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1. m 208 Drug Recognition Syringe Pump Mechanism eene eee ee eene entente eroe tnra tnano 209 xviii CAE Healthcare Table of Contents Drug Recognition Circuit Board Lise cs RR HCONEERRA RUE DUE OUR ERR FUHR DU RE CYE ERA CHEER RUE 209 Fluid crap e 209 MUT m MN 210 OB GIANON o o EDUARD MEO DUE OR EEUU ROMINA LUUD S DOR DIAC HORDEO CA eaaa ESTEE 212 Troubleshooting tle STON CO 1 vexcerkin eie EEEQAYRRDXREEYXYREEYKEPVEPEERRUN KY OPORE RE PN HV ENEPREE 213 TID Meet iis 214 Anesthesia and Scavenging A 7 215 Lite rap eM iie 215 The Anesthesia Delivery Systefi s scisessessssssscssscsisenscsssesonsescussesonsensussncsnsensvssnconseasvaonsenseasvaonnens 216 Hardware Setup Instricti lis uses inen a v vla KE ER YER a EYVE YE KU kK e EVER E REN YR eR HE EP ER EK 217 Step 1 Set Up External Components ccsvxcacsnvescsvocnesonsamenvsdissnaacimaned rARTO Rak CON HAE RAN ORAN a 217 Step 2 Set Up the Anesthesia Delivery System in the HPS Lab Rack s 218 Step Start MUSE pee MT 218 d Jp MET AS 219 p T M n 219 Other Considerations vascos eive Dx qq RbIYF Oak en REN DIT FARSVH Ub oros rovs M YE DERE DU d Rar
2. H A 247 Step 1 Clean the Simulator and the Fluid System esee rtnntnnnnn 247 Step 2 Sh t Down the SoftWare xi vnciasiassus hacrtin pp Re DDR E eret usb B Go oon isse 247 Step 3 Power Off the HPS Lab Ragkciusceduie i itt a a enira est Abad ab ape m ipe 248 Step Power Oil the Clinical MORIQF isses iecore dnte rebos rte tnb e dics 248 Step 5 Tuin OH AR GASES aacra camen heroin plea ceu Return A trad 248 Maintenance AQVICE ines iris xx Ero ERR TOR OH RAIDLHR RI Io adit nta lato in i 249 Hr MeMT TESES 249 Lareof Electronic EqUDIIIehl acaso estt Rb ten ber tbe o gud 249 Ch cking the AMWAY cuan titre Rte HR SHE tti hu ge wd PA EE n REI RE 250 Removing the Chest SKIN aasoscaenciumicedridna rain Qa suerte pecia roseo 25 Replacing the Ces CS Dio p OUR n RD Fibtpa orto RO IQ EDAD PORRO 25 Replacing the Chest Tube Foam INSEL1S casisecaneaussaeunsannaaninnsiennmnacoiannmnaamsedrnanansen 25 Maintaining BIG AU e T 253 Maintaining the M SYSTEM acaicici cie eiii RO v AUR Mir OQ AGA ARRA dtp Ri 255 IET ETIN BA SEIS CT NIST aa a E ARAA 256 Repairing Cuts and Abrasions to the Mannequin ettet 257 Using the IV Atm Kit oso tectorio RUE oerte ee E E 258 Dr g Recognition Barcode Labels ceste tratta eunte an niu Up m ds 258 Table of Contents Table of Contents H ps Recommended Clinical Supply Sizes 4 eere eene eee e ener eere en etna en ene neen ta
3. Diagnostic Peritoneal Lavage The Diagnostic Peritoneal Lavage DPL abdominal cavity allows for the performance of DPL on the mannequin and is interchangeable with the standard abdominal cavity The DPL cavity has a slit down the center and can be filled with distilled water tinted with red food coloring When tape is placed over the slit in the cavity and a needle is placed in it fluid is aspirated back similar to when DPL is performed in the clinical setting Tablet Instructor Workstation Optional for Human Patient Simulator HPS and Health Science HPS The Tablet Instructor Workstation is an optional ruggedized tablet computer that can be used instead of the Desktop Instructor Workstation to run the Muse software An additional Muse license is provided with this option NOTE The Tablet Instructor Workstation cannot perform calibration utilities The Desktop Instructor Workstation is needed to perform these functions Additionally the Tablet Instructor Workstation and the Desktop Instructor Workstation cannot be used at the same time Muse content is not shared between the Tablet and Desktop Instructor Workstations Anesthesia Delivery System Optional for Human Patient Simulator HPS not included with Health Science HPS The Anesthesia Delivery System is optional for the Human Patient Simulator HPS configuration It can be installed in the HPS Lab Rack and allows for the use and detection of real anesthetic agents product HPS
4. 373 X over 13 3327 The Notes 75 9 An expanded Ee 2 vate button 104 mmHg state He 0 94 over 15sec 7 2 68 over LS sec Mild Asthma Attack Atha Att ci argon Collapsed states Initial Assessment 0745 Hours Expanding States in the Scenario Designer E 11 Appendix E hs6 Files and M se HPS 10 Click the Notes button of each state one at a time The State notes for each State appear listing all the items that did not convert and or transfer from the import The following Events are not supported In M se Param Fixed Heart Rate Param Elastance Extrathoracic Arteries Param Elastance Intrathoracic Arteries Please adjust state accordingly Save Close Unsupported Scenario Items 11 Click the Close button to exit the State notes or enter changes to the State notes and click the Save button 12 As desired alter the scenario in the Scenario Designer to coincide with the M se software CAE Healthcare Appendix F Configuring the HPS Gas Analyzer Appendix F Configuring the HPS Gas Analyzer The gas analyzer located in the HPS rack is an integral component controlling the anesthetic vapor within the lungs The volatile agents recognized by the system are sevoflurane isoflurane enflurane and halothane IMPORTANT Isoflurane is set as the default agent recognized by the gas analyzer To assign a different volatile agent to the gas analyzer and ensure proper performance use the
5. Anxiety Pain Stress Vital Signs Approximate vital signs after two to three minutes in state Reset Moderate Severe Extreme 108 63 122 73 132 77 143 90 229 Condition Guidelines for Programming PediaSIM HPS with M se PediaSIM HPS Acute Ventricular Failure Left heart failure can cause right heart failure because of the increased afterload placed on the right ventricle Clinical manifestations include shortness of breath rales crackles jugular venous distention pedal edema and third and fourth heart sounds Acute Ventricular Failure Left and Right Parameter Adjustments Normal 53 and S4 S3 and S4 230 Condition Guidelines for Programming CAE Healthcare PediaSIM HPS with M se Acute Ventricular Failure Left and Right Vital Signs Approximate vital signs after three to five minutes in state Reset Mild Moderate Severe 108 63 231 Condition Guidelines for Programming PediaSIM HPS with M se PediaSIM HPS Acute Ventricular Failure Left Parameter Adjustments Moderate Severe Normal Normal Acute Ventricular Failure Left Vital Signs Approximate vital signs after three to five minutes in state Reset Mild Moderate Severe 108 63 105 60 104 58 102 57 28 11 27 8 232 Condition Guidelines for Programming CAE Healthcare PediaSIM HPS with M se Acute Ventricular Failure Right Parameter Adjustments Reset Mild Moderate Severe 1 00 1 00 1 00 1 00
6. Customer Service Headquarters United States and Latin America Monday Friday from 7 00 a m to 6 00 p m ET Phone 1 866 462 7920 Email customerservice caehealthcare com Customer Service Canada Monday Friday from 8 00 a m to 5 00 p m ET Phone 1 877 223 6273 Email can service caehealthcare com Customer Service Europe Middle East Africa India Asia and Australia Monday Friday from 8 00 a m to 5 00 p m CET Phone 49 0 6131 4950354 Email international service caehealthcare com Customer Service United Kingdom and Ireland Monday Friday from 9 00 a m to 5 00 p m GMT Phone 44 0 800 917 1851 Email uk service caehealthcare com 2013 CAE Healthcare 165K082800 v 2 1
7. Left Intrapleural Volume Right Fraction of Inspired O 2 Chest Tube Flow Central Venous Catheter PA Catheter PA Balloon Defib Pacing Current Pacing Rate Pacing Capture Threshold Cold Fluid Inject PRBC Infusion Whole Blood Infusion Urinary Output Bleeding Hemorrhage Channel 4 Hemorrhage Channel 5 Hemorrhage Channel 6 Secretion Nose Secretion Mouth Secretion Ear Secretion Eye NOTE If your simulator is capable of simulating convulsions ensure the convulsions parameter is visible in Muse prior to logging into the software In the upper right corner of the Muse Start screen select the Simulator Features link then ensure the Convulsions box is checked This causes the Convulsions parameter to appear on the neurological view in Muse The convulsions parameter is visible by default CAE Healthcare Using the HPS Additional parameters available are shown in the table below Additional Parameters Respiratory Rate Tidal Volume Tidal Volume Factor pH Shift PEEP Chest Tube Chest Tube Flow Chest Tube Air Leak O Consumption CO Production Factor PaCO Set point PaO Set point to E Ratio 1 X PetCO PaCO Factor Respiratory Gain Factor Respiratory Quotient Volume Rate Control Factor Chest Wall Capacity Chest Wall Compliance Factor Distended Chest Wall Compliance Factor Functional Residual Capacity Lung Compliance Factor Left
8. The Mute Button To set up the audio for the TouchPro from the Settings menu click Audio Setup Audio Setup Pleth SpO2 The Audio Setup Menu From the Audio Setup window select a waveform to set it as the pulse sound Once a waveform is selected the Audio Setup window automatically closes Clicking the Mute button from the Audio Setup window mutes all alarms Click the Mute button again to return the alarms to their original state 157 Using TouchPro HPS 12 Lead ECG To view a 12 lead ECG report click the 12 Lead ECG button at the bottom of the TouchPro screen The 12 Lead ECG Button The report appears The Close button aR La oo MFSESASESTS C Rh pt AW ima EEEN d 4 il r A L TA ETA J i i EHE as ux ee uc ud ee a dad aee Buc L L 5 The Print button A 12 Lead ECG Report The report can be printed or saved by clicking the Print button in the bottom right corner of the 12 lead ECG report To close the report click the Close button IMPORTANT Prior to saving the report as a PDF or printing to a network printer the print presets must be adjusted The page orientation must be set to Landscape and the margins must be set to 25 inches on all sides These settings vary in location depending on the operating system i e Macintosh or Windows To save the report to a PDF file on a Macintosh Instructor Workstation 1 From the 12 lead ECG report scree
9. Sim Cube Processes noninvasive blood pressure NIBP data from the software and drives the mannequin s physical responses so patient monitoring equipment may be used to measure NIBP Syringe Pump Installed in the rack when the anesthesia system option is in place Delivers liquid anesthetic agents to a vaporizer before they are sent to the mannequin providing a realistic exhalation of agents The syringe pump can also be accessed via the anesthesia delivery system panel see The Anesthesia Delivery System Panel on page 13 Vaporizer Installed in the rack when the anesthesia system option is in place Evaporates anesthetic agents before sending them to the mannequin Bellows Provide the lung functionality of the HPS system Mass Flow Controllers MFCs Control the flow of O CO N and N O to the mannequin Gas Analyzer Analyzes the gases going into and flowing out of the mannequin MUSE Universal Simulator Engine Circuit Boards Control various components of the rack Optional for Health Science HPS standard for Human Patient Simulator HPS Vaporizer Cus ya il 1 Bellows UA Mass flow contollers y Tm P E x Syringe pump Front of Rack with Cover Removed IMPORTANT Do not alter or modify the settings of any of the components inside the rack except the Syringe Pump and Vaporizer Doing so affects performance 12 7 CAE Healthcare Introduction The Anesthesia Delive
10. computers must meet the system requirements mapped out in the System Requirements section on page 46 of this User Guide Follow the steps below to be able to use the M se or TouchPro software on either a TouchPro computer or Wireless Remote computer Step 1 Set Up the HPS The HPS simulator must be set up and powered on and the Instructor Workstation must be connected to the HPS Network via the Ethernet connection to the Rack For directions on how to set up the HPS refer to page 25 of this User Guide Step 2 Obtain the IP Address from the Desktop Instructor Workstation a On the Macintosh Instructor Workstation connected to the HPS Network from the Apple menu click System Preferences 9 Finder File About This Mac Software Update Mac OS X Software Edit View Go System Preferences Dock Location From the Apple menu click System Preferences Recent tems Force Quit E Sleep Restart Shut Down Accessing the System Preferences The System Preferences dialog box appears CAE Healthcare HPS with M se Setup b Onthe System Preferences dialog box click the Network icon Click the Network icon E Ds MobileMe Network QuickTime Internet amp Network Clicking the Network Icon The Network dialog box appears c On the panel on the left side of the Network dialog box select Ethernet and ensure it is connected Ethernet Co
11. 138 J CAE Healthcare System Settings Using Muse From the System Settings panel users can manage the System Configuration Data Management and Product Licensing of the Mise software To access the System Settings panel from the System Administration screen click System Settings The System Settings panel appears System Configuration Disk Space 217 16 GB available 73 free System Time Tue Apr 16 11 34 00 GMT 0400 2013 Data Management l Back Up Data j Restore Data Product Licensing License Manager Error Log View Error Log n Export Localization Change Language The System Settings Panel System Settings The System Settings button The System Settings panel NOTE System Settings functions are available only to users with the System Management privilege 139 Using M se HPS System Configuration Under System Configuration Disk Space and System Time are displayed Data Management The Data Management feature allows users to back up data to an external device Users can also restore the backup data Backing Up Data Back up data to protect and store content and user data To back up data 1 On the System Settings panel click the Back Up Data button Back Up Data The Back Up Data Button A Save dialog box appears 2 Select a location to save the backed up data 3 Click Save IMPORTANT To protect content and user information
12. CAE Healthcare Using Mise Resetting a Patient Resetting a Patient brings the Patient back to its original physiological state before any scenarios were applied or modifications were made Any running scenarios are paused However the SCE time is unaffected Additionally the reset appears in the Event Logs NOTE If baseline physiology settings have been selected they are removed when the Patient is reset To reset a Patient 1 While running an SCE click Patient at the bottom of the Run screen The Patient Button The Patient pop up menu appears The Reset button The Patient Pop Up Menu 2 Click Reset The Reset the Patient dialog box appears stating that the patient s physiology will be reset to its state at load time and all running scenarios will be paused Reset the Patient This will reset the patient to the physiology at load time and pause all currently running scenarios The Reset button The Reset the Patient Dialog Box 3 Click Reset The Patient returns to its original physiological state at the start of the SCE 4 To resume any paused scenarios click the loaded scenario on the left side of the screen The Scenario Management pop up menu appears 5 From the Scenario Management pop up menu select Play The scenario is resumed 85 Using M se HPS The Medication Monitor The Medication Monitor tracks the infusion of medication administered To activate the Medication Monitor
13. HPS Care and Maintenance H ps Replacing the Chest Tube Foam Inserts The chest tube foam inserts can be replaced as needed To replace the chest tube foam inserts 1 Make sure the chest tube feature has been drained For information on draining the chest tube see Draining the Chest Tube on page 253 2 Pull back the chest skin exposing the foam inserts on each side of the mannequin s upper chest 3 Remove the foam insert you want to replace 4 Retrieve a new foam insert from the Replacement Kit and place a drop of super glue on each of the four sides that will touch the sides of the reservoir in the mannequin s chest 5 Place the new foam insert in the reservoir 252 J CAE Healthcare HPS Care and Maintenance Maintaining Trauma Features Follow the steps below to clean and flush the trauma features after each use Draining the Chest Tube The following instructions provide details on how to drain the chest tube feature and how to replace the chest tube foam inserts The chest tube feature must be drained prior to storing after use This reduces the buildup of sediment that may clog the tubing inside the mannequin To drain the chest tube 1 Ensure the Muse software is running and a patient is connected to the simulator 2 Disconnect the IV bag from the TRAUMA IN hose at the back of the rack 3 In M se from the Respiratory view click Chest Tube and select Prime 4 Place the chest tube primin
14. In the Hematology Model the following model variables definitions and relationships have been established Red Blood Cell Volume The volume of red blood cells within the circulation Plasma Volume The volume of plasma within the circulation Total Blood Volume The volume of blood i e Red Blood Cell Volume Plasma Volume within the circulation Blood Volume Loss The amount or rate of decrease in the total blood volume A given amount or rate of blood loss proportionally decreases both the Red Blood Cell Volume and the Plasma Volume according to the current hematocrit Plasma Volume Loss The amount or rate of decrease in the plasma volume A given amount or rate of plasma loss decreases the plasma volume without changing the red blood cell volume Plasma Volume Loss refers collectively and generically to all plasma fluid losses including evaporative transcellular e g ascites pleural effusion bowel and third space losses Hematocrit The ratio of Red Blood Cell Volume to Total Blood Volume expressed as a percentage CAE Heatthcare Using the HPS Genitourinary System The simulator comes with interchangeable male and female genitalia and allows for the insertion of urinary catheters and excretion of urine with a flow rate that is controlled by the instructor Setting Up Fluid for Use with the Genitourinary GU System T 2 Attach the desired genitalia male or female to the mannequin Hang a bag of
15. Stan D Ardman Il is a healthy 33 year old male He demonstrates a HR in the 70s BP in the 110s 70s RR in the teens and SpO in the upper 90s on room air The patient s cardiac rhythm is model driven normal sinus Heart sounds are normal breath sounds are clear in all lung fields and bowel sounds are normal in all four quadrants The patient s weight is 70 0 kg GI Stan is a healthy 20 year old male soldier He demonstrates a HR in the 80s BP in the 100s 70s RR in the low teens and SpO in the upper 90s on room air The patient s cardiac rhythm is model driven normal sinus Heart sounds are normal breath sounds are clear in all lung fields and bowel sounds are normal in all four quadrants The patient s weight is 85 0 kg Grandma Smokey Grandma Smokey is a 73 year old female former smoker She demonstrates a HR in the upper 80s BP in the upper 140s 90s RR in the teens and SpO in the upper mid 90s on room air The patient s cardiac rhythm is right bundle branch block Heart sounds are normal breath sounds are clear in all lung fields and bowel sounds are normal in all four quadrants The patient s weight is 53 0 kg Appendix C Base Patients H PS Norma L Female Norma L Female is a healthy 33 year old female She demonstrates a HR in the 70s BP in the 110s 70s RR in the teens and SpO in the upper 90s on room air The patient s cardiac rhythm is model driven normal sinus Heart sounds are normal breath sounds are clear
16. The Administrative Tools Buttons Click the History button to view and manage simulation session logs Click the System Administration button to manage stored content user accounts groups and system settings Click the Account Profile button to manage and determine preferences for the active account IMPORTANT Changes made to M se for HPS e g account creation content management medication preferences DO NOT affect M se for PediaSIM HPS If a user requires access to both M se for HPS and M se for PediaSIM HPS separate accounts must be created within M se for HPS and M se for PediaSIM HPS Additionally data backup performed from within M se for HPS does not back up data associated with M se for PediaSIM HPS 122 J CAE Healthcare Using Mise History From the History screen users can view and export simulation session logs Each simulation session is listed with the Start Time the title of the SCE and the Patient s name In addition the Physiological Data and Simulation Events are available for review and export Start Time 2011 11 16 14 21 57 2011 11 16 13 06 27 2011 11 15 10 51 44 2011 11 15 10 38 23 Healthy Adult Male Healthy Adult Male Healthy Adult Male Anaphylaxis Patient Stan D Ardman 11 Stan D Ardman 11 Stan D Ardman 11 Holly Monroe Simulation Events Simulation Events Simulation Events Simulation Events Simulation Events Physiological Data
17. 1 0 ome w o o ow S4 0 50 0 4 00 8 0 75 0 75 1 0 0 Normal Acute Ventricular Failure Right Vital Signs Approximate vital signs after three to five minutes in state Reset Mild Moderate Severe 108 63 104 57 93 53 85 52 23 8 27 10 25 11 16 10 82 77 7 oo o1 40 36 35 1 4 5 8 91 233 Condition Guidelines for Programming PediaSIM HPS with M se PediaSIM HPS Idiopathic Hypotension Idiopathic hypotension refers to low blood pressure in a healthy person e g young and thin Idiopathic hypotension is not a disease Idiopathic Hypotension Parameter Adjustments Reset Mild Moderate Severe o s 5 Idiopathic Hypotension Vital Signs Approximate vital signs after one to two minutes in state Reset Mild Moderate Severe 108 63 99 54 89 52 81 45 o o 035 2235 5 82 72 58 A 5 4 2 22 25 5 25 40 41 40 41 234 Condition Guidelines for Programming CAE Healthcare PediaSIM HPS with M se Acute Hypercapnia The essential mechanism underlying all causes of hypercapnia is inadequate alveolar ventilation Potential contributing factors include increased carbon dioxide production decreased minute ventilation increased airway resistance and inefficiency of alveolar gas exchange The most common causes are acute exacerbations of asthma and chronic obstructive pulmonary disease COPD This condition is programmed as an acute
18. 119 mA Cold Fluid Inject The Cold Fluid Inject parameter is used to simulate the injection of 10 mL iced saline into the pulmonary artery catheter The appropriate Thermodilution waveform and cardiac output measurement are then displayed on the Patient Status Display or TouchPro software CAE Healthcare Appendix B M se Parameter Descriptions Cardiovascular Additional Parameters Cardiovascular Parameters Additional B 31 Appendix B M se Parameter Descriptions H PS B 32 Baroreceptor Maximum Pressure Baroreceptor maximum pressure defines the mean arterial pressure MAP at which the baroreceptor inhibitory activity on the heart and systemic vasculature is maximal When a simulated patient s MAP increases above baseline pressure the baroreceptor response exerts greater inhibitory controls on the MAP e g reduction in heart rate in an attempt to return the MAP to the patient s baseline pressure However these controls have an upper limit and this maximum pressure is defined as the baroreceptor maximum pressure In other words as the MAP increases the physiological controls i e baroreceptor response work to bring the pressure back toward baseline primarily by reducing the heart rate For every 5 mmHg increase in MAP the heart rate may decrease by 2 beats per minute in an attempt to keep the MAP in check However there is an upper limit maximum pressure after which these controls are no longer effec
19. Discrete parameters are changed by choosing the appropriate option using a drop down menu or toggle switch In the image below the Needle Decompression parameter is shown The Needle Decompression parameter is set using a discrete parameter switch that toggles between Off and On Needle Decompression Off The Needle Decompression Switch Once the parameter has been set it is reflected in the patient s physiology NOTE Not all changes to parameters affect the patient s physiology but all are logged 69 Using M se HPS Using the Conditions Medications and Interventions Palettes The Conditions Medications and Interventions palettes on the Run screen enable the application of conditions medications and interventions during simulation Once applied conditions are reflected in the patient s physiology and logged All medications and interventions are also logged and most affect the patient s physiology Using the Conditions Palette Conditions are preprogrammed pathophysiological states that use one or more physiological parameters and are designed to enable you to create physiological changes on the fly There are two ways to apply conditions using the Conditions palette using a Quick Link or using the complete Conditions menu Quick Links are preconfigured conditions that are made accessible in the Conditions palette for quick application Quick Links can also be created for the Medications and Interventions palet
20. Ethernet Network 32 bit Green ons Configure IPv4 IPv4 Address Subnet Mask Router Configure IPv6 WINS 802 1X Proxies Manually 10 XXX XX XXX 255 0 0 0 Automatically TCP IP Network Screen Macintosh Internet Protocol Version 4 TCP IPv4 Properties General IP address Subnet mask Default gateway You can get IP settings assigned automatically if your network supports this capability Otherwise you need to ask your network administrator for the appropriate IP settings 5 Obtain an IP address automatically Internet Protocol Version 4 TCP IPv4 Properties Screen Windows b Choose Configure IPv4 Manually Macintosh or Use the following IP address Windows c In the IPv4 Address or IP address field enter a unique IP address The IP address must match the IP address obtained in Step 2 EXCEPT for the number after the third and final period This number can be any number between 2 and 254 BUT must be different from the final number of the IP address of the Instructor Workstation and any other computers on the network No two IP addresses can be the same including the Instructor Workstation s IP address Example If the IP address of your Instructor Workstation is 10 127 91 223 you could assign the TouchPro computer the IP address 10 127 91 224 and the Wireless Remote computer the IP address 10 127 91 225 d In the Subnet Mask field enter 255 0 0 0 e Click OK
21. Lung Compliance Factor Right Venous CO Shift Baroreceptor Maximum None None Pressure Baroreceptor Minimum Pressure Left Ventricle Contractility Factor Right Ventricle Contractility Factor Systemic Vascular Resistance Factor Venous Capacity Factor Systemic Arteries Compliance Factor Pulmonary Arteries Compliance Factor Pulmonary Vasculature Resistance Factor Venous Return Resistance Factor Baroreceptor Gain Overall Factor Baroreceptor Gain Cardiac Factor Baroreceptor Gain Peripheral Factor Chest Compression Efficacy Tamponade Volume Ischemic Index Sensitivity Ischemic Index Averaging 167 Using the HPS H ps Additional Parameters Bronchial Resistance Aortic Valve Resistance Factor Left Factor Bronchial Resistance Mitral Valve Resistance Factor Right Factor Alveolar Enflurane Pulmonic Valve Fraction of Inspired Resistance Factor Enflurane Pericardiocentesis Alveolar Halothane Fraction of Inspired Halothane Alveolar Isoflurane Fraction of Inspired Isoflurane Alveolar Nitrous Oxide Fraction of Inspired Nitrous Oxide Alveolar Sevoflurane Fraction of Inspired Sevoflurane 168 CAE Healthcare Neurological Features The HPS can simulate a variety of neurological clinical indicators such as reactive eyes Anatomy Physiology and Clinical Signs Convulsions Temperature Thumb Twitch Human Patient Simulator HPS Only
22. Medications and oo wm le Vo me Interventions Scenarios aie i cis cee palettes Event Loas_E ae W e The Event Recorder The Run Screen From the Run screen users can manage the SCE perform interventions view physiological status and events save events as states save the Patient and associate records with the Patient 59 Using M se HPS Connecting to the Simulator After starting an SCE by clicking the Run button click Connect to connect to the simulator The Connect button is located in the upper right corner of the Run screen b is Connect The Connect Button An SCE must be running before you can connect to the simulator IMPORTANT When a connection to another HPS from the same Instructor Workstation is desired you must disconnect from the HPS and restart the Instructor Workstation prior to connecting to the second HPS Using the Patient Status Display On the Run screen there are widgets that display the patient s physiological status The Patient Status Display widgets can be changed to reflect the user s needs There are six available display spaces for the widgets Waveform widgets utilize two display spaces Patient Status Display a E The Setup button The Mute All aN m JL 2 button Widgets The Patient Status Display Widgets 60 CAE Healthcare Using M se Use the Mute All button to mute all Patient Status Display alarms
23. PET Basilic Antecubital Cephalic IV Access Smaller needles are recommended to extend the life of the plumbing inside the mannequin Forcing fluids with the syringe technique through the IV source hose is not recommended as this can weaken the internal tubing Permanent IV Access Ports Permanent IV access ports are available at the right jugular and left femoral veins For information on cleanup after using the IV feature refer to Maintaining the IV System on page 255 201 Using the HPS 202 Gastrointestinal Features The HPS allows for diagnostic peritoneal lavage Gastrointestinal Features Manual Control See Diagnostic Peritoneal Lavage on page 202 Diagnostic Peritoneal Lavage Diagnostic peritoneal lavage can be performed on the HPS mannequin using the Diagnostic Peritoneal Lavage abdominal cavity To prepare the mannequin for diagnostic peritoneal lavage 1 Carefully pull back the chest skin just enough to expose the abdominal area Do not lift the chest skin more than 6 to 9 inches above the chest plate as doing so may damage the ECG wires IMPORTANT Be sure not to snag any of the ECG lead wires on the chest plate 2 Ensure the Diagnostic Peritoneal Lavage abdominal cavity is inserted in the abdomen area of the HPS mannequin The cavity is a removable lobe with a small fluid reservoir A slit sealed with red tape in the lower portion of the cavity leads to the reservoir 3 Remove
24. Physiological Data Physiological Data Physiological Data Physiological Data The History Screen By clicking the Simulation Events link of a Simulation Session users can view the entire log of the simulation and all the events that occurred during the SCE When the Physiological Data link of a Simulation Session is clicked users can view all the physiological data that occurred during the SCE On both the Simulation Events and Physiological Data screens there is an Export button that when clicked exports the data to a CSV file that can be stored on an external device 123 Using M se HPS System Administration From the System Administration screen users can control and access Content Management User Accounts Groups Maintenance and System Settings To access the System Administration screen click the System Administration button from the Home page The System Administration Button The System Administration screen is displayed SCEs Base Patients Scenarios Healthy Adult Female n Norma L Female Conditions Patient Records Healthy Adult Male n Stan D Ardmas 1T 33 years old Male 70 0 eg Stan D Ardman i1 Healthy Soldier The System Administration Screen Content Management From the Content Management options users can manage learning applications SCEs Base Patients and Scenarios To access the Content Management options from the System Administration screen click Conten
25. Pulseless Electrical Activity Sinus Sinus Bradycardia Sinus Bradycardia HR 40 Sinus Tachycardia Sinus Tachycardia HR 120 ST Elevation with Chest Pain Torsade de Pointes Trifascicular Block Ventricular Fibrillation Coarse Ventricular Fibrillation Fine Ventricular Tachycardia Ventricular Tachycardia Pulseless Ventricular Tachycardia HR 151 Ventricular Tachycardia Pulseless HR 151 Wellen s Syndrome WPW Syndrome Left Lateral Pathway B 27 Appendix B M se Parameter Descriptions H PS B 28 Arterial Catheter The arterial pressure displayed on the Patient Status Display or TouchPro software is set using this parameter A non pulsatile zero pressure signal is emitted when the Atmosphere position is selected and can be used to simulate zeroing a pressure transducer This may also be used to remove the arterial pressure waveform if desired The Left Ventricle position is useful for simulating cardiac catheterization procedures or for demonstrating left ventricular end diastolic pressure and its relationship to pulmonary artery occlusion wedge and central venous pressure Default Peripheral Artery Options Atmosphere Peripheral Artery Left Ventricle Central Venous Catheter The venous pressure displayed on the Patient Status Display or TouchPro software is set using this parameter A non pulsatile zero pressure signal is emitted when the Atmosphere position is selected and can be used to simulate ze
26. To adjust the widget layout click the Setup button The Widget Setup menu opens displaying available widget types Waveform Numeric and Volume Widget Setup 1322 0 1322 0 The Widget Setup Menu Adjust the Patient Status Display layout by dragging a widget type from the Widget Setup Menu and dropping it over the Patient Status Display The new widget type replaces the old To change a Patient Status Display widget click the widget to be changed A list of available parameters appears NOTE The capnogram waveform is not displayed on the TouchPro software from the Instructor Workstation Capnogram information can be found on the clinical patient monitor if one is connected to the simulator Choose the desired option from the list and the widget changes to reflect the new selection From the numeric widget menu you can also use the Set Color button to change the display color of the widget and the Set Alarm button to change the alarm settings for the selected widget 61 Using M se HPS The Event Logs During an SCE all software operations sensed by the simulator or entered manually e g virtual defibrillation are recorded by an event entry that appears on the screen The event entry notes what occurred and the time it happened Event Logs 00 01 27 Applied condition Bag Valve Mask 73 FiO2 00 01 18 Epinephrine 1 1 000 0 3 meg kg min IM Administered 00 00 00 SCE was started The Event Logs Event Log
27. data should be backed up weekly IMPORTANT Data backup performed from M se for HPS does not back up data associated with M se for PediaSIM HPS Restoring Data Restore data when the backed up data needs to be replaced on the software Restoring data only restores the last backup and does NOT merge the backup data with the current data To restore backup data 1 On the System Settings panel click Restore Data Restore Data The Back Up Data Button 140 CAE Healthcare Using M se The System Restore warning box appears stating that restoring data erases all current data and asks if you want to continue System Restore Warning Restoring data will permanently delete all current data Do you want to continue r r EU A The System Restore Warning Box IMPORTANT Restoring data ERASES all current data and replaces it with the backed up data 2 Click Yes A select file dialog box appears 3 Locate the appropriate bak backup file to restore 4 Click Select The data is restored IMPORTANT Restoring M se for HPS data does not restore M se for PediaSIM HPS data Product Licensing To view product licensing information for your simulator or to enter a license key to activate your software click License Manager Error Log The Error Log is available for technicians and is used when diagnosing the M se software IMPORTANT Do not clear the Error Log Localiza
28. e MP3 audio files A single patient record file cannot exceed 20MB 132 CAE Healthcare Using M se To upload a patient record 1 From Patient Records panel click Upload Patient Records A file selection window appears 2 Select the desired file and click Open or OK The file is uploaded and is now available to display in the TouchPro software M se can store up to 100GB of patient record files To ensure adequate space please delete patient records when they are no longer needed To delete a patient record 1 From the Patient Records panel select the patient record to delete 2 Click Delete The patient record is deleted and is no longer available to display in the TouchPro software Individual patient records can also be previewed renamed or exported by selecting the record and clicking Rename Export or Preview For information about displaying patient records in TouchPro see Displaying Patient Records on page 62 133 Using M se HPS User Accounts To access the User Accounts panel from the System Administration screen click the User Accounts button The User Accounts panel appears From the User Accounts panel users can create edit and delete users The User Accounts button Full Name Student ID admin Email admin admin amp meti com Confirm Password The user list Group Administrators Privileges System Management User Management The us
29. the patient can only respond to arterial oxygen or carbon dioxide levels when the respiratory rate is adjusted Default Modeled Range 0 mL 2500 mL Intrapleural Volume Vol Left and Right The Intrapleural Vol parameters allow intrapleural volume to accumulate for example as happens during pneumothorax hydrothorax or hemothorax To simulate a pneumothorax set the corresponding Intrapleural Vol to a value greater than 0 mL Values more than 1500 mL reduce the corresponding lung volume significantly The breath sounds are automatically diminished on the appropriate side due to decreased ventilation of the affected lung Default 0 Range 0 mL 2500 mL B 9 Appendix B M se Parameter Descriptions H PS B 10 Fraction of Inspired O FiO This parameter is used to simulate changes in the FiO such as would occur with the administration of supplemental oxygen Use this parameter to simulate supplemental oxygen when using HPS with M se SCE Development Software When using the HPS with M se Instructor Workstation while connected to the HPS mannequin the FiO value is overridden by the value measured in the lung Default 2196 Range 096 10096 Chest Tube Flow The Chest Tube Flow parameter is used with the chest tube feature of the simulator The selected Chest Tube Flow rate results in a corresponding Intrapleural Volume decrease Default 50 mL min Range 0 mL min 100 mL min CAE Healthcare Appendi
30. 32 C 099 L b The Run Screen NOTE When switching between running HPS6 software and M se on the same Instructor Workstation or when switching between connecting the same Instructor Workstation to the HPS simulator and PediaSIM the HPS Lab Rack should be restarted to ensure accurate functionality 165 HPS Using the HPS Parameters The M se software has a number of parameters that control the physiological features of the HPS The parameters are grouped by category Neurological Respiratory Cardiovascular Fluids and Sounds Each screen lists default Basic parameters However when the Basic Additional switch located on the Run screen is activated more parameters become available Click the Basic switch to Additional to see more parameters The Basic Additional Switch Below is a table that lists all of the Basic HPS parameters Basic Parameters Blood Pressure Heart Rate Heart Rate Factor Colloid Infusion Cardiac Rhythm Arterial Catheter Eyes Pupil Size Swollen Tongue Fluid Loss Blood Hemorrhage Channel 1 Hemorrhage Channel 2 Hemorrhage Channel 3 Eyes Blinking Fluid Loss Plasma Airway Occluder Convulsions Laryngospasm ICP Needle NMB Decompression Crystalloid Infusion 166 Temperature Body Temperature Blood Bronchial Occlusion Left and Right Respiratory Rate Respiratory Rate Factor Shunt Fraction SpO NMB Tidal Volume Intrapleural Volume
31. 9 2 Amendment This License may only be amended by the duly authorized representatives of CAE Healthcare 9 3 No Waiver The failure of CAE Healthcare to enforce at any time any of the provisions of this License or to require at any time the performance by Licensee of any of the provisions hereof shall not be construed to be a waiver of such provisions nor in any way affect the validity of this License or any part thereof or the right of CAE Healthcare thereafter to enforce any such provision 9 4 No third party beneficiaries Nothing in this Agreement shall be construed as creating or giving rise to any rights for any third parties or any persons other than the parties to this Agreement 9 5 Notices Notices or communications pertaining to this Agreement must be given in writing and delivered to the addressee as indicated in the HEPGTC 9 6 Preamble Headings The preamble forms an integral part of this Agreement The division of this Agreement into Clauses Articles sections subsections and other subdivisions and the insertion of headings are for convenience of reference only and will not affect the construction or interpretation of this Agreement 9 7 Severability If any one or more of the provisions of this License shall be held to be invalid illegal or unenforceable the validity legality or enforceability of the remaining provisions of this Agreement shall not in any way be affected or impaired thereby 9 8 Assignment and Succession
32. Ensure a urinary catheter is inserted in the mannequin s genitalia and a urine collection bag with ample room for fluid is attached to the catheter If any fluid other than distilled water was inadvertently used during the simulation exercise or if food coloring was added to the GU fluid supply flush the system with at least 1 liter of distilled water a Replace the GU supply IV bag with a 1 liter IV bag of distilled water Prime the bulb of the IV stake and ensure that flow has started b In M se from the Fluids view choose Urine Output c Move the slider to 500 or type 500 in the ml hr field and click Accept d Fluid begins to flow through the simulator s GU system and into the urine collection bag e When the fluid flowing into the urine collection bag is clear move the Urine Output slider to 0 or type 0 in the ml hr field f Click Accept g Close the clamp on the GU supply IV bag h Remove the IV bag from the stake set and disconnect the stake set from the GU fitting on the mannequin umbilical Remove the GU tubing from the GU pump so air and fluid can flow freely through it With a large syringe connected to the GU fitting of the mannequin umbilical flush the system with air as though dispensing a bolus of air until no water remains in the system Disconnect and drain the urine collection bag 8 Replace the empty IV bag in the system or store it appropriately 9 The urinary catheter and urine collection
33. Kre EA E 157 12 L ad gre e 158 NIBP Cycling and Manual NIBP ssssassssexscsscssvnenssssvsevnensansns svesucsnsudevesenakscssadsnnskscsseissritsanserernecien 160 Ll Cree 162 Configuring the TouchPro Software eere eerte e eee ee entere tinto erat a tn sna sna tn sensn atas tne 163 Changing the TouchPro Language sssisssssssessececsosdessniecsonssssssecssnsesevacenonsesosssussasavesssuncwsraesssunsioe 164 Exiting the TouchPro Software ssiscsssssccoisasusduscossaswednsensudavasdsensusanasasiocesesnsasiesodsanssavsesnianssoness 164 Using the HPS iu cosciente bobsia Ca aX REPRE prora IN LOUER OMNE oen ASEN Senar nasrani iE 165 L ICI ln SNC 166 Neurological Features fe 169 ji 170 iua Merc 171 Respiratory Features PN C 172 Realistic Upper AWAY acn ci nas a bv AR usta onu un PPAR RUE iur 175 Variable Upper Lower Airway Resistance ucciso etes 175 CHICO thyr Oty oor ORA DO FORURRN YOR ON KEN EE PONO Maloun UIRGO FO EARNED Lor 178 Breakaway Teeth cuan Rn p i donated t ub rue RR iR 178 di c aa 179 Needle Decompress Df a eR FORUM OI ADU DR RURAL QUA ROG d UA ORO AQ ONG D UR RR 181 xvii Table of Content
34. Licensee may not assign or delegate this Agreement in whole or in part expressly or by operation of law without CAE Healthcare s prior written consent CAE Healthcare may assign this Agreement in whole or in part and or its rights and obligations in CAE Healthcare s sole discretion to any party This Agreement shall be binding upon and enure to the benefit of the parties hereto and their permitted successors and assigns Any assignment of this Agreement or any license granted herein in violation of the provisions of this Section shall be void 9 9 Entire Agreement This License constitutes the complete agreement of the parties with respect to the subject matter referred to herein and supersede any other agreements written or oral concerning the subject matter hereof 9 10 Language The parties declare that they have requested and hereby confirm their express wish that this License and related agreements and documents be drawn up in the English language and that any notification letter or any other communication from a party to the other pertaining thereto shall be solely in the English language End of License vi DECLARATION OF CONFORMITY In accordance with EN 45014 Medical Education Technologies Inc 6000 Fruitville Road Sarasota Florida 34232 USA declare under our sole responsibility that the product Type of Equipment Human Patient Simulator with rack mount computer Model Number HPS to which this declaration re
35. Log Into the Desktop Instructor Workstation 36 Step 10 Option 2 Power on and Log Into the Optional Tablet Instructor Workstation 36 xiv J CAE Healthcare Table of Contents Step 11 Activate the Gas Supplies ssssossessosossssosssssosososososososssosossssososssssososososososssosososssssosse 36 Step 12 Launch me s ssas 36 Configuring a TouchPro or Wireless Remote Computer sessessossessossssososssssososososososssososossssossee 38 System REGuineimenns ausa pin HEREDI PNER UON K PM REEVAON EORR HEROUM DARUM DEAE 46 USING MUS m 47 EIE dE OD CDU IT TITLE 47 Navigating the Home Page soap itp YERAREUAEELV DEOR HR OC HERO RD Hee EUU QVE DRAN NUE 50 The SCE cur 51 ThE SEE DUE eot dnc atest eaten n nre to und cia base AGUA e 53 Th SCE Summary PANEL ocio isa plns rti pia Rc toc ada 57 Printing SES fe r H 58 RUNNING rei e c iaasa 59 Connecting to the Simulator isnuio I reu P ekk EDO MARET AQ FAPE POUR INA YE NEEHK EXER RU KI VITE ERO DAE 60 Using th Patient Status Display a issesia e eir rad natia oet Ra Rare nn Re d eae 60 THE EVENCLOGS actas pa nr DURO ES PU RATION E Bila n mn dU quU UP 62 Displaying Patient REGIS iarsan RIHOR URP SUOD Eod Eck OR YOU ROUEN NOME 62 Adding Scenario t a Runnin
36. M se Parameter Descriptions Neuromuscular Blockade NMB The pharmacokinetic and pharmacodynamic models based on the neuromuscular blocking agents administered and the time course of their injection automatically determines the degree of NMB For some educational applications however the instructor may wish to set a fixed degree of neuromuscular blockade that remains stable for an indefinite period This can be accomplished using the NMB parameter The default setting instructs the pharmacologic models to determine the degree of neuromuscular blockade based upon the drugs injected and their pharmacologic properties When a positive numeric value is assigned to this parameter the degree of NMB is set to that level For example 8096 NMB causes the simulator to set the degree of NMB to 8096 regardless of the presence or absence of neuromuscular blocking drugs Clinically the spontaneous tidal volume is markedly reduced Default Modeled Range 096 10096 Tidal Volume The Tidal Volume parameter is used to set the tidal volume to a given volume per breath OnceTidal Volume is set to a numeric value arterial oxygen and carbon dioxide values have no effect on the tidal volume but continue to influence other components of the physiological models For example with the tidal volume set to 600 mL in the adult simulator the tidal volume remains a constant set 600 mL even in the event of falling arterial oxygen levels In such situations
37. Management pop up menu appears Scenarios a Add Scenario Anaphylaxis Show Scenario The Show Scenario option Begining Anaphylaxis TP Beginning Anaphylaxis 00 00 04 Sc Mild Anaphylaxis Moderate Anaphylaxis 00 00 08 Severe Anaphylaxis Epinephrine Administered Condition Improves The Scenario Management Pop Up Menu 2 From the menu select Show Scenario The Scenario screen appears displaying the scenario The Jump to ad ys Caltense A ow Expand an ee A me The Close State button Window sina Anata Button e Selected ylax T States state The Scenario Screen Atthe top of this screen the Scenario Time and State Time are visible Additionally users can pause and continue playing the scenario by clicking the Pause and Play buttons on the Scenario Management pop up menu which is still visible on the left side of the screen 79 Using M se HPS 3 Click the Jump to State button The Jump to State menu appears displaying the available states e Beginning Anaphylaxis Mild Anaphylaxis Moderate Anaphylaxis Severe Anaphylaxis Epinephrine Administered Condition Improves The Jump to State Menu 4 Select the desired state The scenario transitions to the selected state and the state is highlighted on the Scenario screen NOTE Double click on the states to expand to the full view 5 Click the Close Window button to return to the Run screen SCE Time Co
38. NOTE If your simulator is capable of simulating convulsions ensure the convulsions parameter Neurological Features Clinical Interventions Patient Monitoring and Scenarios Each eye has reactive pupils and functional eyelids that blink and close The mannequin simulates convulsions Body and blood temperature measured can be set using these parameters and can be displayed on the Patient Status Display The right arm of the mannequin includes electrode attachments for a standard peripheral nerve stimulator PNS Software Control Manual Control The response None required to clinical intervention must be controlled by the instructor VIEW Neurological PARAMETER S Eye Controls The response to None required clinical intervention must be controlled by the instructor VIEW Neurological PARAMETER S Convulsions The response None required to clinical intervention must be controlled by the instructor VIEW Neurological PARAMETER S Temperature Body Blood iin is visible in M se prior to logging into the software In the upper right corner of the M se Start screen select the Simulator Features link then ensure the Convulsions box is checked This causes the Convulsions parameter to appear on the neurological view in M se The convulsions parameter is visible by default 169 Using the HPS HPS Eyes Each eye has reactive pupils and eyelids that blink and close T
39. O EtCO2 HR ICP MAP Set Color The Numeric Vital Selection Menu 2 Select the desired numeric The new numeric vital display is reflected on the screen 154 Using TouchPro Moving a Waveform or Numeric Display Waveforms and numerics can be moved on the screen to suit the user s needs To move a waveform or numeric click the desired waveform or numeric and drag and drop the display to a desired location A dragged waveform The TouchPro Display 155 Using TouchPro HPS Saving a Layout Once a layout has been configured it can be saved and reused To save a layout 1 Ensure the desired waveforms and numerics are in place 2 Click Settings The Settings menu appears 3 Click Save As The Save Layout window appears 4 In the Save Layout window in the Layout Name field enter a name for the layout Layout Name New Layout The Layout Name field The Save Layout Window 5 Click Save 6 Click the Close button to exit the Settings menu Saved layouts can be deleted from the Settings menu by dragging and dropping them in the Trash NOTE When a layout is saved it is available for use only with the current SCE To enable the layout for use with any other SCE enable the layout from the TouchPro Setup panel for the desired SCE 156 Using TouchPro Sounds All sounds can be silenced by clicking the Mute button in the bottom left corner of the TouchPro display
40. Only Heart Sounds are transmitted through the audio port Sounds are monophonic Genitourinary Pump Forces water in and out of the mannequin through the system hoses SpO Probe Port Provides communication between the OxSim and the rack Bar Code Reader Port Provides communication between the Bar Code Reader and the rack Flow Meter Measures the flow of the fluid to the chest tube and pericardiocentesis features of the HPS Power Switch Toggles simulator power on and off CAE Healthcare Introduction Cover E 35 removal grips Exposed ports The Back of the Rack K i AC OUT The Exposed Ports at the Back of the Rack Introduction H ps The upper back of the rack also contains the drug recognition system which measures the volume displaced when drugs are given and pushes fluids from the drug system into a collection bag The upper back of the rack is covered by a plastic cover To remove the cover hold the grips on both sides of the cover and pull up then out The Back of the Rack with the Cover Removed 10 CAE Healthcare Introduction The Front of the Rack The front of the rack is protected by a plastic cover To remove the cover hold the grips on both sides and pull up then out Cover removal grips HUMAN PATIENT SIMULATOR Front of Rack with Cover in Place 11 Introduction H ps The following components can be accessed from the front of the rack
41. OxSim Battery Compartment and Power Switch 32 CAE Healthcare HPS with M se Setup c Connect the other end of the OxSim cable to the OxSim Connect the OxSim cable to the OxSim Connecting the OxSim Cable to the OxSim NOTE It is recommended that the OxSim be secured to a patient monitor anesthesia machine equipment rack or other secure surface using a hook and loop fastener such as Velcro 33 HPS with M se Setup H ps Step 6 Connect Clinical Monitors Optional a Connect the pin connector end of the Monitor Interface to the back of the rack Connecting the Monitor Interface to the Back of the Rack b Connect the standard monitor cables to the six labeled sections at the remaining end of the Monitor Interface The monitor now interfaces with the HPS as it does with a real patient Connecting Standard Monitor Cables to the Monitor Interface Step 7 Ensure All Gas Supplies Are Turned Off Before proceeding ensure all gas supplies connected to the HPS Lab Rack are turned off Step 8 Turn on Patient Monitors Turn on all patient monitors 34 2 CAE Healthcare HPS with M se Setup Step 9 Power on the HPS Lab Rack Connect the power cord to the rack and to an AC power source then turn on the power switch located in the lower right corner on the back of HPS Lab Rack NHPS HUMAN PATIENT SIMULATOR Turn on the power switch The Back of the HPS Lab Rack 35 HPS
42. Rack Edit utility RackEdit is a supporting application designed to configure specific parameters of the HPS Rack It is distributed as a supporting utility application along with the HPS Version 6 software which is located on the Mac Instructor Workstation The utility allows the user to assign an anesthetic agent type to the gas analyzer Requirements e Macintosh Computer with Mac OS X 10 2 8 or higher e HPS Simulator HPS Rack to be configured Using the RackEdit Utility To begin configuring the gas analyzer 1 From the HPS workstation click on the Desktop to make the Finder application active 2 From the Finder menu bar click Go Finder File Edit View ee Window Help ack Eifl Forward 3e Enclosing Folder et IB Computer MC A Home THH M Desktop 2D Network CHEK B iDisk Applications Documents Y Utilities Recent Folders Go to Folder CHG Connect to Server 36K The Finder Menu 3 Click on Applications F 1 Appendix F Configuring the HPS Gas Analyzer The Applications Window appears DEVICES El iDisk E Macintosh HD _ JFH METI Y PLACES Desktop e hps _ Applications A Documents Y SEARCH FOR LO Today Yesterday LY Past Week All Images All Movies All Documents gt Address Book App Store amp Automator i Calculator amp Chess Dashboard Dictionary G DVD Player iei FaceTime Font Book amp Front Row GarageBand f ic
43. SCEs If this happens relaunch Mise for HPS and stop all running SCEs then relaunch Mise for PediaSIM to run SCEs The inverse is also true If you log out of Muse for PediaSIM without stopping SCEs and then launch M se for HPS you will not be able to run SCEs Relaunch M se for PediaSIM and stop all running SCEs then relaunch Muse for HPS to run SCEs 89 Using M se HPS Developing SCEs Creating and editing SCEs are similar processes Once an SCE is created the steps for modifying the SCE are the same as those for editing a previously created SCE The processes of creating and editing SCEs each begin with a unique button on the Home screen Use the New SCE button to create a new SCE The New SCE Button The minimal requirements for creating a new SCE include selecting a Patient naming the SCE and saving the SCE Once the new SCE is created you can continue with the SCE development or edit it later Use the Review button to edit an existing SCE The Review Button Creating a New SCE Creating an SCE requires naming the SCE and selecting a Base Patient To create a new SCE 1 From the Home screen click New SCE The New SCE Button 90 J CAE Healthcare Using Muse The Patients Palette appears Name Stan D Ardman II Age 33 years old Gender Male Weight The Patients Palette 2 Select a patient from the palette and click Create The SCE Editor appears showing the Enter a name for the
44. These disturbances cause sympathetic activity and arterial pressure to change in the same direction The result is increased blood pressure and heart rate Additionally there is an increase in ventricular contractility secondary to an increase in venous return to the heart due to increased venous tone Anxiety Pain Stress Parameter Adjustments Moderate Extreme A 4 sw Appendix A Condition Guidelines CAE Healthcare for Programming HPS with Mise Anxiety Pain Stress Vital Signs Approximate vital signs after three minutes in state Reset Moderate Severe Extreme 102 118 77 133 82 142 93 151 98 KARS 13 a 40 to 41 40 to 41 39 to 40 38 to 39 A 5 Appendix A Condition Guidelines for Programming HPS with M se H pg Chronic Hypertension In chronic hypertension the blood pressure regulating reflexes become adapted or reset to regulate blood pressure at a higher than normal level Additionally there is an increased total peripheral systemic vascular resistance The programming of this condition is based on the following blood pressure categories defined by the American Heart Association Categor Systolic mm Hg Diastolic mm Hg y M lower than 120 and lower than 80 120 to 139 or 180to89 140 to 159 or 90to99 160 or higher 100 or higher higher than 180 or higher than 110 Chronic Hypertension Parameter Adjustments Reset Pre Stage Stage Two Stage Isolated Hypertension One Thre
45. all fractions to be set Default Modeled Range 0 0096 80 096 Fraction of Inspired Nitrous Oxide The Fraction of Inspired Nitrous Oxide parameter is used to simulate the amount of nitrous oxide set in the anesthetic vaporizer and is used to calculate alveolar nitrous oxide The Fraction of Inspired Nitrous Oxide parameter is only effective when used with SCE Development Software and should not be used with the Instructor Workstation This parameter has a faster effect on physiology than anesthesia machine settings because mixing in the breathing circuit is not simulated NOTE M se does not verify a 100 96 sum of all fractions because this would require all fractions to be set Default 096 Range 0 0096 80 096 CAE Healthcare Appendix B M se Parameter Descriptions Alveolar Sevoflurane The Alveolar Sevoflurane parameter is used to simulate the presence of sevoflurane in the alveolar space without using real anesthetic vapors The sevoflurane percentage is input to the drug models to achieve the expected pharmacodynamic effects e g respiratory depression Using this parameter bypasses pharmacokinetics real and instructor specified inspired fractions venous content lung perfusion and ventilation This parameter can be used to focus on cardiorespiratory effects pharmacodynamics WARNING Using this parameter may result in undesired behavior when switching between SCE Development Software and the Instructor
46. bundled system of fluidic pneumatic hoses and an electrical pigtail attached to the mannequin in the perineum area This is the umbilical assembly The Umbilical Assembly b Attach the pin fitting assembly on the electrical pigtail to the back of the HPS Lab Rack being careful not to bend any of the pins Electrical pigtail pin fitting assembly e Attaching the Electrical Pigtail 28 2 CAE Heatthcare HPS with M se Setup c Attach the Pneumatic Left and Pneumatic Right hoses to the labeled ports on the back of the HPS Lab Rack Pneumatic Left hoses Attaching the Pneumatic Left and Pneumatic Right Hoses d Attach the Left Lung and Right Lung hoses to the labeled ports on the back of the HPS Lab Rack o Left Lung Be hose Right Lung m hose Attaching the Left Lung and Right Lung Hoses 29 HPS with M se Setup H ps Step 3 Connect the Gases In order to use the HPS Compressed Air Oxygen O Carbon Dioxide CO and Nitrogen N must be supplied via central air source or cylinder size G H or K Nitrous Oxide N O may also be supplied for anesthesia delivery if desired All gases must be calibrated to 50 psig 345 kPa a Ensure the supply pressure of all gas tanks and the Compressed Air tank are set to 50 psig 345 kPa b Connect Compressed Air to the labeled port on the back of the HPS Lab Rack C Connect Oxygen O to the labeled port on the back of the H
47. cricothyrotomy Esophagus Lower Esophageal intubation results in None required None required Esophageal Sphincter gastric distension and the absence of ndscomach breath sounds chest excursion and CO output 172 CAE Healthcare Respiratory Features Exhaled CO Measurement of exhaled CO Laryngospasm Needle Decompression Posterior Pharynx Swelling Pulse Oximetry Realistic Upper Airway Oropharynx Nasopharynx and Larynx Spontaneous Self Regulating Breathing Symmetric and Asymmetric Lung Ventilation Closes vocal cords and prevents intubation and ventilation When used with posterior pharynx swelling creates a can t intubate can t ventilate scenario Decompression of a pneumothorax can be performed bilaterally by inserting a needle at the midclavicular line of the second intercostal space Limits view of larynx to hinder intubation but allows mask ventilation creating a can t intubate can ventilate scenario Oxyhemoglobin saturation SpO automatically correlates with the oxygen concentration in the lungs and the intrapulmonary shunt fraction Allows direct laryngoscopy oral and nasal intubation and use of specialty airway devices such as endotracheal tubes combitubes and oropharyngeal airways Normal tidal breathing and pathophysiological conditions such as atelectasis pneumothorax asthma and COPD Tracheal or endobrachial intubation pathophysiologic conditi
48. desired medication from the list 111 HPS Using M se Once a medication is selected The Medication Transition menu appears asking for the comparison type and transition value Dopamine Comparison type A Greater than or Equal Transition value G 5 7 8 9 4 5 6 1 2 3 o meg ko meum The Accept button The Medication Transition Menu Follow the same steps to make selections from similar menus for the Assessment Intervention Physiology Scenario and Vitals variable types 3 Once the variable values e g comparison type and transition value have been selected click Accept The selected transition variable is listed beneath the original state on the Scenario Designer 112 CAE Healthcare Using M se 4 From the Scenario Designer click the GOTO arrow beneath the new transition variable The GOTO arrow The Available States menu Hypotension Begins Hypotension Worsens y None The Scenario Designer The Available States menu appears listing all the available states 5 Select a state from the menu An orange connector line appears indicating that the states are now linked by a transition The Ora nge IF Dopamine Greater than or Equal 5 meg kg GoTo Hypotension Improves Ld connector line The Scenario Designer 113 Using M se H ps ELSE Transitions An ELSE transition is used to transition to a state au
49. each anatomical region Bowel Sounds Locations To affect the bowel sounds simultaneously in all anatomical regions select the desired sound from the Bowel Sounds menu To change the amplitude of bowel sounds adjust the volume slider below the Bowel Sounds menu Default Normal B 43 Appendix B M se Parameter Descriptions H PS B 44 Breath Sounds Normal and abnormal breath sounds are selected using this parameter Breath sounds are synchronized with ventilation of the left and right lungs Breath Sounds To change breath sounds select the desired sound from the Breath Sounds menu Default Normal NOTE The volume control slider may be used to adjust the amplitude of the sound The volume control slider is only enabled while connected to a simulator Heart Sounds Normal and abnormal heart sounds are selected using this parameter Heart sounds are synchronized with the cardiac cycle Heart Sounds Default Normal NOTE The volume control slider may be used to adjust the amplitude of the sound Microphone Volume Microphone Volume is used to adjust the volume of sound coming from the wireless microphone To increase or decrease the volume of the microphone and thus the patient s voice use the volume control slider CAE Healthcare Appendix C Base Patients Appendix C Base Patients The following pages describe the standard M se base patients Stan D Ardman Il GI Stan
50. fac The Scenario Designer Parameters and transitions can be dragged and dropped to the Trash from the Graphical view or the Line Item view Deleted parameters and transitions remain in the Trash until you log out of the software or the Trash is emptied 116 CAE Healthcare Using M se Saving the Scenario At any time during scenario creation or modification the scenario can be saved To save a scenario 1 Click the Scenario button in the upper left of the Scenario Designer The Scenario drop down menu appears LES 5ave Save As A Chi UD Rename The Scenario Drop Down Menu 2 To save the most recent version of a modified scenario click Save OR To save a modified scenario as a new scenario leaving the original scenario intact a Click Save As When Save As is clicked the Save Scenario dialog box appears The Enter Scenario name The Save field button The Save Scenario Dialog Box b Enter the name for the scenario in the Enter scenario name field c Click Save NOTE When naming a scenario the scenario name CANNOT exceed 128 characters Additionally scenario file names CANNOT contain any special characters such as V lt gt 117 Using M se HPS Saving States to the State Library Users can save states to the State Library for later use To save a state drag and drop the state to the States button A dragged state The States button The Sce
51. for HPS with M se Advanced Cardiac Life Support ACLS Adult Nursing Cardiopulmonary Critical Situations CCS Disaster Medical Readiness DMR Emergency Medical Services EMS Learning Application 1 Emergency Medical Services EMS Learning Application 2 Emergency Medical Services EMS Learning Application 3 Emergency Medical Services EMS Learning Application 4 Foundations of Nursing Practice Patient Centred Acute Care Training PACT Simulation Pediatric Advanced Life Support PALS for PediaSIM Pediatric Emergencies Pediatric Nursing Perioperative Management Program for Nursing Curriculum Integration PNCI Program for Nursing Curriculum Integration PNCI Respiratory Education Simulation Program RESP Learning Application 1 Respiratory Education Simulation Program RESP Learning Application 2 Respiratory Education Simulation Program RESP Learning Application 3 Tactical Medical Care TMC 23 Introduction H ps HPS with M se Training Courses HPS Basic and Advanced courses offer learners at all levels in depth instruction in the setup operation development of scenarios and maintenance related to the use of the HPS The HPS Basic course provides learners with an overview of the system and its components as well as an introduction to patient creation and scenario design HPS Basic two days at CAE Healthcare facility HPS Basic On Site two days at learner defined facility HPS Basic On S
52. from the Run screen click the Medication Monitor button in the bottom right portion of the screen The Medication Monitor Button The Medication Monitor appears as a movable box on the Run screen Medication Monitor The Close Medication rocuronium button lt 0 0001 mg kg name The Reset button Normalized effector site concentration The Medication Monitor The normalized effector site concentration is Shown next to each medication listing The Reset button is used to clear a medication from the physiological model and the Medication Monitor To close the Medication Monitor press the Close button in the upper right corner of the medication Monitor window 86 CAE Healthcare Using M se Resetting a Medication To reset a medication from the Medication Monitor click the Reset button on the Medication Monitor The Reset Medication dialog box appears asking you to confirm that you wish to reset the medication Reset Medication Reset the medication rocuronium The Reset button The Reset Medication Dialog Box The medication is cleared from the model and from the Medication Monitor With continuous infusions the amount infused goes back to zero but the infusion continues To stop the infusion you must select the medication from the medication library and set the infusion rate to zero 87 Using M se HPS Returning to the Home Page To exit the SCE and return to the Home p
53. increase in total body carbon dioxide concentration as might occur in trauma or after the removal of a tourniquet Acute Hypercapnia Parameter Adjustments Reset Borderline Mild Moderate Severe Profound Extreme Acute Hypercapnia Vital Signs Approximate vital signs after five to 10 minutes in state Reset Borderline Mild Moderate Severe Profound Extreme Ce fof e e fs pe fa fe fe fa 235 Condition Guidelines for Programming PediaSIM HPS with M se PediaSIM HPS Chronic Obstructive Pulmonary Disease COPD Emphysema Obstructive lung disease describes obstruction to the flow of air through the airways and is characterized by decreased air flow rates during expiration It is often accompanied by an elevated functional residual capacity resulting from trapped gas COPD is the term applied to both emphysema and chronic bronchitis diseases usually caused by chronic pulmonary irritation COPD Emphysema Parameter Adjustments Moderate Severe Very Severe 236 Condition Guidelines for Programming CAE Healthcare PediaSIM HPS with M se COPD Emphysema Vital Signs Approximate vital signs after five to 10 minutes in state Reset Mild Moderate Severe Very Severe 108 63 115 65 124 68 130 72 140 78 237 Condition Guidelines for Programming PediaSIM HPS with M se PediaSIM HPS Tension Pheumothorax Pneumothorax is the result of accumulation of air or fluid in the pleural space Tension p
54. is mim 3 Select the file and click Select or Open 4 Refresh the screen by clicking the Home button in the M se software and then return to the Learning Modules panel The learning application appears on the Learning Modules panel and is available for use To delete a learning application from M se 1 Select a learning application from the Learning Applications panel 2 Click the Remove button The Remove Learning Module warning appears 126 HPS The Remove button J CAE Healthcare Using Mise Remove the Learning Module The associated SCEs and scenarios will be removed The Remove Learning Module Warning 3 Click Delete The learning application and all its SCEs are deleted NOTE Preconfigured learning applications cannot be deleted If a user attempts to delete them a failure message appears SCEs From the Content Management options click SCEs to access the SCEs panel The SCEs panel appears Learning Modules The SCEs link The Import SCEs button The SCEs Panel All user created SCEs are listed in the SCEs panel On the SCEs panel users can review copy delete import and export the SCEs they have created NOTE SCEs purchased from CAE Healthcare CANNOT be exported Click Import SCE to import an SCE from an external device or the hard drive location where the SCE file is saved Click Export to export an SCE to an external device The SCE file extension is sce 1
55. light of a laryngoscope blade or a flashlight visually examine both the upper and lower airway While tears in the upper airway resulting from intubation may be obvious needle holes in the lower bronchus resulting from techniques such as transtracheal jet ventilation may require close inspection to be detected If damage to the airway is found refer to Repairing Cuts and Abrasions to the Mannequin on page 257 or consult CAE Healthcare Customer Service J CAE Healthcare HPS Care and Maintenance Removing the Chest Skin From time to time certain maintenance steps require the removal of the chest skin Ensure this is done with care To remove the chest skin 1 2 6 Disconnect any ECG monitoring leads and unscrew the defibrillation and or pacing disks from the mannequin chest plate Unzip the chest skin Remove the abdominal cavity Disconnect the speaker connections and ECG leads from the mannequin s upper right quadrant Gently pull both sides of the skin toward the mannequin s head Slowly lift the chest skin from the chest plate IMPORTANT Be careful to avoid snagging the ECG lead wires on the chest plate Replacing the Chest Skin To replace the chest skin 1 Re connect the speaker connections and ECG leads at the mannequin s upper right quadrant Replace the abdominal cavity Replace the chest skin on the chest plate aligning it with the chest tube attachment Zip the chest skin 251
56. manipulation of metabolic CO production to simulate a variety of pathophysiological conditions CO production is determined by the O Consumption and Respiratory Quotient settings A CO Production Factor value of 2 doubles the CO production while a value of 0 5 decreases the CO production by 50 Default 1 Range 0 50 4 00 PaCO Set point The PaCO Set point parameter is a set point for PaCO The control of breathing model adjusts tidal volume and respiratory rate in order to bring the PaCO toward this set point Factors that influence the success of this control effort include baseline tidal volume baseline respiratory rate respiratory gain O consumption respiratory quotient lung compliances chest wall compliance bronchial resistances the presence of artificial airways in the simulator and the inspired gas mixture When the PaCO Set point is set to a new value the physiological controls adjust the simulator s respiratory pattern in an attempt to attain the desired set point For example when the set point is raised from 40 to 50 mmHg there is a transitory decrease in respiratory rate and tidal volume as the physiological controls attempt to drive the PaCO toward 50 mmHg When the PaCO reaches the new set point the simulator s respiratory rate and tidal volume are again controlled to maintain the PaCO at the new set point Default 40 mmHg Range 20 0 mmHg 70 0 mmHg CAE Healthcare Appendix B M se Para
57. mannequins 257 HPS Care and Maintenance H ps Using the IV Arm Kit Over time the IV arm becomes worn and the skin or veins may need to be replaced using the contents of the IV Arm Kit included in the mannequin Replacement Kit Replacing the IV Arm Skin To replace the skin 1 Remove the used skin 2 Sprinkle talcum powder from the packet enclosed with the IV Arm Kit into the interior of the new skin 3 Shake out the excess powder and slide the new skin over the hand Pull it into place over the arm 4 Palpate the veins to make sure they are positioned in the channel on the arm and hand Replacing the IV Arm Veins To replace the veins 1 Pull down the skin of the arm 2 Remove the section of tubing that needs to be replaced by cutting the tubing on each side of the affected area Leave at least 1 2 5 cm of the vein extending from the molded arm to ensure enough material in which to install butt connectors 3 Insert one of the supplied butt connectors into each of the ends of tubing 4 Retrieve a new piece of tubing from the Replacement Kit cutting it to the same length as the piece you are replacing 5 Install the new section by lubricating the butt connectors and sliding the new vein all the way over the connectors Be sure the tubing is applied all the way onto the connectors on both ends of the replacement section of tubing 6 Replace the skin over the mannequin s arm Drug Recognition Barcod
58. option This can be done one of two ways a Choose a pre defined dose Q Morphine Intraosseous 10 1mg Iv 2 5 mg IV 5 mg IV 10 mg IV 15 mg IV 1mgio 2 5 mg 10 S mg IO 10 mg 10 15 mg iO 20 mg 10 S mg IM 10 mg IM The Medication Dose Menu The predefined dose options The dose is applied and appears in the patient s physiology CAE Healthcare Using M se OR b Choose a route of administration to administer a custom dose Morphine Intramuscular IM The custom dose options Intraosseous 10 20 mg 10 5 mg IM 10 mg IM The Medication Dose Menu The Custom Dose Administration menu appears Q Morphine Intravenous IV The Administer button The Custom Dose Administration Menu 5 Enter the desired dose and click the Administer button The dose is applied and appears in the patient s physiology NOTE Not all medications affect the patient s physiology but all are logged 75 HPS Using M se Using the Interventions Palette There are two ways to perform and or administer interventions using the Interventions palette using a Quick Link or using the complete Interventions menu Quick Links are preconfigured interventions that are made accessible in the Interventions palette for quick application Quick Links can also be created for the Conditions and Medications palettes To apply an intervention using the Quick Links in the Intervention palett
59. parameter found on the Cardiovascular view To make the patient less sensitive to ischemia lower the value below the default setting To make the patient more sensitive increase the value above the default setting These changes are then reflected in the patient s Ischemic Index as shown in the table above Ischemic Index Averaging Ischemic index averaging determines how quickly myocardial ischemia develops in the presence of an unfavorable oxygen supply demand ratio or how rapidly it resolves when myocardial oxygenation becomes favorable By decreasing the averaging time i e value toward 0 5 ischemia has a faster onset if there is a poor oxygen supply to the heart or a faster resolution with favorable oxygenation Increasing the averaging time i e value toward 0 99 means ischemia takes longer to develop or longer to resolve Use this parameter to speed up the recovery from the model driven death spiral By setting the parameter to 0 5 a patient pulls out of the death spiral at a faster rate than with a setting of 0 99 However the favorable conditions i e better oxygenation and or lower heart rate must exist before the number is made smaller If not the patient s descent increases at a faster rate Default 0 99 Range 0 50 1 00 WJ CAE Healthcare Appendix B M se Parameter Descriptions Aortic Valve Resistance Factor The Aortic Valve Resistance Factor parameter is used to adjust the resistance to blood fl
60. printable PDF of the selected SCE a Anaphylaxis Holly Monroe Age 21 years old WR Add To Favorites Gender Female Weight 70 0 kg 3 Base Nonma L Female Overview Your rescue squad responds to a report of a 21 year old female complaining of trouble breathing She was eating dinner at a cookout when she noticed some tightness in her chest The cook came by asking if anyone wanted another shrimp burger She then told him she was allergic to shellfish She was proceeding to her car to retrieve an epinephrine auto injector when a wasp stung her im Print SCE The Print button The Add to Favorites button The SCE This SCE consists of six states that manually transition During the initial assessment in State 1 Beginning Anaphylaxis the patient presents with early signs of anaphylaxis HR in the 90s BP in the 100s 50s RR in the 20s and SpO2 in the low 90s on room air She remains conscious The learner is expected to assess and manage the patient s airway breathing and circulatory status ABCs identify early signs of allergic reaction consider use of oxygen call for help with interventions consider early use of epinephrine and attach a cardiac monitor If more than 120 seconds elapses without administration of epinephrine the instructor should manually advance the SCE to State 2 Mild Anaphylaxis If epinephrine is administered the SCE is advanced to State 5 Epinephrine Administered In State 2 Mild Anaphylaxis the
61. room to hold one additional liter of fluid b Replace the IV supply with a 1 liter IV bag of distilled water Prime the bulb of the IV stake and ensure flow has started Allow the water to flow until the bag is empty 3 Close the clamps on both the IV supply and the reservoir 4 Remove the IV bags from the stake sets and drain them appropriately 5 With a large syringe flush the IV port with air as though dispensing a bolus of air until all water is dissipated IMPORTANT The system must be cleaned after each use to prevent damage IMPORTANT The system must be cleaned in the prescribed way to prevent damage to the flowmeter IMPORTANT To prevent mold mildew and fungus from growing in the Drug Recognition System it should occasionally be flushed with a 1 liter IV bag of distilled water mixed with 10 mL of white vinegar Follow the procedure above for flushing the system using the vinegar solution then repeat the procedure using plain distilled water The system should be cleaned in this way about once every two months 255 HPS Care and Maintenance H ps 256 Maintaining the GU System After using the Genitourinary GU System in a simulator exercise it must be flushed and purged Complete the following steps to ensure proper performance during subsequent simulator exercises k 2 3 Ensure the HPS Lab Rack is powered on Ensure the M se software is running and a patient is connected to the simulator
62. scenario state has been placed on the canvas it can be modified Additional parameters transitions and notes can be added Each state can contain multiple parameters and transitions Double click the state name to rename it The Collapse State button 145 mmHg 95 mmHg 38 0 C 23 breaths min A State Click the Collapse State button to minimize the state Double click the collapsed state to expand it 108 gw CAE Healthcare Using Mise Adding Conditions Interventions and Parameters Conditions and interventions can be added to states by dragging and dropping them from the Conditions menu to the desired state Adding a condition or intervention to a state The Conditions menu m se Hypotension do ES Remate p cottapse ato w Expand an Lm cardiovascutar Acute Ventricular Failure Both Acute Ventricular Failure Left Acute Ventricular Failure Right Anxiety Pain Stress BP Hypertension BP Hypotension Cardiac Tamponade Chronic Hypertension Heart Rate Bradycardia cow Hypotension Improves LJ Meart Rate Tachycardia I w Time In State Greater than or Equal 360 vec Idiopathic ansion oro Hypotension Worsens LI Patient Stability Lom i 4 Ventricular Failure Both Ventricular Failure Left en d See pu A meti admin lt ir Dopamine Greater man or Equal meg kg The Scenario Designer To ad
63. set to the white Trauma hose on the Umbilical Assembly at the back of the HPS Lab Rack 5 Lubricate the chest tube priming hose in the Replacement Kit with silicone spray 6 Insert the chest tube priming hose into one of the mannequin chest tube openings as far as possible The hose must slide in far enough to engage the valve inside the mannequin that leads to the chest tube reservoir 7 Onthe Respiratory view select the Prime option under Chest Tube XX Setting Chest Tube to Prime 179 180 Using the HPS H PS 8 Once water begins to flow select Disable under Chest Tube Setting Chest Tube to Disable 9 Remove the chest tube from the mannequin 10 Zero the Trauma Flow Meter by pressing the black button on the bottom left corner of the Trauma Flow Meter located on the back of the HPS Lab Rack 11 In M se set the Intrapleural Volume Left Intrapleural Volume Right Chest Tube Flow and Chest Tube Air Leak optional parameters to the desired amounts These parameters are located on the Respiratory view 12 Setthe Chest Tube parameter to Enable For information regarding cleanup after using the Chest Tube feature see Draining the Chest Tube on page 253 Two parameters allow the user to set air flow and fluid rate as well as to determine the type of air leak Chest Tube Air Leak determines the quantity of air that drains with the chest tube output Chest Tube Flow specifies the rate at which flu
64. the vein assembly please take the necessary precautions Gases Follow the standard United States Department of Transportation or applicable national agency s warnings and regulations for handling and using compressed gases e Use caution when engaging the air and medical gas valves Latex Warning CAE simulators incorporate latex into their design When performing certain maintenance procedures the latex can become exposed Users with latex sensitivity should take necessary precautions when handling the simulator while performing those procedures xii J CAE Heatthcare Table of Contents Table of Contents License Copyright scsssscssscvicasussassessicssciensscdascasaiansusdsvonsasesssnasaacessesssssiessaasisescsasbeasianansiasiacsansss i Declaration of Conformity ertt rtkttib bn tht hS Y PEMEETEREREERYEDEERU EN EE XE POSER HEAR sivas SEU vii Specifications q ix CAUTIONS WANING S scs ouo ri Ihe ER IEEINEER EE E NR DRM RUDI CH RIEN ELO IU ANNIS e RUE xi D Mem 1 HP E E AA REM OAM A E u tani POUR AC HLUNU AED ULUN 1 Contained in this User Gill e iioii ERREUR ASQ ERNIUAREG FRQUBEUI HESS RREIHARR VeL RADAR UAM EE 2 Equipment Overview TR 4 Human Patient Simulator HPS Standard Equipment eee 4 Human Patient Simulator HPS Optional Equipment iesssssssseacecsaacavsussvaccesssateneocavononssonnvvteneseasanontoesnnn
65. their entirety without modification of any sort then click the DECLINE button below and your access to the Software and Data is prohibited 1 DEFINITIONS AND INTERPRETATION 1 1 The preamble forms an integral part of this License 1 2 Terms with a capital letter defined in the Preamble have the meaning indicated in the Preamble Whenever used in this License the following terms have the meaning set out below a Confidential Information means any and all scientific and technical information which is in the possession of or belonging to CAE Healthcare and relating to the Product including without limitation all Data Software trade secrets know how processes methodologies samples components analyses compilations guides and other information or documents prepared by CAE Healthcare its subsidiaries and affiliates and or their officers servants agents representatives employees or advisers which contain or are otherwise generated from or reflect any CAE Healthcare proprietary information whether or not covered by intellectual property rights or explicitly designated as confidential or proprietary which is disclosed by any means in written oral electronic or any other form b Purpose means the use of the Software and the Data solely for the operation and maintenance of the Product and the use of the Product solely as an educational tool D d RFRA 1 ARAA KYS Technology 02 2911 5233 02 2911 6855 E i
66. to poor oxygenation and the less likely the patient is to go into a death spiral The Ischemic Index Averaging parameter also located under the Additional parameters on the Cardiovascular view determines how quickly myocardial ischemia develops in the presence of an unfavorable oxygen supply demand ratio or how rapidly it resolves when myocardial oxygenation becomes favorable For additional information on the Ischemic Index refer to Appendix D The Ischemic Index Death Spiral CAE Healthcare Using the HPS Manual Blood Pressure Blood pressure can be taken manually on the left arm Non invasive blood pressure monitoring techniques can be used by attaching the standard cuff modified with a T fitting and adapters To modify a standard cuff for use with the HPS mannequin 1 Take a standard cuff and cut the hose that connects to the pressure gauge Cutting the Hose 2 Insert one of the supplied adapter fittings into each of the open ends of the hose Use a female fitting on one end and a male fitting on the remaining end Inserting the Adapters 3 Insert the T fitting into the hose adapters Inserting the T fitting 187 188 Using the HPS HPS 4 Connect the remaining portion of the T fitting to the hose under the left shoulder of the mannequin Connecting to Mannequin Non invasive blood pressure may now be taken using the return to flow technique NOTE The NIBP monitor interface
67. to the flow of air through the airways and is characterized by decreased air flow rates during expiration It is often accompanied by an elevated functional residual capacity resulting from trapped gas COPD is the term applied to both emphysema and chronic bronchitis diseases usually caused by cigarette smoking or other chronic irritant inhalation COPD Emphysema Parameter Adjustments Reset Mild Moderate Severe Very 2400 2500 2600 2700 A 14 Appendix A Condition Guidelines CAE Healthcare for Programming HPS with M se COPD Emphysema Vital Signs Approximate vital signs after five to 10 minutes in state Reset Mild Moderate Severe Very Severe 118 77 137 91 148 98 156 100 161 107 20 8 24 8 40 to 41 39 to 44 38 to 39 38 to 39 39 to 40 A 15 Appendix A Condition Guidelines for Programming HPS with M se H ps9 Tension Pneumothorax Left or Right Pneumothorax is the result of accumulation of air or fluid in the pleural space Tension pneumothorax occurs when the accumulated fluid creates a positive pressure in the pleural space thereby exerting pressure on the great veins in the thorax and impairing venous return The result is obstructive shock secondary to obstruction of the blood flow within the cardiovascular circuit The results are hypotension decreased cardiac output increased arteriovenous oxygen difference and decreased myocardial oxygen consumption Lung compliance and chest wall compliance decrease wit
68. to the rate indicated causing administered drugs and intravascular volume changes to have no effect on the heart rate Default Modeled Options Modeled Asystole Atrial Enlargement Left Atrial Enlargement Right Atrial Fibrillation Atrial Fibrillation HR 120 Atrial Fibrillation HR 80 Atrial Flutter with 2 1 AV Conduction Atrial Flutter HR 150 Atrial Tachycardia AV Block First Degree AV Block Second Degree Mobitz I AV Block Second Degree Mobitz II AV Block Third Degree Bundle Branch Block Incomplete Right Bundle Branch Block Left Bundle Branch Block Left with PVC 2596 Bundle Branch Block Right Hypercalcemia Hyperkalemia Hypertrophy Biventricular Hypertrophy Left Ventricular Hypertrophy Right Ventricular Hypocalcemia Hypokalemia Hypothermia Junctional Junctional HR 50 Long QT Syndrome Myocardial Infarction with LBBB Myocardial Infarction Anterior Myocardial Infarction Anterolateral B 26 CAE Healthcare Appendix B M se Parameter Descriptions Myocardial Infarction Inferior Myocardial Infarction Lateral Myocardial Infarction Posterior Myocardial Infarction Septal Myocardial Ischemia Mild Myocardial Ischemia Moderate Myocardial Ischemia Moderate with PVC 1096 Myocardial Ischemia Severe Paroxysmal Junctional Tachycardia Paroxysmal Junctional Tachycardia HR 130 Pericarditis Premature Atrial Contraction Premature Ventricular Contraction 1096 Premature Ventricular Contraction 2596
69. trademark of the Microsoft Corporation in the United States and other countries CAE Healthcare Introduction Health Science HPS Standard Equipment HPS Mannequin HPS Lab Rack Desktop Instructor Workstation TouchPro Monitor Wireless Microphone and Receiver Replacement Kit Diagnostic Peritoneal Lavage Health Science HPS Optional Equipment Tablet Instructor Workstation Wireless Remote Control Drug Recognition System OxSim Monitor Interface Gas Accessory Kit Trauma Disaster Casualty Kit TDCK Moulage Kit Tool Kit PediaSIM Plug and Play Mannequin METIVision METI FX Hands Free Training Cables HPS Learning Applications and Training Courses Windows is a registered trademark of the Microsoft Corporation in the United States and other countries Introduction H ps HPS Equipment The descriptions on the following pages outline standard and optional components of the HPS system Refer to the Human Patient Simulator HPS Standard Equipment on page 4 or the Health Science HPS Standard Equipment on page 5 for a list of ssandard components included with your system configuration HPS Mannequin All patient assessments and clinical interventions are played out on the HPS mannequin which represents a human patient At 5 11 180 cm tall and weighing 75 pounds 34 kg it is fully operational in the supine and lateral positions It can be placed on a gurney operating room table or on the ground The
70. which electrical capture and mechanical capture occur VIEW Cardiovascular PARAMETER S Pacing Current Pacing Rate Pacing Capture Threshold The response to clinical intervention must be controlled by the instructor VIEW Cardiovascular PARAMETER S Cardiac Rhythm None required but adjustable VIEW Cardiovascular PARAMETER S Chest Compression Efficacy Manual Control ECG monitor may be utilized None required See Cardiac Pacing on page 190 for cardiac pacing disk locations and instructions None required None required CAE Healthcare Cardiovascular Features Circulation Normal and abnormal circulation e g None required but None required hypovolemia hypervolemia and right left adjustable heart failure can be adjusted VIEW Cardiovascular PARAMETER S Systemic Vascular Resistance Factor Defibrillation HPS supports operation with a variety Defibrillation can See Defibrillation of manual and automatic external be simulated by the on page 190 for defibrillators instructor defibrillation disk locations and VIEW Cardiovascular instructions PARAMETER S Defib Invasive Various hemodynamic physiological None required but None required Hemodynamic indicators are registered and can be adjustable Monitoring monitored VIEW Cardiovascular PARAMETER S Arterial Catheter Central Venous Catheter PA Catheter Manual Blood Systemic blood press
71. with M se Setup H ps Step 10 Option 1 Power on and Log into the Desktop Instructor Workstation a Power on the Desktop Instructor Workstation by pressing the Power button located on the back side of the Instructor Workstation monitor panel b In most instances the Instructor Workstation automatically logs into the HPS User account In this case the user doesn t need to take any further action to log into the Instructor Workstation In some instances e g when a user has manually logged out of the HPS User account a small Users window appears displaying two choices Administrator and HPS User In this case proceed to step 10c C Select HPS User The Login window opens displaying the Password field d Enter hps in the Password field e Click Log In or press the return key on the keyboard Step 10 Option 2 Power on and Log into the Optional Tablet Instructor Workstation Power on the Tablet Instructor Workstation by pressing the Power button on the side of the tablet computer The computer automatically logs in and the desktop appears If the computer does not automatically log in enter the Username METI User and leave the Password field blank Step 11 Activate the Gas Supplies a Remove any artificial airway devices from the HPS mannequin b Open the Compressed Air tank Ensure the supply pressure is set to 50 psig 345 kPa c Open the O CO N and N O optional air tanks Ensure the supply press
72. within the lungs The available volatile agents recognized by the system are sevoflurane isoflurane enflurane and halothane IMPORTANT Isoflurane is set as the default agent recognized by the gas analyzer To assign a different volatile agent to the gas analyzer and ensure proper performance use the Rack Edit utility RackEdit Please see Appendix F Using the RackEdit Utility for more information 215 Anesthesia and Scavenging H ps The Anesthesia Delivery System The Anesthesia Delivery System consists of a number of basic components located in the HPS Lab Rack The system is housed beneath the anesthesia delivery system panel at the top of the rack A syringe loaded into a syringe pump provides a reservoir for the supply of volatile anesthetic required by the system The syringe pump which is controlled by a computer dispenses small quantities of liquid anesthetic that is transported through a fine gauge stainless steel needle to a vaporizer The vaporizer is contained inside a large cylindrical copper heat sink Once the liquid anesthetic has reached the vaporizer it evaporates and is transported to the simulated alveolar volume by the same gas flow that controls the concentrations of oxygen nitrogen and carbon dioxide The components described in the preceding paragraphs are for using volatile anesthetic agents with the HPS system e g isoflurane Nitrous oxide is supplied to the HPS rack from an external source that is conn
73. 0 mins 10 0 mins 15 0 mins 30 0 mins 60 0 mins Custom Cycling The NIBP Cycling Menu Custom cycling is also available 160 Using TouchPro To display the patient s current NIBP click the Manual NIBP button The Manual NIBP button br min The TouchPro Display The current NIBP is displayed NOTE Manual NIBP can be used at any time during cycling However this turns off auto cycling 161 Using TouchPro HPS Patients To view the available Patients click the Settings button in the lower right corner of the TouchPro screen The Settings menu appears From the Settings menu click Patients to view the current Patient A Patients Stan D Ardman II The Available Patients NOTE When connected to the simulator the TouchPro only displays the active Patient 162 Using TouchPro Configuring the TouchPro Software The background color and alarm suspension time can be set from the TouchPro Configure panel To access the Configure panel 1 Click the Settings button in the bottom right corner of the TouchPro screen The Settings menu appears 2 From the Settings menu click the Configure button The Configure panel appears 3 From the Configure panel set the background color and alarm suspension time Background Color x m mH Alarm Suspension Time 20 secs 1 min 5 mins Indefinite The Configure Panel 4 Click the Exit button to exit the Configure panel when
74. 0s 100s 60s 110s 70s 90s 60s Cardiovascular Heart Rate LEKAD Le LE Bradycardia 226 Condition Guidelines for Programming CAE Healthcare PediaSIM HPS with M se Respiratory Respiratory Rate Bradypnea 227 Condition Guidelines for Programming PediaSIM HPS with M se PediaSIM HPS Additional Conditions The following pages provide programming guidelines for additional specific PediaSIM HPS conditions When programming conditions please allow the appropriate time for onset of vital signs The onset time is noted in the Vital Signs section for each condition Slight fluctuations in vital sign values may occur and for some conditions e g Acute Hypercapnia drift of PaCO values is likely Anxiety Pain Stress The response to anxiety pain stress is driven by non arterial baroreceptor influences that act on the medullary cardiovascular centers to raise the baroreceptor set point These disturbances cause sympathetic activity and arterial pressure to change in the same direction The result is increased blood pressure and heart rate Additionally there is an increase in ventricular contractility secondary to an increase in venous return to the heart due to increased venous tone Anxiety Pain Stress Parameter Adjustments Moderate Severe Extreme 110 120 133 9 gt 228 Condition Guidelines for Programming CAE Healthcare PediaSIM HPS with M se
75. 2 28 14 04 23 Q Review Astmatic with Pneumothorax LY Last Updated 2010 01 03 12 35 14 Q Review BA Adult Asthma Last Updated 2010 02 04 14 57 04 Rename Q Review COPD Exacerbation with Respiratory Failure Last updated 2010 01 21 14 08 17 Q Review The Import Heart Failure w Pulmonary Edema Scenario button N Last Updated 2010 02 02 13 54 17 Q Review Interior Myocardial Infarction Import scenario Create New Scenario The Scenarios Panel 4 From the Scenarios panel click the Import Scenarios button A Finder window appears 5 From the Finder window locate the desired hs6 scenario file and click on it Select file ta upload by localhost alel fee mI mj 3 Scenarios 77 Qs DEVICES z E Scenarios bo W Asthmatic Attack hs6 Sunn WR Asthmatic with chest pain hsG E Hypertensive Asthmatic hs6 Wi Post op Pneumonia hs6 SEARCH FOR Wi VA Discharge hs6 1 Today T Past Week E Yesterday I All Images lame Asthmatic BAI movies with chest pain hs amp AN Documents size BKB Kind Unix Executable File The Select button Cancel Locating the hs6 Scenario File NOTE Only hs6 files can be imported To import a gas file the scenario must be converted in the HPS6 software first Appendix E hs6 Files and M se HPS 6 Once the file has been located from the Finder window click Select The scenario loads and produces an U
76. 20 mmHg 300 mmHg Diastolic 10 mmHg 300 mmHg B 24 CAE Healthcare Appendix B M se Parameter Descriptions Heart Rate The Heart Rate parameter is used to set the heart rate to a given fixed number of beats per minute Once the Heart Rate is set to a numeric value administered drugs or intravascular volume changes have no effect on the heart rate but continue to influence other components of the physiological models Use this parameter to fix or set the heart rate to a specific number Resetting the parameter to Modeled returns control of the heart rate to the physiological models Default Modeled Range 30 beats per minute 220 beats per minute Heart Rate Factor The Heart Rate Factor parameter is used to change the baseline heart rate before physiological controls are taken into account A value of 2 doubles the baseline heart rate while a value of 0 5 decreases the heart rate by 5096 Use this parameter to raise or lower the heart rate Default 1 Range 0 10 4 00 B 25 Appendix B M se Parameter Descriptions H PS Cardiac Rhythm The Cardiac Rhythm parameter is used to change the patient s underlying cardiac rhythm displayed on the Patient Status Display TouchPro software or physiological monitor To change the cardiac rhythm click the Cardiac Rhythm parameter and select the desired rhythm from the available list If a number appears following the cardiac rhythm on the list this overrides the heart rate
77. 220 Other Considerations During setup be careful not to get liquid anesthetic into the copper block vaporizer or the 18 inch stainless steel needle This could lead to premature vaporization and unrealistic alveolar anesthetic vapor concentrations If upon patient startup abnormally high alveolar anesthetic concentrations are observed e g greater than 1 096 displayed in the Alveolar Anesthetic Agents on the Patient Status Display stop the simulation shut down the software and turn the HPS Lab Rack off Wait 10 seconds Power the HPS Lab Rack on Restart the M se software as normal opening the stainless steel stopcock after lung calibration and just prior to starting an SCE If the problem persists remove the glass syringe from the pump and disconnect it from the needle with the stopcock closed Run Standard Man for a few minutes until the alveolar gas concentrations of the volatile agent return to zero These methods should resolve the problem 6 mL of liquid anesthetic provides for about 30 minutes of wash in at an inspired fraction of 196 plus 30 minutes of wash out at an inspired fraction of 096 CAE Healthcare recommends using Stan D Ardman II for low flow anesthesia simulation Scavenging In order to accomplish the direct exchange of anesthetic vapors in the HPS lung a sample of the alveolar gases is continually flowing from the HPS mannequin to the HPS Lab Rack The gases are then exhausted from the HPS system and must b
78. 27 Using M se HPS Base Patients From the Content Management options click Base Patients to access the Base Patients panel The Base Patients panel appears The Base Patients link The Import Patient button The Base Patients Panel All Patients are listed in the Base Patients panel From the Base Patients panel users can rename review delete and export Patients they have created by clicking the respective buttons next to each Patient Click Import Patient to import a Patient file from an external device or the hard drive location where the SCE file is saved Click Export to export a Patient file to an external device The Patient file extension is pat NOTE Preconfigured CAE Healthcare Base Patients CANNOT be exported 128 J CAE Healthcare Using Muse Scenarios From the Content Management options click Scenarios to access the Scenarios panel The Scenarios panel appears Learning Modules SCEs Base Patients The Scenarios P link pem COPD Exacerbabon with Respiratory Fatere O Last Updated 2013 04 03 12130158 Q Review Heart Failure w Pulmonary Lderna n Last Updated 2013 04 03 12 30 38 Q Keview The Create The Import New Scenario Scenario button create new scenara button The Scenarios Panel All Scenarios are listed in the Scenarios panel From the Scenarios panel users can rename review delete import and export Scenarios they h
79. 300 Anesthesia Gas Accessory Kit Optional for Human Patient Simulator HPS not included with Health Science HPS The Anesthesia Gas Accessory Kit is optional for the Human Patient Simulator HPS configuration The kit contains regulators and hoses to connect carbon dioxide oxygen air inert gas and carbon dioxide to the HPS Lab Rack along with the components necessary to connect the HPS Lab Rack to a scavenging system product GAS 002 Gas Accessory Kit Optional for Human Patient Simulator HPS and Health Science HPS The optional Gas Accessory Kit contains regulators and hoses to connect carbon dioxide oxygen air and inert gas tanks to the HPS Lab Rack product GAS 001 18 7 CAE Healthcare Introduction Trauma Disaster Casualty Kit TDCK Optional for Human Patient Simulator HPS and Health Science HPS The TDCK adds to the fidelity of a training session by providing the means to add the automatic software controlled flow of blood mucous and secreted fluids from the mannequin product TF 005 The Trauma Disaster Casualty Kit Moulage Kit Optional for Human Patient Simulator HPS and Health Science HPS The Moulage Kit is available separately or as part of the Trauma Disaster Casualty Kit Moulage Kit The Moulage Kit is used to simulate injuries and trauma product 4MODS 999 19 Introduction H ps Tool Kit Optional for Human Patient Simulator HPS and Health Science HPS To simplify
80. CAE Healthcare for replacement b Ensure the HPS Lab Rack is attached to the scavenging system of your anesthesia machine Refer to Scavenging on page 220 for complete details c Ensure the 30 mL glass syringe is clean and empty d Attach the two way stainless steel stopcock and a suitable needle to draw up the liquid anesthetic A 19 gauge 4 cm spinal needle works well for this purpose NOTE Do not use a needle with a plastic connector as the anesthetic agents deteriorate the plastic e Open the stopcock and using the needle draw up 6 mL of the liquid anesthetic agent f Tighten the adjustment on the stopcock switch to prevent leakage g Holding the syringe with the luer lock fitting pointing upward remove all air bubbles from the syringe and close the stopcock IMPORTANT Leave the stopcock closed until the final step in these instructions h Remove the needle and tap the stopcock on the inside edge of the anesthetic bottle to recover any excess drops of liquid anesthetic 217 Anesthesia and Scavenging H ps Step 2 Set Up the Anesthesia Delivery System in the HPS Lab Rack a Remove the front cover of the HPS Lab Rack by holding the hand grips on each side of the cover and pulling up and then out b Locate the Anesthesia Delivery System on the top shelf of the rack The Anesthesia Delivery System consists of a red syringe pump a vaporizer and associated pneumatic tubing c Find the 18 inch stainless s
81. CE to State 2 Mild Anaphylaxis If epinephrine is administered the SCE is advanced to State 5 Epinephrine Administered In State 2 Mild Anaphylaxis the patient experiences increased respiratory distress The patient s HR is in the z 110s BP is 100s 50s and SpO2 is in the 80s on room air The learner is expected to continue to assess patient s The Continue LA dij pop continue button The SCE Summary Panel Stopping the SCE Running SCEs can be stopped from the Run screen or the Home page To stop an SCE from the Run screen 1 Click Stop in the upper right corner of the screen 88 The Stop Button J CAE Healthcare Using Mise The Stop the Simulation dialog box appears Stop the Simulation Do you want to stop the simulation The Stop Simulation button The Stop The Simulation Dialog Box 2 Click Stop Simulation The SCE stops running and the Miise Home page is shown To stop an SCE from the Home page 1 Click the Stop button in the bottom left corner of the SCE Summary Panel The Stop Button The Stop the Simulation dialog box appears Stop the Simulation Do you want to stop the simulation The Stop Simulation button The Stop The Simulation Dialog Box 2 Click Stop Simulation The SCE stops running IMPORTANT Always stop all running SCEs before logging out of Muse If you log out of Muse for HPS without stopping SCEs and then launch Mise for PediaSIM you will not be able to run
82. CO PaCO Factor is set at a value of 2 PetCO is approximately one half of PaCO PetCO depends on CO production and alveolar ventilation The use of the Onset feature e g onset over 1 minute is recommended for this parameter Default 1 Range 0 9 10 0 B 15 Appendix B M se Parameter Descriptions H PS Respiratory Gain Factor The Respiratory Gain Factor determines how strong an influence arterial CO levels have on the simulated patient s tidal volume and respiratory rate Under default conditions value 1 when arterial CO levels rise the patient s respiratory rate and tidal volume show a transitory increase in an attempt to return the patient to the physiological control CO set point If the Respiratory Gain Factor is increased to more than 1 the patient has a more pronounced response while values less than 1 correspond to a blunted response Default 1 Range 0 00 10 00 Respiratory Quotient Respiratory Quotient is the rate of carbon dioxide production divided by the rate of oxygen consumption Changes to the Respiratory Quotient parameter alter the rate of carbon dioxide production relative to the rate of oxygen consumption Default 0 8 Range 0 70 1 10 Volume Rate Control Factor Ventilatory responses to increased arterial carbon dioxide or decreased arterial oxygen may take the form of increased tidal volume increased respiratory rate or both The volume rate control factor determines these re
83. COPD Patient Pregnant Female Preconfigured SCEs Preconfigured SCEs are training tools with scenarios and multiple states They are intended to be used for learner education and training There are five categories of preconfigured SCEs Anesthesia Obstetric Allied Health Advanced Cardiac Life Support ACLS and Advanced Life Support ALS To access a preconfigured SCE from the SCE Library choose Learning Modules then click the name of the SCE category The SCEs in the chosen category are displayed and available for selection HPS with Muse includes the following preconfigured SCEs Anesthesia Aortic Cross Clamping Anaphylaxis in Awake Patient Cannot Intubate Cannot Ventilate Cardiac Tamponade Emergence Apnea Emergence Hypertension Emergence with Laryngospasm Emergence with Negative Pressure Pulmonary Edema Total Spinal Anesthesia 54 CAE Healthcare Using M se Local Anesthetic Toxicity During IV Epidural Injection Sympathectomy due to Epidural Anesthesia Hypoxia due to Bronchospasm During Induction of Anesthesia Hypoxia due to Atelectasis in the Obese Patient During Laparascopy Malignant Hyperthermia Under General Anesthesia Tension Pneumothorax Peripheral Nerve Block Complications Anesthesia Machine Failure Anaphylaxis Under General Anesthesia Awareness During Caesarean Section Perioperative Anterior Myocardial Infarction Obstetric Amniotic Fluid Embolism Epidural Analgesia Pulmonary Aspirati
84. Content Management privileges listed below Users with the System Management privilege can also view system settings back up and restore data and apply software updates User Management Users with the User Management privilege can manage all users and groups Content Management Users with the Content Management privilege can create and manage all SCEs Creating a New Group To create a new Group 1 From the Groups panel click New The Group Name field appears 2 Enter the name of the Group in the Group Name field 3 Click Create Group The group appears in the Groups panel Privileges can now be selected 4 Select the privilege s to be assigned to the Group 5 Click Save 137 Using M se HPS Deleting a Group Groups can be deleted when they are no longer needed Once a Group is deleted all users who were affiliated with the Group are moved to the Deactivated Users Group To permanently delete a Group select the group to be deleted from the Groups panel and click Delete When the Group Deletion warning box appears click Yes Providing Access to Content Only To provide users with the ability to create and manage SCEs but not the ability to manage users or groups 1 Create a new group called Content Only 2 Assign the group the Content Management privilege Do NOT assign any other privileges to the group 3 On the User Accounts tab create or edit the desired users placing each user in the Content Only group
85. Default 1 Range 0 15 10 00 Distended Chest Wall Compliance Factor The Distended Chest Wall Compliance Factor parameter along with the Chest Wall Compliance Factor parameter describes the interaction of the chest wall with the lungs The Chest Wall Compliance Factor parameter defines the volume pressure relationship in normal lung volumes Once distended however the chest wall rapidly becomes much stiffer and resistant to further inflation Also see Chest Wall Compliance Factor The Distended Chest Wall Compliance Factor parameter must be set to a low value for increased intrapleural volumes to result in elevated inspiratory pressures with positive pressure ventilation Also see Intrapleural Volume Vol Left or Intrapleural Volume Vol Right parameters Default 1 Range 0 10 10 00 Functional Residual Capacity The Functional Residual Capacity parameter sets the combined left and right lung volume remaining at the end of a normal spontaneous exhalation This parameter influences the speed of desaturation during apnea Default 2300 mL Range 500 mL 4000 mL B 17 Appendix B M se Parameter Descriptions H PS B 18 Lung Compliance Factor Left and Right These two parameters independently set the left and right lung compliance Lung Compliance Factor determines how easily the lungs inflate Low compliance factors less than 1 create stiff lungs such as in acute respiratory distress syndrome or pulmonar
86. E is running in two ways by using one of the physiological views on the Run screen to modify parameters or by using the Conditions Interventions and Medications palettes Using the Physiological Views From the Run screen users can select from six different views representative of various body systems and features Neurological Respiratory Cardiovascular Fluids TDCK Sounds To access each view click the appropriate organ icon or button e For Neurological click the brain For Respiratory click the lung For Cardiovascular click the heart e For Fluids click the droplet of blood For TDCK click the TDCK icon e For Sounds click the Sounds button 66 J CAE Healthcare Using Mise From each view various parameters can be viewed and adjusted The Physiological Views To change a patient s physiology using the physiological view 1 Click the appropriate organ icon or button from the homunculus to select the appropriate physiological view The associated parameters The homunculus Se ee ee The Run Screen The associated parameters appear to the left of the homunculus 67 Using M se HPS 2 Locate the desired parameter NOTE Basic parameters are shown by default in the Respiratory and Cardiovascular views The Basic Additional switch can be toggled to show more parameters 3 Select the parameter and set the new value Parameters have varying cont
87. Electrical System and HPS Rack Do not drop step on or stack anything on the HPS rack Do not clean the HPS Lab Rack front panel with chemical solvents Use water and a light soap solution only xi Cautions Warnings H ps Mannequin Donotdisassemble factory assembled parts of the mannequin e Apply water to the mannequin only in accordance with the supported clinical procedures identified in this User Guide e Make sure the mannequin is set up on a stable sturdy work surface to avoid collapsing and causing injury to users e Do not introduce foreign substances into the airway with the exception of small amounts of approved silicone based lubricant e The HPS should be operated in ambient temperatures below 104 Fahrenheit 40 Celsius Prolonged operation more than two hours in ambient temperatures greater than 104 Fahrenheit 40 Celsius results in anomalous behavior and out of spec performance e Only perform invasive procedures supported by the system as described in applicable sections of the User Guide Donotpickthe mannequin up by the limbs support head and leverage weight with torso tis essential to power off the entire HPS system before switching the mannequin from the adult patient mannequin to the pediatric patient mannequin for users with this option Latex is contained within the HPS Mannequin in the vein assembly of the right arm i e IV arm Should you need to replace any portion of
88. Factor The Respiratory Rate Factor parameter is used to change the baseline respiratory rate before the control of breathing and drug influences are taken into account The standard baseline respiratory rate is 11 to 13 breaths per minute A Respiratory Rate Factor value of 2 doubles the baseline respiratory rate A value of 0 5 decreases the baseline respiratory rate by 5096 Default 1 Range 0 01 6 00 TIP First decrease the respiratory gain factor to reduce the influence of the respiratory control mechanism on the respiratory rate and tidal volume Shunt Fraction The Shunt Fraction parameter is frequently used to assist in desaturating a patient This parameter creates a physiologic bypass of the normal pulmonary circulation resulting in changes in O CO and anesthetic gases at the alveolar level Typically values of 0 1 to 0 4 are needed to create large alveolar arterial oxygen gradients sufficient to cause arterial hypoxemia Default 0 02 Range 0 00 0 50 TIP If the parameter is set high 0 5 the patient desaturates rapidly and responds negatively to the administration of supplemental O SpO The SpO parameter is used to override the normal pulmonary circulation and set the SpO at a fixed numeric value regardless of the oxygen applied Resetting to Modeled returns control of the underlying SpO to the physiological models 2 Default Modeled Range 096 10096 CAE Healthcare Appendix B
89. H PS nin muse User Guide f A fis 4 ETH KYS Technology CAE Healthcare p J CAE teatthcare License Copyright CAE Healthcare Human Patient Simulator HPS Software and User Guide THIS IS A LEGAL AGREEMENT PLEASE READ THIS DOCUMENT CAREFULLY The software you are about to access is provided to you pursuant to the purchase of the Product by the legal entity which employs you or which you represent the Licensee or You from CAE Healthcare This purchase of the Product is subject to CAE Healthcare s Healthcare Education Products General Terms and Conditions the HEPGTC and this End User License agreement License This License governs the grant of licenses for the software in object code only embedded in or bundled with the Product or required to operate the Product as the case may be Software as well as all related Product documentation and information Data supplied by CAE Healthcare either with or separately from the Product which items as indicated in the HEPGTC are not sold but licensed Acceptance of these terms and conditions must be without modification of any of the terms conditions and notices contained herein Consequently please be sure to read the terms of this License carefully If You agree to these terms conditions and other provisions in their entirety then click the ACCEPT button below If You do not accept these terms conditions and other provisions in
90. HPS Developing Scenarios The Scenario Designer allows users to create and edit scenarios To access the Scenario Designer create a new scenario or choose an existing scenario to edit Creating a New Scenario To create a new scenario 100 1 From the SCE Editor under the Pre Loaded Scenarios heading click the Add Scenario button Pre Loaded Scenarios The Add Scenario button The Pre Loaded Scenarios Heading The Choose Scenario dialog box appears Scenarios lex Name Last Modified Anterior Myocardial Infarction 2011 09 12 09 38 39 COPD Exacerbation with Respiratory Fallure 2011 09 12 09 39 10 Elevated Heart Rate 2011 09 12 09 41 01 Heroin Overdose 2011 09 12 09 39 41 Inferior Myocardial Infarction 2011 09 12 09 40 13 Organophosphate Exposure 2011 09 12 09 40 39 The New button The Choose Scenario Dialog Box J CAE Healthcare Using Muse 2 Click New The Scenario Designer appears displaying the new untitled scenario Untitled Scenario Cm Few state cotapse att expand a The Scenario Designer 101 Using M se HPS Editing a Scenario To edit a scenario 1 From the SCE Editor under the Pre Loaded Scenarios heading click the Add Scenario button Pre Loaded Scenarios The Add 4 Add Scenario Scenario button The Pre Loaded Scenarios Heading The Choose Scenario dialog box appears Scenarios lex Name Last Modified Anteri
91. Lists all the recently run or edited SCEs Favorites tab Lists all SCEs that have been selected as favorites and is only displayed after favorites have been selected To add a favorite SCE to your profile click the Add to Favorites button at the top of any SCE on the Home page Managing favorites is achieved in the Account Profile portion of the software All tab Lists all SCEs including user created SCEs and all SCEs from available learning modules To search for an installed SCE enter part of the name of an SCE in the Search field and click the Search button 51 Using M se HPS Click any SCE to select it Once an SCE is selected it appears in the SCE Summary panel To run an SCE click Run in the SCE Summary panel to execute the SCE A running SCE appears in orange with an X icon Base SCEs are created by CAE Healthcare and represent base patient physiology Base SCEs have no associated scenarios and no physiological progressions The Lock icon indicates a locked SCE AN The Lock icon A E ealthy Adult Male Stan D Ardman II A Locked SCE Locked SCEs are installed by CAE Healthcare and cannot be deleted Base and preconfigured SCEs are locked Click the page arrows to view additional pages of installed SCEs To open the SCE Library click the Open Library button To create a new SCE click the New SCE button 52 J CAE Healthcare Using Mise The SCE Library Access SCEs from you
92. M Patient Profiles M se comes with two preconfigured pediatric patients Using one of these baseline patients as a starting point you can create your own patients and scenarios to help isolate critical learning applications Andy Stevenson Andy Stevenson is a healthy six year old male child He demonstrates a HR in the 100s BP in the 100s 60s RR in the low 20s and SpO in the upper 90s on room air The patient s cardiac rhythm is model driven normal sinus Heart sounds are normal breath sounds are clear in all lung fields and bowel sounds are normal in all four quadrants The patient s weight is 20 kg Emily Liu Emily Liu is a healthy six year old female child She demonstrates a HR in the 100s BP in the 100s 60s RR in the low 20s and SpO in the upper 90s on room air The patient s cardiac rhythm is model driven normal sinus Heart sounds are normal breath sounds are clear in all lung fields and bowel sounds are normal in all four quadrants The patient s weight is 20 kg 222 CAE Healthcare PediaSIM SCEs PediaSIM SCEs There are two types of pre installed SCEs for PediaSIM HPS with Muse Base SCEs and Preconfigured SCEs Base SCEs are fundamental SCEs with no scenarios and no progression of events Each base SCE is designed to provide facilitators with a baseline to run simulations on the fly oras a baseline from which to design their own SCEs Preconfigured SCEs are training tools with scenarios and m
93. M coo RR GARI DAP RR ORARE DR ORO UD saw X LC AR 20 21 V4 LE sodas cis stn cece atone encircles anon aes E A 21 Hands Free Training Cables RE R 22 HPS with M se Learning Applications and Training Courses enn 23 HPS with M se Setup f i s sy 25 Before Beginning Setup mme 26 Step 1 Place the Simulator in the Work Area esesssssosososoeosososseosossesosoecessososososososssososossssossee 27 Step 2 Connect the Umbilical Assembly sssessssesossseosesoseseosoessoosssosososeseososesoosssosesossssososesseese 28 Step 3 Connect Che Gases me 30 Step 4 Connect the Instructor Workstation esesesesosososososososseosossssoseseeesososososososssosososssssssee 31 Step 5 Connect the OxSim Optional ssesssssssssosssssosososososososseosossssososssssososososososssosososssssssee 32 Step 6 Connect Clinical Monitors Optional 4 e eere eere eene enne enean enun 34 Step 7 Ensure All Gas Supplies Are Turned off 4 e eere rere eerte eere eren rnnt 34 Step 8 Turn on Patient Monitors sesssiisissascsssssnesaacssxsstecssncsndensesenceodedessadnesteiesssanessuvavvsnnesiuniives 34 Step 9 Power on the HPS Lab Rack scjssvsvssvsassasnvsonneavansansciscornsanseiseersnavavoveaysnavaenvesssnnsanneoannaneas 35 Step 10 Option 1 Power on and
94. Nes 220 SCHVBHnglI ossi A E A E UR ULAR RM ERU ES 220 xix Table of Contents H ps PediaSIM HPS with H 221 P diaSIM Patient Profiles s ccaissiasascssiyvecorsasssdssssncassadnisdessecsedusoosdacssaysaesansssivesssnnsisasioasesss caine 222 P dia SIM SCES s sstitinsniiasiantinidnmincn nad DU REIR R nao 223 PediaSIM Base SCES oem RC Dc 223 PediasiM Preconfigured SCES siae nad cite udin nen Br Put oe p ong eno dtc 223 Condition Guidelines for Programming PediaSIM HPS with M se eere 225 HPS Care and Maintenance m 243 HPS Warranty Programs ies ssassucscacatssvecesancendessedinecsivssavaassuesssvansecasusiscsdnavessasssdsndsaavesvanssisiecs 243 General INformati h EET 243 Units CUE OF Agreement samenen roti god No EAE RENIER 243 How to Contact Customer Service esesssssosssseososossessossssososesesososososososssososossssosssssososososososssseos 244 Contract Period Mec 245 Limitations of Agreement sisi anne A uc uae anctor onn ned ran ndn 245 Ret rn Materials USITAS E ET a 245 System Software Upgrade Support e sessossessososssssosessosososososososososossssoossssssososesosososososososssssose 246 Pricing ar air e C saiso 246 Timeand Materia scscucun nitri stearic ree wesc canned ln c itai pM spi en n 246 XX CAE Healthcare BGAN OWIN me
95. Onl panel 3 ICU OR NO CVP 3 ICU OR Saturation Pulse e Save Layout Da Audio Setup NIBP Cycling The TouchPro Settings Menu NOTE Preconfigured layouts must be enabled in the Muse TouchPro Setup for the currently running SCE to be accessible in the Layouts panel For more infomation about enabling preconfigured layouts see Modifying the TouchPro Setup on page 97 150 Using TouchPro Changing a Waveform or Numeric Display Waveforms and numeric displays can be changed to suit the user s needs To change a waveform or numeric display 1 Click the waveform or numeric to be changed The Wave Vital Selection menu or the Numeric Vital Selection menu appears displaying all the available waveforms or numerics Wave Vital Selection ECGI ECG II ECG III ECG V1 ECG V2 ECG V3 ECG V4 ECG V5 ECG V6 ECG aVL ECG aVR ECG aVF Pleth Capnogram Blank Set Alarm Set Color Set Scale The Wave Vital Selection Menu 2 Select the desired waveform or numeric The new waveform or numeric is reflected on the screen From the Wave Vital Selection menu the alarm color and scale can be set for the waveform using the Set Alarm Set Color and Set Scale buttons From the Numeric Vital Selection menu the color and alarm for the numeric can also be established using the Set Color and Set Alarm buttons 151 Using TouchPro HPS Adding a Waveform The TouchPro software supports up to six
96. PS Lab Rack d Connect Carbon Dioxide CO to the labeled port on the back of the HPS Lab Rack e Connect Nitrogen N to the labeled port on the back of the HPS Lab Rack f Connect Nitrous Oxide N O to the labeled port on the back of the HPS Lab Rack Optional Compressed Air AIR port Carbon Dioxide CO port Nitrogen N port Oxygen O port Nitrous Oxide N O port IMPORTANT DO NOT turn on the gases until instructed in Step 11 on page 36 Connecting the Gases to the Back of the HPS Lab Rack 30 CAE Heatthcare HPS with M se Setup Step 4 Connect the Instructor Workstation a Place the Desktop or Tablet Instructor Workstation at the location where it will be used b Connect one end of the Ethernet cable to the Instructor Workstation c Connect the other end of the Ethernet cable to the HPS Lab Rack Connecting the Ethernet Cable to the HPS Lab Rack 31 HPS with M se Setup H ps Step 5 Connect the OxSim Optional a Connect the OxSim cable to the SpO PROBE port on the back of the rack Connect the OxSim cable to the SpO PROBE port y um Connecting the OxSim cable to the Back of the Rack b Ensure there is no battery in the OxSim and the power switch is in the OFF position away from the red dot Ensure the power switch is in the OFF position away from the red dot Ensure there is no battery in the battery compartment The
97. Patient Records Patient record Normal Abdominal Ultrasound The Stop Displaying button The Patient Records List To stop displaying a patient record click Stop Displaying at the bottom of the Patient Records list To close the Patient Records list click the Patient Records button The list closes If a patient record is being displayed the Patient Record button remains red until the list is re opened and Stop Displaying is chosen NOTE Only one patient record can be displayed at a time For information about uploading patient records to M se for selection from the Run screen see Patient Records on page 132 CAE Healthcare Using M se Adding a Scenario to a Running SCE SCEs incorporate scenarios that contain pre programmed physiology Scenarios can be added to SCEs to enhance patient physiology To add a scenario to an SCE that is running 1 Click the Add Scenario button on the Run screen Scenarios s Add Scenario The Add Scenario Button The Choose Scenario dialog box appears 2 Select a scenario from the Choose Scenario Dialog Box The Search field can be used to search for a scenario to select 3 Click Add The scenario is added to the SCE and appears under the Scenarios heading on the Run screen Scenarios ge Add Scenario Anaphylaxis Beginning Anaphylaxis 00 00 03 An Added Scenario 65 Using M se HPS Changing Physiology The patient physiology can be adjusted while an SC
98. SCE dialog box Untitled SCE button Name field The SCE Editor Screen 3 Enter the name for the SCE NOTE The name of the SCE may NOT exceed 80 characters Additionally SCE file names CANNOT contain any special characters such as lt gt 4 Click Save Once the SCE is saved it is stored and can be edited and reviewed at any time including creating a Patient Profile and content determining settings and programming scenarios 91 Using M se HPS The SCE Editor The SCE Editor can be used to review preconfigured SCEs and to create or edit custom SCEs To access the SCE Editor click the Review button in the SCE Summary Panel or create a new SCE Anaphylaxis k kas The Return button The SCE title The Print button The Run button Content Management Patient profile SCE Configuration 7 Scenarios The SCE Editor The buttons in the upper right corner of the SCE Editor provide options for running the SCE generating a printable PDF of the SCE or returning to the Home page The Content Management SCE Configuration and Preloaded Scenario links in the left panel are used to review the SCE content and configuration and to view scenarios applied to the SCE 92 CAE Healthcare Using M se Editing a Patient s Profile To edit the Patient Profile 1 From the SCE Editor in the Profile section click Edit Gunshot Wound The Edi
99. Volume to access the Microphone Volume menu Microphone Volume Heart Sounds T The Microphone Volume Menu 206 7 CAE Healthcare Drug Recognition Drug Recognition The HPS Drug Recognition System enhances the learning process by realistically representing the injection of intravenous drugs during simulation Standard syringes are labeled with drug types concentrations and barcodes Each syringe can be filled with distilled water and injected into the mannequin through a specially configured Stopcock Manifold As the bolus is injected via the manifold the Drug Recognition System s barcode reader automatically identifies the drug and its concentration and a syringe pump mechanism measures the dose The drug concentration and dose information are automatically transmitted to the HPS6 software which simulates the appropriate physiological response The components of the Drug Recognition system are described below Labels Labels representing a wide range of drugs are supplied with the HPS The barcode on each label identifies the drug and concentration to the HPS system The labels should be applied to 10 mL 20 mL or 50 mL syringes with the barcode oriented toward the needle end of the syringe and the graduations on the syringe still visible This way when the syringe is inserted into the stopcock with the graduations facing upward the barcode faces the scanner and can be automatically read Syringes and Labels Store t
100. When activated along with the Airway Occluder parameter a cannot ventilate cannot intubate crisis scenario is achieved Laryngospasm otf The Laryngospasm Switch To activate laryngospasm enable the feature using the Laryngospasm switch on the Respiratory view Tongue Edema Swelling Tongue swelling can be activated to varying degrees moderate or severe Swollen Tongue Not Swollen Selecting Swollen Tongue To activate Tongue Swelling select the Swollen Tongue parameter from the Respiratory view and choose either Swollen for severe swelling or Semi swollen The Swollen Tongue option is set by default to Not Swollen CAE Heatthcare Using the HPS Bronchial Occlusion Bronchial Occlusion completely obstructs the right or left bronchi simulating a lower airway obstruction e g mucus plug Improper intubation creates a mainstem occlusion yielding an inability to ventilate the lungs Off Bronchial Occlusion Off The Bronchial Occlusion Switch To activate Bronchial Occlusion enable the feature using the Bronchial Occlusion Left or Right switch on the Respiratory view PEEP The PEEP parameter specifies the amount of positive end expiratory pressure applied during mechanical ventilation Setting this parameter results in clinically appropriate intrathoracic pressures and hemodynamic responses Base Value 0 0 cmH20 Setting PEEP After selecting the PEEP option from the Respiratory vie
101. Workstation IMPORTANT Setting an alveolar fraction override on the Instructor Workstation causes the infusion pump to stop NOTE Muse does not verify a 100 96 sum of all fractions because this would require all fractions to be set Default Modeled Range 0 0096 8 0096 Fraction of Inspired Sevoflurane The Fraction of Inspired Sevoflurane parameter is used to simulate the amount of sevoflurane set in the anesthetic vaporizer and is used to calculate alveolar sevoflurane The Fraction of Inspired Sevoflurane parameter is only effective when used with SCE Development Software and should not be used with the Instructor Workstation This parameter has a faster effect on physiology than anesthesia machine settings because mixing in the breathing circuit is not simulated NOTE M se does not verify a 100 96 sum of all fractions because this would require all fractions to be set Default 096 Range 0 0096 8 0096 B 23 Appendix B M se Parameter Descriptions H PS Cardiovascular Basic Parameters Cardiovascular Parameters Basic Blood Pressure The Blood Pressure parameter is used to override the physiological modeling for blood pres sure The systolic and diastolic blood pressures can both be set to fixed numeric values regard less of interventions performed Resetting the parameter to Modeled returns control of the underlying Blood Pressure to the physiological models Default Modeled Range Systolic
102. a specified amount of energy discharged via an external cardiac defibrillator Setting this parameter results in the characteristic spike in the ECG followed by a return to the pre defibrillation rhythm Defib has no direct effect on the electrical conduction system of the heart Thus synchronized cardioversion may be done on the fly or scripted using the Scenario Designer Default 0 Joules Range 0 Joules 360 Joules Pacing Current The Pacing Current parameter is used to simulate a specified amount of current discharged via an external cardiac pacer Setting this parameter results in the characteristic pacing signal on the ECG waveform when the pacing current is at or above the capture threshold Also see Pacing Capture Threshold Default 0 mA Range 0 mA 200 mA B 29 Appendix B M se Parameter Descriptions H PS B 30 Pacing Rate The Pacing Rate parameter determines the cardiac rate in beats minute when the pacing current is at or above the pacing capture threshold Also see Pacing Current and Pacing Capture Threshold Default 80 beats per minute Range 0 beats per minute 119 beats per minute Pacing Capture Threshold The Pacing Capture Threshold parameter determines the minimum pacing current necessary to pace the heart via an external cardiac pacer Also see Pacing Current Pacing current values below the pacing capture threshold have no effect on the patient s heart rate Default 50 mA Range 0 mA
103. age click the Return button Return The Return Button The SCE continues running and the Home page appears To return to the SCE from the Home page click the Continue button in the SCE summary panel of the running SCE Anaphylaxis Holly Monroe Overview WP Print SCE 21 years old Add To Favorites Female 70 0 kg Norma L Female Your rescue squad responds to a report of a 21 year old female complaining of trouble breathing She was eating dinner at a cookout when she noticed some tightness in her chest The cook came by asking if anyone wanted another shrimp burger She then told him she was allergic to shellfish She was proceeding to her car to retrieve an epinephrine auto injector when a wasp stung her This SCE consists of six states five that manually transition and one State 5 that transitions automatically During the initial assessment in State 1 Beginning Anaphylaxis the patient presents with early signs of anaphylaxis HR in the 90s BP in the 100s 50s RR in the 20s and SpO2 in the low 90s on room air She remains conscious The learner is expected to assess and manage the patient s airway breathing and circulatory status ABCs identify early signs of allergic reaction consider use of oxygen call for help with interventions consider early use of epinephrine and attach a cardiac monitor If more than 120 seconds elapses without administration of epinephrine the instructor should manually advance the S
104. al iChat iovo amp Image Capture K iMovie Z iPhoto G The Applications Window 4 Scroll down and click on the HPSVersion6 folder The corresponding list of options appear Address Book App Store amp Automator LJ Calculator amp Chess Dashboard V Dictionary E DVD Player i FaceTime a Font Book Front Row d GarageBand HPSVersion6 f ical iChat iovo is Image Capture 7X iMovie Z iPhoto iSync F HPS6 Launcher Logs E Model Patients 9 Plug ins ScenarioProcessor D Scenarios Utilities Mi Waveform Display The Applications Window 5 Select the Utilities folder AHPS muse CAE Healthcare Appendix F Configuring the HPS Gas Analyzer The Utility Options appear a FixPermiss command 5 HPS6 A MIDS Utility HPS6 Launcher 38i MonitorCal 3j Logs P S Racktdit E Model 3 Patients Plug ins C ScenarioProcessor L3 Scenarios J Utilities Bi Waveform Display The Applications Window 6 Double click on the RackEdit icon A Warning message may appear to ensure the application is to be opened Utilities aje EJ m 9 4 b m EieDaemeicc ramman Y DEVICES E iDisk E Macintosh HD RackEdit is an application downloaded L JFH METI from the Internet Are you sure you want to open it PLACES Desktop Safari downloaded this file on January 19 2012 esos i Cancel Open p The Rack E
105. al The HPS can simulate a variety of neurological clinical indicators such as secretions and reactive eyes Neurological Parameters B 1 Appendix B M se Parameter Descriptions H PS B 2 Eyes Each eye has reactive pupils and eyelids that blink and close Eyes Pupil Diameter These parameters are used to control the diameter of the pupils in the eyes Each eye has reactive pupils and functional eyelids that blink Currently there are four pupil options that are used to control the diameter of the pupils in both eyes Modeled Reactive Blown or a Fixed Pupil Size 2 mm to 8 mm When the Eyes are set to Reactive the pupils re size in response to changes in lighting condition If both pupils are set to Reactive both pupils re size in a consensual manner If the Eyes are set to Modeled the pupil size is driven by the pharmacology of morphine In this mode the baseline pupil size is 4 7 mm With increasing effector site concentration of morphine the pupils constrict up to a maximum constriction of 2 8 mm A dose of 4 6 mg of morphine results in 5096 of the maximum effect a pupil size of 3 75 mm The reactivity to light is absent for this option and is only available in the Reactive mode Presently when the Modeled option is selected only morphine has an effect on pupil size The pupillary response to other drugs can be made on the fly or scripted using the Scenario Designer Other settings allow the user to fix
106. al Home Assessment NOT SUPPORTED PhyslologicParam Elastance Intrathoracic Arteries Initial Home Assessment NOT SUPPORTED PhysiologicParam Sounds Bowel All Mild Asthma Attack NOT SUPPORTED PhysiologicParam Sounds Breath All Mild Asthma Attack NOT SUPPORTED PhysiologicParam Elastance Intrathoracic Arteries Mild Asthma Attack NOT SUPPORTED Ph gicParam Elastance Extrathoracic Arteries Mild Asthma Attack NOT SUPPORTED PhysiologicParam Sounds Volce Speech Trigger Asthma Attack Worsens NOT SUPPORTED PhyslologicParam Elastance Extrathoracic Arteries Asthma Attack Worsens NOT SUPPORTED PhyslologicParam Elastance intrathoracic Arteries Asthma Attack Worsens NOT SUPPORTED PhyslologicParam Sounds Voice Speech Trigger The Unsupported Log Information Dialog Box The scenario appears in the Scenarios panel Asthmatic with chest pain Last Updated 2010 02 08 15 22 39 Rename Q Review Delete An Imported Scenario E 10 CAE Healthcare Appendix E hs6 Files and M se 8 Click the Review button of the imported scenario to review the scenario Asthmatic with chest pain Click the Last Updated 2010 02 08 15 22 39 Ain and Review button The Review Button of a Scenario in the Scenario Panel The Scenario Designer appears 9 Focusing on one state at a time double click each state to expand it Asthmatic with chest pain ux Scenario kal I b Collapse All W3 Expand All A collapsed state
107. ameter displayed 98 J CAE Healthcare Using Mise Adding a Scenario from the SCE Editor SCEs incorporate scenarios that contain preprogrammed physiology Scenarios can be added to SCEs to enhance patient physiology When a scenario is added to an SCE from the SCE Editor the scenario becomes associated with the SCE and begins automatically when the SCE is run Click the Add Scenario button on the Run screen to add a scenario to an SCE that is running To add a scenario to an SCE from the SCE Editor 1 Click the Add Scenario button under the Preloaded Scenarios heading Pre Loaded Scenarios Add Scenario The Add Scenario Button The Choose Scenario dialog box appears Scenarios es Name Last Modified Anterior Myocardial Infarction 2011 09 12 09 38 39 COPD Exacerbation with Respiratory Fallure 2011 09 12 09 39 10 Elevated Heart Rate 2011 09 12 09 41 01 S cenarios Heroin Overdose 2011 09 12 09 39 41 Inferior Myocardial Infarction 2011 09 12 09 40 13 Organophosphate Exposure 2011 09 12 09 40 39 e Add The Search button field The Choose Scenario Dialog Box 2 Select a saved scenario from the Choose Scenario Dialog Box The Search field can be used to search for a scenario to select 3 Click Add The scenario is added to the SCE and is listed on the SCE Editor beneath the Pre Loaded Scenarios heading For information about editing scenarios see Editing a Scenario on page 102 99 Using M se
108. and TouchPro software Note that changes in arterial temperature may alter the position of the standard oxyhemoglobin dissociation curve shift As temperature increases or pH decreases more oxygen is released from hemoglobin and thus the patient s saturation decreases The inverse is also true Default 37 C Range 32 0 C 42 0 C CAE Healthcare Appendix B M se Parameter Descriptions Respiratory Basic Parameters Respiratory Parameters Basic B 5 Appendix B M se Parameter Descriptions H PS B 6 Swollen Tongue This parameter is used to create two degrees of tongue swelling Semi Swollen and Swollen The Not Swollen setting returns the tongue to its normal anatomic state Default Not Swollen Range Not Swollen Semi Swollen and Swollen Airway Occluder Using the Airway Occluder parameter swelling of the posterior oropharynx can be activated to limit the view of the larynx and hinder intubation but allow mask ventilation of the patient s lungs thereby creating a cannot intubate can ventilate scenario Default Off Laryngospasm Use the Laryngospasm parameter to simulate a laryngospasm A laryngospasm actuator closes the patient s vocal cords and prevents both ventilation and intubation Default Off CAE Healthcare Appendix B M se Parameter Descriptions Needle Decompression The Needle Decompression parameter is used to activate the Needle Decompression hardware in the simulator to
109. ars select Heart Sounds Bowel Sounds Heart Sounds Normal S3 S4 S3 and S4 Early Systolic Murmur Microphone Volume Click Heart Sounds to access the Heart Sounds menu Mid Systolic Murmur Late Systolic Murmur Pan Systolic Murmur Late Diastolic Murmur The Heart Sounds Menu Click the Heart Sounds drop down menu to change the type of sound Click and drag the slider to adjust the volume 205 Using the HPS H PS Wireless Voice Capability Patient responses can be transmitted through the HPS head speaker using the wireless microphone The wireless microphone and receiver are factory configured to use the same channel frequency However if using multiple simulators the wireless microphone and receiver channels must be adjusted so each simulator uses a different channel For each simulator adjust the wireless microphone channel then remove the front panel of the HPS lab rack and set the receiver to the same channel The wireless microphone and receiver for the same simulator MUST be set to the same channel for proper operation Wireless Receiver and Microphone The microphone volume can be adjusted on the microphone itself using the volume control The microphone volume can also be adjusted by clicking the Sounds button on the Run screen When the Sounds panel appears select Microphone Volume Click and drag the slider to adjust the volume Click Microphone
110. aterials should be kept for storing or shipping your product To request an RMA please contact Customer Service 245 HPS Care and Maintenance H ps 246 System Software Upgrade Support Customers with current warranty contracts are entitled to receive upgrades to applications software previously purchased Installation of the system software is the user s responsibility The System Software Upgrades Support includes software upgrades for base software and purchased optional software modules This does not apply for major upgrades or technological enhancements Pricing Structure Time and Materials For those systems not under agreement service will be provided as required on a Time and Material basis Description In House On Site CAE Healthcare s prevailing Technical Support labor rate with a minimum of four hours labor Material As quoted at time of repair Travel Priced at CAE Healthcare s fully burdened cost plus fee Principal period of on site support customer s local time is e Monday through Friday 8 00 AM to 5 00 PM customer s time zone e Holiday and non business days excluded e Support outside the principle period is billed at the premium rate hourly rate x 1 5 A minimum of 48 hours notice is required for scheduling an on site support call Urgent on site support with less that 48 hours notice will be charged at the premium hourly rate On site time is described as the time period commencing fr
111. atory rate is set to 10 breaths per minute the respiratory rate remains at 10 breaths per minute regardless of arterial oxygen or carbon dioxide levels In such situations the patient can only respond to arterial oxygen or carbon dioxide levels by adjusting the Tidal Volume parameter Default Modeled Range 4 breaths per minute 40 breaths per minute Tidal Volume The Tidal Volume parameter is used to set the tidal volume to a given volume per breath Once tidal volume is set to a numeric value arterial oxygen and carbon dioxide values have no effect on the tidal volume but continue to influence other components of the physiological models For example with the tidal volume set to 600 mL in the adult simulator the tidal volume remains a constant set 600 mL even in the event of falling arterial oxygen levels In such situations the patient can only respond to arterial oxygen or carbon dioxide levels when the respiratory rate is adjusted Default Modeled Range 0 mL 2500 mL Tidal Volume Factor The Tidal Volume Factor parameter is used to change the baseline tidal volume before the control of breathing and drug influences are taken into account The standard baseline tidal volume is 500 to 600 mL A Tidal Volume Factor value of 2 doubles the baseline tidal volume A value of 0 5 decreases the baseline tidal volume by 5096 Default 1 Range 0 10 4 00 TIP First decrease the Respiratory Gain Factor parameter to reduce t
112. ave created by clicking the respective buttons within each scenario Locked Scenarios can only be reviewed Users can also create new scenarios from the Scenarios screen by clicking the Create New Scenario button Click Import to import a scenario file from an external device or the hard drive location where the SCE file is saved Click Export to export a scenario file to an external device The scenario file extension is mss NOTE Preconfigured CAE Healthcare scenarios CANNOT be exported 129 Using M se HPS Conditions From the Content Management options click Conditions to access the Conditions Editor The Conditions Editor appears Learning Modules SCEs Th e Base Patients Conditions EE link The Rename button The Delete button The Add butter j The Conditions Editor The Edit Parameters button All conditions can be viewed in the Conditions panel by selecting their associated categories and groups from the Condition Categories and Condition groups panels 130 CAE Healthcare Using M se From the Conditions Editor users can create new Conditions to be used in SCEs To create a new condition 1 From the Condition Categories panel select a category NOTE Conditions CANNOT be added to the Interventions category 2 From the Condition Group panel select a group 3 In the Conditions panel click the Add button The New Condition Name dialog box appears 4 Enter a name for the c
113. bag can be left in place or removed as desired To prevent mold mildew and fungus from growing in the GU system occasionally flush the system with a 1 liter IV bag of distilled water mixed with 10 mL of white vinegar Follow the procedure above for flushing the system using the vinegar solution then repeat the procedure using plain distilled water The system should be cleaned in this way about once every two months J CAE Healthcare HPS Care and Maintenance Repairing Cuts and Abrasions to the Mannequin Cuts and abrasions to the HPS mannequin can be repaired easily using readily available materials Perform the following steps if a cut is found 1 Clean the area around the cut thoroughly using alcohol swabs or liquid alcohol and cotton balls N Allow the area to dry completely UJ Apply a small bead of cyanoacrylate adhesive e g Super Glue to the surfaces to be repaired 4 Wipe away excess glue with a cotton swab 5 Firmly press the surfaces together taking care not to touch the wetted areas The following tips may be useful in the procedure above The repaired area may be gently sanded using a fine grit paper A patch may be formed from the skin used to cover the crichothyroid cartilage to cover large cuts Disposable examination gloves are recommended to prevent inadvertent adhesion of skin to the mannequin Contact CAE Healthcare Customer Service to effect permanent repair of damaged
114. be salt solutions for infusion e g normal saline dextrose in water Ringer s Lactate Range 0 mL 4000 mL PRBC Infusion Packed red blood cells are a preparation of 7096 red blood cells and 3096 liquid plasma often administered in severe anemia to restore adequate levels of hemoglobin and red cells without overloading the vascular system with excess fluids Range 0 mL 4000 mL Whole Blood Infusion The term whole blood is used to refer to blood that has not been separated into its various components It represents a preparation of 4096 red blood cells and 6096 liquid plasma Range 0 mL 4000 mL Urine Output This parameter is used to control the rate of urinary output When fluid is set up for use with the genitourinary system and the genitourinary system is primed setting Urine Output causes urine to flow from the mannequin at the specified rate The Urine Output parameter does not affect the patient s physiology Range 0 mL 1000 mL Bleeding The Bleeding parameter is used to activate bleeding Default Off ZW CAE Healthcare Appendix B M se Parameter Descriptions Sounds A variety of simulated sounds are available to enhance realism A patient must be running on the HPS for any sounds to be available Bowel Sounds Bowel Sounds Normal Hypoactive Hyperactive and absent bowel sounds None are selected using this parameter Independent control of the type of bowel sounds may be selected in
115. c vasculature Under such conditions the arterial blood pressure ABP increases and the heart rate may decrease due to feedback from the physiological control mechanisms Default 1 Range 0 10 10 00 CAE Healthcare Appendix B M se Parameter Descriptions Venous Capacity Factor The Venous Capacity Factor parameter adjusts the volume of blood contained in the unstretched venous system without an increase in venous pressure Raising the value decreases the venous capacitance vasodilatation and decreased vascular tone while lowering the value increases the venous capacitance vasoconstriction and increased vascular tone The volume of blood in the venous system has an inverse relationship to the blood pressure Lowering the value is analogous to a shift in blood from the venous system to the arterial system and this shift when coordinated with increased systemic vascular resistance results in an increase in blood pressure arterial blood pressure ABP pulmonary artery pressure PAP and central venous pressure CVP Default 1 Range 0 10 100 00 Systemic Arteries Compliance Factor The Systemic Arteries Compliance Factor parameter adjusts the pulse pressure difference between systolic and diastolic pressures of the simulated patient s systemic blood pressure Increases in the compliance factor result in a decreased narrower pulse pressure while smaller values increase the pulse pressure Additionally
116. can change their profile information and reset their passwords meti admin Email admin meti com Profile Information ID admin First Name meti The Profile wine a Information link M mmmEEEEE pn enone Uum Es Password Reset Th e Profi e Profile Preferences Information New Password Confirm Password pa n e The Account Profile Screen To change profile information enter the new information in the appropriate fields and click Update Profile when finished To reset a password enter the new password in the New Password field and re enter the new password in the Confirm Password field Click Change Password when finished IMPORTANT It you change your username or password you MUST use the new username and or password upon your next login You cannot access the system with the old username or password once it has been changed 143 Using M se HPS Favorite SCEs To access the Favorite SCEs panel click Favorite SCEs from the Account Profile screen All of the logged in user s favorite SCEs appear in the Favorite SCEs panel meti admin Email admin meti com Favorite SCEs ID admin Angina with Cardiac Arrest Food Poisoning Profile Information The Favorite SCEs link Medication Preferences Profile Preferences The Favorite SCEs panel The Add Favorites button The Account Profile Screen To add SCEs to the Favorite SCEs panel click Add Favorites The SCE L
117. ccess a rich text editor that enables data entry IMPORTANT Text can be copied and pasted into the fields from TextEdit or Notepad only Rize WE Asa E The Rich Text Editor Click Save when all data for the field has been entered 95 Using M se HPS SCE Configuration Setting up the Conditions the TouchPro software and the Patient Status Display is achieved by clicking the buttons under the SCE Configuration heading in the SCE Editor SCE Configuration Condition Setup TouchPro Setup Patient Status Display The SCE Configuration Buttons Condition Setup Screen and Creating Quick Links Click Condition Setup to access the Condition Setup screen From the Condition Setup screen conditions medications and interventions can be preconfigured for the SCE creating Quick Links On the Condition Setup screen Conditions Medications and Interventions buttons are available To navigate through available conditions and interventions click the Conditions Medications and Interventions buttons The Conditions Setup screen appears Q Medications e Interventions gory Quick Links ALL CONDITIONS Cardiovascular Hemorrhage BP Hypertension Apnea Neurologic Respiratory BP Hypotension Desaturation Heart Rate Bradycardia Heart Rate Tachycardia Patient Stability The Condition Setup Screen To create a Quick Link drag and drop the desired choice s from the Conditions Medications or Inter
118. chased as an accessory to the HPS system or as a stand alone simulator For the stand alone user all of the pertinent usage information as it pertains to the PediaSIM is included in this one complete section For users using the PediaSIM as an accessory this section provides a content overview to help orient the user to the system features and functionality The HPS Care and Maintenance section contains warranty details and cleanup and care instructions that must be followed to ensure optimal functioning of the HPS system Introduction HPS Equipment Overview The HPS is comprised of three main components the HPS Lab Rack the Instructor Workstation and the HPS mannequin There are two configurations for the HPS the Human Patient Simulator HPS and the Health Science HPS Human Patient Simulator HPS Standard Equipment HPS Mannequin HPS Lab Rack Desktop Instructor Workstation Wireless Remote Control Drug Recognition System OxSim Monitor Interface Wireless Microphone and Receiver Replacement Kit Diagnostic Peritoneal Lavage Human Patient Simulator HPS Optional Equipment Tablet Instructor Workstation TouchPro Monitor Anesthesia Delivery System Anesthesia Gas Accessory Kit Gas Accessory Kit Trauma Disaster Casualty Kit TDCK Moulage Kit Tool Kit PediaSIM Plug and Play Mannequin METIVision METI FX Hands Free Training Cables HPS Learning Applications and Training Courses Windows is a registered
119. common adjustments and periodic repairs CAE Healthcare has put together a kit containing tools selected for use with the simulator product TOL 001 The Tool Kit PediaSIM Plug and Play Mannequin Optional for Human Patient Simulator HPS and Health Science HPS The optional PediaSIM Plug and Play Mannequin can interface with either of the HPS models to simulate the unique physiology of a pediatric patient product HPS 016 PediaSIM Plug and Play Mannequin 20 CAE Healthcare Introduction METIVision Optional for Human Patient Simulator HPS and Health Science HPS METIVision is a fully integrated digital audio visual management system that is data synchronized in real time for use with CAE Healthcare simulators METIVision is the only solution available with the capability to not only capture and store simulation data but to also broadcast and review any medical simulation exercise using CAE Healthcare simulators Complete with physiologic data logs event logs pharmacology logs and patient monitoring data METIVision offers the capability to provide a complete record of simulation exercises for debriefing assessment and evaluation product MTV 001 METIVision Console METI FX Optional for Human Patient Simulator HPS and Health Science HPS CAE Healthcare takes realism to the next level with METI FX a realistic set for advanced moulage wound simulation and special effects METI FX includes incredibly lif
120. ctivated pulse Pulses Active and Inactive 184 CAE Healthcare Using the HPS A pulse deficit occurs when the systolic arterial blood pressure falls below the threshold indicated in the table below Palpable Pulse Thresholds 60mmHg Click and hold a pulse location to access a window to change the pulse deficit 5 Lead ECG A 5 lead ECG is emitted from the appropriate positions for display on a standard monitor A contact is available on the HPS mannequin s chest for each of five cables ECG Contacts The simulator generates a normal sinus ECG as well as a broad range of abnormalities such as myocardial ischemia sinus tachycardia and bradycardia ventricular fibrillation and asystole The hemodynamic response to the arrhythmias is physiologically correct Myocardial oxygen balance and cardiac ischemia automatically influence the cardiac rhythm resulting in a realistic and automatic response of the rhythm to hypoxemia The degree of influence can be controlled or completely overridden by the instructor 185 186 Using the HPS H PS Myocardial Ischemia The cardiac rhythm can be set using the Cardiac Rhythm parameter located on the Cardiovascular view In addition the Ischemic Index Sensitivity located under the Additional parameters on the Cardiovascular view can be used to set the relative sensitivity of the patient to myocardial ischemia The lower the value the patient has the less sensitive the patient is
121. d McGraw Hill Medical Publishing Division 2 Chobanian A V Bakris G L Black H R Cushman W C Green L A Izzo J L Rocella E J 2003 Seventh report of the Joint National Committee on prevention detection evaluation and treatment of high blood pressure Hypertension 42 1206 1252 3 Braunwald E Fauci A Hauser S Jameson J Kasper D amp Longo D Eds 2005 Harrison s manual of medicine 16th ed McGraw Hill Medical Publishing Division 4 Andreoli T E Carpenter C T Griggs R C amp Loscalzo J Eds 2004 Cecil essentials of medicine 6th ed Saunders CAE Healthcare Appendix B M se Parameter Descriptions Appendix B M se Parameter Descriptions The M se software has a number of parameters that control the physiological features of the HPS The parameters are grouped by category Neurological Respiratory Cardiovascular Fluids and Sounds Each screen lists the Basic parameters by default However when the Basic Additional switch is activated additional parameters become available Click the Basic switch to see J Basic Additional parameters k The Basic Additional Switch Click the Additional switch to return to the Basic parameters The following is a brief description of each parameter Each parameter description lists the default settings for the Stan D Ardman and Norma L Female patients as well as the ranges if available for all patients Neurologic
122. d central venous pressure CVP increase due to back pressure through the right side of the heart Default 1 Range 0 10 10 00 Venous Return Resistance Factor The Venous Return Resistance Factor parameter adjusts the resistance between the extrathoracic and intrathoracic venous compartments Raising the value increases the resistance while lowering the value decreases the resistance With less blood returning to the heart there is a reduced volume entering the ventricles prior to ventricular contraction This results in a drop in the cardiac output and decrease in arterial blood pressures The heart rate increases due to feedback from the physiological control mechanisms in an attempt to maintain adequate blood pressures Default 1 Range 0 10 100 00 Baroreceptor Gain Overall Factor The Baroreceptor Gain Overall Factor parameter adjusts the influence of mean arterial pressure MAP on heart rate contractility systemic vascular resistance and venous capacity Use this parameter to adjust how vigorously the heart and vasculature respond to blood pressure changes The degree of increase in heart rate or vascular response is influenced by the baroreceptor gain overall factor For example when blood pressure falls the heart rate increases the arteries increase their vascular tone resistance and there is less pooling of the blood in the venous system all in an attempt to maintain adequate blood pressure A barorecepto
123. d Ireland Monday Friday from 9 00 a m to 5 00 p m GMT Phone 44 0 800 917 1851 Email Address uk service caehealthcare com Principal hours of operation exclude holiday and non business days J CAE teatthcare HPS Care and Maintenance Contract Period Warranty contracts are not ordinarily offered for periods of less than one year However multiple year warranty contracts may be arranged for up to an additional three years Discounts are available for purchase of multiple year contracts Limitations of Agreement Your exclusive remedy for any defective patient simulator is limited to the repair or replacement of the defective patient simulator CAE Healthcare may elect which remedy or combination of remedies to provide at its sole discretion CAE Healthcare shall have a reasonable time after determining that a defective material exists to repair or replace defective material CAE Healthcare s replacement material will be manufactured from new and or serviceable parts CAE Healthcare s agreement applies to repaired or replaced materials for the balance of the applicable period of the original warranty or ninety days from the date of shipment of a repaired or replaced material whichever is longer CAE Healthcare warrants its LABOR for 30 days or the balance at the applicable period of the original warranty whichever is greater CAE Healthcare shall not be liable under this warranty for incidental or consequential damages or i
124. d Isoflurane The Fraction of Inspired Isoflurane parameter is used to simulate the amount of isoflurane set in the anesthetic vaporizer and is used to calculate alveolar isoflurane The Fraction of Inspired Isoflurane parameter is only effective when used with SCE Development Software and should not be used with the Instructor Workstation This parameter has a faster effect on physiology than anesthesia machine settings because mixing in the breathing circuit is not simulated NOTE Muse does not verify a 100 96 sum of all fractions because this would require all fractions to be set Default 096 Range 0 0096 5 0096 B 21 Appendix B M se Parameter Descriptions H m B 22 Alveolar Nitrous Oxide The Fraction of Inspired Nitrous Oxide parameter is used to simulate the amount of enflurane set in the anesthetic vaporizer and is used to calculate alveolar enflurane Using this parameter bypasses pharmacokinetics real and instructor specified inspired fractions venous content lung perfusion and ventilation This parameter can be used to focus on cardiorespiratory effects pharmacodynamics WARNING Using this parameter may result in undesired behavior when switching between SCE Development Software and the Instructor Workstation IMPORTANT Setting an alveolar fraction override on the Instructor Workstation causes the infusion pump to stop NOTE Muse does not verify a 100 96 sum of all fractions because this would require
125. d degree of neuromuscular blockade that remains stable for an indefinite period This can be accomplished using the NMB parameter The default setting instructs the pharmacologic models to determine the degree of neuromuscular blockade based upon the drugs injected and their pharmacologic properties When a positive numeric value is assigned to this parameter the degree of NMB is set to that level For example 80 NMB causes the simulator to set the degree of NMB to 80 regardless of the presence or absence of neuromuscular blocking drugs Clinically the spontaneous tidal volume is markedly reduced Default Modeled Range 096 10096 NOTE Setting NMB to 10096 in M se for PediaSIM HPS does NOT cause asystole To achieve a negative cardiovascular response in PediaSIM HPS patients set NMB to 10096 and use the Cardiac Rhythm parameters Temperature Body The temperature measured at the body surface can be set using this parameter and can be displayed on the Patient Status Display and TouchPro software The body temperature is not linked to the physiologic models However changes can be made on the fly or scripted using the Scenario Designer Default 36 5 C Range 32 0 C 42 0 C B 3 Appendix B M se Parameter Descriptions H PS B 4 Temperature Blood The arterial blood temperature can be set using the Temperature Blood parameter The arterial blood temperature can then be displayed on the Patient Status Display
126. d in the Event Log It is also possible to have a scenario transition on chest tube placement which can be scripted using the Scenario Designer Default Disable NOTE The Chest Tube and Needle Decompression features cannot be enabled simultaneously Chest Tube Flow The Chest Tube Flow parameter is used with the chest tube feature of the simulator The Chest Tube Flow specifies the rate at which fluid can be removed from the simulated pleural space via a chest tube drainage system As the chest tube drains the volume is automatically subtracted from the set amount of Intrapleural Volume Default 50 mL per minute Range 0 mL per minute 100 mL per minute B 13 Appendix B M se Parameter Descriptions H PS B 14 Chest Tube Air Leak The Chest Tube Air Leak parameter is used with the chest tube feature A setting of 10096 allows only air to be removed via the chest tube while a setting of 096 allows only fluid to be removed Settings between 0 and 10096 create a mixture of air and fluid Default 096 Range 096 to 10096 O Consumption The O Consumption parameter is used to change the rate of consumption of oxygen and production of carbon dioxide When O Consumption is increased and used with increased Shunt Fraction profound levels of hypoxia can be achieved rapidly Default 250 mL per minute Range 0 mL per minute 2000 mL per minute CO Production Factor The CO Production Factor parameter allows for the
127. d parameters to a state click the Parameters button within the state The Parameters button Create A State 109 Using M se HPS The State Parameters screen appears T mt The State Parameters panel The Complete button The State Parameters Screen Click the various organs to change the views and then select the desired parameter Once a parameter has been selected it appears in the State Parameters panel on the right side of the screen Add as many parameters as needed Added parameters appear consecutively within the state Drag and drop to reorder as needed Click Complete to save and exit the State Parameters screen or click Back to exit without saving NOTE If the physiology of any of the parameters conflicts the Muse software reflects the physiology of the last parameter entered 110 CAE Healthcare Using M se Adding Transitions To add a transition the scenario must have both an original state and a state that results from the transition To add a transition 1 Click the Create button in the original state The Create button A State The Transitions Menu appears listing all available transition variable types Assessment Intervention Medications Physiology Scenario Vitals The Transitions Menu 2 Select the desired variable type For example if a transition based on the administration of medication is desired select Medications and then select the
128. develop any product software or service competitive with any of CAE Healthcare s products 2 5 Licensee agrees to grant CAE Healthcare its agents and representatives at any time during Licensee s normal business hours and upon reasonable prior notice the right to access to Licensee s premises to ensure that the use of the Product is done at all times in compliance with the terms and conditions of this License 2 6 CAE Healthcare reserves the right to embed a software security mechanism within the Product to monitor usage of the Product to verify Licensee s compliance with this Agreement as well as to control access to the Software through use of a a hardware lock device and or b a license administration software and or c a license authorization key collectively the Key 2 7 Some Products may provide Licensee with the option of saving and reproducing the images created by such Products Work during their use In this regard Licensee hereby recognizes that the entire rights title and interests in and to such Work remain the exclusive property of CAE Healthcare Licensee shall not modify such Work in any way whatsoever and shall not remove or alter any CAE Healthcare notices However Licensee is permitted to produce and reproduce such Work only for non commercial educational purposes CAE Healthcare License Copyright 3 FEEDBACK Licensee agrees to provide CAE Healthcare from time to time with comments suggesti
129. distilled water on one of the available hooks on the back side of the HPS Lab Rack To simulate urine add 1 5 to 2 mL of yellow food coloring to the water Add an IV solution set to the bag placing the roller clamp in the locked position Open the hood casing on the GU Pump pulling the attachment lever down and lifting the hood up PRESS REGULA Opening the Hood Casing 6 Slide the supplied peristaltic tubing over the wheel The end with the quick connector should be on the left side of the wheel and the end with the luer connector should be on the right side of the wheel The GU Tubing 195 Using the HPS H PS 7 Close the hood and re secure the lever in the up position mm Closing the Hood Casing 8 Pull open the black clips on each side of the GU Pump and carefully thread the tubing into place Start with the right side and repeat on the left Left GU Pump Clip 196 CAE Heatthcare Using the HPS 9 Attach the GU hose from the Umbilical Assembly to the GU tubing Attaching the GU Hose 10 Connect the remaining end of the peristaltic tubing to the IV bag ER Connecting the Peristaltic Tubing to the IV Bag 197 Using the HPS H PS Priming the GU System 1 Catheterize the patient mannequin using a urinary catheter lubricated with silicone spray using standard clinical procedure For supported catheter size see Recommended Clinical Supply Sizes on page 259 2 Open th
130. dit Warning Message 7 Ifthe Warning Message appears click Open to load the Rack Applicator 8 To exit the Applications window click the red Close button in the upper left corner of the Utilities window F 3 Appendix F Configuring the HPS Gas Analyzer ry Mi PS Once loaded the RackEdit Application window will appear Simulators HPS427 10 127 105 171 28997 Host 10 127 105 171 28997 The Rack Application Window 9 Select the desired simulator from the list and click Connect NOTE Once a connection to the simulator is established the Connect button becomes the Disconnect button 10 Click on the Gas Analyzer tab The currently configured agent name appears Connection Lung Driver Atmosphere 760 00 Agent GASAN ISOT Atmosphere Factor 1 00 The Rack Application Window muse CAE Healthcare Appendix F Configuring the HPS Gas Analyzer 11 To change the agent configuration select the existing agent name and replace it with one of the available agents for the Gas Analyzer GASAN ISO GASAN SEVO GAS ENF and GASAN HALO 12 Ensure that the desired agent name is entered correctly including the underscore between GASAN and the agent abbreviation NOTE The fields for Atmosphere and Atmosphere Factor are factory presets and should not be altered by the customer Saving Changes to the Gas Analyzer To Save the desired change once the new agent has been chosen and e
131. dycardia e Ingestion e Motor Vehicle Crash e Pulseless Electrical Activity e Septic Shock Shock e Supraventricular and Ventricular Tachycardia e Ventricular Fibrillation PediaSIM HPS Condition Guidelines for Programming CAE Healthcare PediaSIM HPS with M se Condition Guidelines for Programming PediaSIM HPS with M se This section is intended to help you select M se conditions to achieve desired vital signs within each programmed state All four conditions should be programmed into each state in the order presented below e Respiratory Desaturation e Cardiovascular Blood Pressure e Cardiovascular Heart Rate e Respiratory Respiratory Rate The Mise software is physiologically driven When using multiple conditions e g Desaturation Hypertension Tachycardia Tachypnea physiological regulatory mechanisms such as the baroreceptor reflex and ventilatory control cause compensatory changes within parameters To achieve the desired vital sign select one condition level above greater or below less to achieve the desired physiological effect NOTE The following values are for the PediaSIM HPS simulator For HPS values please see Appendix A Condition Guidelines for Programming HPS with M se Respiratory Desaturation Desaturation SpO Value 225 Condition Guidelines for Programming PediaSIM HPS with M se PediaSIM HPS Cardiovascular Blood Pressure Hypertension Hypotension 100s 6
132. e click an Intervention Quick Link NOTE Not all interventions affect the patient s physiology but all are logged Interventions button Bag Valve Mask Crystalloids intubated Nasal Cannula Non Rebreather Mask The Interventions Quick Links The Interventions Palette Once an Intervention is selected a menu appears with available options for the selected Intervention Click the desired option to select it The intervention is applied and appears in the patient s physiology The Interventions options Bag Valve Mask Crystalloids Intubated A selected Non Rebreather Mask intervention The Selected Intervention Options NOTE Quick Links can only be added while creating or editing the SCE 76 J CAE Healthcare Using Mise Or to apply an intervention that is not set up as a Quick Link in the Interventions palette 1 Click the Interventions button The Interventions menu appears Interventions are organized by type or all available interventions are listed under ALL INTERVENTIONS Close Electrical Therapy Fluids Invasive Procedures The All Interventions Menu 2 Navigate through the menus to find the desired intervention 3 Once the desired intervention has been located click the intervention s name from the list Q ALL INTERVENTIONS Bag Valve Mask Cardioversion Biphasic Cardioversion Monophasic Chest Tube Flow Rate Colloids Crystalloids Defibrillati
133. e Hypertension 1 00 1 10 1 38 1 55 1 95 1 00 1 00 1 00 1 00 0 50 0 50 0 50 0 35 A 6 Appendix A Condition Guidelines CAE Healthcare for Programming HPS with M se Chronic Hypertension Vital Signs Approximate vital signs after one to two minutes in state Reset Pre Stage Stage Two Stage Isolated Hypertension One Three Hypertension 106 122 130 152 107 40 to 41 41 to 42 41 to 42 41 to 42 41 to 42 41 to 42 NOTE Isolated hypertension is a chronic condition affecting elderly patients With isolated hypertension systolic blood pressure increases more than diastolic blood pressure A 7 Appendix A Condition Guidelines for Programming HPS with M se H Pse Acute Ventricular Failure Left heart failure can cause right heart failure because of the increased afterload placed on the right ventricle Clinical manifestations include shortness of breath rales crackles jugular venous distention pedal edema and third and fourth heart sounds Acute Ventricular Failure Both Parameter Adjustments Moderate 0 25 0 25 Normal Normal Normal S3 and S4 S3 and S4 A 8 Appendix A Condition Guidelines CAE Healthcare for Programming HPS with M se Acute Ventricular Failure Both Vital Signs Approximate vital signs after three to five minutes in state Moderate Severe 139 40 to 41 34 to 35 32 to 33 29 to 30 A 9 Appendix A Condition Guidelines for Programming HPS with M se Acute Ve
134. e Labels Eventually barcode labels become worn Their life is extended if they are kept as dry as possible Contact CAE Healthcare Customer Service for replacements 258 J COA heaken Recommended Clinical Supply Sizes Recommended Clinical Supply Sizes The following clinical supply sizes are recommended for use with the simulator Other sizes may cause damage and should not be used Clinical Supply Recommended Size Recommended Size Adult PediaSIM Insertion only 259 Recommended Clinical Supply Sizes H PS 260 Appendix A Condition Guidelines CAE Healthcare for Programming HPS with M se Appendix A Condition Guidelines for Programming HPS with M se This section is intended to help you select M se conditions to achieve desired vital signs within each programmed state All four conditions should be programmed into each state in the order presented below e Respiratory Desaturation e Cardiovascular Blood Pressure e Cardiovascular Heart Rate e Respiratory Respiratory Rate The M se software is physiologically driven When using multiple conditions e g Desaturation Hypertension Tachycardia Tachypnea physiological regulatory mechanisms such as the baroreceptor reflex and ventilatory control cause compensatory changes within parameters To achieve the desired vital sign select one condition level above greater or below less to achieve the desired physiological effect NOTE The
135. e font size click on the Font size selection The Font size drop down menu appears From the Font size drop down menu select Normal Small or Large 146 Using TouchPro UsiNG ToUCHPRO The TouchPro software enables users to view patient physiology The software can be used from the Instructor Workstation or on another computer provided the computer has joined the simulator s wireless network IMPORTANT Only two TouchPro software screens can be open at a time Accessing the TouchPro Software Like the M se software the TouchPro software is compatible with computers that have touch screen capabilities To run the TouchPro software the Instructor Workstation must be connected to the simulator s network IMPORTANT An SCE must be running on the M se software for any physiological data to be displayed on the TouchPro software The TouchPro software can only show one Patient at a time To launch TouchPro from the Instructor Workstation 1 With the M se software running open a new tab in the web browser and go to the Home page of the web browser The M se Start Screen appears Ell TouchPro The TouchPro Patient Monitor Icon The M se Start Screen 2 Select the TouchPro icon 147 Using TouchPro HPS When TouchPro opens the simulated patient monitor appears br min The TouchPro Display NOTE The capnogram waveform is not displayed on the TouchPro software from the Instructor Workstation Cap
136. e fy or as 2 Healthy Adult F emale t ie Y Healthy Adult Mate Healthy Soldier As a Healthy Adult Male Ih Gl Stay PHARM SN fekis Bowel sounds a Hypertensive Patient s Learning Objectives tamtey amp Wrerk Performs a focused history and physical assessment Scenarios The Home Page E 7 Appendix E hs6 Files and M se HPS 2 From the Home Page click the System Administration button The System Administration Button The System Administration screen appears showing the Content Management options COPD Patient Grandma Smokey 73 years old The Content SCEs Management Base Patients Bis Grandma Smokey options Scenarios peres Healthy Adult Female an Norma L Female 26 years old Female f 650kg Norma L Female 1 0 Healthy Adult Male Be Stan D Ardman II 33 years old Male 70 0 kg Stan D Ardman 11 1 0 Healthy Soldier n GI Stan Install Learning Module The Content Management Options E 8 CAE Healthcare Appendix E hs6 Files and M se 3 Click Scenarios The Scenarios panel appears Learning Modules AIDS PCP SCEs Last Updated 2010 02 04 14 49 57 Z Rename Q Review i Anaphylaxis Base Patients N Last updated 2010 02 02 13 54 17 Q Review Angina with Cardiac Arrest Last Updated 2010 01 19 10 47 10 Q Review Conditions Anterior Myocardial Infarction Y Last updated 2009 1
137. e icon on the desktop The files are copied automatically onto the device Double click the memory device icon to open the window for the device and confirm the files have been copied Drag the icon to the Trash to disconnect the memory device Remove the memory device from the USB port CAE Healthcare Appendix E hs6 Files and M se Moving Files Using a CD Saved files can be moved to another computer using a CD To transfer files using a CD 1 Insert a blank CD in the CD drive on the side of the Instructor Workstation A dialog box appears with a Name field for labeling the CD Enter a name for the CD in the Name field You inserted a blank CD Choose what to do from the pop up menu Action K Open Finder Click OK titled CD Make this action the default Ignore Naming the CD Enter the new name in the Name field overwriting the default name Click OK Locate the folder with the information you wish to save wu Fw NM Select the appropriate files from the drive and drag them to the CD A j k com 0003 Phy amp ecrxt Eia Dragging Files to a CD 6 Double click the CD icon to open the window for the CD and confirm the files have been copied E 5 Appendix E hs6 Files and M se HPS 7 Drag the CD file to the Trash icon on the Dock When the CD file is over the Trash the icon changes to a Burn CD icon Burn CD Icon A dialog b
138. e roller clamp on the GU supply source bag 3 Turn on the urinary output by selecting Fluids view in M se then setting the Urinary Output value to the maximum level 500 mL hr For information on how to access the Fluids view see Using the Physiological Views on page 66 Fluid flows into the mannequin filling the reservoir 4 Once the reservoir is full turn off the urinary output in the software and remove the catheter Urinary Catheterization 1 Catheterize the simulator using a standard urinary catheter lubricated with silicone spray For supported catheter size see Recommended Clinical Supply Sizes on page 259 2 Attach a urine collection bag to the urinary catheter 3 Usethe M se software to set the desired urinary output Urinary Output Urinary output can be controlled by adjusting the Urinary Output parameter on the Fluids view Selecting Urinary Output 198 7 CAE Heatthcare Using the HPS Pharmacology System The HPS supports pharmacological interventions through pre programmed pharmacokinetic and pharmacodynamic parameters that are established for more than 50 intravenous drugs Standard syringes and infusion devices can be utilized to administer medications and fluids through veins on the left and right arms Additionally medications and fluids can be administered through the permanent access catheters located at the right jugular and the left femoral veins Priming the IV System The IV system s
139. e scavenged An exhaust port is located on the rear panel of the HPS Lab Rack for this purpose In order to scavenge HPS exhaust gases 1 Locate the Scavenging fitting and tubing included with the HPS system 2 Connect the fitting to the exhaust port on the rear panel of the HPS Lab Rack 3 Connect the scavenging tubing to the scavenging equipment in your simulation center Contact CAE Healthcare or the Biomedical Engineering Department at your institution for assistance locating the proper adapters to connect the supplied tubing to the particular scavenging equipment used in your facility IMPORTANT Ensure that no more than 0 5 cm H 0 continued vacuum or pressure is applied to the HPS exhaust Continued vacuum or pressure in excess of 0 5 cm H 0 can cause abnormal behavior and damage to the simulator HPS CAE Healthcare PediaSIM HPS with M se PediaSIM HPS with M se The PediaSIM mannequin can interface with either of the HPS configurations the HPS or the Health Science HPS using a simple plug and play interface To use the PediaSIM mannequin simply set up the HPS simulator according to the instructions provided in the Setup section of this User Guide substituting the PediaSIM mannequin for the HPS adult mannequin The umbilicals that connect the PediaSIM mannequin to the HPS Lab Rack are identical to those on the HPS adult mannequin PediaSIM Mannequin 221 PediaSIM Patient Profiles PediaSIM HPS PediaSI
140. e software and functions in the same way as the Instructor Workstation product HPS 501 TouchPro Monitor Optional for Human Patient Simulator HPS The optional TouchPro Monitor is a flat panel touchscreen monitor that connects wirelessly to the Instructor Workstation and is used to run the TouchPro software CAE Healthcare Introduction Drug Recognition System Optional for Health Science HPS The HPS and PediaSIM both incorporate barcode technology along with an extensive drug library as part of the drug administration learning features This system gives practicing clinicians a safe environment to learn drug administration prior to working on real human patients The Enhanced Drug Recognition system product HPS 401 is a complete package that includes the following The Barcode Reader or Stopcock Manifold e Three Sheets of Barcode Labels NOTE The remaining components including an IV bag with distilled water two stake sets an empty IV bag and 10 mL 2 mL or 50 mL syringes are all user supplied The individual barcode labels identify a complete library of drugs from a wide range of classifications When appropriately applied to a syringe each label uniquely identifies the drug and concentration to the HPS system using the barcode reader or Stopcock Manifold The Stopcock Manifold electrically connects to the back of the rack and to the IV access ports on the patient mannequin 15 Introduction H ps OxSi
141. ecorder c Click Done The Delete buttons are hidden 4 Click Save State The New State Name window appears New State Name The Save button The New State Name Window 5 Enter a state name 6 Click Save The state is saved to the State Library and can be accessed via the Scenario Designer For more information about the State Library see Saving States to the State Library on page 118 83 Using M se HPS Creating a New Patient When an additional patient with specific physiological characteristics is needed for repeated use a new patient can be created from the Run screen To create a new Patient 1 From the Home page run an SCE that has a Patient with the same gender as the Patient to be created 2 From the Run screen apply the desired conditions and set the necessary parameters 3 Once complete click the Patient button at the bottom of the Run screen The Patient Button The Patient pop up menu appears The Save button The Patient Pop Up Menu 4 Click Save The Save a copy of the Patient dialog box appears Save a copy of the Patient The Enter the Saves this patient s current physiologic state new patient The Save button The Save a Copy of the Patient Dialog Box 5 Enter aname for the new Patient in the Enter the new patient name field 6 Click Save The new Patient is saved and available for selection from the Base Patients Library when creating a new SCE J
142. ected to the rack by a high pressure 50 psi hose The flow of nitrous oxide into the HPS system is regulated by a mass flow controller MFC that is driven by the system s underlying pharmacological models Once the nitrous oxide supply hose is connected to the back of the rack there is no additional setup required NOTE The optional HPS with M se SCE Development software can be used on a computer other than the Instructor Workstation to create and run SCEs without being connected to the HPS simulator When the same SCEs are run on SCE Development Software and on the Instructor Workstation anesthetic gas concentrations displayed within M se may vary slightly 216 CAE Healthcare Anesthesia and Scavenging Hardware Setup Instructions In most cases the Anesthesia Delivery System is set up by a CAE Healthcare technician during your HPS installation You may also follow the instructions below to set up the Anesthesia Delivery System yourself Step 1 Set Up External Components a Locate all of the following items included with the Anesthesia Delivery System e 18 inch stainless steel needle with dual female luer fittings When shipped this needle is normally taped to the copper vaporizer block located on the inside of the HPS Lab Rack 30 mL glass syringe with male luer lock fitting e Two way stainless steel stopcock with male luer and female luer lock fittings NOTE If you are missing any of these items contact
143. ection 5 shall not apply to information which i is or becomes publicly available through no fault of Licensee ii was already in the rightful possession of Licensee prior to its receipt from CAE Healthcare iii is independently developed by Licensee provided it is not in whole or in part related to the Product and iv is obtained by Licensee in good faith and on a non confidential basis and without a use restriction from a third party who lawfully obtained and disclosed such information However Confidential Information does not come within the foregoing exceptions merely because features of it may be found separately or within a general disclosure in the public domain 5 3 Licensee agrees to be responsible for enforcing the terms of this Section 5 and to take such action legal or otherwise to the extent necessary to cause anyone having access to the Confidential Information to comply with the terms and conditions set forth herein including all actions that Licensee would take to protect its own trade secrets and confidential information but with not less than reasonable care Licensee shall be responsible and indemnify defend and hold harmless CAE Healthcare for any default caused by any such persons CAE Healthcare License Copyrig ht 6 IRREPARABLE HARM 6 1 Licensee acknowledges that the Software and Data constitute a special irreplaceable asset of great value to CAE Healthcare and that a breach in any way of any of Licen
144. elike wounds that accurately replicate muscle tissue and subcutaneous fat and reflect the true physical nature of a wound and its treatment METI FX comes complete with CAE Healthcare s own educational learning tools a set of how to treatment cards explaining procedures and learning objectives for both civilian and military patient scenarios product 4MFX 100 METI FX Simulation 21 Introduction H ps Hands Free Training Cables Optional for Human Patient Simulator HPS and Health Science HPS Hands Free Training Cables connect to most popular defibrillators and cardiac pacing units and take the place of non reusable electrode pads Three different cable designs are available to support the most popular defibrillation and pacing equipment Each cable kit includes posts that attach to the defibrillator or pace locations on HPS Zoll Zoll Medical Corporation product ACC 006 Physio Control Medtronic Inc product ACC 007 product ACC 008 22 CAE Healthcare Introduction HPS with M se Learning Applications and Training Courses HPS with M se Learning Applications Learning applications enhance the use of the simulator by providing preprogrammed scenarios and corresponding support documentation e g course objectives instructor s notes that can be readily integrated into a lesson plan a specific curriculum or an educational program The following Learning applications are available
145. er fields Content Management The Edit button Th e Delete The New button button The User Accounts Panel NOTE User Accounts functions are available only to users with the User Management or System Management privilege IMPORTANT Changes made to M se for HPS DO NOT affect M se for PediaSIM HPS If a user requires access to both M se for HPS and M se for PediaSIM HPS separate accounts must be created within M se for HPS and M se for PediaSIM HPS 134 WJ CAE Healthcare Using Mise Creating a User To create a new user 1 From the User Accounts panel click New The New Account Creation panel appears 2 In the New Account Creation panel enter the user s personal data and choose a password 3 Assign the user to a group by selecting a group from the Group menu NOTE A user can only be assigned to one group 4 Click Create The new user is created and the New Account Creation panel disappears Editing a User To edit a user s information or privileges 1 On the User Accounts panel select the user to edit 2 Click Edit The user fields become editable 3 Make the desired changes 4 Click Save Deleting a User To permanently delete a user from the User Accounts panel select a user and click Delete When the User Deletion Warning box appears click Yes The user account and the data associated with it are deleted However the administrative user deleting the account becomes the o
146. er effect on physiology than anesthesia machine settings because mixing in the breathing circuit is not simulated NOTE M se does not verify a 100 96 sum of all fractions because this would require all fractions to be set Default 096 Range 0 0096 5 0096 Appendix B M se Parameter Descriptions H PS B 20 Alveolar Halothane The Alveolar Halothane parameter is used to simulate the presence of halothane in the alveolar space without using real anesthetic vapors The halothane percentage is input to the drug models to achieve the expected pharmacodynamic effects e g respiratory depression Using this parameter bypasses pharmacokinetics real and instructor specified inspired fractions venous content lung perfusion and ventilation This parameter can be used to focus on cardiorespiratory effects pharmacodynamics WARNING Using this parameter may result in undesired behavior when switching between SCE Development Software and the Instructor Workstation IMPORTANT Setting an alveolar fraction override on the Instructor Workstation causes the infusion pump to stop NOTE Muse does not verify a 100 96 sum of all fractions because this would require all fractions to be set Default Modeled Range 0 0096 5 0096 Fraction of Inspired Halothane The Fraction of Inspired Halothane parameter is used to simulate the amount of halothane set in the anesthetic vaporizer and is used to calculate alveolar halothane The F
147. er of zeros required to make the password total eight characters Examples HPS01234 HPS00123 or HPS00012 where 1234 123 or 12 is the HPS unit number The password is case sensitive and HPS is typically all capital letters 42 CAE Healthcare HPS with M se Setup Step 4 Option 2 Join the HPS Network Using a Windows Operating System a Click the Wireless Network icon located in the bottom right hand corner of the screen of the TouchPro Computer Clicking the Wireless Network Icon b Click Connect to a network Not Connected mu Wireless networks are available Connect taa network Network and em Center Clicking Connect to a Network c Select the network labeled HPSXXX where XXX is the unit number of your HPS Wf Connect to a network Select a network to connect to Show All mn DN n Lc ees Selecting the HPS Network de zl Selecting the HPS Network d Enter the Password See note at the end of this step 43 HPS with M se Setup H ps e Click Connect J WW Connect toa network Select a network to connect ta Unsecured network Clicking Connect The computer has joined the HPS network You can now proceed to Step 5 Depending on your HPS router your password has either six or eight characters If the password contains six characters the password is HPS followed by three numbers The numbers are the HPS unit number preceded b
148. erally result in a higher Ischemic Index value whereas unfavorable supply demand ratios faster heart rates lower blood oxygenation levels generally result in a lower Ischemic Index value The patient s Ischemic Index value can be viewed by selecting the Ischemic Index widget from the Patient Status Display For more information on selecting Patient Status Display widgets see Using the Patient Status Display beginning on page 60 The table below lists Ischemic Index values and their corresponding patient conditions Model Driven ECG Rhythm Ischemic Index I I The patient s response to myocardial ischemia may be altered using the Ischemic Index Sensitivity parameter found in the Cardiovascular view To make the patient less sensitive to ischemia lower the value below the default setting To make the patient more sensitive increase the value above the default setting For more information about the Ischemic Index parameters Ischemic Index Sensitivity and Ischemic Index Averaging see Appendix B Miise Parameter Descriptions D 1 Appendix D The Ischemic Index Death Spiral H m D 2 CAE Healthcare Appendix E hs6 Files and M se Appendix E hs6 Files and M se If you had HPS6 software prior to obtaining M se for HPS you can export your old hs6 files and import them to the new Instructor Workstation This document shows how to remove hs6 scenarios from the former Instructor Workstation install them on the M se
149. finished 163 Using TouchPro HPS Changing the TouchPro Language To change the language of the TouchPro software 1 Click the Settings button in the bottom right corner of the TouchPro screen The Settings menu appears 2 From the Settings menu click the Language Selection button The Language Selection panel appears 3 From the Language Selection panel select a language 4 Click Accept Language Selection English US French France Spanish Spain Chinese Traditional Chinese Simplified Polish Russian Korean Cancel Accept The Language Selection Panel The TouchPro software changes to the selected language Exiting the TouchPro Software To exit TouchPro 1 Click the Settings button from the bottom right corner of the TouchPro screen The Settings menu appears 2 From the Settings menu click Shutdown A warning box appears asking if you want to exit 3 Click Shutdown TouchPro shuts down and the M se Start Screen appears 164 CAE teatthcare Using the HPS Using the HPS Once the HPS has been set up see Section 2 HPS with M se Setup the software has been loaded and an SCE started see Section 3 Using the Software the simulator is ready for learner interventions From the Run screen the features of the HPS can be accessed They are broken down into the following categories Neurological Respiratory Cardiovascular Fluids and Sounds 00 09
150. following values are for the HPS simulator For PediaSIM HPS values please see Condition Guidelines for Programming PediaSIM HPS with M se on page 225 of this User Guide Respiratory Desaturation Desaturation SpO Value A 1 Appendix A Condition Guidelines for Programming HPS with M se HPS Cardiovascular Blood Pressure Hypertension Hypotension 150s 90s 160s 100s 170s 100s 190s 110s 220s 120s Cardiovascular Heart Rate LETS D Z8 TE LE Bradycardia 70s High 70s Mid 60s 100s 110s 120s 130s 140s 150s 160s 170s High 170s A 2 Appendix A Condition Guidelines CAE Healthcare for Programming HPS with M se Respiratory Respiratory Rate Tachypnea Bradypnea A 3 Appendix A Condition Guidelines for Programming HPS with M se H pg Additional Conditions The following pages provide programming guidelines for additional specific patient conditions When programming conditions please allow the appropriate time for onset of vital signs The onset time is noted in the Vital Signs section for each condition Slight fluctuations in vital sign values may occur and for some conditions e g Acute Hypercapnia drift of PaCO values is likely Anxiety Pain Stress The response to anxiety pain stress is driven by non arterial baroreceptor influences that act on the medullary cardiovascular centers to raise the baroreceptor set point
151. ftware version the type of simulator and the serial number Click the User Guide link to download the user guide English version To access the User Guide in other languages please visit www caehealthcare com and click the Support link Click the Support link for CAE Healthcare Support contact information Click the globe shaped Language icon in the bottom left corner to change the language of the M se software 48 J CAE Healthcare Using Mise 3 On the Login screen enter the Username admin and the Password admin in the appropriate fields to access Muse Username Password The Miise Login Fields Muse opens to the Home page by default 49 Using M se HPS Navigating the Home Page From the Home page users can run create edit search for and print SCEs The Home page can be accessed by clicking the Home button in the upper right corner of the M se software or on any screen without a Home button by clicking the Return button in the upper left or right corner of the screen Anaphylaxis Holly Monroe Angina with Cardiac Arrest Bruce Stevens Anterior Myocardial Infarction ur responds to a report of Steve Johnson T a noticed COPD Exacerbation with Respiratory Fail tial assessment in State 1 Beginning Anaphylaxis RR in the 20s an Piu Cont COPD Patient rende Senokey e SCE to State 2 Mild Anaphylaxis if epi Epinephrine Administered In S
152. g SCE ccsnnccvsvicasnaceonsnceronzerenesuteonsenisteswssior avin shes enadense Oed doti 65 Changing Physiology cuori itio uei nunt Racer Rs RR QUAE GR RR IR G0 66 SCE TIME CONTOS oo etse eina a FUE GR beri dp esti anra tare adeno inoue 80 Using the Event Recorder to Save States ante rendo e ropa RO eni t RUD UR wien 8 Creating d New Patellaria po ted dentis erent rac c 84 Resetting a Patient T 85 The Medication MONGOL ca cciaiteainG attend audaeiiedan naaa aaan 86 Returning tothe Home PUB socie poeta dep bora ossebu ei coa yeir bep dedico apte 88 Stopping the CE NRI 88 XV Table of Contents HPS Deyel ping SCES sisi tescassaucedansascaacesiasissiucansasauavavintasenasiasessonteat XA EDDA EPOR ROG diaais 90 Creating a New SCE RR 90 The aso eM 92 Developing SCONANOS t 100 Creating a New SCOmario sss cssscnsssonssossccnsssnecesscetasesassisseoneesnssensssbosconseonseansssnssdouscenseedcnsauscauiensessoettans 100 Editing a SCEIOWD ac atercastiri n Reip Rr ance anro Hd 102 Th Scenario D OSL N isse aE EEE ptt basa ok ta reU 104 LXDIDUEInIubltic S 107 Modifying Scehidllo SEEDS aio acest ta eps date b tes e er baee ERO dg 108 Deleting Scenario States usse nativi ti orte b eMe QU Lehrern RA EY re RE HIR RE 115 Deleting Parameters and Trabisti fls uisaneceenceee irons rane pmae eontra 116 Saving tie SENANG acria deed Fea te pQ RU Oba doc mnt e oca ina para
153. g the small green LED light on the top of the reader case It blinks when the barcode is read The red barcode reader light also indicates a reading and blinks rapidly while scanning a syringe Indicator Lights CAE Healthcare Drug Recognition 5 Open the stopcock lever to the three o clock position and inject the syringe Gradually depress the syringe s plunger to dispense the desired dose Injecting the Syringe 6 For optimal accuracy pause for about one second 7 Return the stopcock lever to the OFF or six o clock position An audible beep from the HPS Lab Rack confirms that the dose has been recognized by the system The drug type concentration and dose are displayed in the M se Events Log 8 Remove the syringe from the Stopcock Manifold Troubleshooting the Stopcock If the Drug Recognition System is not working as expected examine the underside of the metal stopcock platform for buildup or corrosion and remove any debris with a soft cloth Always check the placement of the lever on the stopcock prior to drug administration Make sure it is in the OFF or six oclock position when not in use To stop an infusion choose the appropriate drug under the Medications menu and select a 0 infusion option e g 0 mg kg min 0 mcg min 213 Drug Recognition H PS Cleanup After using the Drug Recognition System in a simulator exercise it must be flushed and purged Complete the following steps to e
154. g tube inside a bucket to collect the fluid that drains from the unit Un Use a syringe to push air into the line 6 Thefluid should drain into the collection bucket 7 Continue to push air through the line until there is nothing but air coming out of the chest tube 8 In M se from the Respiratory view click Chest Tube and select Disable IMPORTANT The system must be cleaned in the prescribed way to prevent damage the flowmeter 253 HPS Care and Maintenance H ps 254 Draining the Pericardiocentesis Feature To drain and flush the pericardiocentesis trauma feature 1 m Ensure the M se software is running and a patient is connected to the simulator 2 Disconnect the IV bag from the TRAUMA IN hose at the back of the rack 3 4 Place the chest tube priming tube inside a bucket to collect the fluid that drains In M se from the Respiratory view click Chest Tube and select Prime from the unit Use a syringe to push air into the line 6 The fluid should drain into the collection bucket 10 11 12 13 Continue to push air through the line until there is nothing but air coming out of the chest tube In M se from the Respiratory view click Chest Tube and select Disable Unzip and pull back the chest skin exposing the pericardiocentesis mechanism For information on removing the chest skin see Removing the Chest Skin on page 251 Remove the red tape from the pericardiocen
155. h increasing volume within the pleural space intrapleural volume In M se the Chest Wall Capacity parameter sets the total combined intrapleural and lung volumes at which the chest wall is considered distended There should be a reduction in Chest Wall Capacity with a tension pneumothorax Tension Pneumothorax Left Parameter Adjustments Moderate Severe Extreme A 16 sw Appendix A Condition Guidelines CAE Healthcare for Programming HPS with M se Tension Pneumothorax Left Vital Signs Approximate vital signs after two to three minutes in state Reset Mild Moderate Severe Extreme 118 77 118 80 115 81 103 76 78 65 40 to 41 34 to 35 31 to 32 40 to 41 40 to 41 A 17 Appendix A Condition Guidelines for Programming HPS with M se H pg Tension Pneumothorax Right Parameter Adjustments Reset Mild Moderate Severe Extreme 1 00 0 75 0 50 0 25 0 15 1 00 1 00 1 00 1 00 os 1 00 0 75 0 50 0 25 0 15 3900 3900 3600 3300 3300 sw Appendix A Condition Guidelines CAE Healthcare for Programming HPS with M se Tension Pneumothorax Right Vital Signs Approximate vital signs after two to three minutes in state Reset Mild Moderate Severe Extreme 118 77 118 80 115 81 103 76 78 65 40 to 41 34 to 35 31 to 32 40 to 41 40 to 41 A 19 Appendix A Condition Guidelines for Programming HPS with M se H pg References 1 Heller L J amp Morhman D E 2006 Cardiovascular physiology 6th e
156. he Drug Recognition System Contact CAE Healthcare for replacements 208 CAE Healthcare Drug Recognition Drug Recognition Syringe Pump Mechanism The Drug Recognition System s syringe pump mechanism is located inside the anesthesia delivery system access panel at the top of the HPS rack It measures the flow rate of the injected bolus which is used to calculate the dose administered Drug Recognition Circuit Board The Drug Recognition Circuit Board controls the entire Drug Recognition System and calculates the administered dose using information from the other system components Once the dosage is calculated the circuit board communicates this information to the software which drives the appropriate physiological response The Drug Recognition Circuit Board is located on the drug recognition panel on the back of the rack Fluid Reservoir The water that is injected into the Drug Recognition System is collected in a user supplied second IV bag and stake set as it flows from the Drug Recognition syringe pump mechanism This IV bag and stake set should lie on the floor during a learning session Fluid Reservoir 209 Drug Recognition H PS Setup Complete the following steps to set up the Drug Recognition System Ensure the HPS Lab Rack is powered on with the umbilical assembly connected and gas supplies connected and activated Refer HPS with M se Setup on page 25 of this User Guide for complete instructio
157. he influence of the respiratory control mechanism on the tidal volume CAE Healthcare Appendix B M se Parameter Descriptions pH Shift The pH Shift parameter is used to create a metabolic acidosis or metabolic alkalosis under script control The default pH value displayed on the Patient Status Display or TouchPro software is dependent on respiratory arterial CO values Under default conditions PaCO 40 mmHg the pH is approximately 7 4 Rising arterial CO produces a subsequent drop in pH while falling arterial CO levels result in rising pH values To simulate pH changes with metabolic changes acidosis or alkalosis the pH Shift value is a mathematical addition to or subtraction from the displayed pH value to that which is desired Default 0 Range 0 50 0 50 Positive End Expiratory Pressure PEEP The PEEP parameter specifies the amount of positive end expiratory pressure applied during mechanical ventilation Setting this parameter results in clinically appropriate intrathoracic pressures and hemodynamic responses Default 0 cm H O Range 0 0 cmH O 25 0 cmH O Chest Tube The Chest Tube parameter is used to activate the chest tube hardware in the simulator The Prime option has no physiologic impact Instead it is used to prepare the feature by allowing fluid to flow through the apparatus thereby removing air from the line When a chest tube is placed into the simulator this is sensed and recorde
158. he labels and labeled syringes in a dry location to extend their usability Over time they show signs of wear Contact CAE Healthcare for replacements as needed 207 Drug Recognition H PS Stopcock Manifold The Stopcock Manifold is the system to which the stopcock and barcode reader are mounted The stopcock serves as the injection site for boluses administered through the Drug Recognition System and the barcode reader is the mechanism used to identify drugs administered Drug data read by the barcode reader is communicated from the Stopcock Manifold to the HPS Rack via an electrical cable connected to the back of the rack Stopcock Manifold IV Bag and Stake Set A standard IV bag and stake set are used to prime the Drug Recognition System with distilled water and keep it primed throughout a simulator exercise These items are user supplied IV Bag and Stake Set IV Access Ports The HPS mannequin is equipped with two preconfigured IV access sites at the right jugular and left femoral veins Each site can be attached to the Stopcock Manifold for easy drug administration Through these access sites drugs can be injected into the mannequin and measured by the Drug Recognition System s syringe pump mechanism NOTE Check valves are attached to the access sites to prevent leaks while the manifold is disconnected Caps for the unused sites are also included as a further precaution Spare caps and check valves are included with t
159. he pulse deficit B 40 CAE Healthcare Appendix B M se Parameter Descriptions Fluids The blood droplet provides a means of controlling the amount of fluid lost by or infused into the patient The amount of fluid to be lost or infused and the time frame during which the fluid loss or infusion takes place can be entered Fluid Parameters Fluid Loss Blood When used the Fluid Loss Blood parameter reflects a decrease in total blood volume Blood loss proportionally decreases both the red blood cell volume and the plasma volume according to the current hematocrit Range 0 mL 4000 mL Fluid Loss Plasma When used the Fluid Loss Plasma parameter reflects a decrease in plasma volume Plasma loss decreases the plasma volume without changing the red blood cell volume It refers collectively and generically to all fluid losses including evaporative transcellular bowel and third space fluid losses Range 0 mL 4000 mL Colloid Infusion When used the Colloid Infusion parameter reflects an addition to the plasma volume without changing the red blood cell volume Colloids include modified fluid gelatin starch solutions dextran and human albumin Range 0 mL 4000 mL B 41 Appendix B M se Parameter Descriptions H PS B 42 Crystalloid Infusion When used the Crystalloid Infusion parameter reflects an addition to the plasma volume without changing the red blood cell volume The term crystalloid is used to descri
160. he settings for Pupil Diameter are located on the Neurological view and accessed by select ing from the drop down menu for the appropriate eye Currently there are four pupil options that are used to control the diameter of the pupils in both eyes Reactive Default Modeled Blown or a fixed pupil size from 2 mm to 8 mm Setting the Pupil Diameter to Reactive causes the pupils to re size in response to changes in light If both pupils are set to Reactive both pupils re size accordingly If the Eyes are set to Modeled the pupil size is driven by the pharmacology of morphine Other settings allow the user to fix one or both pupils to a specific size P Modeled gt Modeled Reactive Modeled 2 mm Blinking Srini Closed 4 mm Pupil Diameter TUseou A J 5 mm Slow Normal Fast 6mm 7mm 8mm Blown Altering Pupil Diameter The settings for Blink Control are located on the Neurological view gt Modeled P Modeled Auto Auto Blinking Blinking Closed Closed Blink Speed Controls 170 CAE Heatthcare Using the HPS Choosing the Auto setting which is also the default setting sets the eyes in a blinking mode but allows the simulator to react to physiological changes that cause the eyes to close such as unresponsiveness or a comatose condition Though set in the Closed position the eyelids can still be manually opened for clinical inspect
161. hould be primed prior to use To prime the IV system 1 Hang an IV source bag filled with distilled water A small amount of red food coloring may be added to the water to simulate blood 2 Attach an IV solution set to the source bag and close the clamp 3 Attach the IV tubing from the IV solution set to the small blue IV line located at the end of the fluid umbilicus that extends from the mannequin IV Line 199 Using the HPS HPS 4 Attach an empty IV drain bag to the DRUG REC OUT line of the Pneumatic Left umbilicus on the back of the HPS Lab Rack Drug Rec Out Tube 5 Unclamp the IV solution set attached to the source bag allowing the water to flow into the mannequin and prime the veins 6 The mannequin is fully primed when liquid flows into the IV drain bag with no air bubbles 7 Once the mannequin is primed clamp the IV source bag to stop the flow of liquid into the mannequin 200 CAE Healthcare Using the HPS IV Access Once the system is primed the right arm veins can be cannulated with standard venous access needles and catheters Brachial cephalic basilic and antecubital region veins are available IV cannulations receive a flash when the mannequin s veins are primed WARNING If a flash does NOT occur do NOT inject any fluid and remove the needle immediately Repeat the priming directions and ensure you have injected the needle properly and into the simulated vein T
162. ibrary appears Select the desired SCE and it automatically appears in the Favorite SCEs panel 144 CAE Healthcare Medication Preferences Using M se From the Medication Preferences panel users can import customized medication response files created in the Pharmacology Editor software To access Medication Preferences click Medication Preferences on the Account Profile screen The Medication Preferences panel appears The Medication Preferences link meti admin Email admin meti com ID admin Profile Information Favorite SCEs Profile Preferences Medication Responses Patient Group Medication Responses The Account Profile Screen The Medication Preferences panel To import medication response files click the Set button The select file dialog box appears Select the medication response file to be added and click Open or OK 145 Using M se HPS Profile Preferences From the Profile Preferences panel users can change the font size used in the software To access Profile Preferences click Profile Preferences on the Account Profile screen The Profile Preferences panel appears meti admin Email admingmeti com Profile Preferences ID admin The Font Size P Normal Font size Profile Information menu Favorite SCEs Medication Preferences The Profil The Profile f rome Preferences re erences panel link The Account Profile Screen To change th
163. id can be removed from the simulated pleural space via a chest tube drainage system Both parameters are located on the Respiratory view under Additional Parameters The Intrapleural Volume parameter allows intrapleural volume to accumulate for example as happens during pneumothorax hydrothorax and hemothorax To simulate a pneumothorax set the intrapleural volume to a value greater than 0 mL Values above 500 mL reduce the corresponding lung volume significantly Breath sounds and chest excursion are automatically diminished on the appropriate side due to decreased ventilation of the affected lung For information regarding cleanup after using the Chest Tube feature see see Draining the Chest Tube on page 253 CAE Healthcare Using the HPS Needle Decompression To set up a Pheumothorax Needle Decompression enable the feature using the Needle Decompression parameter on the Respiratory screen The Needle Decompression Switch Select ON OFF to activate the feature Needle decompression can be performed bilaterally into the small hole located in the midclavicular line of the second intercostal space Insert a needle until the hissing sound of the valve release is heard For supported needle size see Recommended Clinical Supply Sizes on page 259 Performing Needle Decompression The Intrapleural Volume parameter can be used to allow intrapleural volume to accumulate Effective needle decompression immediately red
164. igner to the canvas Drag and drop a condition onto the canvas to create a state cardiovascu Q Q BP Hypertension ip BP Hypotension Cardiac Rhythm Set Cardiac Tamponade Heart Rate Bradycardia Heart Rate Tachycardia Patient Stability Pulses Ventricular Failure Both Ventricular Failure Left Ventricular Failure Right The Scenario Designer Canvas Or a new empty state can be added using the New State button To add a new state using the New State button 1 Click the New State button on the upper left side of the Scenario Designer afe New State The New State Button A new state appears A New State 2 From the Graphical View double click the new state or from the Line Item View click the Expand Collapse arrow to the left of the state to expand it The state expands and additional options appear The state name The Expanded State 107 Using M se HPS 3 Double click the state name By default new states are named State The Rename state window appears and contains a field for entering a new state name Ms x id The Save Bede button The Rename State Window 4 Enter a new state name NOTE When naming a Scenario State the state name may NOT exceed 127 characters Additionally scenario file and state names CANNOT contain any special characters such as V lt gt 5 Click Save The state is renamed Modifying Scenario States Once a
165. ill automatically detect and respond to pacing signals Three parameters can be used to simulate pacing within the software Pacing Capture Threshold determines the minimum pacing current necessary to pace the heart Pacing Current simulates a specific amount of current discharged by an external cardiac pacemaker Pacing Rate determines the cardiac rate when the Pacing Current is at or above the Pacing Capture Threshold All three parameters are located on the Cardiovascular view CAE teatthcare Using the HPS Pericardiocentesis The pericardiocentesis feature must be primed prior to use To prime the system for pericardiocentesis 1 Fill an empty IV bag with distilled water Food coloring may be added to the water if desired Attach the IV solution set to the IV bag ensuring the clamp is closed 3 Hang the bag on the back of the HPS Lab Rack Connect the hose from the IV solution set to the white Trauma hose on the Umbilical Assembly at the back of the HPS Lab Rack In M se go to the Cardiovascular view For information on how to access the Cardiovascular view see Using the Physiological Views on page 66 Set the Pericardiocentesis Enable parameter to Prime 7 Insert a needle with a 20 mL syringe into the pericardiocentesis access port 8 9 located near the xiphoid process of the mannequin For supported needle size see Recommended Clinicnal Supply Sizes on page 259 Draw back until fluid fl
166. in all lung fields and bowel sounds are normal in all four quadrants The patient s weight is 66 0 kg Stannette Momtobe Stannette Momtobe is a 20 year old pregnant female She demonstrates a HR in the 80s BP in the 100s 60s RR in the mid teens and SpO in the upper 90s on room air The patient s cardiac rhythm is model driven normal sinus Heart sounds are normal breath sounds are clear in all lung fields and bowel sounds are normal in all four quadrants The patient s weight is 90 0 kg Stanley A Wreck Stanley A Wreck is a hypertensive 61 year old male He demonstrates a HR in the 70s BP in the 180s 100s RR in the mid teens and SpO in the mid 90s on room air The patient s cardiac rhythm is model driven normal sinus Heart sounds are normal breath sounds are clear in all lung fields and bowel sounds are normal in all four quadrants The patient s weight is 100 0 kg C 2 CAE Hoskticare Appendix D The Ischemic Index Death Spiral Appendix D The Ischemic Index Death Spiral The Ischemic Index is a measure of the myocardial ischemia modeled using classical determinants When an unfavorable oxygen supply demand ratio occurs myocardial ischemia follows The lower the Ischemic Index the greater the myocardial ischemia The Ischemic Index is derived through the underlying physiological models and cannot be measured clinically Favorable supply demand ratios slower heart rates higher blood oxygenation levels gen
167. intravenous infusion of fluids such as whole blood packed red blood cells colloids and crystalloids Instructors can create patients with both normal and pathophysiological hematocrit levels In addition learners discover how administering various fluids affects hematocrit the oxygen carrying capacity of blood and the resulting patient response The following important assumptions were made in the design of the Hematology Model Blood is comprised of two components red blood cells and plasma Plasma is comprised of two components colloid and crystalloid The term colloid is used to describe substances that generate a clinically significant colloid osmotic pressure for example fresh frozen plasma albumin and hetastarch The term crystalloid is used to describe salt solutions for infusion for example normal saline dextrose in water and Ringer s Lactate The mixing of blood and its various constituents is instantaneous and homogeneous In other words one liter of crystalloid administered intravenously equilibrates immediately and homogeneously throughout the entire circulation This initial Hematology Model does not yet distinguish between the differing clinical effects of colloids versus crystalloids For example osmotic pressures and capillary leakage rates are not taken into account Likewise fluid kinetics and how fluids distribute within the circulation the interstitial and intracellular spaces are also not presently modeled
168. ion Additionally eyelids can be programmed in scenarios to open and close spontaneously or can be fixed in the closed position Blinking frequency can be set at one of three speeds Normal default Slow and Fast To adjust the blinking frequency click the desired option on the Neurological view Thumb Twitch Human Patient Simulator HPS Only The right arm of the mannequin includes electrode attachments for a standard peripheral nerve stimulator PNS The simulator automatically detects the PNS stimulus pattern single twitch train of four and tetanus Based upon the stimulus pattern detected the level of neuromuscular blockade and the type of neuromuscular agent administered depolarizing or non depolarizing the simulator automatically generates the appropriate thumb twitch response 171 Respiratory Features The HPS s anatomically realistic upper airway provides for the opportunity to intubate and apply other airway interventions to the patient while various clinical signs e g breath sounds chest excursion airway patency can be physically demonstrated A series of speakers inside the simulator can generate a range of breath and throat sounds used in patient assessment Respiratory Features Anatomy Physiology Clinical Interventions Patient Software Control Manual and Clinical Signs Monitoring and Scenarios Control Airway Management Alveolar and arterial gas None required None required and Ventilation concen
169. istered trademark of the Mozilla Foundation Adobe Flash Player is a trademark of Adobe Systems Inc 46 CAE Healthcare Using M se UsiNG M SE The M se software is a browser based application that can communicate directly with the simulator With the software users can run SCEs create scenarios and SCEs import and export educational content and perform administrative functions NOTE For optimal M se performance no other software programs should be open while M se is running IMPORTANT Only one M se application window or tab and one TouchPro window or tab can be used per Instructor Workstation at a time IMPORTANT Do NOT use any of the browser s navigational tools i e back and forward buttons while operating M se Starting the Application Once the simulator is powered on and the Instructor Workstation is connected to the simulator network the M se software can be launched To launch the software 1 Using the Laptop or Tablet Instructor Workstation launch the web browser e 9 Safari Internet Explorer The M se Start Screen appears EN TouchPro Patient Monitor The M se Start Screen 47 Using M se HPS 2 Select M se The Login screen appears 3a User Guide Support The Mise Login Screen The links in the bottom left corner of the screen provide access to additional information about the software e Click the About link to access information about the Muse so
170. ite Physician Instructor two days at learner defined facility with physician led instruction The HPS Advanced course builds upon the concepts introduced in the prerequisite Basic course After a quick review of the Basic course Advanced instruction spends the majority of the two days providing learners with the ability to design patients and scenarios that can be used immediately upon completion of the course HPS Advanced two days at CAE Healthcare facility HPS Advanced On Site two days at learner defined facility HPS Advanced On Site Physician Instructor two days at learner defined facility with physician led instruction 24 CAE Healthcare HPS with M se Setup HPS with M se Setup The following pages guide you through assembling and configuring HPS Below is a list of the steps required to prepare HPS for operation Setting Up HPS HPS with M se Setup H ps Before Beginning Setup Proper operation of the HPS simulator requires the correct configuration Before setting up the system keep in mind these basic guidelines Understand the Cautions Warnings information included in the beginning of this User Guide Follow the sequence of steps carefully Complete all steps in order and Do not power on any components until instructed in the text KEEP all original shipping materials including the BOXES Warranty and repair items must be return shipped to CAE Healthcare in their original packaging Because shippi
171. lates is in conformity with the following standards or other normative documents EMC EN 55011 1998 A1 1999 Group 1 Class A EN 61326 1997 A1 1998 EN 61000 4 2 1995 EN 61000 4 3 2002 A1 2002 EN 61000 4 4 1995 A1 2001 A2 2001 EN 61000 4 5 1995 EN 61000 4 6 1996 EN 61000 4 11 1994 EN 61000 3 2 2000 EN 61000 3 3 1995 A1 2001 following the provision of the EMC Directive 89 336 EEC Sarasota Florida 34232 USA A C Signature and Date Carlos E Moreno Typed Name and Title DreeosQe AF Er erweee m 6 European Contact HPS CAE Healthcare HPS Specifications Size Mannequin Instructor Workstation Lab Rack Weight Mannequin Simulator Lab Rack Instructor Workstation Environmental Requirements Ambient Temperature Range Operation Storage Maximum Altitude Instructor Workstation Maximum operating altitude Maximum storage altitude Maximum shipping altitude Specifications 5 ft 11 inches 180 cm 18 5 H x 19 1 W x 7 4 D 46 9 cm x 48 5 cm x 18 9 cm 42 5 H x 27 W x 28 D 108 cm x 69 cm x 71 2 cm 75 Ibs 34 kg 256 lbs 159 kg 20 Ibs 9 1 kg 40 F to 104 F 4 C to 40 C 40 F to 122 F 4 C to 50 C 10 000 ft 10 000 ft 10 000 ft Specifications HPS Power Rack amp Mannequin AC Input Consumption Instructor Workstation AC Input Electrotherapy Defibrillation AC 100 220 VAC 50 60 Hz Approx 400 W AC 100 240 VAC 50 60 Hz Mo
172. lative changes At a value of 1 increased and decreased ventilatory drive affect tidal volume and respiratory rate equally When volume rate control is greater than 1 increased or decreased minute ventilation is predominantly achieved by changes in tidal volume When the volume rate control factor is less than 1 ventilatory changes are affected primarily by changes in respiratory rate For example set the volume rate control factor to 0 1 and increase the shunt fraction to 0 4 to decrease the arterial O The patient responds to falling arterial oxygen levels with increased minute ventilation Increasing the respiratory rate with minimal increase in tidal volume produces this Default 1 mL Range 0 1 mL 10 0 mL CAE Healthcare Appendix B M se Parameter Descriptions Chest Wall Capacity The Chest Wall Capacity parameter sets the total combined intrapleural and lung volumes at which the chest wall is considered distended Also see Chest Wall Compliance Factor and Distended Chest Wall Compliance Factor Default 3900 Range 1500 3900 Chest Wall Compliance Factor This Chest Wall Compliance Factor parameter describes the interaction of the chest wall with the lungs The Chest Wall Compliance Factor parameter defines the volume pressure relationship in the normal operating lung volumes Once distended however the chest wall rapidly becomes much less compliant i e much stiffer and resistant to further inflation
173. ll volume It refers collectively and generically to all fluid losses including evaporative transcellular e g ascites pleural effusion bowel and third space fluid losses Reflects an addition to the plasma volume without changing the red blood cell volume Colloids include modified fluid gelatin starch solutions pentastarch and hetastarch dextran and human albumin Reflects an addition to the plasma volume without changing the red blood cell volume The term crystalloid is used to describe salt solutions for infusion for example normal saline dextrose in water and Ringer s Lactate A preparation of 70 red blood cells and 30 liquid plasma often administered in severe anemia to restore adequate levels of hemoglobin and red cells without overloading the vascular system with excess fluids The term whole blood is used to refer to blood that has not been separated into its various components It represents a preparation of 40 red blood cells and 60 liquid plasma To control fluids lost or infused select the desired fluid parameter from the Fluids view The amount of fluid to be lost or infused and the time frame during which the fluid loss or infusion takes place can be entered 193 194 Using the HPS H PS Hematology Model The physiological model calculates hematocrit values i e percentage of total blood hemoglobin dynamically and continuously taking into account blood and fluid losses as well as the
174. lying all causes of hypercapnia is inadequate alveolar ventilation Potential contributing factors include increased carbon dioxide production decreased minute ventilation increased airway resistance and inefficiency of alveolar gas exchange The most common causes are acute exacerbations of asthma and chronic obstructive pulmonary disease COPD This condition is programmed as an acute increase in total body carbon dioxide concentration as might occur in trauma or after tourniquet removal NOTE When using patients with acute hypercapnia it is recommended to stop the patient restart the patient and reconnect to the mannequin when moving between states Acute Hypercapnia Parameter Adjustments Reset Borderline Mild Moderate Severe Profound Extreme 250 275 300 310 320 320 320 1 00 1 40 2 00 2 90 3 20 3 40 3 60 oo so 10 159 20 z0 200 1 00 0 10 0 10 0 10 0 10 0 10 0 10 1 00 3 20 1 00 Acute Hypercapnia Vital Signs Approximate vital signs after five to 10 minutes in state Reset Borderline Mild Moderate Severe Profound Extreme 7m 70 70 70 70to8 70to81 70to122 106 to 106 to 105 to 118 77 118 77 118 77 118 77 118 77 1 4 to R to to 86 40 to 41 43 t045 46to49 50to52 52to56 54to61 57 to 65 A 13 Appendix A Condition Guidelines for Programming HPS with M se H pg Chronic Obstructive Pulmonary Disease COPD Emphysema Obstructive lung disease describes obstruction
175. m Optional for Health Science HPS The OxSim is used to provide SpO data to the monitoring equipment used during the simulation session A standard SpO finger probe can be placed on the Index to obtain an SpO reading for a virtual patient OxSim Monitor Interface Optional for Health Science HPS The monitor interface is used to connect the simulator to a standard clinical monitor allowing for the display of a wide range of patient parameters product MI 001 Monitor Interface 16 CAE Healthcare Introduction Wireless Microphone and Receiver The wireless microphone and receiver are used for the patient voice feature of the HPS system The receiver is housed inside the rack The wireless microphone includes an adjustable lapel clip volume control and mute Wireless Microphone and Receiver Replacement Kit The Replacement Kit includes the IV Arm Kit Trauma Features Kit Airway Kit and Genitourinary GU Kit The items contained in each kit are listed below IV Arm Kit e Venous Tubing Splicing Kit 140mL syringe and IV solution sets Trauma Features Kit e Chest tube foam inserts e Chest tube receptacles e Chest tube priming hose e Diagnostic peritoneal lavage abdominal insert Standard abdominal insert Airway Kit Spare neck skins Silicone spray Spool of red airway tape Genitourinary GU Kit e Interchangeable male female genitalia e V solution set 17 Introduction H ps
176. mannequin offers features such as breath and heart sounds palpable pulses patient voice genitourinary features and airway management features Umbilical Assembly The Umbilical Assembly is a long bundled system of hoses and an electrical cable attached to the HPS mannequin in the perineum area The Umbilical Assembly attaches the mannequin to the HPS Lab Rack The Umbilical Assembly The Umbilical Assembly is about 12 feet 4 meters long and is made up of two bundled systems the fluidic pneumatic pigtail and the electrical pigtail The large square electrical connector attaches to the back of the HPS rack while each of the fluidic pneumatic hoses attaches to labeled ports on the back of the rack Introduction CAE Healthcare HPS Lab Rack The HPS Lab Rack is the hub of communication power and pneumatics for the HPS system It contains a central power supply an Ethernet switch lung bellows and other essential components that drive the simulator s physical responses HPS Lab Rack The following descriptions explain the configuration of the HPS Lab Rack Introduction H ps The Back of the Rack The following components are exposed at the back of the rack MUX 6 An open serial port May be used to connect the TDCK MUX 10 An open serial port Exhaust Port Used for scavenging anesthetic gases Audio Out Enables the simulator s audio outputs to be connected directly into an audio system NOTE
177. meter Descriptions PaO Set point The PaO Set point parameter is a set point for PaO When PaO is below the set point value progressive stimulation of spontaneous minute ventilation occurs Both tidal volume and respiratory rate rise which under appropriate conditions results in PaO moving closer to the set point Factors that influence this control effort include baseline tidal volume baseline respiratory rate respiratory gain O consumption respiratory quotient lung compliances chest wall compliance bronchial resistances the presence of artificial airways in the simulator and the inspired gas mixture Minute ventilation is not affected for PaO above the set point For example if PaO Set point is set to 100 mmHg and PaO drops to 90 mmHg ventilatory stimulation occurs When the PaO reaches the new set point the simulator s respiratory rate and tidal volume are again controlled to maintain PaCO at the PaCO set point see PaCO Set point on page B 14 for more information Default 100 00 mmHg Range 20 0 mmHg 100 0 mmHg to E Ratio 1 X The I to E Ratio 1 X parameter sets the inspiratory expiratory I E ratio for spontaneous ventilation At the default setting the time for exhalation is twice that of inhalation Default 2 Range 0 5 7 0 PetCO PaCO Factor The PetCO PaCO Factor adjusts the end tidal CO relative to the PaCO At the default value of 1 PetCO very closely approximates PaCO When Pet
178. n click the Print button located in the bottom right corner of the 12 lead ECG report 2 Select the Save As PDF option 3 The report saves as a PDF on the Macintosh Instructor Workstation 158 Using TouchPro To save the report to a PDF file on a Windows Instructor Workstation 1 From the 12 lead ECG report screen click the Print button located in the bottom right corner of the 12 lead ECG report The Print dialog box appears 2 From the drop down menu select Microsoft XPS Document Writer 3 The report saves on the Windows Instructor Workstation To print a report 1 From the 12 lead ECG report screen click the Print button located in the bottom right corner of the 12 lead ECG report 2 Select the appropriate network printer NOTE A network printer must be configured in order to appear as an option 3 Click the Print button The report prints to the designated network printer 159 Using TouchPro HPS NIBP Cycling and Manual NIBP When non invasive blood pressure NIBP is displayed the patient s NIBP can be updated at specified intervals using NIBP Cycling or the current NIBP can be displayed immediately using the Manual NIBP button To set the patient s NIBP to be updated at regular intervals from the Settings menu click NIBP Cycling The NIBP Cycling menu appears From the NIBP Cycling menu select the desired interval for the cycling and click Start NIBP Cycling SSS 2 0 mins 3 0 mins 5
179. n located in the State of Florida U S A Each Party hereby waives any right that it might otherwise have to object to such venue or seek dismissal of the action on the basis of forum non conveniens EACH PARTY HERETO IRREVOCABLY WAIVES TO THE FULLEST EXTENT PERMITTED BY APPLICABLE LAW ANY AND ALL RIGHT TO TRIAL BY JURY IN ANY LEGAL PROCEEDING ARISING OUT OF OR RELATING TO THIS AGREEMENT 8 3 Notwithstanding the foregoing if a party seeks injunctive proceedings to preserve confidentiality obligations or intellectual property rights then it is entitled to seek relief before the competent court body of any jurisdiction License Copyright H PS 9 MISCELLANEOUS 9 1 United States Government Customer If Licensee is the United States Government U S Government or a unit or agency of the U S Government the Software and Data are deemed to be commercial computer software and commercial computer software documentation respectively pursuant to DFAR Section 227 7202 and FAR Section 12 212 b as applicable Any use modification reproduction release performance display or disclosure of the Software and or Data by the U S Government or any of its units or agencies shall be governed solely by the terms of this License and the HEPGTC Any technical data provided by CAE Healthcare with the Product that is not covered by the above provisions is deemed to be technical data commercial items pursuant to DFAR Section 252 227 7015 a
180. n the event of 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 normal wear and tear staining discoloration or other cosmetic irregularities that do not impede or degrade product performance Any damage or malfunction as a result of the installation of software or hardware not authorized by CAE Healthcare will be repaired under the Time and Materials service plan see Time and Materials section CAE Healthcare s warranty does not cover products that have been received improperly packaged altered or physically damaged Products will be inspected upon receipt Some states in the USA do not allow the exclusion or limitations of incidental or consequential damages so the limitations above may not apply to you This warranty gives you specific legal rights and you may also have other rights which vary from state to state Return Materials Authorization RMA No product may be returned directly to CAE Healthcare without first contacting CAE Healthcare for an RMA number If it is determined that the product may be defective you will be given an RMA number and instructions for product return An unauthorized return e g one for which an RMA number has not been issued will be returned at your expense Authorized shipments are to be shipped prepaid to the address on the RMA Your original box and packaging m
181. nario Designer The state is stored in the library To access the State Library click the States button in the bottom right corner of the Scenario Designer Ed States The States Button 118 CAE Healthcare Using M se The State Library appears listing all saved states Hpertension Begins The State Library Click Conditions to exit the State Library 119 Using M se HPS Emptying the Trash To empty the Trash click the Trash icon in the lower left corner of the Scenario Designer Anaphylaxis Ce E Hres py cotapsean wi Eapana an The Trash icon The Scenario Designer 120 CAE Healthcare Using M se The Trash List appears Cardiac Rhythm Set Heart Rate Tachycardia The Empty Trash button F Empty Trash The Trash List Click Empty Trash to empty the Trash If you do not wish to delete the items listed they can be dragged back into the scenario at which time they are removed from the Trash Logging out of the software automatically empties the Trash IMPORTANT Items emptied from the Trash cannot be retrieved 121 Using M se HPS Administrative Tools The M se software has administrative tools that allow users to manage logs stored content users and system settings The administrative tools are accessed via the Administrative Tools buttons located on the Home page The History button The System Administration button The Account Profile button
182. nen ene 259 Appendix A Condition Guidelines for Programming HPS with M se A 1 Appendix B M se Parameter Descriptions scsssssssssssssssssssssscesssesssscssssesssssssssessonssaes B 1 Appendix C Base Patients m C1 Appendix D The Ischemic Index Death Spiral 4 eere eene n enne D 1 Appendix E JjlLDUe m E 1 Appendix F Configuring the HPS Gas Analyzer scsscsssssssssssssssssssssssssssssessesssssssssssesens F 1 xxii CAE Healthcare Introduction Introduction As the worldwide leader in patient simulation technology and education CAE Healthcare is excited to introduce the Human Patient Simulator HPS With CAE Healthcare s proprietary human physiology model at its core the HPS is designed to automatically determine patient responses to user interventions in real time HPS What makes the HPS so unique is its versatility and usability Combining intricate systems design and flexible user oriented software the HPS creates realistic learning experiences that replicate the complexities of human physiology with reactive eyes heart and breath sounds palpable pulses and a myriad of other features that mirror a true and accurate representation of the human body Introduction H ps Contained in this User Guide This User Guide has been designed for quick access
183. neumothorax occurs when the accumulated fluid creates a positive pressure in the pleural space thereby exerting pressure on the great veins in the thorax and impairing venous return The result is obstructive shock secondary to obstruction of the blood flow within the cardiovascular circuit The results are hypotension decreased cardiac output increased arteriovenous oxygen difference and decreased myocardial oxygen consumption Lung compliance and chest wall compliance decrease with increasing volume within the pleural space intrapleural volume In Muse the Chest Wall Capacity parameter sets the total combined intrapleural and lung volumes at which the chest wall is considered distended There should be a reduction in Chest Wall Capacity with a tension pneumothorax Tension Pneumothorax Left Parameter Adjustments Moderate E33 0 1 Extreme 238 Condition Guidelines for Programming CAE Healthcare PediaSIM HPS with M se Tension Pneumothorax Left Vital Signs Approximate vital signs after two to three minutes in state Reset Mild Moderate Severe Extreme 108 63 103 62 101 60 96 60 80 57 239 Condition Guidelines for Programming PediaSIM HPS with M se PediaSIM HPS Tension Pneumothorax Right Parameter Adjustments Moderate TAA Extreme 240 Condition Guidelines for Programming CAE Healthcare PediaSIM HPS with M se Tension Pneumothorax Right Vital Signs Approximate vital signs after t
184. new states Once created states are displayed on the Scenario Designer canvas 104 CAE Healthcare Using M se Scenario Designer Views The Scenario Designer has two views the Graphical view and the Line Item view The Graphical view allows users to map out scenario states The Line Item view places the states and transitions into a linear format The The Line Graphical x Scenario E Eu New State b Collapse All Yj Expand All Item View View button button The Scenario Designer View Buttons Click the Graphical view button to utilize the Graphical View Anaphylaxis The Collapse State button An expanded state The Graphical View From the Graphical View double click on any state to expand it and view all its components Click the Collapse State button to collapse an expanded state 105 Using M se HPS Click the Line Item view button to utilize the Line Item view The Expand Collapse arrow An expanded state The Line Item View From the Line Item View click the Expand Contract arrow to the left of any state to expand it and view all its components Click the arrow again to collapse the state 106 CAE Healthcare Using M se Adding Scenario States When beginning to create a new scenario the canvas is blank Scenario states can be created by dragging and dropping conditions medications and interventions from their respective menus on the right side of the Scenario Des
185. nfo kyst com tw n4 License Copyright H PS 2 LICENSE 2 1 In consideration of Licensee s agreement and compliance with the terms and conditions contained in the HEPGTC and in this License CAE Healthcare grants to Licensee and Licensee accepts a personal non exclusive non transferable license to use the Software and Data exclusively with the Product and with the computer on which this License appears 2 2 Except for the License granted herein CAE Healthcare grants no express or implied right under any patent copyright mask work right trademark know how or other intellectual property rights Without limiting the foregoing the Licensee shall not obtain any rights to CAE Healthcare s property or any part thereof by implication estoppel or otherwise Title to and full ownership of any trade secrets and other intellectual property rights related to the Product and components thereof shall remain with CAE Healthcare and if applicable its suppliers For clarification Licensee agrees that the source code for the Software is a trade secret of CAE Healthcare and only CAE Healthcare shall have the right to alter maintain enhance or otherwise modify the Software 2 3 Without limiting the foregoing or any other terms in this License Licensee shall and shall ensure that any person authorized to access the Product which are limited to Licensee s employees agents representatives medical staff and students Authorized Users a
186. ng materials should be stored and retained be sure all protective packing materials and unused ancillary computer parts are secured If unpacking HPS for the first time careful use of a box cutter protects both the packaging and the product The Setup Map and Quick Start Chart cover these same steps in abbreviated fashion 26 CAE Healthcare HPS with M se Setup Step 1 Place the Simulator in the Work Area Select a work area with enough room for all equipment providing ample space for easy access to the simulator At least a 12x 14 3 5 meter x 4 5 meter work area is recommended for movement of learners and positioning of standard components around the simulator If you are using optional items such as anesthesia drug recognition Wireless Remote Control or TDCK you need to allow additional room for those components The HPS Mannequin Make sure a multi plug AC power outlet exists within the workspace to power the HPS Lab Rack Instructor Workstation and monitoring equipment Before placing the simulator on a surface be certain the surface can easily support 75 pounds 34 kg NEVER lift the mannequin by the LIMBS Leverage the torso of the simulator and support the head while lifting NOTE Be sure to use the appropriate 110 or 220 power plugs from the rack depending on the power caracteristics of your location 27 HPS with M se Setup H ps Step 2 Connect the Umbilical Assembly a Locate the long
187. nnected AirPort Off Select Ethernet 39 HPS with M se Setup HPS d From the bottom right hand corner of the Network dialog box click the Advanced button ane Location HPS LAN Ethernet Connected Status AirPort e of Configure IPv4 IP Address Subnet Mask Router DNS Server Search Domains ai Click the lock to make changes Connected Ethernet is currently active and has the IP address XX X09 XX XX Manually 10 XXX XX XX 255 0 0 0 10 0 0 1 Click the Advanced button POTETER ee c Revert Assist me Apply Clicking the Advanced Button The TCP IP Network screen appears e Write down the IP address next to the IPv4 Address heading IPv4 Address Subnet Mask DNS Configure IPv4 Manually 255 0 0 0 WINS 802 Write down the IP address next to the IPv4 Address heading The Instructor Workstation s IP Address f Click Cancel to close the TCP IP Network screen g Close the Network settings screen 40 CAE Healthcare HPS with M se Setup Step 3 Configure the Wireless Remote TouchPro Computer s Network Settings a Access the Networking screens the TCP IP settings screens for your operating system If you are unfamiliar with these screens contact your Network Administrator or CAE Healthcare Customer Service 1 866 462 7920 for help with this step EN ETT Q
188. nogram information can be found on the clinical patient monitor if one is connected to the simulator 148 Using TouchPro Modifying the TouchPro Display The layout of the waveforms and numeric data shown on the TouchPro software can be customized The TouchPro software can show up to six waveforms plus an additional four numeric readouts Selecting a Preconfigured Layout There are five preconfigured CAE Healthcare Layouts ICU Arterial Line Only preconfigured with waveform and numeric readouts for ECG Lead II ECG Lead V ABP Pleth and a numeric readout for Body Temperature EMS ED Telemetry preconfigured with a waveform and numeric readout for ECG Lead Il and numeric readouts for SpO and noninvasive blood pressure NIBP ICU OR No CVP preconfigured with waveform and numeric readouts for ECG Lead Il ECG Lead V ABP PAP and Pleth and numeric readouts for NIBP Thermodilution C O Blood Temperature and Body Temperature ICU OR preconfigured with waveform and numeric readouts for ECG Lead II ECG Lead V ABP PAP CVP and Pleth and numeric readouts for NIBP Thermodilution C O Blood Temperature and Body Temperature Saturation Pulse preconfigured with numeric readouts for SpO and pulse 149 Using TouchPro H ps To select a preconfigured layout click Settings select the layout from the Layouts panel and click the Close Settings button The Close Settings button The Layouts ICU Arterial Line
189. nophasic CAE Healthcare Cautions Warnings Cautions Warnings Please read and understand these cautions and warnings before you begin using the HPS system USE OF THIS EQUIPMENT IN AN UNSPECIFIED MANNER MAY IMPAIR DESIGNED PROTECTION Your safety is in your hands Be sure to follow the instructions on the proper setup breakdown and use of the HPS system SHOCK HAZARD Electrical Safety This product must be connected to an electrical outlet that is properly grounded Precautions should be taken so that grounding or polarization is not defeated Do not place defibrillator paddles on or adjacent to the ECG patient electrodes or the PACE patient electrodes Contact between defibrillator paddles and the ECG PACE electrodes may cause injury to the user and damage to the equipment The HPS is tested to work with the Physio Control Model LifePak 11 monophasic defibrillator The use of other defibrillators should be certified by CAE Healthcare prior to use Do not attempt to disassemble the HPS Lab Rack or Portable Rack or service any of the electrical components Operate the system from a power source with the following rating 115VAC 50 60 hertz cycles per second e g North America Japan Be sure to use the appropriate 110 or 220 power plugs from the rack depending on the poser characteristics of your location Do not spill fluids of any kind in or on any piece of HPS PediaSIM equipment General Use Warnings
190. not copy save and except for normal back up and disaster recovery purposes provided such copy shall include CAE Healthcare s copyright and any other proprietary notices indicated on the Software and Data ghost export or produce any derivative works from the Product or any part thereof not network the Product without CAE Healthcare s prior written approval or make it available for concurrent use b not sell attempt to sell or transfer unless in compliance with the HEPGTC sublicense encumber the Software or Data c not modify the Product in any way combine with other programs or reverse engineer screen scratch decompile or disassemble any Software nor otherwise attempt to create or derive the source code related thereto d not deface or remove any copyright or proprietary notices e not use the Product without the Key if provided with the Product or attempt to develop or develop any means or technology which would enable Licensee to bypass the use of the Key to operate the Product f prevent anyone other than Authorized Users from accessing or using the Product g not incorporate the Product in whole or in part to any product or service that Licensee would make available to a third party on a commercial basis or not 2 4 Notwithstanding anything else contained in this License in no event shall Licensee use the Product and or Confidential Information to enable support or otherwise aid Licensee or a third party to
191. ns 1 Gather the components of the Drug Recognition System including the Stopcock Manifold bag of distilled water empty IV bag two IV stake sets and barcodes and syringes Drug Recognition Inventory 2 Secure the electrical connection on the Stopcock Manifold to the BAR CODE READER serial port on the back of the HPS Lab rack firmly tightening the screws The Bar Code Reader Serial Port 3 With the manifold oriented so the barcode reader is to your right and the stopcock mechanism is to your left attach one of the IV access site lines labeled DRUG REC IN to the Stopcock Manifold at the nine o clock position Confirm that the valve is properly in place Attaching the IV Access Line 4 Verify that check valves and caps on unused IV access sites are in place The check valves and caps prevent leakage during the simulation session 210 CAE Healthcare Drug Recognition 5 Attach an empty IV bag and stake set to the DRUG REC OUT port on the Left Pneumatic Umbilical connector on the rear panel of the HPS rack Ensure the clamp on the stake set is open Place the IV bag on the floor This serves as the fluid reservoir Fill an IV bag with distilled water Insert an IV stake set making sure the roller clamp is closed 0 0x90 Secure the open end of the IV stake set on the full IV bag to the Stopcock Manifold port located at the twelve o clock position Attaching the Full IV Bag 10 Place the
192. nsupported Log Information dialog box HPS6 Scenario Importing HPS6 Scenario file is Uploaded Please see unsupported log information Asthmatic with chest pain hs6 Initial Home Assessment NOT SUPPORTED PhyslologicParam Elastance Extrathoracic Arteries Initial Home Assessment NOT SUPPORTED PhysiologicParam Elastance Intrathoracic Arteries Initial Home Assessment NOT SUPPORTED PhyslologicParam Sounds Bowel All Mild Asthma Attack NOT SUPPORTED PhysiologicParam Sounds Breath All Mild Asthma Attack NOT SUPPORTED PhysiologicParam Elastance Intrathoracic Arteries Mild Asthma Attack NOT SUPPORTED PhysiologicParam Elastance Extrathoracic Arteries Mila Asthma Attack NOT SUPPORTED PhysiologicParam Sounds Voice Speech Trigger Asthma Attack Worsens NOT SUPPORTED PhyslologicParam Elastance Extrathoracic Arteries Asthma Attack Worsens NOT SUPPORTED PhyslologicParam Elastance intrathoracic Arteries Asthma Attack Worsens NOT SUPPORTED PhyslologicParam Sounds Voice Speech Trigger The Unsupported Log Information Dialog Box This dialog box appears to let users know not all of the data transferred accurately 7 Click Close HPS6 Scenario Importing HPS6 Scenario file is Uploaded Please see unsupported log information Asthmatic with chest pain hs6 ETTTHBETR Initial Home Assessment NOT SUPPORTED PhysiologicParam Elastance Extrathoracic Arteries Click Close Initi
193. nsure proper performance of the system during subsequent simulator exercises 1 Flush the system with one liter of distilled water a Ensure the IV reservoir bag in the rear of the HPS rack has enough room to hold one additional liter of fluid b Replace the IV supply with a 1 liter IV bag of distilled water c Prime the bulb of the IV stake and ensure that flow has started d Allow the water to flow until the bag is empty 2 Close the clamps on both the IV supply and the reservoir 3 Remove the IV bags from the stake sets and drain them appropriately 4 With a large syringe flush the IV port with air as though dispensing a bolus of air until all water is dissipated IMPORTANT The system must be cleaned after each use to prevent damage IMPORTANT The system must be cleaned in the prescribed way to prevent damage to the flowmeter 5 To prevent mold mildew and fungus from growing in the Drug Recognition System it should occasionally be flushed with a 1 liter IV bag of distilled water mixed with 10 mL of white vinegar Follow the procedure above for flushing the system using the vinegar solution then repeat the procedure using plain distilled water The system should be cleaned in this way about once every two months 214 CAE Healthcare Anesthesia and Scavenging Anesthesia and Scavenging The use of the HPS anesthesia features requires the addition of the HPS Anesthesia Delivery System By adding this option
194. ntered 1 Stay on the Rack Edit window after having made the change Connection Lung Driver Gas Analyzer Atmosphere 760 00 Agent GASAN ISO Atmosphere Factor 1 00 The Rack Application Window 2 Click the Save button to save your configuration changes NOTE If the application is terminated or the HPS rack is disconnected before saving the changes will be lost and the original values retained F 5 Appendix F Configuring the HPS Gas Analyzer ry i PS Once the values are saved a dialog box appears The files have been saved on the remote computer Remember to restart your HPS Rack once all changes have been saved The Values Saved dialog box 3 Click Disconnect to disconnect from the HPS Rack The Rack Edit window automatically returns to the Connection window 4 Click on Quit Rack Edit in the task bar RackEdit About Rack Edit Hide Rack Edit 3H Hide Others Show All Quit Rack Edit EQ The Rack Edit Drop down Menu 5 To close the RackEdit Utility select Quit Rack Edit IMPORTANT Power down and restart the HPS system for the changes to take effect muse CAE Healthcare caehealthcare com For more information about CAE Healthcare products contact your regional sales manager or the CAE Healthcare distributor in your country or visit caehealthcare com Tel 1 941 377 5562 or 866 233 6384 For customer service please contact CAE Healthcare
195. ntricular Failure Left Parameter Adjustments Moderate 0 20 40 45 Normal Normal o 7 lele uo SIAI N SIN a Normal Normal Normal s SB Acute Ventricular Failure Left Vital Signs Approximate vital signs after four to five minutes in state Reset Mild Moderate 118 77 122 84 111 81 20 8 Ola 98 74 21 10 24 15 po 2 40 to 41 33 to 34 32 to 33 31 to 32 sw Appendix A Condition Guidelines CAE Healthcare for Programming HPS with Mise Acute Ventricular Failure Right Parameter Adjustments Moderate Severe 0 25 0 12 Acute Ventricular Failure Right Vital Signs Approximate vital signs after four to five minutes in state Moderate Severe o ana J 9 n 135 118 77 106 74 96 70 73 53 9 s a 40 to 41 33 to 34 30 to 31 30 to 31 A 11 Appendix A Condition Guidelines for Programming HPS with M se H pg Idiopathic Hypotension Idiopathic hypotension refers to low blood pressure in a healthy person e 9 young and of healthy weight Idiopathic hypotension is not a disease Idiopathic Hypotension Parameter Adjustments Moderate Severe orz s Idiopathic Hypotension Vital Signs Approximate vital signs after one to two minutes in state Reset Moderate Severe 118 77 105 63 5 5 2 sw Appendix A Condition Guidelines CAE Healthcare for Programming HPS with Mise Acute Hypercapnia The essential mechanism under
196. ntrols The SCE time controls are located at the top of the Run screen The Fast Forward The Timeline bar button The Pause button The Play The Bookmark button button 00 00 29 A x WB Bookmark C WD gt The SCE Time Controls The Timeline bar shows the amount of time that has elapsed and bookmarks that have been created The Bookmark button creates a bookmark at the current point in the SCE The bookmark can be used later to return to this point in the SCE resetting the patient s physiology to what it was when the bookmark was created The Play button starts the SCE if it has been paused The Pause button pauses the SCE time The Fast Forward button accelerates the SCE time at a 4 1 ratio WARNING Using the Pause or Fast Forward buttons or clicking on a bookmark to return to a previous SCE time causes the simulator to disconnect from Muse 80 J CAE Healthcare Using Muse Using Bookmarks To create a bookmark click the Bookmark button An orange bookmark appears on the Timeline bar A bookmark The Timeline bar The Bookmark button 00 02 14 F Bookmark 0 Q The SCE Time Controls To return to a bookmarked time in the SCE 1 Click the orange bookmark on the timeline The Return to Bookmark message appears Return to Bookmark Return the patient to Bookmark 3 at time 00 01 27 The Return button The Return to Bookmark Message 2 Click Return The SCE returns the selected p
197. off the main power switch near the bottom of the back panel of the HPS Lab Rack Step 4 Power Off the Clinical Monitor a Turn off the clinical monitor if used Step 5 Turn Off All Gases a Turn off all gases used with the simulator 248 J CAE Healthcare HPS Care and Maintenance Maintenance Advice Simple care and maintenance helps to ensure the HPS simulator stays in good working condition Many problems are caused by inadequate or improper maintenance Perform a thorough check of the various components each time the simulator is used The Mannequin Avoid the use of writing instruments and sharp objects near the mannequin to prevent unattractive markings on or tears in the skin Ink cannot be removed from the mannequin s skin A mild detergent and warm water remove most marks and stains Gently rub the soiled area with a soft cloth Do NOT use ABRASIVE soaps or pads A citrus based cleaner or a product such as Goof Off may be used to remove stains that cannot be removed with mild detergent and water Follow the manufacturer s practices and warnings when using these types of cleaners Do NOT use ABRASIVE cleaners or pads Prior to using moulage of any kind in your session CAE Healthcare suggests the application of a very light coating of petroleum jelly followed by a light dusting of baby powder to the mannequin s skin This application makes cleaning the skin easier After using moulage use alcohol and gauze
198. ognition If not using Drug Recognition administered IV fluids must be set by the instructor VIEW Fluids PARAMETER S Colloid Infusion Crystalliod Infusion PRBC Infusion Whole Blood Infusion IV fluid administration can also be achieved by using the Intervention palettes VIEW Fluids PARAMETER S Urinary Output Manual Control See IV Access on page 201 All administered IV medications are collected in the bag attached to the DRUG REC OUT hose located on the back of the HPS Lab Rack All administered IV medications are collected in the bag attached to the DRUG REC OUT hose located on the back of the HPS Lab Rack See Genitourinary System on page 195 CAE Healthcare Circulation Circulation can be affected by blood or plasma loss fluid infusion or changes to the contractility of the left or right ventricles Controlling Fluids The Fluids view contains six parameters that affect circulation Fluid Loss Blood Fluid Loss Plasma Colloid Infusion Crystalloid Infusion Packed Red Blood Cells PRBC Infusion Whole Blood Infusion Fluid Parameters Affecting Circulation Reflects a decrease in total blood volume Blood Loss proportionally decreases both the red blood cell volume and the plasma volume according to the current hematocrit Reflects a decrease in plasma volume Fluid Loss decreases the plasma volume without changing the red blood ce
199. oint in the timeline NOTE The SCE time continues moving forward and does not reset to the bookmarked time 81 Using M se HPS Using the Event Recorder to Save States The Event Recorder can be used to save conditions interventions and parameter changes as states To save a state using the Event Recorder 82 1 Apply the desired conditions interventions and parameters 2 Click the Event Recorder button at the bottom of the Muse screen IM Event Recorder The Event Recorder Button The Event Recorder appears displaying all events that have occurred since the start of the SCE Event Recorder Whole Blood Infusion 17 mL hr Events Bag Valve Mask 73 FiO2 The Edit button The Clear button The Save State ME SaveState Edit 7 dear j The Event Recorder WARNING The Clear button deletes all recorded events This action cannot be undone J CAE Healthcare Using Mise 3 Review the list of events If you wish to remove any events from the state to be saved a Click Edit A Delete button appears next to each recorded event Event Recorder wi Events hole Blood Infusion 17 mL hr Delete buttons Bag Valve Mask 7356 FiO2 The Done button The Save State button rb SaveState 4 Done The Event Recorder lum Clear b Click the Delete button next to each event to be removed The events are removed from the Event R
200. om arrival at customer site through departure from customer site CAE Healthcare HPS Care and Maintenance Breakdown After each use the HPS simulator should be properly disassembled and stored in a secure place To ensure that the HPS remains in good working condition follow the prescribed breakdown procedures below These procedures are estimated to take less than 30 minutes Breakdown Steps Step 1 Clean the Simulator and the Fluid System For detailed instructions on cleaning refer to Maintenance Advice on page 249 Step 2 Shut Down the Software To shut down the Muse software on the Instructor Workstation a Inthe Muse software click the Disconnect icon on the Run screen b Stop any running SCEs The Stop Simulation dialog box appears c Click the Stop Simulation button The simulation stops and the Home page is shown d Click the Account Name in the lower right hand corner of the screen The Logout dialog box appears e Click Logout to exit the software To shut down the TouchPro software optional a Click the Settings button in the bottom right hand corner of the TouchPro screen b From the Settings menu click Shutdown A warning box appears asking if you want to exit c Click Shutdown If using a Wireless Remote Control quit Muse using the same steps described above for the Instructor Workstation 247 HPS Care and Maintenance H ps Step 3 Power Off the HPS Lab Rack a Turn
201. on Supine Hypotension Syndrome Obstetrics Venous Air Embolism Pre Eclampsia Allied Health Angina with Cardiac Arrest Asthmatic with Pheumothorax Chronic Obstructive Pulmonary Disease COPD with Respiratory Failure Heart Failure with Pulmonary Edema Inferior Myocardial Infarction Organophosphate Exposure Pneumonia with Septic Shock Severe Young Asthmatic Splenic Rupture with Pheumothorax Stab Wound to the Chest Subdural Hematoma Anaphylaxis Anterior Myocardial Infarction Tension Pneumothorax 55 Using M se Advanced Cardiac Life Support ACLS ACLS Acute Coronary Syndrome ACLS Acute Stroke ACLS Asystole ACLS Bradycardia and Heart Blocks ACLS Pulseless Electrical Activity ACLS Pulseless Ventricular Tachycardia and Ventricular Fibrillation ACLS Respiratory Arrest ACLS Supraventricular Tachycardia ACLS Ventricular Fibrillation AED ACLS Ventricular Tachycardia Advanced Life Support ALS 56 ALS Acute Coronary Syndrome ALS Acute Stroke ALS Asystole ALS Bradycardia and Heart Blocks ALS Pulseless Electrical Activity ALS Pulseless Ventricular Tachycardia and Ventricular Fibrillation ALS Respiratory Arrest ALS Supraventricular Tachycardia ALS Ventricular Fibrillation ALS Ventricular Tachycardia HPS CAE Healthcare Using M se The SCE Summary Panel The SCE Summary Panel provides information about the selected SCE The Review button The Print SCE button can be used to generate a
202. on Biphasic Defibrillation Monophasic Fraction of Inspired Oxygen FiO2 Intubated Nasal Cannula The All Interventions Menu The Intervention Options menu appears showing the available options for the selected intervention 77 Using M se HPS 4 Click the desired option Face Mask Room Air 50 FiO2 60 FiO2 The Intervention Options The intervention is applied and appears in the patient s physiology Transitioning Scenario States from the Run Screen To move between scenario states from the Run screen 1 Click the desired scenario Anaphylaxis Beginning Anaphylaxis 00 00 11 A Scenario The Scenario Management pop up menu appears and all available states are listed Scenarios s Add Scenario Anaphylaxis nar Begining Anaphylaxis Show Scenario STE Beginning Anaphylaxis 00 00 04 Scenari Mild Anaphylaxis sterted Moderate Anaphylaxis 00 00 00 S Severe Anaphylaxis Epinephrine Administered Condition Improves The Scenario Management Pop Up Menu 2 Select the desired state The scenario proceeds to the selected state The scenario can also be paused or continued by selecting the Pause and Play options from the Scenario Management Pop Up menu 78 CAE Healthcare Using M se Transitioning Scenario States from the Scenario Screen To move between scenario states from the Scenario Screen 1 From the Run screen click the desired loaded scenario The Scenario
203. on and the Product and to return same to CAE Healthcare as well as any copies summaries or extracts thereof with any associated CD ROM s DVD keys dongles or other devices as may be directed by CAE Healthcare At CAE Healthcare s request Licensee shall promptly provide a written certificate signed by an officer of Licensee confirming that such items have been returned to CAE Healthcare or destroyed as so directed by CAE Healthcare 45 The following shall survive and continue in full force and effect notwithstanding any termination of this License the obligations of Licensee under Sections 2 License 5 Non Disclosure as well as any other clauses which by their nature and context are intended to survive License Copyright H PS 5 NON DISCLOSURE 5 1 Licensee agrees to keep this License and all Confidential Information obtained hereunder in strict confidence and shall only disclose same a to Authorized Users solely for the Purpose and provided such access to the Product conforms at all times to the terms and conditions governing the use of the Product contained herein or b if required to be disclosed by law and only to the extent of such disclosure and limited to the purpose requested with prior notice to CAE Healthcare to permit it to seek an appropriate remedy to prevent the disclosure or alternatively to agree to the terms of such disclosure 5 2 The obligations of confidentiality use and non disclosure referred to in this S
204. ondition in the New Condition Name dialog box 5 Click Save The condition is added to the selected Condition category and group 6 From the Conditions panel select the new Condition 7 Click the Edit Parameters button The Parameters screen appears 8 From the Parameters screen select the desired Condition parameters 9 Click Complete The condition is saved with the selected parameters New condition categories and groups can also be added by clicking the Add button in the Condition Categories and Condition Groups panels Use the Delete and Rename buttons in each panel to delete or rename a Condition group or category NOTE CAE Healthcare Conditions groups and categories cannot be deleted or renamed 131 Using M se HPS Patient Records Patient records can be uploaded to M se for display in the TouchPro software Once uploaded a patient record is available for use with any SCE Patient Records are managed from the Patient Records panel on the Content Management tab of the System Administration screen Comtent Management Learning Modules Upload Date 01 10 50 19 SCEs Base Patients Patient records Scenarios Conditions Preview z Rename Upload Patient Records Delete i Q er Export The Patient Records Panel The following patient record file types can be uploaded to M se e JPG or JPEG images GIF images PNG images e XPS images PDF documents MPEG videos MOV videos
205. one or both pupils to a specific size Default Reactive Eyes Blinking In Auto mode the eyelids are normally blinking under the following conditions Minute Ventilation is greater than 1500 mL SpO is greater than 7096 and neuromuscular blockade NMB is less than 3096 The Blinking and Closed settings allow the user to have one or both eyes either blinking or closed and override the automatic response Default Auto The Slow Normal and Fast parameters control the eyelid blinking frequency Presently blinking frequency is not linked to the physiological models However the response can be done on the fly or scripted using the Scenario Designer Default Normal Convulsions The Convulsions parameter is used to simulate the presence of convulsions They are either On or Off Default Off CAE Healthcare Appendix B M se Parameter Descriptions Intracranial Pressure ICP The ICP parameter is used to set the ICP displayed as a numeric value on the TouchPro monitor and the patient monitor The base value is set at 8 mmHg This parameter is uninfluenced by physiological models Default 8 mmHg Range 0 mmHg 65 0 mmHg Neuromuscular Blockade NMB The pharmacokinetic and pharmacodynamic models based on the neuromuscular blocking agents administered and the time course of their injection automatically determines the degree of NMB For some educational applications however the instructor may wish to set a fixe
206. ons data information or feedback Feedback on the Product Licensee acknowledges and agrees that such Feedback may be freely used by CAE Healthcare at its sole discretion for the design development improvement marketing and commercialization of its products and services without any restrictions based on confidentiality or intellectual property rights 4 TERM AND TERMINATION 4 1 This License shall become effective as of the date of Your execution of this License and shall remain in effect until terminated as provided hereafter 4 2 This License terminates immediately upon termination of the HEPGTC 4 3 CAE Healthcare may terminate this License immediately upon written notice should Licensee a fail to comply with any of the terms and conditions of this License b terminate or suspend its business make an assignment for the benefit of creditors or any proceedings are instituted by any party or against it seeking to declare it bankrupt or insolvent or seeking liquidation winding up reorganization arrangement adjustment protection relief or composition of its debts under any law relating to bankruptcy insolvency reorganization or relief of debtors or seeking the entry of an order for relief or the appointment of a receiver trustee or other similar official for it or for any substantial part of its property 44 Upon termination of this License Licensee agrees to immediately discontinue use of the Confidential Informati
207. ons such as pneumothorax VIEW Respiratory PARAMETER S Laryngospasm The instructor must adjust the amount of physiologic intrapleural air present VIEW Respiratory PARAMETER S Needle Decompression Intrapleural Vol Left Intrapleural Vol Right VIEW Respiratory PARAMETER S Airway Occluder None required but adjustable VIEW Respiratory PARAMETER S SpO Shunt Fraction None required None required but adjustable VIEW Respiratory PARAMETER S Respiratory Rate Respiratory Rate Factor None required but adjustable VIEW Respiratory PARAMETER S Chest Wall Compliance Factor See Needle Decompression page 181 173 174 Using the HPS H PS Respiratory Features None required None required None required NOTE Low Chest Wall Compliance Factor Distended Chest Wall Compliance Factor and Lung Compliance Factor Left and Right settings may result in lung oscillations If oscillations occur increase the values of these parameters until oscillations disappear NOTE The optional HPS with Muse SCE Development software can be used on a computer other than the Instructor Workstation to create and run SCEs without being connected to the HPS simulator When the same SCEs are run on SCE Development Software and on the Instructor Workstation respiratory responses and vital signs may vary slightly CAE Heatthcare Using the HPS Realistic Upper Airway The
208. ontract for extended maintenance services for all subsequent years Units Out of Agreement For units no longer under warranty requiring repairs the Time and Materials service plan will apply see Time and Materials section To place an out of warranty unit under a warranty contract CAE Healthcare reserves the right to have the patient simulator inspected by a CAE Healthcare approved technician at the customer s expense If necessary the unit would have to be repaired at the customer s expense prior to issuance of a warranty contract The repairs required as the result of the examination will be quoted on a time and material basis 243 HPS Care and Maintenance H ps 244 How to Contact Customer Service CAE Healthcare Customer Service Headquarters United States and Latin America Monday Friday from 7 00 a m to 6 00 p m ET Toll Free 1 866 462 7920 24 hour Hotline 1 941 342 5605 Fax 1 941 342 5600 Email Address customerservice caehealthcare com Web URL www caehealthcare com CAE Healthcare Customer Service Canada Monday Friday from 8 00 a m to 5 00 p m ET Toll Free 1 877 223 6273 Email Address can service caehealthcare com CAE Healthcare Customer Service Europe Middle East and Africa EMEA Monday Friday from 8 00 a m to 5 00 p m CET Phone 49 0 6131 4950354 Fax 49 0 6131 4950351 Email Address international service caehealthcare com CAE Healthcare Customer Service UK an
209. or Apply to save the changes 4 HPS with M se Setup H ps Step 4 Option 1 Join the HPS Network Using a Macintosh Operating System a Click the AirPort icon A located at the top right hand corner of the screen of the TouchPro or Wireless Remote Computer A list appears with the HPS network listed b Select the AirPort network labeled HPSXXX where XXX is the unit number of your HPS Turn AirPort Off HPS Network v HPSXXX Selecting the HPS Network An Airport dialog box appears requesting the password for the HPS network c Enter the password See the note at the end of this step d Click OK ane AirPort The selected AirPort network requires a password to join Wireless Security WPA Personal Password eeeeses l Show password Remember password in my keychain Click OK Cancel DK k Clicking OK The computer has joined the HPS network You can now proceed to Step 5 Depending on your HPS5 router your password has either six or eight characters If the password contains six characters the password is HPS followed by three numbers The numbers are the HPS unit number preceded by the number of zeros required to make the password total six characters Examples HPS123 or HPS012 where 123 or 12 is the HPS unit number Ifthe password contains eight characters the password is HPS followed by five numbers The numbers are the HPS unit number preceded by the numb
210. or Myocardial Infarction 2011 09 12 09 38 39 COPD Exacerbation with Respiratory Fallure 2011 09 12 09 39 10 Elevated Heart Rate 2011 09 12 09 41 01 Scenarios Heroin Overdose 2011 09 12 09 39 41 Inferior Myocardial Infarction 2011 09 12 09 40 13 Organophosphate Exposure 2011 09 12 09 40 39 Es Add The Search utton Add New Q i e q x field The Choose Scenario Dialog Box 2 Select a saved scenario from the Choose Scenario Dialog Box The Search field can be used to search for a scenario to select 3 Click Add The scenario is added to the SCE and is listed on the SCE Editor beneath the Pre Loaded Scenarios heading 102 CAE Healthcare Using M se 4 Click the scenario s name under the Pre Loaded Scenarios heading The Scenario Designer appears displaying the selected scenario Anaphylaxis sere ae deem State p Coapse AM Expand Alt The Scenario Designer 103 Using M se HPS The Scenario Designer The Scenario Designer is accessed by creating or editing a scenario from the SCE Editor From the Scenario Designer scenario states can be added modified and deleted Anaphylaxis The BE denen py emat Expand an Scenario button The View e buttons Canvas The New State e button U The Scenario Designer The Scenario button is used to manage states and save the scenario The View buttons toggle between Scenario Designer views The New State button is used to add
211. or a gentle cleaning solvent as mentioned above followed by soap and a damp cloth to clean the mannequin After using any of the trauma genitourinary or IV features of the HPS carefully flush the mannequin with distilled water Depending on the features you are using this process may require more than one complete flush Failure to flush the systems may cause problems for the system during attempts at future use NOTE For complete flushing instructions please refer to the Using the HPS section of this User Guide Always store the mannequin horizontally Never place anything on top of the mannequin during storage Care of Electronic Equipment Do NOT use any of the computer components associated with this system for any other use Do NOT connect the computer components to any network of any kind Install any CAE Healthcare software updates as soon as they become available 249 HPS Care and Maintenance H ps 250 Checking the Airway The HPS is equipped with an anatomically accurate airway that supports the practice of difficult airway management techniques In the process of performing these techniques improperly or aggressively the upper airway can be damaged While such damage may be readily apparent during mechanical ventilation manifested as a leak in the breathing circuit it may not be obvious during spontaneous or bag and mask ventilation Occasional visual inspection of the airway is recommended Using the
212. ow across the aortic valve Increasing the value to greater than 1 corresponds to increased resistance to blood flow through the aortic valve Default 1 Range 1 1000 Mitral Valve Resistance Factor The Mitral Valve Resistance Factor parameter is used to adjust the resistance to blood flow across the mitral valve Increasing the value to greater than 1 corresponds to increased resistance to blood flow through the mitral valve Default 1 Range 1 1000 Pulmonic Valve Resistance Factor The Pulmonic Valve Resistance Factor parameter is used to adjust the resistance to blood flow across the pulmonic valve Increasing the value to greater than 1 corresponds to increased resistance to blood flow through the pulmonic valve Default 1 Range 1 1000 Pericardiocentesis The Pericardiocentesis parameter is used to activate and deactivate the pericardiocentesis hardware in the mannequin The Prime option is used to prepare and drain the pericardiocentesis feature and has no physiologic impact Default Disable Options Disable Enable Prime B 39 Appendix B M se Parameter Descriptions H p Pulses The table below shows the defaults and ranges for the pulses and pulse deficits for the HPS Default All pulses unless altered by an SCE are enabled by default To disable a pulse click the pulse location on the human form To enable a pulse click the pulse location again Click and hold a pulse location to adjust t
213. ows into the syringe Set the Pericardiocentesis Enable parameter to Enabled For information on cleanup after using the Pericardiocentesis feature see Draining the Pericardiocentesis Feature on page 254 191 192 Fluids Many HPS fluids such as IV Fluid Administration and Urinary Output can be managed from the Fluids view Anatomy Physiology and Clinical Signs IV Access IV Medication Administration IV Fluid Administration Urinary Output Fluids Clinical Interventions Patient Monitoring and Scenarios The right arm of the simulator provides intravenous access locations at the brachial cephalic antecubital and basilic veins IV cannulations receive a flash Bolus injections are administered utilizing standard syringes while continuous IV infusions can be administered using infusion devices Injections can be administered in the IV arm or in two permanent access catheters located at the right jugular and left femoral veins IV fluids can be administered in the IV arm or in the two permanent access catheters located at the right jugular and left femoral veins Urinary output can be controlled by the instructor Software Control None required None required if using Drug Recognition If not using drug recognition administered IV medications must be set by the instructor Medications are administered via the Medications and Interventions palettes None required if using Drug Rec
214. ox appears with the options to Burn Cancel or Eject s Are you sure you want to burn the contents of ECS Ku to a disc cane You can use this disc on any Mac or Windows computer To eject the disc without burning it click Eject Disc Name ECS Burn Speed 24x faster FH Save Burn Folder To ECS Eject Cancel ure Burn CD Dialog Click the Burn button on the dialog box Once burning is complete the CD icon reappears on the desktop To remove the CD from the CD drive drag the CD file to the Trash icon in the Dock The icon changes to an Eject icon and the CD is ejected CDs can also be ejected by selecting the CD icon and choosing the Eject option from the Finder s File menu or by pressing the Eject key Transferring hs6 Files to a New Instructor Workstation Once the hs6 files have been copied they can then be placed on the new computer in a desired location To import the hs6 files insert the CD or USB Device into the Instructor Workstation and drag and drop the files into the desired location The files are ready to use E 6 CAE Healthcare Appendix E hs6 Files and M se Importing HPS6 Scenarios To import hs6 files into M se 1 Log into the M se software The Home Page appears a Healthy Adult Male d aes he The System cor ae ed Administration Sraetima Smokey button m me Dose mula ts to provide facitators with run simutations on t
215. patient experiences increased respiratory distress The patient s HR is in the 110s chi TES The SCE Summary Panel The Add to Favorites button adds the SCE to your Favorites list Content Summary The Run button Clicking the Review button accesses the SCE Editor which can be used to review and edit SCEs Select the Run button to run the SCE 57 Using M se HPS Printing SCEs To print an SCE 58 1 From the Home page select the SCE to print The SCE summary panel appears Anaphylaxis Print SCE Holly Monroe 21 years old sf Add To Favorites Female 70 0 kg Norma L Female Overview Your rescue squad responds to a report of a 21 year old female complaining of trouble breathing She was eating dinner at a cookout when she noticed some tightness in her chest The cook came by asking if anyone wanted another shrimp burger She then told him she was allergic to shellfish She was proceeding to her car to retrieve an epinephrine auto injector when a wasp stung her This SCE consists of six states that manually transition During the initial assessment in State 1 Beginning Anaphylaxis the patient presents with early signs of anaphylaxis HR in the 90s BP in the 100s 50s RR in the 20s and SpO2 in the low 90s on room air She remains conscious The learner is expected to assess and manage the patient s airway breathing and circulatory status ABCs identify early signs of allergic reaction conside
216. podra esi pcd Gu Rd wines 117 Saving States fo the State Library 2 osoausvonia d ARM NK RROR ONE END MIRI ECKE HANK EIU nanny 118 Emptymagthe TES lou aciei idet t Rr De tion Oe uc n Dn evt on ala en n 120 Administrative Tools f 122 TESTO AE OEE EE XE E E A E RO NE CEN UN CENE ET TTE 123 System AGHIMISH IONS onc I SPIRI apr IQ ONU dpi YE E COR AUR 124 VOI DOWD eem 142 LC dr M 144 Using Touch PrO ioieirbs ti ERR Lb FORD EREOOR DH REA X ODE K REDI QRE Re DRM aaas ievada REN GLRD REED NUBE EDEN 147 Accessing the TouchPro Software ssisicsnsessessscecsensessecenssvecsvasenesnssnsisennedsadsvsenandsndsvenneesssehusnsenns 147 Modifying the TouchPro Display sesssssesosesesesososososososssssosossssoseessosososososososssosossssosssssssoseseeo 149 Selecting a Preconfigured Layout essessosssssososssscosessosososososososososossssoosesessososososososssosososssssose 149 Changing a Waveform or Numeric Display esssssssssssssosososoeosososssosossssosessessososososososssosososssssose 151 xvi J CAE teatthcare Table of Contents PRDIDRE RU PSP E ETC UOTIS 152 Addinga Numeric Display PTT M 154 Moving a Waveform or Numeric Display sesesssosssossessosseseosossssoseessosososososososososossssoseessssoseseeo 155 Saving a Layout e n 156 DU
217. possible hazard for the operator When using a manual defibrillator the ECG can be monitored via the defibrillator paddles Coarse ventricular fibrillation and high rate ventricular tachycardia cardiac rhythms are automatically recognized as shockable rhythms With each defibrillation the HPS automatically records the amount of energy discharged and the time defibrillation was performed The simulated patient response to defibrillation is determined by the scenario script or instructor intervention Thus cardioversion is not automatically determined by the physiological models 189 190 Using the HPS HPS For paddle placement on the chest the simulator has two anterior defibrillation disks which can be unscrewed leaving threaded connections if required FBR TEC 2 2 ANNO OS Defibrillation Disks Defibrillation Disks Monophasic defibrillators can be used with paddles or hands free connectors The Defib parameter is available for virtual defibrillation The Defibrillation parameter is located on the Cardiovascular view Cardiac Pacing A standard transthoracic cardiac pacemaker can be connected to the simulator using the anterior and posterior contacts To use this feature attach the metal defibrillation pacing disks to the contacts by screwing them into place Once the disks are in place attach the pacing pads from a standard transthoracic cardiac pacer to the mannequin at the site of the disks The software w
218. r a Puncture To reseal the cricoid feature apply a small piece of red tape over the punctured area This can be repeated a brief number of times but when the number of layers impedes the cricothyrotomy all existing tape must be removed and replaced with new tape Breakaway Teeth The HPS comes with two upper denture plates one with a complete set of teeth and the other with front Breakaway Teeth that can become dislodged with improper handling of a laryngoscope The breakaway denture includes two teeth replacements one with short attachment posts and the other with longer attachment posts The shorter posts make the teeth easier to dislodge during intubation CAE Healthcare Using the HPS Chest Tube A chest tube can be inserted at the midaxillary line of the fifth intercostal space on either side of the simulator For supported chest tube size see Recommended Clinical Supply Sizes on page 259 Using ordinary chest tube equipment fluid and air can be withdrawn from the pleural space The volume removed influences the patient s physiology to reflect improvement in pulmonary mechanics and gas exchange Inserting a Chest Tube To prime the Chest Tube feature 1 Fill an empty IV bag with distilled water Food coloring may be added to the water if desired 2 Attach the IV solution set to the IV bag ensuring the clamp is closed 3 Hang the bag on the back of the HPS Lab Rack 4 Connect the hose from the IV solution
219. r gain overall factor value of less than 1 corresponds to baroreceptor depression A baroreceptor gain overall factor value greater than 1 leads to a stronger response to MAP changes Default 1 Range 0 00 100 00 WJ CAE Healthcare Appendix B M se Parameter Descriptions Baroreceptor Gain Cardiac Factor The Baroreceptor Gain Cardiac Factor parameter selectively adjusts the influence of mean arterial pressure MAP on the heart rate and contractility influencing how much the heart rate increases or decreases with changes in blood pressure Use this parameter to adjust how vigorously the heart responds to blood pressure changes A baroreceptor gain cardiac factor of less than 1 corresponds to baroreflex depression e g less heart rate response to MAP changes A value greater than 1 leads to a stronger response to MAP changes Default 1 Range 0 00 10 00 Baroreceptor Gain Peripheral Factor The Baroreceptor Gain Peripheral Factor parameter adjusts the influence of mean arterial pressure MAP on systemic vascular resistance and venous capacity influencing how much the vasculature responds to changes in blood pressure For example when blood pressure falls the arteries increase their vascular tone resistance and there is less pooling of the blood in the venous system in an attempt to maintain adequate blood pressure A factor of less than 1 corresponds to baroreflex depression e g less systemic va
220. r library by clicking the Open Library button at the bottom of the SCE Selection panel The SCE Library appears The Learning Modules icon F Learning Modules Preconfigured SCEs 1 0 The Learning Modules menu n The SCEs icon The Close sce Library button doen fig New scen The SCE Library The Learning Modules menu is open by default The Learning Modules menu lists Base SCEs Preconfigured SCEs and all installed learning applications Click the desired learning application name to access its SCEs or click Base SCEs or Preconfigured SCEs The selected SCEs appear Clicking the SCEs icon reveals the SCEs menu which lists all user created SCEs Clicking the Learning Modules icon again reveals the Learning Modules menu To open an SCE click the name of the SCE Click Close Library to exit the SCE Library 53 Using M se HPS Base SCEs Base SCEs are fundamental SCEs with no scenarios and no progression of events Each base SCE is designed to provide facilitators with a baseline to run simulations on the fly or as a physiological baseline from which to design their own SCEs To access a base SCE from the SCE Library choose Learning Modules then click Base SCEs The base SCEs are displayed and available for selection There are six base SCEs included with HPS with M se Healthy Adult Male Healthy Adult Female Healthy Soldier Hypertensive Patient Chronic Obstructive Pulmonary Disease
221. r use of oxygen call for help with interventions consider early use of epinephrine and attach a cardiac monitor If more than 120 seconds elapses without administration of epinephrine the instructor should manually advance the SCE to State 2 Mild Anaphylaxis If epinephrine is administered the SCE is advanced to State 5 Epinephrine Administered In State 2 Mild Anaphylaxis the patient experiences increased respiratorv distress The patient s HR is in the 110s ru Review kb Run The SCE Summary Panel 2 From the SCE summary panel click the Print SCE button A PDF of the selected SCE appears in a new browser window The Print SCE button 3 Save the PDF to an external storage device to print from another computer OR To print from the Instructor Workstation consult your network administrator for assistance connecting to a printer 4 When finished saving or printing the PDF close the browser window containing the PDF to return to M se ZW CAE Healthcare Using Mise Running an SCE To run an SCE from the Home screen select an SCE and click the Run button The Run screen can also be accessed from the Scenario Designer or SCE Editor by clicking the Run button near the top of the screen The Run Button The Run screen appears Patient Records The Connect button X bl The Stop button SCE time controls Physiological z Ed S oe display widgets Y Q esc Condition 7i V op
222. raction of Inspired Halothane parameter is only effective when used with SCE Development Software and should not be used with the Instructor Workstation This parameter has a faster effect on physiology than anesthesia machine settings because mixing in the breathing circuit is not simulated NOTE M se does not verify a 100 96 sum of all fractions because this would require all fractions to be set Default 096 Range 0 0096 5 0096 CAE Healthcare Appendix B M se Parameter Descriptions Alveolar Isoflurane The Alveolar Isoflurane parameter is used to simulate the presence of isoflurane in the alveolar space without using real anesthetic vapors The isoflurane percentage is input to the drug models to achieve the expected pharmacodynamic effects e g respiratory depression Using this parameter bypasses pharmacokinetics real and instructor specified inspired fractions venous content lung perfusion and ventilation This parameter can be used to focus on cardiorespiratory effects pharmacodynamics WARNING Using this parameter may result in undesired behavior when switching between SCE Development Software and the Instructor Workstation IMPORTANT Setting an alveolar fraction override on the Instructor Workstation causes the infusion pump to stop NOTE Muse does not verify a 100 sum of all fractions because this would require all fractions to be set Default Modeled Range 0 00 5 00 Fraction of Inspire
223. re present by default NOTE If your simulator is not capable if simulating bowel sounds hide the bowel sounds functionality in Muse prior to logging into the software To hide bowel sounds in the upper right corner of the Muse Start screen select the Simulator Features link then ensure the box next to Bowel Sounds is unchecked 203 Using the HPS H PS Breath Sounds Breath sounds are independently synchronized with ventilation of the left and right lungs Breath sounds can be auscultated over the apex axilla and posterior anatomic locations Breath Sounds Breath sounds can be adjusted by clicking the Sounds button on the Run screen When the Sounds panel appears select Breath Sounds 7 Close Bowel Sounds Breath Sounds Click Breath Normal Normal i Crackles Sounds to access the Breath Sounds Wheezing menu The Breath Sounds Menu Click the Breath Sounds drop down menu to change the type of sound Click and drag the slider to adjust the volume By default Normal breath sounds are heard 204 CAE Heatthcare Using the HPS Heart Sounds Heart sounds are synchronized with the ORS complex of the ECG Heart sounds can be auscultated over the left and right sternal border right lower sternal border and apex By default heart sounds are set to Normal The following sounds are available Heart sounds can be adjusted by clicking the Sounds button on the Run screen When the Sounds panel appe
224. relieve a pneumothorax in the simulator This causes a rush of air to be heard on successful decompression The amount of decompression is automatically subtracted from the Intrapleural Volume set Default Off NOTE The Chest Tube and Needle Decompression features cannot be enabled simultaneously Bronchial Occlusion Left and Right Turning on the Bronchial Occlusion parameter completely obstructs the right or left bronchi simulating a lower airway obstruction e g mucus plug Right and left bronchi can be occluded individually Default Off Respiratory Rate The Respiratory Rate parameter is used to set the respiratory rate to a given number of breaths per minute Once set arterial oxygen and carbon dioxide values have no effect on the resulting respiratory rate but continue to influence other components of the physiological models The patient continues to breathe at the set number of breaths per minute regardless of the arterial oxygen or carbon dioxide levels For example when the respiratory rate is set to 10 breaths per minute the respiratory rate remains at 10 breaths per minute regardless of arterial oxygen or carbon dioxide levels In such situations the patient can only respond to arterial oxygen or carbon dioxide levels by adjusting the Tidal Volume parameter Default Modeled Range 4 breaths per minute 40 breaths per minute B 7 Appendix B M se Parameter Descriptions H PS B 8 Respiratory Rate
225. roing a pressure transducer This may also be used to remove the central venous pressure waveform if desired e g beginning of an SCE with an unmonitored patient Default Right Atrium Options Atmosphere Extrathoracic Vein Intrathoracic Vein Right Atrium Pulmonary Artery PA Catheter The pulmonary artery pressure displayed on the Patient Status Display or TouchPro software is set using this parameter A non pulsatile zero pressure signal is emitted when the Atmosphere position is selected and can be used to simulate zeroing a pressure transducer This may also be used to remove the pulmonary artery pressure waveform if desired e g beginning of an SCE with an unmonitored patient The pulmonary artery catheter can be floated into position by sequencing through the right heart positions This may also be scripted into a scenario using the Scenario Designer Default Pulmonary Artery Options Atmosphere Intrathoracic Vein Right Atrium Right Ventricle Pulmonary Artery CAE Healthcare Appendix B M se Parameter Descriptions PA Balloon Inflation of the pulmonary artery catheter balloon is simulated by switching to the Inflated option of the PA Balloon parameter The appropriate pulmonary artery occlusion or wedge waveform is then displayed on the Patient Status Display or TouchPro software Default Deflated Options Deflated Inflated Defibrillation Defib The Defib parameter is used to simulate
226. rols such as sliders switches and menus In the image below the Heart Rate parameter is shown Within the Heart Rate parameter there are switches that toggle between Modeled and Override and Seconds and Minutes a slider that sets the beats per minute and it s an available field where the beats per minute value can be keyed in The Override Modeled switch The value setting slider The Heart Rate Parameter Once the parameter has been set it is reflected in the patient s physiology 68 CAE Healthcare Using M se Types of Parameters There are two types of parameters numeric and discrete Once a parameter is selected and set the patient s physiology changes according to the model for that parameter Numeric Parameters Numeric parameters set either a measured value e g 20 mL or a multiplied value called a factor e g Heart Rate Factor 2 0 is two times the baseline Heart Rate Numeric parameters are changed by clicking in the relevant field and entering a new value in place of the existing one or using a slider to move through the range of parameter values until the desired numeric value is established Once a measured value is set that value overrides the physiologically modeled parameter value To return to a physiologically modeled value switch the slider in the parameter dialog from Override to Modeled Discrete Parameters Discrete parameters enable users to select one of two or more options
227. rved Defibrillation should be performed on the defibrillation electrodes only If defibrillation is performed over any ECG electrode high voltage may be present on the remaining connectors during the shock This may also damage ECG circuitry To prevent overheating DO NOT provide more than three 3 defibrillation discharges in a sequence per minute during the training session maximum 360 joules with a monophasic defibrillator Avoid a large number of consecutive discharges For example 20 or 25 discharges without any recovery interval may damage the system Leave at least 20 minutes recovery period after a sequence of more than 10 consecutive discharges Avoid a large number of consecutive discharges For example 20 or 25 discharges without any recovery interval may damage the system Do NOT let the simulator come in contact with electrically conductive surfaces or objects during defibrillation A flame supporting atmosphere for example with a high content of oxygen should be avoided during defibrillation Keep the simulator chest dry Special attention should be taken when using the urinary system or the chest tube feature To prevent pitting of the chest skin electrode 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 simulator torso This could damage the system and may also present a
228. ry System Panel The anesthesia delivery system is optional for the Health Science HPS and the Human Patient Simulator HPS When the anesthesia delivery system is installed the syringe pump can be easily accessed from the panel at the top of the rack The access panel AHPS MAN PATIENT SIMULATOR The Anesthesia Delivery System Access Panel NOTE The Anesthesia Delivery System is optional If the system is not installed on your simulator the access panel reveals only an empty bracket 13 Introduction H ps 14 Desktop Instructor Workstation The Desktop Instructor Workstation is a desktop computer that utilizes the M se Software to operate as the main simulation control center The computer runs the underlying mathematical models that generate the physiological data that is realized on the simulator Instructors control the simulator session from the workstation by selecting Simulated Clinical Experiences SCEs that meet the objectives of the training module IMPORTANT All CAE Healthcare computer components are preconfigured for use with the HPS system There are no software installation or configuration steps required Only approved CAE Healthcare applications should be installed or run on the HPS computer system Wireless Remote Control Optional for Health Science HPS The Wireless Remote Control can be used when the use of an Ethernet cable and a power cord is restrictive It is preconfigured with the sam
229. s HPS Cardiovascular Feat reS 5csseossnscacsedasiiansesnsasnaeansbensseanecsnsqasaanaanesadeasaeansanientsnnsivaipannnaussanasanaNn 182 PPS nto specs RE TTE 184 vicini P 185 Myo cardialilscheMid E T TD 186 Manual Blood PASS IRE EET T 187 Korotkoff Sounds Five Phases eese eteententetntnntnntnne tete tnntn tente tnntnnencs 188 ISI It Pe C c 189 Cardiac Pacing c 190 PericardiocEntesis 3 4 5 aee E S ERR S mr MERE bob SE Gea Hd M RO mE 191 QI m s oe 192 101210 eee ene ee nen ee ne eR re eee Onn ae eee ee 193 Genitourinary System sssrini iaire iE R EE E RRR 195 Pharmacology System NR 199 Gastrointestinal Features e 202 Diagnostic Peritoneal Lavage usse iocis Agite rea pel as n Bd onto 202 DID PM 203 PPO sni e 203 Breath SOUN dS cbe Pee imde prt en s e omui dte arua Up 204 bcr Meme E C 205 Wireless Voice Capability ss sroubesas d ord DN ARN RPUA PNG QU NUNG QR ROTARUM 206 Drug Recognition m 207 labels em S 207 Stopcock Manifold E 208 IV Bad aiid Stake SEE ipee ina RNC PHP FK P PERERRRK EVER URNA ERKKEEUPAYEDU CE FAVRE A EE EDEPE UK 208 LE gg cq
230. s can also be exported For more information see History on page 123 Displaying Patient Records Patient records can be uploaded to Muse and displayed in the TouchPro software while an SCE is running To display an uploaded patient record 1 From the Muse Run screen click the Patient Records button The Patient Records Button 62 Z CAE Healthcare Using Mise The Patient Records list appears displaying all available patient records Patient Records Patient records Normal Abdominal Ultrasound The Start Displaying button Start Displaying The Patient Records List 2 Select a patient record from the list 3 Click Start Displaying The patient record is shown in a new TouchPro web browser window IMPORTANT Ensure pop up blocking is turned OFF in the web browser of the Instructor Workstation and any TouchPro workstations Consult the web browser s help menu for assistance NOTE The web browser window containing the patient record may be minimized initially If the window is not readily visible click the web browser icon on the Dock Macintosh Instructor Workstation or Taskbar Windows Instructor Workstation to locate the new window The Patient Records button turns red indicating that a patient record is being displayed The Patient Records Button 63 Using M se HPS The Start Displaying button at the bottom of the Patient Records list changes to a red Stop Displaying button
231. s in the Medications palette click a Quick Link The medication is applied and appears in the patient s physiology NOTE Not all medications affect the patient s physiology but all are logged The Gh Medications Medications Acetaminophen button Albuterol Amiodarone A E E n Quick Links Atrovent Epinephrine 1 1 000 Epinephrine 1 10 000 Furosemide Lidacaina The Medications Palette NOTE Quick Links can only be added while creating or editing an SCE 72 J CAE Healthcare Using Mise Or to apply a medication that is not set up as a Quick Link in the Medications palette 1 Click the Medications button Medications are organized by type and all available medications are listed under ALL MEDICATIONS 2 Navigate through the menus to locate the desired medication 3 Once the medication has been located click the medication s name from the list ALL MEDICATIONS Acetaminophen Activated Charcoal Diphenhydramine The All Medications Menu 73 Using M se HPS 74 The Medication Dose menu appears displaying the pre defined does and custom does routes for the chosen medication Q Morphine Intramuscular IM The custom s ov dose options 1mgiV 2 5 mg iv 5 mg iv 10 mg IV 15 mg IV 20 mg IV 1 mg iO 2 5 mg IO 5 mg 10 10 mg 10 15 mg 10 20 mg iO 5 mg IM 10 mg IM The Medication Dose Menu The predefined dose options 4 Select a dose
232. scular resistance response to MAP changes A value greater than 1 leads to a stronger response to MAP changes Default 1 Range 1 00 10 00 Chest Compression Efficacy The Chest Compression Efficacy parameter is used to determine the effectiveness of the chest compression administered by the caregiver The 10096 setting indicates that chest compressions are completely effective while the 096 setting prevents them from having any effect on intrathoracic pressure Default 10096 Options 10096 096 Tamponade Volume The Tamponade Volume parameter is used to set the amount of fluid or blood that is building up in the space between the myocardium and the pericardium causing a cardiac tamponade Default 0 mL Range 0 mL 500 mL B 37 Appendix B M se Parameter Descriptions H PS B 38 Ischemic Index Sensitivity The Ischemic Index Sensitivity parameter determines the relative sensitivity of the simulated patient to myocardial ischemia A lower ischemic index sensitivity value corresponds to less sensitivity to an unfavorable oxygen supply demand ratio i e poor oxygenation with high heart rate A patient with a low value is less sensitive to poor oxygenation takes longer to go into the death spiral and therefore survives longer Default 0 45 Range 0 10 5 00 Model Driven ECG Rhythm Ischemic Index I 1 The patient s response to myocardial ischemia may be altered using the Ischemic Index Sensitivity
233. see s obligations under Sections 2 License and 5 Non Disclosure hereof would cause serious and irreparable harm to CAE Healthcare which may not be adequately compensated for in damages If the Licensee breaches any of such provisions Licensee consents to an injunction being issued against it restraining it from any further breach of such provision without derogation from any other remedy which CAE Healthcare may have in the event of such a breach 7 WARRANTY LIMITATION OF LIABILITY 7 1 THE SOLE WARRANTIES PROVIDED BY CAE HEALTHCARE ARE LIMITED TO THE WARRANTIES PROVIDED IN THE HEPGTC ANY WARRANTIES PROVIDED ARE PERSONAL AND NOT TRANSFERABLE 7 2 CAE HEALTHCARE S LIABILITY SHALL IN NO CIRCUMSTANCES EXCEED THE LIMITATION OF LIABILITY INDICATED IN THE HEPGTC LIABILITY IF ANY SHALL BE SOLELY FOR DIRECT DAMAGES NOT TO EXCEED ON A CUMULATIVE BASIS THE AMOUNT PAID BY LICENSEE FOR THE PRODUCT 8 GOVERNING LAW 8 1 This Agreement shall be governed by subject to and interpreted according to the laws of the State of Florida U S A without regard to its conflict of law rules In all cases the Parties expressly exclude and waive the application of the United Nations Convention on Commercial Agreements for the International Sale of Goods 1980 Vienna Sales Convention as amended 82 The exclusive forum for the resolution of any and all disputes arising out of or in connection with this Agreement shall be a court of appropriate jurisdictio
234. set to occur over time Default 1 cm H O Range 0 0 cmH O 250 000 0 cmH O CAE Healthcare Appendix B M se Parameter Descriptions Alveolar Enflurane The Alveolar Enflurane parameter is used to simulate the presence of enflurane in the alveolar space without using real anesthetic vapors The enflurane percentage is input to the drug models to achieve the expected pharmacodynamic effects e g respiratory depression Using this parameter bypasses pharmacokinetics real and instructor specified inspired fractions venous content lung perfusion and ventilation This parameter can be used to focus on cardiorespiratory effects pharmacodynamics WARNING Using this parameter may result in undesired behavior when switching between SCE Development Software and the Instructor Workstation IMPORTANT Setting an alveolar fraction override on the Instructor Workstation causes the infusion pump to stop NOTE Muse does not verify a 100 96 sum of all fractions because this would require all fractions to be set Default Modeled Range 0 0096 5 0096 Fraction of Inspired Enflurane The Fraction of Inspired Enflurane parameter is used to simulate the amount of enflurane set in the anesthetic vaporizer and is used to calculate alveolar enflurane The Fraction of Inspired Enflurane parameter is only effective when used with SCE Development Software and should not be used with the Instructor Workstation This parameter has a fast
235. software and convert the files for use with M se The examples shown apply to any hs6 file being converted into M se NOTE hs6 information can be transferred to external storage via a CD or a USB memory device Locating hs6 Files By default custom scenario files are stored in the preset Users Shared folder on the Instructor Workstation s hard drive However files can be stored in any folder on the hard drive i LJ Customer s Scenarios ajr ajsa e J z Q F DEVICES Applications Gi admin E Customer s Patients MB Abnormal ar Old hs6 E Macintosh HD Library fi hps Toe E Abnormal ar Old hs6 TEE G System i Shared WI Abruptio Placentae hs6 Ras Ki User Guide formation E Acute Cor ndrome hs6 gt Wl Adult with Dementia hs6 A Applications F Documents Locating an hs6 File Appendix E hs6 Files and M se HPS Moving Files Using a USB Memory Device Saved files can be moved to another computer using a USB memory device To transfer files using a USB memory device T E4 Insert the USB memory device into an available USB port on the Instructor Workstation An icon appears on the desktop indicating that the memory device has been recognized USB MEMORY DEVIGE USB Memory Device Icon Locate the appropriate folder on the hard drive containing the file s to be saved Drag the file s from the folder on the hard drive to the memory devic
236. stopcock lever in the six o clock position 11 To prime the port open the roller clamp on the IV source bag and allow the fluid to fill up the IV line The Drug Recognition System is now ready for use Note that the system does not accurately register doses unless it is properly primed A test dose can be administered to confirm proper operation by using the Operation steps Compare the dose dispensed with the dose displayed in the Events Log If the registered dose is inaccurate repeat the priming procedures 211 Drug Recognition H PS Operation Once setup is complete a bolus dose of any drug included in the Drug Recognition Barcode sheets can be administered using the steps outlined below T 212 Ensure the entire HPS system is connected and powered on and the M se software is connected to the mannequin Refer HPS with M se Setup on page 25 of this User Guide for complete instructions Fill the desired labeled syringe with distilled water Make sure no air remains in the syringe and the plunger is aligned exactly with the correct graduation on the syringe Insert the syringe into the Stopcock Manifold at the three o clock position The port into which the syringe is inserted should be the only open port on the Stopcock Manifold The barcode on the syringe should be oriented parallel to the LED side of the barcode reader Inserting the Syringe Confirm that the barcode reader is scanning the syringe by observin
237. structor Workstation MUST remain on and connected to the HPS network for the Wireless Remote or TouchPro computers to be able to operate 45 HPS with M se Setup H ps System Requirements If you are not using a TouchPro computer or Wireless Remote provided by CAE Healthcare please be sure to utilize a computer with wireless capability When operating the TouchPro or Muse software a computer with a Macintosh or Microsoft Windows operating system may be used To run the TouchPro or M se software the computer used must meet the following minimum requirements Macintosh Operating System e Mac OS X 10 5 8 minimum e Safari 5 x x or Firefox 10 ESR minimum e Adobe Flash Player 10 1 x x minimum e Adobe Reader 9 x or higher Windows Operating System e XP Service Pack 2 Vista Windows 7 or Windows 8 e Firefox 10 ESR Internet Explorer 8 or Safari 5 x x minimum e Adobe Flash Player 10 1 x x minimum Adobe Reader 9 x or higher Hardware Windows and Macintosh e Intel Core Duo 2 0 GHz minimum e 2 GB DDR3 RAM minimum e 8 GB Hard Drive space available e 1024x768 screen resolution minimum e USB 2 0 e Wireless 802 11b g n Ethernet card e TOOBASE T Ethernet Adapter Macintosh Quicktime and Safari are registered trademarks of Apple Inc Windows Media and Internet Explorer are registered trademarks of the Microsoft Corporation in the United States and or other countries Firefox is a reg
238. supports systolic readings of 67 to 200 mmHg diastolic pressure readings of 42 to 175 mmHg and pulse pressure readings of 25 mmHg and above Store the modified blood pressure cuff with the HPS system Korotkoff Sounds Five Phases Korotkoff sounds can be auscultated on the left arm To auscultate Korotkoff sounds 1 Place the stethoscope on the left arm just above the brachial pulse 2 Let the cuff pressure drop slowly by opening the valve on the bulb slightly 3 Monitor the pressure displayed on the cuff gauge All five phases should be recognized Phase Clear repetitive tapping sounds Systolic Phase Il Longer beats with some swishing sounds Phase Ill Crisp more intense rhythm sounds Phase IV Muffled less distinct sounds Phase V Sounds disappear completely Diastolic CAE Heatthcare Using the HPS Defibrillation The HPS is designed to safely absorb the energy discharged from manual and automatic defibrillators Standard defibrillation energy levels should be used for positive learning reinforcement and to avoid negative training transfer However use of a defibrillator for training purposes represents an operational hazard equivalent to use of a defibrillator on a real patient Consequently ALL SAFETY PRECAUTIONS for the use of defibrillators MUST BE FOLLOWED as if the simulator were a patient Consult the specific defibrillator s user manual for further information The following cautions should be obse
239. t Management The Content Management options appear 124 J CAE Healthcare SCEs The Content Base Patients Management Scenarios options Conditions Patient Records Learning Modules Using Muse The Content Management button Healthy Adult Female a Norma L Female Healthy Adult Male 1 Stan D Antena Ht 53 veers old Maa 70 0 keg Stan D Ar man 11 Healthy Soldier The System Administration Screen From the Learning Modules panel learning applications can be installed or deleted When the Content Management button is selected the Learning Modules panel appears by default If another panel has been selected return to the Learning Modules panel by clicking the Learning Modules link 125 Using M se The Learning Modules link sces Scenarios The Learning Conditions Applications patient Records panel The Install Learning Module button To install a learning application Instat Learning Module The Learning Modules Panel a Condmo Smokey 73 years oi re Mon Healthy Adult Female n Norma L Female 33 years oid n Healthy Adult Male 4 Stan D Ardenan 11 33 years old 70 0 eg Stan D Arman 11 Healthy Soldier 1 Click Install Learning Module The Select file to upload dialog box appears 2 Locate the correct learning application file on the external storage device or the hard drive location where the SCE file is saved The file extension
240. t button The SCE Editor Screen The Profile Editor appears Stan D Ardman II The Change Picture button The Save button The Profile Editor 2 Set the Patient s name age gender and weight by filling in the appropriate fields 3 Click the Change Picture button to change the patient s picture optional 4 Click Save IMPORTANT No part of the patient s profile can contain any special characters such as lt gt 93 Using M se HPS Setting a Patient s Baseline To set the Patient s Baseline 1 From the SCE Editor click Baseline Gunshot Wound The Baseline button The SCE Editor Screen The Patient Baseline screen appears Patient Baseline The Complete button The Patient Baseline Screen 2 Set the Patient s baseline physiology by modifying the desired parameters 3 Click Complete When the SCE begins the Patient presents with the selected baseline settings 94 WJ CAE Healthcare Using Mise Content Management SCE Content is entered from the SCE Editor using the Overview Background Preparation and Notes buttons under the Content Management heading Content Management Overview Background Preparation Notes The Content Management Buttons Each button accesses a screen that allows users to enter information for the chosen section Overview Background Preparation or Notes Click the Edit button of each section on the SCE Editor to a
241. tate 2 Mild Anaphylaxis the patient experiences increased respiratory ctrees The patient s HR is inthe 1108 The Home Page NOTE To activate a fullscreen view in Internet Explorer press F11 to toggle Internet Explorer s fullscreen mode 50 CAE Healthcare Using M se The SCE Selection Panel SCEs are process tools that enable the facilitator to execute a learning strategy using simulation Preconfigured CAE Healthcare SCEs provide an extensive overview and outline of the learning exercise and require minimal additional faculty development time for use Each SCE is comprised of a patient and up to four scenarios Available SCEs appear in the SCE Selection panel on the Home page The Search button The Clear button The Search field Running Now Recent Tabs Asthma Attack Norma L Female Food Poisoning Stan D Ardman II a Healthy Adult Female Norma L Female O Healthy Adult Male 1 The selected SCE Base SCEs a Healthy Soldier GI Stan a Hypertensive Patient Stanley A Wreck Page arrows Page The Open Library rd rd Open ubrary f New sce The SCE Selection Panel N v The New SCE button The SCE Selection panel has four tabs that access SCEs Running Now Recent Favorites and All Running Now tab Lists the SCEs that are currently running and is only available when at least one SCE is running e Recent tab
242. teel needle and stopcock The rack is shipped with the needle and stopcock attached to the metal bar in front of the Anesthesia Delivery System d Detach the needle and stopcock from the metal bar and remove any packing materials e Unlock the glass syringe from the red syringe pump housing by pulling and twisting the spring loaded syringe holder f Remove the syringe from the housing g Remove any packaging materials from the syringe h Screw the stopcock onto the syringe i Ensure the stopcock lever is in the closed position j Place the syringe in the syringe pump housing k Adjust the plunger block on the pump so it is flush with the syringe plunger IMPORTANT Do not over pressurize the syringe with the pump plunger block This may cause anesthetic to be vaporized prematurely Lock down the syringe with the spring loaded syringe holder m Replace the front cover of the HPS Lab Rack NOTE For subsequent use the Anesthesia Delivery System can be accessed through the flip panel at the top of the HPS Lab Rack However when setting up the Anesthesia Delivery System for the first time removing the front cover provides the easiest access to packaged components Step 3 Start Muse a Start the Muse software and perform the normal setup procedures IMPORTANT During lung calibration ensure that the stainless steel stopcock on the glass syringe remains closed to prevent premature anesthetic vaporization b Immediatel
243. tes To set parameters using the Quick Links in the Conditions palette click one of the Quick Links The condition is applied and affects the patient s physiology The Conditions button Q Conditions Apnea BP Hypertension H H Hypotension Quick Links SUM Heart Rate Bradycardla Heart Rate Tachycardia Patient Stability The Conditions Palette NOTE Quick Links can only be added while creating or editing an SCE 70 CAE Healthcare Using M se Or to apply a condition that is not set up as a Quick Link in the Conditions palette 1 Click the Conditions button The Conditions menu appears Conditions are organized by system or all available conditions are listed under ALL CONDITIONS Q Close ALL CONDITIONS Cardiovascular Hemorrhage Neurologic Respiratory The Conditions Menu 2 Navigate the menus to find the desired condition Once the desired condition has been located click the condition s name from the list The condition is applied and affects the patient s physiology 71 Using M se HPS Using the Medications Palette There are two ways to administer medications using the Medications palette using a Quick Link or using the Medications menu Quick Links are preconfigured medications that are made accessible in the Medications palette for quick application Quick Links can also be created for the Conditions and Interventions palettes To set parameters using the Quick Link
244. tesis mechanism exposing the pericardiocentesis orifice In M se from the Cardiovascular view click Pericardiocentesis Enable and select Prime Insert a needle with a 30 mL syringe into the pericardiocentesis reservoir and slowly draw up all the fluid in the reservoir until nothing but air flows into the syringe In M se from the Cardiovascular view click Pericardiocentesis Enable and select Disable Replacing the Needle Decompression Tape The red tape that covers the needle decompression cones inside the mannequin torso should be replaced after each procedure 1 2 Unzip the chest skin to access the left and right needle decompression cones Carefully peel back the red tape on each cone used during the session and replace it with a new piece of tape from the spool included in the mannequin Replacement Kit Once the tape is replaced carefully replace the mannequin chest skin making sure not to disconnect any of the electrical wiring attached to the internal area of the skin covering CAE Healthcare HPS Care and Maintenance Maintaining the IV System After using the IV System in a simulator exercise it must be flushed and purged Complete the following steps to ensure proper performance of the system during subsequent simulator exercises 1 Ensure the HPS Lab Rack is powered on 2 Flush the system with one liter of distilled water a Ensure the IV reservoir bag in the rear of the HPS rack has enough
245. the red tape covering the slit in the cavity 4 Using a syringe push the desired amount of distilled water tinted with food coloring if desired directly into the Diagnostic Peritoneal Lavage abdominal cavity The cavity holds up to one liter of fluid 5 Reseal the tape over the slit in the cavity ensuring the tape is sealed well HPS CAE Heatthcare Using the HPS Sounds A variety of simulated sounds are available to enhance realism A patient must be running on the HPS for any sounds to be available Bowel Sounds Learners can auscultate bowel sounds over each of four intestinal quadrants the Upper Right Upper Left Lower Right and Lower Left The sounds can be independently set in each anatomical region to Normal Hypoactive Hyperactive or None bowel sounds are absent Bowel Sounds Ex zs Bowel sounds can be adjusted by clicking the Sounds button on the Run screen When the Sounds panel appears select Bowel Sounds Bowel Sounds Normal i RUQ Bowe SOSE Normal Hypoactive Hyperactive None LUQ Bovel Sounds Click Bowel Sounds to access the Bowel Sounds menu LLQ Bovel Sounds RLQ Bowel Sounds Microphone Volume The Bowel Sounds Menu Click any one of the Bowel Sounds drop down menus that each control one of four quadrants to change the type of sound Click and drag the slider below the Bowel Sounds drop down menu to adjust the volume Normal bowel sounds a
246. tion To change the language of the M se software 1 From the System Settings panel under the Localization heading Click Change Language The Change Language dialog box appears 2 Select a language from the dialog box 141 Using M se HPS 3 Click Accept The M se user interface changes to the selected language NOTE Only the English version of the User Guide is available via the software regardless of the M se language selection To access the User Guide in other languages please visit www caehealthcare com and click the Support link Account Profile From the Account Profile screen users can view update and reset personal profile information Users can also view and add favorite SCEs from this screen Click the Account Profile button to access the Account Profile features The Account Profile Button The Account Profile screen appears meti admin Email admin meti com Profile Information ID admin First Name meti LastName admin Email admin meti com Favorite SCEs 1D admin Medication Preferences Password Reset Profile Preferences New Password Confirm Password The Account Profile Screen 142 J CAE Healthcare Using Mise Profile Information From the Account Profile screen the Profile Information panel appears by default If another panel has been selected click Profile Information to return to the Profile Information panel From the Profile Information panel users
247. tive Once the MAP reaches the baroreceptor maximum pressure there is no additional reduction in heart rate if the pressure continues to rise For example should the pressure continue to rise the heart rate would not show a corresponding slowing The MAP set point is exactly between baroreceptor maximum pressure and baroreceptor minimum pressure Default 112 mmHg Range 40 mmHg 220 mmHg CAE Healthcare Appendix B M se Parameter Descriptions Baroreceptor Minimum Pressure Baroreceptor minimum pressure defines the mean arterial pressure MAP at which the baroreceptor inhibitory activity on the heart and systemic vasculature is minimal When a simulated patient s MAP decreases below baseline pressure the baroreceptor response exerts inhibitory controls on the MAP e g increase in heart rate in an attempt to return the MAP to the patient s baseline pressure However these controls have a lower limit and this minimum pressure is defined as the baroreceptor minimum pressure In other words as the MAP decreases the physiological controls i e baroreceptor response work to bring the pressure back toward baseline primarily by increasing the heart rate For every 5 mmHg decrease in MAP the heart rate may increase by 2 beats per minute in an attempt to keep the MAP in check However there is a lower limit minimum pressure after which these controls are no longer effective Once the MAP reaches the baroreceptor minim
248. to information on how to use and maintain the HPS system Please be sure to read and follow the Cautions and Warnings on the pages preceding the Table of Contents This is for the safety of users as well as for the protection of the simulator Before using the system follow the step by step instructions included in the HPS with M se Setup section The Using the Software Section section provides instructions on the use of the various software features as well as how to create and save a new patient The Using HPS with M se section includes information on how the simulator and software components work and the functionality that each supports Various clinical interventions are explained in this section along with how these interventions isolate critically important learning objectives In addition detailed instructions are provided on how to develop and save custom patients CAE Healthcare Introduction The Drug Recognition section includes usage and orientation content to use this feature of the HPS system This section also includes content pertaining to the use of the bar code reader The Anesthesia and Scavenging section applies to users with the optional anesthesia package This section provides important usage instructions as well as scavenging guidelines to support the use of this optional equipment component The PediaSIM HPS with M se section is available for users who purchased the HPS PediaSIM The PediaSIM can be pur
249. to the HPS package instructors can test a learner s critical thinking skills and skill acquisition in an area of medicine that has an inherent risk The anesthesia system adds the ability for uptake and distribution of nitrous oxide and volatile anesthetics If you did not purchase the optional Anesthesia Delivery System and would like to add it to your HPS package please contact your CAE Healthcare sales representative Introduction The Human Patient Simulator s lungs consume oxygen produce carbon dioxide and intake and eliminate real nitrous oxide sevoflurane isoflurane enflurane and halothane in accordance with the principles of uptake and distribution This capability is made possible by direct gas exchange within the lungs resulting in realistic inspired concentrations exhaled concentrations and minimum alveolar concentrations MAC and appropriate wash in and wash out In order to control the direct exchange of anesthetic vapor in the HPS lungs a supply of anesthetic is controlled just as analogous supplies of oxygen and carbon dioxide are controlled to create oxygen consumption and carbon dioxide production As a result computer controlled concentrations of gas and vapor flow into the simulated patient s alveolar space accomplishing appropriate consumption production wash in and wash out and alveolar and end tidal concentrations The gas analyzer located in the HPS rack is an integral component controling the anesthetic vapor
250. tomatically when none of the other programmed transitions occur Before specifying an ELSE transition from a state the state must first contain at least one other transition To add an ELSE transition click ELSE in the original state The ELSE menu appears listing all the available states The ELSE button Rapid Trauma Assessment Pulseless Electrical Activity Casualty Evacuation The ELSE menu Unresponsive esr The Scenario Designer Select the desired state A black connector line appears indicating that the states are now linked by an ELSE transition Black connector line The Scenario Designer 114 CAE Healthcare Using M se Deleting Scenario States To delete a state drag and drop the state into the Trash ST Fe opes m edi c a A dragged state The Trash The Scenario Designer States can be dragged and dropped to the Trash from the Graphical view or the Line Item view Deleted states remain in the Trash until you log out of the software or the Trash is cleared 115 Using M se HPS Deleting Parameters and Transitions To delete a parameter or transition from an active state drag and drop the desired parameter or transition into the Trash To drag a parameter click anywhere within the parameter To drag a transition click the yellow selection bar to the left of the transition BE e The yellow 2 selection bar a A dragged transition The
251. trations appropriately reflect the efficacy of ventilation and oxygen administration Arterial Blood Gases PaO PaCO and pH are continuously None required but None required calculated and displayed when adjustable selected for the Patient Status Display VIEW Respiratory PARAMETER S O Consumption CO Production Factor Breakaway Teeth Upper front teeth can be dislodged None required See Breakaway if laryngoscopy is performed Teeth page 178 incorrectly Bronchial Occlusion Completely obstructs right and or left VIEW Respiratory None required mainstem bronchi simulating a lower airway obstruction e g mucus plug PARAMETER S This yields an inability to ventilate the Bronchial Occlusion lungs Chest Excursion Synchronized with ventilation None required None required spontaneous or mechanical Excursion depth proportional to tidal volume Chest Tube Placement Chest tubes can be inserted bilaterally The instructor must See Chest Tube into the midaxillary line of the fifth adjust the amount page 179 intercostal space Suction equipment of physiologic can be applied to withdraw fluid from intrapleural fluid the simulated intrapleural space present VIEW Respiratory PARAMETER S Chest Tube Chest Tube Flow Chest Tube Air Leak Cricothyroid Membrane Allows needle cricothyrotomy None required See transtracheal jet ventilation Cricothyrotomy retrograde wire techniques and page 178
252. ts 4 Health Science HPS Standard Equipment 1 ierit vito orina 5 Health Science HPS Optional Equipment osse epatis aereo bebe enich tni ct oai 5 HPS EDU BIBEDE ioo pa or EHE UQARUH RR DH NECK RAR ERROR rH adi dasan ania KLR ma OR A DEPO RACE MR ACERO E 6 HPS WAMU coacto eor c cao nit Er Oo bes ean dod cercasi Eia 6 iplb deem c 7 Desktop Instructor WoIKSEaHQN iuueni sterio Ure ERR RAO BEA RM REM 14 Wireless Remote COntrOl seoseis xod pa to petes eben etd iia 14 TouchPro MONILOE t n 14 Drug RecogMition Syte M iocans a me urere e n nrbi Dp urn poder id 15 5 w 7 O00 16 Monitor Interface ose Gleason eae ania a au p aba URDU RU DRM EE 16 Wireless Microphone and Receiver c uses eene tetas evaserit axeadaciandncesbeczainne 17 Replacement I MN NR RR RR RR IRR ORE RR 17 xiii Table of Contents HPS Diagnostic Peritoneal Lage e REI ERER cage PUN RORI URN a OB DO iawn 18 Tablet Instructor WOLRST ANION mM 18 Anesthesia Delivery Sy SURI nonnisi aai 18 Anesthesia Gas Accessory RIO edo Un OON Ua RR RUN RN CH ROUES DR HA ONU 18 GaS ACCESSOTY Muss acus cepere end od reto date ebook ideae ere oben enact ae oed 18 Trauma Disaster Casualty kit TDCK no EIE 19 Moulage Kit usse esci cR patat leto n E EE eR td RA Ga EDUC gions wise 19 20 PediaSIM Pl gand Play Mali d
253. uces the intrapleural volume The hissing sound stops when intrapleural volume is zero 181 182 Cardiovascular Features The HPS produces realistic heart sounds and a wide range of pathophysiologic conditions synchronized to the ORS complex of the ECG and audible with a standard stethoscope Anatomy Physiology and Clinical Signs 5 Lead ECG Baroreceptor Reflex Cardiac Pacing Cardiac Rhythms Chest Compression Cardiovascular Features Clinical Interventions Patient Monitoring and Scenarios ECG waveforms can be viewed ona standard monitor and or on the Patient Status Display Normal and abnormal cardiac rhythms are linked to patient physiology e g blood pressure cardiac output Cardiovascular system automatically compensates for changing hemodynamic conditions A transthoracic cardiac pacemaker can be used with the HPS Pacing results in appropriate physiological changes in blood pressure and cardiac output The desired arrhythmia can be selected Effective chest compression results in artificial circulation cardiac output central and peripheral blood pressures palpable pulses and CO return Software Control None required specific rhythms can be selected VIEW Cardiovascular PARAMETER S Cardiac Rhythm None required but adjustable VIEW Cardiovascular PARAMETER S Baroreceptor Maximum Pressure Baroreceptor Minimum Pressure The instructor can set the level at
254. ultiple states They are intended to be used for learner education and training PediaSIM Base SCEs There are two base SCEs for PediaSIM HPS with M se Healthy Female Child Healthy Male Child PediaSIM Preconfigured SCEs Preconfigured SCEs are training tools with scenarios and multiple states They are intended to be used for learner education and training There are four categories of PediaSIM HPS preconfigured SCEs Allied Health Anesthesia Pediatric Advanced Life Support PALS and PALS Europe To access a preconfigured SCE from the SCE Library choose Learning Modules then click the name of the SCE category The SCEs in the chosen category are displayed and available for selection The following preconfigured SCEs are included with PediaSIM HPS with M se Allied Health Accidental Electrocution Accidental Overdose e Closed Head Injury e Diabetic Ketoacidosis with Hypoxemia e Obstructed Airway e Trauma with Pneumothorax 223 PediaSIM SCEs 224 Anesthesia e Cannot Intubate Cannot Ventilate e Epidural High Spinal Foreigh Body Aspiration e Hypertension and Tachycardia e Spontaneous Tension Pneumothorax e Upper Airway Obstruction Asthma Attack e Asystole Bradycardia e Ingestion e Motor Vehicle Crash e Pulseless Electrical Activity e Septic Shock e Shock e Supraventricular and Ventricular Tachycardia e Ventricular Fibrillation PALS Europe Asthma Attack e Asystole e Bra
255. um pressure there is no additional increase in heart rate if the pressure continues to fall For example should the pressure continue to fall the heart rate would not show a corresponding increase The MAP set point is exactly between baroreceptor maximum pressure and baroreceptor minimum pressure Default 72 mmHg Range 20 mmHg 160 mmHg Left Ventricle Contractility Factor The Left Ventricle Contractility Factor parameter adjusts the contractility of the left ventricle and has a direct effect on cardiac output and blood pressure Use this parameter to raise or lower the cardiac output Default 1 Range 0 10 10 00 B 33 Appendix B M se Parameter Descriptions H PS B 34 Right Ventricle Contractility Factor The Right Ventricle Contractility Factor parameter adjusts the contractility of the right ventricle and has a direct effect on pulmonary artery pressure and an inverse effect on central venous pressure Use this parameter to raise or lower pulmonary artery pressure PAP or to change the central venous pressure CVP Default 1 Range 0 10 10 00 Systemic Vascular Resistance Factor The Systemic Vascular Resistance Factor parameter adjusts the baseline systemic vascular resistance Raising the value increases the systemic vascular resistance while lowering the value decreases the vascular resistance Raising the parameter value is analogous to increasing the resistance to blood flow through the systemi
256. upper airway of the HPS is designed to allow for intubation and laryngoscopy Oral and nasal intubation can be performed using a variety of airway devices including endotracheal tubes nasal pharyngeal airways and oropharyngeal airways For supported sizes see Recommended Clinical Supply Sizes on page 259 Intubation incorrectly applied into the esophagus causes abdominal distension IMPORTANT Airways can be damaged by improper insertion of an airway adjunct e 9 endotracheal tube To protect the airway lubricate the adjunct prior to insertion using the silicone spray provided Use ONLY the provided SILICONE SPRAY to lubricate the adjunct NEVER use a water based lubricant because of resulting residue damage Variable Upper Lower Airway Resistance Airway interventions can be necessitated and complicated by a number of variables Located in the Respiratory view are five parameters that affect ventilation and intubation Posterior Pharynx Swelling Swelling of the posterior pharynx can be activated to limit the view of the larynx and hinder intubation but allow mask ventilation of the patient s lungs thereby creating a cannot intubate can ventilate scenario To activate posterior pharynx swelling enable the feature using the Airway Occluder switch on the Respiratory view 175 176 Using the HPS H PS Laryngospasm A laryngospasm actuator closes the patient s vocal cords and prevents both ventilation and intubation
257. ure can be measured None required Use of modified Pressure using the return to flow technique blood pressure cuff Korotkoff sounds can also be auscultated Myocardial Myocardial oxygen supply and demand None required but None required Ischemia automatically influence the cardiac adjustable rhythm yielding response to hypoxemia VIEW Cardiovascular PARAMETER S Ischemic Index Sensitivity Ischemic Index Averaging Pericardiocentesis Subxyphoid pericardiocentesis can The instructor must See be performed to resolve acute cardiac adjust the amount of Pericardiocentesis tamponade physiologic pericardial page 191 fluid present VIEW Cardiovascular PARAMETER S Tamponade Volume Palpable Pulses Carotid brachial radial femoral None required but None required popliteal and pedal pulses can be adjustable palpated bilaterally and are synchronous with the cardiac cycle A pulse deficit VIEW All automatically occurs if the systolic arterial blood pressure falls below specified thresholds 183 Using the HPS H PS Pulses The HPS has 12 palpable pulses Carotid 2 Brachial 2 Radial 2 Femoral 2 Popliteal 2 Pedal 2 Pulses are visible and can be controlled from any physiological view All pulses unless altered by an SCE are enabled by default To disable a pulse click the pulse location on the human form To enable a pulse click the pulse location again Activated pulse Dea
258. ures are set to 50 psig 345 kPa Step 12 Launch M se a Using the Desktop or Tablet Instructor Workstation launch the web browser e g Safari Internet Explorer The Simulator Selection screen appears 36 CAE Healthcare HPS with M se Setup b From the Simulator Selection screen select a simulator Select a simulator Selecting a Simulator The M se Start screen appears c From the M se Start screen select M se Select EN TouchPro Patient Monitor Selecting M se The Login screen appears d On the Login screen enter the Username admin and the Password admin in the appropriate fields to access M se Enter the Username admin and the Password admin eee q D togin Entering the Username and Password M se opens to the Home page by default NOTE Each time you launch M se CAE Healthcare recommends starting a Simulated Clinical Experience SCE letting the SCE run for two minutes and then closing the SCE before proceeding Running and closing the initial SCE prepares the system for accurate clinical behavior moving forward For information about running an SCE see Running an SCE on page 59 37 HPS with M se Setup 38 Configuring a TouchPro or Wireless Remote Computer The HPS network supports up to four computers the Instructor Workstation and three additional computers a Wireless Remote computer and two TouchPro workstations All HPS
259. ventions palette to the list of Quick Links Click the minus sign to remove a Quick Link from the SCE 96 Using M se CAE Healthcare Modifying the TouchPro Setup Use the TouchPro Setup link to access the TouchPro Setup panel From the TouchPro Setup panel TouchPro layouts can be enabled or disabled for the selected SCE When a layout is enabled it is available to be used in the TouchPro software with the selected SCE When a layout is disabled it is unavailable to be used in the TouchPro software with this SCE Click the On Off switch next to a layout to enable or disable it nd TouchPro Pre selected Layout EMS ED Telemetry CI The On Off switch ICU Arterial Line Only ICU OR NO CVP ICU OR The TouchPro Setup Panel 97 Using M se HPS Patient Status Display To configure the Patient Status Display displayed on the Run screen click Patient Status Display under the SCE Configuration heading on the SCE Editor The Patient Status Display screen appears Patient Status Display Available Widgets Th e Ava i a b e Widgets panel Patient Status Display spaces The Patient Status Display Screen To modify the Patient Status Display drag and drop the desired waveform numeric or volume widgets from the Available Widgets panel to an available Patient Status Display space NOTE Waveforms occupy two spaces Once the desired widget is placed click the widget to change the physiologic par
260. w use the slider bar or enter an amount to establish the rate of pressure The Seconds or Minutes field can also be used to establish an onset time Once the desired settings have been selected click Accept PEEP must be set in both the software and on the ventilator 177 178 Using the HPS H PS Cricothyrotomy To replicate a needle cricothyrotomy 1 Spray the silicone lubricant onto the airway adjunct prior to the simulation session 2 Locate the simulated cricothyroid membrane sealed with tape under the neck skin 3 Follow standard clinical techniques and palpate to find the cricothyroid space 4 Puncture the space through the neck skin of the patient simulator and into the tape membrane This puncture goes all the way through to the trachea simulating the clinical procedure Users must replace the tape that simulates the cricothyroid membrane after each cricothyrotomy A replacement neck skin airway lubricant and spools of tape are available in the Replacement Kit Replacing the Cricothyrotomy Tape It is important to replace the red tape that simulates the cricothyroid membrane after each cricothyrotomy procedure In the Replacement Kit is airway lubricant a spool of red tape and additional neck skins Remove the punctured tape and apply a new strip of the red tape ensuring the opening is completely sealed off The neck skin only needs to be replaced when it is showing signs of wear Resealing the Membrane afte
261. waveforms To add a waveform 1 Click the Settings button in the bottom right corner of the TouchPro display The Settings Button The Settings menu opens and the Add Waveform and Remove Waveform buttons appear 2 Click the plus button in the location above which you want the empty waveform to appear An empty waveform field appears The Add Waveform An empty and Remove waveform Waveform field buttons The TouchPro Display Settings 3 Click the empty waveform field 152 Using TouchPro The Wave Vital Selection menu appears Wave Vital Selection ECGI ECG II ECG III ECG V1 ECG V2 ECG V3 ECG V4 ECG V5 ECG V6 ECG aVL ECG aVR ECG aVF ABP PAP CVP Pleth Capnogram Blank Set Alarm SetColor Set Scale The Wave Vital Selection Menu 4 Select the desired waveform from the Wave Vital Selection menu The new waveform is reflected on the screen 153 Using TouchPro HPS Adding a Numeric Display The TouchPro software contains four numeric display fields All four numeric display fields are located on one row beneath the waveform displays When fewer than four numeric readouts are being displayed the remaining fields are blank To add a numeric to a blank display field 1 Click a blank numeric display field A blank numeric field The TouchPro Display The Numeric Vital Selection menu appears Numeric Vital Selection ABP TAxial TBlood TBody CVP C
262. when the pulse pressure increases as a result of a reduced compliance factor both systolic and diastolic pressures increase Conversely with a narrower pulse pressure higher compliance factor both the systolic and diastolic blood pressures also drop Default 1 Range 0 50 5 00 Pulmonary Arteries Compliance Factor The Pulmonary Arteries Compliance Factor parameter adjusts the pulse pressure difference between systolic and diastolic pressures of the simulated patient s pulmonary blood pressure Increases in the compliance factor decrease narrow the pulse pressure while smaller values increase the pulse pressure Additionally when the pulse pressure increases as a result of a reduced compliance factor both systolic and diastolic pulmonary pressures increase Conversely with a narrower pulse pressure higher compliance factor both the systolic and diastolic pulmonary pressures also drop Default 1 Range 0 20 5 00 B 35 Appendix B M se Parameter Descriptions H PS B 36 Pulmonary Vasculature Resistance Factor The Pulmonary Vasculature Resistance Factor parameter adjusts the baseline pulmonary vascular resistance Raising the value increases the pulmonary vascular resistance while lowering the value decreases the vascular resistance Raising the parameter value is analogous to increasing the resistance to blood flow through the pulmonary vasculature Under such conditions the pulmonary artery pressure PAP an
263. wner of any SCEs scenarios or patients created by the user being deleted i e the SCEs scenarios and patients created by the deleted user are moved to the deleting user s account 135 Using M se HPS Groups Users are assigned to groups to define access privileges To access the Groups panel from the System Administration screen click Groups The Groups panel appears Content Management User Accounts roups System Settings The Groups tab Groups Privileges Educators Deactivated Users The Groups panel The New button The Delete M Save button button The Groups Panel NOTE Groups functions are available only to users with the User Management or System Management privilege From the Groups panel users can create new groups delete groups and assign privileges to groups In the Groups panel three groups appear by default e Administrators e Educators e Deactivated Users Each default group has privileges assigned 136 WJ CAE Healthcare Using Mise Privilege System The Mise software has three different privileges System Management User Management Content Management User Management and Content Management can be assigned independently or combined The System Management privilege contains all privileges System Management Users with the System Management privilege have access to all features of the M se software including the benefits of the User Management and
264. wo to three minutes in state Severe Extreme Reset Mild Moderate 108 63 103 62 101 60 96 60 80 57 23 8 24 9 26 10 28 13 241 Condition Guidelines for Programming i PediaSIM HPS with M se PediaSIM HPS References 1 Heller L J amp Morhman D E 2006 Cardiovascular physiology 6th ed McGraw Hill Medical Publishing Division 2 Braunwald E Fauci A Hauser S Jameson J Kasper D amp Longo D Eds 2005 Harrison s manual of medicine 16th ed McGraw Hill Medical Publishing Division 3 Andreoli T E Carpenter C T Griggs R C amp Loscalzo J Eds 2004 Cecil essentials of medicine 6th ed Saunders 242 CAE Healthcare HPS Care and Maintenance HPS Care and Maintenance Maintaining the HPS simulator requires careful treatment of the electronic and mechanical components Each time the simulator is assembled or disassembled make sure all components are properly handled and either removed from or placed into storage correctly HPS Warranty Programs General Information CAE Healthcare patient simulator products come with a one year Manufacturer s Warranty excluding batteries and consumables All warranties begin at date of shipment or CAE Healthcare installation You may upgrade your first year Warranty to an Enhanced Warranty and receive remedial and planned maintenance To prevent equipment downtime and delays after your warranty expires we encourage you to c
265. x B M se Parameter Descriptions Respiratory Additional Parameters Respiratory Parameters Additional Respiratory Rate Tidal Volume Tidal Volume Factor Chest Tube Chest Tube Flow Chest Tube Air Leak O Consumption CO Production Factor PaCO Set point PaO Set point I to E Ratio 1 X PetCO PaCO Factor Respiratory Gain Factor Respiratory Quotient Volume Rate Control Factor Chest Wall Capacity Chest Wall Compliance Factor Distended Chest Wall Compliance Factor Functional Residual Capacity Lung Compliance Factor Left Lung Compliance Factor Right Venous CO Shift Bronchial Resistance Factor Left Bronchial Resistance Factor Right Alveolar Enflurane Fraction of Inspired Enflurane Alveolar Halothane Fraction of Inspired Halothane Alveolar Isoflurane Fraction of Inspired Isoflurane Alveolar Nitrous Oxide Fraction of Inspired Nitrous Oxide Alveolar Sevoflurane Fraction of Inspired Sevoflurane Appendix B M se Parameter Descriptions H PS Respiratory Rate The Respiratory Rate parameter is used to set the respiratory rate to a given number of breaths per minute Once set arterial oxygen and carbon dioxide values have no effect on the resulting respiratory rate but continue to influence other components of the physiological models The patient continues to breathe at the set number of breaths per minute regardless of the arterial oxygen or carbon dioxide levels For example when the respir
266. y edema requiring more pressure for expansion High compliance factors greater than 1 create loose lungs that easily inflate with less pressure Default 1 Range 0 15 10 00 Venous CO Shift The Venous CO Shift parameter affects the partial pressure of CO in the venous blood Changing this parameter allows large and rapid shifts in total body CO concentration Increases in alveolar and arterial CO follow rapidly in a physiologically correct magnitude and time course This parameter is useful for giving a bolus of CO to the venous system The alveolar and arterial CO levels rise rapidly in response to the added carbon dioxide but soon returns to pre bolus levels as increased ventilation efforts work to eliminate the added CO Therefore the rise in CO levels is only transitory This parameter can be used to simulated external CO administration such as that used during laparoscopy NOTE This parameter is only intended to be used while running an SCE SCEs and patients should NOT be saved once the parameter has been applied If an SCE or patient is saved after the Venous CO Shift parameter has been applied unexpected behavior may occur when the SCE or patient is reloaded Default 0 mmHg Range 0 0 mmHg 60 0 mmHg Bronchial Resistance Factor Left and Right The Bronchial Resistance Factor parameter can be used to set the rate of left and right bronchial resistance individually The rate of resistance can also be
267. y prior to starting an SCE carefully open the stainless steel stopcock on the syringe 218 J CAE Healthcare Anesthesia and Scavenging Operation Once the Anesthesia Delivery System is configured its operation is automatic and requires no user intervention Dispense anesthesia to the HPS as you would to a normal patient Cleanup Use the following cleanup steps after each simulation session in which the anesthetic vaporizer system is used 1 Um x Ud INS Quit the M se software For information on quitting M se and shutting down the simulator see Breakdown on page 247 Close the two way stainless steel stopcock on the end of the glass syringe Disconnect the syringe stopcock assembly from the 18 inch stainless steel needle Disconnect the stainless steel needle from the copper block vaporizer Return any unused liquid anesthetic to the original bottle for future use with the HPS Carefully flush with air clean and dry the glass syringe stopcock and stainless steel needle for future use with the HPS Using the quick connects disconnect the inlet and outlet hoses of the copper block from the MFC OUT hoses Reconnect the two MFC OUT hoses to each other removing the vaporizer from the configuration and returning the plumbing to its original configuration IMPORTANT Failure to return the plumbing to the original configuration may result in unrecognized system leaks 219 Anesthesia and Scavenging
268. y the number of zeros required to make the password total six characters Examples HPS123 or HPSO12 where 123 or 12 is the HPS unit number If the password contains eight characters the password is HPS followed by five numbers The numbers are the HPS unit number preceded by the number of zeros required to make the password total eight characters Examples HPS01234 HPS00123 or HPS00012 where 1234 123 or 12 is the HPS unit number The password is case sensitive and HPS is typically all capital letters CAE Healthcare HPS with M se Setup Step 5 Access the Software from the TouchPro or Wireless Remote Computer a Onthe TouchPro computer or Wireless Remote computer launch the web browser e g Safari b Enter the IP address obtained in Step 2 into the browser s address field The Simulator Selection screen appears c From the Simulator Selection screen select a simulator Select a simulator Selecting a Simulator The M se Start screen appears I TouchPro Patient Monitor The M se Start Screen The M se software or the TouchPro software can now be launched and the software can be used in the same fashion as on the Instructor Workstation OPTIONAL From your web browser a bookmark can be created on the TouchPro or Wireless Remote computer for ease of access to the M se or TouchPro software Please consult your web browser s help menu for aid in creating a bookmark IMPORTANT The In

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