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Premie HAL User's Guide

1. CPR Monitors Scenario Click find available to find an available communication port Alternately assign a port manually then click connect The status will not read connected until the F N configuration is completed on the Premie HAL tablet Fetal Neo Link Information Adapter Wireless Network Connection Controller IP 10 0 0 1 Connected to 10 0 0 2 PREMIE HAL GAUMARDUI AUTOMATIC MODE Access the F N setup menu on Premie HAL tablet If the menu is not shown click Setup gt Options gt Other and checkmark Use fetus Neonate Link S ool FA B _C 0O Adv gt Appearance Enter the IP address of the NOELLE tablet and matching port number and click connect Fetal Neo Link Information Noelle Enter the IP and port selected on the controlling computer Controller IP 10 0 0 1 Port Once the connection is established the system is ready to transfer the information between computers Fetal Neo Link Information Noelle Enter the IP and port selected on the controlling computer Controller IP 10 0 0 1 Port 9090 Premie HAL User Guide 97 After the NEO LINK connection is established the fetal vital information will be automatically sent to the Premie HAL tablet when a labor scenario is complete The Data Received window prompts the facilitator to accept the incoming neonatal
2. It is recommended that documents are first saved as XPS files before being printed into hard copies Each evaluation is based on an evaluation template Facilitators can create new evaluation templates to tailor specific assessment needs Template design and creation is done in the evaluation form edit mode To enter the edit mode toggle the Go To button located on the top right of the evaluation form window In edit mode enter the name of the evaluation template in the Evaluation Name field Evaluation Form Load template il Save Clear Delete Evaluation Name Vacuum Delivery On Site Reviewer Category PRIMES IR ee Add Delete Insert A From the Category menu click Add Load template i Save Clear Delete Evaluation Name Vacuum Delivery On Site Reviewer Category pm mm AW ee Premie HAL User Guide 77 Select the Question with answer region category type and enter the category information title To save the changes click OK Category Options 1 Select Category Type Question with answer region Multiple choice Yes No Multiple choice Disagree Neither Agree or Disagree Agree Multiple choice Unacceptable Poor Average Good Perfect 2 Category Information Problem Description The newly created category is shown Evaluation Name Vacuum Delivery On
3. Premie HAL User Guide 35 The Save as Palette Item dialog box is displayed Type in the palette item name and a brief description assign a color tag and click Save Htings LoadPaletteltem Save as Pa Save as Palette Item q Palette Item Name pper Initial state Palette Item Description Patient s initial statel Color Healthy FERRER Care Required Other Save nn _ After the first palette is saved create the next palette item by saving only those vital sign parameters that simulate the second stage in the patient s condition Repeat this process to create palettes for the third and final stage in the scenario If you are creating scenarios for the automatic operating mode recall that the physiologic model s calculations are based on accurate physiologic principles and therefore choosing a combination of vitals that are inconsistent with medical principles will not deliver desirable results After all creating the vital sign palettes go to the Scenario tab and click Add to Scenario 2 Brio Save Scenario Scenario Auto Responses Go to Bi car nching Fa 36 User Guide Premie HAL The Add Palette item menu is shown Select the vital sign palette previously programmed to be first state in the scenario Enter Omin Osec for the transition time so the initial vital signs are applied immediately Click Add to add the p
4. Details Palette Lab Scenario Speech Log Gaumard Lab Reports z Name Template Description Sent Clear Save Cancel Lab Template CBC DIFF kw Color Healthy Critical oO Care O other Report Name Report Time Description CBC Both 4 u Variable Normal Range Value Comment Abs Lymph 0 60 3 10 Abs Netus 1 10 8 00 Basophils 0 00 1 00 Eosinophils 0 00 7 00 Lymphocytes 17 00 45 00 MCH pg 26 00 35 00 MCHC g dL 32 00 36 00 Pepper ee ie Ui l First select a Lab Template from the drop down menu Edit Lab Report Lab Template Lipid Panel las CBC DIFF Description Metabolic Panel Neonate Blood test OB Blood test PPT Report Name Prothrombin Time Provide a Report Name Report Time and Description In addition select a condition color tag for the lab report on the right panel Color tags aid the sorting of lab reports on the report list window A ns Edit Lab Report Lab Template Lipid Panel g Cholesterol HDL LDL Triglycerides Description Gritical Other Report Time 11 15am u Report Name Lab 01 f Description Above normal range Cholesterol LDL Cholesterol 52 User Guide Premie HAL Input the results of the tests on the Value column Values abo
5. On the right adjust the Max Alpha to modify the type of interactivity effect Monitor the graph for a visual model of the plasma concentration e Alpha 1 Additive e Alpha lt 1 Synergistic Induction e Alpha gt 1 Antagonistic Inhibition EZ Max Alpha 0 75 Fr TZ i E T T B a m O z m m Go 190 150 201 Naloxone Narcan mg dL 10 6 Premie HAL User Guide 65 The test panel simulates the interactivity between the drugs based on dosage and time of administration Test Panel Test object weight 75 kg Time Effect Graph Naloxone Narcan interaction pply Naloxone Narcan only Dose 2 mg Attime 9F 06 OF Captopril Capoten only Apply Captopril Capoten Dose 2 mg Attime 01 0 0 Results Attime 00 09 00 Max Interaction Effect 96 17 Alpha 1 00 150 Time min To simulate the interaction first enter the patient s weight and then the dose for each drug Test Panel Test object weight 75 kg Apply Naloxone Narcan Dose 2 mg Attime 0 OF OF Apply Captopril Capoten Dose E mg Attime 05 0 0 Lastly enter the time of administration for each drug and click Update Graph Test Panel Test object weight 75 kg Time Effect Graph A Naloxone Narcan interaction Dose 2 mg Attime 95 107 05 sptopril Capoten Apply Captopril Capoten Dose 25 mg Attime 95
6. 11 The battery on the simulator is depleted Turn off the software and plug charger adapter to the simulator The charger s LED will turn green when the simulator is completely charged Do not turn on the GaumardUI software until the charging process is complete The adapter labeled Power Supply does not recharge the battery RF module not connected Connect the RF module to any USB port Close the software and disconnect the RF module for at least five seconds then plug it back in and restart the software RF module not identified by the computer Is the communication indi cator panel consistently yellow See solution above in section making reference to blinking communication indicator is consistently yellow Is the respiratory rate set to 0 min Chest com pressions are only detected when the respiratory rate is set to 0 per minute 0 min Otherwise they are ignored Set respiration rate to zero 122 User Guide Premie HAL Possible Cause See Calibration Wizard section inside User s Manual All others Artificial ventilations Is the communication indi are not properly cator panel consistently detected or not yellow detected at all All others Simulator s chest Simulator not running does not rise with artificial ventilation e g BVM Low chest rise or no Wrong settings or disabled chest rise at all while breathing Pre built scenarios
7. High Dose Over Dose Select from the following options Unselect Unselect a highlighted drug Current Effects View the effect on the patient s vital signs All effects View all the available programmed drug effects for this medication Drug effect toggle Turn the drug effect off on Controls for fluids and gas administration are found at the bottom of the Drugs page Two fluids can be administered saline or blood Fluids amp Gas Saline v Volume mi Rate ml min SsartW Oxygen v Concentration Rate L min Starto To apply any of these options including oxygen select the desired choice and specify the volume or concentration and the rate Then click on Start IV or Start O2 You can pause the administration at any time by clicking Stop Fluids amp Gas Saline X Volume ml Rate ml min Start IV Oxygen Concentration 100 Rate 4 L min Start 07 58 User Guide Premie HAL To add new drugs edit or update existing items and program drug interactions click the Manage Drug List button Change Dose and or Rate Warp Factor Volume ml Rate Concentration Co Rate Care Provided Select a drug from the Medication List and click edit to view the medication s properties Add New Medication New Medication Medication Response Medication List Epinephrine Primatene Adrenalin EC50 0 0095 mg dl Concentration that pro
8. 8 Pace Previous End Premie HAL User Guide 43 In the example below node 2 is configured with four alternate paths Once the provider performs any one of the actions listed as key events the facilitator will checkmark the key event to alter the trajectory of the node sequence 2 Deteriorate oo A 3 gt gt Wait 02 00 No changes are made to manikin E Atropine F1 fey B Speech 1 00 01 confusion What happened E Cardio Drop 01 00 HR 15 BP 10 OSat 5 gt 4 E Epinephrine EA fey B Additem Add scenario Copy Remove Add path gt dns E Dopamine F1 el CI a 6 E Pace fe CI gt 8 If the provider administers Dopamine the facilitator checkmarks the Dopamine key event to progress the scenario to node 6 Node 6 is programmed with the effects of the medication l J C JS Dopamine PCR a 00 01 E gt ee Node Start ee vital signs palettes simulate bradycardia Go to node bradycardia Vital signs palettes deteriorate the patient s condition by 15 Care provider has 4 options Each option key event moves the scenario to the node specified If no action is taken the scenario will move to node 3 at the end of the Deteriorate time limit p Keyevent S p Keyevent S Atropine Epinephrine Dopamine Node 4 Node 5 Node 6 Wait indefinitely vital signs are on hold Provi
9. Save Interactor Data Half Life 00 30 00 Peak Time 00 45 00 i E e 0 SD 40mg OD 120mg b gt EC50 2 6400mg dL Test Panel Test object weight 75 kg Apply Naloxone Narcan interaction 2 Aspirin Bayer only Dose 2 mg Attime 271 1091 05 Furosemide Lasix on Apply Furosemide Lasix Dose 40 mg Attime 05 10 Results Attime 02 12 51 Max Interaction Effect 22 07 Alpha 1 68 Compared to Additive individual drug effect reduced by 39 70 i 200 300 40 Time min Furosemide Lasix mg dL ho 05 10 15 20 Aspirin Bayer mg dL Time Effect Graph First select the drug from the drug list that will be programmed to interact with the current medication and click Add Information about the interactor drug is displayed in the Interactor Data window ol ZT Uo Immy EC50 0 0001mg dL Interactors Remove Remove All OOo Eit Drug List Captopril Capoten Interactor Data Half Life 01 54 00 Peak Time 01 00 00 SD 25mg Ob 73mg ER 0 0240mg dL 64 User Guide Premie HAL Once added the drug is shown in the interactors list Repeat the process to add more drugs to the interactors list if necessary Interactors Sodium Nitroprusside Nitropress Drug List Select the interactor and click Edit Interactors Captopril Capoten Sodium Nitroprusside Nitropress
10. 106 User Guide Premie HAL The Pro system is an all in one session recording and simulator control solution for facilitators in a lab or mobile environment The built in GaumardUI software allows the facilitator to control Premie HAL while recording care provider interaction and event logs The upgrade replaces the standard tablet with a convertible touchscreen laptop loaded with the Pro environment and GaumardUl 2 WIFI enabled cameras 1 motorized 180 view USB camera and carrying case For more information on using the Pro system refer to the documentation included with the upgrade option Appendix Premie HAL User Guide 107 More about Scenarios Factory Preset Scenarios Scenario Operating Type mode Scenario Title Name 1 Diabetic Mother Diabetic Mother Branching Manual 2 Ductal Dependant Heart Lesion HLHS Linear Manual 3 Group B Sepsis and Secondary Group B Sepsis Branching Manual Apnea 4 Hyaline Membrane Disease HMD Linear Manual 5 Meconium Aspiration and Meconium Branching Manual Pneumonia Aspiration 6 Necrotizing Enterocolitis NEC Branching Manual 7 Normal Normal Branching Manual 8 Patent Ductus Arteriosus PDA Branching Manual 9 Pneumothorax Pneumothorax Linear Manual Meds Profile 1 Adenosine OD Adenosine OD Linear Automatic 2 Adenosine SD Adenosine SD Linear Automatic 3 Adenosine UD Adenosine UD Linear Automatic 108 User Guide Premie HAL Gaumard ln
11. 45 0 Results Attime 01 27 03 Max Interaction Effect 93 38 Alpha 1 01 Compared to Additive individual drug effect reduced by 0 08 Time min The results indicate that the maximum interaction effect 93 38 occurs at 01 27 03 The alpha at that point is 1 01 and the drug effect for each drug is reduced by 0 08 If the drug interaction effect is not realistic fine tune the Max Alpha control and retest Results At time 01 27 03 Max Interaction Effect 93 38 Alpha 1 01 Compared to Additive individual drug effect reduced by 0 08 66 User Guide Premie HAL A time effect graph is also generated from the test results Tap and hold to draw a zoom area Time Effect Graph interaction Naloxone Narcan only Le 15 200 Time min interaction Naloxone Naran only Capoten anh Copy Save Image As Page Setup Print Show Point Values Set Scale to Default After all the interactors are configured and tested click on Finish to save the interaction settings 24 Max Alpha 1 1 Isobologram plasma concentration Premie HAL User Guide 67 Lastly review all the properties of the new medication and click Add to save In the example below two drugs programmed with interactions have been administered The physiologic model has detected the interaction and displays additional information for the f
12. Indude contents of Default Include contents w of Quick Start Premie HAL O OR g Copy current profile Premie HAL User Guide 17 Environment The GaumardUl environment is used by the facilitator as the simulation command center In addition to controlling the simulator s functionality and vital signs the facilitator can evaluate student training This powerful combination of tools provides the facilitator with an indispensable tool for simulation training and testing The Status panel is visible along the left edge of the GaumardUI window at all times After the connection with the simulator is established the status panel displays the current information about the battery level signal strength volume controls levels and vital signs in real time Click the right arrow to expand the status viewer File Setup Monitors Status oD I Appearance Skin Color MANUAL MODE AUTOMATIC MODE Status ll Status ll 4 Appearance A B co Adv ig Skin Color Appearance Circulation Cardiac m Crying Skin Color MG Tricuspid Valve H Airway A eee Throat Sound none In pen 9 Pulmonary Valve PTS oz Regurgitation Resistance Ber a A Mitral Valve sae tom wie Breath orate carn 9 Lo PR Penn OSat Postductal 59 RA 100 RV 100 EtCO2 40 mmHg LA 100 LV 100 Resp Pattern Circulation Cardiac Rhythm Rate 12 Sinus arrhythmia er Circulatory
13. 1 Exit the GaumardUI software and disconnect the RF module on the control computer 2 Connect the RF module to the virtual monitor computer 3 Verify that both computers are connected to the ad hoc network e g GaumardNet 4 Initialize the GaumardUI software on the tablet computer and on the menu bar click Setup gt Remote Access via Network Premie HAL User Guide 87 The Remote Access via Network Window is displayed 5 Select the Remote access via network option Remote Access Via Network Standard RF Communication Remote Access Via Network Remote Access Via Network m PRES 6 On the adapter list select Wireless Network Connection If the option is greyed click the Stop button first 7 Click Find available to auto assign a port for this connection 8 Write down the Controller IP and Port number then click the Connect button The status will not show connected until the last step of this guide 9 Open the Gaumard Monitors software on the virtual monitor computer 10 Click the V menu and select Remote access Via Network Please wait 30 seconds for the feature to initialize 11 Enter the Controller IP and port number as shown on step 7 and click Connect The Non Scenario Automatic Response feature allows the facilitator to set preprogrammed responses to electrical th
14. A 32 week premie remains cyanotic despite breathing HMD A teenage mother who received no prenatal care delivered a 1300g infant in L D Pneumothorax Infant delivered at 32 weeks had no respiratory effort at birth The baby required intubation and is now on a ventilator set at 40 bom The mother received regular prenatal care and was given two doses of antenatal steroids prior to delivery Diabetic Mother A thirty two week infant is born to a 23 year old insulin dependent mother who was diagnosed at age 21 She is classified as Type B and has been followed in the high risk clinic Suction and stimulation have already been applied Scenario Description Group B Sepsis A mother with no prenatal care delivers a premature baby with foul smelling amniotic fluid in the emergency room The baby is being bagged with O2 Meconium Aspiration 31 week infant delivered with thick meconium staining Baby is not breathing and meconium aspiration is suspected with possible pneumonia A two week old premature infant began enteral feeds a week ago He required some resuscitation at birth for perinatal asphyxia and received antibiotics for possible sepsis His nurse reports increasing gastric residuals and a few episodes of apnea and increasing abdominal girths A mother is admitted to the hospital for preterm labor She has had good prenatal care and her dates show the infant to be approximately 32 weeks She received two doses of antenatal steroids her membranes
15. Agreement In the event of termination you agree to immediately return this Software accompanying items and any copies thereof to Gaumard 6 LIMITED WARRANTY A THE CD ROM MEDIA THE MEDIA WHICH CONTAINS THIS SOFTWARE IS WARRANTED FOR A PERIOD OF 30 DAYS FROM THE DATE OF PURCHASE TO BE FREE FROM DEFECTS IN MATERIAL AND WORKMANSHIP ELECTRONIC TRANSMISSION IS WARRANTED TO BE FREE FROM DEFECTS AT THE MOMENT OF TRANSMISSION YOUR SOLE AND EXCLUSIVE REMEDY AND GAUMARD S SOLE LIABILITY IS TO REPLACE THE DEFECTIVE MEDIA OR TO REPEAT THE ELECTRONIC TRANSMISSION PROVIDED THAT YOU NOTIFY GAUMARD IN WRITING OF SUCH DEFECT OR DEFECTIVE TRANSMISSION AND RETURN THE DEFECTIVE MEDIA IF ANY DURING THE 30 DAY WARRANTY PERIOD B EXCEPT AND TO THE EXTENT EXPRESSLY PROVIDED IN PARAGRAPH A THE SOFTWARE AND ACCOMPANYING WRITTEN MATERIALS ARE PROVIDED ON AN AS IS BASIS WITHOUT ANY WARRANTIES OF ANY KIND INCLUDING BUT NOT LIMITED TO ANY IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR ANY PARTICULAR PURPOSE NO ORAL OR WRITTEN INFORMATION OR ADVICE GIVEN BY GAUMARD ITS DEALERS DISTRIBUTORS AGENTS OR EMPLOYEES SHALL CREATE A WARRANTY OR IN ANY WAY INCREASE THE SCOPE OF THIS WARRANTY AND YOU MAY NOT RELY ON ANY SUCH INFORMATION OR ADVICE GAUMARD DOES NOT WARRANT GUARANTEE OR MAKE ANY REPRESENTATIONS REGARDING THE USE OR THE RESULTS OF USE OF THE SOFTWARE OR WRITTEN MATERIALS IN TERMS OF CORRECTNESS ACCURACY RELIABILITY CURRENTNESS OR
16. Charles Parker As shown in the Log Page image a colored button is inserted on the Team Logging region for the provider just added There can be up to 6 different providers each with a corresponding button Every time one of the provider buttons is clicked that person becomes the active provider To indicate the active provider the vertical bars on each side of the Log page will match the color chosen for that person On the Log Page image for example the provider Charles Parker is the active provider so the vertical bars are teal colored While there is an active provider every time a Provider Action or Evaluation log entry is created it will have the name of the provider added to it as follows 00 07 41 Charles Parker Action Check for pulses brachial To deactivate deselect the active provider and return to general logging click the Team button and the vertical bars will return to neutral color All provider buttons can be edited or deleted by right clicking them and selecting an option from the menu The session info area contains the Session Title and Facilitator fields at the top of the page These fields are included when a report is saved or printed Details Palette Lab Scenario Model Log Gaumard Session Title Sirnulation 101 Facilitator John Eggert Providers z Charles Parter eam Add m Emergency Reported Airway Breathing Circulation ba Assessresponsi
17. Details Palette Scenario Labor Lab nr Log Clear Load Save Auto Res ponses Go to Normal Scenario fm ee Se 40 User Guide Premie HAL Click the node s identifier number to edit the node properties Enter a name for the node and description then click Save Node Properties Unique Identifier 1 Description Click Add Item to add palette items or Add Scenario to add full scenarios to this node m a Start Bradycardia E I J cc ae In this example the following nodes are created 1 Start Bradycardia 2 Deteriorate 3 Interventions 4 Atropine 5 Epinephrine 6 Dopamine and 7 Pace Each node is programmed with palettes that simulate the effect described copy Remove addpath gt Premie HAL User Guide 41 path refers to the trajectory from one node to another after the last palette in a node expires Click on the Time Limit icon to modify the Go To point for the default path Time imit E gt End Path Go to Add path gt Configure the countdown timer and the go to point for the default path Click OK to save Set Time Limit min Sec OF 1 59 59 Max Go to 2 Deteriorate z After the last palette expires the scenario will move on to the node as indicated by the arrow Node 1 is now configured to
18. EME multichoice is enabled rer External Pacing Defibrillation Shock Cardioversiol off O off Er O off Prompt Prompt RR Prompt Auto 4 Auto nn Auto The following message is displayed if electrical therapy is detected and the cardiac irritability on the details page does not match the selection on the responses window N Defibrillation shock detected Shock 3 300 Joules But current cardiac irritability does NOT allow rhythm to change Drug Model Effect Configure the auto response behavior when the administration of a medication is detected e Auto Apply the drug effects based on medication s programmed properties and dosage e Prompt Display a confirm prompt before applying the drug s effects 2 0ug of Naloxone Narcan through IV_Push has just been Administered This dose will be treated as StandardDose Do you want this drug to take the following effect Standard Dose v View Effect C Reverse effect when the drug s level begins to drop me eu Premie HAL User Guide 89 Manually select the best possible RF channel for tablet simulator communications by selecting Setup then Scan RF channels The following notice displays while the scan is in progress When the scan is complete a series of bars will display with the highest bar indicating the best signal On mouseover a popup will dis
19. HAL operating To recharge the battery turn off the GaumardUI software and connect the adapter labeled Charger The volume of each sound can be adjusted from the Status Panel Click on the volume level indicator next to each sound and a volume control will display Select the volume level you want and the sound will be adjusted instantly on the simulator i e there is no need to click Apply Throat Sound Throat Sound _ normal _ i Breathing I Breathing 4 A normal Resp Pattern Resp Pattern Breathi Ra Cc Respirato 20 User Guide Premie HAL The standby button is located on the bottom right corner of the GaumardUI software Use the standby mode to save battery power between exercises Premie HAL will establish a connection less than one minute after resuming from standby The connection bars will display the connection strength confirming that the wireless RF link between the controller and model has been established Premie HAL User Guide 21 Details It is best to think of controlling the simulator in terms of three levels of complexity Details then the Palette and finally Scenarios From the details tab facilitators can manually control the simulator s vitals enable disable features or complications and create palette items later used to build labor scenarios Changing controls directly from the details page is the simplest form of control availa
20. OTHERWISE AND THE ENTIRE RISK AS TO THE RESULTS AND PERFORMANCE OF THE SOFTWARE IS ASSUMED BY YOU IF THE SOFTWARE OR WRITTEN MATERIALS ARE DEFECTIVE YOU AND NOT GAUMARD OR ITS DEALERS DISTRIBUTORS AGENTS OR EMPLOYEES ASSUME THE ENTIRE COST OF ALL NECESSARY SERVICING REPAIR OR CORRECTION OTHER THAN EXPRESSLY DESCRIBED ABOVE 4 User Guide Premie HAL C NEITHER GAUMARD NOR ANYONE ELSE WHO HAS BEEN INVOLVED IN THE CREATION PRODUCTION OR DELIVERY OF THIS PRODUCT SHALL BE LIABLE FOR ANY DIRECT INDIRECT CONSEQUENTIAL OR INCIDENTAL DAMAGES INCLUDING DAMAGES FOR LOSS OF BUSINESS PROFITS BUSINESS INTERRUPTION LOSS OF BUSINESS INFORMATION AND THE LIKE ARISING OUT OF THE USE OR INABILITY TO USE SUCH PRODUCT OR RELATED TO THIS AGREEMENT EVEN IF GAUMARD HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH DAMAGES GAUMARD SHALL NOT BE LIABLE TO YOU FOR ANY INDIRECT SPECIAL INCIDENTAL OR CONSEQUENTIAL DAMAGES OR LOST PROFITS ARISING OUT OF OR RELATED TO THIS AGREEMENT OR YOUR USE OF THE SOFTWARE AND OR THE RELATED DOCUMENTATION EVEN IF GAUMARD HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH DAMAGES IN NO EVENT SHALL GAUMARD S LIABILITY HERE UNDER IF ANY EXCEED THE PURCHASE PRICE PAID BY YOU FOR THE SOFTWARE ALL RIGHTS NOT EXPRESSLY GRANTED IN THIS LICENSE AGREEMENT ARE RESERVED BY GAUMARD BY INSTALLATION OF THIS SOFTWARE YOU ACKNOWLEDGE THAT YOU HAVE READ AND UNDERSTAND THE FORE GOING AND THAT YOU AGREE TO BE BOUND BY ITS TERMS AND CONDITI
21. Sinus x Blood Pressure L R assel Diameter Tidal Volume 8 ml aa F Lost beats 100 Right Lung arm 36 27 mmHg Heart Rate 160 bpm snd leg 36 27 mmHg Vessel Stiffness a mms Left Lung S a a PRES Respirato arm 36 27 OSat Other Be Pressure 1 00ATM leg 36 27 mmHg Preductal 96 Inspire O2 21 ae en a 0 Temperature 36 8 C B Glucose 70 mg d ph 7 26 B Glucose 70 mg dL EtCO2 41 mmHg A 2 c Shunt Flow 32 CRT 2 sc Dead Space 7 mi 18 User Guide Premie HAL Status panel entries and features mirror the simulator s hardware configuration Light blue icons show active features and values undergoing changes are highlighted yellow Click on the volume bars to adjust the volume of each sound Some status panel entries and features might not be visible depending on the simulator s hardware configuration Battery Level sa vom i Control Active sa normal OSat Preductal 74 OSat Postductal 74 ED 55 mmHg Circulation SN Cardiac Rhythm Lost beats 100 Heart Rate 160 bom Heart Sound l Blood Pressure arm 37 27 mmHg leg 37 27 mmHg Temperature 36 8 C B Glucose 70 ma dLl CRT 2 sec Premie HAL User Guide 19 The communication indicator shows the status of the radio link between the control computer and the simulator Full bars indicate excellent communication between the computer and the simulator i e nor
22. Site Reviewer Category 1 Problem description Click Add to include another category Select the Multiple choice category type enter the category information title and click OK Category Options 1 Select Category Type Question with answer region Multiple choice Yes No Multiple choice Disagree Neither Agree or Disagree Agree Multiple choice Unacceptable Poor Average Good Perfect 2 Category Information Provider Tasks and performance 78 User Guide Premie HAL Highlight the Provider tasks and performance category and then click Add from the Multiple Choice Entry menu On Site Reviewer Category Multiple Choice Entry 2 PASSENT 1 Problem Description 2 Provider Tasks and performance Yes No N A Enter the multiple choice information in the entry fields Category Multiple Choice Entry 2 a Remove tne pve co te 1 Problem Description 2 Provider Tasks and performance Physician Provider introduces themselves to the patient Repeat the previous steps to add more categories questions and multiple choice options Category Multiple Choice Entry 2 bene se em ny ct fr Fm How would you rate teamwork during this delivery emergency 5 Communication Unnaceptable Poor Average Good Perfect N A Overall Communication Rating Orient new members SBAR Transparent thinking Directed c
23. and Scenarios sections of this guide it should be clear how to build a scenario You may have already tried building your own or modifying some of the factory presets The following four guidelines will refine your ability to build the best possible scenarios 1 How will the scenario begin The first thing to consider is the initial condition of the patient Create a Palette Item to describe this condition Make sure that this first step in the scenario is a complete state that is indicate some selection for each and every available setting on the Details page Remember that only the settings you specify will cause a change in Premie HAL and all other settings will remain constant So by starting with a complete state Premie HAL s condition will always be the same when the scenario starts regardless of what he was doing previously Likewise the transition duration of the first step in the scenario should be zero indicating that changes are applied immediately There is one point that can cause confusion and warrants further explanation It is an extension of the above discussion of partial states The issue is best illustrated through the following example Suppose that you are creating a Palette Item to start your scenario In this case you have decided that the patient will be apneic The question is How should the lung sounds be set Most people s first inclination is to set the lung sounds to none This is incorrect despite
24. apnea Obviously no lung sounds should be heard during apnea but since you have already set respiratory rate to zero none will be Sounds are synchronized to the breathing cycle What you are really setting here when you choose a lung sound is the condition of the lungs given respiratory drive That is if the patient s respiratory rate were changed from zero what sound would be heard Assuming that the lungs themselves are normal in this scenario you would choose normal for the lung sound setting Then as the scenario progresses if the patient starts breathing there will be no need to set the lung sound again It will already be set The same principle applies to the heart sound and other settings 2 Include notes to guide the facilitator during the simulation It is common for scenario designers especially those who act as facilitators to neglect the importance of notes in the scenario They think that they will remember the learning objectives patient history and other details at the time they are ready to conduct the simulation They usually don t especially when revisiting a scenario months after creating it When you add Wait and Wait Indefinitely steps to a scenario you have an opportunity to edit the item description Use this description field to hold notes to the facilitator Typically scenario designers write notes in that space to indicate what the provider s or facilitator should be doing at that point Fu
25. applies the following vital sign parameter changes NSR 75 bpm BP 120 80 Click on the palette button to program a specific palette item as the auto response Defibrillation Shock Off O Prompt Auto Setting at Joules Shocks convert to NSR 75 bpm BP 120 80 200 7 The Load Palette Item window is displayed Select the desired palette and click Load Load Palette Item Palette Healthy Resting Q Improvement Item Description normal vitals Posessesssnssnssuvsussevsensensenssnseneenees The desired palette is now displayed in the Setting section Defibrillation Shock Ca O off q Prompt RL q Auto gt G Setting g E 200 Joules Shocks The auto response is now configured to automatically apply the Healthy Resting palette if a virtual defibrillation shock of 200 Joules or greater is detected AUTOMATIC MODE NON SCENARIO AUTOMATIC RESPONSES The additional auto responses listed below are unique to the automatic mode Link All Auto Response to Cardiac Irritability Auto responses will work only if the cardiac irritability option on the details page matches the selection on this window Non scenario automatic responses settings aof Link All Auto Response to Cardiac Irritability Modeling DE great random i O Off slight improve On if Cardiac Irritability is
26. available for the Automatic operating mode are Default Modeling includes one preprogrammed palette with healthy vital signs Meds Profile contains a library of preprogrammed medications Quick Start Premie Modeling includes four linear scenarios and six branching scenario allowing instant simulation of a wide range of conditions For more information on each of the scenario exercises included with the Quick Start profile go to page 47 Profiles store palette scenario and option settings independently changes made to one profile have no effect on the others Below are some examples on how profiles are used e Assign one profile to each user of your Gaumard simulator system e Use profiles to organize and protect palettes and scenarios e Create a profile dedicated to a specific academic course taught by multiple instructors e Devote an entire profile to one particular subject area or even one particular scenario To create a new profile click New Profile Manage rm sie a nit Rename Delete Enter a name for the new profile followed by a description To include scenarios and palettes from other profiles click the check box For security enable PIN protection and enter a four digit key Finally click create to save the new profile To import and export profiles navigate to page 81 Create New Profile Profile Name Winter Session Profile Description
27. don t show up A sound is absent or Volume not set to user s is not heard at criterion desired volume level See solution above in section making reference to blinking communication indicator is consistently yellow See Calibration Wizard section inside User s Manual In some simulators the trachea is disconnected from the lungs when they are not on Enable the lungs from Detail page on the GaumardUl software Make sure lungs are enabled and both respiration rate and inspiration percent are different than 0 Try changing the respiration rate to a different value and if still nothing happens try turning the restart the simulator Select Quick Start Scenarios when Starting the software Should user forget to do so there s no need to shut down the software and open it again in order to load the pre built scenarios Go to File Profile menu and then select Modeled Scenarios Every sound has a volume control Play with the volume control to get it to the desired level Premie HAL User Guide 123 Diagnostics On the menu bard click Help gt Diagnostics to open the module diagnostics window The diagnostics window is used to test the status of each of the modules equipped in the simulator during troubleshooting Click Check All Modules to perform a full status test Active modules report light blue and inactive modules report black If there is a specific module
28. made for backup purposes You may not network this Software or allow multiple users unless you purchased a multi user workstation license Sharing this Software with other individuals or allowing other individuals to view the contents of this Software is in violation of this license 2 Copyright The Software is owned by Gaumard and protected by United States copyright laws and international treaty provisions Therefore you must treat this Software like any other copyrighted material You may not make this Software or copies thereof available in any manner or form or use copy or transfer the Software in whole or in part except as provided herein 3 Other Restrictions You may not rent or lease this Software to any other party You may not alter merge modify adapt reverse engineer decompile or disassemble the software or disclose the contents of this Software to any other party 4 Electronic Transmission of Software If you received the Software by electronic transmission or by Internet delivery by installation of the Software you acknowledge that you have read and understand this license agreement and agree to be bound by its terms and conditions 5 Term of Agreement The term of this Agreement and the license granted to you pursuant hereto shall commence upon installation of this Software This Agreement and the license granted herein may otherwise be terminated by Gaumard in the event that you are in breach of any provision of this
29. of third party A V recording systems Checkmark the Use AV System to enable the AV setup option on the menu bar For more information about the A V menu go to page 97 Checkmark Use Fetus Neonate Link to enable the F N setup menu on the menu bar For more information about using the Neonate Link feature go to page 87 General Premie Features Environment Premie Hal Add Ons E Once a Palette is applied load to Details Tab Link Respiration sensor to ECG Leads sensors E Use Fetus Neonate Link E Use AV System Start AV Automatically on Scenario Start Output Log Events to Windows Log The Remote Access via Network connection feature allows the simulator to receive control commands from the virtual monitor computer stationed at the bedside In this configuration the RF module is connected to the virtual monitor computer instead of the control tablet The close proximity between the RF module and the simulator may provide better connectivity in environments with solid walls between the simulator and the control computer On the menu bar click Setup gt Remote Access via Network to open the configuration window To use this alternate configuration first install the USB RF module drivers on the virtual monitor computer Navigate to www Gaumard com to download the USB RF module drivers and then transfer them to the virtual monitor computer using a USB flash drive
30. page 95 e S T A B L E Activate the S T A B L E scenarios e Automatic Mode Activate the Automatic mode and the physiologic model NEWBORN HAL s Add Ons add even more fidelity to your simulation NEWBORN HAL Virtual Monitor Use Newborn Hal Virtual Vital Signs Monitor 5 1 ABLE This tab allows the facilitator to e Enable auto saving of the log e Save your current log report e Enable stand by warning e Select units SI or English e Enable electrical therapy virtual shock panel Premie HAL User Guide 85 Options Premie Hal Add Ons Premie Features Tolerances Auto Save Enable Log Auto Save Auto save every Session Timer Reset session timer once scenario is started Electrical therapy Panel Show defibrillation cardioversion pacer panel Stand by warning Warn the first time trying to apply settings when system is on Stand By mode Units International System SI Imperial OK Cancel Checkmark the Defibrillation Cardioversion Panel to show the virtual Shock Panel shortcut on the main screen cm Denise vi Gaumard Legend Oo of The shock panel is a floating control used by the facilitator to administer electrical therapy to the patient via software For more information on working with the shock panel during a scenario go to page 22 Shock Pace Panel Oo 86 User Guide Premie HAL C
31. part of a scenario Scenario Items may also represent a fixed delay period Wait or a pause Wait Indefinitely Stylus a special pointing device for the tablet computer The stylus is the fastest and easiest means of controlling the Premie HAL software See the Equipment Set up section of this guide for more information on working with the stylus 10 User Guide Premie HAL Equipment Set up Premie HAL User Guide 11 Control Tablet Computer The touchscreen tablet computer serves as the simulator s control center Startup and control commands are sent from the Gaumard control software GaumardUl to the simulator wirelessly using the RF communication module shown in the next section Please refer to the computer s documentation for important user and safety information before powering on the tablet computer for the first time The stylus operates very much like a mouse You will notice that the pointer moves when the stylus is held near but without touching the screen Tapping the screen with the Stylus tip is like clicking the primary usually left mouse button Holding the stylus button while tapping the screen is like clicking the secondary usually right mouse button For working with the Gaumard control software and many other applications the Stylus input is far superior to a mouse in both speed and comfort An additional advantage is it can be easily calibrated for your personal comfort Th
32. patient age gender height weight and or additional notes Then click Save To load an already existing patient go to Modeling Modeling Patient Load Patient Load Model Patient Select Last Modified 11 05 2010 16 02 56 11 05 2010 16 02 56 11 05 2010 16 02 58 11 05 2010 16 02 58 11 05 2010 16 02 58 11 05 2010 16 03 00 11 05 2010 16 03 00 Patient Informatid Premie is 28 week 25 0 cm His weight 11 05 2010 16 03 00 Zrereserenenne Select the desired patient and click on Load Notice that the factory pre set patient Premie cannot be deleted as opposed to any of the patients that you create yourself which can be deleted Patient information is displayed on the right side and near the top of the Details tab Clicking on Reset Model under the Modeling drop down menu will restore all vitals and physiologic controls to normal state For instance if the ECG rhythm is currently on Ventricular Fibrillation clicking on reset model changes the ECG rhythm back to Sinus Use the Import between patients menu to import palettes scenarios and branching scenarios from other patient profiles into the current active one en Import Between Patients Importing Select Anthony Brent Then select the patient name that contains the items that will be imported into the active Scenarios Branching Scenarios start State patie
33. specified Selected Item Wait 00 45 Care provider intervention and assessment A Send Lab Lab Results 1 00 00 Lab results are sent to the Gaumard Monitors screen Hoye Deteriorating 00 30 Patients vital signs deteriorate 20 in 30 seconds _ Wait Indefinitely Hold in current state until action is taken Improvement 00 45 Vital signs improve 50 in 45 seconds Healthy Resting 00 00 normal vitals are loaded immediately After the scenario is completed click Save Scenario to store the scenario in the current profile for later use Details Palette Scenario Lab Speech Log Save Scenario Scenario Name Allergy to medication Scenario Description Demo scenario 38 User Guide Premie HAL Instructors can also incorporate the following features into a scenario for added realism e Auto responses Automatically move onto the next palette item when electric therapy is detected e File sharing and lab reports Send lab reports to the virtual monitor computer The scenario can also automate the distribution of shared files and labs Click on the Add to scenario button the select the File and Lab tabs to view the files available For more information making files available for file sharing go to page 92 and to create a new lab report go to page 49 o 1 O OF H 59 59 Max Item Description Lab results are sent to the Gaumard Monitors screen Add Pale
34. that fails to respond please contact customer support Modules for features not installed on the simulator will report inactive Audio Mechanical Other Legend Throat voice V 5 M 5 R 0 Ecc Active Trachea Intubation Inactive Heart V 5 M 5 R 0 Check Modules Lung Front Upper Right Val NA Carotid Check Single Lung Front Upper Left V 1 M 5 R 0 Radial Right Modules Radial Left Cyanosis KK Right V 5 M 5 R 0 Lung Right Virtual Temperature kK Left V 5 M 5 R 0 Lung Left Bowel Upper Right Vol NA Breathing Right Arm Motion Left Arm Motion Pressure er Right EP Left Ventilation Compression Compressor To perform an individual module check first select the module and click Check Single Module Notice that the name of the module is displayed on the right column when it is selected Check Modules 124 User Guide Premie HAL Replacement Parts Contact Gaumard Scientific for a complete list of consumables and replacement parts and their prices C Consumables R Replacements A Accessories U Upgrades M Factory Repair ONLY S3009 001 A C Virtual Monitor A A C Powered 17 Touch Screen monitor and desktop S3009 002 D C Virtual Monitor A D C Powered 12 Touch Screen Mobile Monitor with stylus S3009 080 Simulated Blood Concentrate C S3009 081 Silicone Oil C Oil based silicone lubricant S3009 200 Audio amp Video Rec
35. the Evaluation panel will be prepended with the provider s name For more information on Team Logging see the previous section of this guide on Logging Model Log_ Gaumard Session Title Simulation 101 Facilitator John Eggert Providers SIE Details Palette Lab Scenario Evaluation Form The evaluation tool assists facilitators in reporting and assessing provider interaction using a questionnaire form completed evaluation form can then be stored as a digital document or printed for distribution Log Gaumard Facilitator Several evaluation templates are built in to GaumardUI s evaluation tool Each template includes a set of multiple choice questions related to the type of assessment being performed To begin select an evaluation template from the Load Template dropdown New templates created in the edit mode will also be listed Evaluation Form Load template Breech Vaginal Delivery Evaluation Nar orceps Delivery On Site Reviey Postpartum Hemorrhage Shoulder Dystocia Vacuum Delivery Insert Arid Delete Insert w Enter the name of the facilitator performing the review in the On Site Reviewer field Evaluation Form Load template Eclamptic Seizure iv Clear Print GoTo Edit Mode Evaluation Name Eclamptic
36. the current profile Quick Launch Details Palette Scenario Model Lab Log Scenario te tj Branch Scenario wee Build new scenarios to expand the number of exercises available in a training program The general process of creating a new linear scenario is the following e Create a vital sign palette item for each state in the scenario e Add the vital signs palettes and wait times to the scenario e Play the scenario e Modify and edit palettes e Save the scenario The first step is to create several vital sign palette items using the Details tab Each palette item will represent a physiological state in the patient s condition during the scenario Remember to program the vital signs for the target state the transition time will handle trending the values lt is recommended that the first vital signs palette includes instructions for all of the physiological parameters sound types and volumes By specifying each parameter at the beginning of the scenario you will ensure that no vital signs are inherited from a previous exercise Enter the vital signs for the first physiological state in the scenario and click the Save as Palette Item button Shock Panel Mater D Tongue Edema Pharyngeal Swelling Laryngospasm Upper Airway Sound ol m Left Lung Right Lung Resp Pattern Apnea ka el Chest Rice chest Rice
37. time to gradually increase or decrease to the numerical value specified e g heart rate blood pressure in the time allotted The right most button can be customized to any transition time you require by clicking the part of the button labeled Edit Please note that settings not specified will remain unchanged Some settings are applied immediately such as cardiac rhythm and breathing pattern while numerical settings such as heart rate and respiratory rate can be easily made to transition As transitions are applied the time remaining in the transition is displayed in the Clocks panel at the bottom of the GaumardUI window If there is already an ongoing transition at the moment you click an Apply button it will stop and a new transition will begin from the current physiological state J Clocks E Transition remaining 00 00 09 Session 00 05 03 Ni Premie HAL User Guide 23 When cardiac rhythm is maintained at Ventricular Tachycardia for one minute the following prompt dialog box will be displayed Ventricular Tachycardia x i 1 minute has passed since the patient is in Ventricular tachycardia do you wish to degrade to Ventricular fibrillation Click NO to re check the Cardiac Rhythm in one minute No Cancel Click Yes to degrade the cardiac rhythm to ventricular fibrillation Click No to maintain the card
38. using the shortcut key Alt F4 You can also exit by clicking on the x button at the top right corner of the user interface Monitors CPR A V Help Calibration Options Remote Access Via Network Auto Responses Scan RF Channels This tool allows you to easily calibrate the sensors inside the simulator First choose which function you would like to calibrate chest compressions artificial ventilations or blood pressure cuff Calibration Calibration Wizard Welcome to the Manikin s calibration wizard Proceed only after you have reviewed the calibration section in the user manual Please select the function you would like to calibrate Chest Compressions Artificial Ventilation The procedures for each specific calibration are described in the sections below COMPRESSIONS ARTIFICIAL VENTILATIONS This tool helps you calibrate the chest compressions and the artificial ventilations to your specific criteria That is you will be telling the system what a correct chest compression is and or what a correct artificial ventilation is Providers will be evaluated by the system based on this criteria The chest compressions and ventilations are calibrated the same way After making a selection this window is displayed The software will now ask you to perform a number of correct chest compressions or artificial ventilations depending on what you are calibrating Ca
39. 0 00 01 The shortcut key for staring a new session is Ctrl N Clicking on Reset Session Clock resets the clock back to zero It does not have any effect on the transition time remaining on a scenario it does not reset the vital signs or clear out loaded scenarios The session clock may also be reset by clicking on the Session button next to the session time This option allows all the information recorded in the log page to be saved as a text file Clicking on it brings up the Save As dialog box Save in Gaumard User Interface 2 em di Automatic installationFiles My Recent Ai Labs Documents d manikins my recordings network profiles amp profiles2 di resources ryms My Network Save as type Text files txt t Select the desired name and path and click Save The shortcut key for saving a report is Ctrl S For a sample report look at the figure below jort 1 1xt Notepad Fie Edt Format iew Help 10 1 14 2008 12 16 22 or oviders Te aam model to Brent foo O03 Details ETCO2 19 model to erent 00 00 Details EtCO2 14 p C 1 ET s del model ta mn vony 09 09 _ oevat Is RR 12 ECO 40 Info 00 J Start Applied ogee action Coo 700 Palette Start State betails Ahythm Asystole AR 0 Ins 5 model to ADENY 003 00 f Details RR 12 Inspire 33 Detalls RR 0 ms on 0 Palette vfib
40. 2 petals negim ventricular fibril Palet I V Tach er Details Rhythm ventricular tach 115 HR 120 ib ren 37 Is HR 120 HR 120 HR 120 HR 120 WR 120 RR 16 EtCO2 38 15 Hs 120 I HR 120 ils Be 30 is 25 is Exco2 20 s Ercoe 14 1s Etcoz 9 Details Eich 45 FE Of HeartSnd normal LSLU normal This option allows printing a text file containing all the information in the log for the latest session Clicking on Print Report brings up the Print dialog box The shortcut key for this option is Ctrl P Premie HAL User Guide 81 This tool allows the import of palettes scenarios or modeling patients that may have been created in another tablet PC When Import is clicked the Open dialog box displays Look in Quick Start Newbom a O28 amp amp E baby deteriorates plt 4 Asphyxia Sen E APGAR 2 pit E Beth s Baby 1 plt My Recent d Beth s Donna s Baby es APGAR 3 plt El Beth s Baby 2 plt Documents _ Cynthia s baby E APGAR 4 plt E C Section Delivery plt a Elaine s Baby E APGAR 5 plt E Cardiopulmo decline plt Francines s Baby e APGAR 6 plt E Comp Response plt B Gloria s Baby E APGAR 7 plt E Continued response plt dd Helen s Irene s Baby E APGAR 8 plt E Cynthia s Baby 1 plt e APGAR 9 plt E Cynthia s Baby 2 plt e APGAR 10 plt E Cynthia s Baby 3 plt E apnea plt E Cynthia s Baby 4 plt Alice s Baby 1 plt eg Asphyxia 1 plt E Cynt
41. IBP O Sat EtCO2 Temp ABP Time a A A g AESI The figure below shows two new values Glucose level and hematocrit levels Return to the custom parameter menu on the GaumardUI software to update the values when necessary On the GaumardUI menu bar click Monitors gt Configuration to open the virtual monitor setup window Use the virtual monitor setup window to verify the connection between the GaumardUl software and the Gaumard Monitors vital signs software re configure the communication ports and view the controller IP address To troubleshoot connectivity ISSUES go to page 121 Newborn HAL Virtual Monitor Setup Select the number of monitors that will be used with this manikin Also you can name each monitor with an appropiate description O Al sensors always ON except tor Swan Ganz Adapter Controller IP 10 0 1 1 Port 8001 Connected to 10 0 1 2 Stop CPR GaumardUI features a CPR performance evaluator and trainer On the menu bar click CPR gt Evaluator to access the CPR Evaluator window File Setup Monitors Status oE I Bette Options Tongue Edema The CPR evaluator feature provides real time feedback on the provider s compression and ventilation performance He Gaumard Scientific CPR Evaluator 0 10 30 Compression Data 26 Ventilation Data Rate Ct LE Rate PIP Ti 0 0 2 00 00 0 133 2 4 I E PEEP LV 1 0 6 14 12 Too Many Compr
42. L s conductive skin sites allow the attachment of real EKG electrodes This feature permits the user to track cardiac rhythms with their own equipment just like with a human patient A few special concerns are described below Premie HAL does not accept real electrical therapy Do not pace or defibrillate Premie HAL with real electrical equipment The Gaumard User Interface features a virtual electrical therapy function to simulate defibrillation or pacing Premie HAL User Guide 7 Getting Started 8 User Guide Premie HAL Overview e Tetherless and fully responsive even while being transported e Powered from an internal rechargeable battery or wall outlet using power adapter e Battery capable of 300 recharges and e Simulator receives commands from a wireless tablet PC and operate at distances up to 150 feet e Option to operate automatically using Automatic mode or manually by the Instructor e Training Guide with both basic and advanced interactive scenarios e Use pre programmed scenarios modify them or create your own quickly and easily e Installation and training worldwide e Simulation Made Easy e Oral and nasal intubation e Use an ET tube or LMA e Unilateral chest rise with right main stem intubation e Multiple upper airway sounds e Heart sounds include a normal heart as well as atrial and ventricular septal defects e Chest compressions are measured and logged e Palp
43. ONS YOU ALSO AGREE THAT THIS AGREEMENT IS THE COMPLETE AND EXCLUSIVE STATEMENT OF AGREEMENT BETWEEN THE PARTIES AND SUPERSEDES ALL PROPOSED OR PRIOR AGREEMENTS ORAL OR WRITTEN AND ANY OTHER COMMUNICATIONS BETWEEN THE PARTIES RELATING TO THE LICENSE DESCRIBED HEREIN Premie HAL User Guide 5 Care and Cautions 6 User Guide Premie HAL Overall Warnings Remember that damage caused by misuse is not covered by your warranty It is critical to understand and comply with the following guidelines Additional warnings are found throughout the documentation If the simulator will not be used for an extended period re charge the battery at least once every 3 months to prevent damage to the battery Do not attempt to intubate without lubricating the airway adjunct with a silicone oil lubricant provided Failure to do so will make intubation very difficult and is likely to result in damage NEVER disconnect the communications module while the GaumardUI software is running The software will halt and the module may be damaged When simulating drug administration via endotracheal tube providers must use an empty syringe Passing liquids into the trachea or esophagus may cause internal damage Premie HAL should be cleaned with a cloth dampened with diluted liquid dishwashing soap If medical adhesives remain on the skin clean with alcohol wipes DO NOT USE GOO GONE as the citric acid in the formula will cause pit
44. P 83 54 02 Sat 9 eit In Progress indicator Wait palette items During the scenario each vital signs palette updates the patient s condition As outlined previously palette items are created using the Details tab The transition time trends the increase or decrease of numerical vital signs such as blood pressure over seconds or minutes Wait palettes do not update or change vital signs Instead wait palettes give the provider time to perform an action this may be treatment in response to a complication or performing a standard assessment Premie HAL User Guide 33 Scenarios are controlled using the buttons at the bottom of the tab The same way a music player plays songs the scenario plays palette items Intuitively the facilitator can play stop pause skip or repeat items as necessary Wait Indefinitely Wait for suction and O2 BR Asphyxia 3 00 30 Limp RR 0 02 Sat 70 HR 55 BP 35 20 Wait Indefinitely Wait for ventilations and chest compressions Asphyxia 1 01 00 Crying none NSR HR 140 RR 40 BP 83 54 02 Sat 95 Previous palette Fi An unfilled triangle means that the scenario is stopped When the Play button is clicked the item pointed by the indicator is be played gt A rapidly blinking triangle means that the scenario is playing the item to which the indicator is pointing A slowly blinking triangle means that the scenario is paused at the item to which
45. Premie HAL Premature Neonatal Simulator 53009 Gaumard Simulators for Health Care Education User Guide B 12 7 1 Premie HAL is an interactive educational system developed to Gaumard Scientific Company 2012 assist a certified instructor It is not a substitute for a All Rights Reserved comprehensive understanding of the subject matter and not G d intended for clinical decision making hal El 1 2 User Guide Premie HAL Contents GONIENIS ane da eee era en ue ie rere a ace etat 3 End User License Agreement uuu uu002n00nan0nnnnnnanunnnnunnnnnnnnunnanunannnnanennnnn 4 Care and Cautions iscscssccsssconvasececsccacssesvascocsavecussenteasescarcosssessesvetesracsssesueesutersress 6 Overall VV ATOS RS RS een ti ie 7 BIECENEAN TI N RADN es en ana einer 7 Getting Started s aedini nedin e iaa haaha e ha a 8 OY COW noce e TER TO 9 TEMNO O V cesna a e ee tert er meen aa ne a a a S 10 E GUIDMENL Del UD er naeh 11 Control Tabler Compu asane ne ee 12 Premie MAL AS ONY en 13 WELLE MIN IO MORE n a a ee AR Smee re it 14 Working with GaumardUl u a 15 TANIA Frome HAL se ae een nee 16 Prones and Operating MOSS ae ea 16 ENVILORMIENT ee ee een essen aus sine Cie pese 18 DET See een nee en eier 22 ROIS Re a dd een ad ae ae 32 SCEN AE S ed ed dei 33 AR an dt de aie es at a dd din 49 Drugs Automatic Mode On sde else 55 MOTOS de du tere en sc eee 69 KO A A ams ke RD EIER RL 70 PVA Om ON ee ee ee eu ee M een ne 74 OVS
46. Seizure On Site Reviewer James C Date 08 08 2011 1 Problems Identified 74 User Guide Premie HAL Complete the form by first entering the written response in the Problems Identified field and selecting the applicable multiple choice responses throughout Janes U Vale VOJ UOJ ZUILI 1 Problems Identified Eclamptic Seizure a m 2 Provider Tasks and Performance Yes No N A Calls for additional help Nursing or Physician O Calls for anesthesia _ S Providers turn or assist in turning patient to side during seizure Inserts tonque blade into mouth 9 Places supplemental oxygen on patient pp xyg pa Places pulse oximeter on patient S Once the evaluation is completed click the Print button located at the top right corner of the screen plate Eclamptic Seizure im Clear Print GoTo Edit mode pn Name Eclamptic Seizure Daviewar lamac lC Date n8 n8 2n11 To save the finished evaluation as digital document select Microsoft XPS Document writer and click Print Select Printer fm Microsoft XPS Document Writer i Eipriiote Fri Page Range Al Number of copies 1 al Selection Current Page Pages Collate a 3 128 128 Premie HAL User Guide 75 Enter the name of the evaluation Select a location and click Sav
47. Simulators for Health Care Education Diabetic Mother A thirty two week infant is born to a 23 year old insulin dependant mother who was diagnosed at age 21 She is classified as Type B and has been followed in the high risk clinic Suction and stimulation have already been applied Begin BVM with O2 Wait indefinitely for action Transfer to NICU Treat for RDS Give a mini bolus 2ml kg of D10W at 1 ml min followed by an infusion by peripheral IV Wait indefinitely for actions Correct Action Begin Calcium Gluconate IV to treat hypocalcemia Incorrect Action Failure to treat hypocalcemia Check Serum Calcium Premie HAL User Guide 109 Premie HAL Gaumard E Ductal Dependant Heart Lesion nai in et ei Lis Hypoplastic Left Heart Syndrome 32 week premie remains cyanotic despite breathing 100 Oxygen 110 User Guide Premie HAL at Premie HAL Svs fer ha a Group B Sepsis and Secondary Apnea A mother with no prenatal care delivers a premature baby with foul smelling amniotic fluid in the emergency room The baby is being bagged with O2 Incorrect Actions Continue BVM and chest compressions Correct Actions Immediate intubation with O2 Perform Actions Place UAC to monitor ABG Secondary Actions Ne BP and deliver peripheral IV only a f
48. Ss eae the EEE EN NEE STE aaa EA EE TEE ee A NA 81 Working with Premie HAL a 99 AWAY ee ee A E E gaat S SE 101 ES AU MIN Gean ee 101 Eira o en tu E A T oy eee eee oes eer eer eee eer 102 ICU 11 6 0 PR E E 103 SYSIEMIC nee ir ee ae Bet 105 OB E E de ects nn ut 106 PRO DGNIGIN EEE ans tes E fee res ane ten fee ten a notes dettes access A 107 More apott ScenaNo Seiras en else an 108 IIOUDIE SOA on eeeenaes 121 Replacement PARIS see ana nee adancednaueued te de ane ati eee ni 125 MN a O nee a a ti tee D Toni 126 COAST aetna sb nerd a een ee ee ee saeco ee aes ian nee 127 Premie HAL User Guide 3 End User License Agreement This is a legal agreement between you the end user and Gaumard Scientific Company Inc Gaumard This software is protected by copyright laws and remains the sole property of Gaumard By installing the GaumardUI the Software media you agree to be bound by the terms of this agreement If you do not agree to the terms of this agreement promptly return the uninstalled media and accompanying items to Gaumard at the address indicated below 1 Grant of License Gaumard hereby grants to you an individual or institution the right to install and activate the Software on one computer for use with one Interactive patient simulator system The software may also be installed on any number of other computers at the same institution so that students may access the learning resources One copy of the software may be
49. a scenario a sequence of Palette Items and delay periods played back in succession Scenarios let the facilitator automate changes to the simulator s condition so their attention can remain on the providers actions The scenario feature also standardizes the patient s presentation of symptoms For fair assessment of providers and any research application such standardization is key GaumardUI includes several preprogrammed scenarios to simulate variety of complications All preprogrammed scenarios are included in the Quick Start Profile To switch between profiles without exiting the software click FILE gt Profile For this example select and load the Quick Start Profile To use a preprogrammed scenario go to the Scenario tab and click Load Scenario The Load Scenario dialog box appears Select a scenario and click on Load For a list of all the scenarios available go to page 47 Linear scenarios are composed of vital signs palette items and wait palette items played in succession need to give ventilations to help bring back the tosd vitals to a healthy state more Name Transition Description a j Crying none NSR HR 140 RR 40 BP 83 54 02 Sat 95 Selects gt l Wait Indefinitely ome Wait for suction and O2 N Asphyxia 3 00 30 Limp RR 0 02 Sat 70 HR 55 BP 35 20 I Wait Indefinitely u Wait for ventilations and chest compressions Asphyxia 1 01 00 Crying none NSR HR 140 RR 40 B
50. able fontanelle brachial femoral and umbilical pulse sites e Pulse strengths vary with blood pressure and pulses are synchronized with ECG e Internal rechargeable NiMH battery e Venous access e Bilateral IV training arms e Patent umbilicus e Intraosseous access at tibia e Wireless tablet PC with stylus control e Communication modules are FCC and CE Compliant e Communications module can be used simultaneously with the tablet computer s integrated wireless IEEE 802 11b networking device 100 240 VAC Charger Power supply adapter e Battery Charger synchronized with breathing Instructions ee Carrying case APPEARANCE ttt i ea OTHER Color responds to hypoxic events and me A E _ interventions healthy mild cyanosis severe cyanosis e Control rate and depth of respiration and observe chest rise e Ventilation is measured and logged e Select independent left and right lung sounds e Chest rise and lung sounds are synchronized with selectable breathing patterns e Accommodates assisted ventilation including BVM and mechanical support e Unilateral chest rise e Conductive skin regions allow for ECG monitoring with real equipment e Multiple heart rhythms rates and complications e One year limited warranty extended warranty to three years option e Installation and training services available Premie HAL User Guide 9 Terminology It is wise to spend a moment familiarizing yourself with
51. acilitator to monitor Drug Dose Units Route Rate Onboard Hiner Marca Li Lag Er Pui BEP gS a Ge ihe I erschen Habs More Potent Drug Less Potent Drug Max Alpha Current Alpha 68 User Guide Premie HAL Model The physiological model controls all vital signs and skin color and depending on effectiveness of provider intervention it will improve or deteriorate the state of Premie HAL The model speed can be controlled through the Model warp factor which goes from 1 to 5 1 representing real time Details Palette Lab Model Scenario Log Gaumard Physiological Modeling State Model rate 1 PAUSE physiological oxygenation modeling Modeled Therapy Improve Gain Reset IMPROVE adequate oxygen perfusion breathing 5 3 DETERIORATE compromised oxygen perfusion apnea Oxygen 0 Limin Epinephrine 0 04 3 mg Administer A i d board ka omo omom ocean eoten el Ww Can al be indicat CPR Monitor Effective Min Ventilation Range 30 VENTILATION COMPRESSION E Mae en 65 Pause Model will pause at the current state Improve Model trend to a healthy state Once the model reaches the complete Healthy state the model will go to Pause mode Deteriorate Model will trend to a severe cyanotic state If ventilations given to the neonate are of correct dept
52. alette to the scenario Details Palette Scenario Lab Speech Log Load Scenario Save Scenario Scenario Add Palette Item palette File Lab Transition Initial state Q murs min sec o of H Healthy Resting 59 59 Max Improvement Item Description EE titel cordon al vial sig are specified Deteriorating Wait Wait Indefinitely nat ce The first palette is now added Click Add Palette to Scenario again to add the following vital sign palettes and wait palette items Name Transition Description ame ooo tetera vais SN SY 4 Md Premie HAL User Guide 37 Wait item holds the vital signs until the transition time expires Alternatively add a Wait Indefinitely palette to hold the vital signs until the facilitator manually advances to the next item using the scenario controls Use wait palette items to give the care provider time to perform an assessment or action Add Palette Item Palette File Lab Transition Multi Q ru aa Deteriorating 16 oF H Healthy Resting 59 59 Max Improvement Item Description Initial state Care provider intervention ize re l l After the palettes are loaded use the Selected Item menu to edit the scenario items Name Transition Description gt gt initial state 00 00 Initial condition all vital signs are
53. any direction and it will be possible to choose the response on a case by case basis Other learning exercises require a higher degree of automation For such applications most facilitators choose Auto mode for the auto response settings The key issue is standardized timing of symptom presentation A consistent repeatable simulation is essential for fair assessment of that care provider in relation to others and for the broader interpretation of results in the context of training validation studies When in doubt it is best to choose Prompt mode in which the facilitator will be given direct control of the responses as events are detected Advanced users may find it helpful to understand the GaumardUI directory structure With direct file manipulation one can easily move palette items and scenarios between profiles as well as move entire profiles from one computer to another Ei Desktop My Documents 4 My Computer S Local Disk 0 4 5 Program Files I Gaumard Scientific E Oo Gaurmard User Interface Li manikins 2 profiles ID Default Profile Quick Start Scenarios Li resources In the GUI program folder is the profiles sub folder e g C Program Files Gaumard Scientific Gaumard User Interface profiles All user information is saved there and it is the only folder that should be modified manually In the example shown notice that there are 2 profiles in this installation Default Profile a
54. aphs also show each compression and ventilation Log The Log page allows the facilitator to keep track of every event during a session It automatically creates an entry whenever a detected event occurs as well as every time there is a change in the patient s condition In addition the facilitator can log observed provider actions with a simple click Gaumard Facilitator Details Palette Lab Model Scenario Log Session Title Providers Add Team Emergency Reported Airway Breathing Circulation Vagalmaneuver Attach electrodes Checkfor pulses EstablshIv Interpret rhythm Medication Bloodloss Drug Dose Units Route Se Log CPR z m Z 00 00 00 Applied to Newborn Details Reset the Model 00 00 01 Model to Newborn 00 00 Details HR 140 BP 65 49 RR 14 Inspire 17 OSat 73 EtCO2 40 Temp 36 8 Cyanosis 75 00 00 02 Applied to Newborn 00 00 Details Cyanosis 55 00 00 03 Applied to Newborn 00 00 Details Cyanosis 30 00 00 04 Applied to Newborn 00 00 Details Cyanosis 20 MuscleTone reduced 00 00 05 Model to Newborn 00 00 Details RR 23 EtCO2 46 Cyanosis 10 00 00 06 Applied to Newborn 00 00 Details Cyanosis 0 00 00 07 Model to Newborn 00 00 Details RR 30 g il p The Log page consists of four d
55. are intact and the baby s L S ratio is 1 9 1 She continues to labor and the baby s scalp pH is 7 5 Despite attempts to delay delivery she delivers a 1300g infant After suctioning and gentle stimulation the baby begins to cry On the second day of life a premie who has had a good response to surfactant and ventilation develops deteriorating vital signs Premie HAL User Guide 47 The scenarios in the Automatic mode are found in the Quick Start Premie Modeling profile There are eight linear scenarios and one branching scenario All shown are for a premature infant patient Scenario nario Description Name Scenario Descriptio Variations A Uterine Rupture A Shoulder Dystocia A Preeclampsia A Healthy Baby B Baby was delivered SVD and is fairly vigorous Healthy Baby A Baby is vigorous and earns good APGARS Faye Baby Embolism Baby A Branching Variations Branching To view a flowchart of the scenario information go to page 108 48 User Guide Premie HAL Lab Laboratory tests are helpful tools for evaluating the health of a patient To simulate this process the Lab tab allows the facilitator to create laboratory tests to aid the provider during simulation Any number of custom templates can be created to supplement many types of scenarios In addition the facilitator is in control of the results of each test Once a laboratory test is prepared the facilitator can send the results to the virtual moni
56. ator by automatically changing vital signs in response to caregiver participation pharmacologic intervention and manual input For example if the instructor increases the heart rate the physiologic model will calculate a realistic response to the event and automatically adjust the blood pressure values If the Automatic mode option is not available on the Profiles menu click Setup gt Options gt Other and enter the code included the feature in the Model Activation Code field To switch between operating modes without restarting the software click File gt Profile The physiologic model is a software engine that calculates responses based on physiologic principles Click the Pause button located on the right panel to freeze the model calculations during lectures and then to resume To return the patient to the initial state click Reset l Legend on of Model on Reset Dotrant c Infan Patient files store general information such as weight height and age The physiologic model factors in the patient s weight as it adjust related physiological parameters GaumardUI includes several preprogrammed patients in the Quick Start Modeling profile For more information on the each patient profile go to page 90 Premie is the default patient loaded when the Quick Start Modeling Profile is selected and it is an ideal candidate for most simulations Information about the patient is shown on the right
57. aumardUI software and connected connect the USB RF module to the tablet computer Trying to communicate After clicking the GaumardUI icon select with a different simulator the name of the applicable simulator and click Start On the menu bar go to Setup gt Options gt Environment and select FIXED Then enter the simulator s serial number in the text box Finally restart the software Multiple simulators are on Select different channels for each of the at the same time simulators and then turn them on one ata time meaning Wait until a link has been established between the tablet and the simulator the yellow window goes away Only after that start running the GaumardUI software in the second tablet and so on for the rest of the simulators To do so go to menu Setup Options gt Environment Select Auto change to channel number from 1 11 All others Close the GaumardUI software and unplug the RF module for at least 5 seconds then plug it back in Restart the software and wait for initialization On the menu bar go to Setup gt Options gt Environment and select FIXED Then enter the simulator s serial number in the text box Finally restart the software Premie HAL User Guide 121 Simulator doesn t run for the time specified on the manual Simulator doesn t respond to any com mand even that blin king communication indicator is consis tently green Commands a
58. ble to the facilitator Details Palette Lab Scenario Model Log Gaumard Legend Clear Settings LoadPaletteltem Save as Palette Item on or lost Cyanosis Muscle Tone Appearance w Airway Upper Airway Sound l O Crying general t ductal 5 Breathing Resp Pattern ics eee Left Lung Right Lung Respiratory Rate EtCO2 _ Chest Rise Chest Rise breaths min mmHg change Sound Sound change change km kml Inspiratory Time Circulation Rhythm Im Heart Rate re Blood Pressure Absent Pulses beats min Heart Sound Systolic Diastoli Brachial Right change l ystolic TI mmHg O g change Brachial Left Sinus Arrhythmia z Other Temperature C Blood Glucose mg dL 1Osee 30sec imin 2min Smin 10 00 min Vital controls are divided in several categories For each vital control on the details tab there is a corresponding entry on the status panel providing real time information Set the changes on the available fields and then use the Apply panel located at the bottom of the Details tab area to submit GaumardUI only sends updated vital information to the simulator and the virtual monitors settings not specified will remain unchanged Outlined below are common control behaviors in the Manual operating mode Click or tap slider control to adjust numerical values using the stylus Alternatively use the onscreen keyboard
59. cal therapy use the virtual shock panel Edit Path Key events Defibrillation gt 3 Shocks Selected Rename Delete Linked Action Defibrillation Shock Joules Shocks Cardioversion Shock Joules Shocks Non Sync Shock Joules External Pacing mA Premie HAL User Guide 45 In Automatic Mode use the model medication tab add medications from the Drugs list to the branching scenario Similarly to the Electrical Therapy entries the Model Medication is added via Edit Path Linked Action Select from a list of medications dose and routes click Add to list in the Key events window then OK to add to the path itself Linked Action Therapy Model Medication Medication Dose Route Rate Adenosine Adenocard SD W Infusion medium Go to o Lam Node 1 of a Cardiac Arrest branching scenario with Model Medication and Electrical Therapy paths added Model Medication events use blue text in the node display 02 0 E gt 2 Effective shock delivered A CA gt E Adenosine SD IV Push A fe C1 Remove Add path gt D End gt End 46 User Guide Premie HAL These scenarios in the manual mode are found in the Quick Start Premie profile There are three linear scenarios and six branching scenarios All shown are for a premature infant patient Scenario Name HLHS
60. change Drug Model Effect to Auto i se Non scenario automatic responses settings AIO Link All Auto Response to Cardiac Irritability Modeling f slight random A i ER oa eh nd A e ee E pessan Display warning when non shockable multichoice is enabled great improve cardiac rhythm is shocked External Pacing Defibrillation Shock Cardioversion Shock Non Sync Shock Drug Model Effect 5 Prompt 5 Prompt 5 Prompt 5 Prompt Aa eg x an EN ee SQ Prompt Auto p Auto SS Auto N N Auto SS Auto Setting Setting Setting Setting Erbe NE at at at Capture at 3 2 Drug takes effect 200 Joules 100 Joules 100 Joules according to the dose m Shocks Shocks Shocks applied auto or user convert to NSR convert to NSR degrade to setting prompt ej 75 bpm BP 75 bpm BP la ventricular 120 80 120 80 fibrilation to paced rhythm SS 56 User Guide Premie HAL The administered drug panel displays information on dosage rate percentage of dose completed and total time of administration Drug _ Dose Units Route _ Rate Dass Amiodarone Cordarone 0 mg IV Push 3639 025ug kg 02 12 14 In addition if a drug interaction is detected information about the effect and the interactor is displayed in the interaction status panel Drug Dose Units Route Rate Das Onboard Admini
61. cial button lets the facilitator log actions in more detail For example if the button Assess breathing is clicked the following entry is created 00 01 28 Action Assess breathing On the other hand if the button next to Ventilate is clicked a list of additional options appears The facilitator can be more specific and choose for example look listen feel Breathing Circulation Options look listen Feel anterior auscultation posterior auscultation abdominal auscultation axillary auscultation and the following entry is added Premie HAL User Guide 71 00 01 28 Action Ventilate look listen feel The second special button gt allows pre programming common responses to specific actions For example the facilitator can pre program normal respiratory sounds and re enable the lungs when the provider performs a needle decompression Airway A Breath m m When the extubate button is clicked the following entry is created 00 01 28 Action Extubate cry The Medications section allows for easy and fast logging of drugs administration including dose and route The software comes preloaded with a set of commonly used drugs Each of these drugs has a default dose unit and a default route for administration which can be overwritten by just typing over For example for Epinephrine the default dose unit is ml kg and the default route
62. cilitator by clicking on the Satisfactory or Unsatisfactory buttons on the Evaluation panel Team Logging allows the facilitator to evaluate individual providers with a single click For example if provider Charles Parker did a correct procedure the Evaluation entry would be 00 00 28 Charles Parker Evaluation Care Provided SATISFACTORY When the facilitator changes the state of the cyanosis model from the Model page an entry in the text log is automatically generated 00 18 10 Action Hypoxia Model deteriorating Notes can be entered directly from the Evaluation panel or by right clicking on the text log and adding anote The following is an example of a Note entry 00 10 10 Note provider took too long to assess patient Provider actions The Provider Actions section refers to the collection of buttons in the middle of the page It allows the facilitator to accurately keep track of provider actions The buttons are grouped into 5 groups Emergency Reported Airway Breathing Circulation and Medication Anytime the facilitator clicks one of the buttons a time stamped log entry is generated with that particular action For example if the Assess responsiveness button is clicked when the session clock reads 00 07 24 the following entry is automatically generated 00 07 24 Action Assess Responsiveness Special Buttons Some provider action buttons are accompanied by a special option button The first spe
63. contacting Tech Support you must 1 Have the simulator s Serial Number located in the left leg under the IM site 2 Access to the simulator and the control computer if troubleshooting is needed Post Gaumard Scientific 14700 SW 136 Street Miami FL 33196 5691 USA Office hours Monday Friday 8 30am 4 30pm EST GMT 4 Summer Time Gaumard Premie and HAL are trademarks of Gaumard Scientific Company Inc FE CE Premie HAL User Guide 127 Gaumard Scientific Company 2012 All rights reserved All rights reserved
64. continue to Node 2 as indicated by the path s time limit ba Start Bradycardia Agg ieii a 00 01 gt 2 gt mer lt lt Speech 1 00 01 complaint Feel dizzy AddItem Add Scenario Copy Remove Add path amp gt KEY EVENTS Key events allow the facilitator to select from multiple paths within a node to alter the trajectory of the scenario To add a key event to a node first click the Add path button to add an alternate path and then click the key event Edit button am Node Description a 00 01 are made to manikin In What happened lo BP 10 OSat 5 Remove add path gt 42 User Guide Premie HAL Use the Edit Path window to name sort and create key events First type a name for the action and then click Add Key events Selected Rename Delete Action Linked Action Defibrillation Shock 200 Joules Shocks Cardioversion Shock 100 After the action is added to the Key Events list assign the node that this action will move the scenario to using the Go to menu Click OK to save changes Edit Path Key events Selected Rename Delete Action RE Linked Action Defibrillation Shock Cardioversion Shock Non Sync Shock External Pacing 1 Start Bradycardia 2 Deteriorate Evalu3 Interventions 4 Atropine 5 Epinephrine Note 6 Dopamine
65. dd more tests and categories using the Category and Single Entry menu Please note that individual items can be moved deleted or modified after they are created Click the Save button to create the new lab template Hel Edit Lab Results Template Name i id Panel Description Cholesterol HDL LDL Triglycerides Category Single Entry Ad Delete Variable HDL Cholesterol mg dL 35 00 85 00 Cholesterold HDL Ratio 0 00 4 40 Lipid Panel Male Variable Normal Range HDL Cholesterol mg dL 29 00 71 00 Cholesterol HDL Ratio Ratio 0 00 4 90 Lipid Panel Both Variable Normal Range Cholesterol mg dL 0 00 199 00 LDL Cholesterol mg dL 0 00 129 00 Triglycerides mg dL 30 00 200 00 Allowed value range is displayed in Value column It won t be visible when entering data Once a new format is created it is listed on the Lab Template section at the bottom of the Lab tab Use the buttons on the left panel to edit or delete lab templates Lab Template E Template Description New Template CBC DIFF Platelets Differential A selected Rem S 1 Metabolic Panel Anion Gap Albumin Alkaline Phos Calcium Choride ms Neonate Blood test For newborn and premie 8 Dee E Premie HAL User Guide 51 To begin click on Create a New Lab Report from the right panel
66. der is to Provider is to intervene again Intervention p Keyevent S p Keyevent S Atropine Epinephrine Dopamine Pace Node 4 Node 5 Node 6 Node vital signs palettes simulate the response to atropine Time limit Go to node 3 after 1 minute Node vital signs palettes simulate the response to PHSPAIRE epinephrine Time limit Go to node 3 after 1 minute Hepatic Node vital signs palettes simulate the response to p dopamine Time limit Go to node 3 after 1 minute 7 Vital signs simulate the effect of pacing Scenario ends Aropne 44 User Guide Premie HAL Linked action automatically triggers a key event when virtual electrical therapy is detected To add a linked action first open the Edit Path window Click the Linked Action radio button and select from Defibrillation Shock Cardioversion Shock Non Sync Shock or External Pacing Then set the parameters for response to either joules or number of shocks Specify the Go To node the linked action will move the scenario to and click Add to insert the electrical therapy into the Key Events list Click OK to save the changes Delete Add Defibrillation Shock Shocks O Cardioversion Shock O Shocks O Non Sync Shock O External Pacing l Got us Specify the Go To node the linked action will move the scenario to and click the Add to insert the electrical therapy into the Key Events Click OK to save the changes To apply electri
67. duces 50 of the maximum effect Description Treats cardiac arrest and other cardiac Available Palettes r Apply Items Threshold ug X dysrhythmias and severe hypotension Common drug Standard Dose Epinephrine SD Epinephrine OD Properties Properties Drug Effect Tester Other 9 BE aa Update Graph Mug E ugkg Mmg El mg kg Eg E g kg Test Object weight 75 00 kg Route W V Push WW Infusion F IM F SubQ E Topical E Per Oral E Inhalation Half Life hr min sec A a A Precise o 24 of Approximate very quick lt 5m Peak Time hr min sec Precise 0 oF 304 Approximate very quick lt 5m Premie HAL User Guide 59 First go to the Details tab and create a palette item with vital sign parameters consistent with the effects of a standard drug dose Then create an additional palette for the effects of an overdose These two palette items will be later used to program the medication s dosage effect For general information on creating a palette items go to page 32 Details Palette Scenario Lab Drugs Speech Log Clear Settings Load Palette Item Save as Palette Item one SE a mModelon Cardiac Right Heart Chambers Left Heart Chambers Regurgitation Tricuspid Pulm
68. during the charge period and green once the process is complete The simulator s battery charges only when the control software is disabled Avoid using the simulator while the battery charger is connected If the simulator is in use while the charger is connected the battery will not charge To charge the battery you must 1 If connected unplug the charger adapter from the simulator and the wall outlet 2 Turn off the simulator by closing the GaumardUI control software 3 Re connect the charger adapter to the wall outlet and the simulator s battery port 4 Leave the simulator charging for 2 3 hours with the GaumardUI control software disabled Premie HAL has a maximum battery runtime of approximately 2 hrs Total runtime is dependent on factors such as breathing rate and sounds The battery status is displayed on the software status panel after the connection with the simulator is established For more information about the battery indicator refer to page 20 Warning If the simulator will not be used for an extended period re charge the battery at least once every 3 months to prevent damage to the internal battery USING THE POWER SUPPLY SYSTEM S N p6009067 OR HIGHER The power supply adapter allows the simulator to operate through long simulations sessions by drawing power from the wall outlet and not battery reserve Use the power supply for simulation sessions lasting 2 hours or
69. e Save the file as gO Documents Evaluations v Organize New folder o wr Favorites a Documents library en Folie v Evaluations Libraries Ea Dan No items match your search ad Music E Pictures E Videos ME Computer vr Filename Eclamptic Seizure Session 3 xps v eye 25 Dec SBA Hide Folders If the tablet is connected to a printer first select and open the evaluation document saved in the previous step gt Evaluations CJM Libraries Documen Organize Open Share with Print E mail Burn New fold Fr Favorites Documents library Evaluations Libraries Documents D Music In the XPS Viewer navigate to the file menu and select print di Eclamptic Seizure Session 3 xps XPS Viewer CIO Permissions Signatures Open Ctrl O Save as Ctrl s Print Ctrl P Properties Alt Enter Exit Alt F4 ptic Seizu On Site Reviewer James C Date 08 08 2011 76 User Guide Premie HAL Select the printer device from the list box and click print Select Printer Add Printer wn Canon iR C4080 C4580 PCL5c m Status Ready E Print to file Location Comment Find Printer Page Range Al Number of copies 1 Selection Current Page Pages 1 3 Collate Enter either a single page number or a single 1 22 33 page range For example 5 12
70. e calibration utility found in the control panel will present the user with crosshair targets at each of the four corners of the screen Position yourself and the tablet as if you are working and carefully touch the exact center of each of the targets After calibration the pointer should be displayed directly beneath the stylus tip Significant changes to viewing angle should be followed by calibration for best performance 12 User Guide Premie HAL Communications Module Connect the RF communication module to an available USB port on the tablet s PRO left side i LE Secure the RF communication module to the tablet or PRO computer using the Velcro patch The tablet is now ready to communicate with simulator For information about the signal strength indicator go to page 20 Warning Never disconnect the communications module while the Premie HAL software is running Doing So can seriously damage the module Premie HAL Battery Premie HAL S N p6009067 or higher includes two separate power adapters labeled Premie HAL Charger and Premie HAL Power Supply Before using the simulator for the first time reference the use for each adapter below To charge the battery connect the adapter labeled Premie HAL Charger to the battery port and charge Premie HAL for 2 3 hours or until the charger displays a green light The charger indicator light will show red
71. ee the Tips on Palette Item and Scenario Creation section of the appendix To apply a palette and change the simulator s condition select the palette item and click one of the Apply menu options Quick Launch Details Palette Scenario Model Lab Log Name Description APGAR 10 A 23 P 2 G 2 gag cough sneeze A 2 R 2 g vev APGAR 7 A 1 P 2 G 1 coughs A 1 R 2 SortbyName Healthy APGAR 9 A 2 P 2 G 1 coughs A 2 R 2 Diabetic Mother 4 BP 50 30 RR 60 O2 Sat 93 Dextrostick 53 Care Required HMD 3 HR 150 BP 52 33 RR 55 O2 Sat 94 NEC2 Resp Pattern Normal RR 55 O2 Sat 96 HR 161 BP 51 32 Normal 1 HR 140 BP 50 30 RR 50 O2 Sat 98 J Other Normal 4 RR 50 Dextrostick 70 PDA2 HR 140 BP 58 40 RR 42 Normal Heart Sound Normal Lung Sound Pneumothorax 3 HR 160 BP 50 30 O2 Sat 95 APGAR 4 A 0 P 2 G 1 responds to pain A 0 R 1 Selected Item APGAR 5 A 0 P 2 G 1 responds to pain A 1 some tone R 1 edit APGAR 6 A 1 P 2 G 1 responds to pain A 1 some tone R 1 Diabetic Mother 2 HR 160 RR 80 ve Diabetic Mother 3 RR 72 O2 Sat 88 Dextrostick 40 Properties Diabetic Mother 5 ST Elevation Dextrostick 53 O2 Sat 93 7 Apply se Fao 30 imin 2min 5min 10 00 min 32 User Guide Premie HAL Scenarios The most advanced method of controlling Premie HAL is to build
72. erapy events When the electrical therapy IS detected auto responses can automatically load a specific palette item or prompt the facilitator before making preprogrammed changes to the simulator s vital signs Non scenario response settings only detect electrical therapy administered when a scenario is not in progress For information on how to configure auto responses for scenarios go to page 39 To activate the virtual shock panel go to page 85 88 User Guide Premie HAL Warning Do not defibrillate or pace Premie HAL with real medical equipment Doing so will result in damage to the simulator s internal components Defibrillation Shock ne ER w Prompt N Auto 2 Setting Joules h s Shocks l convert to NSR 120 80 S OK The behavior of each auto response option is explained below e Off The software does not respond to the electric therapy e Prompt The software detects the electrical therapy and prompts the facilitator before applying the changes configured in the Settings section e Auto The software automatically detects the electrical therapy and compares it to a threshold selected by the provider If the threshold is met the vitals will automatically change to the parameters specified on the Settings section Each type of electrical therapy has a unique set of default parameters For example the default response to a virtual defibrillation Shock
73. essions 242 Too Many Ventilations 9 L 9 OK 129 H 104 L 0 OK 0 H 9 The provider performance indicator boxes are located on the right The V ventilation and C compression box fill color changes between the following states me 60 sec Grey No intervention was detected Yellow Compression was too shallow Ventilation was too weak e Green Compression ventilation was performed correctly e Red Compression was too deep Ventilation was too strong Compression and ventilation data is displayed at the bottom of the window as CPR is performed by the provider 0 10 20 30 40 Compression Data 306 Ventilation Data Rate Ct LC Rate PIP Ti 96 0 3 00 00 0 0 0 5 I E PEEP LV 0 08 57 Too Many Compressions 42 Too Many Ventilations 8 L 3 OK 11 H 28 L 0 OK 0 H 8 Compression Data e Rate Rate of compressions in real time e Ct Compression time Average length of each compression in seconds e LC Last Compression Time elapsed since the last compression performed Ventilation Data e Rate Ventilation rate in real time e PIP approx Peak Inspiratory Pressure e Ti Time Inspiration Premie HAL User Guide 95 e I E Inspiratory Expiratory Ratio PERFORMANCE EXAMPLES PEEP approx Positive end Compressions are too shallow Waveforms expiratory p
74. ethacin IV up to 3 doses No improvement after 24 hours 116 User Guide Premie HAL Gsumarnd Premie HAL Simulators for Health Care Education Pneu mothorax This 32 week infant had no respiratory effort at birth and required intubation is now on a ventilator with a setting of 40 The mother had good prenatal care and received two doses of antenatal steroids prior to delivery Withdraw the ET tube slightly Wait indefinitely for action Perform emergency needle decompression followed by chest tube placement Wait indefinitely for actions 1 Premie HAL User Guide 117 Tips on Creating Scenarios As described previously palette items represent complete or partial groups of settings that have been stored as a single item We learned how applying partial states will hold constant all settings that are left unspecified Not only does it take time to customize the palette but a very large palette also becomes difficult to navigate So it is desirable to minimize the number of palette Items in each profile To accomplish this an experienced facilitator tries to create items that are as generally applicable as possible and can thus be applied to a wide range of scenarios The key is to only include in your palette Items the settings that are directly related to the physiological event represented by that palette Item After reading the Details Palette
75. for the changes to take effect and displays the message Done If the wizard displays the message Can t reset it means that the new calibration values will take effect next time you start the software If the changes need to take immediate effect close the GaumardUl software wait about 1 minute for the simulator to turn off and then start the GaumardUI software again The GaumardUl has several options that can be preset by the instructor Each of these sections is explained below Help Calibration ey Stal Detail a Remote Access Via Network Auto Responses Scan RF Channels 7 JE compro To connect to a specific simulator select the FIXED option and enter the simulator s serial number in the text box Establishing a FIXED connection is required before entering the activation codes for the simulators add ons features and detecting hardware upgrades If you cannot locate the simulator s serial number first set the mode to GENERIC and establish a connection with the simulator Then click the Can t find Serial Number to retrieve the serial number from the simulator you are currently connected to Jot down the serial and switch over to the FIXED mode once the information is saved Options Premie Features Premie Hal Add Ons GENERIC Find and establish a connection with Premie Hal Please switch to FIXED once connected i FIXED The software will enable con
76. h and between 40 and 60 per minute the vital signs will improve Otherwise they will continue to deteriorate The facilitator can quickly jump to any of the three points in the state of the model Healthy Pedi is pink with adequate oxygenation Mild Cyanosis Pedi is bluish and vital signs are starting to deteriorate Severe Cyanosis Pedi is blue apneic and vital signs are rapidly worsening Improve Gain Moving this slider will help increase or decrease the cyanotic response to ventilations Oxygen By selecting an oxygen rate the baby will improve faster with proper ventilation Flow On must be selected to activate the oxygen response Epinephrine Select the desired epinephrine dose and then select Administer Immediately the heart rate of the Premie HAL should rise and the dose on board should start diminishing over time The dose should be enough to increase the heart rate a small percentage in order to help the oxygen delivery in the system therefore helping improve the neonate with proper ventilation Reset By selecting Reset the oxygen flow and the epinephrine dose onboard will be eliminated Premie HAL User Guide 69 The CPR monitor has two bar graphs and a real time display that give the user some feedback on the CPR given to Premie HAL Both bar graphs have a label on the left that change color representing low yellow correct green and high red levels of treatment At the same time the real time gr
77. hia s baby plt Alice s Baby 2 plt E Asphyxia 2 plt E Elaine s Baby 1 plt Alice s Baby 3 plt e Asphyxia 3 plt E Elaine s Baby 2 plt APGAR 0 plt E Asystole plt E Elaine s Baby 3 plt i Li Alice s Baby E APGAR 1 plt File name My Network Files of type Palette Items plt Browse to the location where the documents are saved and open it They are automatically brought into the GaumardUl Make sure that to select the correct file type x File name Files of type Scenario Files scz Branched Scenarios bsz Palette Items plt Palettes scenarios branched or linear model patients and drugs and profiles may be all exported 82 User Guide Premie HAL Make a selection and click Export The Save As dialog box is then displayed Save As Save in E Desktop my Documents p My Computer My Recent my Network Places Documents dwlg510_driver_100 e520 Gaumard User Interface CD Gaumard_UI nb Palettes Tech Support GD Shortcut to Debug GD Shortcut to Gaumard User Interface fa Shortcut to Help Images 2 Shortcut to manuals on devin Desktop My Computer File name Healthy Resting pl My Network Save as type Palette Items plt You can exit the software at any time by going to File Exit You can also close down the software by
78. iac rhythm and recheck after 1 more minute Click Cancel to stop the software from checking the cardiac rhythm every minute To use virtual electrical therapy click the shock panel shortcut near the top of the screen If the Shock Panel shortcut is not displayed click Setup gt Options gt General and check mark Show defibrillation cardioversion pacer panel on the menu bar Shock Panel The Details page is also used to create Palette Items A Palette Item is any full or partial set of physiological parameters that have been grouped and saved together under a single name A collection of these palette items applied in succession are referred to as a scenario For more information about scenario building navigate to page 33 To create a Palette Item choose the desired parameters on the Details page and click the Save as Palette Item button near the top of the page b Speech Log Gal Legend Oo On Q 1 fl 24 User Guide Premie HAL You will be prompted to name the palette specify a description and color code Click Save to create the new palette Item Navigate to the Palette tab to view a collection of all the palette items in the current profile Save as Palette Item Palette Item Name Healthy Palette Item Description Normal Vital Signs Color Healthy Care Required In the automatic mode the software s physiologic model assists the facilit
79. ifferent areas from bottom to top the text log provider action buttons team logging buttons and session info This is the large panel at the bottom of the Log Page containing all the time stamped text entries Every event in a session is recorded as an entry in the Text Log The different types of entries are Actions Applied Changes Detected Events Evaluations Model and Notes Actions refer to those performed by one of the providers in the session The facilitator can quickly log actions from the Provider Actions section and make the entry more specific using the Team Logging feature The following is an example of an Action entry 00 07 24 Action Assess responsiveness An Applied log entry occurs automatically every time there is a change to the physiological condition of the simulator In other words every time changes are made from the Details page Palette page or from a Scenario a log entry like the following is created 00 04 01 Applied 00 30 Details Rhythm Sinus Cardiac event 0 HR 140 70 User Guide Premie HAL Every time one of the various sensors in the simulator detects a provider action it is automatically logged as a Detected entry These actions include intubation BP cuff placement artificial ventilations and chest compressions The following example shows an entry after a provider performs BVM ventilation 00 03 26 Detected ventilation correct Evaluations are added by the fa
80. imited obligations specifically set forth in this one year limited warranty Gaumard will not be liable for any direct indirect special incidental or consequential damages whether based on contract tort or any other legal theory regardless of whether Gaumard has been advised of the possibilities of such damages Some jurisdictions do not allow disclaimers of implied warranties or the exclusion or limitation of consequential damages so the above disclaimers and exclusions may not apply and the first purchaser may have other legal rights This limited warranty applies only to the first purchaser of the product and is not transferable Any subsequent purchasers or users of the product acquire the product as is and this limited warranty does not apply This limited warranty applies only to the products manufactured and produced by Gaumard This limited warranty does not apply to any products provided along with the Gaumard product that are manufactured by third parties For example third party products such as computers desktop laptop tablet or handheld and monitors standard or touch screen are not covered by this limited warranty Gaumard does not provide any warranty express or implied with respect to any third party products Defects in third party products are covered exclusively by the warranty if any provided by the third party Any waiver or amendment of this warranty must be in writing and signed by an officer of Gaumard In
81. ing button on the right panel to remove any items on the virtual monitors file list Lab Reports name Template Description sn Saut Report Healthy 2 OB Blood test Healthy Levels Y TER Healthy Neonate Blood test Healthy Levels u James Metabolic Panel Session 1 Y z Selected Item Lab 02 CBC DIFF High levels Oo Bite Lab 03 Neonate Blood test High levels Y Delete Lab 04 CBC DIFF Simulation 1 Pentti il An editable copy of the lab report is also copied onto the Gaumard_UI folder on the laptop s home screen For information on how to access other files from the Gaumard Monitor screen go to page 92 54 User Guide Premie HAL Drugs Automatic Mode Only The drug tab is available only in automatic operating mode It is used by facilitators to simulate the physiological effects and reactions of medications administered to the patient model The physiologic model processes the drug s properties dosage administration time and interactions then adjusts the patient model vital signs accordingly While operating in the automatic mode select the Meds Profile to load the library of preprogrammed drugs The built in drug editor allows facilitators to stay current with new medications or make changes to the properties of existing drugs All of the preprogrammed drugs included in the library are found in the 2008 Handbook of Emergency Cardiovascular Care published by the American Hear
82. ions 2 4 take from 30 seconds to 3 minutes to change Lower OSat settings will decrease the models stability and put patient into crisis O2 Saturation EI osa e Total O level oxygen reserve in the body e Shunt flow the percentage of deoxygenated blood in pulmonary capillaries e Respiratory pattern Airway construction Shunt Flow e Airway obstruction Respiratory Pattern Obstruction e Total CO level CO build up in the body e Dead Space part of tidal volume that doesn t Total CO level participate in gas Dead Space exchange Respiratory Pattern e Respiratory Pattern PH level Ph level Premie HAL User Guide 27 Change the condition and the model will automatically adjust the shunt flow dead space airway resistance and respiratory pattern H Emoh mphysema ee Fihrosis nge z via Asthma Adjust the tidal volume or amount of air breathed in or out during normal respiration In the model a tidal volume of 500 m L is considered the normal level for an average adult build If the respiratory rate goes to zero the model does not restore it automatically Always remember to specify a new respiratory rate Respiration Pattern Ei Rate De Ei inspiration Ya Era Volume mi The C O vertical details tab includes the circulation and breathing controls Circulation Patient Status Im 2 Heart Sound IMO S A 2 ECG Rh
83. is IVP intravenous push In order to enter for example that a provider administered 1 ml kg of epinephrine via IVP the facilitator just has to enter the text e and the software automatically searches the drug list and displays the best match if any Details Palette Lab Model Scenario Log Gaumard Session Title Facilitator Providers Add Emergency Reported Breathing Circulation Team Medication Assessresponsiveness Callfor assistance NotBreathing lowHeatRate Bloodless Drug T Log CPR After a drug has been selected just clicking on the dose text field automatically fills the units and route fields with the default values for that particular drug Medication Drug Dose Units Route The facilitator then enters the dose and clicks on the Administered button and a log entry is created let s say the dose entered was 1 00 05 43 Action Medication Administered Epinephrine 1ml kg IVB IVP 72 User Guide Premie HAL The Team Logging feature allows the facilitator to designate which member of the team performed a particular action The Team Logging section is right above the Provider Actions section on the Log page First the facilitator should add all providers in the team one by one by clicking on the Add button and filling the Add Provider window Add Provider Name
84. it additional parameters that have an effect on the cardiovascular and respiratory systems Use this page if you want to add complexity to a scenario or if you need to superimpose special conditions Cardiac irritability can be used to modify cardiac rhythms indirectly You can improve move towards normal sinus rhythm or deteriorate move towards ventricular fibrillation and asystole any of the rhythms none slight randam greatirandom slighttimprove qreatcimprove slightideter iorate greatideter ior ate 30 User Guide Premie HAL The progression of rhythms generally follows the pattern displayed in the figure below where X represents normal sinus rhythm multifocal atrial tachycardia atrial flutter atrial fibrillation junctional rhythm left or right bundle branch block or atrio ventricular block X rhythm A X vith PACS X with unifocal PYC s X with multifocal PYC s Unifacal V tach Multifocal V tach Ventricular Fibrillation Asystole Premie HAL User Guide 31 Palette Use the Palette tab to sort manage and edit the palette items in the current profile Each profile stores an independent library of palette items To modify the vital sign parameters programmed into a palette select a palette and click the Edit button After the changes are made using the Details tab click the Save as Palette Item button For more information on customizing the Palette s
85. ital signs information displayed on the Gaumard Monitors program To verify the connection between the computers click on the wireless icon located on the task tray of both the tablet and virtual monitor For troubleshooting information on the ad hoc connectivity navigate to page 121 Currently connected to gt Unidentified network No Internet access Wireless Network Connection 2 GaumardNet gaumard Other Network Open Network and Sharing Center ete y 4 2 54PM 14 User Guide Premie HAL Gaumard Monitors After the ad hoc connection is established double click or tap the Gaumard Virtual Monitors icon located on the virtual monitor s home screen The Gaumard Virtual Monitor software is now ready to receive vital sign information To learn more about the Gaumard Monitors features and functionality click then V menu and select Help to open a digital copy of the Gaumard Virtual Monitor User Guide Working with GaumardUl Premie HAL User Guide 15 Initializing Premie HAL After reading the Care and Cautions and Equipment Set Up section of the guide double click the GaumardUl icon on the tablet s home screen to start the simulator J ss a My Computer GaumardUI If you are working with the PRO system login by entering admin for the user name and password fields then click submit to continue elC Event Triggered Cameras KbPo
86. l monitors activation code For more information go to page 85 92 User Guide Premie HAL Use the sensors option to enable or disable any of the waveforms displayed in the vital signs monitor Select the waveform and click ON to display the readings on the virtual monitor screen To disable a parameter reading click OFF The vital signs monitor sensors defaults to All On Setup Monitors CPR Help SpO2 Probe ECG Leads Resp Monitor File sharing Custom numbers Thermometer TT NIBP Cuff gt Configuration Ingospasm ABP cannula und Capnography normal i 4 AILON All OFF Window B bpm In 33 Some sensors such as NIBP and Thermometer are equipped with a STAT control that will allow the facilitator to activate readings on the virtual monitors from the controller software The sensor control window is a floating panel with on off toggle controls Click Monitors gt Sensors gt Window to open the floating sensor control panel Single click the circular icon to enable or disable the sensors displayed on the virtual monitor screen Click the circle dark to disable the sensor and light blue to re enable it In the example above all the sensors are on except the thermometer The file sharing menu allows the facilitator to send images audio and text files to the virtual monitor screen Use the file sharing featu
87. l opening prior to performing any nasal or oral intubation Failure to do so will make intubation very difficult and is likely to result in damage Do not insert liquids or spray silicone oil into the mouth and airway Use the Detail tab parameter controls to change the upper airway sounds on the simulator Upper Airway Sound Ir Crying Resp Pattern mu y Rate EtCO OD 1 breaths min mmHg p see ostductal OSat Use the Detail tab parameter controls to change the simulator s respiratory pattern Resp Pattern la Rate breaths min normal change E Apnea Time Use the Detail tab parameter controls to change the audible respiratory sounds on the simulator Left Lung Right Lung Chest Rise G Chest Rise Sound Premie HAL User Guide 101 Set the respiratory rate higher than zero to enable automatic bilateral chest rise and fall Breathing Resp Pattern Respiratory Rate nn Si breaths min at LE g Ci change Inspirato Disable the right or left lung individually Left Lung Right Lung Chest Rise Chest Rise Sound _ Sound _ Heart Sound 7 PULMONARY VENTILATON Ventilate the simulator using a bag valve mask or a mechanical ventilator Set the respiratory rate to 0 to display chest rise during ventilation and receive feedback on the CPR window For more i
88. libration Chest Compressions Please select the type of calibration you would like to do Normal Calibration You will be asked to C perform based on your criteria Providers Sees will be evaluated based on that criteria Never calibrated We e Calibration Chest Compressions The values from the last compressions user calibration are shown below Press START and do 5 correct chest compressions fone at a time following the text cue Never Calibrated ES lt Bak Finish The facilitator should follow the text cue on the screen to perform just ONE compression or ventilation at a time until prompted for the next one For example if calibrating chest compressions The wizard prompts you with a 1 Calibration Chest Compressions The values from the last compressions user calibration are shown below Press START and do 5 correct chest compressions one at a time following the text cue 1 Finish Factory F Perform one correct chest compression F A green filled oval indicates that the chest compression was successfully recorded Premie HAL User Guide 83 F The wizard prompts you with a 2 F Perform a second correct chest compression F A green filled oval indicates that the chest compression was successfully recorded F and so on Calibration Chest Compressions The values from the last compressions user calibration are shown be
89. low Press START and do 5 correct chest compressions one at a time following the text cue 3 OK At the end of the calibrating session the wizard shows the average peak depth and duration values for the procedure If you feel you performed the procedures correctly click the Save button Otherwise press the Back button to repeat the calibration Calibration Chest Compressions Press SAVE if you are satisfied with these values or BACK to re do calibration Sum 972 Peak 278 Duration 0 5 Notice that you can go back abort or cancel at any time during the procedure Factory Settings is a very useful tool to consider when recalibrating It restores the sensors to factory settings over riding any calibrations performed by users Make sure that when you are restoring the sensors to the factory settings that no one is practicing chest compressions ventilations intubation or reading a blood pressure Any of these actions may interfere with the reset 84 User Guide Premie HAL Each time that one of these sensors is clicked a message will appear at the bottom left of the screen notifying the user of the status of the reset OK or TRY AGAIN Should the sensor not respond please refer to the troubleshooting guide or contact Customer Support Calibration Factory Default Settings At the end of calibrating a function the Calibration Wizard resets the simulator
90. luid bolus Administer Pressor Wait indefinitely for action Premie HAL User Guide 111 Premie HAL Gaumard Simulators for Health Care Education Hyal l ne Mem brane Disease A teenage mother with no prenatal care delivers a 1300g Infant in L D Administer supplemental oxygen and transfer baby to the NICU Wait indefinitely for actions Intubate and administer surfactant Wait indefinitely for actions 112 User Guide Premie HAL Simulators for Health Care Education Premie HAL Gaumard caer Meconium Aspiration and Pneumonia A thirty one week infant is delivered with thick meconium stained amniotic fluid Perform endotracheal intubation Suction meconium from below the cords Gentle stimulation and warming Wait indefinitely for actions Mild Severe Mild Meconium Aspiration Severe Premie HAL User Guide 113 o Premie HAL Gaumard son Simulators for Health Care Education Necrotizi ng Enterocolitis A two week old premature infant began enteral feeds a week ago He required some resuscitation at birth for perinatal asphyxia and received antibiotics for possible sepsis His nurse reports increasing gastric residuals and a few episodes of apnea and increasing abdominal girths Correct Actions Stop feeding by mouth Sta
91. mal operation The indicator is clear when no attempts to communicate with the simulator are being made for example when the module is not connected to the computer or the system is in STAND BY mode Status AGL N ccc cca ol The warning icon indicates a signal conflict with another simulator Click the exclamation icon for more information To configure individual communication channels for each simulator manually go to 84 RF Communication 75 There is currently another Gaumard Simulator on the same channel For optimal communication performance switch to another channel Note Use Setup gt Scan RF Channels for a recommended channel The battery status indicator progresses as the battery in the simulator is used Premie HAL has a maximum battery runtime of approximately 2 hrs Total runtime is dependent on factors such as breathing and sounds JIIEEEIEENE The exclamation mark indicator is shown when there is no communication with the simulator and the program cannot get the battery information The bolt symbol indicates that the power supply is connected When the battery is so low that the indicator turns blinking red the simulator is sent automatically to STAND BY mode to protect some of the simulator s internal components and will not operate until the battery is recharged Please note that the power supply will not re charge the battery and an initial charge is necessary for the power supply to maintain Premie
92. me and drug concentration are listed in addition to the standard and over dose dosages Drug Dose Units Route Rate Dose 2 Adenosine Adenocard v mg IV Push v Onboard Administe Drug Properties Description Half Life 00 00 10 Peak Time 00 00 25 EC50 0 0355mg dl Treats paroxysmal supraventricular tachycardia Note Initial dose is6mg fno effect is observed in 2 minutes an additional 12mg may be administered This Standard Dose Adenosine SD 6mg 12mg dose may be repeated one more time after 10 minutes if no effect is observed Common drug ly Over Dose Adenosine OD 30mg Enter the dose units route and rate if applicable and click the Administer button Drug Dose Units Route Rate Adenosine Adenocard 6 mg IV Push v L_Drun Pranartias Premie HAL User Guide 55 By default the Proceed Drug window prompts the facilitator to confirm dosage effects before applying them Adjust the peak effect percentage and or the dosage effect Click Yes to begin administering the drug Proceed Drug 6 0mg of Adenosine Adenocard through IV_Push has just been Administered This dose will be treated as Dose Do you want this drug to take the following peak effect HOO Standard Dose x ViewEfet Reverse effect when the drug s level begins to drop Yes Nos To turn off the Proceed Drug prompt go to the menu bar and click Setup gt Auto Responses then
93. more If simulation sessions are shorter than 2 hours use the simulators battery reserve The power supply adapter will NOT re charge the battery Avoid using the power supply adapter when the simulator s battery is completely depleted To use the power supply adapter 1 Fully charge the simulator s battery using the Charger adapter 2 Disconnect the Charger and connect the Power Supply adapter 3 Activate the GaumardUI software The GaumardUI battery icon will display a lightning icon when the power supply is connected Please contact Gaumard for information on the power supply upgrade for earlier Premie HAL models Premie HAL User Guide 13 Virtual Monitor The optional virtual patient vital sign monitor system works with GaumardUI to receive and display the simulators vital sign information The system includes an all in one touchscreen computer and the Gaumard Virtual Monitor software Please refer to the documentation included with the all in one computer for important safety installation and start up information Secure all the systems connection and power on the touchscreen computer as indicated by the product s documentation WIRELESS AD HOC CONNECTIVITY The tablet and virtual monitor computer automatically establish an ad hoc computer to computer wireless connection at startup The wireless connection between both systems allows GaumardUI to update the v
94. nd Quick Start Scenarios Saved as plt files palette items in each profile are located at the top level of each profile folder To copy palette items from one profile to another copy the plt file found in the source profile folder Premie HAL User Guide 119 Scenarios are stored as sub folders within profile directories Scenarios can also be transferred between profiles by copying the scenario folder and its contents Modify files in the resources directory or those at the top level of the Gaumard User Interface directory Manipulate files or folders while the GaumardUI software is running Modify or delete dll scn or sys files 120 User Guide Premie HAL Troubleshooting Use the following table to find causes and solutions to a number of possible problems Communication Battery is discharged Turn off the software and plug charger never gets adapter to the simulator The charger s LED established or is lost will turn green when the simulator is completely charged Do not turn on the GaumardUl software until the charging process is complete blinking communi cation indicator is consistently red The adapter labeled Power Supply does not recharge the battery Disconnect the Power Supply and follow the charging procedure explained above Computer is too far away Get simulator closer to computer from simulator RF module is not Close the G
95. nformation on the CPR trainer go to page 95 102 User Guide Premie HAL Cardiac Use the Detail tab parameter controls to change the audible heart tones on the simulator Heart Sound i normal none atrial septal Heart sounds are synchronized with the heart rate and selectable cardiac rhythms ECG MONITORING AND ELECTRICAL THERAPY Conductive skin sites allow the attachment of real EKG electrodes This feature permits the provider to track cardiac rhythms with real medical equipment just like with a human patient Use the virtual shock panel to simulate the administration of electrical therapy via software To enable the virtual shock panel feature go to page 85 Warning Do not physically pace or defibrillate Premie HAL with real medical equipment Doing so will damage the electrical components From the CPR trainer window monitor the cadence and force of chest compressions applied by the provider For more information on the CPR trainer go to page 95 Palpable pulses fontanel brachial umbilical and femoral are dependent on blood pressure Bilateral IV training arms allow for intravenous infusions as well as drawing fluids Use a flashlight to detect veins in the dorsum of the hand Warning Use only Gaumard s provided simulated blood Any other simulated blood brand containing sugar or any additive may cause blockage and or interruption
96. nt Ti Importing Palettes Asystole Healthy Reg Christian ue Evan V Tach apni V Tach stal el Frank Rien bon FREE YFib For this example select one or more palettes to import from the list and click Import Darrell Hal Healthy Resting normal vitals The palettes are now imported and saved into the HAL patient VFib V Fib Premie HAL User Guide 91 This menu option is used to specify various vitals to be logged automatically after reaching a specific threshold Auto Log Setting Auto Log Log Vitals when Heart Rate changes more than Systolic BP changes more than Diastolic BP changes more than Resp Rate changes more than Insp Percentage changes more than EtCO2 changes more than Sp O2 changes more than Temperature changes more than Monitors Use the Monitors drop down menu to enable disable sensors on the virtual monitor screen share files program custom scalars and verify the connection between the GaumardUI and Gaumard Virtual Monitor software For detailed instructions on how to configure and connect the Gaumard Vital Signs Monitors refer to the Gaumard Monitors User Guide Monitors CPR Help Sensors File sharing Custom numbers Configuration E ns Vo mn md If the Monitors menu option is not shown go to Setup gt Options gt Premie HAL Add Ons and enter the virtua
97. nto the bone marrow cavity Remove stylet aspirate bone marrow and infuse fluids Following the procedures aspirate infused fluids using an empty syringe through the rubber stoppers To extend the life of each bone insert seal puncture marks with cement glue and leave to dry before re inserting them into the holder Systemic Control and program the visible cyanosis on the simulator Use the Model tab to automate the change in cyanosis as the provider performs CPR intervention For more information on the Model feature go to page 95 Catheterize or inject the umbilical cord To fill the umbilical cord with fluid inject any of the three blood vessels with 2 mL of water using the syringe For catheterization exercises use a 6 Fr urethral round tip catheter lubricated with silicon oil Let The replaceable umbilical cord can be trimmed or cut Before removing or replacing the umbilical cord after an exercise turn off the simulator by exiting the software File gt Exit or set the simulator on STAND BY mode After the simulator is powered down the umbilical cord can be safely unplugged For information about ordering replacement umbilical cords go to page 125 Warning Do not remove umbilical cord while Premie HAL is in operation To remove the umbilical cord first turn the simulator off by clicking on File Exit on the GaumardUI software or set the manikin on STAND BY mode Replacement of cord
98. o to page 124 Ado Thoat voce V 5 M 5 R 0 Heart V 5 M 5 R 0 Lung Front Upper Right Vol NA Lung Front Upper Left V 1 M 5 R 0 KK Right V 5 M 5 R 0 kK Left V 5 M 5 R 0 Bowel Lowe Right Vol NA Working with Premie HAL Premie HAL User Guide 99 Disclaimer The content of this table are subject to change without prior notice Please contact Gaumard Scientific for the most current information Category Simulator Feature Nasal Intubation Oral Intubation Breathing Airway Sounds Suction exercises Automatic Chest Rise Independent chest rise Breathing Lung Sounds Heart Sounds Cardiac ECG generated in real time 4 patches Chest compressions sensor Bilateral IV Fontanel Brachial Umbilical Circulation Pulses Femoral Cyanosis Pedal Vein left Frog legs position Systemic Intraosseous access Temperature sensor Physiologic Model Optional Audio Video recording and ETC Pro Optional debriefing Gaumard Virtual Monitor Optional 100 User Guide Premie HAL Premie HAL s airway can be intubated orally using LMA or endotracheal tubes Intubate nasally using a nasogastric tube for placement exercises Recommended Pr r ocedure Device Size Intubation Miller O Blade size LMA Size 1 Nasal 8 Fr catheter Intubation Oral ETT 2 5 no cuff 6 Fr Intubation suction catheter Warning Always lubricate tubing airway and nasa
99. of the vasculature system Follow the steps below to fill the IV vasculature for drawing fluids 1 Fill the modified syringe with water or diluted Gaumard simulated blood 2 Connect the syringe into the fill port and the drain connector to the drain port as shown 3 Slowly push the fluid into the IV circuit until it begins to flow out of the drain connector 4 Remove the fil syringe and drain connector The self sealing ports will keep the fluid inside the veins Repeat the procedure to fill the IV vasculature on the lower leg Use a flashlight to detect veins For simulation of high volume infusions it is necessary to leave the drain tube attached and run it to a suitable outlet or container Premie HAL User Guide 103 Establish intraosseous infusions access to administer fluids and medications To use this feature follow these simple steps 1 Remove the skin from the leg to access tibia bone insert 2 Lift the tibia insert out of the holder a 3 Hold the tibia bone vertically and inject 2cc of fluid through the rubber stopper Air and excess fluid are purged through the vent port near the top of the bone 104 User Guide Premie HAL 4 Insert the fluid filled bone back into the holder 5 Replace the skin and palpate tibial tuberosity 6 Insert the IO device into the tibia bone to perform an exercise Notice the decrease in needle resistance as it passes i
100. ommunication Closed loop communication 6 Situational Awareness E Unnaceptable Poor Average Good Perfect N A Overall Situational Awareness Rating Premie HAL User Guide 79 After the evaluation template design is complete click Save at the top of the window Evaluation Form Load template Iv Save Clear Delete Evaluation Name Vacuum Delivery On Site Reviewer Category Multiple Choice Entry 6 uen ar on onne rr Trimmed A w Finally select the new template from the Load template drop down to use the completed evaluation form Load template Im Save Gear Delete Breech Vaginal Delivery Edamptic Seizure Forceps Delivery On Site Reviev Postpartum Hemorrhage Shoulder Dystocia Evaluation Nan Category LI Multiple Choice Entry 6 Vacuum Delivery 80 User Guide Premie HAL Menus Setup Monitors CPR Profile New Session Reset Session Clock Save Report Print Report Import Export Exit This option allows you to change your current profile Clicking New Session in the file menu will e Clear any loaded playing scenario e Clear any loaded playing palette e Resets vital signs to normal values e Clears out log page e Restart the session clock The session clock is located at the bottom of the window Clocks Transition remaining 00 00 00 Session 0
101. onary Regurgitation Mitral Aortic Resistance E le ol Resistance B l el Contractility Contractility normal 100 El normal 100 ek SU Circulatory Blood Volume ml Cardiac Irritability slight improve g Vascular Properties 5 Vessel Diameter is Vessel Stiffness Respiratory Shunt flow 8 Dead Space ml PH Environment ambient Pressure ATM Inspired Air Mix 02 CO2 After creating the dose effect palettes got to the drug tab and click the Manage Drug List button Warp Factor lt ml Rate ml min Stat Rate L min Stato 60 User Guide Premie HAL The Add New Medication shown on the right Add New Medication New Medication Medication Response Medication List Description Unit EC50 mg dl Concentration that produces 50 of the maximum effect Available Palettes A Items Threshold Abciximab UD Adenosine OD Adenosine SD 4 Properties other Drug Effect Tester Test object weight kg 7A ug E F mg E Route E IV Push C IV Infusion F Topical Per Oral Inhalation Half Life hr _ min _ Precise of og E Approximate very quick lt 5m Peak Time Precise off hr min sec oF oF Approximate very quick lt 5m 10 10 Plasma Concen
102. ording System S3009 204 Tablet PC R Wireless tablet PC with stylus control S3009 205 Bump Case R Bump case for tablet PC S3009 206 RF Module R Radio Frequency Module with USB connector S3009 EXW Two Year Extended Warranty A Extended warranty for years Two AND Three S3009 INST In Service Training A Day of in service training and installation Premie HAL User Guide 125 Warranty Gaumard warrants that if the accompanying Gaumard product proves to be defective in material or workmanship within one year from the date on which the product is shipped from Gaumard to the customer Gaumard will at Gaumard s option repair or replace the Gaumard product This limited warranty covers all defects in material and workmanship in the Gaumard product except Damage resulting from accident misuse abuse neglect or unintended use of the Gaumard product Damage resulting from failure to properly maintain the Gaumard product in accordance with Gaumard product instructions including failure to property clean the Gaumard product and Damage resulting from a repair or attempted repair of the Gaumard product by anyone other than Gaumard or a Gaumard representative This one year limited warranty is the sole and exclusive warranty provided by Gaumard for the accompanying Gaumard product and Gaumard hereby explicitly disclaims the implied warranties of merchantability satisfactory quality and fitness for a particular purpose Except for the l
103. p a series of tests in a lab report From the category box click Add to name and create a category He Edit Lab Results Template Name Lipid Panel Description Cholesterol HDL LDL Triglycerides gti eee Remove Rename insert A v Add Delete Edit Insert A A HS Category Name Lipid Panel Female Comment Then click OK to save the new category Use the Single Entry menu to add a test under the category previously created EI Edit Lab Results Template Name Liquid Panel Description Cholesterol HDL LDL Triglycerides Category Single Entry Add Remove Rename Insert A v Delete Lipid Panel Female Variable 50 User Guide Premie HAL Use the Add Edit Entry menu to customize the different parameters on a specific test Begin by providing the name of the test unit and decimal precision The Normal Range will be displayed on the lab report for the provider to use as guide while reading the results Meanwhile the Allowed Range restricts the minimum and maximum value a facilitator can input as a test result Once the test entry is configured click OK to add the new test Me Add Insert Entry EN RE Name HDL Cholesterol Unit mg dL Precision 2 E Normal Range Minimum 35 00 Maximum Allowed Range Minimum Maximum e a Repeat the process to a
104. panel For information on creating new patient profiles go to page 90 Premie HAL User Guide 25 In the automatic mode the Details tab includes additional vital sign parameters and control options E Legend Clear Settings Load Palette Item Save as Palette Item on Oor Reset with fetal Data Model On Pause Reset Airway Appearance Cyanosis Level Patient s Info g Name Premie Click to Cancel Upper Airway Sound f Crying Gender M 7 Tern 28 weeks Breathing Respiratory Pattern ll Lung Condition B Height 25 0 cm Respiration Pattern EtCO2 Preductal OSat Weight 1 5 kg z bpm r P Resp Rate Auto Wa mmHg EE CI change peco Auto Esa Auto ee Inspiration Aut Ss o via Total CO2 level w via Total o2 levet ls a Erioa Volume Auto ml Postductal OSat Differential Left Lung Right Lung Chest Rise Chest Rise less than Preductal Sound Sound of Preductal p a New Edit Load Note Auto means this vital is auto controlled by model Click H button to hold this vital to Current Value Apply Approximate Time a m ni d m To navigate between the vital sign parameter categories click the vertical tabs The tabs divide controls related to airway breathing and circulation among others No Circulation Absent Pulses Radial Left Other Tem Be Hemorrhage m A
105. performed correctly Waveform peak is inside the green zone O H 30 40 50 60 sec A V GaumardUI is capable of interfacing with a number of third party A V recording systems that enable the capture of Audio and Video interlaced with the events recorded in the software log To enable the A V menu go Setup gt Options gt Other and checkmark Use A V system File Setup Monitors CPR Status ol Qui Airway Tongue Edema A PFEFFER Click Setup to open the configuration window Configure the communication adapter and port number to send log information to a third party recording system In order to set up the connection on the A V System side please consult your A V System s documentation AIV Link Information A V Link Information Adapter Intel R PRO 1000 PL Network Connectior lt refresh Controller IP 192 168 1 10 8080 lt find avail Connected to Fetal Neo Link Automatic Mode The Fetal Neo Link feature automatically transfers fetal vitals to the Premie HAL tablet once a labor scenario is complete To configure this feature follow the steps below to establish a connection between the NOELLE Model and the Premie HAL model NOELLE GAUMARDUI CONFIGURATION AUTOMATIC MODE On the menu bar click FN gt Setup If the menu is not shown click Setup gt Options gt Other and checkmark Use fetus Neonate Link
106. play Recommended Channel over the channel bar with the best measured signal The other bars will only display a Double Click to Select Channel message Channel Strength Recommended Channel Double Click to Select Channel Click on the recommended channel in the graph to select it The following message will display while the command is processed The new channel should subsequently ensure four solid bars display in the communications indicator at the top of the Status bar Modeling Automatic Mode Only The Modeling drop down menu in the top left corner of the GaumardUI contains four options Modeling Patient Reset Model Import Between Patients and Auto Log Setting Setup Modeling Monitors CPR F T US of Modeling Patients c o Reset Model Import Between Patients Auto Log Settings 90 User Guide Premie HAL This option allows you to create a new patient or load an already existing one new patient load patient recent patients gt Reset Model Import Between Patients Auto Log Settings 4 To create a new patient go to Modeling Modeling Patient new patient The following dialog box is displayed ag New Patient New Patient Name Term OM OF Height Weight kg Other Enter the name of the
107. r User Name admin Password admin The simulator selection menu is shown Select Premie HAL and click Start Gaumardul Version 1 30 13 0 Please select one Simulator Premie HAL The RF link between the computer and the simulator is established in approximately 1 minute or less hs min Sounds _ ange change upper m Communication info 16 User Guide Premie HAL When the GaumardUI is not active the simulator is in stand by To troubleshoot connection and startup issues go to page 121 Profiles and Operating Modes After the startup screen the profile and operating mode selection menu is shown Newborn HAL Profiles Select Operating Mode a Ame Profiles Profile Description Gomme ent Noelle Advanced Quick Start Hal Quick Start Newborn Quick Start Noelle Quick Start Pediatric 1 amp Manage Profile Rename New Profile ww The GaumardUI control software has two modes of operation Manual and Automatic Each mode includes a Quick Start profile with preprogrammed scenarios exercises created in conjunction with experienced healthcare instructors and working medical professionals Continue to the next section to learn more about the each operating mode and the profiles included After selecting an option for each click Load to continue Manual Mode In the manual ope
108. rating mode the facilitator programs the simulators vital signs independently Newborn HAL Profiles Select Operating Mode TE EEE m ma tomate Profiles Profile Description Default Profile factory preset scenarios Noelle Advanced Quick Start Hal Gsm Quick Start Noelle Quick Start Pediatric 1 h oyi gt Manage Profile Rename New Profile The profiles available under Manual Mode are the following Default Profile includes one preprogrammed palette with healthy vital signs Quick Start Premie HAL contains nine preprogrammed scenarios exercises Automatic Mode In the automatic mode the software s physiologic model assists the facilitator by automatically changing vital signs in response to caregiver participation pharmacologic intervention and manual input The physiologic model calculates responses based on physiologic principles For example when facilitator increases the heart rate the physiologic model will calculate the response and automatically adjust the blood pressure To activate this operating mode as an upgrade option go to page 85 For more information on this mode and its features go to page 25 Newborn HAL Profiles Select Operating Mode eu Em Profiles Profile Description Default Modeling Newborn Modeling Scenarios Meds Profile worn Modeling Manage Profile New Profile toa cancel The profiles
109. re taking longer than usual to take effect or simulator is not reporting every action blinking com munication indicator is consistently yellow GaumardUI has set the power mode to STAND BY automatically RF module not found message is displayed when GaumardUl is started Chest compressions are not properly detected or not detected at all Battery not charged charger requires reset Turn off the software and unplug charger adapter from the wall and the simulator for 1 minute Reconnect the charger to the wall and the simulator Unplug the charger when the chargers LED turns green indicating that the simulator is completely charged Do not turn on the GaumardUl software until the charging process is complete The computer is properly communicating with a different simulator On the menu bar go to Setup gt Options gt Environment and select FIXED Then enter the simulator s serial number in the text box Finally restart the software Distance between computer and simulator is reaching its limit Get simulator closer to computer or move away from obstructions or there are too many ob structions between walls etc There s too much RF inter ference either from another Gaumard tetherless simulator in the vicinity or an RF radiator Try changing the RF channel by going to the menu for Setup Options gt Environment Select Auto change to channel number from 1
110. re to fulfill laboratory reports and x ray requests by the provider during simulation To begin first add the mock image jpg bmp or text files txt into the Gaumar_UIl folder located on the home screen of the control computer On the GaumardUI menu bar click Monitors gt File sharing to open the File Sharing Setup menu Airway Tongue Eden Laryngospasr Throat Sound If m The File Sharing Setup menu is used to manage files shared with the virtual monitor software The list of files stored on the Gaumard_UI folder available for sharing is displayed on the left panel To share a file first select the file from the left panel and click the Add button Custom numbers Configuration File Sharing Setup The files on this list will be accessible from the patient men Name will be the name displayed Available Files Shared Files File Refresh amp Enter a context name on the pop up menu and click OK to share Enter Context Name X ray Chest Files currently shared are listed on the Shared Files list Shared Files File Context Name Remove Remove All de Once a file is added to the Shared Files list a yellow notification icon is shown on the patient menu at the top left of the virtual monitor screen The icon notifies the provider that a file is available for vie
111. ressure p mostly do not reach the green zone e LV Last Ventilation Time elapsed Compression indicator is yellow since the last ventilation performed The CPR trainer reference boxes generate a visual prompt of the compression to ventilation ratio programmed in the CPR Options menu Click the Trainer button to start The V ventilations and C compressions box borders blink to indicate the correct reference CPR rate 30 40 50 60 sec Compressions are too deep Waveforms mostly exceed the green zone Compression indicator is red j l Mi LIL iii y WN 30 Compressions are performed correctly Waveform peaks are mostly inside the green 60 sec 60 sec By default the CPR trainer is configured to blink the reference borders at a 30 2 compression to ventilation ratio To change the ratio navigate to the menu bar and click the CPR dropdown and CPR Options 30 40 50 60 Ventilations are too shallow Waveform zen peaks do not reach the green zone Environment General i Hal Add Ons Hal Pulses ventilations and Compressions 100 Compressions per minute Ze Compression Ventilation Ratio 30 12 Only Ventilations 30 40 50 60 sec 12 ventilations per minute Ventilations are too strong Waveform peaks exceed the green zone 96 User Guide Premie HAL Ventilation was
112. rt TPN and begin antibiotics 22 Incorrect Actions Decrease enteral feeding and delay physical exam and X Ray Perform actions 114 User Guide Premie HAL Premie HAL Gaumard Simulators for Health Care Education Normal A mother is admitted to the hospital for preterm labor She has had good prenatal care and her dates show the infant to be approximately 32 weeks She received two doses of antenatal steroids her membranes are intact and the baby s Lecithin Sphingomyelin L S ratio is 1 9 1 She continues to labor and the baby s scalp pH is 7 5 Despite attempts to delay delivery she delivers a 1300g infant After suctioning and gentle stimulation the baby begins to cry Incorrect Action Correct Action Perform Actions Prolonged suctioning of posterior pharynx Supply O2 by blow by Bi Wait Time 20 sec Start peripheral IV with D10W and monitor pulse oximetry Wait indefinitely for actions Premie HAL User Guide 115 Gaumard Simulators for Health Care Education Premie HAL Patent Ductus Arteriosus develops deteriorating vital signs On the second day of life apremie who has had a good response to surfactant and ventilation Improvement after 24 hours Increase PEEP Restrict fluids Begin Indom
113. rterial B Venous B The HOLD and Auto buttons are unique to the automatic mode Similar to manual mode click an apply button to submit changes Some changes are gradual and even the NOW apply button is pressed The delay results from using a closed loop model that adjusts other related values over time rather than displaying a unique value that is unrelated to other parameters HOLD Allows you to keep a current value constant Recall that in the manual mode to keep a value constant simply leave the control blank Click on the H to change the option from Auto to HOLD Respiration Pattern Resp Rate Hold es change Inspiration Auto o Erica Volume Auto ml 26 User Guide Premie HAL Auto Allow the model to auto adjust the value Click the input field blank to return to the default auto state Respiration Pattern Resp Rate le Sochang E Pfr spiration Auto Eric Volume Auto mi Manual Input the value of the parameter manually The model automatically adjusts related physiological values Respiration Pattern resp Rate 17 7 C change Pfr spiration Auto Ya Eric Volume Auto mi The A B vertical details tab includes the airway appearance and breathing controls Change the oxygen saturation by adjusting one of the following four parameters Click on the button to view a brief description of the four options Opt
114. rther when saving the scenario you may edit the scenario description This is the best place to put patient history and any other longer notes and instructions 3 Assume that providers will do the right thing 118 User Guide Premie HAL Usually you should create a scenario with the assumption that the providers will perform correctly As long as they do the scenario can be allowed to continue Naturally you must be prepared for what might happen to Premie HAL when providers deviate from expectations The consequences of such deviations can sometimes be included in the scenario punctuated by Wait Indefinitely items In other cases the simulation will require more direct control by the facilitator via either the Palette or Details page 4 Choose auto response settings based on the scenario content and the objectives As you ve seen auto responses can be used to free the facilitator s attention They also enhance realism by presenting instant reactions to the care providers On the other hand sometimes it is not possible or desirable to determine the responses before the simulation begins Different environments and applications call for different settings Some teaching practices are best done with the auto response settings in Prompt mode Responses must be triggered by a vigilant facilitator Though it is slower and requires more attention the benefit of Prompt over other modes is that the simulation can be allowed to go in
115. s should also be done while the manikin is turned off or set on STAND BY mode The temperature reading on the vital signs monitor is displayed when a temperature probe is placed on the lower right quadrant of the abdominal area To enable the temperature sensor detection feature go to Setup gt Options gt Neonate features Tab Checkmark Use temp sensor and click OK to save The log panel detects the placement of the sensor Details Palette Lab Scenario Model Log Providers add mm Emergency Reported Airway Breathing Assessresponsiveness Determine patency M Managebiesdng Arway management creme tntubation check as ne en ac om Action Assess responsiveness 00 00 05 Action Call for assistance activate EMS Action Open airway head tilt 8 Action 02 device nasal cannula Premie HAL User Guide 105 The Gaumard Monitors touchscreen display simulates the functionality of a patient vital signs monitor Users can customize the type of waveforms and scalars displayed set alarms and display lab reports x rays and other files for the provider to access during simulation The Gaumard Monitors vital signs system is available in a mobile and desktop solution 10 25 08 I taea ar For information on how to setup Gaumard Monitors with GUI please refer to the help File included with the Gaumard Monitors software
116. some of the terminology that will be used to discuss simulation with the Premie HAL system Automatic Mode In this mode vital signs respond automatically to caregiver participation instructor specifications and pharmacologic intervention The model used in this operating mode was developed based on physiologic principles Features unique to this mode include a comprehensive list of drugs for easy administration a drug profile editor for adding new drugs or editing existing ones among other things Facilitator the person conducting the simulation an instructor or lab staff member GUI the Gaumard User Interface is the software application used to control the simulator and evaluate care providers Palette a collection of Palette Items Each profile has its own palette Palette Item Any full or partial set of physiological parameters that have been grouped and saved together under a single name Profile a unique Premie HAL software configuration including custom Palette Scenarios and options Each Profile acts as a separate program in that changes made to one profile have no effect on the others Provider a person participating in the simulation as a healthcare provider Scenario a saved sequence of physiological states like a playlist Scenarios provide a level of automation that unburdens the facilitator and allows standardized presentation of symptoms Scenario Item a Palette Item that is
117. ster Epinephrine Primatene Adrenalin 0 ug IV Push 0 05ug kg 0 48 sd 00 01 04 Amiodarone Cordarone 0 mg IV Push 0 2ug kg 0 02 sd 00 00 57 Interaction Status More Potent Drug Effect Change Less Potent Drug Effect Change Max Alpha Current Alpha Stop Infusion Remove from list Change Dose and or Rate Warp Factor 1 ra Manage Drug List Increase the warp factor to speed up the effect of a medication on the patient model After the drug s administration is complete select the drug and click Remove from list Drugs cannot be removed from the list during the administration process with the exception of IV infusions However the drug effects for each medication can be turned off To remove all the drugs from the list and reset the patient model click File and New Session Click Stop Infusion to pause the drug s administration During this state the IV infusion dose and or rate can be adjusted or removed altogether if necessary Drug _ Dose Units _ Route _ Rate _ Epinephrine Primatene Adrenalin 0 mg IV Push 0 ug kg 02 40 23 Amiodarone Cordarone 0 mg IV Push 3634 019 ug kg 02 13 43 Remove from list wrai ij Premie HAL User Guide 57 Right click on the drug entry to show the drug effect menu Epinephrine Primatene Adrenalin 0 ug IV Push 0 0133 ug kg 00 04 48 Unselect Current Effect All Effects gt Effect Off under Standard Dose
118. t Association Follow the steps below to administer a medication directly from the medication tab Begin by selecting a medication from the drug list Details Palette Scenario Lab Drugs Speech Log Gaumard Drug Dose Units Route Rate Dose Naloxone Narcan p ug IV Push v a Administe Furosemide Lasix a Glucagon Glucagen Heparin LMW Enoxaparin Lovenox Heparin UFH Ibutilide Corvert Inamrinone Isoproterenol Isuprel Labetalol Trandate Normodyne Lidocaine Xylocaine Lisinopril Prinivil Zestril Lorazepam Ativan Magnesium Sulfate Mannitol Osmotrol Metroprolol Tartrate Lopressor Milrinone Primacor Morphine Sulfate Avinza Roxanol Naloxone Narcan Nicardipine Cardene Ls Nitroglycerin Nitrostat Norephinephrine Levophed Procainamide Pronestyl Propranolol Inderal Ramipril Altace Retaplase Retavase Sodium Nitroprusside Nitropress Nipride 0 Peak Time 00 02 00 EC50 0 0001mg dl overdose Note Dose may be g Standard Dose Naloxone SD 2mg Over Dose Naloxone OD 10mg m Warp Factor Manage Drug List lume ml Rate ml min StartN ncentration Rate L min Startoz Sotalol Sotacor Betapace Tenecteplase TNKase Tirofiban Aggrastat Vasopressin Pitressin Verapamil Isoptin Calan brief description is displayed at the top of the window The half life peak ti
119. t palette to the Over Dose option Medication Response EC50 0 0001 mg dl Concentration that produces 50 of the maximum effect 17 Naloxone UD Nirardinine On 3 4 1 ss Properties Edit Clear 62 User Guide Premie HAL 7 Select the threshold unit and adjust the value for each dosage effect Medication Response ECSO 0 0001 mg dl Concentration that produces 50 of the maximum effect Apply Items Threshold mg Naloxane 5D 2 Naloxone UD Over Dose Nicardipine OD ah Naloxone OD 10 Froperties edit lea After configuring the drug properties click the Update Graph button to generate the effect plasma concentration results Continue to the next section to program interactors for this drug Drug Effect Tester Test object weight 175 00 kg Premie HAL User Guide 63 The Interaction Editor window is used to program and test interactions between medications in the drug library When two or more medications preprogrammed to interact are administered the physiologic model will adjust vital signs as a response of the interaction effect Interaction Editor Naloxone Narcan Current Drug Data lz Max Alpha 1 9 Half Life 01 15 00 Peak Time 00 02 00 SD 2mg OD 10mg EC50 0 000img dL Isobologram plasma concentration CR RE 70 Interactors gt 7 Sodium Nitroprusside Nitropress un Drug List
120. the gt indicator is pointing Start or play the item to which the scenario position indicator is pointing This button has two states play or pause Pauses the scenario This state of the play button is only active when the scenario is playing It is disabled when a Wait indefinitely item is playing because in such case the scenario is already paused The stop button has 2 behaviors depending on when it is clicked When clicked once the Stop button halts the scenario at the end of the currently playing item When clicked a second time the scenario is stopped immediately For example if the currently playing item has a transition of 1 00 minute and the Stop button is pressed when it has 0 10 seconds left the scenario will be halted at the end the transition i e in 10 seconds If the Stop button is clicked again within those remaining 10 seconds the scenario stops immediately The next button advances the progress indicator to the next item on the scenario Click next when a wait indefinitely palette is playing to proceed to the next palette Similar to the Next button the Previous button returns the indicator to the previous item in the scenario The Reset button stops the scenario immediately and returns the indicator to the first item in the scenario 34 User Guide Premie HAL Use the scenario quick launch window to start a scenario with a single click The Quick Launch window displays all the scenarios saved in
121. the event of a perceived defect in material or workmanship of the Gaumard product the first purchaser must Contact Gaumard and request authorization to return the Gaumard product Do NOT return the Gaumard product to Gaumard without prior authorization Upon receiving authorization from Gaumard send the Gaumard product along with copies of 1 the original bill of sale or receipt and 2 this limited warranty document to Gaumard at 14700 SW 136 Street Miami FL 33196 5691 USA If the necessary repairs to the Gaumard product are covered by this limited warranty then the first purchaser will pay only the incidental expenses associated with the repair including any shipping handling and related costs for sending the product to Gaumard and for sending the product back to the first purchaser However if the repairs are not covered by this limited warranty then the first purchaser will be liable for all repair costs in addition to costs of shipping and handling In addition to the standard one year of coverage the following support plans are available Two Year Extension covers second and third years Call for pricing USA only 126 User Guide Premie HAL Gaumard Simulators for Health Care Education Contact Us E mail Technical Support support gaumard com E mail Sales and Customer Service sales gaumard com Phone Toll free in the USA 800 882 6655 Worldwide 01 305 971 3790 Fax 305 667 6085 Before
122. ting of the various materials comprising your simulator Store Premie HAL in a cool dry place Extended storage above 85 degrees Fahrenheit 29 Celsius will cause the simulator to soften and slowly warp It is acceptable to operate Premie HAL at an ambient temperature of 95 degrees Fahrenheit 35 Celsius Premie HAL is splash proof but not water proof Do not submerge or allow a large volume of fluid to enter the interior of the simulator Do not expose the tablet computer to water or excessive dust unless it is protected by a rugged case available separately Mouth to mouth resuscitation without a barrier device is not recommended as it will contaminate the airway Treat Premie HAL with the same precautions that would be used with a real patient The use of needles larger than 22 gauge will reduce the lifetime of the lower arms skin and veins When the arm veins require replacement contact Gaumard to arrange for a lower arm exchange Refer to the Consumables and Replacement Parts section of this guide and contact customer service for more information Do not inject fluids into the intramuscular sites Intramuscular sites are for placement exercises only Do not remove or replace the umbilical cord while Premie HAL is in operation Doing so will cause damage to the system Do not pull or carry the simulator by the limbs Handle Premie HAL with the same care as a human patient Electrical Therapy Premie HA
123. to manually type in a numerical value Breathing Resp Pattern Respiratory Rate Trdg ss breaths m change aspiratory Time ulation Rhythm eart Rate beats min 22 User Guide Premie HAL Click on the down arrow to access sound types and rhythms Upper Airway Sound IT Resp Pattern nor du espiratory Rate stridor inspiratory breaths min stridor expiratory change stridor biphasic Click on the feature control button to enable blue or disable black features such as crying Some feature controls may not be available depending on the simulator configuration No changes will be made to the simulator until the new settings are submitted using the apply panel N crying gt aoa a Preductal OSat Left Li Preductal OSat Left a Och se O change Ci change For more information about the simulator s features navigate to the Working with Premie HAL section of this guide After the settings are selected in the details area changes are submitted using any of the apply buttons located near the bottom of the page Apply Now 30sec 30sec imin 2min Smin 10 00 min Clocks Evaluation Care Drovided ME RS Power Click the NOW button to change the simulator s condition instantly Alternatively click a trending
124. tor computer for the provider access during the exercise Details Palette Lab Scenario Speech Log Gaumard Lab Reports Template Description Sent esse Lab Template Template Description New Template CBC DIFF Platelets Differential A Selected Item Lipid Panel Cholesterol HDL LDL Triglycerides tee Metabolic Panel Anion Gap Albumin Alkaline Phos Calcium Choride Delete Neonate Blood test For newborn and premie The Gaumard Virtual monitors must be connected before using the file sharing feature To verify the connection go to page 9 To begin navigate to the bottom of the tab and click on the New Template button on the right panel Lab Template A Template Description New Template CBC DIFF Platelets Differential A Selected Item Lipid Panel Cholesterol HDL LDL Triglycerides a 1 Metabolic Panel Anion Gap Albumin Alkaline Phos Calcium Choride Neonate Blood test For newborn and premie v Dete E Premie HAL User Guide 49 The Edit Lab Results Template window is used to create templates that will be later used to create lab reports Description Category Single Entry as see ame met ee ee 0 Allowed value range is displayed in Value column It won t be visible when entering data Enter a name for the lab template followed by a description Categories are used to grou
125. tration mg dL Drug Interactions Type the name of the new drug under New Medication following this pattern Brand Name New Medication Naloxone Narcan window appears A list of all the drugs included with the Meds Profile is Generic Name In the Description field type the condition this medication treats and reference information about the dosage Description Used to reverse the effects of opioid narcotic overdose Note Dose may be repead in 2 3 min intervals until reaching 10mg Select the units and the administration route Unit va ma a unit Other W ug ET ug kg W mg E mg kg E g E g kg Route IV Push AN Infusion IM SubQ Topical Per Oral Inhalation Premie HAL User Guide 61 4 Enter the drug s Half Life and Peak time If these numbers are unknown use the approximate Half Life Precise NE ise oF Approximate very quick lt 5m option hr min sec Peak Time hr min sec Precise OS 25 OF Approximate very quick lt 5m 5 Enter half maximal effective concentration Medication Response EC50 0 0001 mg dl Concentration that produces 50 of the maximum effect Available Palettes Apply Items Threshold Naloxone OD __ From the list select the dose effect palette created earlier and click the applicable dosage 6 button to assign Repeat this step to assign the over dose effec
126. trols for features available on your simulator FIXED Premie Hal Setup Enter the Serial Number from the Premie Hal simulator that THIS computer will control SN on RF Module p 8505004 Can t find Serial Number Automatic Channel Change Select desired channel 1 M Check noise in channel Use the Select desired channel field to set the channel that the RF module will use to communicate with the simulator Checkmark the Check noise in channel button to switch automatically to a cleaner channel if poor signal or interference is detected Manually assign a unique channel for each simulator to prevent crosstalk when operating multiple Gaumard simulators in close proximity For best results leave one channel open between the channels in use Set the intensity tolerances for the following features e CPR intensity for artificial ventilations and chest compressions e CPR rate tolerances for artificial ventilation and chest compression e Max cyanosis intensity level Enter the activation code to enable upgrade features Activation codes are unique to the simulator s serial number Before entering a code go to the Environment tab and set the connection mode to FIXED then enter the simulator s serial number e Virtual Monitor Enable the Monitors menu option to configure the virtual monitor connection To verify the connection status between GaumardUI and the Gaumard Monitors go to
127. tte Item The scenario auto response settings move the scenario to the next palette item when virtual electrical therapy is detected Use the Virtual Shock panel to simulate electrical therapy intervention Warning Do not defibrillate or pace Premie HAL with real medical equipment Doing so will result in damage to the simulator s internal components Auto responses advance to the next palette if the virtual shock is applied while a wait indefinitely palette is being played and if the simulator s is in a shockable rhythm Scenario Brent automaticresponses settings m Display warning when non shockable cardiac rhythm is shocked External Pacing Off C Prompt C Auto L Setting Capture at to paced rhythm Defibrillation Shock C Off Prompt Auto SIT SS r Setting a Joules Shocks advance to next scenario item when at INFINITE WAIT Cardioversion Shock C off Prompt Auto NS m Setting at J Joules C Shocks advance to next scenario item when at INFINITE WAIT mNon Sync Shock Off Prompt Sha C Auto NS Setting BE os Joules Shocks advance to next scenario item when at INFINITE WAIT The three response options are defined below e Off The scenario does not respond to the electric therapy e Prompt The software detects the electrical therapy and prompts the facilitator if they
128. ual bleeding click the Bleed button and adjust the bleeding rate using the Wound Size control F PORT NT Other Temperature F Blood Glucose morrhage Wound S it Once activated the physiologic model gradually adjusts the simulator s vital signs in response to the blood loss Without intervention the vital signs will gradually deteriorate until eventually ischemia of the heart occurs For information on how to infuse blood to the model virtually go to page 55 Blood Pressure Pats min b change lial nperature bleed Stop Bleeding rate 11 ml min bleed Wound Size Sst Premie HAL User Guide 29 The Adv vertical tab includes advanced cardiac circulatory respiratory and environment controls All the controls in this page are unique to the automatic mode A Cardiac B Right Heart Chambers Left Heart Chambers Reqauraitation Tricuspid Q Pulmonary Requraitation Mitral Aortic Resistance kw i Resistance Ir Ir Contractility RA RV Contractility La LV normal 100 normal 100 Circulatory Blood Volume ml Cardiac Irritability BA Vascular Properties Vessel Diameter slightly constricted Vessel Stiffness Respiratory Shunt flow Dead Space ml PH Environment Ambient Pressure ATM Inspired Air Mix O2 CO2 The advanced tab gives you more control over the model by allowing you to ed
129. uired Lipid Panel Both Variable Normal Range Value Comment Cholesterol mg dL 0 00 199 00 190 00 LDL Cholesterol mg dL 0 00 129 00 135 00 Care required Triglycerides mg dL 30 00 200 00 100 00 The preview window also allows the printing of results for distribution and archiving Premie HAL User Guide 53 Send the completed lab report to the virtual monitor screen to assist the care provider Begin by selecting the report from the lab reports list Lab Reports Hate Template Description sent Este Report Healthy 2 OB Blood test Healthy Levels qe Healthy Neonate Blood test Healthy Levels mue James Metabolic Panel Session 1 m Lipid Panel Tas Selected Item Lab 02 CBC DIFF High levels mihin Lab 03 Neonate Blood test High levels Delete Lab 04 CBC DIFF Simulation 1 n Preview Lab 05 OB Blood test Session 2 Lab 06 PPT Session 2 Send to monitor Susan Lipid Panel Session 4 Click the Send to Monitor button to transfer the lab report to the virtual monitor Selected Item Delete Preview On the virtual monitor window an exclamation icon notifies the provider a file is ready for access Click the patient monitor drop down menu to select the available lab report Premie HAL Ask for The lab report will open using the system s default application Lab 01 Once the report is sent the letter Y will be present on the Sent column Use the Stop Shar
130. ustomize the following simulator specific features e Fine tune the pulse intensity for normal blood pressure e Synchronize the leg blood pressure to the arm blood pressure when the values are not specified e Synchronize post ductal and pre ductal oxygen saturation parameters when values are not specified e Use temperature sensor Options Set pulse strengths for normal Virtual Temperature BP Use temp sensor 60 40 1 0 Sync Vitals when left blank Sync Leg BP to Arm Sync Postductal OSat to Preductal On the Log tab color set the color tag for the available log event entries Options Environment I General Premie Hal Add Ons Fremie Features Applied Details Tracheal Intubation Defibrilation Cardioversion Compression Ventilation Pacing Customize the compression to ventilation ratio signaled by CPR Trainer prompt e Set the number of compressions per minute e Set the compression ventilation ratio e Set number of ventilations per minute if the Only Ventilations button is selected Checkmark Once a Palette is applied load to Details Tab to show the value of each of the palette s vital signs parameters on the Details tab control entries Link the respiration sensor to the ECG to generate a waveform every time a compression is performed GaumardUIl is capable of interfacing with a number
131. ve the normal range specified will be displayed in bold Include any comments associated with the test performed Finally click Save from the top right menu to create the lab report Description Above normal range Cholesterol LDL Cholesterol Lipid Panel Female Variable Normal Range Value Comment HDL Cholesterol mg dL 35 00 85 00 85 Cholesterold HDL Ratio 0 00 4 40 5 1 care required Lipid Panel Male 0 Variable Normal Range Value Comment HDL Cholesterol mg dL 29 00 71 00 II Cholesterol HDL Ratio Ratio 0 00 4 90 IN Lipid Panel Both Variable Normal Range Value Comment Cholesterol mg dL 0 00 199 00 1190 00 II LL Cholesterol mg dL 0 00 129 00 135 il Triglycerides mg dL 30 00 200 00 1100 Il The newly created lab report is now listed in the Lab Reports section Sort lab reports by name template description or color tag Details Palette Lab Scenario Speech Log Lab Reports On the right panel click Preview to view final lab report on the facilitator s screen To make the lab report available to the provider on the patient monitor screen click Send to VM Lab Preview Lab 01 11 36 Above normal range Cholesterol LDL Cholesterol Normal Range Value Comment HDL Cholesterol mg dL 35 00 85 00 85 00 Cholesterold HDL Ratio 0 00 4 40 5 10 Care req
132. veness Determine patency Assess breathing fa h Yagal maneuver fe i Onen airs O2 device ale The Evaluation panel always visible at the bottom of the software window allows the facilitator to insert standard evaluations or arbitrary notes into the log The stylus device and hand writing recognition technology makes annotating in real time very fast and convenient Pe Care Provided Unsatisfactory Sa atisfactory wif el Premie HAL User Guide 73 Standard evaluations are given context by their position in the log relative to detected and observed provider actions The following example illustrates this idea 01 36 37 Info 00 00 Start scenario 01 36 37 Applied 01 00 Palette Asphyxia 1 Details HR 140 BP 83 54 RR 40 Inspire 25 OSat 95 EtCO2 40 Temp 37 Cyano 01 37 37 Applied 00 30 Palette Asphyxia 2 Details HR 112 BP 66 43 OSat 80 Cyanosis 71 01 39 05 Charles Parker Action Open airway suction 01 39 09 Charles Parker Action Call for assistance additional staffing 01 39 16 Charles Parker Evaluation Care Provided Satisfactory Sg Il 3 Note in the highlighted lines above that the provider Charles Parker cleared the patient s airway called for help and was then evaluated on those actions The evaluation panel is part of the team logging system described previously When a particular provider is selected log entries generated via
133. vital information from the NOELLE model Click Yes to load the information onto the Premie HAL tablet and continue the scenario Help On the menu bar click the Help option to perform the following options 1 Connect an Ethernet cable to the laptop PC 2 Go to the Help menu and click on Check for Updates The GaumardUl automatically starts searching for available updates 3 Click Install to begin the update The download progress bar begins to auto fill as the setup file is downloaded Upon completion the software automatically launches the setup wizard 4 Click Next and follow the wizard instructions to complete the software download GUI Help option opens a digital copy of the simulator s User Guide Click About GUI for information on the GaumardUl software version and the simulator s firmware revision ADOUT Gaumard Simuators for Health Care Education Gaumardll Version 119 9 0 Firmware 1 19 Copyright 2010 Gaumard Scientific Co www gaumand com OK Redistributable GaumardUI installer files are available for download at http www gaumard com software updates Follow the steps below to check for software updates using the built in update feature 98 User Guide Premie HAL Use this feature as a troubleshooting tool to verify the status of the simulator s features For more information on using the diagnostics screen for troubleshooting g
134. wing Click on the patient name button to bring down the selection of available files and select the context name to open X Ray Chest The x ray file is now open To troubleshoot file sharing access errors go refer to the Gaumard Monitors Guide Premie HAL User Guide 93 Use the custom numbers menu to add custom numerical parameters to the virtual monitor main screen such as a glucose levels or a platelet count On the GaumardUl menu bar click Monitors gt Custom Numbers to open the Custom Numerical Parameters on Monitor menu Click the Add button to create a new parameter Custom Numerical Parameters on Monitor s Load Type the name and units of the new parameter and then click OK Custom Numerical Parameters on Monitor s Name Hematocrit The scalar parameter is now created Enter a value for the parameter and click Update Custom Numerical Parameters on Monitor s Save Load Remove On of Hematocrit 52 update Glucose 83 mg dl update On the virtual monitor screen click on a scalars menu and select Close to make the entry available for the custom parameter 94 User Guide Premie HAL The scalar entry is now a blank field Click on the empty scalar menu and select Other from the list of available scalar parameters Select the name of the custom parameter am F N
135. would like to advance to the next palette e Auto Automatically advance to the next palette only if the electrical therapy meets the threshold specified Premie HAL User Guide 39 Unlike linear scenarios which progress from one palette to the next the interactive branching scenario controls allow the facilitator to change the scenario s trajectory in response to provider actions To access the Branching window click the Go to Branching Scenario button on the Scenario tab Details Palette Lab Scenario Speech Log The top panel buttons are used to clear load and save a scenario or to switch from branching to linear scenarios Click Load Scenario to access the preprogrammed branched scenarios in the Quick Start Profile Quick Launch Details Palette Scenario Lab Speech Log ee GC Save Auto Responses Go to Normal Scenario The basic process of creating a new branching scenario is the following e Add nodes e Add palettes or scenarios to each node e Add paths to nodes that require provider action e Create key events to alter the progress and trajectory of the nodes within the scenario A branching scenario consists of several Nodes Each node is preconfigured to run a normal scenario or a series of palettes simulating a specific condition or effect To add nodes click the Add node button Quick Launch
136. ythm Heart Rate Blood Pressure arm beats min en mmHg a n Oe Auto Auto SE via Vascular Properties I EA Blood Pressure leg Differential less than arm BP BE em Bowel Sounds 00 UL UR Other Temperature F Blood Glucose mg dL mJ LO Our Hemorrhage Bleed Capillary Refill Time sec Wound Size j Each cardiac rhythm has a specific effect on the blood pressure wave forms The pressure wave forms include ABP CVP PAWP and Pulse Mild cyanosis is activated when the oxygen saturation is less than 92 and or the temperature is less than 35 C Values under these thresholds will cause the cyanosis to get progressively worse 28 User Guide Premie HAL Similar to OzSat and EtCO blood pressure can be changed indirectly when using the modeling mode You can do so by selecting one of four options e Vascular profiles vessel diameter and vessel stiffness e Heart Rate e LV Contractility e Total Blood Volume Set the patient status to Excited after exercise to increases heart rate temperature respiratory rate tidal volume O2 CO2 diffusion capacity metabolism rate and CO2 formation rate Set the status to resting for a normal state Circulation Patient Status ECG er sting Rhythm Sinus pes yt L excited The Bleed and Wound size option allows the facilitator to simulate blood loss within the patient model To start the virt

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