniser be created This is not necessary if SimMan is being upgraded This is the new SimMan User User Name a DK dialog Passwords may be blank Password meee Confirm Password Enter User Name and Password A new user and user data area will be created 2 1 2 SimMan Log In Once you have created a user name this is the ordinary SimMan log in screen that will be displayed when you log on to the system SimMan Log In Username Password Cancel New User Admin 6895 rev F Laerdal Medical 2002 page 28 of 125 2 1 3 Administrator Tasks Enter administrator mode to give users who forget their passwords new ones or to delete no longer needed users Administrator Log In This can be accomplished by clicking the Admin button in the log in dialog and logging in as administrator The default administrator password Is password F Laerdal heitung umar Fert laser name Administrator Password Cancel Then select the desired user and click Password to assign a new one or Delete User to remove the selected user SimMan Administrator If you choose to delete a user a warning note will Password
43. with administrator rights to install the Laerdal SimMan software The installation program will let you choose between installation for all users or for the current user only TCP IP If the PC is setup for Internet usage TCP IP is already installed Windows 98 Me 2000 XP are by default Internet ready and come with TCP IP pre installed If TCP IP is not installed you should follow these steps 1 If you are connected to a network consult your network administrator 2 If you are not connected to a network Be sure to have your Windows installation CD or floppy disks available Install Laerdal SimMan software and Internet Explorer by following the loading instructions Go to the Start menu select Programs and the Internet Explorer folder and then select Connection Wizard You will be presented with a number of choices select want to set up a new connection on this computer to my existing Internet account using my phone line or local area network LAN Click Next select Connect using my phone line Click Next The necessary files will be installed you may be prompted for Windows installation disks When prompted for modem click Cancel and exit the Connection Wizard Restart Windows You should now be ready Double click the SimMan desktop icon to start the Laerdal SimMan program If the Connection Wizard starts again select My computer is already set up for the Internet Do not show this wizard again
44. with this file Please contact your system administrator or This application must be installed to run Please run setup from the location where you originally installed the application To fix the error start Laerdal SimMan installation from the Laerdal SimMan CD ROM and reinstall the Laerdal SimMan software This will activate the program for the Current user 6895 rev F Laerdal Medical 2002 page 12 of 125 F Assembly and Setup of Laerdal SimMan System See the Operating Guide CD ROM for further details F 1 Attaching the Legs 1 Locate bag containing attachment hardware 2 Remove insert pad from upper leg 3 Lift genitalia and reservoir section out of the pelvis of the manikin DO NOT remove upper abdominal section 4 Place a washer a spring and another washer onto threaded 15cm 6 bolt 5 Insert threaded bolt through upper leg through hole and into internal cavity of lower pelvic area 6 From inside pelvic area slip a washer on the bolt 7 Screw a locking wing nut provided onto bolt and tighten until desired articulation is achieved AE y A F 8 Replace genitalia urinary reservoir and insert pad ea replacing the genitalia and urinary reservoir make B that the pelvic pin has been replaced 9 To remove leg s reverse the procedure F 2 Crico Thyroid Membrane Hy Tape 1 Expose neck to visualize opening that has been molded in place of crico thyroid membrane 2 Remove used Hy T
45. 1 1 Head The head allows for performance of head tilt and jaw thrust manuevers however the airway is open in all positions D 1 2 Airway and Lungs a oimMan s airway is instructor controlled to allow simulation of various airway complications including the failure of therapeutic airway devices This encourages students to extend their airway management skills beyond those used on a daily basis oimMan accepts a wide range of airway management devices and techniques Some examples are Oral nasal pharyngeal airways Endotracheal tubes nasal and oral Laryngeal Mask Airways Combitube Needle cricothyroidotomy Surgical cricothyroidotomy Retrograde intubation Fiberoptic procedures Light Wand intubation Bronchoscopy Ventilation can be performed using any of the following Bag Valve Mask devices Jet ventilation Ventilator The manikin contains two lungs Intubation that is too deep will result in unilateral lung filling This usually occurs on the right side due to the accurate anatomical modeling of the tracheobronchial junction and bronchial tree The system does not accept PEEP modes of ventilation Mouth to mouth nose mask ventilation should not be performed on SimMan Please note that thorough cleaning of the upper airways as well as changing the lungs will be necessary if mouth to mouth nose mask has been performed on the manikin The airway contains a number of instructor controlled complication
46. 1 7 Insert Pads a SimMan contains bilateral thigh gluteal ventro gluteal and right deltoid insert pads b The pads can be used for intramuscular and subcutaneous injection practice c These can be interchanged with optional trauma or nursing wound modules 6895 rev F OLaerdal Medical 2002 page 7 of 125 D 2 SimMan Software The SimMan Software serves as the instructor s tool for controlling the training scenario It requires a Pentium computer with MMX processor 233MHz or better a minimum of 128 MB of RAM with 150MB available on the hard disc Windows 98 Me 2000 XP NT and a CD ROM drive with minimum speed of 4x The software features are a raining controls via computer keyboard and or remote controls b Over 2 500 ECG rhythm variations Variable extrasystole rate Choice of various extrasystole types Variable pacemaker threshold external pacemaker training only Control of manikin functions Airway complications Tension pneumothorax Breathing BP NIBP and Arterial opO simulation Temperature display g Auscultation sounds o0 ao Lung Heart Bowel h Vocal sounds Numerous vocal sounds are available moan vomit cough etc Additional sounds can be recorded by the user Microphone option instructor may speak directly through the manikin s on head speaker by using the microphone Left right or bilateral lung obstruction j Pulse strength i o Activity Log scenario Buil
47. 25 In Windows 2000 XP you can also make the list window transparent by right clicking it and selecting Transparent To dock the list back into the SimMan window again right click it and select Dock 7 Albumin Aminophylline e Amiodarone e Anaesthetised ainvays Appropriate cardiac drugs ASA vee Atropine z Benzodiazepines Blood M Bretvulium E Dextran Ee D obutamine A apamin ve Epinephrine E Fentanyl Ee Flumazenil v Glucose 50 vee Ialycopyraniumbramide m Inhalation Therapy bet Ketamine Lactated Finger Lidocain A Magnesium Sulfate v I annital he Morphine 5 Morphine Sulfate bet Naloxone Neostigmine 2 Nitroglycerine me Mitraprusside v Pancuranium hu Flasma a Fracainamide 6895 rev F OLaerdal Medical 2002 page 50 of 125 2 10 2 Edit Registered Events List Register Events ABL Action Using the Edit button new events can be added deleted or assigned from the event logging lists This function also allows you to assign events to remote control keys Miscellaneous Medication Edit Menu ABC Action Miscellaneous Abort attempt Auscultate heart Auscultate lungs Awaken the patient Call for help Check diuresis Check Hemoglobine Consciousness Check Bag tube ventilation BURP Combi Cricoid pressure Cricothyrotomy Extubation fiberoptic intubation hyperventilation
48. 895 rev F Laerdal Medical 2002 page 108 of 125 Starting another sound in another frame overrides a previously programmed sound However the sound will not start until the one playing has completed 5 16 6 Breathing Rate The Breathing Rate Action Breathing Breathing Rate min CO Exhalation button can be set from 0 40 10 m Ma Change breaths per minute in increments to of two C Disable Output of CO in the exhaled air is also controlled from this function 5 16 7 Vital Signs Patient Monitor Sp Os E rc Coe Vital Signs Temp Sp02 x Fi N20 The Vital Signs Action NoChanoe S DRE TEC a button allows you to set Ems xm z Patient Monitor ET N20 No Change Change No Chanos a sl parameters ka g Temp CF Fl Anaest No Change a Change NoCh Only the parameters with niak F Change the Change tick box Perf Temp CF ET Anaest ticked will be changed the others remain unchanged CO and Temperature scales are controlled by the SimMan settings 6895 rev F No Change ka Change No Change v co No Change F CYP mmHg No Change kd No Change Es No Change E Change Change Change Change TOF No Change TOF a No Change a Laerdal Medical 2002 Change Change Change Cancel page 109 of 125 5 16 8 Trends The Trends Action button allows Trends to be started
49. Breath Sounds See 2 6 7 Le neare Anaso w Lung Animation Heart Animation See 2 6 8 v Temp in Fahrenheit Lung Animation See 2 6 8 wv COZ in mmHg l wv Remote Enabled Temp in Fahrenheit See 2 7 1 Exhaled CO min Auta OFF CO2 in mmHg see 2 7 1 w Monitor Parameter Variability Remote Enabled See 2 4 Save irene images when saving log Chest Drain Exhaled CO2 2 min See 2 6 3 Trend MaxJMin values Auto Off Monitor Parameter See 2 7 4 Variability Save trend images See 2 9 1 3 when saving log Chest Drain See 2 2 Trend Max Min values See 2 11 3 2 14 5 Tools Menu The Tools menu controls various commands En Help I Mic tantrols Mic Monitor Opens the microphone monitor dialog for Calibrate BP improving direct microphone volume This Calibrate Patient Monitor control can also set the Windows volume Reset Patient control See 2 6 6 Calibrate BP Allow you to calibrate the SimMan SW to your cuff pressure meter See 2 8 Calibrate Patient Opens the calibrate dialog on the Patient Monitor Monitor Follow the on screen instructions to complete the calibration Reset Patient Restores the SimMan and Manikin picture to its original setting at start up 2 14 6 Help Menu The Help menu provides access to SimMan Help and displays software version information in the about dialog Show Help Show Help Opens SimMan Help window About SimMan About SimMan Shows SimMan SW version info See A
50. CONTENTS A LIMITED VV ATI Vacca teazb tee esit es nbee pasa tiet dac tiat tec odes so eade de ierat ecu een eruitur 2 B CAUTIONS AND WARNINGS ree ee rere uuu 3 eese ygbee 4 D SYSTEM FEATURES 1 5i dris v CEU pd VE Eri sd we ipo Eve Gi vU P Cub Save E Lipa vCR iee iaae iE 5 E SOFTWARE INSTALLATION eeeee eere nennen nennen nnn 10 F ASSEMBLY AND SETUP OF LAERDAL SIMMAN SYSTEM 13 G INSTRUCTIONS FOR USE ics ectinu necu ho npn Eee sax ero EER a 17 H REPAIR AND REPLACEMENT INSTRUCTIONS 20 I CARE AND MAINTENANCE 11eeeeeeseeeeee eene nennen nennen nnn 23 J SIANDABHDS APPHOVALSJS 1 e eue Ec ee PeuE Eas qe ceo oce pee aov Eus oe nnmnnn EE Eee Eee 23 K PARTS ACCESSORIES LIST ecszsvnssknEERNFnFLE ES NNREE TEN nEEE USE NEENNES RUE FEE SEN FEEEE 24 L OPTIONAL FEATURES miis cece ines cents cias a Eee E E Oise E20 CE va Ec Cc e s cve sa ees 26 1 SOFTWARE HOW TO GUIDE ecce eren nennen 27 2 SIMMAN MAIN PROGRAM eereeee re neeeen ener nnn 28 3 EDIT IRENDS coats ce ease aie se cance ORE ER REM aae tate cubi Ese cesta cesis 63 4 SCENARIO BUILDER tss ieo bat ao e 68 5 EVENT HANDLERS 2 xeiolexUioerhusioc ta epi uucHineutossbuee te snin s ietates ui seat esi Fosie 97 6 SIMMAN PATIEN
51. Cancel Bl seconds amp 6895 rev F OLaerdal Medical 2002 page 91 of 125 The CPR Performed Event function allows you to set one of the following CPR related events Started e Ventilations started e Compressions started e CPR started Either compressions or ventilations are started on the manikin Stopped e Ventilations stopped No ventilations detected for five seconds e Compressions started No compressions detected for five seconds e CPR stopped No ventilations or compressions detected for five seconds Performed e Ventilations Compressions CPR performed To set the amount of time allowed between the starting and stopping of a specified activity click the Up Down buttons for Performed accumulated for until the desired number of seconds is reached If the activity is started and stopped several times within the same frame the time of the sequences are accumulated 4 16 6 Precordial Thump The Precordial Thump Event occurs when a Precordial thump is performed on the manikin This BPeewd hump event has no dialog and is displayed immediately in the Event field 4 16 7 Defibrillation Performed 5 Defibrillation performed The Defibrillation Performed Event allows you to 1 E cemere set the event for execution when a certain number of shocks are given Set Shocks Delivered by clicking Cancel on the Up Down buttons and then click OK
52. Inadequate ventilation aus dn Intubation Gasth Add Folder IV Line Req Add Event IVLine Removed 5B Syste Hide JET ventilation LMA Delete Mask ventilation Rename NPA Sort Alphabetically OPA Oxygen Oxygen Removed Pneumothorax Decompr te ea Medication Adenosine Albumin Aminophylline Amiodarone Anaesthetised airwar Appropriate cardiac ASA Atropine Benzodiazepines Blood Bretylium Dextran Dobutamine Dopamin Epinephrine Fentanyl Flumazenil Furosemide General naesthesiz Glucose 5 Configure your remote by dragging the items you want from the listboxes onto the remote buttons Assign an item to a shift function by dropping it in the shift field above the button OPA NPA LMA Combi Cricoth Cardiac Glucose 50 Nitrogl Morphi Glycopyroniumbromic Inhalation Therapy Ketamine Oxygen IV Line ASA Lactated Ringer Lidocain Sj Drop here to delete M Magnesium Sulfate Mannitol M OK Cancel Help gt Suction 3 System Events Two person mask ventil Volume Infusion Morohine Right clicking on the title of the event list you want to edit gives you th Add Folder the Edit menu q dd Event ote Hide Delete Rename Sort Alphabetically Add Folder ADDS A NEW FOLDER IN THE SELECTED LIST Add Event Adds a new event to the selected list Hide Hides the event under the cursor Hidden events are shown in the example on the right ee Hidden events are not shown
53. Intubation Epinephrine each frame They specify events that will cause the scenario to advance 6895 rev F Laerdal Medical 2002 page 73 of 125 To control which frame the scenario moves to connection lines are drawn from each event box to the desired frame When the specified event occurs the scenario moves to the corresponding frame Blood Pressure 120 80 Wital Spl 88 LO 34 0 mmHg Temp 99 0 F Breathing Hate 10 COZ Exhalation OFF Away Reset All Pulse checked Intubation Epinephrine Frame Framez Comment Corect Step Start Trend IncreaseHA Start 0 0 Dur 10 0 Pulse checked or Intubation The scenario always starts in FrameO The Action field sets the initial parameters when starting a scenario When the scenario moves to another frame the new frame s Action field changes the parameters as specified All other parameters are not changed The actions in the Action field are performed one time when the Scenario enters a new frame While in a frame the instructor can change any of its values When the Scenario is running the frame name Frame time 16 and time and Patient time are displayed next to n m Patient time O the control buttons 4 9 Creating a Frame To create a frame click the Create Frame button and then on the screen in the location desired The frame automatically receives a name that displays in the Action field After the button is clicked the
54. P 120 f 80 T EMD PEA E Bap 9 a 6895 rev F Laerdal Medical 2002 Cardiac Controls Running Rhythm A Sinus EX Extrasyst 10 m Muscular 50 60 Hz Rate min Waiting Rhythm Wait Run Weait lt gt Run Manual Activate Paroxysmal Extrasyst Threshold m page 30 of 125 Airway and Auscultation Controls controls and indicates Airway and Auscultation Controls status for spontaneous breathing the airway features Breathing Rate auscultation and vocal sounds Apea Reset All CO2 Exhaled BY E See 2 6 for more information on using Airway and Auscultation Controls Vocal Sounds Moan 7 Monitor Controls controls and indicates status Monitor Controls for patient monitor parameters CO3 mmHg spo 5 9 amp Temp C E sE 215 x Clicking the more button opens the TuS MER Monitor Control dialog for adjusting all Link SE parameters on the Patient Monitor BPSys BP Dia Temp PTemp TOF By ticking the Link tick box you can 4 E 4 l 7 Jj A E a make the Systolic and Diastolic sliders 120 5 5 l min 6 0 mmHg ss GI move together Sp02 FIO2 ETOZ FlAnaes ETAnaest FINZO ETN20 TOF See 2 7 for more information on Ji ry p Ji dl Ji a controlling the Patient Monitor ae un 3s Ge ay Ge nd t Register E vents Register Events allows you to register ABC M v Action Miscella
55. Same as F ri With the Cardiac remote control press the QRS Type key repeatedly until the desired QRS type is displayed 2 5 3 2 Basic Rhythm Select a new basic rhythm by pulling down the Basic Rhythm list box and selecting the desired type The Basic rhythm will appear with default HR and no extrasystoles Torsade de Fointes ri CARDIAC REMOTE AIRWAY REMOTE With the Cardiac or Airway ETUR EE Sinus WV ib V tach Asystole remote control press any Basic 8 NM BM BM BM B BM Rhythm key Atach A flutt A fib Idiov Junct If V Fib or Pacemaker rhythms 3 B o are selected the HR Up Down keys can be used to select the desired type of V Fib or Pacemaker rhythms 2 5 3 3 Extrasystole 1AVB 2 AVB 1 2 AVBH2 3 AVB Pacemaker Select the desired extrasystole by pulling down the Extrasyst list box and selecting the desired type peers Available extrasystoles vary with the basic rhythm For example all PVC RonT extrasystole types are available with a Sinus rhythm and none are available Coupled PVC with an Asystole rhythm r PJC Cardiac Remote Airway ri With the Cardiac or Airway remote control UTICA NEF CIES kat INCI Remote press any Extrasystole key PVC RonT PVC PVC Pressing the same key again will clear the Extrasyst selection If no Waiting Rhythm is selected the extrasystole will go directly into the Running Rhythm Unifocal Couplet PVC PVC 2 5 3 4
56. Scenarios Trends Events Menus etc Note After a software upgrade the default folder has been upgraded with new scenarios but the other user folders have not oee below for instructions on copying new scenarios from the default folder to other user folders c First StartUp After Software Upgrade When the software is upgraded with a new version any new scenario trend or handler files are only installed into the default user The first time SimMan Software is started it will give you the option to copy the new files to all existing SimMan users 6895 rev F OLaerdal Medical 2002 page 119 of 125 New Installation Siz bd New Scenario Event handler and or Trend files have been installed Do you want to make them easily available to all users F tis recomended that you answer res This dialog box is only shown once so unless you prefer to copy these files manually you should answer Yes Once Yes is selected the program will automatically copy all new files from the default user to all other users If an existing file with the same name as a new one exists this message Is displayed Hew installation The fle trends T estS ample tnid already exist for the user SIR m Do vau want to overwrite iE with a new file t is recommended to answer res unless if the user has customized il Mo es to All Ma to All You must consider whether the user has made change
57. T MONITOR eeeeeeeeee rere rennen 112 7 UPDATING MANIKIN LINK AND MONITOR SOFTWARE 118 I SIMMAN DIRECTORY STRUCTURE eere 120 Il SIMMAN PROGRAM FILES OVERVIEW esee 122 Ill FACTORS THAT INFLUENCE HEAD SPEAKER SOUND QUALITY 123 IV SIMMAN XML EVENT LOG FORMAT eere eere 124 V AVAILABLE EGG RELY CRIM Sc iii ipseusta accu ine ocean io quat aa oer aa Coin e coit cues 125 6895 rev F OLaerdal Medical 2002 page 1 of 125 A Limited Warranty Laerdal Medical warrants to the purchaser that its product s is are free from defects in material and workmanship for a period of one 1 year from the date of purchase by the original user During the designated one 1 year period Laerdal Medical will upon receipt of a product found to be defective due to materials or workmanship from the purchaser and notification in writing of the defect at its option repair or replace any parts found to be defective or the entire product if repair is not possible Products found to be defective and notification of defects may also be sent to the authorized Laerdal Medical dealer from whom the product was purchased All postage shipping or handling charges shall be the sole responsibility of the purchaser Laerdal Medical is responsible for the effects of safety reliability and performance
58. The overall slider to the left and the wave slider control the volume You can also adjust these two sliders in parallel by going to the SimMan Tools menu and selecting Mic controls Deselect Activate Microphone Amplifier if you don t need it Now you can adjust the two volume levers by adjusting the Master out Warning If the output volume from the PC is too high the Link box amplifier will become overloaded switch itself off You will clearly hear this almost no sound will be coming out of the speaker If this happens you must reduce the Windows sound level Distortion in speaker sound will be caused if the total level is too high You will have to adjust it to a level acceptable to you IV SimMan XML Event Log Format The reports are stored in XML format XML stands for extended Markup Language and is thought of as an extension to HTML Hyper Text Markup Language although XML is quite different and is not handled in the same way HTML is the format used on the Internet to format and display text and pictures XML is used on the Internet as a common text language for transferring data The advantage of using XML to store the logs is that the logs can later be processed in different ways It is possible to customize how the logs are displayed and it is also possible to import the data into a database that recognizes XML Together with the log files having the xml extension there are two other needed file types for processing
59. a log when the student performs an action or another event occurs e g a time event 6895 rev F Laerdal Medical 2002 field Add Event Comment Pd S Pulse check Intubation Epinephrine Pulse checl ntubatian Add Event Output Delete Event Output Add eh E Comment Pulse checlIntubation Add Event Output Delete Event Output page 90 of 125 Comment W ribe Comment Here The Student did nat perform the right action within the time limit 0K _Eancel Cancel C Corect Step t Mat Applicable The comment can be earmarked if the action was a correct or wrong step or that the comment is not applicable to the action When going through the log during debriefing this can aid finding interesting log items An event frame containing a comment is marked with a button Click on this WFrameTime 200 button to edit the comment Available Events 4 16 4 Pulse Checked PA 1 pe The Pulse Checked Event occurs when pulse is checked on the manikin This event has no dialog Pulse checked Cd and is displayed immediately in the Event field It does not matter where the pulse is checked any pulse check Carotid Radial Brachial or Femoral on the manikin will fulfill the criteria for the event 4 16 5 CPR Performed CPR EE Detect C Yentilations f Started C C Compressions Misco CPR C Perfomed accumulated for
60. acts E trasust EMD PEA Hate rr No Change Mo Change C Ma EMD PEA C EMD PEA GAS Basic Rhythm Extrasust HH OF 4 Sinus J 20 Muscular 50 60 Hz Cancel EI The ECG Action button allows you to set the ECG and ECG related parameters If Extrasyst is blank default Extrasyst Rate min will not change from its previous state Note EMD PEA can be set from this Action Selecting EMD PEA will set the blood pressure to zero independent of the ECG rhythm and the blood pressure setting Selecting No EMD PEA will bring the blood pressure to the previous setting if the ECG is a perfusing rhythm 6895 rev F OLaerdal Medical 2002 page 80 of 125 4 15 2 Blood Pressure Blood Pressure Eorotkoff Volume Systolic Diastolic E E at T E BP The BP Action button allows you to set blood pressure Systolic and Diastolic pressures can be set independently and Korotkoff sound volume If the volume set lever is not moved the sound volume will be unaffected and indicated by to the lower right of the lever i If the volume is changed the volume level will display as 0 to 10 Koro F Tick the Gap tick box to make an auscultation gap in the Korotkoff sound i Gap 4 15 3 Set Trend Max Min Vital Signs Hax z 100 4 4 mmHg Ha Change Mo Change Change CFI Mo Change No Change
61. age 29 of 125 2 3 SimMan Personal Computer User Interface SimMan Universal Patient Simulator File Edit Patient Monitor Options Tools Help SEH Monitor Controls Cardiac Controls C05 mmHg Spo c s Temp C La m 37 2 n Airway and Auscultation Controls more Breathing Hate 10 Apnea CO Exhaled Reset All E E Running Rhythm A Sinus Ec Extrasyst 10 R ate min Manual _ Extrasyst Muscular 50 60 Hz Waiting Rhythm W ai Hun Activate Waitt gt Hun Paroxysmal Vocal Sounds Cough BP EE 80 T EMD PEA Threshold mA Lc m l Register Events ABC Acton Miscellaneous sj i E dit Medication 2 4 Personal Computer User Interface Overview Event logging The SimMan User Interface allows you to control the SimMan Universal Patient Simulator The user interface also presents status of the simulator and an event log which can be saved or printed The SimMan user interface is divided into sections Cardiac Controls controls and indicates status for ECG Blood Pressure with BP auscultation sound Defibrillation and External Pacing See 2 5 for more information on using Cardiac Controls B
62. and stopped from a Handler Trends Start Trend hi E dit Start This Trend Stop All Others Stop Trend t Step All Trends 0K Za Cancel Start Time Set Duration There are two options for starting a trend 1 Start Trend starts the selected trend to run simultaneously with all other trends that may be running when the handler enters this frame 2 Start This Trend Stop All Others starts the selected trend to run while stopping all others when the handler enters this frame There are two options for stopping a trend as well 1 Selecting Stop Trend stops a specific Trend 2 Selecting Stop all Trends stops all active Trends Click the Edit button to open the Trend Editor Trend Editor allows you to specify the Start Time and Duration of a Trend Start Time defines how far into the programmed trend the trend will be started For example this Trend will skip to the start position and start from there Duration defines how long the trend will run The default is that a trend starts from the beginning and continues until its last defined point except for Minutes infusion trends that last until they are stopped Trends cannot be started and stopped in the same frame 6895 rev F OLaerdal Medical 2002 page 110 of 125 5 16 9 Comments Comment Write Comment Here Pulse checked Cancel Em Daned Corect Step C False Step C Not Applicable The
63. ape from opening 3 Cut a 4cm 1 strip of Crico Thyroid Membrane Hy Tape and apply it over the opening to create simulated membrane 4 A tight seal will enhance actual feel and sound of crico thyroid membrane penetration F 3 Neck Skin Collar 1 Lay a neck skin collar with dull side out into molded track around neck area of trainer 2 Attach collar ends together 3 he collar is designed to provide multiple sites for needle and surgical techniques When a fresh site is needed rotate the collar in either direction F 4 Link Box The Link Box connects the manikin to the computer To connect also see connection guide on page 17 1 Attach manikin cable to right lower side of manikin s torso and to the connector marked Manikin on the back of the Link Box 2 Connect serial cable to connector marked PC on the back of the Link Box and to serial port on back of your computer If your computer has USB connectors only and does not have a serial port you need a USB to serial adaptor to be sourced locally 3 Connect other serial cable to connector marked Monitor on the back of the Link Box and to COM port on back of the Simulated Patient Monitor 4 Connect clear tubing from blood pressure cuff to the inlet marked BP cuff on the back of the Link Box 6895 rev F OLaerdal Medical 2002 page 13 of 125 5 Connect the SpO cable to the SpO connector on the back of the Link Box 6 Connect one end of the audio cable to t
64. ario is an alternative way of starting a scenario See 2 12 Starts an ABC Event Handler See 2 13 Starts a Miscellaneous Event Handler See Starts a Medication Event Handler See 2 13 Miscellaneous TE Medication SimMan Universal Patient Simulator File Edit Patient Monitor Options Tools Help Edit Patient Monitor Stark Scenario Start ABC Handler Start Misc Handler Start Medic Handler Save Lag Print Saved Lag Print Current Lag Login as another user Save Log Saves the Event Log See 2 9 1 2 EN Print Log Prints the Event Log See 2 9 1 4 Log in as another Allows a different SimMan user to log in See user 2 1 2 Exit Closes the program Clicking the X in the upper right corner of the SimMan window also closes the program 2 14 2 Edit Menu The Edit menu controls edit commands Edit Scenario Edit ABC Handler Edit Misc Handler Edit Medic Handler Edit Trends 2 14 3 Patient Monitor Menu The Patient Monitor menu controls as the name implies the Patient Monitor See 2 7 3 6895 rev F Laerdal Medical 2002 SimMan Universal Patie File E E ne Patient Monitor Op dit Scenario i Edit ABC Handler i M4 Edit Misc Handler Edit Medic Handler E Edit Trends page 61 of 125 2 14 4 Options Menu The Options menu controls various settings Check the Tools Help references for more information on each control setting i Sounds Dual
65. cal 2002 page 43 of 125 2 7 2 Monitor Parameter Control Dialog Monitor Controls Link HR BP Sys BP Dia 4 d 4 a0 120 Clicking the more button next to the temperature control opens the Monitor Control dialog Temp EEE The Monitor Control dialog controls 55l min 6 0 mmHg 93 F all parameters shown on the Patient Monitor spe i Y FI U2 44 34 mmHg 0 21 ETOU2 FlAnaest ET A amp naest FI N20 A ee Note Ticking the Link tick box vi Ya Yel yY makes the Systolic and Diastolic 016 00z 00o 0 00 sliders move together The sliders are only suitable for course adjustments Click on arrows for fine adjustment or use the mouse scroll wheel while hovering the mouse cursor above the control 2 7 3 Patient Monitor Control The parameters of the Patient Monitor can be turned on and off individually from the Patient Monitor menu The idea is that the instructor can add new parameters as they become available Selecting Select All or Remove All turns on or off all parameters TOF indicates the number of responses TOF indicates the ratio in strength between the first and fourth response If the TOF is less the 4 then this ratio is 0 Cycle NIBP now starts a NIBP measurement on the Patient Monitor This allows the instructor to guide the students back on the right track if desired See chapter 6 for more information on the SimMan Patient Monito
66. can be simulated and cut can be made at left mid axillary line at 4 and 5 intercostal space i Abdominal distension occurs with normal ventilation while using Bag Valve Mask or if the esophagus is intubated D 1 5 Arms a Right Arm is a Multi venous IV Arm allowing Cannulation Phlebotomy Drug administration Infusion The veins are self sealing allowing multiple uses however repetitive insertions in the same area will result in leakage sooner than if the cannulations had been spread over a wider area The venous system and the skin sleeve are both replaceable The venous system is fluid filled when charged with simulated blood using a closed infusion and drainage system b Left Arm is a BP Arm with radial and brachial pulses and Korotkoff sounds The BP arm allows palpation and auscultation of a blood pressure that can be measured automatically on the Simulated Patient Monitor Auscultation gap can also be simulated D 1 6 Pulses a SimMan has physiologically correct palpable pulses Bilateral carotid pulse Bilateral femoral pulse Left radial pulse Left brachial pulse b The pulses are synchronized to the simulated ECG and when activated the external pacemaker upon capture C Pulses once activated will remain on for approximately five 5 seconds before reactivation is required Caution Care should be taken when palpating pulses Use of excessive force results in the inability to feel pulse D
67. cept for infusion trends that continue until they are stopped Trends cannot be started and stopped in the same frame 6895 rev F OLaerdal Medical 2002 page 86 of 125 Note It is only possible to have one action of each type in a frame To overcome this limitation you can use two frames and have the scenario automatically progress to the next frame immediately See 4 16 12 for more information on Time Events 4 15 13 Patient Time Patient time Set Patient time to w Add to Patient tine t Subtract fram Patient time Framet Stop Trend Trend Frame imesOmOsf 00000 Frame Start Trend Trend Stark 0 0 0ur 10 0 Cancel The Patient time Action button allows you to manipulate the Patient time Patient time is a time parameter counted down in every frame of a scenario It will count down and stop at zero You can use the value of the Patient time as an Event to move to another frame See 4 16 for more information on using Events This scenario action can be used to set a Patient time value add a value to Patient time or to subtract a value from Patient time The default value is O so it must be set to a value greater than zero to be of any use When running a Scenario Patient time is displayed below the Frame number time next to the control buttons Frame time 16 n a Patient time Os 6895 rev F Laerdal Medical 2002 page 87 of 125 Frame Example In th
68. ch Event field but multiple connections to a frame The connection line arrows show the direction of the connection Non empty Event fields not connected to a frame will shade red Empty Event fields having connections will also shade red If a frame has no input connector the Action field will shade red Frame Comment Corect Step Pulse checked or Intubation Pulse checked Intubation Epinephrine Frame Comment Corect Step Pulse checked or Intubation A Sinus B Blood Pressure 120 80 Vital 5p 2 38 CO 34 0 mmHg Temp 99 0 F Breathing Hate 10 COZ Exhalation OFF Away Reset All Pulse checked Intubation Epinephrine Frames Start Trend IncreaseHA Start 0 0 Dur 10 0 Vital Sp02 38 CO 34 0 mmHg Temp 99 0 F Breathing Hate 10 CO2 Exhalation OFF Away Reset All Frames Start Trend IncreaseHH Start 0 0 Dur 10 0 To connect frames click the Connect Frames button Frames can now be connected in three different ways 1 Connection with a line Click the Event field you want to connect and drag the mouse to the Action field for connection before releasing the mouse button 6895 rev F Laerdal Medical 2002 page 77 of 125 2 Connecting through a node Connecting through a node is useful when connecting backwards in a Scenario because connection lines going back and forth can make the scenario hard to read
69. cking the Calibrate BP button allows you to calibrate the CalibrateBP x blue bar indicator to your measurement instrument When the ress Calibrate button when your BP instrument new window appears inflate the cuff until the measurement measures 100 mmHg instrument shows 100mmHg and then press the Calibrate button The blue bar is now calibrated to 100mmHg a EI The Calibrate BP dialog can also be started from the Tools Cose menu by selecting Calibrate BP from the menu list In addition some manual registrations can be indicated on the manikin picture Intubation cC Oa Oxygen 2 M s rm Suction IV line automatically removed after 5 10 sec 2 9 Event Log The Manikin picture can be exchanged for an 00 00 Restart A Sinus 80 Extrasyst Rate 10 Defib enabled Pacing enabled 20 m Event Log view by clicking on the al button 0 00 00 Defib enabled wee Hie enabled Em found in the lower right corner of the screen E INE odii 72 0 00 05 C02 Exhalation Off 0 00 08 SpO2 96 Every new operator setting and every action on 0 00 08 Temp 372 H n nn na Rresthing P sta 1n the manikin is entered into the Event Log 6895 rev F OLaerdal Medical 2002 page 45 of 125 2 9 1 Event Log Controls The Event Log time indication defaults to zero when the SimMan program is started Elapsed time from the start of the session is displayed This Event logging
70. cursor changes as shown to the right and then changes a back again after the new frame is placed in the scenario Note Frame names do not indicate any order of execution They are reference names for programming purposes only 4 10 Moving Frames To move a frame click the Select Frame button x Click on the border of the frame you want to move and drag it to the desired location before releasing the Frame mouse button 6895 rev F OLaerdal Medical 2002 page 74 of 125 You can select several frames by holding down the CTRL key while clicking the border of additional frames or using the cursor to click and drag a frame around the desired frames Frame Framez Comment Corect Step Start Trend IncreaseHR Start 0 0 0ur 10 0 Pulse checked or Intubation Once the selected frames are marked with a blue border you can click on one and drag them around Frames Comment Correct step Start Trend IncreaseHA Stark 0 0 Dur 10 0 Pulse checked or Intubation 4 11 Copying Frames A frame must be selected before you can copy it x First click on the Select button To select one frame click its border To select several frames hold down the CTRL key while clicking the Frame border of additional frames Or click and drag a frame around the frames you want to copy Frame Frame Comment Corect Step Start Trend IncreaseHR Start 0 0 0ur 10 0 Pulse checked or Intubation
71. der ECG sequence builder for your own training scenarios m Trend Editor n Event Handler D 3 Link Box a he computer connects to the manikin via the Link Box b 12V DC or 110 240 V AC operation c Remote controlled interface connectivity to Manikin Simulated Patient Monitor BP arm on manikin External speakers Computer headphone to link audio sounds opO probe 6895 rev F OLaerdal Medical 2002 page 8 of 125 D 4 Air and CO Source Compressed air is provided by a compressor or other type of pressurized air source via a regulator unit allowing many functions to take place e Airway complications e Spontaneous breathing e Tension pneumothorax inflation e Carotid pulse a 110 240 V AC operation b CO source c Connects to alternate compressed air source D 5 Simulated Patient Monitor The Simulated Patient Monitor provides concise clinical feedback of physiological parameters All parameters are instructor activated with the ability to set a lower and higher alarm limit for every parameter shown on the monitor The monitor may be configurred to display the desired parameters and curves and it is possible to save and retrieve five 5 configurations Colors and curve trace speeds can also be changed The COs curve has by default a slower trace speed a 110 240 V AC operation b Simulated patient information synchronized with all other clinical outputs ECG Arterial blood pressure waveform CO and capnog
72. e Help menu allows access to the SimMan Handler Editor Help and displays software version information in the about dialog Shaw Help Show Help Opens the SimMan Handler Editor Help About window About Shows software version info in the dialog 5 5 Load Handler The button allows you to load and edit an existing handler The function can also be activated from the File menu Once you select a handler its comments are displayed in the window on the right PR Look ir drughandlers P E E Comments le MedicHandler 1 dhn NewMedEyventHandler dhn TestMedHandler dhn Files of type Handler files dhn Cancel 6895 rev F Laerdal Medical 2002 page 101 of 125 5 6 Save Handler The button allows you to save a Handler to your Handler folder The function can also be activated from the File menu Descriptive text about the handler can be entered in the comment field This text can be read in the open dialog when a handler is opened for editing or execution Note the Save Menus check box This box is checked by default When checked the Event Menus of the event handler will be saved along with the handler You can edit how the menus will look by clicking the Edit Menus button See 5 8 for more info about event menu customization Save As Save In i abc_handlers E Ei Comment E Test bcHandler ahr File name MedicH and
73. e P Test sce anabolic steraides And so he looks He is on the I m il operating table connected to the ECG Sp0 and BP 2 C section sce monitor Leaming objectives The trainee is to take proper action when experiencing a E EE Cant ventilate Cantintubalesce E EEEE ETO E E patient that goes in to a can t intubate can t ventilate za T mode The trainee has to da a cricathyretamu FA procedeure and ventilate the patient in order ta save Files of type Scenario files sce T Cancel him 4 4 Save Scenario The button allows you to save a Scenario to your Scenarios folder The function can also be activated from the File menu The comment field allows you to enter descriptive text about the scenario to be read in the Open dialog when a Scenario is opened for editing or execution Note the Save Menus check box This box is checked by default When checked the scenario s Event Menus will be saved along with the scenario You can edit how the menus will look by clicking the Edit Menus button See 4 6 for more information about event menu customization All trends handlers and sounds that are used in the scenario are saved in the scenario file If you want to send the scenario to someone else the scenario file is the only file you need to send 6895 rev F OLaerdal Medical 2002 page 70 of 125 Save As Save in scenarios d E Ea Comment E Can E ventilate Can t
74. e remote buttons Combi amp uscultate lungs Aminophylline Assign an item to a Cricoid pressure S Awaken the patient Amiodarone shift function by dropping Cricothyrotomy Call for help 8 Anaesthetised ainva Ne ipe smithiesd an Ove Sa y e button E tubatian 8 Check diuresis 8 Appropriate cardiac fiberoptic intubation amp Check Hemoglobine ASA hyperventilation Consciousness Check 6 Atropine 6 Inadequate ventilation C section performed 8 Benzodiazepines Intubation Request blood 8 Blood E IM Line Stomach Decompressiot Bretylium Line Removed Se System E vents Destran JET ventilation Dobutamine 9 LMA 8 Dopamin 6 Mask ventilation Epinephrine E NPA Fentanyl OPA Flumazenil Oxygen Furosemide 3 Oxegen Removed General Anaesthesie Preumothoray D ecompr Glucose 5 m Suction Glucose 50 i System Events 4 Glycopyroniumbromic 9E Two person mask ventil Inhalation Therapy 8 Volume Infusion sound Ketamine 4v Drop here to delete 8 Lactated Ringer ag 8 Lidocain Magnesium Sulfate 8 Mannitol 8 Morphine E OF Cancel Help When saving the handler the customized event menus is by default included in the handler file and these menus will be shown when running the handler instead of the logged in users menus If you un check the Save Menus tick box the menus will NOT be saved with the handler and the logged i
75. e speaker in the Manikin are not able to reproduce low frequency signals in the sounds but still these low frequency signals influence the sound quality It is therefore recommended that the low frequency signals become filtered from the sounds Signals with a frequency of lower than 150 Hz should be filtered away Goldwave can perform this task Apply a Highpass filter with a cutoff frequency of 150 Hz b Sound Playback Optimization The big issue regarding playback is volume control Sound volumes that are too low cannot be heard well Sound volumes that are too high cause distortion If the volume optimized to its maximum level as described below still is too low for your needs you will need to purchase a set of PC speakers with an external power supply and connect them to the speaker output and place them as close to the Manikin head as possible Vocal sounds are played back using the Windows sound system There is also an amplifier in the Link box The volume control beside the sound selection list in the SimMan program adjusts this amplifier Since SimMan uses the PC and Windows sound system for playback their volume controls also influence the playback volume The SimMan program sets the Windows output volume to about 80 at startup Some laptops also have a physical volume control for the speaker output The Windows Play Control controls the Windows output volume and can be accessed by double clicking the speaker icon on the task bar
76. eminy every second beat is an extrasystole and they will occur randomly at approximately the rate selected Click on the Up Down buttons to vary the rate EZ n With the Cardiac remote control press ESR Up Down keys to vary the Extrasystole Rate 2 5 1 4 Manual Extrasyst Clicking the Manual Extrasyst button immediately generates an extrasystole of the Manual selected type If the Running Rhythm does not specify extrasystoles one Unifocal Extras yst PVC will be generated Manual nl Extrasyst With the Cardiac or Airway remote control press the Manual Extrasyst key 6895 rev F Laerdal Medical 2002 page 33 of 125 2 5 2 Waiting Rhythm The Waiting Rhythm section allows you to havea waiting Rhythm new rhythm waiting for activation by user or by a m i shock Wait Run Wait Run Manual Activate Farcxysmal Extrasyst To move the Waiting Rhythm to the Running Rhythm click the Wait gt Run Wait Run Activate button Activate The Waiting Rhythm now becomes the Running Rhythm and the Waiting Rhythm field will be empty A shock on the manikin will have the same result as Activate if shock is enabled Activate ri With the Cardiac or Airway remote control press the Activate key To exchange the Waiting Rhythm and the Running Rhythm click the Wait Run Wait eRun Paroxysmal button Paroxysmal Clicking the Wait Run Paroxysmal button w
77. emote Il Primary airway functions and other miscellaneous items For complete operating instructions please refer to the PC User Interface section of this manual For details regarding import and export of files and recording of sounds please refer to your Windows manual and Windows help files G 7 Needle Decompression We recommend a 22 gauge needle for decompression of the chest Using a smaller gauge needle increases the longevity of the chest skin and bladders 6895 rev F Laerdal Medical 2002 page 19 of 125 H Repair and Replacement Instructions H 1 Tension Pneumothorax Decompression Bilateral Mid Clavicular Sites To repair a vulcanizing contact cement is needed 1 Remove skin at shoulder sides mid clavicular and remove bladder from site cavity 2 Cover the surface of the pneumo bladder with vulcanizing contact cement not included Avoid getting contact cement on chest plate 3 Allow to air dry completely 4 Replace bladder and chest skin over torso and secure skin at the shoulders and both sides 5 Fill puncture marks on exterior of chest skin with modeling wax supplied in repair kit by applying firmly with fingertip while stretching skin To replace 1 Remove skin at torso sides 2 Lift the chest plate exposing its underside 3 Disconnect bladder hose from in line hose connector 4 Remove bladder from site cavity by pulling it from top side of chest plate 5 Insert new pneumo bladder into si
78. end time position to current log time To stop the trend select it in the Active Trends folder and click the Stop Trend button To pause the trend select it in the Active Trends folder and click the Pause Trend button 6895 rev F Laerdal Medical 2002 All Active Trends n FE All Active Trends T Active Trends anaesthetised hypoxia brief sympathomimetic respon LOPOD Deterioration COPD Hypotension hypoxii 2 Hypasiaz Mew Trend Folder Oesophageal Tube Active Trends 7 anaesthetised hypoxia anaesthetised hypoxia brief sympathomimetic responsi COPD Deteroration COPD Hypotension hyposi 2 Hvpasiaz New Trend Folder lll unning AllActive Trends Active Trends ci E arem Trends Jc anaesthetised hypoxia anaesthetized hypoxia brief sympathomimetic respon LU PD Deterioration COFO Hypotension hyposi 2 Hypoxia New Trend Folder Active Trends 3l Jc anaesthetized hyposia anaesthetized ween ie Trends E anaesthetised hypoxia anaesthetised hypoxia page 53 of 125 To resume the trend select it in the Active Trends folder click the Start Trend button J Active Trends JE anaesthetised hypoxia am cable Len re u To run another trend simultaneously select it from the s Multiple list and click the Start Trend button The title will now All Active Trends hd g change to Multiple Trends Running Note When the title says Multi
79. ent Handlers using the Handler Editor EVENT HANDLERS ARE STARTED BY SELECTING START ABC HANDLER START MISC HANDLER OR START MEDIC HANDLER FROM THE FILE MENU The Open dialog allows you to select a Handler and read its comments Look in rm drughandlers amp e Eg Comments Si NewMedEventHandler dhn E TestMedHandler dhn File name TestM edH andler dhn Files of type Handler files dh r Cancel A hand icon appears next to its category name in the Register Events control to indicate a Running Handler Moving the cursor over the hand displays a ToolTip describing the Running Handler B su Register Events ABC Action Miscellaneous WOO Medication CLICKING ON THE HAND ICON CAUSES THE STOP MEDICATION HANDLER PROMPT TO DISPLAY Clicking the prompt stops the Handler 6895 rev F Laerdal Medical 2002 page 60 of 125 ONLY ONE HANDLER FROM EACH CATEGORY CAN BE RUNNING SIMULTANEOUSLY A HAND ICON IS DISPLAYED NEXT TO EACH EVENT CATEGORY HAVING A RUNNING HANDLER 2 14 Program Menu The Program menu is in some cases an alternative way of performing some actions In other cases it is the only way 2 14 1 File Menu The File menu controls system wide commands Start Scenario Start ABC Handler Start Misc Handler 2 13 Start Medic Handler Start Scen
80. ete a group of frames by selecting them using the cursor to drag a frame around them FrameO cannot be deleted from any scenario 6895 rev F OLaerdal Medical 2002 page 78 of 125 To remove a connection select it by clicking it the connection line will become blue when selected ill Blood Pressure 120 80 and then clicking the Delete Item button EET SEMEN Frame Lo ee L1 To remove an Action or Event select the item Framed by clicking on it the item will be highlighted in Sinus BD blue and then clicking the Delete Item button Blood Pressure 170 80 ai pistes o 0000 4 14 1 Undoing Last Deletion a The last performed deletions can be undone using the button If undo is not possible the button will be disabled 6895 rev F OLaerdal Medical 2002 page 79 of 125 4 15 Actions These are the Actions the Scenario performs when a new frame is entered They are located in the Action fields of a frame and are performed once each time the running scenario enters a frame To add or edit Actions in a frame Framel ie X Frame Sulit eb EMO PEA me E t Ma Lt N Museu SO Hz nus Actions z PEE EL d d 4 Lancs L T T Click on the Click the Action Edit the dialog and click OK The programmed desired Action field in the frame you action will now button want to edit appear in the frame s Action field Available Actions 4 15 1 ECG ECG x Artif
81. fault FrameO of a Scenario When you create a new scenario it does always starts with a default frameO that sets the state of the Manikin If you are continually editing this frame you can instead change it for future scenarios by opening the Scenario Editor browsing to the template folder and opening the DefaultFrameO scenario 6895 rev F OLaerdal Medical 2002 page 120 of 125 ll SimMan Program Files Overview a PC Programs SimMan consists of these PC programs Name Function Ss Filename SimMan main program The main program the instructor SimMan exe uses to control the training SimMan Application folder session SimMan host program Handles communication with Hs3kHost exe EN Mo ER T ne ae i Monitor SimMan Application folder Event handler editor Edits the event handlers EventHandlerEditor exe Fventhancleredior Pals the eventhancers SimmantApplicston flier and Patient Monitor SimMan folder b Other Programs In addition there are separate programs for the Manikin Link box and the Patient Monitor These programs are located in the respective units but they can be updated using the SimManUpdate program The files must be located in the same folder as the SimManUpdate program Program name Filename SimMan Manikin program SimMan Link box program Alink hex SimMan Patient Monitor program CEMonitr exe c Program Communication Problems The programs need to communicate with eac
82. g electrical output If the pacing spikes are being L eu produced above the set Pacing Threshold level pacing capture will be seen and felt if the blood pressure is adequate Clicking on the Pacing Threshold Up or Down buttons alters the threshold level Clicking on the Pacing button selects Pacing Disabled and external pacing will not result in capture regardless of the current pacing strength r Pacing With the Cardiac remote control toggle between enable disable using the Enable Pacing Enable key External Pacing is indicated with a pacing symbol I on the manikin picture and is registered in the event log regardless of whether pacing is enabled or disabled 6895 rev F Laerdal Medical 2002 page 37 of 125 2 5 6 Blood Pressure BP The Blood Pressure function affects the BP shown on the patient monitor the auscultated or palpated blood pressure on the manikin s left arm and the strength of the pulses Blood pressure can be set as part of the ECG rhythm see 2 5 3 6 or adjusted directly on the BP controls BP ajha y 803 F EMD PEA P Gap buttons The BP will be adjusted maintaining the same pulse pressure To adjust both systolic and diastolic at the same time use the left up down i j BP 3620 24 00 2 between the systolic and diastolic pressures ri With the Cardiac or Airway remote control press the BP Up Down keys To adjust systolic or diastolic p
83. ght Lung Left Lung Heart and Bowel sounds in addition to setting sound volume Note Right and Left Lung sounds are set T B T independently If No Change is selected the corresponding sound is unaffected If the volume set levers are not moved the volume will be unaffected and indicated by to lower right of the lever If the volume is changed the level will be displayed as 0 to 1 0 6895 rev F OLaerdal Medical 2002 page 83 of 125 4 15 8 Airway The Airway Action button allows you to set the state of all SimMan airway functions Ni Each function is identified with GR km a ToolTip when the mouse is moved over the button Each airway function has three states No change The function will remain as set in previous frames E Not Active The function will be cleared For instance Trismus off X Active This function will be activated For instance Trismus on 4 15 8 1 Preset Buttons Reset All sets all functions to Not Active 2 Can t intubate Can Ventilate sets Tongue Edema Pharyngeal Obstruction Decreased Cerv ROM and Stomach Decompr Can t Intubate Can t Ventilate additionally sets Right and Left Lung Compliance 4 15 9 Vocal Sounds The Vocal Sounds Action button allows you to select one of the manikin vocal sounds Yocal Sounds Start Sound The sound can be repeated several times at the selected interval
84. h other for the SimMan system to work Sometimes they will not for various reasons The SimMan host program communicates with the external devices It is normally hidden but it can be opened from the system tray on the Taskbar found at the bottom of the PC screen Double click on the ECG Heart icon Once opened the program displays a dialog which gives a SimMan Host Program good indication of communication status between the external devices and the PC 5imM an amp Host version 2 0 0 0 Copyright Laerdal Medical 2002 Connected clients displays the number of PC programs that have connected to it SimMan s main program Scenario Builder and the Handler Editors can make a connection It is R not possible to close this program while the count is greater than zero Manikin The Manikin is green if the connection with the Manikin is OK otherwise it is red Link bos Link box E Sw version As Hw version The dialog also displays the external device version numbers Manikin pgz Manik and a colored square to the left of them The colored square is T SW version hw version reen if the software version is ok red if it is out dated or gra Monitor 18 Monitor g g y E SW Version 1 0 HW version if it has not made a connection 6895 rev F OLaerdal Medical 2002 page 121 of 125 At startup the SimMan host program tries to determine to which COM port the Link box is connected It first tries the
85. he connector marked Audio input on the back of the Link Box and the other end with the mini jack plug into the headphone outlet of your computer 7 Plug the Link Box AC power cable into a power supply 110 240 V AC If you are using the Portability Kit attach to the 12 V DC input according to the Portability Kit instructions 8 Connect external speakers if used to connector marked Ext speaker on the back of Link Box F 5 SpO Finger Probe The SpO finger probe provides enhanced realism for the care provider by simulating the use of an actual pulse oximeter probe When the probe cable is connected to the Link Box SpOe will not be displayed until the probe is placed on one of the manikin s fingers If the probe is not attached to the Link Box SpO s will only be displayed automatically when selected by the user through the instructor panel on the PC F 6 Simulated Patient Monitor The Simulated Patient Monitor allows any or all of the patients status data ECG Heart Rate Arterial BP waveform NIBP Temperature SoO2 CO CVP etc to be displayed To connect attach one end of the supplied cable to the COM port on the back of the Simulated Patient Monitor and the other end to the Link Box Plug the simulated Patient Monitor into a power supply 110 V or 230 240 V AC A monitor stand is included and separate mounting instructions are located in carton F 7 Air and CO Source optional F 7 1 Option 1 Compressor Unit If
86. hen there is no Waiting Rhythm copies the Running Rhythm into the Waiting Rhythm field ri With the Cardiac remote control press the Parox key 2 5 3 Setting the Running and Waiting Rhythms See Appendix 5 for a complete list of available ECGs To set a new Running or Waiting Rhythm click on the corresponding Set Rhythm button to activate the ECG selection menu You can now set the parameters of the ECG rhythm ri With the Cardiac or Airway remote control press QRS Type or any Basic Rhythm key to I eel A 2 5 3 1 QRS Type There are seven different QRS waveforms named A to G which can be selected Available QRS types vary with each Basic rhythm Supraventricular QRS types for Sinus A Tach A flutt A fib Junctional 1 AVB 2 AVB types 1 and 2 3 AVB rate 60 Atrial Pacemaker PACs and PJCs A Normal upright QRS T B Upright QRS with ST depression and T inversion C Upright QRS with ST elevation D Bundle Branch Block Broad R wave with T inversion E Biphasic QRS with T inversion F QS with ST elevation G Bundle Branch Block Broad R wave with upright T 6895 rev F Laerdal Medical 2002 page 34 of 125 o M IN I F G Ventricular QRS types for Idioventricular V Tach and PVCs A Broad rS wave B Broad R wave C Broad QS wave D Broad QS wave Same as C E Broad R wave F Broad Rr Wave G Broad Rr Wave
87. intubate sce Spontaneaous Pneumatharax sce n COPD Exacerbation sce m Test5cen l sce n C section sce IE Cesophageal_Intubation sce r Rapid Sequence_Induction sce n Sedated awake intubation sce Es gt save as type Scenario files sce L ancel vw Save Menus Edit Menus 4 5 Print Scenario To print a Scenario select Print Scenario from the File menu Select Print Mod Select preferred print mode in the Select Print EEEE Mode dialog and click OK 1 a fe i i Reduced size prints the scenario on one A4 Reduced size 1 page Letter page C Full size 2 pages Cancel Full size prints the scenario on two A4 Letter pages iw Print Comments You can include the comments with the printout by ticking unticking the Print Comments tick box The comments will be printed on a separate page If you are printing the scenario Full size on two pages you can use the page break preview line in mer the drawing area to see where the page break will naturally occur PPusechecked If the break splits a frame you can drag the line to force appropriate page breaks Frame PRstted 6895 rev F OLaerdal Medical 2002 page 71 of 125 4 6 Customize Event Menus When creating a scenario you can customize how the event menus will look for a user running the scenario to ensure that the menus are organ
88. irst name Lastname Comments Save as hype Log files sml Cancel The save dialog allows you to enter student name s and comments prior to saving the file Type in filename and click Save to save the log The file is saved in XML format See Appendix IV for more information on the XML Event Log Format and its usage 6895 rev F Laerdal Medical 2002 page 46 of 125 2 9 1 3 Saving the Trend History when Saving the Event Log lt is possible to save pictures of all trend view windows along with the log file Depending on which style template you choose when printing the log these pictures may be shown in the log From the Options menu select Save trends images when saving the log A Trend View dialog will appear immediately after saving the log View Trend All Active Trends Representation Al Active Trends af a n Session duration 60 min Windows width i D min Time 3 12 Blood Pressure Trend Save Image Heart Hate Trend M Savelmage Breathing Rate Trend V Save Image 300 jug ggg ug vj 0 Se ee mili 2z ad B E 7 ES T iTi IUE E e gI Time 3 2 minutes Minutes Time 3 2 minutes Minutes Time 3 2 minutes Minutes CYF Trend iv Save Image i Save Image 8 iz 4 B 0 u1 2 3 adag E Doi z azada fF E SI E Time 3 2 minutes Minutes Time 3 2 minutes Minutes v Time Scrollbar gt Save Images This dialog has a new b
89. is example AN Abr O OVO the Patient time is set to Patient time 21 min 0 sec 90 seconds in Frameo If no CPR is given the CPR stated Pat TimeclmOs patient will go from V fibr to Asystole in 90 seconds If CPR is Started the patient is given 15 more seconds and for every 10 seconds of CPR given the patient is given back 15 seconds in Patient time 4 15 14 Add Medication Handler Medication Handler Start Medic Handler t Stop Medic Handler The Medication Handler Action button allows you to start or stop a Medication Handler Only one Medication Handler can be active at one time If you start a new Medication Handler while another one is active the running Handler will automatically be stopped before the new one is started See chapter 5 for more information on Event Handlers Clicking the Edit button starts the Medication Handler editor 4 15 15 Add ABC Handler ABC Handler t Start ABC Handler E dit t Stop ABC Handler du Cancel The ABC Handler Action button allows you to start or stop an ABC Handler Only one ABC Handler can be active at one time If you start a new ABC Handler while another one is active the running Handler will automatically be stopped before the new one is started See chapter 5 for more information on Event Handlers Clicking the Edit button starts the ABC Handler editor
90. ized and easy to operate Selecting Edit Event Menus from the Edit menu displays this dialog This function also allows you to assign events to remote control keys The functionality is almost identical to the edit menus in the GUI See 0 The difference is that by default the events used by the scenario are visible and the non used are hidden You must unhide non used events if you want them to be seen when running the scenario Edit Menu ABC Action Miscellaneous _ Medication Configure your remote by um d ing the it Bag tube ventilation Abort attempt Adenosine M ie Mi eene S BURP B Auscultate heart Albumin onto the remote buttons Combi amp uscultate lungs Aminophylline Assign an item to a 8 Cricoid pressure S Awaken the patient Amiodarone shift function by dropping Cricothyrotomy Call for help 6 Anaesthetised ainval d lugens Extubation 8 Check diuresis 8 Appropriate cardiac i fiberoptic intubation amp Check Hemoglobine ASA hyperventilation Consciousness Check 8 Atropine 6 Inadequate ventilation C section performed Benzodiazepines Intubation Request blood 8 Blood 6 IM Line amp Stomach Decompressior Bretulium IvLine Removed BS System Events Dextran JET ventilation Dobutamine 9 LMA Dopamin Mask ventilation 8 Epinephrine E NPA Fentanyl OPA Flumazenil Oxygen Furosemide E Oevgen Removed General Anaesthesie Preum
91. lays software version information in the About dialog Show Help Opens the Help window for SimMan Scenario Builder About SimMan Shows software version info in the About dialog 6895 rev F Laerdal Medical 2002 Shaw Help About page 69 of 125 4 3 Load Scenario The button allows you to load and edit an existing Scenario The Open dialog allows you to select a Scenario and read its comments Once the desired Scenario is selected click OK This function can be activated from the File menu as well If someone send you a new scenario or you download it from the web it may contain new trends handlers or sounds When you run or edit the scenario all trends handlers and sounds used by the scenario will be copied to the logged in users profile But only if a trend handler or sound with the same name doesn t already exist If it already exists the existing one will be used instead Look in E scenarios 4 c EJ Comments io Mew Folder ea Cesophageal_Intubation sce Case history ol n 1 need En debug sce e Fapid_Sequence_Induction sce Male 2b years old Acute Appendicitis ate 3 hours ago II i l Is nauseous and has vomited as in severe pain but l3 1111ACLS bradvcardias sce ea Sedated_awake intubation sce has been given 75 mg of Pethidin im 45 minutes ago ECan EE spontaneaous Pneumathorax sce No previous hospital record but admits frequent use of lta COPD Exacerbation sc
92. left corner File Edit View Help of the Scenario Builder window s 4 2 1 File Menu The File menu controls Windows system commands Edit View Hel New Window New Window Opens a new scenario builder window Good New Scenario for copying frames from one scenario to iad sena another New Scenario Clears the view and displays a new scenario save Scenario containing only FrameO with its initial values Print Scenario Load Scenario Loads an existing scenario Exit Save Scenario Saves a scenario Print Scenario Prints a scenario 6895 rev F OLaerdal Medical 2002 page 68 of 125 Exit Exits the Scenario Builder 4 2 2 Edit Menu The Edit menu contains copy and paste controls Copy Copies the selected item s to the clipboard Paste Pastes the copied items from the clipboard Select All Selects all items Edit Event Menus Customizes the Event Menu for this scenario lt is also possible to assign specific events to the remote control keys See 4 6 for more info on customizing event menus 4 2 3 View Menu The View menu contains one item that opens a dialog Help listing the Used Events and Trends view Help Copy Paste Select All Edit Event Menus List Used Events and Trends Below is an example from a simple scenario Used Events and Trends Hew Scenario Events Trends Epinephrine test rend 4 2 4 Help Menu The Help menu provides access to SimMan Scenario Builder Help and disp
93. leri Save as type Handler files Fahri T Cancel M Save Menus Edit Menus 5 7 Print Handler To print a Handler select Print Handler from the File menu Select Print Mod Select desired print mode in the Select Print ELLE Mode dialog and click OK W fe Reduced size prints the Handler on one A4 J Meas Letter page C Full size 2 pages Cancel Full size prints the Handler on two A4 Letter pages Iw Print Comments You can include the comments with the printout by ticking unticking the Print Comments tick box 5 8 Customize Event Menus When creating an event handler you can customize how the event menus will look for a user running the handler to ensure that the menus are organized and easy to operate Selecting Edit Event Menus from the Edit menu displays this dialog This function also allows you to assign events to remote control keys The functionality is almost identical to the edit menus in the GUI See O The difference is that by default the events used by the scenario are visible and the non used are hidden You must unhide non used events if you want them to be seen when running the event handler 6895 rev F OLaerdal Medical 2002 page 102 of 125 Edit Menu ABC Action Miscellaneous Medication Configure your remote by r um d ing the it B Bag tube ventilation Abort attempt 8 Adenosine TM ie bee Cate BURP B Auscultate heart Albumin 3 onto th
94. mation on creating your own Scenarios Trends allows you to select a trend and has trend run pause and stop controls D H ooo See 2 11 for more information on running Trends and see chapter 2 14 2 for more information on creating your own Trends The Program menu bar in the top left corner of the screen File Edit Patient Monitor Options Tools Help controls system options See 2 14 for more information on the SimMan Program Menu Most SimMan functions can also be controlled by two infrared remote controls SimMan an One remote control specifically controls airway functions while the other controls cardiac functions Cardiac The remote controls may be used simultaneously Several functions are common to both remotes allowing use of only one L Sto an P 88 7 The green keys on the lower row can be user defined with up to ten events per remote See 2 10 2 1 for more information on programming the user definable green keys on the remote controls lower row To disable the remote controls deselect Remote Enabled in the Options menu This will be useful if there is more than one SimMan in a room and other instructors are also using the remote control 6895 rev F OLaerdal Medical 2002 page 32 of 125 2 5 ECG Rhythm Selection 2 5 1 Running Rhythm The Running Rhythm field shows the ECG currently running on the Patient Monitor and Manikin Running Rhythm ASims ay Extrasyst 10
95. mg of Pethidin im 45 minutes ago n Can t ventilate Can t intubate sce e Spontaneaous Pneumoathorax sce Ma previous hospital record but admits frequent use of VITECIESDAE anabolic steraides And so he looks He is on the E t1 Rc operating table connected to the ECG Sp02 and BP El C seckio Type SCE File monitor Date Modified 13 11 2000 01 00 size 27 5 KB Learning objectives z The trainee iz to take proper action when experiencing a El IE Cam venite Cant stabat ste patient that goes into a can t intubate cant ventilate n es ee made The trainee has to do a cricathyratamy 1 3 pracedeure and ventilate the patient in order to save Files of type Scenario files sce Cancel him A SCENARIO CAN ALSO BE STARTED DIRECTLY FROM THE SCENARIO CONTROLS BY SELECTING THE DESIRED SCENARIO AND CLICKING THE RUN SCENARIO BUTTON When a scenario is running the text Scenario Running x Running That Scenario will display The Scenario Frame number with Frame time and Patient time Frame time 16 s are displayed to the right of the scenario controls Patient time s When a scenario is running Event Log controls are disabled but may be controlled by the Scenario controls Event logging Note Stopping pausing resuming a scenario controls affect 0 00 40 2 un EH all running trends However trends can be controlled without affecting scenario execu
96. minutes Minutes Time 3 7 minutes Minutes aba E 8 3 Blood Pressure Trend Heart Rate Trend Breathing Rate Trend 150 150 40 100 100 3l 0 0 50 100 100 J ae el J ale i 2 amp 1S 2 5 DiI 2 3d B E Time 3 7 minutes i Time 3 7 minutes i Time 3 7 minutes Minutes 2 20 Representation allows you to select the desired value mode Absolute Values mode reflects the actual values Relative Values S e Relative Values mode reflects the relative changes from the start of the trend See above Infusion noninfusion allows you to specify Infusion noninfusion whether or not the trend is an infusion trend In Ordinary trends automatically stop when they reach their end An infusion trend does not stop it continues until stopped manually or by a scenario and then returns to its relative starting point Representation See 3 4 3 for more information on Infusion Trends The Time Scrollbar at the bottom allows you to scroll within the display window Time Scrollbar gt 4 Session duration allows you to set the l 60 maximum value of the Scroll Bar Session session duration rit Duration is automatically increased as needed Windows width allows you to set display D 10 window width windows width min 6895 rev F Laerdal Medical 2002 page 56 of 125 Dragging the scrollbar to the right brings the last two trend curves into view MS view Trend anae
97. n t Absolute Values Do CO Trend puse pus qpcw ede ae e oua t S Ai mp 2a aa eT mp wA ume xe m Time 24 8 minutes Minutes Heart Rate Trend eJ 200 150 t5 100 JD 0 CEPE E ee E IS 20 2 22 2a 24 A5 2b 2 2a 2 Time 24 8 minutes Minutes L1 Active Trends JE anaesthetised hypoxia 7E brief sympathomimetic resp JE anaesthetised hypoxia OLaerdal Medical 2002 DER Session duration 60 min U min Windows width Temperature Trend a ox pote pee aps aen oer etr pec ee 19 20 21 22 23 24 25 26 27 20 29 Time 24 8 minutes Minutes Breathing Rate Trend ju gsyvgpyeug ggpeugwgugugvg 18 20 21 22 23 24 25 26 ap 28 3 Time 24 8 minutes Minutes anaesthetised hyposia brief sympathomimetic response COPD Deternoration COPO Hypotension hypo 2 page 55 of 125 When an individual Active Trend is selected the displayed time will switched to reflect how long the Trend has been running The values are now shown in relative mode For example the trend starts at 0 and the view shows how much the trend has affected the values and how much it will affect them MS View Trend anaesthetised hypoxia Representation n B r f Relative Values session duration 60 min Infuston noninfusion RS dih 1 0 a Time 3 38 B Spl Trend CO Trend Temperature Trend 100 PARTRA Far ea ue des a al ee R23 W i 2 om ob me Ee m UB mil TS Time 3 7 minutes Time 3 7
98. n attempts via the electrode monitoring connectors will also damage the internal electronics requiring that they be replaced d Manikin is equipped with two defibrillation connectors ECG signal can also be monitored across these connectors Instructor can via appropriate keyboard or remote control command select the Ignore Defib function This determines if the defibrillation shock results in conversion to a selected waiting rhythm Manual paddle adapters are supplied for use with manual defibrillators Caution Defibrillation must be performed only over the two defibrillation connectors See the Cautions and Warnings section e Connectors for external pacing are connected to the manikin s defibrillation connectors Patient pads should not be used as they do not guarantee sufficient contact The system has a variable pacing threshold and the ability to ignore pacing Pacing capture results in a pulse synchronized with the heart rate and the display of a paced rhythm on the Simulated Patient Monitor f The torso contains a number of hidden speakers that allow the realistic auscultation of sounds Lung Heart Bowel g Tension pneumothoraces can be simulated through the inflation of resealable bladders Needle decompression can be performed at Bilateral mid clavicular line 2 intercostal space Right mid axillary line 5 intercostal space 6895 rev F Laerdal Medical 2002 page 6 of 125 h Chest tube insertion
99. n installed Microsoft Java Virtual Machine will automatically be installed on your PC This installation will require you to restart your computer before the installation is complete For the Laerdal SimMan Help to function correctly Microsoft Internet Explorer 4 01 SP1 or newer must be installed on your computer If you are running a Windows 98 Me 2000 XP operating system this is already installed You can install the English version of Microsoft Internet Explorer 5 5 from the Laerdal SimMan CD by clicking Install Internet Explorer Local versions of Internet Explorer can be obtained from the Microsoft web site www microsoft com The Internet communication protocol TCP IP must be installed on the computer for the Laerdal SimMan program to run Windows 98 Me 2000 XP come with TCP IP installed so normally you will not need to install it however if using Windows NT you may be required to install it See information below for installing TCP IP To start Laerdal SimMan software double click the SimMan desktop icon Note for Windows 98 Me users If several users will be logging into your computer each user may be required to run the Laerdal SimMan software installation separately This will depend on your Windows user profiles settings See information below for details Multi User Installation Notes 6895 rev F Laerdal Medical 2002 page 10 of 125 Note for Windows NT 2000 XP users You must be logged into Windows
100. n users menus will be shown when running the handler Cardiac Save As Save In E abc_handlers E Eil Comment E TestAbcHandler ahn File name MedicHandlerl Save as type Handler files ahn Cancel Ww Save Menus Edit Menus The edit menus dialog can also be opened by clicking the Edit Menus button in the save dialog If a scenario is running when the handler is started the menu saved with the handler will not be shown Instead the events used in the handler will be automatically appended to the corresponding menu already loaded by the scenario Thus all events used by either scenario or handler will be visible in the menu 5 9 Frames A frame in the Event Handler handles an event Select the event to be handled from the pull down menu at the top of the frame and add the actions in the Actions field Note Unlike scenarios frames arent numbered 6895 rev F Laerdal Medical 2002 page 103 of 125 5 10 Creating a Frame To create a frame click the Create Frame button and then on the screen where you want to place the frame After the Create Frame button is clicked the cursor changes as shown to the right Na and changes back again after the new frame is placed in the handler 5 11 Moving Frames To move a frame click on the Select Frame button Click the border of the frame you
101. nd determines the actual Trend length 3 4 5 Trend Max Min Limits Infusion noninfuzion rj i c 120 see to normalize Heart Rate Trend ia 4 im ing pg i0 i ls Cursor 0 0 0 0 Minutes 10 Trend length in minutes Since the starting point is not known when making a trend the trend can cause values to exceed a desired level To prevent this from happening set the Trend Max Min Values from the Options menu See 2 11 3 3 5 Print Trends EF To print a trend click the print trend button 6895 rev F Laerdal Medical 2002 page 67 of 125 4 Scenario Builder This is a graphical editing tool that allows you to create edit and save scenarios to be run under the Run Scenario function See 2 12 for more information on running scenarios Note Be aware that the Scenario Builder and Run Scenario function can be running simultaneously This is useful when creating and testing of scenarios Laerdal Scenario Builder File Edit View Help s m o New Scenario Actions Al BP Dod A Sinus 80 Blood Pressure 120780 Vital Spl 38 C02 34 0 mmHg Temp 99 0 F Breathing Rate 10 COZ Exhalation OFF Almay cs Reset All cee L4 i Ao 4 1 Startup The Scenario Builder is started by selecting Edit Scenario from SimMan s main program Edit menu 4 2 Program Menu The Program menu is located on the upper
102. nd the text turns white and stops flashing A timer appears to the right of the text counting down the Alarm re engage time When it reaches zero the alarm is activated again When other alarm limits are broken simultaneously the first non acknowledged alarm will be shown If all alarms are acknowledged the alarm with the most time left last acknowledged will be shown 7 Updating Manikin Link and Monitor Software The SimMan Manikin Link and Monitor Software can be updated MP Start SimMan through a separate program Make sure the SimMan program is not running when you start the Update Manikin Software through the Windows Start button SimMan Update x Select the desired target Link Manikin or Monitor Target C Link C bankin Monitor Select the PC Serial Port used to connect the Link Download Progress COM 1 COM or COM3 The Link and Monitor if selected must be powered Simblan Update Version 1 2 1 on Click Start to begin downloading Target During download the LED indicator on the Link will be su ee u The progress bars will indicate progress of download Siml an Update Version 1 2 1 ig Application The Manikin Link and Monitor programs man hex and alink hex alink hex and CEMonitr exe must reside in the Em PER mE SimMan folder man hex NOTE Switch off power to the Monitor when updating Link or Manikin Software Alway
103. neous and Medication events sS sl s ai that are not automatically registered on the simulator See 2 9 1 5 for more information on registering Events and customizing Event Lists The Manikin picture indicates manikin status and performed events including BP Auscultation Pulse Check Ventilations Performed Defibrillation Performed Pacing Intubation IV line Suction and Precordial Thump See 2 8 for more information on Manikin Functions iki I O00 Restart A Sinus 80 The Manikin picture can be exchanged for an ei Extrasyst Rate 10 Defib enabled Pacing enabled 20 m 0 00 00 Defib enabled naa log Maas by uid on i button Se MB acer 0 00 03 Temp 37 2 ound in the lower right corner ot the screen E Pss M 0 00 05 CO2Exhalation Off 0 00 08 SpO2 96 0 00 08 Temp 37 2 n an na Presthinn P ste 1n 6895 rev F OLaerdal Medical 2002 page 31 of 125 Event logging gt Em 0 06 24 Li gt TEE Comment to Log Event Logging controls found in the lower right corner can be used to pause resume and restart the event log The button automatically adds user entered comments directly to the log L See 2 9 for more information on the Event Log Scenarios allows you to select a scenario and has scenario run pause and stop controls See 2 12 for more information on running a Scenario and see chapter 4 for more infor
104. ng Amputation Thigh e Bleeding Amputation Arm 6895 rev F Laerdal Medical 2002 page 26 of 125 1 Software How to Guide The How to Guide is a quick reference for finding answers to questions that may not easily be found in the table of contents 1 1 Software Usage Questions 1 1 1 General Questions What are users and how do manage them oee 2 1 How can ensure that all components are up and running See Appendix Il c Head speaker sound is poor how can optimize it see Appendix Ill want to import a scenario where do place the files See Appendix l c 1 1 2 SimMan Patient Monitor Questions How do get waveforms on the monitor See 2 7 3 lt is hard to use the touch screen on the patient monitor how can make it See 2 14 5 better How do configure the patient monitor see 6 2 1 2 Startup Error Messages SimMan Link Not Found see Appendix Il c SimMan Fatal Error SimMan could not establish contact with the SimMan See Appendix ll c host program 1 3 First StartUp After a SimMan Software Upgrade The first time SimMan is started following an upgrade a dialog box will See Appendix l c appear giving you the option to automatically copy the new Scenario Trend and Handler files to all users 1 4 General Operation The SimMan SW makes use of general Windows operating techniques 1 4 1 ToolTips When the mouse is moved over an item on the SimMan screen an identifying ToolTip will usually appear
105. nge closes the menu HR options Change upper limit Change lower limit Enable upper alarm Enable lower alarm Change color Change function Clear No change Selecting Change upper limit allows you to change the upper alarm limit Selecting Change lower limit allows you to change the lower alarm limit Selecting Enable upper alarm enables the upper limit alarm The limit is then displayed to the top right of the number Selecting Enable lower alarm enables the lower limit alarm The limit is displayed to the bottom right of the number 6895 rev F OLaerdal Medical 2002 page 115 of 125 selecting Change color allows you to change the color of the Red number Green Blue Yellow White Brown Grey Magenta Cyan No change Selecting Change function allows you to display another number HR ABP CVP SpO2 CO2 RR Core temp NIBP Train of four HR SpO2 CO Peri temp Train of four ratio FI O2 FI N20 FI Anesthetic agent ET Anesthetic agent Log time Clear No change Selecting Clear clears the number field 6895 rev F Laerdal Medical 2002 page 116 of 125 6 4 2 Selecting a Number for an Empty Number Field If no number is selected for the touched number field the menu for HR selecting a new number will appear ABP CVP SpO2 CO2 RR Core temp NIBP Train of four HR SpO2 CO Peri temp Train of four ratio FI O2 FI N2O Fl Anesthetic agent ET C2 ET N2O ET
106. normal 240 260 absent 20 80 Systolic max 300 normal normal absent 30 3 blk 50 60 70 80 4120 80 Demaemaze 979 normal 90 100 110 120 140 Diastolic max 210 weak 160 180 200 absent O 130 50 60 70 80 100 120 80 Systolic max 300 normal normal absent gt T C gt Q lt a S gt pe O z h D zn O S zi 5 00 75 100 150 A G A fib O gt O 10 20 30 40 50 60 100 70 Systolic max 300 normal normal absent 80 120 140 160 180 200 70 40 Systolic max 300 weak normal absent T C N A Torsades des 200 200 7 0 40 Systolic max 300 weak normal absent Very Coarse Coarse one V fi N A A 0 A OLaerdal Medical 2002 page 124 of 125 V fib Fine Z one o em a D Q O O 3 e O Co cO C1 e D lt T1 lt o Z Ss gt U U U Y U Y U N N N lt D gt P lt NY NY NY NY NY NY O O oj o S gt Q o O Q O Q O O PSK oj sie I za 2 55 GM i i d gl 3 s See i A x A t t D D D D D D D D N A s s sx sx s s one v one one one gt G T C N A acemaker gt gt 6895 rev F X X X tt LLL dL dl dlll Pot Pt T Laerdal Medical 2002 Z 10 20 30 40 50 60 70 1120 80 Systolic max 300 normal normal 80 90 100 110 120 140 iastolic max 210 weak absent ystolic max 300 normal normal iastolic max 210 rene es absent S
107. ntrol e Plates for Manual Defibrillation Replaceable Neck Skin Collars 6 Roll of Crico Thyroid Membrane Hy Tape 2 Chest Tube Insertion Modules 6 Airway Lubricant Upper Dentures one 1 non breakable installed and 3 breakable Replaceable Male and Female Genitalia with Urinary Connection Valves Tool Kit consisting of e Pliers e Screw driver e Nut Driver e Bolts for attaching legs to body including locking wing nuts Maintenance Repair Kit consisting of e Extra Pneumothorax Bladders e Modeling Wax e Talcum Powder IV Kit consisting of e Tubing 2 e Simulated Blood Concentrate e IV Bag 2 Blood Pressure Measuring Kit Track Suit jacket and trousers Connection Cables and Tubing consisting of e AC Line Cord Simulated Patient Monitor AC Line Cord Link Box AC Line Cord Air Compressor optional Cable Link Box to Manikin Cable Link Box to Simulated Patient Monitor Cable Link Box to PC Cable for Sounds PC to Link Box Hose Manikin Air and CO Supply Pressurized Air and COs source to be purchased separately e Compressor Unit included in some configurations e or Regulator Unit 6895 rev F Laerdal Medical 2002 page 4 of 125 D System Features D 1 SimMan Manikin SimMan is a full body adult male manikin that allows the simulation of Basic and Advanced Life Support Skills and Assessment to develop both individual and team skills Hinged joints allow the manikin to be placed in various positions D
108. nu ECG curve options For example this menu will display for the ECG waveform Change sweep rate Selecting No change closes the menu Change color Change function Clear No change Selecting Change sweep rate allows you to choose a sweep rate of 25 mm s either 12 5 mm s or 25 0 mm s These values are only approximate 12 5 mm s Selecting Change color allows you to change the color of the Red waveform Green Blue Yellow White Brown Grey Magenta Cyan No change 6895 rev F Laerdal Medical 2002 page 114 of 125 Selecting Change function allows you to display another waveform ECG or clear the current waveform field ABP Note If you select to display a waveform already displayed in CVP another waveform field the waveform will be moved and its previous SHO position cleared p CO2 Clear No change Selecting Clear will clear the current waveform field 6 3 2 Selecting a New Waveform for an Empty Waveform Field If no waveform is selected for the waveform field touched the menu ECG for selecting a new waveform appears ABP Note This is different from no displayed waveform A waveform field CVP may have a selected waveform and still not display a waveform if the instructor has not enabled the waveform SpO2 CO2 Clear No change 6 4 Number Fields 6 4 1 Modifying a Number This menu appears when you touch a number field that already contains a number In this case the HR Selecting No cha
109. o set the state of all SimMan s airway functions e Trismus e Right Pneumothorax e Tongue Edema e Left Pneumothorax e Pharyngeal Obstruction e Reduced Right Lung e Decreased Cervical Range of Compliance Motion e Reduced Left Lung Compliance e Laryngospasm e Stomach Decompression Each function is identified with a ToolTip when the mouse is moved over the button Each airway function has two states Not Active For instance Trismus off Active For instance Trismus on The Cu indicates clear or less trouble for the student while the X indicates trouble The X always indicates that a bladder inside the Manikin has been filled with air Note Activating Right Pneumothorax will also activate Reduced Right Lung Compliance and activating Left Pneumothorax will also activate Reduced Left Lung Compliance Tongue Laryngo Pharyn Cery ri With the Airway remote control press a button to activate the desired function s Press the button again Left Right Left Stomach um Lung Pneumo Pneumo Decompr for deactivation 2 6 1 1 Preset Buttons E a m Reset All l will set all functions to Not Active E ri With the Airway remote control press Reset All 6895 rev F Laerdal Medical 2002 page 39 of 125 S Can t mmm Can Ventilate will Can t mm Can t Ventilate w set will additionally set Right and Tongue Edema Pharyngeal ap Left Lung compliance Obstruction Cerv ROM and n oa
110. older and view the events saved in that folder Normally the list closes when an event is selected but it can be pinned Clicking on the pin symbol at the bottom of the list will cause It to stay open Click the symbol again to unpin the list The list can also be undocked from the main SimMan window into its own window by right clicking the list and selecting Undock This window can then be moved freely over the screen The list is now in its own window with a title bar Click on the title bar to drag the list anywhere on the screen You can also resize it by clicking the mouse in the window s lower right corner and dragging it to the desired size before releasing the mouse button 6895 rev F Hegister Eventz ABC Action Laerdal Medical 2002 Miscellaneous Medication be Call for help Check diuresis en Check Hemaglob Consciousness Cl C section perform J Female sounds Womit Gastic Extentian Request blood J E Vocal sound ever Call for help Check diuresis Check Hemoglob Female sounds Vomit Gastric Distention Request blood Vocal sound ever wr Event log H xj Mi oc Awaken the patient al i m Call for help Check diuresis e Check Hemoglobine e Consciousness Chec vee L sechon performed J E Female sounds arit Gastie Distention Request blood Vocal sound events w DE page 49 of 1
111. ombitube to fail to ventilate by activating decreased lung compliance for both right and left lungs G 2 Chest Drain Chest Tube The Chest Tube insertion module is located at the left mid axillary site This module allows chest tube insertion to be performed A cut can be made at left mid axillary line at the 4 and 5 intercostal space To replace the used Chest Tube insertion module simply remove from its location and add a new one with the opening positioned toward the shoulder G 3 Circulatory Skills and IV Drug Administration The IV arm can be used with simulated blood by attaching the supplied IV bag tubing to one of the two latex vein openings near the top of the arm Using the supplied simulated blood concentrate mix the desired volume of simulated blood and add to the IV bag Release simulated blood until it runs via the tubing into the arm and out the other latex vein Once fluid is running freely out of the second vein seal it using a clamp Using an 18 gauge or smaller needle for IV training increases the life of the IV arm skin If you want the student to infuse medicines attach a second IV bag for free flow G 4 IM SC Injections The insert pads are foam filled and can be injected with fluids The foam is removable and should be squeezed out as a sponge and allowed to air dry immediately following the practice of these procedures Powdering foam pads with talcum powder eases reinsertion into the skin There are five sites
112. on the frame s right edge to resize the frame horizontally 5 14 Deleting Frames or Frame Items To delete a frame click the Select button and select the whole frame by clicking its k border the border will be highlighted in blue Or select the item you wish to delete selected items are highlighted in blue Note Select frame is usually the default mode when no other function is selected Click on the Delete Item button a and the selected item s will be deleted 5 14 1 Undoing Last Deletion P The last performed deletions can be undone using the Lu button If undo is not possible the button will be disabled 5 15 Select an Event Pull down the event menu Select the event you want the frame to handle and click OK Medication Medication Epinephrine Fentanyl Flumazenil Furosemide 6895 rev F Laerdal Medical 2002 page 105 of 125 5 16 Actions Actions are what you want the Handler to do when the handled event happens To add or edit actions in a frame Actions Epinephrine Ael m af E an Click on the Click the Action Edit the dialog that appears and The programmed desired Action field of the frame you click OK action will now button want to edit appear in the frame s Action field Available Actions 5 16 1 ECG ECG EMD PEA No Change C No EMD PEA C EMD PEA Extrasust Hate min No Change Artifacts
113. othoray D ecompr Glucose 5 m Suction Glucose 50 i System Events Glecopyroniumbromic 9E Two person mask ventil Inhalation Therapy Volume Infusion sound Ketamine 4g Drop here to delete 8 Lactated Ringer My Lidacain Magnesium Sulfate 8 Mannitol 8 Morphine OF Cancel Help When saving the scenario the customized event menus is by default included in the scenario file and these menus will be shown when running the scenario instead of the logged in users menus If you un check the Save Menus tick box the menus will NOT be saved with the scenario and the logged in users menus will be shown when running the scenario Cardiac Save As Save in 3 scenarios E Ea Comment n Can E ventilate Can E intubate sce Spontaneanous Pneumaetharax sce E COPD Exacerbation sce m Test5cen l sce te C section sce Cesophageal_Intubation sce Rapid Sequence_Induction sce jeg Sedated awake intubation sce LE gt File name unm save as type Scenario files Psc o on Cancel iW Save Menus Edit Menus The edit menus dialog can also be opened by clicking the Edit Menus button in the save dialog If a running scenario starts a handler the events used in that handler will be appended to the corresponding event menu 6895 rev F Laerdal Medical 2002 page 72 of 125 4 7 Actions Events Terminology It is important to understand the
114. ound from the list to the desired key identifier Releasing the event sound on or below the key assigns it to the key directly Releasing the event sound above the key assigns it to the shift function of the key To remove an assignment from a remote control key click and drag the assignment from the remote control to the recycle bin This event will still appear on the event list N Drop here to delete l Make sure to click the OK button on the screen to save your changes 2 10 2 2 Using Events while Running Scenarios or Event Handlers When starting a Scenario or an Event Handler two things can happen Medication to the event menus a 1 i 1 If the Scenario or Event Handler has customized event menus stored with it the event menus in the GUI will change to these Curent Scenario menus when the Scenario or Handler starts See 4 6 for more General Anae info Adenosine 2 Ifthe Scenario or Handler does not have customized event Albumin menus a new folder in the event menu is created called i A minaphylline Current Scenario Events This folder contains all events used Amiodarone in the Scenario or Handler Anaesthetised ain Appropriate cardi In both of these cases all events used in the Scenario or Event bs AGA Handler will be visible when they are started even if the events are not defined in event menus prior to starting Atropine ve If you start a Scenario and the Scenario starts an Even
115. ple Trends Running the stop pause and resume controls affect all running trends To control an individual trend you must first select it from the Active Trends folder 2 11 2 Trend View For a graphical view of the Trends click the View button WEW In addition to many other controls the View Trend window also contains start stop and pause controls When All Active Trends is selected the time reflects the log time and all values are absolute The moving cursor describes the now time Values to the left of the cursor are the history All changes are recorded To the right of the cursor are the projected values i e the contribution of all active trends added together Making manual changes to the values will cause the projected trend to shift up or down 6895 rev F Laerdal Medical 2002 page 54 of 125 MS View Trend anaesthetised hypoxia All Active Trends n B Time 24 52 Spl Trend eser suce pente peur ote ques gu e eet petra m qs ai 2 22 23 ebb 25 Am ey am 2 Time 24 8 minutes Minutes Blood Pressure Trend 300 250 200 rm 150 E 100 FO Oe saepe petes pene prster esqpaes pestes pestes hes lS ai 2 22 23 2l 25 2b ay ae 2 Time 24 8 minutes Minutes E Time ScrallBar This is a list of the Active Trends running in the above view Note It is possible to have multiple instances of the same Trend running simultaneously 6895 rev F Representatio
116. ppendix II for more information on other programs that make up the SimMan software 6895 rev F Laerdal Medical 2002 page 62 of 125 3 Edit Trends TO EDIT A NEW OR EXISTING TREND SELECT EDIT TRENDS FROM THE EDIT MENU SEE 2 14 2 Edit Trends allows you to create edit print and save Trends Edit Trends Default Representation Infusion nonintusion t Absolute Values i Relative Values Infusion 10 Trend length in minutes SpO Trend CO Trend Minutes Blood Pressure Trend Heart Hate Trend 150 150 100 100 50 Minutes Edit Diastolic 6895 rev F Laerdal Medical 2002 page 63 of 125 Use the scrollbar on the right to bring the remaining two trend curves into view Edit Trends Default Representation t Absolute Values Infusion nonintusion Infusion s ul amp Breathing Hate Trend Relative Values 10 Trend length in minutes Blood Pressure Trend Heart Hate Trend 40 oj 2 Cursor 0 0 0 0 Minutes Edit Diastolic CO Trend l Cursor 0 070 0 Cursor 0 0 0 0 Minutes 3 1 Load Trend To load an existing trend click the Load gt b l b Trend button for the Open dialog select the desired Trend and click Open 6895 rev F dg cm Minutes E Look in gt trends New Trend Folder El F E E COPD Deterioration tnd E COPD Hypotension knd E hypoxi 2 tnd lt
117. previous selections Cancel Activate Carcel EA ri With the Cardiac or Airway remote control pressing the Activate key will move the new selection into the Running Rhythm ri With the Cardiac remote control pressing the Parox key will move the new selection to the Running Rhythm and the previously Running Rhythm into the Waiting Rhythm 2 5 4 Defibrillation This button allows you to enable or disable the response to a defibrillator shock on the manikin When enabled a shock of 5J or more will activate the Waiting Rhythm providing one has been selected Clicking the button disables this function When disabled the simulator will not respond to a shock Clicking the button enables this function Defib Ee H ri With the Cardiac remote control toggle between enable disable using the Defib Enable key A shock is indicated with a shock symbol A the manikin picture and is registered in the event log regardless of whether shock is enabled or disabled Shock enable disable does not effect a scenario shock event 6895 rev F OLaerdal Medical 2002 page 36 of 125 2 5 5 Pacing This button allows you to enable or disable a response to external pacing and to alter the pacing threshold At start up Pacing is enabled and pacing Threshold defaults to 80 mA Threshold m When Pacing is enabled SimMan will automatically detect the external d pacer once it is producin
118. r You can also turn off or set the QRS Beeper volume from this menu d B en ri alume ah Weak Ott 2 4 Parameter Variability For enhanced realism selecting Monitor Parameter Variability on the Options menu enables variability of some values shown on the Patient Monitor 6895 rev F Laerdal Medical 2002 PT emp TOF A ol a0 F ET N20 TOF X A 0 00 d3 EC Arterial BP Spo Coe NIBP Core Temp Breathing Rate CVP Peripheral Temp TOF TOF 95 Heart rate SPOzZ co FI oz FI M2O FI Anesthetic agent ET oz ET N20 ET Anesthetic agent Select All Remove All Beeper Valume b Cycle NIBP now page 44 of 125 2 8 Manikin Functions The Manikin picture indicates manikin status and shows performance of specified events Calibrate BP Pulse Check UP E This symbol is placed on the manikin at Chest Compressions v the location a check for pulse is being E Performed m palpated and can be carotid femoral brachial or radial Defibrillation Performed Ventilations Performed detects shocks above 5 joules Precordial Thump px s Pacing detects external I A pacing Blood Pressure Auscultation Palpation The symbol the bar and the Calibrate BP button appear when T pressure is building up in the cuff Calibrate BP The blue bar indicates the cuff pressure Ecosse The green lines indicate the set diastolic and systolic pressures Cli
119. r Diastolic Murmur Friction Hub Mitral Valve Prolapse The list boxes are identified with ToolTips Preumaria when the mouse is moved over them der Wheezes Lung sounds will by default be the same for both lungs and is selected through the Right Lung list box The Left Lung list box will be gray disabled and cannot be used However the volume of each lung is controlled separately There are two options for lung auscultation sounds 1 Having the same sound in both lungs 2 Having a different sound in each lung In the first case the left lung sound selection menu is disabled Using the Option menu you can select or deselect Dual Breath Sounds Note that the sound levels are always separate for each lung p Auscultation sounds cannot be selected from the remote controls 2 6 7 1 Auscultation Sound Volumes At start up all Auscultation Sound Volumes will be set to medium 6895 rev F Laerdal Medical 2002 Hyperactive Borborygmus Marmal page 42 of 125 To adjust a sound s volume drag the corresponding slide control to the desired level The slide controls are identified with ToolTips when the mouse is moved over them Left Lun Heart vol Bowel Volt ri With the Airway remote control right and left lung volumes can be adjusted by pressing the RL Vol and LL Vol Up Down keys 2 6 8 Heart and Lung Animation During spontaneous breathing or forced ventilations air
120. raph waveform Heart rate related to SpO2 BP with timed automatic updating and BP now function Respiratory rate Temperature opO waveform and numerical display with audio output CVP waveform and numerical display output TOF TOF CO FIO2 FIN2O Fl Anesthetic agent ETO2 ET Anesthetic agent Core temperature Peripheral temperature Please note Because all information is simulated rather than actual the parameters with the exception of ECG cannot be measured or displayed on clinical equipment 6895 rev F Laerdal Medical 2002 page 9 of 125 E Software Installation Installing the Laerdal SimMan software on your PC Laerdal SimMan software requires Windows Installer 1 1 for installation This will automatically be added to your system if needed and may require a restart of your computer Installation of Laerdal SimMan software will proceed after restart Follow the on screen instructions e Insert the Laerdal SimMan CD in your CD ROM drive e f your CD ROM is set up for Auto run the installation program will start automatically e f your CD ROM is not set up for Auto run start the installation program by clicking Run on the Start menu and typing d setup exe where d is the drive letter of your CD drive e Then click OK or press ENTER e Onthe Installation Start up screen click Install SimMan e Follow the on screen instructions for installation After the Laerdal SimMan software has bee
121. registration of the event can be done in Frameft Framet AcAsystole 00 0 Patient time 30 sec Pat Times CPP started Frame1 Patient time 15 sec PatTime 0 FrameTime 15 CPR 10s FrameTime 2 Intubation V Line FrameTime 2 Frame3 Patient time 15 sec E 6895 rev F Laerdal Medical 2002 page 94 of 125 4 16 10 Miscellaneous Miscellaneous x Miscellaneous a Cancel Miso The Miscellaneous Event button allows you to set any of the Miscellaneous actions Actions added by the Edit menu function can be programmed as events 4 16 11 Medication Medication Cancel p The Medication Event button allows any of the Medications including medications added by the Edit menu function to be programmed as Events 4 16 12 Time Events 6895 rev F Laerdal Medical 2002 page 95 of 125 Time x C Patient time lt C Time in this Frame EX Seconds c Cancel The Time Event button allows you to set events based on either Patient time or frame time time in the current frame After selecting Patient time lt or Time in this Frame set the desired time by clicking the Up Down buttons to the desired seconds and click OK Patient Time The Patient time is equal to or less than the set number of seconds Time in this Frame The amount of elapsed time since the scenario entered this frame
122. release of high levels of electrical energy into the training manikin Consequently All safety precautions for use of defibrillators must be followed as if the manikin were a patient Consult your defibrillator s User Manual Defibrillation should be performed on the defibrillation connectors only If defibrillation is performed over one or more of the ECG connectors high voltages may be present on the remaining connectors during the shock o prevent overheating do not provide more than three 3 defibrillator discharges max 360J in a sequence Do not exceed an average of two 2 defibrillator discharges per minute during the training session The manikin must not be in contact with electrically conducting surfaces or objects during defibrillation A flame supporting atmosphere for example with a high content of oxygen should be avoided during defibrillation The manikin chest must be kept dry Special attention should be taken when using IV Arm Urinary system or Bleeding Control Modules To prevent chest skin electrode pitting do not apply conductive gel or conductive defibrillation pads intended for patient use Do not use cables or connectors having visible damage Do not spill fluids over any component inside the manikin torso since this could damage the unit and might also present a possible hazard for the operator fa training session involves the administration of fluids and or drugs into the IV arm empty
123. rences There are differences between the various handler types as well The most obvious differences are that the frames look different and that the handlers do not have connection lines between the frames Each frame handles an event a medication event in the Medication Handler You select the event at the top of the frame Start Trend Trend Start 0 0 Dur 10 0 The actions are about the same as for scenarios j i BAA except that you can t start handlers T rismus OFF Larynges OFF There are no event fields at the bottom of the frames Handlers work differently than scenarios They wait until an event occurs and then check for any frames having that selected event If so it jumps to that frame and performs its actions before going into wait again If you think in terms of scenarios the scenario below is equivalent to the above handler 6895 rev F Laerdal Medical 2002 page 99 of 125 A scenario equivalent to a drug handler It is always waiting in frameO0 for a selected event to happen Then it moves to the corresponding frame performs the actions and immediately moves back to frameO again pee Epinephrine Succhinyicholin Frame Frame Start Trend Trendi Start 0 0 Dur 10 0 Start Trend Trend Start 0 0 Dur 10 0 Away Trismus OFF FrameTime OmOq J mses OF FameTime 0m s A list of all used events can be found on the lower Used Events left side of the handler
124. rend is started To edit a trend curve click and drag a point to the desired position When the cursor moves over a point it will change to a cross hair As you drag a point its position is shown in the lower left corner of the Edit Point 8 3 36 3 Trends window as Time in minutes Relative value 6895 rev F OLaerdal Medical 2002 page 65 of 125 Blood Pressure Trend By default only the systolic pressure can be edited in the 150 blood pressure trend 100 50 The trend will maintain the start value difference between E systolic and diastolic pressures E oystolic and diastolic pressures can be edited individually by ticking the Edit Diastolic tick box D Cursor 0070 0 3 4 2 Absolute Relative Mode There are two modes of Representation including Absolute Values and Relative Values Here Relative means that the trend begins at the system s current value when you start the trend This is relatively O and the trend either increases or decreases this value Absolute displays a view of what the trend would look like with the current Trends are stored relatively rather than absolutely Trends may be viewed in absolute values taking the current starting values as the zero value and showing them on an absolute scale In both Relative and Absolute views the cursor can be dragged across a trend curve Cursors on all the other curves will follow the dragged cursor The n
125. ressor Manikin Air CO2 C9 1005163 Audio Cable 25 ft PC Link Box E 1005164 Cable Assy 25 ft Manikin Link Box 15 pin D sub gt gt 381200 Compressor 230 V SS E a E 381201 Jet Vent Adapter Kit 381210 Compressor 110 V 381220 Regulator Unit for Fixed Air Supply 1 0 0 O Transportation Cases Cd 381850 Portability Kit 381950 Technical ServiceManual o Z o Z O K 2 Consumables 1005128 Multi vein System IV Arm aS 1005129 Maintenance Repair Kit ee 1005131 Tape Crico Thyroid 1 roll e Pe Ex 1000722 Blood Concentrate 4oz 1000262 Silicone Liquid 4 oz 252090 Airway Lubricant glycerol version 1202 4 Skin amp Vein IV Arm iis o 380405 Bladder Assy Mid Clavicular Pheumothorax Chest 380406 Bladder Set Mid Axillary Pneumothorax Side O gt 381106 Teeth Upper Rigid polyester A w 381107 Teeth Upper Soft vinyl ae 6895 rev F OLaerdal Medical 2002 page 24 of 125 K 3 Spare Parts Power cord UK Cable 9 pin D sub PC Monitor to Link Box 380110 Remote Control Cardiac 380111 Remote Control Airway 380200 Arm Assy Blood Pressure 380210 Cuff Assy Blood Pressure 380310 Cable Assy Manikin Link Box 15 pin D sub 380410 Post Set ECG Defib 380435 Breathing Bladder 380455 Chest Skin with Chest Drain 380600 Leg Assy Plain left 1005162 Thigh Pads set of 2 380650 Leg Assy Plain
126. ressures individually use the up down buttons to the right of the corresponding parameter A difference of 10 mmHg between the systolic and diastolic pressures will BF 31720 3 903 be maintained Ticking the EMD PEA box will set BP to 0 0 oz o5 X Removing the tick will bring the BP back to its previous setting ri With the Cardiac or Airway remote control press the EMD PEA key The Korotkoff sound volume in the manikin s left arm can be adjusted by R dragging the volume control lever M Gap To simulate an auscultatory gap in the Korotkoff sound tick the Gap ge box 2 5 6 1 Blood Pressure Pulse Relationship The pulse strength relates to the BP setting according to the following table Systolic Carotid Femoral Radial Brachial Pulse Pulse Pulse Blood Pressure will also influence NIBP and SPO2 measurement and the SPO2 curve on the Patient Monitor When the systolic BP drops below 50 mmHg the Patient Monitor will fail to measure NIBP and SPO2 measurement and the SPO2 curve will flatten 6895 rev F Laerdal Medical 2002 page 38 of 125 2 6 Airway and Auscultation Controls Breathing Hate Airway and Auscultation Controls controls and indicates 10 r Apnea Reset All status for soontaneous breathing difficult airway functions auscultation sounds and vocal sounds CO2 Exhaled Vocal Sounds Cough h Normal 2 6 1 Airway Controls This function allows you t
127. right 380700 IV Arm right 380810 Pad Set Shoulder and Hip 381010 Tubing Assy Compressor Manikin Air CO2 h 381100 Head Assy without Bronchial Branches 381101 Head Skin w Airway 381102 Fasteners for Neck Skin pkg 10 381150 Audio Cable 381300 Pulse Oximeter Probe 381900 Directions for Use 389200 Operating Guide Volume I CD ROM 500510 Air filter Silencer for Compressor 381200 381210 6895 rev F Laerdal Medical 2002 page 25 of 125 L Optional Features Nursing Wound Module Set 881450 including Abdominal Packing Module Abdominal Incision Module Abdominal Module with Sutures amp Drain Abdominal Module with Staples amp Drain Chest Incision Module with Staples Sutured Thigh Module Thigh Packing Module Thigh Debridement Module Varicose Leg Module Diabetic Foot Module Gluteal Ulcer Module Ventral Gluteal Ulcer Module Infected Stoma Lacerated Palm Module Upper Arm Module Leg Stump Trauma Module Set 381500 including Trauma Head Cover Right Crushed Foot 1 2 3 degree burn sleeve Deltoid Pad small caliber entry wound Deltoid Pad large caliber entry wound Deltoid Pad small caliber exit wound Deltoid Pad large caliber exit wound Impaled object pad Open fracture pad Compound fracture leg Contused ankle assembly Fractured clavicle lay on Exposed viscera module Bleeding Control Module Set 381550 including e Bleeding Control Thigh e Bleedi
128. s Laryngospasm Posterior Pharyngeal swelling Tongue edema Trismus Verbal response Decreased cervical range of motion Decreased right and or left lung compliance 6895 rev F Laerdal Medical 2002 page 5 of 125 h The manikin simulates spontaneous respiration with the following features Chest rise and fall Exhalation of air Exhalation of CO instructor controlled he variable respiratory rate is synchronized to the Simulated Patient Monitor display and lung sounds The tidal volumes dynamically alter in line with the selected respiratory rate D 1 3 Neck a Bilateral carotid pulses b Airway access through simulated cricothyroid membrane c Decreased Cervical Range of Motion DCROM instructor controlled D 1 4 Torso a Anatomically modeled from a human specimen the torso demonstrates normal anatomical surface landmarks b SimMan has correct anatomical landmarks for external chest compressions Chest compressions will produce carotid pulses as well as compression artifacts on the Simulated Patient Monitor c Manikin is equipped with separate defibrillation and ECG monitoring connectors The system provides 3 and 4 Lead ECG readings Caution These connectors are designed for ECG monitoring only If defibrillation is attempted over any of the ECG connectors high voltages may be present on one or more of the uncovered connectors during the shock See the Cautions and Warnings section Defibrillatio
129. s have power on the Link box when updating the Monitor Software 6895 rev F Laerdal Medical 2002 page 117 of 125 Appendix l SimMan Directory Structure The root of the SimMan directory structure is the SimMan folder All other folders of the SimMan software are related relative to this folder The location of the SimMan folder is determined during installation The default location is C Program Files Laerdal Medical SimMan a Overview These are the most important sub folders in the SimMan folder C3 SimMan o l Application Application Folders the SimMan main program and Scenario amp help Builder and Event Handler Editor uses mn images Profiles Folder where all files belonging to particular SimMan ints users are located C9 Languages en picks Sounds Where all vocal sounds are stored 3 c Profiles default 3 StaaleH 3 abc handlers 9 medic handlers ES menus 9 misc handlers scenarios O trends 0 StaaleH 3 report E als gt Templates 7 sounds T temp 7 template en text b SimMan Users Before starting SimMan you must log in as a user A folder with its own name is created in the Profiles directory for each user When a new user is created the files and folders in the default folder are automatically copied into the new user s folder The default folder is created during installation and contains the originally supplied
130. s to the file he will want to keep If you answer Yes the old file will be overwritten with the new one d How to Import Export Scenarios and Trends from to Other Folders There are two cases when you might want to manually copy files into the right folders to ease usage 1 You want to copy a scenario trend from another SimMan user on the same PC 2 You want to copy a scenario trend from another SimMan user on another PC Both cases are very similar You must save the files into the respective user s folder in the profile folder See Directory Structure Overview above the user StaaleH has his own folder in the profile directory with subfolders for the various file types Locate the correct user and copy the files into the correct folder Note Scenario and Handler files contain all Trends Events and Sounds used by the Scenario Handlers Therefore it is not necessary to copy those files when copying a scenario Be particularly careful when copying the files in the menus directory they will overwrite the Event Menu changes you have made You should not need to copy these files when copying a scenario or handler Both scenarios and handlers have customizable menus See 4 6 and 5 8 After upgrading new files will need to be copied from the default folder to each existing user s folder This is not done automatically to prevent user modified files from being unintentionally overwritten e How to Edit the De
131. sthetised hypoxia Representation anaesthetised hyposia n LI M CE CE USE Session duration 100 min Infusion noninfusion Windan WIDE 1 D mim Time 3 30 m Blood Pressure Trend Heart Rate Trend Breathing Rate Trend 150 150 40 100 100 AO o 0 50 100 100 AEN ar Ena lS a ee SLUT eee 20 0 1 2 3 m iIi 2 3 D l 2 X oc om m oy Bm o Time 3 5 minutes i Time 3 5 minutes i Time 3 5 minutes Minutes a qu 20 pw Ig se ee a Oo 1 da 5 E Time 3 5 minutes Minutes Time 3 5 minutes Minutes pop rg Time ScrollBar Clicking the Printer symbol prints the trend curves view m Right clicking any of the trend windows allows you to save the window as a picture for future review Save Image to JPEG File Save Image to Bitmap File Select the desired picture format and a standard save dialog will appear The pictures are by default stored in the same folder as the log files That is the SimMan Application Report Als folder 6895 rev F Laerdal Medical 2002 page 57 of 125 2 11 3 Trend Max Min Value Control Prevent the parameter values from changing Set Max Min Trend Yalues beyond the desired range by selecting Trend Max Min Values in the Options menu to open the Set Max Min Trend Values dialog Max EN SpO 2 100 Ok pass Cancel E Apply CO mmHg 150 si Temp F Ia BP sys 300 4 ol a
132. t Handler the events of the Event Handler will be added to the menus See 2 12 for more information about running Scenarios and 2 13 for information about running Event Handlers 2 11 Trends Trends allow CO2 SpO2 Temperature Blood Pressure Heartrate Breathing Rate Cardiac Output and Central Venous Pressure to develop over a time period according to a preprogrammed trend Several Trends can be preprogrammed Trends are relative Trend parameters will always begin from the system s current settings and all changes made by the Trend are relative to those settings See chapter 3 for more information on working with Trends 6895 rev F Laerdal Medical 2002 page 52 of 125 2 11 1 Main Window Trend Controls Trends controls can be used to start stop and pause trends The Trends list box shows available trends Trends can be organized in folders All Active Trends must be selected to perform an action on all running trends The Active Trends folder contains a list of currently running trends The rest of the items are either Trends or folders containing Trends To start a trend select the desired trend and click the Start Trend button When a trend is running the text Trend Running will display with its current time position The running Trend also appears in the Active Trends folder When selected it will show its current time position Selecting All Active Trends changes the Tr
133. te cavity and reconnect to the inline hose connector by threading it through from top side of chest plate 6 Replace chest plate 7 Replace chest skin over torso and secure skin at the shoulders and both sides 8 Fill puncture marks on exterior of the chest skin with modeling wax supplied in repair kit by applying firmly with fingertip while stretching skin H 2 Tension Pneumothorax Decompression Right Mid Axillary Site To repair a vulcanizing contact cement is needed Hemove skin at torso side Remove flesh colored box from mid axillary side of manikin 3 Remove pneumo bladder from the box 4 Cover surface of pneumo bladder with vulcanizing contact cement not included 5 Allow to air dry completely 6 Fold bladder and replace in box return box to torso 7 Replace chest skin over torso and secure skin at the shoulders and both sides 8 Fill puncture marks on exterior of chest skin with modeling wax supplied in repair kit by applying firmly with fingertip while stretching skin To replace 1 Remove skin at torso side 2 Remove flesh colored box from mid axillary side of manikin 3 Remove pneumo bladder from box 4 Disconnect bladder hose from in line hose connector 5 Remove bladder from site cavity 6895 rev F OLaerdal Medical 2002 page 20 of 125 6 Insert new pneumo bladder into site cavity and reconnect to in line hose connector 7 Fold bladder and replace in box return box to torso
134. the arm immediately following the training session Do not allow the manikin s skin to come in direct contact with ink or photocopied paper as this can permanently stain the skin Avoid using colored plastic gloves when handling the manikin as they may also cause discoloration Do not introduce any fluids except airway lubricant in small amounts to lubricate the airway into the esophagus or trachea of the manikin This device generates uses and possibly radiates radio frequency energy If it is not installed and used in accordance with the instructions it may cause harmful interference to radio communications In that case the user is encouraged to attempt correction of the interference by Reorienting or relocating the receiving antenna Increasing the distance between the device and receiver Connecting the device to an outlet on a circuit different from that to which the receiver is connected Consulting the dealer or an experienced radio TV technician for help 6895 rev F OLaerdal Medical 2002 page 3 of 125 C Components The Laerdal SimMan includes the following main components Laerdal SimMan Manikin SimMan Software CD ROM for Windows 98 Me 2000 XP and NT Operating Guide Volume CD ROM Set up Maintenance Trouble shooting Remote Control Units 2 Pulse Oximetry Probe Simulated Patient Monitor Link Box Set of Defibrillation Studs e Hands Free Defibrillation Pacing Adaptors Heartstart and Physio Co
135. the logs First you have the XML schema file called SimManLogSchema xsd This file describes the data types used in the SimMan log files The other file types are the XML Style Sheets these files describe how the log files are displayed and have the xsl extension The process of utilizing a style sheet to display a log file is called parsing The SimMan program print log performs this process when printing a log The user then selects which style sheet to use and the printout looks different based on his her choice Note If you want to save the log as it is printed you can save the log when it is displayed in the browser during the print process The log is then saved in HTML format As mentioned above this format contains layout information SimMan customers are free to customize the log print format or import the log data into the database of their choice however this requires expertise in XML SimMan currently only supports the printing of those formats listed in the print dialog and is currently not supporting any particular database 6895 rev F OLaerdal Medical 2002 page 123 of 125 V Available ECG rhythms a Adult Rhythms QRS Basic Premature complexes Hear Blood pressure Pulse strength type rhythms t rates Std RonT PVC PVC A G Sinus X X X X X X 10 12 14 Systolic max 300 120 124 Diastolic max 210 160 170 180 190 200 G_ A tach X X X 180 90 2 1 140 MAT 150 1100 70 Systolic max 300 normal j
136. tion All controls are available when a scenario is running and can be used to override the values set by the current scenario frame Note If the scenario changes frame it may again override your manual selections The scenario may also start trends that could cause the values to change To pause a running scenario click the Pause Scenario Scenario Running button Bn While the scenario is paused it will not accept manually ucenano Paused input events Running trends and event logging are also i Soonar L paused and the text Scenario Paused will be blinking To terminate a scenario click Stop Scenario button Fire Son Running nino BE 6895 rev F OLaerdal Medical 2002 page 59 of 125 2 13 Running an Event Handler THERE ARE THREE TYPES OF EVENT HANDLERS ONE FOR EACH TYPE OF EVENT CATEGORIES ABC MISCELLANEOUS AND MEDICATIONS An Event handler is programmed to perform a specified action each time a specified event occurs The programmer selects the events to handle and the desired action A running Event Handler is common to a running Scenario Both respond to events and both can perform actions However the Scenario can respond to some Events in additional to those the Handlers can respond to Also the Scenario can change its response to an event a Handler always responds in the same way The Handlers are easier to understand and to build on your own See chapter 5 for more information on building Ev
137. tion See 2 7 for more information on using the PC to control the Patient Monitor ABP hf 120 78 CVP SpO2 IN IN SS SSIS CO2 34 C Temp NIBP Systolic ims Next meas 37 2 120 78 92 intervals min 6895 rev F OLaerdal Medical 2002 page 112 of 125 As mentioned above the screen is touch sensitive It is split into several fields and two buttons When a field is touched a menu appears A picture representing of the layout of the fields is shown below There are two types of fields waveform fields and number fields The waveform fields are the upper ones to the left The rest are number fields Note that one number field is much wider at the bottom Its layout is specialized to contain the NIBP numbers besides its layout it is an ordinary number field The two buttons are the Setup button that opens the Setup Menu and the Alarm Disable button that switches off a sounding alarm Setup Alarm disable 6 2 Setup The Setup Menu is displayed when the Setup button Setup Menu is pressed Disable alarm sounds selecting No change closes the menu Set time to re engage alarms Set beeper volume Save setup Restore setup Reset to default Help Calibrate touch screen No change Selecting Disable alarm sounds disables alarm sounds and the green bell in the lower left corner changes to red and is overwritten with a line Selecting Set time to re engage alarms allows you to set the amount of
138. tly into the frame without setting any dialog Example The following scenario will convert the patient after Fama three shocks The patient will then re fibrillate after 30 AM fib coarse D DO seconds and can be converted again after three Shock Count 0 shocks and so on If there had been no Shock count 0 in FrameO the pBshecks scenario would have worked the first time but when the patient re fibrillated return to FrameO the scenario shock counter already has three shocks so it would Framed have gone directly to Frame1 again C Sinus Unifocal PVC 100 ER 15 fameTme 30 00 4 15 5 Pacing Enable Ignore x Pacing Enable r Pacing threshold ri Bl Cancel C Pacing Ignored Pacing Enable Enables Pacing capture and allows you to set a Pacing threshold Pacing Ignored Disables Pacing Capture The Pacing Capture Started and Pacing with Capture events cannot occur if Pacing Ignored is set 6895 rev F Laerdal Medical 2002 page 82 of 125 4 15 6 Comments Comment Write Comment Here Pulse checked OK Cancel f Corect Step C False Step C Not Applicable The Comments Action button allows the addition of user entered comments in the Event Log to aid in evaluation of student performance 4 15 7 Auscultation Sounds Auscultation Sounds i X The Auscultation Sounds button allows you to select Ri
139. u wish to reuse it lubricate inside of skin with liquid detergent Beginning at the top of the arm roll the skin down and off arm and hand 4 Remove old veins and discard 5 Use acetone or equivalent to remove spots of old glue from vein grooves Dry and swab grooves with alcohol Place new veins along grooves extending both veins beyond arm at least 10cm 4 allowing room for connections Spot glue veins as needed We recommend using Vynabond or VLP from PDI Plasti Dip International PL 400 from Tremco or an equivalent To replace skin 1 Roll top of skin down to the hand Spread liquid detergent generously over lower part of the arm Holding skin and arm with palms upward slide hand into skin working the skin over the fingers as with a glove Then roll the skin up the arm 2 Reattach arm when finished 6895 rev F OLaerdal Medical 2002 page 22 of 125 l Care and Maintenance A Do not introduce fluids into the torso area or left BP arm of the manikin as electronic components may become damaged Clean with mild soap and water DO NOT SUBMERGE MANIKIN Modules and all other parts should be drained and air dried thoroughly prior to storage Disinfectants should be used when appropriate All subcutaneous and intramuscular injection pads should be squeezed to eliminate excess water To prevent mildew and mold the foam filling should be soaked in a mild solution of bleach and water or a
140. umber in the lower left corner of each trend curve displays the time at the cursor position 6895 rev F Edit Diastolic A Representation 100 Laerdal Medical 2002 Blood Pressure Trend 150 100 a 0 50 mmHg 12 Minutes Cursor 0 0 0 0 Minutes e A Representation Absolute Values Relative Values Sp02 Trend Q Relative Values PADSOIUME values an 60 D 40 20 a a lee Cursor 0 0 0 0 Sp Trend Minutes 100 a0 bl ex 40 2 0 4 5 6 7 8 9 10 Minutes aaa i l a 3 4 Time 4 4 minutes page 66 of 125 3 4 3 Infusion Trends There is a special type of trend for infusions An ordinary trend stops by itself when it reaches the last point Infusion trends do not stop by themselves Once they reach the last point they will not make any more changes until they are stopped manually or by a Scenario or Event Handler see 2 11 When an infusion trend stops it will normalize its current value back to the original value in the specified number of seconds The infusion trend on the right will cause the heartrate to increase by 25 BPM within 10 minutes When the trend is later stopped the heart rate will drop by 25 BPM within 2 minutes This occurs independently of other changes made to the heartrate 3 4 4 Trend Length You can set the width of the Trend Window The last point except for in an Infusion Tre
141. utton Save Images rather than the usual Close button There is also a Save Image check box for each trend that let you select which trend images to save Adjust the time scrollbar and window s width so that the desired period of the trend history is displayed Then click the Save Images button In the SimMan Application Report MIs folder a folder will be created with the same name as the saved report but with images at the end This folder will contain one picture for each of the trends displayed at the time you clicked the Save Images button When printing the saved report these pictures will be copied to the same temporary folder not a subfolder the generated html file is copied to It is then possible to create a style template that also displays these curves See appendix IV for more information 2 9 1 4 Printing the Saved Log Select the Print Saved Log from the file menu to print a previously saved log 6895 rev F Laerdal Medical 2002 page 47 of 125 PR Look in 3 als ee Ed Style Template E Event Logl html Simple xsl e Event Logl xrnl E TestLoge xml Ei TestLog3 xml E TestLag4 xml E Testlogsayve xml Print Intructions 1 Select which log file to print 2 Select style template 3 Click on Open to view log and enable printing File name 4 Click an the Print button to select printer and print lag Files of type Log files
142. want to move and drag it to the desired position releasing the mouse button You can select several frames by holding down the CTRL key while clicking the border of the additional frames or by clicking and dragging a frame around the frames you want to move Epinephrine gt Actions Start Trend Trend Start D DO Drur 10 0 Start Trend Trend Start 0 0 Our 10 0 BIA y Trismus OFF Larynges OFF When the selected frames are marked with a blue border you can click on one of them and drag both around 5 12 Copying Frames A frame must be selected before you can copy it First click the Select button To select one frame click on its border To select several frames hold down the CTRL key while clicking the border of the additional frames You can also use the cursor to click and drag a frame around the frames you want to move The selected frames will be marked with a blue border To copy the selected frames select Copy from the Edit menu and then select Paste You can also use the standard Windows hotkeys CTRL C for copy and CTRL V for paste The copied frames are pasted in the top left of the drawing area and are already selected for moving to the desired location You can also open a new Handler Editor window and use copy and paste to copy frames from one handler to another 6895 rev F Laerdal Medical 2002 page 104 of 125 5 13 Resizing frames Click and drag
143. x Palm Desktop may be running This maw disturb SimMan TCPIIP is not setup corrrectly SimMan will now clase down The SimMan main program uses TCP IP to communicate with the SimMan host program In Windows 95 TCP IP was not installed by default it is in newer Windows versions A personal firewall used to protect your PC from intrusion through the internet may also block communication between the SimMan main program and host program by default The personal firewall must be configured to allow these two programs to communicate locally on the same PC This has nothing to do with a firewall that is running external to the PC Such a firewall will never cause problems for SimMan Contact your personal firewall vendor for configuration instructions We have observed that a personal organizer synchronization programs may also cause this error If you get this error and have such a program attempt to disable it Ill Factors that Influence Head Speaker Sound Quality There are two issues regarding sound quality sound volume and noise They are somewhat interrelated To get a good result the recording of the sound has to be good and the playback must be optimized a Recorded Sound Quality It is not possible to get good quality from a poorly recorded sound Recording a new sound may sound easy but there are a few things you should consider You must have a good microphone it doesn t have to be expensive You must also think about echo
144. y functions may be activated and deactivated Pharyngeal Obstruction Tongue Edema rismus Laryngospasm Decreased Cervical Range of Motion Decreased Right Left Lung Compliance Pneumothorax Stomach Decompression Can t Intubate Can Ventilate Can t Intubate Can t Ventilate Exhale CO Variable breathing rate Apnea Variable pulse oximeter display Breath sounds Important Prior to using airway adjuncts spray the inside of the pharynx nostrils and all airway management devices to be inserted with a liberal amount of the provided airway lubricant The Laerdal SimMan contains a unique patented difficult airway Correct form and technique are required to perform direct laryngoscopy and endotracheal intubation Correct use of a variety of airway adjuncts will successfully ventilate the patient simulator When airway adjuncts are used ventilation may be made more difficult by activating decreased lung compliance for either the right lung or left lung Activating decreased lung compliance for both lungs causes airway adjuncts to fail to ventilate Special notice regarding laryngoscopy and the use of airway adjuncts Endotracheal Tubes While ET tubes as large as 8 5 may be used we recommend the use of ET tube size 7 5 to extend the life of the simulator We also recommend the use of a malleable stylette Care should be taken as with any direct intubation that the stylette does not extend beyond the end of the tube Lar
145. yngeal Mask Airway LMA The Laerdal SimMan will allow use of the LMA Classic LMA Unique and LMA Fastrach Although a 5 LMA may seal correctly the airway has been designed for use with a 44 LMA The following procedure should be followed when an LMA is used 6895 rev F OLaerdal Medical 2002 page 17 of 125 For the LMA to successfully ventilate the simulator the instructor should observe the care provider as the 4 LMA is inserted When the care provider inflates the cuff of the LMA the instructor should simultaneously activate pharyngeal obstruction This not only allows the LMA to obtain a proper seal it also causes the LMA to retract slightly from the pharyngeal cavity as seen in most actual clinical uses of the device Activating the stomach distention function will also create a better chest rise The instructor can cause the LMA to fail to ventilate by either deactivating pharyngeal obstruction or activating decreased lung compliance for both right and left lungs Combitube The Laerdal SimMan will allow the use of the Combitube as it will successfully ventilate the patient We recommend the use of the Combitube trainer as it will generally withstand multiple uses The Combitube trainer is sized the same as a large adult Combitube Although a small adult size Combitube may work with varying success the Combitube trainer provides more cost effective training and reliability of function The instructor can cause the C
146. you have purchased Laerdal SimMan with a Compressor Unit attach one end of the double lumen tube into the compressor and the other to the right axillary side of the manikin Starting the Compressor 1 Check Compressor Unit for transport damage Check that Power Switch 4 is set to off position 0 Plug power supply cable into plug 5 in Compressor panel Plug power supply cable into power source Connect all hoses to SimMan Check that drain valve 1 is closed hand tighten only Close Air valve 2 and CO valve 3 blue valves in middle of panel Push Power Switch 4 to on position 1 the compressor will start and run for approximately 45 seconds to build pressure in tank When the compressor stops the Laerdal SimMan is ready for use Open Air 2 and CO 3 valves 10 Jet ventilation TTJV feature is also included and requires a special connector available for purchase using part number 381201 11 The compressor will start and stop with different intervals depending on consumption of air E ec CO 6895 rev F OLaerdal Medical 2002 page 14 of 125 Shutting the compressor down after use 1 Push Power Switch 4 to off position O the compressor will stop if running 2 Open Drain valve 1 to drain air out off system 3 Close Drain valve 1 and disconnect all hoses SimMan amp AirMan Compressor Unit 4 6 bar NC E 60 90 psi Shut off CO N OFF POWER SUPPLY Warning Do
147. z Muscular 50 60 Hz Rate min ut H At start up the simulator will always have a Sinus rhythm with a HR of 80 2 5 1 1 Editing the Running Rhythm See Appendix 5 for a complete list of available ECGs The heartrate of the Running Rhythm can be increased or decreased by clicking on Es the HR Up Down buttons Heartrate steps and available heartrates are dependent on the basic running rhythm Musing the Cardiac or Airway remote control press the HR Up Down keys when no Waiting Rhythm is selected When a Waiting Rhythm is selected the HR for the Running Rhythm cannot be adjusted using the remote controls To edit a new Running Rhythm click on the Set Running Rhythm button to activate the ECG selection menu You can now set the parameters of the ECG rhythm See 2 5 3 for instructions on r setting Running and Waiting Rhythms lt oer ri When using the remote control only the Heartrate of the Running Rhythm can be adjusted directly 2 5 1 2 Artifacts ECG artifacts directly affect the Running Rhythm Muscular or electrical artifacts can be selected by ticking the appropriate Muscular 50 60 Hz box Ticking the box again deselects the artifact 2 5 1 3 Extrasyst Rate min This control shows and controls the extrasystole rate of the Running Extrasvst Rhythm The frequency of extrasystoles if selected can be varied from Ets m 10 2 min to Big

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