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NOELLE S574/S575/S576 User Guide

1. 200 NOELLE S574 575 576 User Guide Gaumard Simulators for Health Care Educatior Noelle S574 575 Labor Scenario Gail Uterine Rupture Physically place Noelle on ventilator Prep for c s Wait time 1 30 min Begin c s procedure Wait time 1 min y Deliver Baby repair uterus Wait indefinitely 201 NOELLE S574 575 576 User Guide Noelle S574 5757 Labor Scenario Gaumard Heidi Simulators for Health Care Education i i Peripartum Hemorrhage Previa 202 Heidi is a 25 yr old primip 35 weeks She has experienced several mild bleeding episodes during pregnancy and is known to have a low lying placenta She arrives in L amp D complaining of abdominal cramps and has bright red vaginal bleeding Labor duration 30 minutes Labor duration 35 45 minutes Is scenario Branching NOELLE S574 575 576 User Guide Noelle S574 575 Labor Scenario Gaumard Heidi Simulators for Health Care Educatior Peripartum Hemorrhage Previa Deliver placenta Wait time 1 min Sedate and perform bimanual exploration Wait time 2 30 min Give pitocin fundal massage Wait time 1 30 min 203 NOELLE S574 575 576 User Guide Gaumard Simulators for
2. y Move to OR to deliver baby Wait indefinitely Requires PRBCs Wait time 2 20 min 206 NOELLE S574 575 576 User Guide Gaumard Simulators for Health Care Education y Noelle S574 575 Labor Scenario India Peripartum Hemorrhage Abruptio India is a 19 yr old gravida 2 37 weeks She arrives at hospital with her husband who says she fell down the stairs and she has been cramping and bleeding for about an hour During admitting interview husband answers all the questions and India doesn t make eye contact The nurse palpates uterus initiates fetal monitoring and starts a pad count Labor duration 25 minutes 207 NOELLE S574 575 576 User Guide 208 Noelle S574 575 Labor Scenario Gaumard Inez Simulators for Health Care Education Peripartum Hemorrhage Abruption Inez is a 27 yr old primip Y 35 weeks She arrives at hospital one evening crying and doubled over in pain She is admitted to a birthing room and the nurse notices bright red blood on Inez s panties She is having very intense and close contractions Labor duration 10 minutes Scenario duration 18 minutes Reset birthing motor and attach PP uterus Wait time 3 min NOELLE S574 575 576 User Guide M Noelle S574 575 Labor Scenario Gaumard Inez Simulators for Health Care Education
3. 178 NOELLE S574 575 576 User Guide Noelle Labor Scenario Helen Hemorrhage Gaumard Simulators for Health Care Educatior Helen is a 25 year old gravida 1 0 at 35 weeks She weighs 180 lbs She has had prenatal care Labor duration 30 minutes 179 NOELLE S574 575 576 User Guide Gaumard Simulators for Health re Educatior Noelle Labor Scenario Irene Cesarean Delivery duration 45 minutes lrene is a 19 year old gravida 2 0 at 29 weeks She has had one spontaneous abortion Labor 180 Admit patient Routine labs notify HCP of admission and status Set up delivery table and infant warmer configure bed for delivery NOELLE S574 575 576 User Guide NOELLE Advanced Scenario Name Labor Type p ios CO eenaton Em escimpee ee e e oR or renin pa perronen en m oa EN pa trons enmon Premio 181 NOELLE S574 575 576 User Guide 182 gt Noelle S574 575 Labor Scenario Gaumard Alyssa Simulators for Health Care Education Normal Labor Alyssa is a 23 yr old primip at term Her health is generally good and she has experienced no prenatal complications She wishes to receive no medications and will have the CNM attending her delivery Labor duration 30 minutes NOELLE 574 575 576 User Guide Gaumard
4. Amy is 19 years and she weighs 160 lbs Her OB history shows a gravida of 1 She is currently 40 weeks pregnant She enters LD accompanied by her mother Labor duration 30 minutes 171 NOELLE S574 575 576 User Guide 172 Noelle Labor Scenario Angelica Variations on Normal Gaumard Simulators for Health Care Education Angelica is a 31 year old gravida 5 3 at 41 weeks She weighs 160 lbs She has experienced no prenatal complications and has a history of fast labors Labor duration 20 minutes NOELLE S574 575 576 User Guide G d Noelle Labor Scenario aumar Simulators for Health Care Educatior Beth Variations on Normal Beth is a 16 year old gravida 2 0 at 37 weeks She has had one elective abortion She has had prenatal care Labor duration 10 minutes Speech bathroom blood coming out baby is coming bathroom 173 NOELLE S574 575 576 User Guide 174 4 Gaumard Simulators for Health Care Education Noelle Labor Scenario Cynthia Shoulder Dystocia Cynthia is a 31 year old gravida 3 1 at 41 weeks She weighs 170 lbs Labor duration 30 minutes Admit patient Routine labs notify HCP of admission and status Set up delivery table and infant warmer configure bed for delivery Perform Supr
5. Uterine Rupture Abruptio Grade 0 Dead Space 155 ml Some status panel entries and features might not be visible depending on the simulator s hardware configuration 22 NOELLE 574 575 576 User Guide Communication Indicator The communication indicator shows the status of the radio link between the computer and the simulator Full bars indicate excellent communication between the computer and the simulator i e normal 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 Avail if etl eal aaa call The warning icon indicates a signal conflict with another simulator Clicking the icon produces the following message RF Communication b 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 For more information on the Scan RF Channel window navigate to page 134 Battery Indicator The battery status indicator progresses as the battery in the simulator is used Approximate maximum battery run time is 2hrs30mins depending on usage The exclamation mark indicator is shown when there is no communication with the simulator and the program cannot get the battery information EA i Sound Volumes The volume of each sound
6. 4 5 NOELLE S574 575 576 User Guide Slowly pull the birth canal insert towards you When the urine catheter tube is visible detach from the birth canal insert Finally after removing the urine catheter tube gently remove the birth canal insert Attach the birth canal 1 Place birth canal insert into polythene bag and ensure the bag covers the Velcro on the outer wall of the insert as shown in picture While first inserting the plastic bag through the birth canal opening on the mannequin gently position the birth canal insert with the approximate final alignment to the opening Push the birth canal insert into position Place your hands on the lower half of the insert with your fingers holding the bag in place Steady the front of the insert with your thumbs Without removing the plastic orient the birth canal insert so that it is properly aligned with the opening on the lower torso of the mannequin 259 NOELLE S574 575 576 User Guide 5 260 Gently begin to remove the polythene bag with one hand while holding the insert in place with the other as pictured below It is easier to start at the top then work down the sides towards the bottom Place one hand towards the bottom of the birth canal insert when pulling out the bottom portion of the polythene bag With the birth canal insert in place pull the post partum hemorrhage tube through the hole in the bottom of the birth cana
7. Simulators for Health Care Education Noelle S574 575 Labor Scenario Normal Labor Angela Angela is a 31 yr old grand multip term She tells the triage nurse that even though she has had few contractions she came in because she has a history of rapid labors Her general health is good and she has had no problems during this pregnancy V E shows the cervix to be paper thin and Angela is admitted to birthing room Labor duration 30 minutes S amp S Comfortable excited about delivery S amp S feeling pain Urge to push strong Perform V E admit patient to BR initiate continuous EFM Notify HCP of imminent delivery 183 NOELLE S574 575 576 User Guide Noelle S574 575 Labor Scenario Gaumard Becca Simulators for Health Care Educatior Variations on Normal Becca is a young pregnant teen who is living on the streets She is a heavy smoker and drug user She was seen twice in the Adolescent Clinic and referred to Social Services but she only saw the social worker once and did not go to the follow up appointment Labor duration 18 22 minutes S amp S Patient is screaming and uncooperative Prep for precipitous delivery support fetal head to prevent explosive delivery check for nuchal cord if possible check for intact placenta
8. Find the Internet Protocol TCPAP inside the selection box labeled This connection uses the following items Highlight it and click the Properties button L Wireless Network Connection Properties General Wireless Networks Advanced Connect using 38 Intell PRO wireless LAN 2100 34 This connection uses the following tema W AEGIS Protocol IEEE 802 18 v2 2 1 0 SF WLAN Transport internet Protocol TCP IP r Install Uninstall Properties Description Transmission Control Protocolnterret Protocol The default wide area network protocol that provides communication across diverse interconmected networks IY Show icon in notification area when connected M Notify me when this connection has limited or no connectivity 255 NOELLE S574 575 576 User Guide The Internet Protocol TCP IP Properties window is displayed Select Use the following IP address to write in a static IP address Internet Protocol TCP IP Properties ajx You can get A automatically if your network supports this capi _ you need to ask your network administrator for he nica P setie Virtual Monitor computer static address Internet Protocol TCP IP Properties General fou can get IP settings assigned automatically if your network supports this capability Otherwise you need to ask pour network administrator for the appropriate IP settings Obtain an IP addr
9. NOELLE S574 575 576 User Guide Getting Started Overview Your NOELLE S574 575 576 patient simulator is completely self contained and tetherless and includes the following features e Self contained and mobile e RF communications up to 150 feet in open space 50 meters e Powerful yet intuitive user interface software Airway e Oral and nasal intubation e Use anET tube or LMA e Sensors detect depth of intubation Breathing e Spontaneous breathing with chest rise e Independently programmable left and right lung sounds e Upper airway sounds and pre programmed speech e Control rate and depth of respiration e Ventilation is measured and logged Circulation e Bilateral carotid radial and brachial pulses that vary in strength with blood pressure e Blood pressure measured by palpation or auscultation e Normal and abnormal heart sounds e Conductive sites on skin accommodate real electrodes and monitoring with real equipment accommodates full energy Defibrillation Cardioversion and anterior cardiac pacing e Sensors detect electrical therapy chest compression ventilation blood pressure cuff use and depth of intubation e Distal pulses individually disabled for simulation of arterial occlusion or rupture e Programmable responses to electrical therapy Control e Proprietary communications module can be used simultaneously with the tablet computer s integrated wireless IEEE 802 11b networking device
10. Na Delivery Position Rotate baby Breech C Check ROT LOT delivery 81 NOELLE 574 575 576 User Guide Breech Use this control when planning a breech delivery When selected it disables the motor rotation Check ROT LOT delivery this control limits the release mechanism to trigger only when the neonate s shoulders are positioned vertically If the shoulders are not aligned vertically the mechanism will not release The only way to detach the baby then is by manually clicking on the Release Baby button Labor Control Enable Smart Labor this option allows you to run all non speech palettes in real time You can specify for how long the palettes will run in real time The software defaults to ten seconds Labor Control Enable Smart Labor j10 E sec 2 E Descend only with contractions Pause Run When the Smart Labor is activated the window circled in red below is displayed Be all tien a a a A A et A Smart Labor Activated ALLL i alice02 6 ATT Tal E E E E Ei g EA a m S 10 0 120 140 160 180 200 220 240 2 Hide the message by clicking the Hide button or Stop that palette from running in real time otherwise the message will display for ten seconds The number in red indicates how many seconds are left before switching back to warped speed The name of the palette being applied in real time is also sh
11. Place the lubricated fetus onto the lubricated inflatable cushion and snap the lubricated abdominal cover into place Inflate the cushion lifting the fetus anteriorly Inflate the cushion at the base of the pelvic cavity to position fetus NOELLE 574 575 576 User Guide Confirm the breech position and attempt to manually turn the fetus within the uterus by trans abdominal manipulation Breech Birth Breech birth occurs when either the buttocks or lower extremities of the fetus are the presenting part There are three types of breech birth frank complete and incomplete or footling e Frank breech occurs when the buttocks are the presenting part and the legs of the fetus are extended up toward the baby s head e Complete breech occurs when the buttocks are the presenting part and the baby s legs are flexed along the lower torso e Footling or incomplete breech occurs when one or both of the legs are the presenting part There are many differences in labor between the breech presentation and the vertex presentation During the descent the posterior hip encounters the pelvic floor and internal rotation takes place allowing the anterior hip to move beneath the pubic arch The anterior hip then delivers followed by the posterior hip the legs and the feet External rotation allows the shoulders to move into the maternal pelvis and internal rotation allows the shoulders to deliver Downward traction allows the deliver
12. Runs for 40 minutes Progressive cervical change and fetal descent are noted during 9 hour induction Fetal descent continues with little active pushing FHTs show decreased variability and mild to moderate decelerations Delivery is accompanied with outlet forceps Female infant is dusky limp and does not breathe spontaneously at delivery Meconium is noted and a small amount is observed below vocal cords Baby is suctioned and is eventually transferred to NICU for continued observation Runs for 10 minutes Delivery of male infant is accomplished through a low transverse uterine incision The infant exhibits good tone and cries spontaneously at delivery peripheral Runs for 10 minutes Gloria arrives at the hospital with ruptured membranes and an obviously prolapsed cord Profound fetal bradycardia is noted Delivery occurs almost immediately after the patient is moved to the delivery room C amp S is obtained and sent to pathology The male infant is placed on infant warmer His earns APGAR score Runs for 30 minutes FHT remain WNL Midline episiotomy is performed and the delivery is spontaneous The placenta delivers but is not intact Bimanual uterine exploration removes small amount of placental tissue The male infant is pale and flaccid He is covered with vernix and blood Neonatal resuscitation is begun immediately Runs for 45 minutes Sterile speculum exam indicates a shortened cervix with a cerclage in place Fluid is
13. When the arm veins require replacement contact Gaumard to arrange for a lower arm exchange For a small fee we will deliver reconditioned and warrantied lower arm assemblies to your facility After receiving the replacement arms use the same box and the enclosed shipping label to return the old arms to Gaumard For international and express service additional fees may be charged Refer to the Consumables and Replacement Parts section of this guide and contact customer service for more information Storage Store NOELLEin 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 NOELLEat an ambient temperature of 95 degrees Fahrenheit 35 Celsius 10 Do not store the simulator with a discharged battery It is good practice to re charge the battery at the end of every simulation session In addition make sure the battery is re charged at least once every 6 months even if the simulator is not being used otherwise permanent loss of capacity might occur because of self discharge Cleaning NOELLE should be cleaned with a cloth dampened with diluted liquid dishwashing soap If medical adhesives remain on the skin clean with alcohol wipes DO NOT USE GOO GONE as the citric acid in the formula will cause pitting of the various materials comprising your simulator NOELLE is splash proof but not water proof Do not submerge o
14. suprapubic pressure maneuvers are required Male infant is centrally cyanotic limp and flaccid and requires immediate resuscitation Stat CXR reveals a fractured right clavicle and right pneumothorax 91 NOELLE S574 575 576 User Guide Scenario Name Donna Elaine Francine Gloria Helen Irene 92 Labor Type Breech Preeclampsia Cesarean Delivery Cord Prolapse Hemorrhage Cesarean Delivery History Donna is a 20 year old gravida 4 2 at 31 weeks She weighs 180 lbs She has had one elective abortion She has had prenatal care Elaine is a 23 year old gravida 1 0 at 37 weeks She weighs 140 lbs She has had prenatal care She complains of mind frontal headache 3 tibial edema and 4 DTRs with 2 beats clonus are noted Francine is a 19 year old female gravida 2 1 at 37 weeks She weighs 145 lbs She has had prenatal care She has SID Herpes Gloria is a 34 years old gravida 1 0 at 25 weeks She weighs 190 lbs She has had prenatal care Helen is a 25 year old gravida 1 0 at 35 weeks She weighs 180 Ibs She has had prenatal care lrene is a 19 year old gravida 2 0 at 29 weeks She has had one spontaneous abortion Overview Runs for 20 minutes Labor progresses quickly and breech is delivered by the nurse Meconium is noted The preterm female baby cries weakly with stimulation but color and tone are poor She is transferred to the nursery for stabilization and continuing care
15. EtCO2 Inspiratory Time 33 mmHg ed 5 dange ii O change O change Circulation Rhythm i R Heart Rate Blood Pressure Absent Pulses Heart Sound beats min mates 80 O change Systolic Diastolic mmHg Radial Right v 120 80 change Radial Left Sinus Arrhythmia Other Temperature F Seizures Eyes State Pupils 5205 Apply 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 24 NOELLE 574 575 576 User Guide Some controls on the Details tab change depending on the operating mode automatic or manual and features installed on the simulator Additional controls on either mode can be accessed by clicking on the vertical tab located on the left of the screen Changing Vitals 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 settings not specified will remain unchanged Outlined below are common control behaviors Click or tap slider control to quickly adjust numerical values using the stylus Alternatively use the onscreen keyboard to manually type in a numerical value Breathing Resp Pattern Respi
16. Noelle S574 575 Labor Scenario Kelly Amniotic Fluid Embolism Automatic Mode y NEWBORN ASSESSMENT Female Heart rate absent Respiratory effort none Perform emergency C section Wait time 3 min Electrical defibrilation Wait time 1 min Administer resuscitation per ACLS protocols Inspect placenta following delivery administer Pitocin to promote uterine ctx Full resuscitation Wait indefinitely Give blood products for DIC management stabilize patient transfer to ICU NOELLE S574 575 576 User Guide Gaumard Simulators for Health Care Education Noelle S574 575 Labor Scenario Madonna Preterm Labor Automatic Mode Madonna is a 41 yr old multip 31 weeks She has experienced difficult pregnancies and has one Downs Syndrome baby She has had several episodes of preterm contractions that resolved with LLP bed rest This time the bed rest and oral hydration are not resolving the contractions in fact they seem to be getting worse Labor duration 35 minutes S amp S Patient is anxious and shaky she says her heart is racing S amp S Patient is anxious and shaky Palpitations tachycardia and PVCs result from second dose of SQ Terbutaline S amp S no adverse reaction to Procardia Perf
17. Use the checklist below to confirm the necessary connections Desktop PC Touchscreen Touchscreen PC Power cable USB USB l Monitor Monitor Monitor Audio 1 Wideo Video Monitor Monitor Monitor Audio 2 Auda Audio Monitor Monitor Power Cable Power Cable Touchscreen USB 1 Touchscreen USB 2 Monitor Video 1 Monitor Video 2 Wireless antenna PC tower rear view System 2 This setup consists 1 all in one PC and 1 touchscreen monitor Use the checklist below to confirm the necessary connections All in One PC Touchscreen USB cable Touchscreen USB cable DVI Video cable DVI Video Cable eel 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 vital signs information displayed on the Gaumard Monitors program NOELLE S574 575 576 User Guide To verify the connection between the computers click on the wireless icon located on the task tray of both the tablet and virtual monitor computer Earlier systems may display NOELLENet575 as the wireless network connection name To troubleshoot connection issues please navigate to page 241 Currently connected to Unidentified network No Internet access Wireless Network Connection 2 GaumardNet gaumard Other Network Open Network and Shari
18. i Peripartum Hemorrhage Abruption Administer Pitocin manage bleeding and massage fundus Wait time 3 min 209 NOELLE S574 575 576 User Guide Gaumard Simulators for Health Care Education Noelle S574 575 Labor Scenario Janie Peripartum Hemorrhage PPH Scenario duration 25 minutes Janie is a 23 yr old G 2 O 38 weeks She has experienced several bleeding episodes due to a low lying placenta She has been counseled about the potential for postpartum hemorrhage Her religious beliefs prohibit the administration of any blood products Labor duration 15 minutes 210 Reset delivery motor and insert postpartum uterus Wait time 3 min NOELLE S574 575 576 User Guide Noelle S574 575 Labor Scenario Gaumard Janie Simulators for Health Care Education Peripartum Hemorrhage PPH y Massage fundus to stem bleeding Wait time 1 min Administer hemabate 250mcg IM stat Wait time 2 min Administer Lomotil 2 tabs for nausea Wait time 35 sec 211 NOELLE S574 575 576 User Guide 212 Noelle 574 575 Labor Scenario June Peripartum Hemorrhage PPH Gaumard Simulators for Health Care Education June is a 31 yr old multip about to have her 5 baby She has had a normal pregnancy and she is planning natural childbirth She enters
19. min 2 O mmH 20 i i g Inspiratory Time 33 change P 98 change change qa Upper Airway Sound normal Laryngospasm U A Circulation Rhythm Sinus El R Heart Rate Blood Pressure Absent Pulses Heart Sound beats min y ee F a normal v change Systolic Diastolic mmHg Radial Right 114 80 change O Radial Left O Sinus Arrhythmia Other Temperature F Seizures none Eyes State 20 blinks min Pupils L Enable Rxn Time sec Hemorrhage Uterine Pres Enable Rxn q ee ee Geen ee ee Ge When operating in automatic mode if inconsistent combinations or vitals are selected the model does not adjust to the specified values The model is based on accurate physiologic principles and therefore choosing a combination of vitals that is inconstant with these principles will not deliver the appointed results 1 Save your palette s by clicking on the Save as Palette Item button on the upper right side of the page Assign a name to the Palette Item and specify a brief description Also select a color that represents the palette s condition Green for healthy red for critical yellow for care required and blue for other Then click Save Save as Palette Item Palette Item Name Resting Palette Item Descriptio
20. 55 NOELLE 574 575 576 User Guide Auto transition to Labor Scenario To automatically transition from a linear scenario to a labor scenario add a Go to labor palette at the end of the list From the drop down select the labor that will begin at the end of this scenario and click add Add Palette Item nn ant A Y 59 59 Max irene01 irene02 Item Description Select labor scenario from the pulldown menu below irene03 irene04 irene05 irene06 respiratory allergy Resting Wait Wait Indefinitely Go to Labor Upon reaching the Go to Labor palette the software will automatically begin the labor scenario named Alice Start State Asthma Sinus respiratory allergy wheezing difficulty exhaling tongue edema Closed airway all difficult airway actuators on Wait Indefinitely oe Hold in current state until action is taken Resting Normal Vitals gt co to Labor 3 Alice WARNING Prepare the simulator for delivery before using a linear scenario that automatically transitions to a labor scenario 56 NOELLE 574 575 576 User Guide Branching Scenarios The branching scenario is an advanced linear scenario editor It allows the user to branch towards different scenarios palettes depending on specific Key Events activated by the instructor To access the Branching window click on the Go to Branching Scenario button on the Scenario tab Similar to the linear scenario page t
21. 75 bpm BP 120 80 The Load Palette Item window is displayed Highlight the desired palette and click Load Add Palette Item Transition Healthy EA ma min sec eee aj o8 of 59 59 Max Item Description Normal Vitals elaine02 Wait Indefinitely Go to Labor ad comal The desired palette is now displayed in the Setting section You can delete the palette by clicking the xX button Deleting the palette defaults the electrical therapy to NSR 75 bpm BP 120 80 Defibrillation Shock Prompt 7 a i Automatic Mode Non Scenario automatic responses The non scenario automatic responses settings window has two additional features in the automatic mode Link All Auto Response to Cardiac Irritability and the Drug Model Effect panel Link All Auto Response to Cardiac Irritability if this feature is turned on the auto responses will work auto or prompt if and only if the cardiac irritability option on the details page matches the selection on this window Non scenario automaticresponses settings O off great random slight improve i itahility ic oreat improve on e oe Irritability ts slight deteriorate multichoice is enabled External Pacing Defibrillation Shock O Prompt O Prompt o O Prompt O Auto gt O Auto YA O Auto If the cardiac irritability on the details page does not match the selection o
22. Details RR 23 OSat 97 ContractionFreq 3 min ContractionDurat 70 sec ContractionInt 60 mmHg FHRPeriodic early decels 00 01 37 Applied 00 00 Palette alice04 Details HR 70 RR 19 Print Report This option allows you to print a text file containing all the information in the log for the latest session Clicking on Print Report brings up the Print dialog box The shortcut key for this option is Ctrl P Import This tool allows the import of palettes scenarios or modeling patients that may have been created on another tablet PC When Import is clicked the Open dialog box is displayed Organize v New folder gt Wr Favorites oras Type _ Chris scz SCZ File gt E Libraries gt 2 Homegroup gt i Computer D Gu Network 4 File name v Scenario Files scz y Browse to the location where the palette scenario or patient files have been saved and open it They are automatically brought into the GaumardUI Make sure that you have the correct file type selected 118 File name Scenario Files scz Branched Scenarios bsz Labor Scenarios Isz Palette Items plt Profiles pfz Export You can export palettes scenarios branched or linear and model patients After selecting the kind of file to be exported the following dialog box is displayed e Export Export File Type 11 05 2010 15 02 12 11 05 2010 15 02 12
23. EI Noele 574 575 Virtual Monitor Setup Select the number of monitors that will be used with this manikin Also you can name each monitor with an appropiate description Keep in mind that Noelle s vital signs and fetal monitor are considered h 7 together as 1 monitor All sensors always ON connected Adapter Wireless network Connection Controller IP 10 0 0 1 Port 8001 Connected to 10 0 0 3 To configure the connection between the computers and establish a connection to the virtual monitors software refer to page 250 139 NOELLE S574 575 576 User Guide CPR GaumardUl features a CPR performance evaluator and trainer From the menu bar click on CPR and select Evaluator to access the CPR Evaluator window Evaluator Options Chest compressions will not be detected if the cardiac rhythm is set to a healthy state Ventilations are reported only if the respiration rate is set to zero The CPR evaluator feature provides real time feedback on the providers compression and ventilation performance El Gaumard Scientific CPR Evaluator 0 10 30 Compression Data 26 Ventilation Data Rate ct LC Rate PIP Ti 0 0 2 00 00 0 133 24 IE PEEP LV 1 0 6 14 12 Too Many Compressions 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 co
24. Epinephrine Primatene Adrenalin gt 2 ml gt Dosage 2 mg Drug Dose Units Route v v v The log panel also records the drug detected Details Palette Lab Scenario Drugs Speech Log Session Title Providers Add Basic Airway Breathing nn A A a Openasmmay intubation check Intipatoneval ventie Trauma Care Selick s ao My le ovo eno gt is Log CPR 152 In addition to calculating the dosage and concentration the software automatically changes the vital signs of the simulator to reflect the effect of the medication applied To show a prompt before applying the effect of the medication navigate to page 130 Status call y Details Palette Lab RFID Detected au on Epinephrine Primatene Patient Status resting Heart Sound Cardiac Rhythm Heart Rate 75 bpm Sinus arrhythmia Blood Pressure L R mmHg Absent Pulses Radial L UR Pedal BL Un To edit the effects of a medication navigate to page 67 If the software does not recognize the drug that is being administered the Log page reports Detected Medication Unknown Med followed by the amount of drug detected Log CPR 00 09 48 Detected Medication Unknown Med gt 1 mL 00 09 49 Detected Medication Unknown Med gt 3
25. Nasal Intubation 8 mm outer diameter max ETT Fr 7 or 7 5 Oral Intubation WARNING Do not introduce liquids when performing nasal and oral intubation Doing so can permanently damage the system Always lubricate tubing airway and nasal opening prior to performing any nasal or oral intubation Resuscitation Ventilation and manual chest compressions are measured and logged showing the instructor exactly how students are performing Teeth NOELLE is supplied with fixed upper and lower dentures The tongue may be moved gently from side to side Airway Sounds NOELLE has multiple upper airway sounds synchronized with her breathing Breathing Respiratory Patterns Users can easily control rate and depth of respiration and choose independent right or left lung sounds which are synchronized with selectable breathing patterns Kussmaul s Cheyne Stokes Biot s Apneustic apnea and normal Lung Sounds Multiple lung sounds available include normal wheezing inspiratory squeaks crackles and rales Pulmonary Ventilation The airway contains nominal landmarks permitting either BVM or intubation exercises including the use of a LMA The trachea extends to the bronchi and lungs 148 Chest Rise Lungs expand normally permitting realistic chest rise Chest compressions are measured and logged CPR Use a normal size adult BVM which will seal around the mouth and nose The ribs have normal anatomic landmar
26. The files on this list will be accessible from the patient menu on the vital sign monitor The Context Name will be the name displayed Shared Files Available Files File Context Name Quiz rtf Quiz X ay bmp X Ray Chest Hematology rtf Blood Test A yellow icon will be shown on the top left of the screen once a file is shared This will inform the provider that a file is available for viewing Click on the NOELLE button to bring down the selection of available files Once a file is selected it will automatically open on the Gaumard Monitor screen 138 Custom Numbers Use the custom numbers tool to add a new parameter such as glucose level or platelet count to NOELLE s virtual monitor Sensors File sharing Custom numbers Configuration On clicking the Custom numbers option the following window Is displayed Custom Numerical Parameters on Monitor s Click Add to enter a new parameter for display in the virtual monitor This dialog box is displayed Custom Numerical Parameters on Monitor s Name Units Enter the name and units of the new parameter and click OK The new parameter is displayed Several custom numbers may be entered at a time Custom Numerical Parameters on Monitor s Hematocrit Ho Glucose EE mg dl update Remove ae Enter the amount to be displayed in the virtual monitors and click update Have the stud
27. To add a key event to a node first click the Add path button then the edit button located on the right l Edit 2 Deteriorate ino 3 00 01 O gt wait 02 00 No changes are made to mankin cal ie eet Delete Speech 1 00 01 confusion What happened 3 Cardo Drop 01 00 HR 15 BP 10 OSat 5 y Copy Additem AddScenaro lt Copy Remove Add path Hp Use the Edit Path window to name sort and create key events Begin by naming the key event and then assigning a node destination from the Go to drop down menu Click OK to save changes 59 NOELLE 574 575 576 User Guide In this example the provider will have the option to administer Atropine Key events 9 Action m Linked Action Defibrillation Shock Cardioversion Shock Non Sync Shock External Pacing Go to 1 Start Bradycardia 2 Deteriorate 3 Interventions 4 Atropine 5 Epinephrine 6 Dopamine 8 Pace Previous End The facilitator added a total of four paths to Node 2 Deteriorate Atropine Epinephrine Dopamine and Pace Once the provider performs an action administration of Atropine or epinephrine the facilitator clicks the key event to alter the path of the scenario 2 Deteriorate O gt wait Speech 1 Cardio Drop gE a Ae A 2 8 8 8 E Additem Add Scenario E Dopamine 5 MIE CJ Linked Action Key Events A linke
28. convert to NSR degrade to setting prompt 75 bpm BP 75 bpm BP ventricular 120 80 120 80 fibrilation Scenario Controls Scenarios are controlled from the buttons at the bottom of the Scenario page The same way a music player plays songs the Scenario plays palette items Intuitively the facilitator can play stop pause skip or repeat items as appropriate The Scenario Position Indicator points to the current item and shows the current status of the scenario The following paragraphs describe in detail the behavior of each button and indicator The Scenario Position Indicator the Play button is clicked the item pointed by the indicator is An unfilled triangle means that the scenario is stopped When be played A rapidly blinking triangle means that the scenario is playing the item to which the indicator is pointing y A slowly blinking triangle means that the scenario is paused at the item to which the indicator is pointing y 46 NOELLE S574 575 576 User Guide The Scenario Buttons Bo Plays the item to which the scenario position indicator is pointing This button has to 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 Wh
29. s Manual Artificial ventilations are not properly detected or not detected at all Korotkoff sounds do not match systolic and or diastolic set values Wrong placement of BP Cuff See correct cuff placement under section Simulator only for simulators with Features Circulation tetherless BP cuff feature Weak RF signal Verify connection strength Simulator s chest Simulator not running Simulator must be powered on and respiratory rate set does not rise with at 0 243 NOELLE S574 575 576 User Guide artificial ventilation Disable lung s e g BVM Low chest rise or no Wrong settings or disabled chest rise at all while breathing NOELLE s delivery baby is disengaged prematurely Wrong force sensor reading NOELLE s delivery baby does not release at delivery end when user is pulling the baby Wrong force sensor reading Dystocia is ON NOELLE s delivery Motor is disoriented mechanism doesn t come to its initial position when using the Reset button under the Labor tab or it makes a grinding noise when reaching the end of the rails Enable the lungs from Detail page on the GaumardUl software Make sure lungs are enabled and both respiration rate and inspiration percent are different from 0 If problem persist shut down the simulator and restart the tablet Turn on the system then verify connection battery and lung settings Wh
30. 25 weeks gestation She had been involved with a married man and this unexpected and unwanted pregnancy caused a great deal of stress in her life After much emotional upheaval she decided to have the baby The affair ended and she is no longer involved with the father of the baby None of her family or friends are aware of the pregnancy She began cramping about 3 hours ago and decided to drive herself to the hospital when she began leaking clear fluid An admitting clerk helps her into a wheelchair and takes her to L amp D Overview Runs for approximately 20 minutes Instructor must place C collar on NOELLE simulator before beginning scenario During delivery patient has tonic clonic seizure followed by tetanic contractions Fetal baseline drops to approximately 60 bpm SVD occurs very quickly Infant is cyanotic and limp and no respiratory effort is evident Baby is pronounced dead after 20 minutes of resuscitation Runs for approximately 20 minutes Prolapse cord is protruding into the vaginal opening Faye is put into deep Trendelenburg position There is no palpable cord pulsation and FHTs are not audible with Doppler Upon VE fetus presents as double footling breech and is already partially into birth canal Therefore baby has to be delivered vaginally Fetus is non viable Patient Name Labor Type Gabriella June Kelly Uterine Rupture Peripartum Hemorrhage PPH Amniotic Fluid Embolism History Gab
31. 575 576 User Guide Appendix 167 NOELLE S574 575 576 User Guide Factory Preset Labor Scenarios Manual Mode Flowcharts Quick start Scenarios Beat os ae veces ease arti on emer os me AN E IEC IA EIN ect Frere AN El IEC CL El IEA E ICI Sense 168 NOELLE S574 575 576 User Guide Gaumard Simulators for Health Care Education Alice Normal Noelle Labor Scenario Alice is a 24 year old female weighing 170 pounds Her OB history shows a gravida of 2 and a term of 1 She is currently 39 weeks pregnant and has one living child She has had prenatal care She has not been using medications of any kind Labor duration 30 minutes Admit patient Routine labs notify HCP of admission and status Set up delivery table and infant warmer configure bed for delivery 169 NOELLE S574 575 576 User Guide 170 Noelle Labor Scenario Alicia Variations on Normal Gaumard Simulators for Health Care Education Alicia is a 24 year old gravida 2 1 at 39 weeks She weighs 160 pounds She has had prenatal care She has not been using medications of any kind Labor duration 20 minutes NOELLE 574 575 576 User Guide Noelle Labor Scenario Amy Variations on Normal Gaumard Simulators for Health Care Education
32. 87 NOELLE 574 575 576 User Guide The user can remove all palette items at once by pressing the Clear button located to the left of the timeline When all palette items are removed the user is left with a clean slate to either rebuild or to completely change the scenario Stages The stages shown in colored blocks under the timeline are also dependent on the descent curve The blocks representing different stages of labor change size as the points on the descent curve are moved Click on each stage label to view the details Maternal Info Respratory status Cardac status Pain Bleeding E AS Membranes P Sas Dilation Station mf Fetal Info Decreased No fetal movement me 88 NOELLE 574 575 576 User Guide Release Baby This button activates the release mechanism on the baby which allows either the providers to disengage the baby or the instructor to connect the baby ROA Save Labor Load Labor carers duration 30 El 2 30 Emi Warp Factor 21 approx 1 min Labor Control stocia Contraction Response Den i Aria i C Enable Smart Labor sec papas pad Y Enable Contraction Response Q O fo El 2 O ase e O Descend only with contractions Station O speech speech vitals gt O Check ROT LOT delivery Je Alice Labor Su de 28 50 e Ra rs o o e e jp es ps DESCENT Pause Run Reset After clicking on the Release Baby button as shown below the syste
33. BP port for Virtual BP system Connect the Luer Lok fitting on the end of the extra branch to the Luer Lok port on NOELLE s left shoulder Some facilitators prefer to make this connection before commencing a simulation session 150 Drug Recognition option The drug recognition module can be used to simulate drug administration by reading a programmed syringe filled with water GaumardUI identifies the programmed drug type and volume injected into veins of the right lower arm as a medication This feature can also be used to practice drug administration to patients using V procedures Physiologic changes as a result of the medications administered are calculated by the physiologic model WARNING The simulator must be powered on when working with the drug recognition arm This includes calibration purging draining IV infusion Set Med Id and injecting fluids Failure to do so will permanently damage the simulator and void the warranty Do not attempt to fill IV system without the drain connector in place Always leave the drain port connected when injecting fluids into the system Use only Gaumard s provided simulated blood Any other simulated blood brand containing sugar or any additive may cause blockage and or interruption of the vasculature system Always flush the IV system with distilled water at the end of every simulation A drug recognition arm is equipped with a black drainage port Reversing the
34. Disconnected power plug The power plug must be connected in order to turn NOELLE on and it should be connected while being operated Still it can be disconnected if the simulator has to be taken to a different location while the simulation is still running Note see section Start the system on User s Manual Close the GaumardUl software and unplug the RF module for at least 5 seconds then plug it back in Disconnect one terminal from the battery and reconnect after 5 seconds Restart the software and wait for initialization 241 NOELLE S574 575 576 User Guide 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 are taking longer than usual to take effect or simulator is not reporting every action blinking communica tion indicator is con sistently yellow Sound quality while streaming is poor 242 Battery not charged properly The computer is properly communicating with a simu lator but not necessarily the one you intend to control Distance between computer and simulator is reaching its limit or there are too many obstructions between walls etc There s too much RF inter ference either from another Gaumard tetherless simu lator in the vicinity or an RF radiator Noise channel or another Gaumard tetherless simulator is nearby Computer is located to
35. Driver QoS Packet Scheduler El File and Printer Sharing for Microsoft Networks a Intemet Protocol Version 6 TCP IP v6 Sed Intemet Protocol Version 4 TCP IP v4 wi Link Layer Topology Discovery Mapper 1 0 Driver wi Link Layer Topology Discovery Responder Transmission Control Protocol Intemet Protocol The default wide area network protocol that provides communication across diverse interconnected networks Uninstall 6 Configure both computers with static IP addresses and subnet masks following the IP address convention below Each computer in the ad hoc network must be configured with the same first three octets and only differ on the last Computer IP SSID Network address Name Tablet 1 NOELLE 1001 255 0 0 0 GaumardNet Tablet 2 Newborn 0 0 2 255 0 0 0 GaumardNet HAL Virtual 255 0 0 0 GaumardNet Monitor Computer Tou can get IP settings assigned sutomabcally if your network supports this capabdity Othervase you need to ask your network administrator for the appropriate F settings Obtain an IP address automatically OS the folowing IP address IP address Subnet mak Default gateway Obie DAS server Miren automaS5caly Use the folowing DNS server addresses Preferred ONS server Wabdate settings upon exit Example of IP addresses that will NOT communicate with each other Tablet 1 1 0 10 1 VM Computer 1 0 0 3 Tablet 1 50 0 10 1 VM Computer 1 0 10 3 Tablet 1 10 10 10 1 VM Compu
36. E e Absent Pulses O Radial Left Radial Right Other Temperature SE Hemorrhage Hemorrhage Uterine Pres Bleed Uterine Rupture Wound Size l y Note Auto means this vital is auto controlled by model Click H button to hold this vital to Current Each cardiac rhythm has a specific effect on the blood pressure wave forms The pressure wave forms include ABP CVP PAWP and Pulse 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 There are three controls on this tab unique to the automatic mode 31 NOELLE 574 575 576 User Guide e Patient status Selecting one of the two available options affects heart rate temperature respiratory rate tidal volume metabolism rate and carbon dioxide formation rate indirectly Circulation Patient Status ECG as sting Rhythm Sinus Ti J excited e Bleed Click the bleed button to simulate internal bleeding e Wound size Adjust the bleeding rate using the wound size slider control Combine the wound size control with the post partum hemorrhage feature to simulate labor complications For information on filling the hemorrhage reservoir navigate page 166 The model will automatically calculate the appropria
37. Health Care Educatior Noelle S574 575 Labor Scenario Heidi Peripartum Hemorrhage Previa Insert Bakri balloon Deliver and inspect placenta Wait time 1 min Sedate and perform bimanual exploration Wait time 2 30 min NO Increase pitocin fundal massage give Cytotec rectally Wait time 1 10 min Does bleeding stop NO Does bleeding stop Wait time 1 min 204 YES 2008 Gaumard Scientific All rights reserved NOELLE S574 575 576 User Guide Noelle S574 575 Labor Scenario Gaumard Haley Simulators for Health Care Education Peripartum Hemorrhage Previa Haley is a 33yr old G2 35 weeks Previous U S revealed a low lying placenta and this is the 5 time in 11 weeks she been admitted for bleeding This time the bleeding is is heavier and is not resolving Her OB is on the way to the hospital bimanual palpation shows the uterus to be soft and non tender Labor duration 15 minutes Monitor FHR and Vaginal bleeding Wait time 3 min Bleeding increases and fetal trace becomes a concern Wait time 2 min Fetal strip worsens prep for c section Wait time 2 min 205 NOELLE S574 575 576 User Guide Noelle S574 575 Labor Scenario Gaumard Haley Simulators for Health Care Education Peripartum Hemorrhage Previa
38. Her treatment history includes NO Normal allergic to shellfish Also notice that after loading a patient there are two places where you can see the name Patient information is displayed on the right panel of the details page Use the control buttons to pause or reset the model back to the initial model stage Legend n or Patient s Info Name Alyssa Gestional Age 40 w Age 23 y Height 68 0 in Weight 205 0 lbs Her companion s name is Bill husband Her OB history shows a gravida of 0 a term of 0 a preterm of 0 and that she is currently 40 weeks pregnant w 135 NOELLE S574 575 576 User Guide To load an already existing patient go to Modeling Modeling Patient Load Patient Load Model Patient Last Modified 11 05 2010 15 02 14 11 05 2010 15 02 14 11 05 2010 15 02 14 11 05 2010 15 02 16 11 05 2010 15 02 16 11 05 2010 15 02 16 11 05 2010 15 02 16 Patient Information Alyssa is a 23 year old female Her height is 172 7 cm Her weight is 93 0 kg Her companion s name is Bill husband Her OB history shows a gravida of 0 a term of 0 a preterm of 0 and that she is currently 40 weeks pregnant she has had 0 spontaneous abortions 0 elective abortions and 0 living children 11 05 2010 15 02 16 11 05 2010 15 02 18 11 05 2010 15 02 18 11 05 2010 15 02 18 11 05 2010 15 02 18 11 05 2010 15 02 18 i e Tt TN Reset Model Clicking on Reset Model under th
39. IP address For information on creating a network and configuring a static IP on Windows XP systems go to page 254 1 Locate the wireless connection icon on the bottom right corner of the computer screen 8 15 AM 1 4 2011 a gt a Re old 2 Click the wireless icon and select Open Network and Sharing Center from the options on the menu Open Network and Sharing Center 1 40 PM eile E a al agi Is 250 3 In the Network and Sharing Center window click Change adapter settings from the left hand panel Control Panel Home View your basic networ Manage wireless networks Me Change adapter settin nge adapter settings ENGI PC Change adwanced sharing This computer settings View your active networks Change your networking setti Set up a new connec Click on the Wireless Network Connection icon to select it and then click Change settings of this connection on the menu panel The Properties window for the connection will be shown twot k and Internet Network Connec tions gt Wireless Network Connection 2 Not connected trolld x i Intel R WiFi Link 5300 AGN Select Internet Protocol Version 4 TCP IPv4 to highlight it and click Properties H Wireless Network Connection 2 Properties Connect using EP Intel R WiFi Link 5300 AGN Configure This connection uses the following items 0 Client for Microsoft Networks El Virtual PC Network Filter
40. Never disconnect the communications module while GaumardUl software is running Doing so can damage the module 1 Connect the RF module to the Gaumard Monitors PC 2 Verify that both computers are connected to the ad hoc network e g GaumardNet 3 Initialize the Gaumard software on the tablet computer and navigate to the Remote Access Via network option from the set up drop down menu 4 Select the Remote access via network radio button 5 Verify that Wireless Network Connection is selected from the adapter list 6 Click the find available to auto configure the port used for this connection 7 Write down the controller IP and port number then click the connect button 8 Navigate to the V menu on the virtual monitor computer and select Remote access Via Network Please wait 30 seconds for the feature to initialize 9 Enter the controller IP and port number as specified on step 7 and click connect Standard RF Communication Remote Access Via Network 1 Remote Access Via Network Adapter Local Area Connection lt refresh Controller IP 192 168 1 126 Port 8002 lt findawal Connected to Connect 129 NOELLE S574 575 576 User Guide Auto Responses The GaumardUl Module software can be configured to respond to electrical therapy when changes are applied using the detail list Auto responses configured from the set up menu respond to shocks when a scenario is not in pro
41. O Station O speech speech vitals 2 O Check ROT LOT delivery 2 LoT Rop edit Lop O Pause Run Rese Delivery Position NOELLE s birthing mechanism can be preset to four different initial configurations if a regular vertex delivery is desired These conditions are ROA LOA LOP and ROP It is very important that once the motor has been reset the instructor selects the desired delivery configuration in the software Then the baby has to be connected representing this state Select the initial position for the baby Make sure it represents the position at which the baby was inserted inside NOELLE 5 4 3 2 1 0 1 2 3 4 5 6 PUTT PUTT CMA eT ETAT PUTT 80 NOELLE 574 575 576 User Guide Each of these states has a different rotation program that will represent the internal rotation and the external rotation The rotation is also dependent on the labor curve Notice that the internal rotation marked as 1 on the diagram above will be calculated between the stations 5 and 1 and the external rotation marked as 2 on the diagram will be calculated between the stations 3 and 5 If by any chance a labor curve is designed in such a way that the first point of the curve is below 1 the internal rotation will not be calculated The rotations may be edited by the instructor Click on the Edit button at the bottom of the head rotation selection box to expand the f
42. Session 4 Lab 04 CBC DIFF Simulation 1 Lab 02 CBC DIFF High levels Lab 03 Neonate Blood test High levels Lab 05 OB Blood test Session 2 Lab 06 PPT Session 2 Select a lab report and click the Preview button on the right panel to view the report on the facilitator s screen From the Lab Preview window the facilitator can print as well as send the report to the virtual monitor computer To make changes click Close and then edit Lab Preview Lab 01 11 36am Above normal range Cholesterol LDL Cholesterol Comment HDL Cholesterol mg dL 35 00 85 00 Cholesterold HDL Ratio 0 00 4 40 Care required Cholesterol mg dL 0 00 199 00 LDL Cholesterol mg dL 0 00 129 00 Triglycerides mg dL 30 00 200 00 The preview window also allows the printing of results for distribution and archiving To make changes click Close and then edit Send to monitor To send the lab report to the virtual monitor computer for the student to access first select the lab from the list and then click Send to Monitor On the Gaumard Monitor s window an exclamation icon notifies the provider a file is ready for access Click the NOELLE drop down menu to select the available lab report 41 NOELLE S574 575 576 User Guide The lab report will open using the system s default application Lab 01 ormal range Cholesterol LDL Cholesterol Once the report is sent the letter Y will be present on the Sent column Use th
43. TRANSMISSION PROVIDED THAT YOU NOTIFY GAUMARD IN WRITING OF SUCH DEFECT OR DEFECTIVE TRANSMISSION AND RETURN THE DEFECTIVE MEDIA IF ANY DURING THE 30 DAY WARRANTY PERIOD NOELLE S574 575 576 User Guide 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 OTHERWISE AND THE ENTIRE RISK AS TO THE RESULTS AND PERFORMANCE OF THE SOFTWARE IS ASSUMED BY YOU IF THE SOFTWARE OR WRITTEN MATERIALS ARE DEFECTIVE YOU AND NOT GAUMARD OR ITS DEALERS DISTRIBUTORS AGENTS OR EMPLOYEES ASSUME THE ENTIRE COST OF ALL NECESSARY SERVICING REPAIR OR CORRECTION OTHER THAN EXPRESSLY DESCRIBED ABOVE C NEITHER GAUMARD NOR ANYONE ELSE WHO HAS BEEN INVOLVED IN THE CREATION PRODUCTION OR DELIVERY OF THIS PRODUCT SHALL BE LIABLE FOR ANY DIRECT INDIRECT CONSEQUENTIAL OR INCIDENTAL DAMAGES IN
44. To achieve better clarity e Verify that the physical MIC control on your headset is set to high e Enable Microphone boost from the Windows setting e Use the Output Gain to increase the microphone volume as a last resource To raise the output gain in increments tap and hold the control then slide to the desired level Voice Recorder The instructor is able to record his her own speech phrases at any time Once the instructor clicks on the Rec button the software automatically starts capturing everything that is said into the microphone Voice Recorder ee Press Stop to finish recording Use the Enter Audio Name window to name the speech phrase Enter Audio Name Enter a name and click OK The phrase will now be accessible under the Prerecorded Speech menu Prerecorded Speech On this section the instructor is able to play any of the custom phrases by either typing on the text box or clicking on the menu option Once a phrase is selected it can be played as the simulator s voice or deleted Voice Recorder pane lt Prerecorded Speech I m scared My head hurts a My name is Delete More If the instructor wishes to play any of the Simulators prerecorded speech phrases he will need to click on the More button located on the bottom right corner of the Speech page Technical considerations for improved Communication Range
45. a suspected spousal abuse case Patient has a central abruption of the placenta Instructor must fill hemorrhage kit with fluids before running the scenario Runs for approximately 18 minutes This scenario involves a precipitous delivery with heavy bleeding due to placental abruption Abruption was brought on by use of alcohol and cocaine Instructor must fill hemorrhage kit with fluids before running the scenario Runs for approximately 25 minutes Even though patient suffers heavy blood loss blood products are not to be used so alternative methods must be found Instructor must fill hemorrhage kit with fluids before running the scenario Patient Name June Kelly Kimberly Madonna Labor Type Peripartum Hemorrhage PPH Amniotic Embolism Amniotic Embolism Preterm Labor Fluid Fluid History June is a 31 year old who is about to deliver her Sth baby She has had a normal pregnancy and plans natural childbirth and breastfeeding Her husband and oldest daughter attended the CBE refresher course and she has arranged for the 11 year old to attend the delivery Kelly is a 34 year old gravida 5 2 38 weeks She is scheduled for an induction due to problems with her last pregnancy That baby weighed almost 10 pounds and she had experienced a severe shoulder dystocia with the delivery She has gained 43 pounds with this pregnancy and her glucose tolerance test GTT is borderline An ultrasound a few days
46. ago estimated current fetal weight at 3800 to 4000 grams Kelly s physician feels that her cervix is favorable so he has recommen ded an elective induction Kimberly is a 27 yr old multip 42 weeks She began having contractions at home and now they are becoming stronger She is excited to be finally going into labor By the time the nurse completes admission Kimberly is requesting pain meds as her labor is progressing quickly Madonna is a 41 year old multip 31 weeks She has experienced difficult pregnancies in the past and has one Downs Syndrome baby so she is very apprehensive An early U S and genetic Studies showed this baby to be a normal female She has had several episodes of preterm contractions that resolved with LLP bed rest and oral hydration She be gan contracting again 3 hours ago and again tried LLP bed rest and oral hydration but the contractions have continued amp become stronger NOELLE S574 575 576 User Guide Overview Full scenario runs approximately for 22 25 minutes PPH runs for 8 10 minutes Labor and delivery progress uneventfully Heavy bleeding begins immediately upon delivery of placenta Uterus remains atonic despite Fundal massage and rapid pitosin infusion Patient s BP drops to 80 50 and uterus begins to clamp down following Cytotec rectal insertion Note Running full scenario requires retraction of motor mechanism and insertion of PPH kit following delivery To run PPH only loa
47. and Sound Quality 104 e Streaming audio doesn t reach as far as normal data It has a range of up to 300 ft 150 meters line of sight between simulator and PC Keep Tablet PC as steady as possible and point it to simulator to get the best possible range e When more than one Gaumard tetherless simulator is in the vicinity try to allocate one channel in between to avoid interference see Options and more section in your simulator manual e At any time the user can change the sound volume for sending and receiving To change volume at simulator s end change the tablet s microphone gain To change volume on the tablet use the speaker volume control e See troubleshooting section in the manual for more info To increase the microphone volume go to page 248 in the Appendix NOELLE 574 575 576 User Guide Log The Log page allows the facilitator Instructor or tablet operator to keep track of every event during a session It automatically creates an entry whenever a detected event occurs as well as every change in the condition of the patient In addition the facilitator can enter observed provider actions to the log with a simple click Details Palette Lab Scenario Labor Speech Log Session Title Facilitator Emergency Reported Airway Circulation Log CPR 00 02 45 Chris Action Call for assistance 00 02 52 Chris Action Call for assistance ad
48. at delivery S amp S SROM followed by Becca pushing hard n Program swithces to scenario tab automatically Stat Page anesthesia for sedation bimanual Instructor to reset birthing motor exploration for retained sedate for bimanual exploration secundes collect labs for tox Wait time 2 40 min screen Use of Bimanual uterine massage and pitocin to maintain contractions Remove placental fragments Wait indefinitely 184 NOELLE 574 575 576 User Guide G d Noelle S574 575 Labor Scenario pakia Bianca Simulators for Health Care Education Variations on Normal Bianca is a 16 yr old 38 weeks who shows up in L amp D in active labor She had a previous elective AB as a result of incest at age 13 She now lives with her boyfriend and his mother who are both with her at the hospital Her prenatal visits have been irregular due to transportation issues She is leaking light meconium fluid and she vomits as she is undressing Labor duration 25 minutes Scenario duration 30 minutes Attach EFM Notice variables turn patient e Wait time 3 30 min tie Check resolution of variables Goto labor Bianca Wait time 1 45 min 185 NOELLE S574 575 576 User Guide Noelle S574 575 Labor Scenario Gaumard Bianca Simulators for Heal
49. below 7 Select a drug from the drop down menu yringe perpendicular to the forearm 2 See eae 3 Designate a volume concentration specific for this syringe 4 Click the Add button lca haga ld y E eR Syringe Identifier Place syringe perpendicular to the forearm Add Delete Selected Medication 132 8 Assign a volume concentration for this syringe i specific for 4 Click the Add button as o al En EN Syringe Identifier Place syringe perpendicular to the forearm A When the syringe is ready to be programmed the Syringe Identifier will say Ready and the Add button will be enabled specific for this syringe 4 Click the Add button range a pb i REN Concentration mg ml aye Adrenaiin 1 1 4 Syringe Identifier Delete Selected Medication 9 Click on the Add button and wait while the syringe is being programmed Set Medication Identifier Instructions 1 Place the Syringe perpendicular to the forearm 2 Select a drug from the drop down menu 3 Designate a volume concentration specific for this syringe 4 Click the Add button then wait a couple of seconds while the syringe is being programmed Medication Concentration mg ml Epinephrine Primatene Adrenalin 1 f i Syringe Identifier Ready Please wait while the syringe is being programmed Ii 10 After the syringe is programmed it will be liste
50. bolts from the knee joints using the hexagonal wrench included 2 Position the lower legs and insert the bolts Use the two provided hexagonal wrenches to secure the knee bolts Do not over tighten Battery Power NOELLE will only turn on while the AC adapter is connected Once NOELLE is ON and fully charged the simulator can operate on internal battery for a maximum time 2hr 30min Battery operating time is dependent on factors such as number of deliveries sounds and seizures Operating on battery power can accommodate labor scenarios during room to room transport If NOELLE is turned off while operating on battery it will be necessary to re connect the power adapter to restart the simulator NOELLE can be used while the power adapter is connected NOELLE S574 575 576 User Guide Connect the power adapter to the power input located on NOELLE s right side The power adapter s LED indicator will display red while the battery is charging and green when fully charged The battery charge level is displayed on the GaumardUl status panel To display a reading the software must first establish a connection with the simulator For more information about the battery indicator refer to page 23 WARNING Do not store the simulator with a discharged battery It is good practice to re charge the battery at the end of every simulation session In addition make sure the battery is re charged at least once eve
51. can be adjusted from the Status Panel Click on the volume level indicator next to each sound and a volume control will pop up Simply 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 Sound thing me Breathing pr Pattern Resp Pattern 23 NOELLE 574 575 576 User Guide Soft Power and Standby The standby button is located on the bottom right corner of the GaumardUl software Use the standby mode to save battery power between exercises NOELLE 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 The power adapter must be connected when resuming from stand by Details The Details page is the first tab on the main environment window From this 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 available to the facilitator Details Palette Scenario Lab Labor Speech Log A Airway Upper Airway Sound Laryngospasm Breathing Resp Pattern y Left Lung Sound y Right Lung Sound e Respiratory Rate breaths min OSat
52. care She has been currently using no medications of any kind Her medical records shows she has no previous history Her treatment history includes NO Maternal Info Respiratory status Cardiac status Pain Bleeding Membranes Dilation Station Other Fetal Info Decreased No fetal movement Other The preset labor scenarios are only found in the Quick Start NOELLE or NOELLE Advanced profiles There are no factory preset scenarios in the Default Profile Time Information Labor duration This is the time of the delivery being simulated from stage one to stage three Warp Factor By increasing this number the labor duration will be shortened so that the labor can be simulated faster An approximation of the Labor duration will be given in parenthesis In this way a two hour labor can be simulated in five minutes as an example Time Information Labor duration 30 min Warp Factor approx 30 min 79 NOELLE 574 575 576 User Guide Labor Time This timer represents the time on the labor curve ime ormaton ROA Save Labor Load Labor Labor duration 30 min Warp Factor 21 approx 1 min Labor Control Dystocia Contraction Response Delivery Position O Enable Smart Labor 10 sec f ON OFF El Enable contraction Response k Rotate ar O O RoT Breech Descend only with contractions s gt
53. contraction NOELLE S574 575 576 User Guide Gaumard Simulators for Health Care Educa Noelle S574 575 Labor Scenario Eleanor Variations on Normal 193 NOELLE S574 575 576 User Guide 194 Noelle S574 575 Labor Scenario Gaumard Erin Simulators for Health Care Education Preeclampsia Erin is a 28 yr old 38 weeks admitted by her physician for preeclampsia She is stared on Magnesium sulfate per protocol induced with pitocin and her membranes are ruptured Light meconium staining is noted following AROM Labor duration 60 minuntes NOELLE S574 575 576 User Guide Noelle S574 575 Labor Scenario Faye Cord Prolapse Gaumard Simulators for Health Care Educatior Faye is a 34 yr old gravida 1 25 weeks gestation She began cramping about 3 hours ago and decided to drive herself to the hospital She began leaking clear fluid on the way An admitting clerk helps her into a wheel chair and takes her to L amp D Labor duration 20 minutes S amp S Prolapsed cord is protruding from the vaginal opening V E reveals double footling breech partially into vagina Admit place bed in deep trendelenburg position cover extruded cord with warm NS gauze Culture placenta and send to lab Notify Priest for emotional care document according to facility requir
54. control tablet static address Internet Protocol TCP IP Properties General fou can get IF settings assigned automatically if your network supports this capability Otherwise you need to ask your network administrator hor the appropriate IP settings Obtain an IP address automatically Use the following IP address IF address Subnet mask Default gateway 256 NOELLE S574 575 576 User Guide Selected Consumables and Replacements Parts Selected Parts List Contact Gaumard Scientific for a complete list of consumables and replacement parts and their prices rem me een 575 001 A C Virtual Monitor LA A C Powered 17 Touch Screen monitor and desktop S575 002 D C Virtual Monitor ES o 12 Touch Screen Mobile Monitor with S575 004L L Lower Left Arm Skin Cover EN Lower left arm skin cover light color S575 004R L Lower Right Arm Skin Cover M Lower right arm skin cover light color Lower Lower right arm skin cover light color arm skin cover light color S575 007 L C Section Abdominal Cover ES mer stomach cover for C Section Exercises light remem comico n ayasa a a S575011 Battery Charger Battery charger with label Battery charger with label charger with label A n pronen srno ros pam a peee A n ommers A n e O A A n peorvens ornon erso nays Soyo eros ony ann n ensorrar nanen orsoni preoa n prennon A a pussaspersroornoenn moe Sorsom Suerte Ce n oen soge ora varse oso
55. did not attend any childbirth classes Her plan is to return to high school while her mother cares for the baby The baby s father will not accept any responsibility and does not wish to be involved NOELLE S574 575 576 User Guide Overview Runs for approximately 30 minutes simulates 8 hour labor without complications resulting in SVD over intact perineum Baby is vigorous and earns good APGARS Runs for approximately 18 22 minutes Following ROM nurse must support fetal head to prevent explosive delivery Patient has retained secundes therefore bimanual exam is required Safety Note To run full scenario load Becca Sedation from the scenario tab Instructor is required to reset motor before allowing learner to perform bimanual exam Full scenario runs for approximately 23 25 minutes Dystocia drill runs for 15 min Labor progresses normally for about 6 hours but after 45 minutes of pushing patient is unable to bring vertex to perineum A vacuum extractor is necessary to bring the head to the perineum Patient is still unable to deliver McRobert s suprapubic pressure Woods and Rubin maneuvers fail Baby is finally delivered using Gaskin maneuver Note To run full scenario load Candice Admit from scenario tab To run dystocia drill only load Candice from labor tab Runs for approximately 30 minutes Frank breech position has been confirmed by real time U S Patient refuses Cesarean delivery Pinard maneuver m
56. epidural Turn patient LLP to resolve variables put O2 mask on patient discontinue Pitocin S amp S Patient says she is having trouble breathing vomits suddenly becomes non responsive Give SQ Terbutaline to reduce ctx Rush to OR for emergency c section Intubate ventilate stat page anesthesia and NICU personnel NOELLE S574 575 576 User Guide Noelle S574 575 Labor Scenario Gaumard Kelly Simulators for Health Care Education Amniotic Fluid Embolism Perform emergency C section Wait time 3 min Electrical defibrilation Wait time 1 min Administer resuscitation per ACLS protocols Inspect placenta following delivery administer Pitocin to promote uterine ctx Full resuscitation Wait indefinitely Give blood products for DIC management stabilize patient transfer to ICU 215 NOELLE S574 575 576 User Guide 216 Noelle S 574 575 Labor Scenario Gaumard Kimberly Simulators for Health Care Education AFE Kimberly is a 27 yr old multip 42 weeks She began having contractions at home and now they are becoming stronger She is excited to be finally going into labor By the time the nurse completes admission Kimberly is requesting pain meds as her labor is
57. establish the ad hoc wireless connection between the computers before activating the GaumardUl and Gaumard Monitors program 1 On the tablet computer start the GaumardUl software and navigate to Monitors gt Configuration File sharing Custom numbers 2 In the NOELLE Virtual Monitor Setup window access the Adapter dropdown menu and select Wireless Network Connection If the adapter is inaccessible click the stop button first ES Noelle 574 575 Virtual Monitor Setup Select the number of monitors that will be used with this manikin Also you can name each monitor with an appropiate description O All sensors always ON Adapter Wireless Network Connection Controller IP Wireless Network Connection Loopback no network Connected to The controller IP shown is the static IP address previously configured BS Noele 574 575 Virtual Monitor Setup Select the number of monitors that will be used with this manikin Also you can name each monitor with an appropiate description Adapter Wireless Network Connection vw lt refresh Controller IP 10 0 0 1 C All sensors always ON Port 8001 lt fndavad Connected to Connect Click Connect and take note of the controller IP address and port number This information will be used on the following steps The status icon will read connecting until the Gaumard Monitor software is configured Activate the Gaumard Monitors softwa
58. for each dosage effect Medication Response EC50 0 0001 mg dl Concentration that produces 50 of the maximum effect Available Palettes Apply Items Threshold mg Naloxone OD Naloxone SD Naloxone 5D Naloxone UD Nicardipine OD 4 Drug effect Tester 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 75 00 kg Fffect Plasma Concentration log Graph Plasma Concentration mg dL Drug Interaction Editor Click on the Drug Interactions button to begin 71 NOELLE 574 575 576 User Guide Use the Interaction Editor window 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 Half Life 01 15 00 Peak Time 00 02 00 SD 2mg OD 10mg EC50 0 0001mg dL Isobologram plasma concentration Interactors 7 Sodium Nitroprusside Nitropress un b Drug List Interactor Data Half Life 00 30 00 Peak Time 00 45 00 SD 40mg OD 120mg l a ps EC50 2 6400mg dL Aspirin Bayer mg dL Test Panel Test object weight 175 kg Apply Naloxone Narcan Dose 2 mg At time Apply F
59. hand Pull the latex tube off the white connector Remove both black rings on the tube and place them on the replacement antecubital vein as shown below 12 13 14 Use the shortest piece of tubing in the replacement antecubital vein kit You will be using the same black rings to secure the new vein in place Connect one end of the tube to the white connector in hole 9 and the other end of the tube to the white connector in hole 10 Gently push down the connectors on both ends so they sit tightly on each hole 15 Place a small piece of tape over the vein The 18 tape will help keep the vein in place when you Slide the skin back on the arm 16 Now pull up the connectors in holes 1 and 8 19 17 Disconnect the tubes from the connectors in holes 1 and 8 20 NOELLE S574 575 576 User Guide Remove the black rings and place one on one end of the replacement tube from the antecubital vein kit reserve the second ring for placing after threading the latex tube through the arm Now insert one end of the replacement tube in hole 2 Feed the tube through hole 3 You may use a hemostat to help you pull out the tube 263 NOELLE S574 575 576 User Guide 21 22 23 24 264 Now insert the tube in hole 4 Insert the tube in hole 5 as shown below Insert tube in hole 6 Make sure the tube is not tight Turn the arm so the anterior part is facing up and fe
60. increasing their diameter To set pupils to react to proper low ambient light intensity cover both eyes blocking MOST not ALL incoming light then click Set Dilation Light button e Increase Decrease Use these controls to increase or decrease the sensitivity to light e Reset to Default Use this button to reset the pupils sensitivity to the factory settings Other This tab gives you additional control over the simulation The first option Once a Palette is applied load to Details Tab is useful for people who want to keep track of the latest parameters that were updated using the Details Tab Options Once a Palette is applied load to Details Tab Use AV System Start AV Automatically on Scenario Start Output Log Events to Windows Log Use single monitor for maternal vitals and fetal traces C ae oe and Fetal Monitors fos os l 03 m3 59 59 Max Model Activation Code Model Activation Code Input the activation code required to enable the Automatic operating mode option in the GaumardUl software First enter the serial number in the FIXED environment field before entering the activation code AV System GaumardUl is capable of interfacing with a number of third party A V recording systems Checkmark the Use AV System to display the AV drop down as shown on page 142 Single Vital Monitors You can display Gaumard Monitors using one monitor To do so select the checkbox use singl
61. infusion following placental delivery to encourage uterine contraction NOELLE S574 575 576 User Guide Gaumard Simulators for Health Care Educatior Noelle S574 575 Labor Scenario Eleanor Variations on Normal Automatic Mode 227 NOELLE S574 575 576 User Guide Gaumard Simulators tor Health Care Educatior Noelle S574 575 Labor Scenario Faye Cord Prolapse Automatic Mode Faye is a 34 yr old gravida 1 25 weeks gestation She began cramping about 3 hours ago and decided to drive herself to the hospital She began leaking clear fluid on the way An admitting clerk helps her into a wheel chair and takes her to L amp D Labor duration 20 minutes S amp S Prolapsed cord is protruding from the vaginal opening V E reveals double footling breech partially into vagina i i ac Admit place bed in deep trendelenburg position cover extruded cord with warm NS gauze 228 Culture placenta and send to lab Notify Priest for emotional care document according to facility e requirements NOELLE S574 575 576 User Guide Noelle S574 575 Labor Scenario Gaumard Frances Simulators for Health Care Education Prolapsed Cord Automatic Mode Frances is admitted into a small town hospital due to regular contractions 4 minutes a
62. is the 5th time she has been admitted in Previa 11 weeks Previous U S showed partial placenta previa and she was given orders to rest and avoid any kind of vaginal stimulation At 32 weeks she had a very heavy bleed and was admitted for three days Presently she has arrived by ambulance with heavy bright red bleeding and her OB is on the way in to the hospital palpation reveals the uterus to be soft and non tender Heidi postpartum Heidi Peripartum Heidi had low lying placenta but still Hemorrhage delivered vaginally The baby does not Previa breathe spontaneously and needs some resuscitation Heidi begins hemorrhaging following delivery of the placenta which has a Velamentous cord at the attachment point Inez postpartum Inez Peripartum Inez suffered massive uterine abruption She Hemorrhage is bleeding heavily post partum and uterus is Abruption boggy Janie PPH Janie Peripartum Janie had history of low lying placenta but Hemorrhage PPH delivered with no problems 20 minutes after delivery the placenta is delivered with a gush of bleeding She has been hemorrhaging since June PPH June Peripartum June suffers PPH following svd of healthy Hemorrhage PPH baby boy Kelly resuscitation Kelly Amniotic Fluid Kelly has suffered an AFE in stage 2 labor Embolism She is rushed into OR for emergency c section and placed on a ventilator She codes as the c s is being performed and needs full resuscitation Kimberly C_S Kim
63. it is not connected then recalibrate BP cuff sensors on the simulator as per Calibration Wizard on User s Manual Reset ET Tube sensor on simulator as per Calibration Wizard on User s Manual Don t ever turn on or power cycle the simulator while being intubated that can cause a false reading Select Quick Start Scenarios when starting the software To change profiles from within the GaumardUl Go to File Profile menu and then select Modeled Scenarios NOELLE S574 575 576 User Guide A sound is absent or is not heard at desired volume level Cyanosis intensity is too much or too little Pupils either one or both dilating either while blinking or when not supposed to Pupils constricting dilating constantly Pulse oximeter is not functioning correctly if Oxygen Saturation feature is factory in stalled Drug ID is not being read Volume not set to user s criterion Cyanosis intensity not set to user s criterion Wrong dilation calibration This might happen either when the simulator is under intense light or it has been improperly calibrated Using a different oximeter sensor for which the simula tor was calibrated Pulse Oximeter Sensor not properly placed Offset value within 2 Incorrect readings after calibration Syringe has not been programmed Syringe is not in the field of the RFID reader Every sound has a volume control Adjust
64. manufactured by third parties For example third party products such as computers desktop laptop tablet or handheld and monitors standard or touch screen are not covered by this limited warranty Gaumard does not provide any warranty express or implied with respect to any third party products Defects in third party products are covered exclusively by the warranty if any provided by the third party Any waiver or amendment of this warranty must be in writing and signed by an officer of Gaumard In the event of a perceived defect in material or workmanship of the Gaumard product the first purchaser must 1 Contact Gaumard and request authorization to return the Gaumard product Do NOT return the Gaumard product to Gaumard without prior authorization 2 Upon receiving authorization from Gaumard send the Gaumard product along with copies of 1 the original bill of sale or receipt and 2 this limited warranty document to Gaumard at 14700 SW 136 Street Miami FL 33196 5691 USA 3 Ifthe 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
65. or on the Dystocia Control Box Dystocia can be used during any scenario by switching the control on in the Dystocia control box When the dystocia is set to On and the labor starts the warp factors for labor and perinatal monitor will change to real time warp factor 1 as the descent curve passes the preset dystocia threshold While in dystocia mode a Turtle Sign will occur with each uterine contraction Dystocia Station The dystocia controls are disabled when the last point on the descent curve is less than the indicated dystocia station 83 NOELLE 574 575 576 User Guide In the example below dystocia controls are disabled because the last point is less than seven the current dystocia station Time Information a ROA Save Labor LoadLabor Labor duration 30 min Warp Factor E approx 30 min Labor Control Dystocia Contraction Response Delivery Position O Enable Smart Labor 10 seo 2 G ON gt OFF C Enable Contraction Response i Q O pad Bre Descend only with actions E m E Station O speech speech vitals 2 E Check ROT LOT delivery 2 A O Pause O Run Alice Labor Time 00 00 00 AA o e e o o lr ENS IN In the example below shoulder dystocia and turtle signs begin station 10 Labor Control Dystocia Contraction Response Delivery Position Enable Smart Labor 10 gt sec 24 ON OFF E Enable Contraction Response ma O O E im E B
66. progressing quickly Labor duration 25 minutes Scenario duration 30 minutes NOELLE S574 575 576 User Guide Gaumard Simulators tor Health Care auc 1HOr Noelle S574 575 Labor Scenario Kimberly AFE Begin CPR Wait time 4 min y Deliver baby perimortum c s Wait time 3 min 217 NOELLE S574 575 576 User Guide Noelle S574 575 Labor Scenario Gaumard Madonna Simulators for Health Care Education Preterm Labor Madonna is a 41 yr old multip 31 weeks She has experienced difficult pregnancies and has one Downs Syndrome baby She has had several episodes of preterm contractions that resolved with LLP bed rest This time the bed rest and oral hydration are not resolving the contractions in fact they seem to be getting worse Labor duration 35 minutes Perform SSE to determine cervical status give Terbutaline SQ for tocolysis S amp S Patient is anxious and shaky she says her heart is racing Reassure patient about effects of beta mimetic drugs Give second dose of SQ Terbutaline for cessation of breakthrough ctx S amp S Patient is anxious and shaky Palpitations tachycardia and PVCs result from second dose of SQ Terbutaline Discontinue Terbutaline give 300ml IV bolus replace
67. reading on the monitor so that it matches the GaumardUI value then click OK 98 The oxygen saturation calibration dialog box for 80 is now displayed Calibrate using the instructions from step 6 and 7 Once the value on the oximeter matches the screen click OK Calibration Left Oxygen Saturation Calibration Use the arrows to increase decrease the OSat reading on the monitor so that it matches the GaumardUl value then click OK AAA Calibration Left Oxygen Saturation Calibration Use the arrows to increase decrease the OSat reading on the monitor so that it matches the GaumardUI value then click OK AAA Aia w O vw 10 The oxygen saturation calibration dialog box for 60 is now displayed Calibrate using the instructions from step 6 and 7 Once you achieve the desired results click OK Calibration Left Oxygen Saturation Calibration Use the arrows to increase decrease the OSat reading on the monitor so that it matches the GaumardUI value then click OK AMA Calibration Left Oxygen Saturation Calibration Use the arrows to increase decrease the OSat reading on the monitor so that it matches the GaumardUI value then click OK 11 After the calibration oval blinks green the following dialog box will be displayed indicating that the calibration has been completed Calibration Left Oxygen Saturation Calibration Use the arrows to increas
68. said dad id 23 Batey INICIO E os en ee eee ere errr 23 SUV A A IA 23 A A 24 A A IN IO e A 24 ci See eReN ener eee ro Sverre A eee tee Reeaeer Sata Re Ree am ete IN eae Ee ens Seren Sr emer eee er ne aeen et ene eee 28 E eo Es ce ee EE E A A 35 A r a a r EN 36 PAID PE PETEA E NE EA ASEE S EN E EES EN AE ENSE E EEEE EES EEEREN ASEENA 37 Creating a Lab Temple dt 37 Grealing hee ia lee Leg REDOT een eE E ici 40 JA aa a a a a a aa ators 41 O 43 Linea o NA A A O O 43 SCENO CONIO S eaa ee ee ee ee ee ee 46 Factory Preset SCONANOS three ete etd a a ei Ooh des hel eh ie a den ue E enemas 48 SEC MANO QUICK Lancia dia daria dara bbdd 51 UsingiFkactory Presets conanOS mui lle e ta e od 52 Creating your own Scenarios ii dba 54 Branching SCONAMOS suas ads A anal ol a a a a o do akin 57 Drugs Automati Mode ele ceed 63 PACIMIDISTSHINGIMCCICATONS a etcce 25 do et aioe 63 A E AAA e guint OO In E a atiatin gate Eee ET SEEE 66 BAM Ea S E A EE EE A EEEE EAEE EE TEE ee Pe Ren ed ee eee 67 Drug Imeracion Edo cts a a E O aE A E 71 A a a a ERE 77 SVE LADO r E a 77 A A ee 79 AMA A A A 79 DEVEN ROS Ma EO E RE 80 LADOK CONTOR o A TA A A 82 NOELLE S574 575 576 User Guide DY IOC eo A sa aate maou E aaeceoe 83 Contaction RESPONSE A e nn aa e cieagi Messed ensag TE e aa Osan tt 84 Descent CV Cas oath ct Pinan ae Seat batsmen A A A a 86 A ace pia cae aoc cates acne E cach aise ETE E E T en soos eaten carpet nasa E E EE 87 COS cadet age Neils eat Art let ae eli
69. second mouse button usually the right button while the pointer is positioned over an Item Note that when using the tablet computer this is best done by holding the stylus button while tapping the screen For more information on customizing the Palette see the Tips on Palette Item and Scenario Creation section of the Appendix at the end of this guide 36 NOELLE S574 575 576 User Guide Lab Laboratory tests are helpful tools for evaluating the health of a patient To simulate this process the Lab Tab allows the facilitator to create laboratory reports to aid providers during simulation Once a laboratory test is created the facilitator can display the results on the Virtual Monitor window for the provider to utilize Details Palette Lab Scenario Labor Speech Log Gaumard Lab Reports Create New Lab ETT Template Description sont NSAR Lab Template Template Description CBC DIFF Platelets Differential Lipid Panel Cholesterol HDL LDL Triglycerides Metabolic Panel Anion Gap Albumin Alkaline Phos Calcium Choride Neonate Blood test For newborn and premie OB Blood test Noelle The Gaumard Virtual monitors must be connected before using the file sharing feature To verify the connection navigate to PAGE 139 Creating a Lab Template To begin navigate to the bottom of the tab and click on the New Template button on the right panel Lab Template Template Description New Templ
70. the hospital in active labor The family is very excited as they know this baby is a boy Labor duration 15 minutes Scenario duration 22 25 minutes S amp S Abdominal and low back pain with ctx S amp S Patient looking pale early signs of hemorrhage NOELLE S574 575 576 User Guide Gaumard Simulators for Health Care Education Noelle 574 575 Labor Scenario June Peripartum Hemorrhage PPH y Place PPH kit inside Noelle simulator Wait indefinitely Massage fundus page anesthesia for stat sedation bimanual exploration and massage Increase Pitocin give Methergine straight cath administer Cytotec rectally Transition time 3 min Discontinue massage as the uterus bagins to firm up following Cytotec dosing 213 NOELLE S574 575 576 User Guide 214 Noelle S574 575 Labor Scenario Gaumard Kelly Simulators for Health Care Education ows i Amniotic Fluid Embolism Kelly is a 34 yr old gravida 5 2 38 weeks She is scheduled for induction as her last baby weighed almost 10lbs and she experienced a severe shoulder dystocia with that delivery She has gained 43lbs with this pregnancy and her GTT is borderline Labor duration 25 minutes Scenario duration 35 40 minutes S amp S sudden onset of pain following ROM asks for
71. the placenta with Velcro You may reverse one or both fragments causing one or both to birth with the placenta or remain affixed to the uterine wall Students must carefully inspect the birthed placenta to make sure it is complete and that no fragments remain internally If retained fragments are noted the student must retrieve them using a gloved hand under appropriate sterile conditions Postpartum Activity After delivery the uterus normally contracts reducing postpartum bleeding Under certain conditions contraction does not occur and extensive bleeding may continue If this condition is not recognized and treated in a timely manner the new mother may go into shock and die Inadequate uterine contraction may present as a boggy or soft uterus assessed through abdominal palpation Uterine contraction may be augmented using certain drugs and or uterine massage NOELLE S574 575 576 User Guide To simulate postpartum activity follow these simple steps 1 Connect the white Styrofoam block between the rails of the birth mechanism 2 Place the uterus over the Styrofoam block lining up the Velcro attachment so that the uterus does not move around and then insert the tip of the uterus inside the cervix The cervix should fit on the ring on the tip of the uterus 3 Connect the hose on the back of the uterus to the same outlet port the tummy is connected to Should the instructor wish to use the tummy with the i
72. unresponsive is not specific to an Add On feature that is not installed on your simulator 247 NOELLE S574 575 576 User Guide Microphone Boost for Streaming Audio Use the instructions below to increase the streaming audio volume Double click on the speaker icon found in the tablet s task bar in the lower right corner The Volume Control dialog box is displayed Click on the Option menu and select Properties li Volume Control IN z 1 fete ite ota le Dart c y PVG TL ASADO G Exit The Properties dialog box is displayed Under Adjust volume for select the Recording option and click OK Properties Other E Show the following volume controls Microphone Alt Mic 248 The Recording Control dialog box is now displayed Make sure that the Advanced Controls option is checked in the Options menu id Recording Control a Help Options Properties we Advanced Controls i Click on the Advanced button under the Alt Mic volume control i Recording Control E ES The Advanced Controls for Alt Mic window is displayed Select Microphone boost under the Other Controls section Click Close Advanced Controls for Alt Mic Tone Controls These settings control how the tone of your audio sounds Bass Low High Treble Low High Other Controls These settings make other changes to how your audio sounds See
73. user can manipulate this curve by clicking over a point on the line and dragging it to the desired location on the grid In order to add more points right click on the line between existing points and select Add Point To remove points right click over the point and select Remove Point 5 4 3 2 1 0 1 2 AUT AEE ss O a Ss EA A EA A SF ss a a ss Ls A A 20 E 5 4 3 2 1 a 1 2 3 5 86 NOELLE 574 575 576 User Guide Time Line The time line is where Palette Items are added to build the labor scenario As the time indicator line passes over each point the corresponding Palette Item is implemented To add a palette item right click on the time line and select Add Palette This will open a window with all the palette items available in the current profile Select a palette item or speech and specify a transition time then click Add Add Palette Item A min sec ic Y 59 59 Max Ttem Description Transitional Labor Once the point has been added you can touch it with the stylus and drag it to the desired location on the time line Double click over the point to bring up a window displaying the properties of the Palette Item represented by the point To remove or edit a palette item from the time line right click over the point and select the desired option
74. 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 Cancel NOELLE S574 575 576 User Guide Calibration At the end of calibrating a function the Calibration Wizard resets the simulator for the changes to take effect and displays the message Done If the wizard displays the message Can t reset it simply means that the new calibration values will take effect next time you start the software If the changes need to take immediate effect simply close the GaumardUl software wait about one minute for the simulator to turn off and then start the GaumardUl software again Options The GaumardUl has several options that can be preset by the instructor Auto Responses Set Med ID Scan RF Channels The Options window contains seven tabs Environment Tolerances General NOELLE Features Pacing CPR Options and Other Environment If the FIXED button is selected you must enter the correct simulator s serial number in the text box Fixed mode is required when entering Automatic Mode and Virtual Monitor activation codes and detecting optional upgrades such as streaming voice and drug recognition 125 NOELLE S574 575 576 User Guide If you cannot find the serial number first connect to the simulator using GENERIC and then press on the button that says Can t find Serial Number and fo
75. 11 05 2010 15 02 12 11 05 2010 15 02 12 11 05 2010 15 02 12 11 05 2010 15 02 12 11 05 2010 15 02 12 11 05 2010 15 02 14 11 05 2010 15 02 14 Description Alice is a 24 year old female weighing 170 pounds Her A companion s name is Mike O OHer OB history shows a gravida of 2 a term of 1 a preterm of 0 and that she is currently 39 weeks pregnant she has had 0 spontaneous abortions 0 elective abortions and 1 living children OO She has been currently using no medications of any Make a selection and click Export The Save As window Is then displayed a Save As s o m gO E gt Libraries Documents gt Filename Alicia Save as type abot Scepados EA cr cc No Browse Folders Once the files are saved on to the flash drive plug the drive to the computer where the files will be imported From the GaumardUl select import from the file menu Navigate to the location where the file was saved on the flash drive and click open GaumardUl will copy the scenario to the computer during the import process Exit You can exit the software at any time by going to File Exit or by clicking on the x button at the top right corner of the user interface Auto Responses Set Med ID Scan RF Channels Calibration This tool allows you to easily calibrate the sensors inside the simulator First choose which function you would like to calibrate chest compressions artif
76. AA A 149 SGIRCULA TON lt a e ote e e e a e o esta 150 Baler PUSO S nabo 150 Programmable DIOOO FroSSurE ac dicos 150 DOG CCOGIIUON ODUON usaste daniela 150 PN ALCAN VATS isis dla tae Sloan by A 153 OB TELRIC Saa cares A A A ato 154 Noma LAD Or aNd DEI A A AS 154 Prepannd tora CI A E E N ANES 154 LOCKING Mechanic ans 155 Belo RUE oe AAA a a a aa T 156 SA i A 156 Ss A catia ele are ala kere ctneataede an aelcne adorn EA 156 Resemng the Delivery Mechans 2sis a dle ee Oe ead cat lh er I ie a a TOO lo eee 157 VACUURT ASSISICG DEVE Vta dilo ciedad E ECONO VIAINC UY CF sarna A 158 NS a A E A ea ney ern ee ee ene eee 159 Biers ole lg hy Ble 2 A een neem nee CAE Ee ent en i aa et ee eee en eee Re Dee Od ee en mar eT 159 Prolapse or Hat AG OO ofits tier hace tee dase A Ae cee andra teas 160 leg felelelg A eee ee eT PRR Te ee eNO MNT aaa Ot Mee ere eee mee ST ner ort Mere Tey er renee nr 160 ENVIO iia 161 O O 161 Placenta DOI Vai aida 163 FOS TD ITTY ACI Va dude areas a yaad unlbuiade a a a sade neds a gee aatel 163 Episiotomy FAC OA serorea a mat balay yaad am eae cased diab aca ck a sales aid a N 164 OY NG ndo ld rial lid ra cid rondas 165 OVINA A a 165 INtramuscu lar injection SHO Sii di waa r a A a setae Angad eawel 165 Bla CG GINGLCVIZANION AAA ar occ r a eae e abh ccd eae E ceaes 165 A A 166 POSI PANUNT HOMO Midi iii A A Ai A ia IAE E ci EA a AA id 166 Vilak ICIS MOMO iS iaa eaten 166 NOELLE S574 575 576 User Guide APPEND
77. CLUDING DAMAGES FOR LOSS OF BUSINESS PROFITS BUSINESS INTERRUPTION LOSS OF BUSINESS INFORMATION AND THE LIKE ARISING OUT OF THE USE OR INABILITY TO USE SUCH PRODUCT OR RELATED TO THIS AGREEMENT EVEN IF GAUMARD HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH DAMAGES GAUMARD SHALL NOT BE LIABLE TO YOU FOR ANY INDIRECT SPECIAL INCIDENTAL OR CONSEQUENTIAL DAMAGES OR LOST PROFITS ARISING OUT OF OR RELATED TO THIS AGREEMENT OR YOUR USE OF THE SOFTWARE AND OR THE RELATED DOCUMENTATION EVEN IF GAUMARD HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH DAMAGES IN NO EVENT SHALL GAUMARD S LIABILITY HERE UNDER IF ANY EXCEED THE PURCHASE PRICE PAID BY YOU FOR THE SOFTWARE ALL RIGHTS NOT EXPRESSLY GRANTED IN THIS LICENSE AGREEMENT ARE RESERVED BY GAUMARD ACKNOWLEDGMENT BY INSTALLATION OF THIS SOFTWARE YOU ACKNOWLEDGE THAT YOU HAVE READ AND UNDERSTAND THE FORE GOING AND THAT YOU AGREE TO BE BOUND BY ITS TERMS AND CONDITIONS YOU ALSO AGREE THAT THIS AGREEMENT IS THE COMPLETE AND EXCLUSIVE STATEMENT OF AGREEMENT BETWEEN THE PARTIES AND SUPERSEDES ALL PROPOSED OR PRIOR AGREEMENTS ORAL OR WRITTEN AND ANY OTHER COMMUNICATIONS BETWEEN THE PARTIES RELATING TO THE LICENSE DESCRIBED HEREIN NOELLE S574 575 576 User Guide Care and Cautions NOELLE S574 575 576 User Guide 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 Procedures Do not att
78. Children Gestational Age Prenatal care O Alcohol O Tobacco C ilegal Drug Use C Rx Drugs O Allergies CI Anemia O Diabetes O Heart Disease C Hytertension C Tuberculosis C Group 8 Strep C Infectious Diseases O sri Previous C S C PROM PPROM Treatment History O None O 02 O AROM O cpr O N Started C Amino Infusion O FSE O N Pain Meds O mee O Epidural Pan Bleeding Membranes Dilation Station Other Fetal Info C Decreased No fetal movement Other Post Partum Scenario none O Save Translation and Rotation Parameters Enter the name of the patient age gender height weight and or additional notes Then click on Save NOELLE S574 575 576 User Guide To load an already existing patient go to Modeling Modeling Patient load patient Select the desired patient and click on Load Notice that the factory pre set patients cannot be deleted as opposed to any of the patients that you create yourself which can be deleted Fl Load Labor Scenario Patient Information Alyssa is a 23 year old female weighing 170 pounds W Gain 35 Her significant other is Bill husband Her OB history shows a gravida of 0 a term of 0 a preterm of 0 and that she is currently 40 weeks pregnant she has had 0 spontaneous abortions 0 elective abortions and 0 living children She has had prenatal care She has been currently using no medications of any kind Her medical records shows she has allergies
79. Effect 93 38 Alpha 1 01 Compared to Additive individual drug effect reduced by 0 08 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 Captop Capoten 2 135 200 Time min To un zoom or print right click anywhere on the graph to access additional options Time Effect Graph Copy Save Image As Page Setup Print Show Point Values Bo a iil Set Scale to Default 75 NOELLE 574 575 576 User Guide After all the interactors are configured and tested click on Finish to save the interaction settings gt Max Alpha 1 1 Isobologram plasma concentration save 1 Clear All 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 facilitator to monitor Dose Onboard O10 Suen og 76 NOELLE 574 575 576 User Guide Labor The most advanced method of controlling the NOELLE birthing system is to build a Labor Scenario which is a sequence of Palette Items with delay periods corresponding to a labor curve Time Information Labor duration 30 min Warp Factor d S approx 30 min Labor Control Dystocia Contraction Response Delivery Position O Enable Smart Labor 10 2 ON
80. Gaumard Simulators for Health Care Education NOELLE S574 575 576 user Guide Maternal and Neonatal Birthing Simulator NOELLE is an interactive educational system developed to assist a User Guide N 12 3 2 certified instructor lt is not a substitute for a comprehensive Gaumard Scientific Company 2012 understanding of the subject matter and not intended for clinical All Rights Reserved decision making www Gaumard com NOELLE S574 575 576 User Guide NOELLE S574 575 576 User Guide Contents CONTENTS at A A AA 3 END USER LICENSE AGREEMENT crcsancaszavassisiconssecconncecssauesauaesuaysesaceensascaensteessunedaaceunssanscanssonteuenseapesvatuanounecees 7 CARE AND CAUTIONS 0 sei arses a ease teen eee nate eet a eee 9 INERTE NO otto 10 JM A AA A A A A a talcinecttae 11 GETTING STARTED omita 12 OVERVIEW hee thee tees elo e lo ll e onal oe 13 Ms A A Ne Renee oe 13 EQUIPMENT SE FUP ana AO 14 LEGAS SENON aiii Tt Ne ET oe Pe E een re Ne ey Te Reet Tore 15 Ei 2 C0 63 AAN Oa Me ey A E E Ee ee 15 ad A AAA A O ee RATT a OT PaO Te eT 16 Ai A ie ne Cea teed tench een n ee RON ae On A A a eee tee 16 Wireless Ad Hoc Connectivity cz miooo nadaa cdas 17 Gaumara Mont Si cad 17 WORKING WITH GAUMARDUO cata aa 18 INITIALIZING NOEL sc sa iio 19 USE pPrames ana Opera lO MIES acia 19 ME APA A A A A A A eee 19 AUTO MAHOMA do oa 19 Greatind a new DONG ia a a le lr es a O 20 ENT ide tante 21 WS Slats dl dd eco 21 SOMMUNICAatoOn IMA ICAO
81. Generic Name Brand Name New Medication Naloxone Narcan 2 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 3 Select the units and the administration route Unit W ug El ug kg Y mg C mg kg O g El g kg Route TY Push he Infusion IM SubQ Topical Per Oral Inhalation 69 NOELLE S574 575 576 User Guide 4 Enter the drug s Half Life and Peak time If these numbers are unknown use the approximate option Half Life hr min sec Precise 15 0 Approximate very quick lt 5m Peak Time hr min sec Precise DE JE OK Approximate very quick lt 5m 5 Enter half maximal effective concentration Medication Response ECSO 0 0001 mg dl Concentration that produces 50 of the maximum effect Available Palettes A tems Threshold TTT OT ENTE TD Naloxone OD 6 From the list select the dose effect palette created earlier and click the applicable dosage button to assign Repeat this step to assign the over dose effect palette to the Over Dose option Medication Response EC50 0 0001 mg dl Concentration that produces 50 of the maximum effect A Naloxone UD Nirardinine On 70 NOELLE S574 575 576 User Guide 7 Select the threshold unit and adjust the value
82. LLE S574 575 576 User Guide 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 GaumardUl simulation the Software media you agree to be bound by the terms of this agreement If you do not agree to the terms of this agreement promptly return the uninstalled media and accompanying items to Gaumard at the address indicated below 1 Grant of License Gaumard hereby grants to you an individual or institution the right to install and activate the Software on one computer for use with one Code Blue lll 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 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 mann
83. Locate the hole on the upper part of the birth canal reading oxygen saturation also read carbon monoxide SpCO and methemoglobin SpMet are not supported and may provide inaccurate readings For information on how to calibrate this feature go to page 165 Intramuscular injection sites IM sites for placement exercises are located on both deltoids and quadriceps 3 Carefully insert the bladder tube from stomach cover through the hole in the birth canal as shown below 4 Make sure that the tube comes out the opposite ae aes end of the birth canal WARNING Do not inject fluids into the IM sites 5 Use urinary catheter size 18Fr to drain out urinary fluids 165 NOELLE S574 575 576 User Guide Other Post Partum Hemorrhage You can simulate extensive postpartum bleeding and incorporate the feature to work with labor scenarios Follow the guide below to prepare the hemorrhage feature WARNING Always position the simulator so the postpartum hemorrhage fluid flows away from the birth canal and the simulator itself Do not allow postpartum hemorrhage fluid to puddle beneath the simulator or reach the lower back Filling the PPH Reservoir The post partum hemorrhage fluid reservoir port is located behind the right knee Fill the PPH reservoir with water or Gaumard simulated blood mix using the PPH Fill Kit Syringe The hemorrhage reservoir has a maximum capacity of 900 mL or approximately 15 full
84. Manual Mode Non scenario automaticresponses settings Alof Display warning when non shockable AlAuto External Pacing Defibrillation Shock Prompt x Prompt Auto o Auto 3 Setting Setting at 200 2 9 Joules Shocks D convert to NSR 9 75 bpm BP 120 80 cardiac rhythm is shocked Cardioversion Shock O off Prompt 9 Auto Setting ee 100 9 Joules Shocks D convert to NSR 9 75 bpm BP 120 80 Non Sync Shock Prompt pd EA 9 Auto S3 Setting AE 100 9 Joules Shocks D degrade to 9 ventricular fibrillation 45 NOELLE 574 575 576 User Guide Automatic Mode Non scenario automatic responses settings All Off Link All Auto Response to Cardiac Irritability Modeling none a D Off slight random All Prompt al 5 9 On if Cardiac Irritability is ro nanan Display warning when non shockable All Auto Auto multichoice is enabled greatimprove cardiac rhythm is shocked External Pacing Defibrillation Shock Cardioversion Shock Non Sync Shock Drug Model Effect Prompt a Prompt Prompt Prompt Prompt dl eN E Y y sy xl O Auto Auto Sa Auto Sy Auto Ss Auto Setting Setting Setting Setting a E Drug takes effect 200 Y Joules 100 Joules 2 0 Joules according to the dose Shocks Shocks Shocks applied auto or user la convert to NSR
85. OFF Enable Contraction Response Rotate baby O ro a C Descend only with contractions O Breech 2 Station O speech speech vitals 2 C Check ROT LOT delivery 2 Q LOP Pause O Run Alice Labor Time 00 00 00 DESCENT 3 1 gia The sections that follow describe in detail the function of the various controls found in the Labor page Save Labor Click on the Save Labor button to save the current configuration of the descent curve Labor Control _ Enable Smart Labor 10 5 sed C Descend only with contractions Pause Run 77 NOELLE 574 575 576 User Guide The window shown below opens Use this window to input relevant information about the scenario for future reference You must enter the Mother s name which will become the name of the scenario All the remaining information can be left blank as it is optional Save Labor Scenario Mother Alice Age 24 Height Stage Information Weight 170 Weight gain Sa Latent s1 Active 51 Transition Stage 2 stage3 Significant Other Mike Maternal Info Respiratory status OB History Cardiac status Gravida vw Spont Abortions Pain Bleeding Membranes Dilation Station C Alcohol C Tobacco C Illegal Drug Use Other Term 0 Elective Abortions Preterm 1 Living Childre
86. S Time fmit B End Click Add Item to add specific palette items or Add Scenario to add full scenarios to this node Repeat the process and add palettes to the rest of the nodes 2 Node Name 2 02 00 No changes are made to manikin Cardio Drop 01 00 HR 15 BP 10 OSat 5 58 NOELLE 574 575 576 User Guide Adding Paths A path refers to the trajectory from one node to another after the last palette in a node expires Click on the Time Limit icon to modify the Go To point for the default path After the last palette expires the scenario will move on to the node as indicated by the arrow Load Scenario Go to Normal Scenario Time limit End Path Go to point Configure the countdown timer and the go to point for the default path Click OK to save Set Time Limit min Sec 08 18 59 59 Max Go to 2 Deteriorate rs Node 1 is now configured to continue to Node 2 as indicated by the path s time limit htl Start Bradycardia ee 3 gt Eradycardia 00 00 RR 10 HR 45 2nd deg AVB Speech 1 00 01 complaint Feel dizzy Additem Add Scenario S Copy Remove Add path 8 gt Key Events Key events allow the facilitator to alter the trajectory of a branched scenario This is done by assigning multiple paths to a single node then selecting one of the paths when the provider completes a desired task
87. Tylenol for pain antibiotic therapy NOELLE S574 575 576 User Guide G q Noelle S574 575 Labor Scenario cota Charlotte Simulators for Health Care Education Shoulder Dystocia Charlotte is a 31 yr old gravida 3 1 41 5 7 weeks Her physician stripped her membranes yesterday and she began contracting during the night She is admitted in active labor Labor duration 40 minutes 189 NOELLE S574 575 576 User Guide Noelle S574 575 Labor Scenario Gaumard Dana Simulators for Health Care Education Breech Presentation Dana is a 24 yr old multip 29 weeks who was admitted because she began contracting Upon V E physician discovers that she is 4 5cm with bulging membranes She was given Terbutaline subQ and then transported to the regional medical center Labor duration 45 minutes 190 NOELLE 574 575 576 User Guide Noelle S574 575 Labor Scenario Gaumard Simulators for Health Care Education Demaris Breech Presentation Demaris is a young Hispanic teen who has received prenatal care in the Adolescent OB clinic She kept the pregnancy a secret as long as was possible and did not attend any childbirth classes Her plan is to return to high school while her mother cares for the baby The baby s father will not accept any responsibility and does not wish to be involved La
88. Yes to load the transferred information onto the Newborn tablet arance E Level Patient s Info i v Name Newborn d crying Muscle Tone Auto Gender M Tern 40 weeks spiratory Pattern Lung Condition v Height 13 8 in Weight 5 5 lbs z End Tidal CO2 general pre post ductal Data Received The Neo Link feature also allows the facilitator to send a current state of the fetal data from the NOELLE Model Setup Transfer current fetal data Click on the Transfer current fetal data perform this action 143 NOELLE S574 575 576 User Guide Help The help menu has four options Instruction Manual About GaumardUl Check for Updates and Diagnostics Instruction Manual Check for Updates Diagnostics Instruction Manual allows you to view a soft copy of the entire NOELLE S574 575 576 help manual About GaumardUl The About GaumardUl window displays the software and simulator firmware version Check for Updates To check and install software upgrades follow these simple steps CAUTION Do not change the network configurations of the tablet to connect it to your local wireless network Such changes will interfere with the proper operation between the tablet and your virtual monitor virtual monitor computer 1 Connect an Ethernet cable to the tablet PC 2 Go to the Help menu and click on Che
89. _Push has just been Administered This dose will be treated as Dose Do you want this drug to take the following peak effect 100 Standard Dose x Reverse effect when the drug s level begins to drop To turn off the Proceed Drug prompt go to the menu bar and click Setup gt Auto Responses then change Drug Model Effect to Auto arot Link All Auto Response to Cardiac Irritability Modeling qx AAA Off none a slight random 8 i i itabilitv is do 5 On if Cardiac Irritability is ao ene 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 a Prompt ba p s gt p GA ed p GA p A Prompt Auto y O Auto S Auto S q Auto Sy Auto Setting Setting Setting Setting at at ae ne ie Drug takes effect 200 Y Joules 1004 O Joules 100 O Joules according to the dose Shocks Shocks Shocks applied auto or user convert to NSR convert to NSR degrade to setting prompt 75 bpm BP l l 75 bpm BP ventricular 120 80 120 80 fibrillation et 64 NOELLE 574 575 576 User Guide The administered drug panel displays information on dosage rate percentage of dose completed and total time of administration Drug _Dose Units Route _ Rate fe CBA AE
90. a healthcare provider Scenario a saved sequence of physiological states which flow like a play list Scenarios provide a level of automation that unburdens the facilitator and allows standardized presentation of symptoms Scenario ltem a Palette ltem that is part of a scenario Scenario ltems 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 GaumardUI software See the Equipment Set up section of this guide for more information on working with the stylus Manual Mode In this mode vital signs and other responses are changed according to the specifications given by the instructor 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 13 NOELLE S574 575 576 User Guide Equipment Set up Perform the following steps as part of the first install process Leg Assembly Follow the steps below to install the lower legs Remove the legs when transporting NOELLE inside the protective case 1 Remove the fixed
91. a text file Clicking on it brings up the Save As dialog box Ey Save As gO di Reports a T eee Organize v New folder gt Y Favorites Name Date modified Type No items match your search gt DJ Libraries gt 3 Homegroup gt 1 Computer D Cu Network 4 mW File name Report 1 Save as type Text files txt a Hide Folders Select the desired name and path and click Save 117 NOELLE S574 575 576 User Guide The shortcut key for saving a report is Ctrl S Fora sample report look at the figure below File Edit Format View Help 02 11 2011 01 38 12 Session Facilitator Providers Team Alice is a 24 year old female weighing 170 pounds W Gain NA Her significant other is Mike Her OB history shows a gravida of 2 a term of 1 a preterm of 0 and that she is currently 39 weeks pregnant she has had 0 spontaneous abortions 0 elective abortions and 1 living children She has had prenatal care She has been currently using no medications of any kind Her medical records shows she has no previous history Her treatment history includes NO 00 00 12 Applied 00 00 Palette alice01 Details HR 75 RR 21 Temp 37 1 ContractionFreq 6 min ContractionDurat 30 sec FHRSpont non reactive 00 01 00 Applied 00 00 Palette alice02 Details ContractionFreq 4 min ContractionDurat 40 sec 00 01 16 Applied 00 00 Palette alice03
92. ablet 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 Communications Module Connect the RF communication module to an available USB port on the tablet s left side The module s USB cable can be connected whether the tablet computer is on or off WARNING Never disconnect the communications module while GaumardUl software is running Doing so can damage the module Secure the RF communication module to the tablet using the Velcro patch The tablet is now ready to communicate with NOELLE For more information about the signal strength indicator refer to page 23 Virtual Monitor The dual virtual monitor system works with GaumardUl to display the vital signs of NOELLE Newborn HAL and birthing baby Equipment installation Please refer to the documentation included with the virtual monitor system components for important safety installation and start up information Lastly refer to the applicable system type for additional configuration System 1 The setup consists of 1 desktop computer and 2 touchscreen monitors Each monitor requires an independent video audio and USB touchscreen connection to the desktop computer in addition to the power source me
93. ach training session the session title and facilitator fields can be filled in and the information contained in them is stored with the text file when the log is saved or printed Session Title Simulation 101 Facilitator Randy Pausch Providers on I Deny Emergency Reported Breathing 109 NOELLE 574 575 576 User Guide Evaluation The Evaluation panel always visible at the bottom of the GaumardUl window allows the facilitator to insert standard evaluations or other relevant notes into the log The stylus device and hand writing recognition technology makes annotation in real time rapid and convenient penal Care Provided Unsatisfactory Satisfactory Power Note O Ad to Hg Standard evaluations satisfactory or not are given context by their position in the log relative to detected and observed provider actions The following example illustrates this idea 00 03 12 Patricia Action Shoulder dystocia 00 03 20 Chris Action Shoulder dystocia Suprapubic pressure 00 03 30 Chris Action Shoulder dystocia McRoberts maneuver 00 03 37 Patricia Action Shoulder dystocia McRoberts maneuver 00 03 52 Patricia Evaluation Care Provided Satisfactory The evaluation panel is part of the team logging system described previously When a particular provider is selected log entries generated via the Evaluation panel will be prefaced with the provider s name For more information
94. apse cord prior to beginning scenario Instructor may disconnect NOELLE simulator from power outlet and continue running scenario while transferring the NOELLE birthing simulator to the OR Runs for approximately 25 minutes Shortly after admission patient clutches her abdomen and fetal baseline bradys down to the 80s Patient becomes very pale and diaphoretic BP drops to 80 60 and pulse is 120 She suffers heavy vaginal bleeding Patient is rushed for emergency C Section Baby is limp and severely depressed needs to be intubated and ventilated Runs for approximately 181 20 minutes Use file sharing feature to display pictures of C spine x ray as patient was involved in car crash 95 NOELLE S574 575 576 User Guide Patient Name Haley Heidi India Inez Janie 96 Labor Type Peripartum Hemorrhage Previa Peripartum Hemorrhage Previa Peripartum Hemorrhage Abruption Peripartum Hemorrhage Abruption Peripartum Hemorrhage PPH History Haley is a 33yr old G2 35 weeks Previous U S revealed a low lying placenta and this is the 5 time in 11 weeks she been admitted for bleeding This time the bleeding is is heavier and is not resolving Her OB is on the way to the hospital bi manual palpation shows the uterus to be soft and non tender Heidi is a 25 yr old primip 35 weeks She has experienced several mild bleeding episodes during pregnancy and is known to have a low lying placenta Sh
95. apubic pressure McRoberts Woods and Rubin maneuvers Alleviate Dystocia with Gaskin maneuver NOELLE S574 575 576 User Guide A Noelle Labor Scenario Gaumard Simulators for Health Care Educatior Donna 2 Breech Donna is a 20 year old gravida 4 2 at 31 weeks She weighs 180 lbs She has had one elective abortion She has had prenatal care Labor duration 20 minutes 175 NOELLE S574 575 576 User Guide 176 A Noelle Labor Scenario Gaumard f z Simulators for Health Care Educatior Elaine Preeclampsia Elaine is a 23 year old gravida 1 0 at 37 weeks She weighs 140 lbs She has had prenatal care She complains of mind frontal headache 3 tibial edema and 4 DTRs with 2 beats clonus are noted Labor duration 40 minutes NOELLE S574 575 576 User Guide G d Noelle Labor Scenario aumar i Simulators for Health Care Educatio Francine Cesarean Delivery Francine is a 19 year old female gravida 2 1 at 37 weeks She weighs 145 Ibs She has had prenatal care She has STD Herpes Labor duration 10 minutes 177 NOELLE S574 575 576 User Guide Noelle Labor Scenario Gloria Cord Prolapse Gaumard Simulators for Health Care Educatior Gloria is a 34 years old gravida 1 0 at 25 weeks She weighs 190 lbs She has had prenatal care Labor duration 10 minutes
96. arged Make sure battery is charged If NOELLE s battery is gets established or is completely discharged connect the AC Adapter and wait lost 20 minutes to power on the simulator Leave the blinking communica simulator connected while in use tion indicator is con NOELLE should always be plugged in while being sistently red operated The birth mechanism is power intensive and will drain the battery quickly Computer is too far away Minimize the distance between simulator and the tablet from simulator Interference Maintain line of sight with the simulator and maintain the RF module in an upright position directed at the simulator Trying to communicate with Make sure to select the right simulator when opening the a different simulator software In a multiple simulator environment make sure to enter the right Serial Number under Setup gt Options gt Environment Multiple Starting more than one Select different channels for each of the simulators and simulator with its own tablet then turn them on one at a time meaning Wait until a link has been established between the tablet and the simulator the yellow dialog box goes away Only after that start running the GaumardUl software in the second tablet and so on for the rest of the simulators To do so go to menu Setup gt Options gt Environment gt Select Auto change to channel number from 1 11 RF driver Perform a full shutdown of the tablet
97. art tones speaker inside the fetus There will be one actuation of the locking mechanism when the articulating baby is inserted which is normal WARNING On first revision birthing mechanisms always adjust the motor arm before every delivery to prevent the power cable from wrapping around the motor arm First revision systems can be identified by the warning label located atop of the labor mechanism Do not operate the birthing mechanism without the tummy cover in place NOELLE S574 575 576 User Guide Position the baby so that its face is upward anterior Connect the baby to the birthing mechanism while the simulator is ON so that the electromechanical mechanism allows the baby to be locked into place Once the baby is connected and locked onto the mechanism position the baby to its initial birthing position The user has the choice of ROP LOP ROA LOA On the labor tab select the fetal position that matches the birthing baby s initial position on the simulator ght 1 i Mute Listen Talk Gaumard ROA a prox 60 min 155 NOELLE S574 575 576 User Guide Loading a Labor Scenario Several prebuilt labor scenarios are included in the Quick Start NOELLE Profile Click the Load Labor button to load a labor scenario Navigate to File gt Profile from the menu bar to quickly change between profiles Labor Control E Enable Smart Labor 110 s
98. ate CBC DIFF Platelets Differential Selected Item l peel meee 1 94 Lipid Panel Cholesterol HDL LDL Triglycerides Ello Metabolic Panel Anion Gap Albumin Alkaline Phos Calcium Choride o Delete Neonate Blood test For newborn and premie b 37 NOELLE S574 575 576 User Guide The Edit Lab Results Template window is used to create templates that will be later used to create lab reports Enter a name for the lab template followed by a description ES Edit Lab Results Template Description Category Single Entry add Remove Rename Insert A y Add e Delete Allowed value range is displayed in Value column It won t be visible when entering data Categories are used to group a series of tests in a lab report From the Category box click Add to name and create a category Then click OK to save the new category HE Edit Lab Results Template Name Lipid Panel Description Cholesterol HDL LDL Triglycerides Category Single Entry i Remove Rename insert a v adi Delete HE Category Name Lipid Panel Female Comment Use the Single Entry menu to add a test under the category previously created ES Edit Lab Results Template a Name Liquid Panel Description Cholesterol HDL LDL Triglycerides Category Single Entry add Re
99. attern 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 GaumardUl 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 Clocks Transition remaining 00 00 00 17 31 21 26 NOELLE 574 575 576 User Guide Ventricular Tachycardia When cardiac rhythm is maintained at Ventricular Tachycardia for one minute the following prompt dialog box will be displayed Ventricular Tachycardia fa 1 minute has passed since the patient is in Ventricular tachycardia A do you wish to degrade to Ventricular fibrillation Click NO to re check the Cardiac Rhythm in one minute Click CANCEL to stop checking every minute the Cardiac Rhythm Cde oe ona Click Yes to degrade the cardiac rhythm to ventricular fibrillation Click No to maintain the cardiac rhythm and recheck after 1 more minute Click Cancel to stop the software from checking the cardiac rhythm every minute Uterine Activity Fetal Heart Rate Click on the UA FHR vertical tab to access uterine activity and Fetal Heart Rate controls A UA lt Click button to generate spontaneous contraction with current pa
100. be initiated with a single click on the Speech page The collection of speech and other sounds was chosen to cover a wide range of simulated emergencies Dont feel i Don t feel j tal nt on seman Burns when I Had a drink Swollen all Havent seen a m vena ine High blood Previous mastona poe e Mevate Worst isi ck Used cocaine Ri today For ease of use NOELLE s expressions are divided into categories complaints history description confusion reply location occurrence urgency effect and numbers These categories are labeled in blue on the speech page Any of the speech items listed on the Speech page can be incorporated into labor and post partum scenarios Streaming Audio If factory installed Streaming audio makes simulation even more realistic It allows the facilitator to hear everything the providers are discussing around the simulator At the same time the facilitator can interact as the patients voice for the provider t The instructor will also be able to record his own speech phrases that can be used at any given time or within a scenario The streaming audio controls can be accessed by clicking on the More button in the lower right corner of the Speech tab NOELLE S574 575 576 User Guide Please verify that the simulator is conn
101. berly Amniotic Fluid Kimberly has coded during delivery and the Embolism doctor has decided to deliver the baby by emergency c s due to severe bradycardia Maria PTL Preterm Labor Maria is 30 yr old multip 27 weeks She s had 2 miscarriages in the last 4 years due to an incompetent cervix For this pregnancy she had a McDonald s suture placed 14 weeks She is admitted c o abdominal cramping Branching Heidi PP Branch Heidi Heidi delivered with a low lying placenta Upon delivery of the placenta a velamentous cord insertion was noted Heidi begins hemorrhaging due to a retain portion of the placenta which must be removed 49 NOELLE S574 575 576 User Guide Automatic Mode These scenarios in the automatic mode are found in NOELLE s Quick Start NOELLE Modeling profile There seven linear scenarios and no branching scenarios Linear June PPH June Peripartum June suffers PPH following svd of healthy baby Hemorrhage PPH boy Becca sedation Becca Variations on Normal Becca delivered precipitously and has retained secundines Frances section Frances Cord Prolapse Frances was found to have a cord prolapse following SROM during labor The fetus began to brady down but stabilized back to 120 bpm when the head was displaced Candice admit Candice Shoulder Dystocia Candice is 19 yr old multip Approximately 8 months pregnant No PNC Ruptured gt 24 hrs Meconium Variables Probable chorioamnionitis Gabriella cesa
102. bor duration 30 minutes Admit patient Routine labs notify HCP of admission and status Order real time U S to determine fetal position S amp S Agitated uncooperative FHTs are above the umbilicus Attempt to get patient consent for c s transfer patient to OR for delivery insert FSE on fetal buttocks S amp S Patient and mother vehemently refuse to consent to C S AROM 191 NOELLE S574 575 576 User Guide Gaumard Simulators for Health Care Education Noelle S574 575 Labor Scenario Eleanor Variations on Normal minutes Elenor is a 19 yr old post ictal patient being transferred to the ER by EMS She was found convulsing in the bathroom According to relatives she is 81 2 months pregnant with her first baby She has been on an IV during transport and her BP is 180 120 Labor duration 20 S amp S Responsive only to pain with groans Vaginal bleeding S amp S Suffers tonic clonic seizure prolonged fetal bradycardia results 192 Stat page on call OB attending Give Magnesium sulfate bonus Employ safety measures during seizure give another Magnesium sulfate bonus Prep for precipitous delivery following tetanic ctx Hang pitocin infusion following placental delivery to encourage uterine
103. bration Use the arrows to increase decrease the OSat reading on the monitor so that it matches the GaumardUI value then click OK Oxygen Saturation O IV Medication Infusion A message box is displayed to remind you to have the oximeter turned off Click OK Oximeter Information 7 Click the arrows on the left column of the calibration window to adjust the oximeter monitor screen reading to 98 3 Select which finger you want to calibrate left Then For large increases or decreases use the triple click Next arrows For moderate changes use the double arrows Use single arrows for small changes of one Sa or two percent reading only for 98 calibration Calibration Please select the finger pou would ike to calbrate Left Oxygen Saturation Calibration Use the arrows to increase decrease the OSat reading on the monitor so that it matches the GaumardUI value then click OK Manikin s LEFT Index finger E camel CAUTION To ensure proper calibration always allow the oximeter to stabilize readings by waiting 3 5 seconds after the value is adjusted After the value on the oximeter screen stabilizes click Next to continue calibration 121 NOELLE S574 575 576 User Guide 8 9 122 Click OK The calibration oval blinks green before showing the next value Calibration Left Oxygen Saturation Calibration Use the arrows to increase decrease the OSat
104. cal Disk 25 E Program Files E 5 Gaumard Scientific E a Gaumard User Interface 5 manikins E profiles C Default Profile Quick Stark Scenarios 9 resources Profiles 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 two profiles in this installation Default Profile and Quick Start Scenarios Palette Items 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 simply copy the plt file found in the source profile folder Scenarios Scenarios are stored as sub folders within profile directories Scenarios can also be transferred between profiles by copying the scenario folder and its contents NEVER e modify files in the resources directory or those at the top level of the Gaumard User Interface directory e manipulate files or folders while the GaumardUl software is running ox e modify or delete dll scn or sys files 240 NOELLE S574 575 576 User Guide Troubleshooting General Troubleshooting Guide Use the following table to find causes and solutions to a number of possible problems Communication never Battery is disch
105. catheter UA FHR Swan Ganz All ON All OFF This option brings up a floating window that can be viewed from any of the tabs in GUI It can also remain opened as the users work in different scenarios The sensors dialog box will look like the example below Sensors Light blue buttons indicate that a particular sensor is turned on and dark blue buttons indicate that a sensor is turned off In the example above all the sensors are turned on except the thermometer and the ABP cannula File Sharing File sharing is only available when using the Gaumard vital signs monitor To use this tool you must first locate the GaumardUIl folder on the desktop of the tablet Make sure you enable it for file sharing This can be done by doing a right click over the folder selecting Properties and then enable sharing 137 NOELLE S574 575 576 User Guide Add to this folder any kind of files that you wish to share with your students or providers Gaumard UI The File Sharing Setup menu is used to manage shared files Custom numbers Configuration Files in the Gaumard UI folder will be listed on the Available Files panel located on the left To share a file click on the Add button in the middle of the screen Enter a context name on the pop up menu and click OK The shared file will appear on the right list box Remove individual files by using the remove button on the right File Sharing Setup
106. ce Entry menu On Site Reviewer Multiple Choice Entry 2 1 Problem Description 2 Provider Tasks and performance Enter the multiple choice information in the entry fields Category Multiple Choice Entry 2 Add Remove inerte oe arse P 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 Multiple Choice Entry 2 How would you rate teamwork during this delivery emergency 5 Communication Perfect N A Overall Communication Rating Orient new members SBAR Transparent thinking Directed communication Closed loop communication 6 Situational Awareness Perfect N A Overall Situational Awareness Rating 115 NOELLE 574 575 576 User Guide After the evaluation template design is complete click Save at the top of the window Evaluation Form Load template lx Save dear Delete Evaluation Name Vacuum Delivery On Site Reviewer Category Multiple Choice Entry 6 Finally select the new template from the Load template drop down to use the completed evaluation form Evaluation Form Load template K Save Gear Delete Breech Vaginal Delivery Edamptic Seizure Forceps Delivery Evaluation Nan On Site Reviev Postpart
107. ce the elevating cushion within the birthing torso Route the inflation bulb outside NOELLE through any space open on the left side Place the birthing baby in the elevating cushion in the vertex breech or transverse positions Install the tummy cover Inflate the elevating cushion until the fetus can be felt under the abdomen cover WARNING Do not enable the motorized birthing mechanism while performing this exercise 158 Placing elevating pillow within simulator Place fetus onto elevating pillow and lift fetus anteriorly using the squeeze bulb Lift fetus anteriorly using squeeze bulb until it can be felt under the cover Shoulder Dystocia Shoulder dystocia is a dangerous condition defined in the NOELLE Guide as the arrest of delivery of the fetal body after the successful delivery of the fetal head It may be characterized by the so called turtle sign wherein the fetal head moves forward and then retracts During dystocia the fetal shoulders become wedged behind the symphysis pubis NOELLE may be used to practice the resolution of dystocia using episiotomy techniques the McRoberts maneuver suprapubic pressure posterior arm sweep or eloow knee delivery The McRobert s maneuver causes pelvic tilt that helps release the fetal shoulder from behind the pubic bone NOELLE 574 575 576 User Guide Suprapubic pressure may also release the fetal shoulder To demonstrate shoulder dyst
108. ck 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 144 Diagnostics Use this feature as a troubleshooting tool E Diagnostics Info SN N8505004 Audio l Mechanical Throat voice Throat Streaming O Heart O Larynx Lung Front Upper Right O Carotid Lung Front Upper Left Radial Right Radial Left KK Right O KK Left Breathing Seizures Rev 1 O Seizures Rev 2 Pi BP Right BP Left Ventilation Compression Compressor Other O ECG O Trachea Intubation O Eyelids O Right Pupil Dilation Left Pupil Dilation O Sat Right 0 Sat Left Drug Recognition Noelle Specific Delivery Motor Rotation Motor O Rotation Encoder Tummy Pressure Load Cell Baby Hemorrhage Air Hemorrhage Liquid For more information go to the Appendix Legend Active Inactive Check Modules UT NOELLE S574 575 576 User Guide Working with NOELLE 145 NOELLE S574 575 576 User Guide DISCLAIMER The section below describes all possible features in the NOELLE simulator These features are available in all three NOELLE Model
109. costs of shipping and handling Extended Warranty In addition to the standard one year of coverage the following support plans are available e Two Year Extension covers second and third years e Call for pricing USA only 266 Contact Us E mail Technical Support support gaumard com E mail Sales and Customer Service sales gaumard com Phone Toll free in the USA 800 882 6655 Worldwide 01 805 971 3790 Fax 805 667 6085 Before contacting Tech Support you must 1 Have the simulator s Serial Number located in the left leg under the IM site 2 Be next to the simulator 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 5 4 Summer Time Gaumard Scientific Company 2012 All rights reserved NOELLE S574 575 576 User Guide Gaumard NOELLE HAL are trademarks of Gaumard Scientific Company Inc Patented Other Patents Pending Always dispose of this product and its components in compliance with local laws and regulations C 267
110. cting a medication from the drug list is not necessary Instead GaumardUl will automatically load the medication s details when the provider injects volume into the simulator s drug recognition arm For information on programming tagged syringes go to page 131 Information on calibrating the drug recognition arm go to page 123 e Software administration Facilitators can administer medications directly from the medication tab by selecting the medication from the Drug list and clicking Administer 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 Dose Naloxone Narcan r ug Y IV Push Onboard Furosemide Lasix Glucagon Glucagen Heparin LMW Enoxaparin Lovenox Heparin UFH overdose Note Dose may be Ibutilide Corvert g Standard Dose Naloxone SD 2mg Inamrinone Isoproterenol Isuprel Labetalol Trandate Normodyne Over Dose Naloxone OD 10mg 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 Retava
111. d June PPH from the scenario tab Runs approximately for 35 40 minutes Shortly following SROM Kelly begins having mild variable decels that are associated with contractions Over the next few minutes variables become more severe Kelly vomits and begins gasping then suddenly becomes unresponsive Decels now have late characteristics She is given SQ Terbutaline and fetal baseline drops to 90 She is intubated and very difficult to ventilate Patient develops VFib and then arrests Baby is removed by emergency C Section Kelly remains on a ventilator Baby is limp and unresponsive and requires resuscitation and suffers repetitive seizure activity Runs for approximately 30 minutes In this scenario patient has an AFE and resuscitation efforts are in vain Fetus is delivered via perimortem C section Runs for approximately 35 minutes Patient starts having contractions and is given SQ Terbutaline to stop contractions She begins to have unfavorable reactions to the drug and contractions break through about 30 minutes later Another dose of Terbutaline is given and her reaction is worse and contractions break through yet again Eventually she s given Procardia which resolves the contractions and does not give adverse reactions 97 NOELLE S574 575 576 User Guide aah Labor Type History Overview Maria is a 30 yr old multip 27 weeks She has an 11 yr old and has been trying for more children She has had 2 Arun for approxima
112. d action key event could either be a facilitators checkmark student interaction or automatically triggered actions Electrical Therapy The key event can be triggered by the electrical therapy applied by the students Configure the electrical therapy linked action menu to automatically trigger a key event or palette progression when electrical therapy is detected The software responds to physical interaction and GaumardUl s software shock panel The settings for each Auto Response configured as a linked action event will override the general settings made in Setup Auto Responses auto prompt off Select from Defibrillation Shock Cardioversion Shock Non Sync Shock or External Pacing Set the parameters for response to either joules or number of shocks using the number fields and radio buttons 60 NOELLE 574 575 576 User Guide Click Add to insert the electrical therapy into the Key Events field and then OK to apply to the path Electrical therapy can be identified by pink text in the node display Edit Path Key events Pacing gt 40 mA Selected Rename Delete Linked Action Defibrillation Shock Joules Shocks Cardioversion Shock Joules Shocks Non Sync Shock H 0 Joules Shocks External Pacing mA Drug Recognition The event is triggered by the administration of a medication using a preprogramed syringe by the facilitator For information on pro
113. d called 911 The aunt told the EMS providers that Eleanor was 8 months pregnant with her first baby and that it was a difficult family situation She added that Eleanor had just moved in with them and had not yet seen a doctor The paramedic reports to the ER physician by radio that the patient is responsive only to pain Her initial blood pressure is 180 120 The EMS crew applies a C collar and move her onto a backboard for transport The para medic initiates ECG monitoring and does a genital exam before they move her She notes a small amount of vaginal bleeding The crew moves her to the ambulance and the paramedic starts an IV of LR and initiates oxygen 10L by non rebreather mask She monitors the ECG and VS dur ing transport and also tilts the backboard about 15 to the left with a blanket roll to decrease vena caval compression Eleanor has no further seizure activity during transport but her BP remains consistently 180 110 The ER notifies L amp D about the patient and asks that an OB nurse come to the ER to assist Overview Runs for approximately 45 minutes Instructor must set up baby for double footling breech delivery To skip resolution of contractions portion of scenario it is suggested that the instructor warp to around 20 minute mark on the timeline Runs for approximately 30 minutes Frank breech position has been confirmed by real time U S Patient refuses Cesarean delivery Pinard maneuver must be utilized
114. d on the Set Medication Identifier dialog box Set Medication Identifier Instructions 1 Place the Syringe perpendicular to the forearm 2 Select a drug from the drop down menu 3 Designate a volume concentration specific for this syringe 4 Click the Add button then wait a couple of seconds while the syringe is being programmed Medication Concentration mg ml Epinephrine Primatene Adrenalin 1mg 1ml Syringe Identifier Add Delete Selected Medication If there is a problem with the programming of the syringe the following error box will be displayed Programming Error The syringe was not programmed correctly Please make sure the syringe is close to the forearm in a perpendicular position and then try again NOELLE S574 575 576 User Guide Click the Retry button until you see the drug listed on the Set Medication Identifier dialog box 11 After the drug is listed on the Set Medication Identifier dialog box identify the syringe with the drug name and concentration using the labels provided Epinephrine 1mg mL Y a 12 Repeat steps 5 10 to program additional syringes CAUTION If you accidentally misplace a syringe you must delete the drug from this list and reprogram a new syringe with this drug and concentration Set Medication Identifier Instructions 1 Place the Syringe perpendicular to the forearm 2 Select a drug from th
115. d template Evaluation Name Vacuum Delivery On Site Reviewer Delete Insert 113 NOELLE 574 575 576 User Guide From the Category menu click Add Evaluation Name Vacuum Delivery On Site Reviewer Category Add Remove insert A W Select the Question with answer region category type and enter the category information title To save the changes click OK Category Options 1 Select Category Type Question with answer region Multiple choice Yes No Multiple choice Disagree Neither Agree or Disagree Agree Multiple choice Unacceptable Poor Average Good Perfect 2 Category Information Problem Description Evaluation Name Vacuum Delivery On Site Reviewer Category add Remove met A V 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 114 NOELLE 574 575 576 User Guide Highlight the Provider tasks and performance category and then click Add from the Multiple Choi
116. day use e Use hard paddles or wet gel pads preferably Avoid using solid gel pads since they present higher risk of burning the simulator s skin e Gel pads have a shelf life Make sure they are not expired to avoid arcing e Make sure the simulator is not in contact with any electrically conductive surfaces e Use the simulator only in a well ventilated area free of all flammable gases NOELLE S574 575 576 User Guide NEVER attempt to service or modify any of the electrical connections especially those between conductive skin sites and the internal electronics Discontinue use if any wires are found exposed with damaged insulation Real medical products especially electrodes sometimes use powerful adhesives that can be difficult to remove A gentle degreasing cleanser may be needed Refer to Care and Cautions for more information Electrode gel on the skin between any two electrode targets can become a pathway for electrical current just as in real life If this occurs NOELLE s skin can be burned Do not allow defibrillation pads to overlap ECG sites Doing so will may damage the simulator and cause arcing Should dark traces appear on the conductive patches due to gel residue or previous arcing use a pencil eraser to remove the traces and then clean with alcohol DO NOT SCRATCH the patches with abrasive objects doing so will cause irreversible damage to the conductive sites and subsequently cause arcing 11
117. de A V GaumardUl 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 Enabling the AV Link displays the following A V menu Click Start AV to enable the Audio Video messages in the log system GaumardUl also permits automatic sending of a Start Record message to the A V Unit Because it is possible to extend a simulation session beyond the last step in a scenario the Stop Recording message does not have an automatically stop option Setup A V Clicking on A V Setup displays the following dialog box This menu permits sending Start and Stop messages to the recorder as well as displaying the connection status In order to set up the connection on the A V System side please consult your A V System s documentation A V Link Information A V Link Information Adapter Local Area Connection Controller IP 192 168 1 159 Connected to 142 Fetal Neo Link Automatic Mode The Fetal Neo Link feature automatically transfers fetal vitals to the Newborn HAL Preemie 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 Newborn HAL Preemie HAL model NOELLE Tablet Enabling the Fetus Neonate Link from the options menu displays the following drop down menu T
118. ditional staffing 00 03 12 Patricia Action Shoulder dystocia 00 03 20 Chris Action Shoulder dystocia Suprapubic pressure 00 03 30 Chris Action Shoulder dystocia McRoberts maneuver 00 03 37 Patricia Action Shoulder dystocia McRoberts maneuver 00 03 52 Patricia Evaluation Care Provided Satisfactory 00 04 02 Chris Action Manage bleeding The Log page consists of four different areas from bottom to top the text log provider action buttons team logging buttons and session info Text Log This is the large panel at the bottom of the Log page containing all of the time stamped text entries Every event that occurs in a session is recorded as an entry in the Text Log The types of entries recorded by the log are categorized as follows Actions Applied Changes Detected Events Evaluations Speech and Notes 00 02 45 Chris Action Call for assistance 00 02 52 Chris Action Call for assistance additional staffing 00 03 12 Patricia Action Shoulder dystocia 00 03 20 Chris Action Shoulder dystocia Suprapubic pressure 00 03 30 Chris Action Shoulder dystocia McRoberts maneuver 00 03 37 Patricia Action Shoulder dystocia McRoberts maneuver 00 03 52 Patricia Evaluation Care Provided Satisfactory 00 04 02 Chris Action Manage bleeding Actions The term actions refers to tasks performed by one or more of the providers on the simulator during the session The facilitat
119. e Cholesterol LDL Cholesterol The lab and file tab allows the facilitator to include previously created lab reports or files These files will be sent automatically to the Gaumard Monitor computer once the playlist reaches the item 44 NOELLE 574 575 576 User Guide After a palette is added you may select it to move it up and down from the list using the arrows You may also edit the transition time insert a new palette remove or duplicate the palette or check the properties using the buttons on the Select Item panel shown in the figure below The buttons found on the top panel can be used to clear any palettes listed on the scenario page load or save a scenario program settings for electrical therapy and switch from linear to branching scenarios Details Palette Lab Scenario Labor Drugs Speech Log Gaumard Clear Load Scenario Save Scenario Scenario Auto Responses Go to Branching Unlike the Non Scenario Auto Responses window described in page 130 setting shock therapy to Auto does not convert the vital signs to a pre selected palette rather it advances the scenario to the next palette item Please note that it will only advance to the next palette if the shock is applied while a wait indefinitely palette is being played The settings on the Scenario Auto Responses are applied for both linear and branching scenarios
120. e Bluetooth r technology in the tablet computer allows wireless printing to compatible printer and quick connections to other devices e Touchscreen virtual vital signs monitor e Optional Streaming audio Simulator e Birth mechanism with cardinal movements e Articulating body NOELLE S574 575 576 User Guide Venous Access Bilateral arm venous network in forearms e Bilateral quadriceps and deltoid intramuscular injection sites Other e One year limited warranty available extended warranty to three years e Installation and training services available e Technical support and onsite repair Terminology Apply In the context of a simulation to apply settings is to send details of the patient s condition to the simulator itself When settings are successfully applied NOELLE s condition should match that shown on the Status panel GaumardUl the Gaumard User Interface software application used to control the simulator and evaluate care providers Facilitator the person conducting the simulation an instructor or lab staff member Palette Item any full or partial set of physiological parameters that have been grouped and saved together under a single name Profile a unique GaumardUl configuration including custom palettes scenarios and options Each profile acts as a separate program whereby changes made to one profile have no effect on the others Provider a person participating in the simulation as
121. e 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 After clicking this menu option the following dialog box is displayed A Are you sure you want to reset the model mw Click yes to proceed with the reset Import between Patients This menu option allows you to import palettes scenarios and branching scenarios from one patient to another To do so select what you will like to import highlight the patient you would like to import items from and then select the specific item and click on import After importing an item it appears under the patient to whom it was imported The following figure illustrates how to import palettes from patient Faye to Alyssa 136 After importing an item it appears under the patient to whom it was imported Auto Log Setting This menu option is used to specify various vitals that you would like to be logged automatically after reaching a specific threshold Auto Log Setting 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 02 changes more than Temperature changes more than Monitors The optional Virtual Signs Monitor computer
122. e Stop Sharing button on the right panel to remove any items on the Gaumard Monitor file list Lab Reports ams DN Template Description create ew tab epo Healthy 2 OB Blood test Healthy Levels View Healthy Neonate Blood test Healthy Levels Sort by Col James Metabolic Panel Session 1 r A Selected Item CBC DIFF High levels Neonate Blood test High levels CBC DIFF Simulation 1 OB Blood test Session 2 PPT Session 2 Lipid Panel Session 4 An editable copy of the lab report is also copied onto the Gaumard_UI folder on the tablets home screen For information on how to access other files from the Gaumard Monitor screen navigate to page 137 42 NOELLE 574 575 576 User Guide Scenarios The most advanced method of controlling the system is to build a Scenario a sequence of Palette Items and delay periods This is done on the third tab page in the main area of the GaumardUI window The best way to think of a scenario is like a playlist of palette items Consistent with this analogy scenario controls at the bottom of the page look and behave just like traditional and software based media players Scenarios let the facilitator automate most of the changes to NOELLE s condition so that their attention can remain on the providers actions The scenario system can also provide standardization of the patient s presentation of symptoms For fair assessment of providers and any research application such sta
123. e Transition Description Becca 2 00 00 Delivery 00 40 instructor to reset birthing motor 02 00 sedate for bimanual exploration Ea remove placental fragments postpartum 51 NOELLE 574 575 576 User Guide Labor scenario Quick Launch To start a labor scenario from the quick start tab first specify the position of the birthing baby on the birthing mechanism by clicking on the corresponding labor position radio button Before using the labor quick launch feature for the first time go to page 154 for important information on preparing NOELLE for delivery Labor Scenario ROA loa aioe After the position is set click on the labor scenario to start o Labor Scenario GaumardUl will automatically start the labor scenario and switch to the labor tab F Only descend duri traction z A a ETS my D Only ee ee Station 10 2 speech 0 speech vitals 1 Check ROT LOT delivery gt Pause Run Reset ROP edit Lo Alyssa Labor Time 00 01 29 y A Sa a al ar al IDESCENE a TAT CUT SHAT SHU ATTA SUT SHAT SHAAN SHAUL Using Factory Preset Scenarios A powerful way to supplement the labor feature is to load factory preset scenarios To locate and load these scenarios follow the steps below 52 NOELLE 574 575 576 User Guide While operating under a Quick Start Profile go to the Scenario tab and Click on Load Scenario Details Palette Scenar
124. e arrives in L amp D complaining of abdomi nal cramps and has bright red vaginal bleeding India is a 19 yr old gravida 2 37 weeks She arrives at hospital with her husband who says she fell down the stairs and she has been cramping and bleeding for about an hour During admitting interview husband answers all the questions and India doesnt make eye contact The nurse palpates uterus initiates fetal monitoring and starts a pad count Inez is a 27 yr old primip 35 weeks She arrives at hospital one evening crying and doubled over in pain She is admitted to a birthing room and the nurse notices bright red blood on Inez s panties She is having very intense and close contrac tions Janie is a 23 yr old G 2 38 weeks She has experienced several bleeding episodes due to a low lying placenta She has been counseled about the potential for postpartum hemorrhage Her religious beliefs prohibit the administration of any blood products Overview Runs for approximately 15 minutes Instructor must set up for partial placenta previa Instructor must fill hemorrhage kit with fluids before running the scenario Runs for 35 45 minutes This scenario utilizes a vaginal delivery even though there is a low lying placenta Instructor has option to run a linear or a branching postpartum section of the scenario Instructor must fill hemorrhage kit with fluids before running the scenario Runs for approximately 25 minutes This scenario is
125. e 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 Smart Scenarios After reading the Details Palette and Scenarios sections of this guide it should be clear how to build a scenario You may have already tried building your own or modifying some of the factory presets The following four guidelines will refine your ability to build the best possible scenarios 1 How will the scenario begin The first thing to consider is the initial condition of the patient Create a Palette Item to describe this condition Make sure that this first step in the scenario is a complete state That is indicate some selection for each and every available setting on the Details page Remember that only the settings you specify will cause a change in NOELLE and all other settings will remain constant So by starting with a complete state NOELLE s condition will always be the same when the scenario starts regardless of what he was doing previously Likewise the transition duration of the first step in the scenario should be zero indicating that changes are applied immediately There is on
126. e decrease the OSat reading on the monitor so that it matches the GaumardUI value then click OK AAN 12 Click Finish Verifying O Sat calibration settings 1 2 Go to the details page and vary the oxygen saturation value on the software Observe that the oximeter reading coincides with the value you specified 3 differences are acceptable on readings above 80 Test calibration at two points values between 80 and 95 are recommended NOELLE S574 575 576 User Guide 4 Now take the oximeter sensor off the finger wait for five seconds and again place the sensor on the finger Make sure to slide the finger all the way into the oximeter sensor and in the same position as it was Calibrated 5 Check that the oximeter reading coincides with the value specified on the Details page 3 value differences are accepted 6 If it does you are ready to use the oxygen saturation feature with this oximeter If the first 3 Insert water in the system until fluids flow through second or both readings do not coincide make the drainage hose into the container The fluid sure to slide the finger all the way into the oximeter drained must flow in a downward direction sensor If the reading still does not coincide the feature was not properly calibrated Go back to WARNING You must always have water in the IV step one and repeat the procedure vasculature for the drug recognition module to work Fo
127. e det ie ea a ce at Tete Ua Lie A eat alah oh vizad E ea its Lala vied at loner 88 EOcKINO Mec aniS Misato a ld Seth eh cen eal cid dee tl 89 Labor ACUM e tl dt ds ads ds lso ito leas 90 Factory Preset Labor cenas ici 91 SPECO ier O 103 Prerecorded Sond Sesine a hahah es uelenet et ot ie alsa le haere ae laa ae EA 103 Streaming Audioi iactory installed os ta a lola 103 BO i chine scale Bn gh ct ti tec nek SE a did hua nc Suna ak ssh Sac te ell Ase eats one eee 105 PA o Senne ene eee eer EA Seater eee ee 105 A A A e nats 106 Team EOC ONG 32 ac cane aoe acdaeseercaros A E N E AS 108 A o A ein nee oeu tad ahi i eerecn unr tied N cues 109 XA oc fae cr ee S ee a ego ee eee eed Se eee ee ee eee 110 Evaluation ON io 110 MENUS rar io td ta da 117 Ple iir A tZ AA IA e a II IA 117 A E eee areas 117 FRESCE A A hehe oat eh des Il NN 117 Save TRC DOM ex sigeecn LO 117 A a a a N T a a a ee nek cen ment eee 118 A ETE A EA ee ge ee A E el ot eer dese clea ets EEEE E E A A A A ATA NA E 118 pd 6 EE E E E A E EE AI id la E E EE E A E E E A E E ote 118 FEM T EAE EAA S OT I E A EEEE eat EE EPE A AEE A E E E i E E 118 OO ea a a A tet weeds 119 Calbi UO ee eaten e al los ad meine i ey en unui ae 119 POMS eee E team e hese oul Ma ube uhedie et elu Nat Mee utah hse 125 Remote ACCESS Via INGIWOIK noise actas colones 129 AMO ES SES a a ue ee canes 130 A e Ce a a a a a 131 SA e 134 Moelo AUIOMANC MOS O ld til 135 Uco e ere ea ae a A iaae Ee aE Eaa 135 Reser Model a
128. e drop down menu 3 Designate a volume concentration specific for this syringe 4 Click the Add button then wait a couple of seconds while the syringe is being programmed Medication Concentration mg ml Epinephrine Primatene Adrenalin 1mg 1ml 1mg 1ml 1mg 1ml Syringe Identifier 2mg 1ml 1mg 1ml PA Ready Add Delete Selected Medication 133 NOELLE S574 575 576 User Guide 13 You may delete a drug ID at any time First highlight the desired drug This enables the Delete Selected Medication button Click on this button to remove the drug from the list Set Medication Identifier Instructions 1 Place the Syringe perpendicular to the forearm 2 Select a drug from the drop down menu 3 Designate a volume concentration specific for this syringe 4 Click the Add button then wait a couple of seconds while the syringe is being programmed Medication Concentration mg ml 1mg 1ml 1mg 1ml 1mg 1ml 2mg 1ml 1mg iml Syringe Identifier Ready Add Scan RF Channels 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 Communication info When the scan is complete a series of bars will display with the highest bar indicating the best signal On mouseover a popup will di
129. e fundus page anesthesia for stat sedation bimanual exploration and massage Increase Pitocin give Methergine straight cath administer Cytotec rectally Transition time 3 min Discontinue massage as the uterus bagins to firm up following Cytotec dosing NOELLE S574 575 576 User Guide Gaumard Simulators for Health Care Education Noelle S574 575 Labor Scenario Kelly Amniotic Fluid Embolism Automatic Mode 35 40 minutes Kelly is a 34 yr old gravida 5 2 38 weeks She is scheduled for induction as her last baby weighed almost 10lbs and she experienced a severe shoulder dystocia with that delivery She has gained 43lbs with this pregnancy and her GTT is borderline Labor duration 25 minutes Scenario duration S amp S sudden onset of pain following ROM asks for epidural S amp S Patient says she is having trouble breathing vomits suddenly becomes non responsive RS 3 Rush to OR for emergency c section Intubate ventilate stat page anesthesia and NICU personnel Turn patient LLP to resolve variables put O2 mask on patient discontinue Pitocin Give SQ Terbutaline to reduce COG 235 NOELLE S574 575 576 User Guide 236 Gaumard Simulators for Health Care Educatior
130. e monitor for maternal vitals and fetal traces When you enable this checkbox the Maternal Vitals Fetal Monitor control is shown in the GUI These controls enable you to change the display on the vital signs monitor mv FM Mute Listen Tak Gaumard Legend Oo or Select FM to display the fetal monitor and MV for maternal vitals You can also have both screens auto change from one to the other To do so select the box labeled auto flip and specify how often you will like the switch to take place Remote Access via Network The Remote Access Via Network option is used as an alternate configuration of the RF module to simulator wireless connection When the feature is enabled NOELLE will receive the control commands from the Virtual monitor computer normally stationed at the bedside via the USB RF module This alternate configuration is recommended only for environments with many walls between the Simulator and the controlling PC Options Remote Access Via Network Auto Responses Set Med ID Scan RF Channels NOELLE S574 575 576 User Guide Configuration To use this alternate configuration please 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 Exit the GaumardUl software and disconnect the RF module from the tablet WARNING
131. e number of desired compressions per minute e Specify the compression ventilation ratio e Select number of ventilations per minute if the Only Ventilations button is selected Options Pacing Reporting Heart Rate Change Current Change Shock Threshold Detect Shock Threshold Tolerances This tab is used to select the tolerance and intensity of both chest compressions and ventilations At the bottom of the tab you can find controls related to pupil sensitivity Options CPR Intensity Tolerances Artificial ventilation intensity evaluation tolerance SS 10 Chest compression intensity evaluation tolerance SS gt 10 CPR Rate Tolerances Artificial ventilation rate evaluation tolerance J 10 Chest compression rate evaluation tolerance Pupil Sensitivity ean ED Set Dilation L Reset to ES _ n 128 If the Blinking eyes kit is installed the Pupil Sensitivity section is displayed You can use these controls to calibrate the pupil sensitivity The five buttons are described below e Set to Ambient Light If the pupils are constantly closing with the current ambient light you can disable the pupil reactivity and open the pupils to the desired diameter Use the Set to Ambient Light button to recalibrate the sensitivity to the current environment and then enable the reactivity on each pupil e Set Dilation Light The pupils should react to low ambient light by
132. e point that can cause confusion and warrants further explanation It is an extension of the above discussion of partial states The issue is best illustrated through the following example Suppose that you are creating a Palette Item to start your scenario In this case you have decided that the patient will be apneic The question is How should the lung sounds be set Most people s first inclination is to set the lung sounds to none This is incorrect despite apnea Obviously no lung sounds should be heard during apnea but since you have already set respiratory rate to zero none will be Sounds are synchronized to the breathing cycle What you are really setting here when you choose a lung sound is the condition of the lungs given respiratory drive That is if the patient s respiratory rate were changed from zero what sound would be heard Assuming that the lungs themselves are normal in this scenario you would choose normal for the lung sound setting Then as the scenario progresses if the patient starts breathing there will be no need to set the lung sound again It will already be set The same principle applies to the heart 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 ot
133. e post partum scenario upon delivery of the fetus and completion of the labor scenario To view the Stage information while a labor is in progress click on the label for the corresponding labor stage Refer to page 168 for more information 78 NOELLE 574 575 576 User Guide Load Labor To load a labor scenario click the Load Labor button on the Labor tab and the Load screen will open Labor Control OFF Station Q E Enable Smart Labor fio sec El C Descend only with contractions 2 Pause Run Reset All the previously saved files will appear on the left hand side text box A single click over a name displays the patient information for that labor scenario To see the details for each stage select each tab on the right hand side individually la Load Labor Scenario Patient Information Alice is a 24 year old female weighing 170 S1 gt Latent 51 Actve S1 Transition Stage 2 stages 11 05 2010 15 02 12 11 05 2010 15 02 12 11 05 2010 15 02 12 11 05 2010 15 02 12 11 05 2010 15 02 12 11 05 2010 15 02 12 11 05 2010 15 02 14 11 05 2010 15 02 14 11 05 2010 15 02 14 11 05 2010 15 02 14 11 05 2010 15 02 14 pounds W Gain NA Her significant other is Mike Her OB history shows a gravida of 2 a term of 1 a preterm of 0 and that she is currently 39 weeks pregnant she has had 0 spontaneous abortions 0 elective abortions and 1 living children She has had prenatal
134. e 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 A Nal N interact pply Naloxone Narcan ma lt a AE a Dose 2 mg Attime Captopril Capoten on Apply Captopril Capoten Dose 2 mg Attime 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 OF Apply Captopril Capoten Dose E mg Attime OS Lastly enter the time of administration for each drug and click Update Graph Test Panel Test object weight 75 kg Time Effect Graph Apply Naloxone Narcan interaction Dose 2 mg Attime 9 Apply Captopril Capoten Dose 25 mg Attime 9 Results At time 01 27 03 Max Interaction Effect 93 38 Alpha 1 01 Compared to Additive individual drug effect reduced by 0 08 Time min 5 o ii 74 NOELLE S574 575 576 User Guide 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 Attime 01 27 03 Max Interaction
135. e unless you wish to change the drug and concentration associated with it Follow the instructions below to program the syringes WARNING The simulator must be powered on when working with the drug recognition arm This includes calibration purging draining IV infusion Set Med Id and injecting fluids Failure to do so will permanently damage the simulator and void the warranty 1 Set the GaumardUl operating mode to Automatic 2 From the Setup menu click on Set Med ID 3 The Set Medication Identifier dialog box is displayed This dialog box is used to program each of the syringes provided with a specific drug and concentration Set Medication Identifier Instructions 1 Place the Syringe perpendicular to the forearm 2 Select a drug from the drop down menu 3 Designate a volume concentration specific for this syringe 4 Click the Add button then wait a couple of seconds while the syringe is being programmed Medication Concentration mg ml Syringe Identifier Place syringe perpendicular to the forearm Add Delete Selected Medication 131 NOELLE S574 575 576 User Guide 4 Rotate the lower right arm so the palm of the hand is facing up 5 Place the syringe holder on the simulator s right wrist as shown below 6 Place the syringe without the needle on the holder The syringe must be perpendicular to the surface of the forearm as shown in the figure
136. eave them on for next day use e Use hard paddles or wet gel pads preferably Avoid using solid gel pads since they present higher risk of burning the simulator s skin e Gel pads have a shelf life Make sure they are not expired to avoid arcing e Make sure the simulator is not in contact with any electrically conductive surfaces e Use the simulator only in a well ventilated area free of all flammable gases NOELLE S574 575 576 User Guide e NEVER attempt to service or modify any of the electrical connections especially those between conductive skin sites and the internal electronics Discontinue use if any wires are found exposed with damaged insulation e Real medical products especially electrodes sometimes use powerful adhesives that can be difficult to remove A gentle degreasing cleanser may be needed Refer to Care and Cautions for more information e Electrode gel on the skin between any two electrode targets can become a pathway for electrical current just as in real life If this occurs NOELLE s skin can be burned e Do not allow defibrillation pads to overlap ECG sites Doing so will may damage the simulator and cause arcing e Should dark traces appear on the conductive patches due to gel residue or previous arcing use a pencil eraser to remove the traces and then clean with alcohol e DO NOT SCRATCH the patches with abrasive objects doing so will cause irreversible damage to the conductive sites a
137. ec z E Only descend during contractions On the Load Labor Scenario window select the Alice labor from and click Load 11 05 2010 16 02 12 11 05 2010 16 02 12 11 05 2010 16 02 12 11 05 2010 16 02 12 Starting the Labor The labor process is started from the labor control panel Increase the Warp Factor to simulate a 30 minute labor in a fraction of the time WARNING Always place the tummy cover on the birthing cavity prior to starting the labor mechanism Click the Run to begin the labor process Details Palette Scenario Labor Lab eed Load Labor n E Labor duration Labor Control Dystocia Contraction Enable Smart Labor 10 sed z ON OFF E Enable Co E Only descend during contractions Pause Run Reset Save Labor Station 4 speech 156 The labor mechanism will descend as indicated by the green vertical progress bar and descent curve 4 Jar LR TO LL PL LL O edk UEA Y 1 i 1 speed i Pause 2 Run Reset E Alice 60 60 100 120 140 160 During delivery fetal heart tones can be heard by placing the bell of a conventional stethoscope on the abdomen Move it around until the tones are clearly heard Tones are supplied via a small speaker located in the fetus Completing a Delivery The first few centimeters of movement normally take about half the total delivery time The baby rotates internally as it moves forward after the head
138. ected by serial number on the Setup gt Options gt Environment FIXED field to access the more button Streaming Voice Control window Streaming Voice Controls This button opens a new dialog box that is available to the user at all times Selections on that dialog box include Mute Listen and Talk Select Mute to stop the communication Listen to hear what providers are saying or Talk to speak to the providers as the simulator s voice Prerecorded Speech My head hurts My name is Mute Listen and Talk controls are always available on the top right corner of the user interface Streaming Voice Output Gain O Mute Listen O Talk Push toTalk E Voice Activation Headset Required Gaumard Voice Recorder ES Stop It is recommended that the instructor uses a headset to improve sound quality The headset also allows the user to use the Voice Activation so that at any time the instructor wishes to speak it is sent directly to the simulator without user intervention The voice activation threshold can be adjusted The Mic Threshold is used to adjust how sensitive the microphone is to the user s voice The higher the threshold the less sensitive the microphone is and vice versa For instance if the threshold is set to high users must speak loudly for the microphone to detect the audio 103 NOELLE S574 575 576 User Guide Voice Clarity
139. ed While calibrating wait 5 10 seconds for values to stabilize on the oximeter Then click next to calibrate the next value If simulator is equipped with bilateral O2Sat arms select the left arm from the calibration menu and place the oximeter on the left finger Program syringe as per manual s instructions This could happen when injecting the cephalic vein close to the hand and having the syringe sideways to the plane of the forearm 245 NOELLE S574 575 576 User Guide Drug amount Wrong calibration Calibrate the drug arm as per calibration instructions registered is not correct Injecting too fast Maximum injection rate is 9999 ml hr This rate won t be exceeded when injecting into the veins using a 22 g needle Not reading the syringe ID If RFID tag on syringe is not read the system tends to read fewer amounts than actually injected This could happen when infusing the drug thru the side port on the arm When doing so place a tagged syringe on the syringe holder See troubleshooting section Drug ID is not being read too Fluid reservoir is full The maximum amount of fluid injected properly read before purging the internal reservoir is 50 cc Make sure to purge the reservoir or permanently connect a purging line see instructions 246 NOELLE 574 575 576 User Guide Diagnostics The Diagnostics window can be accessed by going to the Help menu and selecting Diagnostics This window Is very usefu
140. ed and the presenting part lifted off the cord to relieve pressure from the cord This procedure must be maintained until the prolapse has been resolved either by termination of the compression of the cord or until delivery of the fetus by C section Placenta Previa Placenta previa is a condition in which the placenta is in the lower half of the uterus located near to or covering the cervical os There are three types of placenta previa Total partial and marginal e Total placenta previa is when the placenta completely covers the cervical os e Partial placenta previa is when the cervical os is partially covered by the placenta e Marginal placenta previa is when the edge of the placenta extends to the internal os where the uterus opens into the vaginal canal To simulate placenta previa with NOELLE place the placenta in the desired position to simulate the condition with the maternal side against the uterine wall or the cervical os Then position the fetus within the uterine cavity with the presenting part closest to the placenta External Version Version may be attempted by the care provider to rotate the fetus from a breech position into one permitting normal vertex presentation To practice version remove the abdominal cover and the fetus retract the delivery mechanism fully and insert the inflatable cushion Thoroughly lubricate the inside surface of the abdominal cover the fetus and the inflatable cushion
141. ed the tube through hole 7 as shown below 25 26 27 Place a black ring on the end of the tube and connect the tube to the white port in hole 8 Place a black ring on the other end of the tube and connect it to the white connector in hole 1 Push the white connectors down to make sure they are flushed with the holes as shown in the picture below Put a small piece of tape to hold the vein in place in the segments from holes 1 to 2 and holes 7 to 8 NOELLE S574 575 576 User Guide 28 Insert foam inside the hand 32 Pull the skin all the way up 29 Heat the skin 30 Apply small amounts of silicone oil on the forearm to aid the skin placement 31 Place the skin over the hand Stop half way and insert the foam covering the IV fill and drainage ports 265 NOELLE S574 575 576 User Guide Warranty EXCLUSIVE ONE YEAR LIMITED WARRANTY Gaumard warrants that if the accompanying Gaumard product proves to be defective in material or workmanship within one year from the date on which the product is shipped from Gaumard to the customer Gaumard will at Gaumard s option repair or replace the Gaumard product This limited warranty covers all defects in material and workmanship in the Gaumard product except 1 Damage resulting from accident misuse abuse neglect or unintended use of the Gaumard product 2 Damage resulting from failure to properly maintain the Gaumard product in accordance
142. een inconsistent with appointments at the teen clinic due to transportation issues Candice is a 19 year old multip She and her boyfriend and 3 year old daughter are homeless and currently living in a car She has not seen a doctor but believes that she is about 8 months pregnant Charlotte is a 31 year old gravida 3 1 at 41 5 7 weeks Her physician stripped her membranes yesterday and she began contracting during the night She is admitted in active labor NOELLE S574 575 576 User Guide Overview Runs for approximately 30 minutes Simulates 8 hour labor without complications resulting in SVD over intact perineum Baby is vigorous and earns good APGARS Runs for approximately 30 minutes Simulates normal labor and delivery of grand multip resulting in shorter labor duration Runs for approximately 18 22 minutes Following ROM nurse must support fetal head to prevent explosive delivery Patient has retained secundes therefore bimanual exam is required Safety Note Instructor is required to reset motor before allowing learner to perform bimanual exam Runs for approximately 30 minutes La3 25 Note To run full scenario load Bianca at Admit from scenario tab Instructor has to set up fetus with Nuchal chord prior to running scenario Full scenario runs for approximately 23 25 minutes Dystocia drill runs for 15 min Labor progresses normally for about 6 hours but after 45 minutes of pushing patient is unable to bri
143. eference CPR rate CPR Options By default the trainer is configured to blink the reference borders at a 30 2 compression to ventilation ratio To change the ratio navigate to the menu bar and click the CPR dropdown and CPR Options Options Hal Add Ons Add Ons a CPR Options Pacing Shock Tolerances Log ventilations and Compressions Environment General 100 Compressions per minute Compression Ventilation Ratio 30 2 Only Ventilations 12 Ventilations per minute Performance Examples Compressions are too shallow Waveforms mostly do not reach the green zone Compression indicator is yellow Compressions are too deep Waveforms mostly exceed the green zone Compression indicator is red Compressions are performed correctly Waveform peaks are mostly inside the green zone NOELLE S574 575 576 User Guide Ventilations are too shallow Waveform peaks do not reach the green zone WP Ventilations are too strong Waveform peaks exceed the green zone Ventilation was performed correctly Waveform peak is inside the green zone Options Navigate to CPR gt Options to modify the ventilation and compression ratio Options Environment General Moelle Features Ventilations and Compressions Compressions per minute Compression Ventilation Ratio Only Ventilations Ventilations per minute 141 NOELLE S574 575 576 User Gui
144. egrees corresponds to the fetus facing upwards with the shoulders horizontal Export Data to Desktop exports labor force data to an Excel file Use the data to make graphs to study trends and performance patterns Slider The slider at the bottom of this screen lets you rewind the strip to see the previous graph data Activity on fetus Activity sta rted 00 22 26 Export Data to Desktop 90 NOELLE S574 575 576 User Guide Factory Preset Labor Scenarios NOELLE has a total of thirty six factory preset labor scenarios which were designed in conjunction with healthcare professionals The scenarios are divided into two separate profiles Below is information on the scenarios available under the Manual Mode and Automatic Mode Manual Mode Below follows a brief overview of these scenarios For more details refer to the Appendix Quick Start Scenarios Scenario Name Labor Type History Overview Alice is a 24 year old gravida 2 1 at 39 weeks She weighs 170 pounds Runs for 30 minutes Labor progresses normally Alice Normal She has had prenatal care She has and fetal heart tones remain within normal limits not been using medications of any The normal male infant earns good APGAR scores kind Alicia is a 24 year old gravida 2 1 at anais m 39 weeks She weighs 160 pounds Runs for 20 minutes Labor progresses normally Alicia Neima She has had prenatal care She has and fetal heart tone
145. ements 195 NOELLE S574 575 576 User Guide Noelle S574 575 Labor Scenario Gaumard Frances Simulators for Health Care Education Prolapsed Cord Frances is admitted into a small town hospital due to regular contractions 4 minutes apart and bloody show She labors without problems for about 4 hours and then the fetus starts to brady down after SROM A V E reveals a prolapsed coed in the vagina Labor duration 20 minutes Scenario duration 22 27 minutes 196 NOELLE 574 575 576 User Guide A Gaumard Simulators for Health Care Education Noelle S574 575 Labor Scenario Frances Prolapsed Cord Perform c section delivery infant repair incision Wait indefinitely 197 NOELLE S574 575 576 User Guide Gaumard Simulators for Health Care Education Noelle S574 575 Labor Scenario Gabriella Uterine Rupture 25 minutes Gabriella is a young Hispanic woman who presents at a small hospital just across the Mexican border She appears to be in late pregnancy and in active labor As the nurse helps her to bed she notices a midline abdominal scar Gabriella has had one prvious child in Mexico but shares no more information Labor duration 15 minutes Scenario duration S amp S Patient feels pain with ctx Sy 198 S amp S Vaginal bleeding ext
146. empt to intubate without lubricating the airway adjunct with silicone lubricant provided Failure to do so will make intubation very difficult and is likely to result in damage When simulating drug administration via endotracheal tube providers must use an empty syringe Passing liquids into the trachea or esophagus may cause internal damage Talcum powder should be used sparingly on top of the lungs and ribs to eliminate any noise caused by rubbing of internal parts during breathing Mouth to mouth resuscitation without a barrier device is not recommended as it will contaminate the airway Treat NOELLE with the same precautions that would be used with a real patient Always adjust the motor arm prior to every delivery to prevent the power cable from wrapping around the mechanism Revision 1 motor Always keep clear of the birthing mechanism while the system is on Do not operate the birthing mechanism without the tummy cover in place IV arm Vein tubing contains latex which may cause allergic reactions Users allergic or sensitive to latex should avoid contact Discontinue use of this product and seek medical attention if an allergic reaction occurs Only use Gaumard s provided simulated blood Any other simulated blood containing sugar or any additive may cause blockage and or interruption of the vasculature system The use of needles larger than 22 gauge will reduce the lifetime of the lower arms skin and veins
147. en baby is pulled with more than 35 Ibs of force to avoid damage the baby is released If user is not pulling the baby it means that Force Sensor is offset See the Calibration Wizard section inside User s Manual and reset the force sensor to its default value Reset to Default Force button Try manual Release from button located on the left hand site corner under Delivery tab If baby releases then calibrate Force Sensor See the Calibration Wizard section inside User s Manual and reset the force sensor to its default value Reset to Default Force button When Dystocia On button is checked the baby is not released until checking Dystocia Off Reset the delivery motor by going to Setup Options menu NOELLE Features tab and then click on Labor Motor under Reset tab If delivery mechanism is at the very beginning in a way that it is compressing the rubber boots the grinding noise won t go away for a minute or so Should that be the case either let it go it won t break or simply move motor forward a few turns and then reset Loss of brachial pulse Brachial pulses disabled Make sure to enable brachial pulse on Details tab page Wrong reading of corresponding BP sensor Reporting Intubation when it is not Wrong sensor reading Pre built scenarios do cannot be loaded 244 Brachial pulse is cut off when BP cuff is above Systolic If
148. en 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 indicator to the next item on the scenario regardless if the scenario is playing paused or stopped It can also be used to move the indicator to select an item before playing it Similar to the Next button the Previous button returns the indicator to the previous item in the scenario The Reset button stops the scenario immediately and returns the indicator to the first item in the scenario 47 NOELLE S574 575 576 User Guide Factory Preset Scenarios The following tables provide a brief description on the labor scenarios available under manual mode and automatic mode Manual Mode The scenarios in the manual mode are found in the NOELLE Advanced Fourteen scenarios are linear and one is branching Linear Becca Sedation Becca Variations on Becca delivered precipitously and has Normal retained secundines Bianca at Admit Bianca Variations on Bianca is 16 yr old gravida 2 1 38 weeks Normal She presents in active labor and is admit
149. ent or provider close one of the parameters currently displayed by the virtual monitor by clicking on the button of the value to be removed and selecting Close Now the new custom number has a display slot Click on the button and select Other Choose the value to display Time Glucose Do the same for as many new values as preferred for display The figure below shows three new values Glucose level hematocrit and TSH levels along the bottom of the display come mesias Hematocrit i Glucose E Hematocrit 32 ALL Glucose lez mg dl NOELLE S574 575 576 User Guide Save any list of added custom numbers by clicking on the Save button After clicking this button the Save As window is displayed Save As _ _ OU i profiles Custom Numbers v 4 Search Custom Numbers p Organize v New folder o gt Name Date modified Type No items match your search A Libraries 22 Homegroup E Computer Cu Network File name Glucose Hematocrit y Save as type Custom Scalars files csc y Hide Folders Cancel Type a file name and click Save You can load any of the pre saved combination of custom numbers by clicking on the Load button Configuration The configuration button is used to properly connect the virtual monitor to the tablet Clicking on it displays the following dialog box
150. er 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 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
151. es 50 of the maximum effect Description Treats cardiac arrest and other cardiac a Available Palettes y Apply Items Threshold ug dysrhythmias and severe hypotension Common drug Epinephrine SD 1000 E OD Over Dose Epineciai Properties Properties Edit Unit pote Drug Effect Tester Mug E ug kg Wi mg El mg kg Og Test object weight 75 00 Update Graph ute Y IV Push IV Infusion E IM ia E Topical Per Oral 7 Inhalation Half Life hr min sec Precise OF 28 08 Approximate very quick lt 5m Peak Time hr min sec 0 Precise of of 306 Approximate very quick lt 5m 67 NOELLE 574 575 576 User Guide Adding New Drugs 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 24 tte Scenario Lab Drugs Speech Log M Naloxone SD OO modelon Cardiac Right Heart Chambers Left Heart Chambers Regurgitation Tricuspid Pulmonary Regurgitation Mitral Aortic Resistance BA BA Resistance la Contractility pa Contract
152. esarian from the scenario tab Full scenario runs approximately for 22 25 minutes PPH runs for 8 10 minutes Labor and delivery progress uneventfully Heavy bleeding begins immediately upon delivery of placenta Uterus remains atonic despite fundal massage and rapid pitosin infusion Patients BP drops to 80 50 and uterus begins to clamp down following Cytotec rectal insertion Note Running full scenario requires retraction of motor mechanism and insertion of PPH kit following delivery To run PPH only load June PPH from the scenario tab Runs approximately for 35 40 minutes Shortly following SROM Kelly begins having mild variable decels that are associated with contractions Over the next few minutes variables become more severe Kelly vomits and begins gasping then suddenly becomes unresponsive Decels now have late characteristics She is given SQ Terbutaline and fetal baseline drops to 90 She is intubated and very difficult to ventilate Patient develops VFib and then arrests Baby is removed by emergency C Section Kelly remains on a ventilator Baby is limp and unresponsive and requires resuscitation and suffers repetitive seizure activity Select Kelly Resuscitation from the scenario tab to run resuscitation drill only 101 NOELLE S574 575 576 User Guide Patient Name Labor Type History Overview Madonna is a 41 year old multip 31 weeks She has experienced difficult pregnancies in the past and has one Do
153. ess automatically Use the following IP address IP address Obtain an IP address automatically Subnet mask Default gateway Example of IP addresses that will NOT communicate with each other Computer 1 1 0 10 1 Computer 1 50 0 10 1 Computer 1 10 10 10 1 11 Click OK in the Internet Protocol dialog box to save the address settings Then click Close on the Wireless Network Connection Properties to save all the changes C Obtain ONS server address automatically Use the following DNS server addresses Prefered DNS server Virtual Monitors 1 0 0 3 Virtual Monitors 1 0 10 3 Virtual Monitors 10 10 10 1 Altemate DNS server 9 Configure both computers with static IP addresses and subnet mask following the addressing 12 Restart both computers UT below On startup both computers will automatically Computer IP address Subnet Mask connect to each other via ad hoc Continue to page Tablet 1 252 to establishing a connection between 10 0 0 1 255 0 0 0 GaumardUl and the Virtual Monitor software NOELLE Haaa 10 0 0 3 255 0 0 0 ewborn Virtual Monitor 10 0 0 3 255 0 0 0 10 Click once in the subnet mask field to auto populate the correct address Leave all other fields blank and click OK to save the changes Each computer must be configured with the same first three IP address octets and only differ on the last The subnet mask value is the same on all computers NOELLE
154. f the log displays incorrect intubation readings Prior to performing a calibration ensure that the airway is clear of tubing or obstructions Pulse Strength Configure the pulse strength or reset to default Increase or decrease the intensity of the pulse for a healthy patient Normal sinus rhythm BP 120 80 Labor force display Set the threshold for the labor force display To read more about the labor force display go to page 90 NOELLE Kits Use hemorrhage kit if factory installed Check this box to use this option if your NOELLE is equipped with the hemorrhage kit Use Blinking eyes kit if factory installed Check this box to use the active eyes feature and to display the blinking control on the details page Fetal Monitor paper Speed Use this feature to adjust the speed of the fetal monitor paper on the FHR monitor screen NOELLE S574 575 576 User Guide Pacing When NOELLE is being paced the pacers oscillate by a minimum fraction both on the heart rate and the current This oscillation can make the software fire an event each time these small changes are captured In this tab you can set a threshold for each parameter so that only changes greater than these settings will be taken into account by the software Options Pacing Reporting Heart Rate Change Current 6 mA Change Shock Threshold 127 NOELLE S574 575 576 User Guide CPR Options In this tab you can e Select th
155. fforts continue A soft skin scalp cover for the articulating baby is provided for vacuum assisted deliveries WARNING The soft skin scalp cover is meant to be used during the process of a vacuum delivery and not resting against the cervix during non simulation times If pressure is left on the cervix from the scalp cover for lengthy times both pieces will be damaged 157 NOELLE S574 575 576 User Guide Vacuum assisted delivery may be practiced with the NOELLE simulator using a vacuum cup available from a number of suppliers Vacuum assist device attaches to fetal scalp between fontanelles Await the next contraction that may be simulated by asking NOELLE to bear down and have the student apply steady traction perpendicular to the plane of the cup Some vacuum assisted delivery devices are equipped with a means for measuring the amount of traction which may be on the order of about fifteen pounds The software will also give the instructor a graph that indicates applied force as the delivery mechanism is equipped with a strain gauge The student must stop traction when the simulated contraction ceases Repeat this procedure of waiting for the simulated contraction and providing traction during the contraction if and only if the fetus is moving down the birth canal with each contraction Leopold Maneuver To perform Leopold Maneuvers retract the birthing mechanism fully and remove the articulating birthing baby Pla
156. fill and drain connections on a drug recognition arm will damage the system and void the warranty A drug recognition capable arm can be identified by the black drainage port located on the right forearm 1 Power on the simulator by starting the GUI software on the tablet Select NOELLE from the menu and click start 2 Locate the IV Filling kit which contains Drainage tube with black tip filling tube with white tip and syringe 3 Attach the drain tube to the black output port and place the end of the drain hose inside a container CAUTION The location of the container must be lower than the arm in order to siphon the fluids in the next step NOELLE S574 575 576 User Guide 4 Next attach the fill syringe with clean water to the white port 5 Insert water in the system until fluids flow through the drainage tube into the container You may remove the drain tube and the fill syringe The fluid drained must flow in a downward direction WARNING You must have water in the IV vasculature for the drug recognition module to work Failure to do so will damage the module and void the warranty 6 Check which drugs have been programmed to a syringe by clicking on Setup then Set Med ID The Set Medication Identifier is displayed Set Medication Identifier Instructions 1 Place the Syringe perpendicular to the forearm 2 Select a drug from the drop down menu 3 Desi
157. fill kit syringes WARNING Only use Gaumard provided simulated blood Any other simulated blood brand containing sugar or any additive may cause blockage and or interruption of the vasculature system At the end of every simulation always flush the system with distilled water to prevent clogging To prevent staining or molding always clean NOELLE using diluted soap and water Remove the birth canal and clean thoroughly Enabling post partum hemorrhage To manually enable the PPH feature first click the hemorrhage icon blue to set the control to active Then click the apply NOW button to start the hemorrhage 166 Other Temperature C Seizures IN Hemorrioge Uterine Pres AP NOW 10sec 30sec To stop the hemorrhage click the control icon to black and then click apply NOW If the hemorrhage control is not shown navigate to Setup gt Options gt NOELLE Features and checkmark Use Hemorrhage Kit Vital Signs Monitor The vital signs monitor simulates a vital signs monitor attached to the simulated patient The vital signs are synchronized through a wireless network between the facilitator s tablet and the computer running the monitor You can customize each trace independently of each other users can set alarms time scales boundaries and grid options 09 57 47 Turn On FHR Beep For information on how to setup Gaumard Monitors with GUI please refer to the Appendix NOELLE S574
158. gnate a volume concentration specific for this syringe 4 Click the Add button then wait a couple of seconds while the syringe is being programmed Concentration mg ml Syringe Identifier Ready Add Delete Selected Medication 151 NOELLE S574 575 576 User Guide If none of the drugs required display on this list go to page 131 to set up the syringes Otherwise exit out of the Set Medication Identifier dialog box and proceed to the next step 7 Prepare the desired syringe for use by filling with water or simulated blood WARNING Use only Gaumard s provided simulated blood Any other simulated blood brand containing sugar or any additive may cause blockage and or interruption of the vasculature system 8 Using the desired syringe inject one of the veins posterior to the hand or one of the veins anterior to the arm in the forearm For IV infusion exercises make sure to place a tagged syringe on top of the arm The tagged syringe must be close to the arm for the drug recognition module to function properly WARNING Maximum amount of fluid injected without draining should not exceed 40 mL and the maximum injection rate is 9999 mL hr The software automatically recognizes the drug administered and calculates the dosage given and the current concentration of the drug in the simulator This information is shown on the Drug page Details Palette Lab Drugs Scenario Speech Log RFID Detected
159. gramming a syringe navigate to page 131 Edit Path Key events Selectec Epinephrine Primatene Adrenali elected Rename Delete AAA 9 Linked Action Medication Dose threshold mg Epinephrine Primatene A v 1 Go to o cancel 61 NOELLE 574 575 576 User Guide Model Medication Automatic Mode The key event applies a medication palette to the model Select the medication dose and route and then assign a Go To point from the drop down list Medications activated by this key event can be monitored through the drug tab Edit Path Key events Aspirin Bayer SD Per Oral Rename Delete 9 Linked Action Electrical Therapy Drug Recognition Model Medication Medication Dose Route Rate ncn gt SD PerOral medium id Go to A Node 1 of a Cardiac Arrest branching scenario with Model Medication and Electrical Therapy paths added 1 Initial assessment A 02 00 E gt 2 gt VFib 1 00 00 vV fib El Effective shock delivered el ca E gt 3 en E Adenosine SD IV Push lz EJ _ Additem AddScenaro E Copy Remove Addpath E q El o E gt End Path Controls Oe vv E Once a path is opened for any node you can edit copy or delete the path using the buttons below Edit This button allows you to add remove or change the order of actions in a specific path Clicking on
160. gress This type of auto response is referred to as a Non Scenario Automatic Responses Non scenario automaticresponses settings allot a o Display warning when non shockable All Auto cardiac rhythm is shocked External Pacing Defibrillation Shock Cardioversion Shock Non Sync Shock O off EA O off ee O off O off Prompt O Prompt pt O Prompt poe Prompt eN NO AS O Auto 4 Auto S3 Auto SSS Auto Setting Setting Setting Setting Capture at als aE at a 200 O Joules 100 Joules 100 Joules 40 mA O Shocks 100 3 O Shocks O Shocks convert to NSR convert to NSR degrade to 75 bpm BP 75 bpm BP ventricular A 120 80 120 80 fibrilation These three states are defined below e Off The software does not respond to the electric therapy e Prompt The software detects the electrical therapy and prompts the user if they would want to change the simulator s vitals to some preset healthy vitals e Auto The software automatically detects the electrical therapy and compares it to a threshold selected by the provider and once this threshold is accomplished the vitals automatically change to a healthy vital state 130 Click on the palette button to program a specific palette to be applied after the electrical therapy Defibrillation Shock Prompt oS he SS 3 Auto Setting si convert to NSR
161. he buttons on the top panel can be used to clear load and save a scenario or to switch from branching to linear scenarios 00 00 RR 10 HR 45 2nd deg AVB 00 01 complaint Feel dizzy S copy Remove ac Node Description 02 00 No changes are made to manikin O Atropine 00 01 confusion a El 01 00 HR 15 BP 10 OSat 5 gt 4 E Epinephrine 03 5 ea E Dopamine I ico En gt 6 Eee pene y Addnode OU E Go to the linear scenario page by clicking on the Go to Normal Scenario button Adding Nodes A branching scenario will consist of several Nodes added by the facilitator Each node is preconfigured to run a normal scenario or a series of palettes The facilitator will then activate key events that will alter the trajectory of the nodes To add a node click Add node near the bottom of the page Addnode AA 57 NOELLE 574 575 576 User Guide To edit the node name and description click the node s Unique Identifier number Click Save to apply changes Node Properties Unique Identifier ji Description In this example the following nodes will be created 1 Start Bradycardia 2 Deteriorate 3 Interventions 4 Atropine 5 Epinephrine 6 Dopamine and 8 Pace Each node has been programmed with specific palettes Adding Palettes or Scenarios Each node is configured with a set of palettes or scenarios Start Bradycardia i
162. he computer will only try to connect to registered ad hoc connections Click Close Networks to access Any available network access point preferred Access point infrastructure networks only Automatically connect to non preferred networks Close Click Add on the Wireless Network Connection Properties window The Wireless network properties window is displayed Here is where the wireless network will be created On the Network name SSID type the desired network name Network names are case sensitive so ensure it is typed exactly the same on any computer to which connection is attempted Example network names HalNet NOELLENet GaumardNet Ensure the Network Authentication is Open and the Data encryption is Disabled Click OK NOELLE S574 575 576 User Guide Wireless network properties l ajx Association Authentication Connection NetworkN ame Network name 55 01 Wireless network key This network requires a key for the following Open Disabled Network Authentication Data encryption Network kepi A kep indes advanced 1 Eontim network kepi I The kepis provided for me automatically I This is a computer to computer ad hoc network wireless access pointe are not used The new network now appears on the Wireless Network Connection Properties dialog box under Preferred networks
163. her details at the time they are ready to conduct the simulation They usually don t especially when revisiting a scenario months after creating it When you add Wait and Wait Indefinitely steps to a scenario you have an opportunity to edit the item description Use this description field to hold notes to the facilitator Typically scenario designers put notes there to indicate what the provider s or facilitator should be doing at that point Further when saving the scenario you may edit the scenario description This is the best place to put patient history and any other longer notes and instructions 3 Assume that providers will do the right thing Usually you should create a scenario with the assumption that the providers will perform correctly As long as they do the scenario can simply be allowed to continue Naturally you must be prepared for what might happen to NOELLE when providers deviate from expectations The consequences of such deviations can sometimes be included in the scenario punctuated by Wait Indefinitely items In other cases the simulation will require more direct control by the facilitator via either the Palette or Details page 4 Choose auto response settings based on the scenario content and the objectives As you ve seen auto responses can be used to free the facilitators attention They also enhance realism by presenting instant reactions to the care providers On the other hand sometimes it is not p
164. higher physiologic accuracy 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 Gaumard Legend Ortodeion Pause Reset Ainway Appearance Patient s Info Upper Arway Sound gt Seizures tame Noelle Eyes Pugels O Enable Ran Tire sec Gestoral Age 40 w Hegr 65 0 n Breathing Pespratory Pattern Lung Condon w Weight 187 4 bs Respiration Panem 02 Saturation End Tidal CO Her comparion s Os natty name is hal Her O ro z i er ann haere o OSat A O ere EJ evcoz un O wwo cade ri dores f n a graidd i Ef roroa i had v a Total 02 level b l we Total CO level h i term of 0 a d Pia vorme a mi Left Lung foght Lung Sounds v Sounds Note Auto reos TS wie s ato CN DES Dy modeil Chk Y ution do hod Mis wit to Grent Apply Approximate Time gt m 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 bpm change Inspiration Auto o Ol a Volume Auto ml Auto Allow the model to auto adjust the value Click the input field blank to return t
165. icial ventilations or blood pressure cuff The Simulator will not breathe or have chest rise during any calibration procedure 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 Blood Pressure Cuff Oxygen Saturation The procedures for each specific calibration are described in the sections below Chest Compressions Artificial Ventilations This tool helps you calibrate the chest compressions and the artificial ventilations to your specific criteria That is you will be telling the system what a correct chest compression is and or what a correct artificial ventilation is Providers will be evaluated by the system based on this criteria The chest compressions and ventilations are calibrated the same way After making a selection this dialog box is displayed NOELLE S574 575 576 User Guide Calibration Chest Compressions Please select the type of calibration you would like to do Normal Calibration You will be asked to iin z perform based on your criteria Providers Bav will be evaluated based on that criteria Never calibrated Click next to proceed with the calibration The software will now ask you to perform a number of correct chest compressions or artificial ventilations depending
166. ields The first two rows allow you to set where in the delivery curve the two rotations occur The software will not allow an overlap of the rotations the stations specified for Rotation 2 will always be values greater than those specified for Rotation 1 further down the curve Each head position has two pairs of fields one pair each for Rotation 1 and Rotation 2 The provider can set the arc of the rotation to be as shallow or complete as desired Please remember that the zero point in the arc will always be at the top of the head position rotation box between ROA and LOA a of These settings will be retained until Rotate baby 8 5 O O 20 dn lar ch a l i WE g LOP 195 gt ROP 45 i Wf i in gt gl y E ge T i T T ail i W 6 T E i either altered again or the Reset button is pressed Reset will return all stations and arcs to factory defaults Make sure the labor curve covers all the points from 5 to 5 if both rotations are desired Also notice that the rotations are somewhat exaggerated this is done because the head swivels a couple of degrees separately from the alignment of the torso The torso is the portion of the baby that s being rotated by the motor so the head lags behind by a small amount Both of these arrows allow the instructor to rotate the baby to any desired position while the delivery is in progress
167. ility normal 100 RA RV normal 100 fm if Circulatory Blood Volume ml Cardiac Irritability M Vascular Properties Respiratory Shunt flow e Dead Space m PH I Environment Ambient Pressure ATM Inspired Air Mix 02 coz Note Auto means this vital is auto controlled by model Click H button to hold this vital to Current This tab gives you more control over the model by allowing you to edit 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 Vessel Stiffness i none slight random great random slight improve ml great improve slight deteriorate Inspired Air 33 NOELLE 574 575 576 User Guide 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 EA X with PACs X with unifocal PYC s X with multifocal PYC s Unifocal V tach Multifocal Y tach lt Ventricular Fibrillation A
168. ility y LV normal 100 normal 100 Circulatory Blood Volume ml Cardiac Irritability slight improve Vascular Properties Vessel Diameter Vessel Stiffness Respiratory Shunt flow 8 Dead Space ml PH Environment Ambient Pressure ATM Inspired Air Mix 02 After creating the dose effect palettes got to the Drug tab and click the Manage Drug List button Warp Factor H Rate __ mymn G Rate Un G 68 NOELLE 574 575 576 User Guide The Add New Medication window appears A list of all the drugs included with the Meds Profile is shown on the right gt Add New Medication New Medication Medication Response Medication List EC50 mg dl p E anD Concentration that produces 50 of the maximum effect Description Available Palettes Apply Items Threshold lug kg 3 fomes Drug OE TS F ug Fi mg El mg kg Test object weight 75 00 kg Route FP IV Push 7 IV Infusion F IM 7 Topical 7 Per Oral PF Inhalation Half Life min sec 9 Precise oF of of Approximate very quick lt 5m y Peak Time SS mn ec 0 Precise oH of oH Approximate very quick lt 5m 10 10 10 Plasma Concentration mg dL Drug Interactions 1 Type the name of the new drug under New Medication following this pattern
169. into a small town hospital due to regular contractions 4 minutes apart and bloody show She labors without problems for about 4 hours and then the fetus starts to brady down after SROM A V E reveals a prolapsed coed in the vagina Gabriella is a young Hispanic woman who presents to a small hospital just across the Mexican border She is alone and speaks little English Her nurse is fluent in Spanish but Gabriella is very quiet and gives little information Gail is a 29 year old primip 35 weeks She was admitted to L amp D from the ER after being involved in car accident Both she and her husband Alan were seriously injured and she is on a backboard wearing a c collar to stabilize the spine Her right humerus is fractured and seat belt marks are visible across the abdomen NOELLE S574 575 576 User Guide Overview Runs for approximately 60 minutes Upon induction of pitosin and rupture of membranes instructor should tell participants to switch audio output on fetal monitors to FSE tones Runs for approximately 20 minutes Pro lapsed cord is protruding into the vaginal Opening Faye is put into deep Trendelenburg position There is no palpable cord pulsation and FHTs are not audible with Doppler Upon VE fetus presents as double footling breech and is already partially into birth canal Therefore baby has to be delivered vaginally Fetus is non viable Runs for approximately 22 27 minutes Instructor must set up prol
170. io Lab Labor Speech Log Gaumard Save Scenario Scenario Auto Responses CIID Select the desired scenario and click on Load Scenario Description June suffers PPH following svd of healthy baby boy After loading the desired scenario click the Play button and watch the vital signs adjust according to the specifications of each palette Details Palette Scenario Lab Labor Speech Log Gaumard Save Scenario Scenario Auto Responses pia June suffers PPH following svd of healthy baby boy June PPH Name Description pa June 3_1 early signs of hemorrhage Wait Indefinitely i allow time for instructor to place PPH kit in Noelle simulator June 3_1 1 hemorrhaging increase Pit give methergine cath bimanual exploration Bimanual fundal massage Give Cytotec rectally June 3_1 2 fundus firms up June 4 recovering Pm A resents 53 NOELLE 574 575 576 User Guide Creating your own Scenarios First create the palette items to be used in the scenario To do so go to the Details tab and change the controls that best describe the condition to be simulated Not every field has to be populated in order to save a palette item Details Palette Lab Scenario Labor Speech Log Breathing Resp Pattern normal Y Left Lung Sound normal y Right Lung Sound normal Respiratory Rate OSat EtCO2 breaths
171. is accessible at all times Team Logging allows the facilitator to evaluate individual providers with a single click For example if provider Charles Parker performed a procedure satisfactorily the Evaluation entry would be 00 07 43 Charles Parker Evaluation Care Provided SATISFACTORY Speech When the facilitator makes NOELLE speak by pressing buttons on the Speech page an entry into the text log is automatically generated 00 18 10 Speech Urgency Don t touch me Notes Notes can be entered directly from the Evaluation panel or by right clicking on the text log at any time by the facilitator Note entries display each and every character the facilitator types into the text box The following is an example of a Note entry 00 10 10 Note provider took too long to assess patient Provider Actions The Provider Actions section refers to the collection of buttons in the middle of the log page These buttons permit the facilitator to accurately and quickly track common provider actions Emergency Reported i Circulation Vagalmaneuver atodos Check for pulses interret enyim Estabishiv Cams EZ Log CPR The buttons are categorized into five groups Emergency Reported Airway Breathing Circulation and Medication Any time the facilitator clicks one of the buttons a time stamped log entry is generated documenting the action For examp
172. is delivered and before the shoulders are delivered The fetus is turning and the head is crowning The student or instructor may help the fetal head and shoulders through the vulva just as in real life However the fetus will automatically unlock only after the vertical progress bar reaches Stage 3 of the delivery process The automatic unlock process is indicated by the Releasing status Click the Release Button to manually disengage the baby NOELLE S574 575 576 User Guide WARNING Do not pull the baby upward in contrast to the birthing mechanism s linear trajectory Doing so can bend the motor arm and cause damage to the birthing mechanism Resetting the Delivery Mechanism After the delivery is complete click the reset button to return the delivery mechanism to the initial position WARNING Do not turn off the simulator until the birthing mechanism has fully retracted to its initial position Load Labor Labor Control Dystocia E Enable Smart Labor 10 sec ON OFF Save Labor E Only descend during PA Vacuum Assisted Delivery Vacuum assisted delivery is a technique for the management of arrest during the second stage of labor Criteria for successful delivery include 1 cervical dilation is complete 2 cephalic presentation is confirmed 3 the fetal head is no more than 1 5 palpable above the pubic bone 4 effective uterine contractions continue 5 maternal expulsive e
173. is completed DO NOT leave birthing baby in contact with the birth canal Always lubricate the birth canal prior to delivery Preparing for a delivery A 154 Lubricate the fetal head and shoulders plus the inside of the birth canal insert using the silicone oil provided WARNING Always lubricate the fetus and the birth canal before every delivery Failure to do so will result in damage to the birthing mechanism and the birth canal 3 Attach the umbilicus to the placenta O a OR A wa PE eS hs A 4 4 3 Ny Jy I if ie ee RN ae ee ne Attach placenta to either side of the abdominal wall Orienting the Velcro patches in parallel causes segments of the placenta to be retained if secundes are reversed orienting them at right angles causes the placenta to release with modest traction Attach the umbilical cord to the baby route the cord so it does not bind in the mechanism and attach the placenta to the pelvic cavity using the Velcro fastener Note that the fetus has 2 receptacles at the perineum into which the matching pins located on the birthing mechanism are inserted 6 Position the fetal arms and legs as shown 7 Umbilical cord can be wrapped around the neck demonstrating a nuchal cord Locking Mechanism The birthing mechanism arm attaches and locks into the fetus attachment port The motor arm low voltage cable feeds power to the locking mechanism and fetal he
174. ks and Performance Calls for additional help Nursing or Physician Calls for anesthesia Providers turn or assist in turning patient to side during seizure Inserts tongue blade into mouth Places supplemental oxygen on patient Places pulse oximeter on patient Once the evaluation is completed click the Print button located at the top right corner of the screen Eclamptic Seizure iv Eclamptic Seizure 111 NOELLE 574 575 576 User Guide To save the finished evaluation as digital document select Microsoft XPS Document writer and click Print It is recommended that documents are first saved as XPS files before being printed into hard copies Microsoft XPS Document Writer 4 Status Location Comment Page Range Al Number of copies 1 Selection Current Page Pages 7 Collate 63 322 28 Enter the name of the evaluation Select a location and click Save a Save the file as OL Wi Documents Evaluations v 4 Search Evaluations Organize v New folder vir Favorites Documents library i Arrange by Folder Evaluations A Libraries ES Documents No items match your search ad Music E Pictures E Videos Computer ba File name Eclamptic Seizure Session 3 xps Soe pe ES Dosen 399 Ca Hide Folders Printing an evaluation If a print de
175. ks and the lungs permit an adequate chest rise Normal CPR procedures can be followed with aid of GaumardUl s CPR trainer CAUTION Do not perform mouth to mouth ventilation Doing so may lead to molding of the airway The airway itself cannot be sanitized or cleaned Cardiac Heart Sounds NOELLE is equipped with several realistic heart sounds which are related to the user defined heart rate and cardiac rhythm ECG Monitoring and Electrical Therapy NOELLE is equipped with conductive skin sites that allow the attachment of real electrodes and defibrillator pads This feature permits the user to track cardiac rhythms and events with their own equipment just like with a human patient NOELLE can be shocked or paced with real energy for cardioversion defibrillation and pacing drills AED will display NOELLE s ECG analyze her cardiac rhythm and advice action O Defibrillation Sites xX ECG Sites ECG and electrical therapy checklist and warnings e Only deliver electrical therapy when the simulator is fully assembled dry and undamaged e Make sure the defibrillation patches on the simulator are in good condition including removing any and all gel residue on the defibrillation patches from previous use s It is a good practice to remove gel residues after every use Failure to do so will leave behind a film of electrode gel that hardens causing arcing and pitting e Do not re use the gel adhesive pads Do not l
176. l Mode In this operating mode vital signs and other responses are changed according to the specifications given by the instructor This mode has three factory preset profiles Default Quick Start NOELLE scenarios and NOELLE Advanced Noelle 574 575 Profiles Select Operating Mode Manual Automatic Profiles o Profile Description Default Noelle Advanced Quick Start Noelle Manage The profiles available under Manual Mode are the following e Default Profile includes one palette with healthy vital signs e Quick Start NOELLE contains a total of twelve labor scenarios e NOELLE Advanced Contains fourteen linear scenarios twenty two labor scenarios and one branched scenario Automatic Mode In this operating mode vital signs respond automatically to caregiver participation instructor specifications and pharmacologic intervention The model used in this operating mode was developed using 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 and preset scenarios for Advanced Life Support To activate this operating mode as an upgrade option navigate to page 128 Noelle 574 575 Profiles Select Operating Mode Manual Automatic Profile Description Default Modeling Scenarios Manage 19 NOELLE S574 575 576 User Guide The profile
177. l for troubleshooting because it gives the user feedback on all of the working modules inside the simulator The user can click on the button that says Check All Modules and the software checks which modules are responding ES Dignoriies toto GN NE004004 File Audio Other Legend Throat voice O Ecc Active Throat Streaming Trachea Intubation Inactive Heart Larynx Check Modules Lung Front Upper Right Carotid Eyelids ED Lung Front Upper Left Radial Right Right Pupil Dilation Module O Radial Left Left Pupil Dilation O Sat Right 0 Sat Left KK Right KK Left Drug Recognition Breathing Noelle Specific Delivery Motor O Sebres Rei Rotation Motor Seizures Rev 2 Rotation Encoder Pressure O BP Right Tummy Pressure O BP Left Load Cell Baby Ventilation Hemorrhage Air Compression Hemorrhage Liquid Compressor Also check individual modules by clicking on the module to highlight Notice that the name of the module is displayed on the right column Now click on the Check Single Module button Other Legend C ECG ECG 2 Active Trachea Intubation Inactive Check Modul Module selected eck Modules Eyelids gt Right Pupil Dilation gt Left Pupil Dilation Active modules report light blue and inactive modules report black If there is a specific module that fails to respond please contact customer support ensure that the module that is
178. l insert as shown in the picture This is to position the hemorrhage tube in the correct location The birth canal insert is now ready for normal use Replacing Common Consumables Antecubital Veins in Drug Recognition Arm WARNING Vein tubing contains latex which may cause allergic reactions Users allergic or sensitive to latex should avoid contact Discontinue use of this product and seek medical attention if an allergic reaction occurs To replace the veins used in drug recognition arm follow the instructions below Gather the following items Replacement antecubital vein set Silicone oil Heat gun or blow dryer Tape Gloves optional Hemostat optional If currently turned on exit the software on the tablet PC to turn off the simulator Gently heat the arm skin Recall that the drug recognition feature is available only on the right arm Pull back the skin from the arm and remove it completely NOELLE 574 575 576 User Guide Anterior foreman 4 The antecubital veins are exposed 6 5 Label each hole in the arm as shown in the pictures below Posterior forearm 7 Hold the white connector with one hand and hold the latex tube with the other 261 NOELLE S574 575 576 User Guide 8 9 10 11 262 Pull out the latex tube from the connector Now pull up the white connector in hole 9 Hold the connector with one hand and the latex tube with the other
179. l model exchanges gas and temperature information with the fetal model At the end of the delivery important model parameters are then transferred from the fetal model in NOELLE to the neonate model in Newborn HAL Therefore NOELLE s conditions impact the fetus and the fetal conditions drive the Newborn s APGAR score For more information on transferring fetal model information to the Newborn HAL system using the Neonate Link feature navigate to page 143 The physiologic model is constantly calculating and adjusting vitals automatically Click on the pause button located on the right panel to freeze the model during lectures and then click again to resume To return the patient to a healthy state click Reset Patient Profile Palette items and scenarios are saved under individual patient profiles A facilitator can load create and edit patients from the status details panel or from the menu located on the right To create new patients navigate to page 135 Patient s Infa Name Noelle Gestional Age 40 w Age 27 Y Height 165 0 cm Weight 35 0 kg Her companion s name is hal Her OB history shows a gravida of 1 a term of 0 a preterm of 0 and that she is E currently 40 weeks pregnant she has had 0 28 NOELLE 574 575 576 User Guide Automatic Mode Controls The HOLD and Auto buttons on the Details page are unique to the automatic mode These controls add a new level of regulation that allows
180. l scenario duration 23 25 minutes S amp S Complains of tenderness in abdomen finds ctx very painful Admit to birthing room administer medication change position to relive variables Turn patient LLP to resolve variables Wait time 2 30 min Check that variables have resolved Wait time 3 min Go to Labor Candice Wait time 2 min 223 NOELLE S574 575 576 User Guide 224 Gaumard Simulators for Health Care Educatior Noelle 574 575 Labor Scenario Candice Shoulder Dystocia Automatic Mode Perform Suprapubic pressure McRoberts Woods and Rubin maneuvers Alleviate Dystocia with Gaskin maneuver Titrate pitocin to maitain uterine contractions give Tylenol for pain antibiotic therapy NOELLE S574 575 576 User Guide Gaumard Simulators for Health Care Education Noelle S574 575 Labor Scenario Demaris Breech Presentation Automatic Mode Demaris is a young Hispanic teen who has received prenatal care in the Adolescent OB clinic She kept the pregnancy a secret as long as was possible and did not attend any childbirth classes Her plan is to return to high school while her mother cares for the baby The baby s father will not accept any responsibility and does
181. le 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 106 NOELLE 574 575 576 User Guide The first special button lets the facilitator be a log actions in more detail For example if the button Assess breathing is clicked the following 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 Breathing look listen feel abdominal auscultation axillary auscultation and the following entry is added 00 01 28 Action Ventilate look listen feel The second special button gt allows pre programming common responses to specific actions For example the facilitator can pre program normal respiratory sounds and re enable the lungs when the provider performs a needle decompression Airway Response When the extubate button is the following entry is created 00 01 28 Action Extubate cough Medications Manual Mode Only The Medications section allows for quick and easy logging of drug administration including dosage and route The sof
182. llow the instructions Options CPR Options Pacing Shock Tolerances Other i Noelle Features GENERIC Find and establish a connection with Noelle Please switch to FIXED once connected FIXED The software will enable controls for features available on your simulator FIXED Noelle Setup Enter the Serial Number from the Noelle simulator that THIS computer will control SN on RF Module N 8505004 Automatic Channel Change Select desired channel 1 E Check noise in channel At the bottom of this tab optionally select the channel that the RF module will use to communicate with the simulator It is recommended to set the Auto Channel Change to active because it makes sure the initialization channel is always clear for other simulators start up If it is preferred that the simulator automatically switches to a cleaner channel when possible select the Check noise in channel button When more than one Gaumard tetherless simulator is in the vicinity allocate one channel in between to avoid interference General This tab allows the facilitator to e Enable auto saving of the log e Save your current log report e Enable stand by warning e Select units SI or English e Enable electrical therapy shock panel 126 The shock panel is a floating window used for simulating electrical therapy It can also be used in conjunction with auto responses For more i
183. m will take a few seconds to send the release commands to the simulator Locking Mechanism Once the baby is plugged into the motor arm the locking mechanism acts twice to secure the birthing baby a clicking noise can be heard coming from inside the baby The user then must hold the baby until the noise stops and make sure that it is locked by pulling the baby to check that it is held fast For more information on preparing the simulator for delivery navigate to page 154 Follow the guidelines below when releasing the baby from the birthing mechanism To troubleshoot any additional issues please navigate to page 241 If shoulder dystocia turned OFF e The release mechanism is automatically actuated ten times in one second intervals once vertical progress bar reaches STAGE 3 e The baby has descended more than 80 of its entire translation baby s head is out and user pulls the baby with more than three pounds of force e By pressing the Release Baby button inside the Labor tab If shoulder dystocia is turned on e When user pulls the baby with more than 35 Ibs the baby is released as a safety feature in order to avoid damage e By pressing the Release Baby button inside the Labor tab e Allow at least 30 seconds after the baby has been initially locked before trying to release it e The labor progress line reaches Stage 3 and dystocia is turned off 89 NOELLE 574 575 576 User Guide WARNING Guide the baby
184. m is power intensive and will drain the battery quickly RF module not RF module not connected Connect the RF module to any USB port found message is displayed when GaumardUl is started RF module not identified by Close the software and try disconnecting the RF module the computer for at least five seconds then plug it back in and restart the software Drivers not properly loaded Perform a full shutdown procedure on the tablet Is the communication indica See solution above in section making reference to tor panel consistently blinking communication indicator is consistently yellow yellow Chest compressions are not properly detected or not detected at all Is the respiratory rate set to Set respiration rate to zero 0 min Chest compres sions are only detected when the respiratory rate is set to 0 per minute 0 min Otherwise they are ignored Simulator is not connected Verify connection to the simulator Alothers See Calibration Wizard section inside User s Manual See solution above in section making reference to blinking communication indicator is consistently yellow Is the communication indi cator panel consistently yellow Simulator is not connected Verify connection to the simulator At others See Calibration Wizard section inside User s Manual BP sensors are offset Recalibrate BP cuff sensors on the simulator as per Calibration Wizard on User
185. mL 00 09 50 Detected Medication Unknown Med gt 5 mL 00 09 54 Detected Medication Unknown Med gt FmL If you are running a branching scenario where a drug is added as a path in one of the nodes the software automatically checks the action and moves to the next node if no other actions are pending For more information about adding drugs as actions on a node s path go to page 57 g stops upon sing Cytotec NOELLE S574 575 576 User Guide 1 First locate the fill syringe with tubing and the drain tube with pinch clamp Fill the syringe with the desired fluid water or simulated blood WARNING At the end of every simulation session you must purge the IV system with clean water with the simulator powered on If the drug recognition arm is not going to be used for a week or more purge the system with 70 isopropyl alcohol solution Failure to do so may permanently damage the system Bilateral IV arms NOELLE has a bilateral IV training arms that can be used for bolus or intravenous infusions as well as for drawing fluids 2 Connect the syringe with tubing to one port and the drain tube with clamp to the other port as shown WARNING A drug recognition arm is equipped with a black drainage port Reversing the fill and drain connections on a drug recognition arm will damage the system and void the warranty WARNING The simulator must be powered on when working with the drug recog
186. move Rename h Insert AD y Lipid Panel Female Variable 38 NOELLE 574 575 576 User Guide 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 E Add Insert Entry Name HDL Cholesterol Precision 2 a Normal Range Minimum 35 00 Maximum Allowed Range Minimums Maximum Repeat the process to add more tests and categories using the Category and Single Entry menu Please note that individual items can be moved deleted or modified after they are created After all the tests are entered navigate to the bottom of the page to Save the new template GE Edit Lab Results Template Name Lipid Panel Description Cholesterol HDL LDL Triglycerides Category Single Entry naa rn eee Lipid Panel Female Variable Normal Range 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 Ra
187. mpression box fill color changes between the following states e Grey No intervention was detected e 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 140 Compression and ventilation data is displayed at the bottom of the window as CPR is performed by the provider 0 10 30 Compression Data 306 Ventilation Data Rate Ct LE Rate PIP Ti 96 0 3 00 00 0 0 0 5 IE PEEP LV O 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 e E Inspiratory Expiratory Ratio e PEEP approx Positive end expiratory pressure e LV Last Ventilation Time elapsed since the last ventilation performed Trainer The CPR trainer features generates a visual queue of the compression to ventilation ratio programmed in the CPR Options menu When the Trainer button is clicked the V ventilations and C compressions box borders blink to indicate the correct r
188. n Gestational Age Prenatal care C Rx Drugs C Allergies C Anemia O Diabetes C Heart Disease O Hytertension Fetal Info C Tuberculosis Group B Strep C Infectious Diseases O Decreased No fetal movement O STI C Previous C S C PROM PPROM Other Treatment History None 02 AROM IV Started Amino Infusion Post Partum Scenario none IV Pain Meds Epidural O Save Translation and Rotation Parameters mew on cot The Save Labor Scenario dialog box is divided into the various sections listed below e Mother you can enter specific information about the mother including age height weight among others The only field that must be completed is the name of the Mother e OB History Use this section to select specific details about the medical history of the patient e Treatment History Use this section to check off any treatment histories that apply e Labor type Other Use this field to enter specific text regarding the labor Entries may include notes such as Postpartum Hemorrhage or Preterm Labor e Stage Information this section contains a total of five tabs Each tab corresponds to a labor stage Use each tab to describe specific details about the patient during each stage of labor e Post Partum Scenario You can link a labor scenario to a postpartum scenario This allows the software to automatically start th
189. n oO Osat change otal 02 level sel Total 02 level Shunt Flow Respiratory Pattern e Respiratory pattern Airway Obstruction Airway construction e Total O level oxygen reserve in the body e Shunt flow the percentage of deoxygenated blood in pulmonary capillaries e Airway obstruction Similarly EtCO2 can be changed by adjusting one of four parameters e Total CO level CO build up in the body vachang O mg e Dead Space part of tidal volume that doesn t Total CO level participate in gas exchange Respiratory Pattern e Respiratory Pattern PH level e Ph level 30 NOELLE 574 575 576 User Guide Lung Condition Change the condition and shunt flow dead space airway resistance and respiratory pattern are adjusted by the model Lung Condition iii Tidal Volume 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 Elres Rate de Circulation Other The C O vertical tab includes circulation and other emergency controls Notable behaviors are outlined below Circulation Patient Status v 2 Heart Sound MO S A El ECG Rhythm e Heart Rate Blood Pressure C Sane MN
190. n Normal Vitals Color O Healthy Care Required Gaumard 3 Click on the Add to Scenario button Select a single palette or enable Multi to select multiple palettes at the same time Specify a transition time for the palette and click Add 54 NOELLE 574 575 576 User Guide 4 From the add menu you may also choose the Wait item which causes a delay of a specified duration or a Wait Indefinitely item which causes the scenario to pause until the facilitator manually advances to the next item Add Palette Item 59 59 Max Item Description Normal Vitals 5 Repeat the previous step to add more palettes wait times speech or labs Details Palette Lab Scenario Labor Speech Log Gaumard Clear Load Scenario Save Scenario Scenario Auto Responses ery Alice suffers from allergies before the labor Alice Allergy begins Name Transition Description gt start State 00 20 Asthma Sinus respiratory allergy 04 00 wheezing difficulty exhaling tongue edema Closed airway 00 00 all difficult airway actuators on Wait Indefinitely Hold in current state until action is taken Resting 01 00 Normal Vitals 6 Begin the scenario by pressing play Watch the vital signs adjust according to the specifications of each palette item Hold the stylus button and tap the palette item to access the right click menu and view additional options
191. n the Add Provider name field Edit Provider 108 NOELLE 574 575 576 User Guide As shown in the Log page image a colored button is inserted onto the Team Logging region for the provider just added The software allows up to six different providers each with a corresponding button to be entered Each time one of the provider buttons is clicked the indicated person becomes the active provider in the evaluation window Session Title Providers z Emergency Reported Airway Log CPR The colored vertical bars on either side of the log text box will match the color that is coded to the chosen provider On the Log page image above Chris is the active provider so the vertical bars are turquoise Notice that Patricia who has a green colored button is not the active provider While there is an active provider every time a Provider Action or Evaluation log entry is created it will have the name of the provider prefixed to it as follows 00 07 41 Chris Action Check for pulses radial To deactivate this feature deselect the active provider and return to general logging click the Team button and the vertical bars will return to neutral color All provider buttons can be edited or deleted by right clicking them and selecting an option from the menu that appears Session Information The session info area contains the Session Title and Facilitator fields at the top of the page At the beginning of e
192. n this window the following error message is displayed when the electrical therapy is detected Event i Defibrillation shock detected Shock 3 300 Joules But current cardiac irritability does NOT allow rhythm to change Drug Model Effect this feature is used to panel has two options e Auto applies drug effect as soon as the drug recognition module detects a drug Note that the effect applied will be determined by the calculated dosage e Prompt this option displays the Proceed Drug every time a drug is detected by the drug recognition module to ask the user if the drug effect should be applied now This option allows the user to select which drug effect to apply and whether or not the drug effect should reverse when the drug s level begins to drop Proceed Drug 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 re natant NOELLE S574 575 576 User Guide Set Med ID The Set Med ld option is available on simulators equipped with the Drug Recognition Arm Scan RF Channels The syringes supplied with the Drug Recognition Arm must be programmed before use Each syringe will be linked with a specific drug and concentration You only need to program the syringes onc
193. ncorporate electrical therapy of any kind always follow the guidelines below in addition to the electrical therapy equipment s safety guidelines ECG lead Il the monitoring lead is the only ECG signal produced by the simulator NOELLE has sites on her chest for up to four ECG electrodes to accommodate today s most common monitors These sites are electrically tied together by an appropriate impedance preventing lead off alarms from the monitor O Defibrillation Sites ME ECG Sites Defibrillation is allowed only on the large sternum and apex sites marked in green below NEVER deliver a shock to ECG lead targets on the shoulders and waist Doing so will neither create a fire hazard nor create a risk of shock to the provider but major internal damage will result This situation is considered improper use and is NOT covered by the NOELLE warranty The system will require repair at our facility Electrical therapy checklist and warnings e Only deliver electrical therapy when the simulator is fully assembled dry and undamaged e Make sure the defibrillation patches on the simulator are in good condition including removing any and all gel residue on the defibrillation patches from previous use s It is a good practice to remove gel residues after every use Failure to do so will leave behind a film of electrode gel that hardens causing arcing and pitting e Do not re use the gel adhesive pads Do not leave them on for next
194. nd subsequently cause arcing Cephalic Reactive Eyes NOELLE has blinking eyes with photo sensitive pupils The dilatation state of the pupils the blinking rate and light reactivity are easily manipulated from the tablet PC giving the user total control simulators with serial number NO908408 or higher only Seizures NOELLE is outfitted with a convulsion mechanism that can be used in conjunction with scenarios preeclampsia for example The severity of the convulsions can be programmed with a touch of the stylus 149 NOELLE S574 575 576 User Guide Circulation Bilateral Pulses NOELLE s palpable pulses carotid brachial radial are dependent on blood pressure Users can also disable distal pulses to simulate severe hypotension Programmable Blood Pressure Programmable blood pressure can be measured using any standard sphygmomanometer Korotkoff sounds are heard between systolic and diastolic To use this feature 1 Put the cuff around the simulator s upper left arm with the cuff mark at the medial site of the bicep brachii about an inch two cm above the anterior elbow which is the correct site when taking the blood pressure on real patients CAUTION Placing the cuff any differently might give an incorrect reading 2 Calibrate the BP arm if it has not been calibrated Refer to page 120 for information 3 Inflate the BP cuff and auscultate Korotkoff sounds as you would a normal patient Modified
195. ndardization Is key Scenarios can be linear or branching The sections that follow explain in detail the difference between the two Linear Scenarios Linear scenarios consist of palette items added in sequence with specific transition times as shown in the figure below Details Palette Scenario Lab Labor Speech Log Gaumard Candice is 19 yr old multip Approximately 8 Candice admit months pregnant No PNC Ruptured gt 24 hrs Meconium Variables Probable chorioamnionitis more Name Transition Description gt candice 1 00 00 Admission Wait 02 30 Turn patient LLP Candice 1 1 00 00 Labor 1 03 00 check that variables resolve 01 00 Labor 2 02 00 continue routine care Candice AS To add palettes to the scenario click on the Add to scenario button 43 NOELLE 574 575 576 User Guide The following window is displayed Add Palette Item Transition min sec D oi OF CUE amp 59 59 Max Item Description Admission Choose the desired palette and specify a transition time If the list of palettes is long you may search a desired palette using the search bar next to the search icon To select multiple palettes at one time enable the Multi control button The palettes selected will be shown on the right panel Add Palette Item Palette File Lab Transition 1 59 59 Max Item Description Above normal rang
196. nesor e a a N a a A a N Died a a Peat ae i 136 IMPortbelween FAUNI inao o id ostti co 136 A A a a S 136 MONOT usoen ai 137 SENSO ose pe II E 137 A a ste see eecinene cee uted ate oct meee acon eae hee eetae nase 137 Custom NUMDEIS 2 1 444a wa be Maa heh LMI MeN A 138 o O yrer eomeut as 139 A O aac a cy Recta de Gene A A A O 140 A A 141 O 142 SU o e 142 Fetal NEO Link ATOM TO MIA o aed do 143 E ee E One ee ee Oe eee ae one ene ee oe 144 A ree eC er eee ee ee 144 A A O ee een eo ne 144 Ele Ae 8 ole 2 lt 1 AA nine Ne siren See ner Neeson RR PRE PR ersee Cen te sere eRe ter near ene 144 A stabs a aa ae a e 144 NOELLE S574 575 576 User Guide WORKING WITA NOELLE eis ee Sas tered yn due teres cacao acs easel wend dai idea 145 AIRWAY o aaah A tae T prea dat ac ee Sees eet nae ees ra 148 NaS alan Oral IMUDAION ierosin itches Bae tears ead latinas Meee ceed ceased A A T 148 FACS US CIA ON soiuis snl neta oad ii 148 AA aie 2 so isa wai ha E BE a ta eebacd umibed sede ead a 148 Arway SOUNA S sii alee Pasig castes nena cas pe za nadine Saseu bead mbna suds ea eaa webct saunas Aona oe oetauen ae a dade aes 148 A Seca oles motu a E E A 148 PUIMONALY A a i n 148 SS ic ees eed co ai a sate tec Lea acc vied eeu eae ie acade 148 A 148 CARDIACA ici 149 ANSIOSO ada 149 ECG MONTORO a a Electrical TRAD cote a eter A E cc ia a eee eae 149 CEPHA A A ee A ae Seat Chae 149 FACACIVG E VOS orrea n RS acute dual ers LI a ll iia 149 OV BUCS SANS AAA AAA
197. nflatable bladders the tummy can be connected to the extra port on the hose NOELLE S574 575 576 User Guide 4 Once the uterus is in place the instructor will be able to change the uterus pressure using the Uterine Pressure option inside the Details tab or a palette item that has this setting saved 5 Use bimanual massage to shrink the boggy uterus into a smaller and firmer condition 6 For postpartum bleeding refer to the hemorrhage kit instructions found on page 166 Episiotomy Repair Remove the fully dilated vulva used during delivery and select one of the three episiotomy repair modules Snap a repair module into place Use a 000 size suture and small curved needle to repair the surgical incision or repair 000 sized sutures are recommended to extend the life of the repair modules 164 NOELLE S574 575 576 User Guide Urinary Catheterization Systemic The bladder in NOELLE is located on the stomach cover The reservoir can be filled with 240 mL four Oxygen Saturation syringes and the fluids can be drained out using a urinary catheter size 18Fr To set up your NOELLE for urinary catheterization follow the steps below Use commercially available monitors to read oxygen saturation from the left index finger 1 Locate the urinary bladder fill port in the stomach cover Fill the bladder with up to 240 mL of water Fill Port CAUTION Co oximeters that in addition to 2
198. nformation navigate to page 130 Options Auto Save C Enable Log Auto Save Save Auto save every report Session Timer C Reset session timer once scenario is started Electrical therapy Panel Show defibrillation cardioversion panel Stand by warning O Warn the first time trying to apply settings when system is on Stand By mode Units International System SI Imperial oe e If the Electrical therapy panel is enabled a new control will be accessible from the top right of the screen nia wv a e teen Tak Gaumard Legend Oo of Use this control to bring focus to the floating shock pace control window Shock Pace Panel Close sync O At any moment the shock pace window can be moved or closed while remaining accessible by clicking the button above NOELLE Features Configure NOELLE specific features Options Pulse Strength Set pulse strenghts for normal BP 120 80 0 10 39 Noelle Kits Use Hemorrhage Kit if factory installed Use Blinking Eyes Kit if factory installed Fetal Monitor Paper Speed icm min 2cm min 3 cm min ok Cancel Reset the labor motor If the motor is not moving properly through the track during a labor remove the baby and click Reset Labor Motor The motor will move down the track and calibrate the proper starting position Reset the ET tube Calibrate the ET sensor using the reset button i
199. ng Center eto a a 254PM Gaumard Monitors After both computers are on and the ad hoc connection is established double click or tap the Gaumard Monitors icon located on the virtual monitor s home screen The Gaumard Monitors software is now ready to receive vital sign information once GaumardUl is initialized on the tablet Continue to the next section to begin working with NOELLE and the GaumardUl software 17 NOELLE S574 575 576 User Guide Working with GaumardUl Initializing NOELLE After reading the Care and Cautions section of the guide click on the GaumardUl icon located on the tablets home screen to start the simulator NOELLE uses what is referred to as soft power which means that the simulator is activated by the software less than 1 minute after clicking on the Gaumard icon To address connection and startup issues navigate to page 241 A dialog box is then displayed which prompts you to select the active simulator Select NOELLE and click start Gaumard Please select one Simulator CIHAL OldRF DHALO O Newborn biec O Pediatric HALO F Five Year DPediatric HAL One Year OPremie HAL CL Susie User profiles and operating modes A profile is a unique configuration of customized palettes scenarios and options Each profile functions independenily in that changes made to one profile have no effect on the others NOELLE S574 575 576 User Guide Manua
200. ng vertex to perineum A vacuum extractor is necessary to bring the head to the perineum Patient is still unable to deliver McRobert s suprapubic pressure Woods and Rubin maneuvers fail Baby is finally delivered using Gaskin maneuver Note To run full scenario load Candice Admit from scenario tab To run dystocia drill only load Candice from labor tab Scenario runs for approximately 40 minutes Baby is delivered after basic shoulder dystocia maneuvers such as McRoberts and stiff arm suprapubic pressure 93 NOELLE S574 575 576 User Guide Patient Name Dana Demaris Eleanor 94 Labor Type Breech Presentation Breech Presentation Preeclampsia History Dana is a 24 yr old multip 29 weeks who was admitted because she began contracting Upon V E physician discovers that she is 4 5cm with bulging membranes She was given Terbutaline subQ and then transported to the regional medical center Demaris is a young Hispanic teen who has received prenatal care in the Adolescent OB clinic She kept the pregnancy a secret as long as was possible and did not attend any childbirth classes Her plan is to return to high school while her mother cares for the baby The baby s father will not accept any responsibility and does not wish to be involved The ER is notified that EMS is about 4 minutes away with a 19 year old pregnant post ictal patient named Eleanor Her aunt found her convulsing in the bathroom an
201. nge Cholesterol mg dL 0 00 199 00 LDL Cholesterol mg dL 0 00 129 00 Triglycerides mg dL 30 00 200 00 Allowed value range is displayed in Value column It won t be visible when entering data Once a new format is created it will be listed on the Lab Format section at the bottom of the Lab tab Use the buttons on the left panel to edit or delete lab formats Lab Template Template Description New Template CBC DIFF Platelets Differential Selected Item A Lipid Panel Cholesterol HDL LDL Triglycerides y Metabolic Panel Anion Gap Albumin Alkaline Phos Calcium Choride Neonate Blood test For newborn and premie 39 NOELLE 574 575 576 User Guide Creating a Lab Report To begin click on Create a New Lab Report from the right panel Details Palette Lab Scenario Labor Speech Log Lab Reports Hamel Template Description The Edit Lab Report window is used to prepare new lab report First select a Lab Template from the drop down menu Edit Lab Report Lab Template Lipid Panel CBC DIFF Template E Description Metabolic Panel Meonate Blood test OB Blood test PPT Report Name Prothrombin Time Provide a Report Name Report Time and Description In addition select a condition color tag for the lab report on the right panel Color tags aid the sorting of lab reports on the report list window Edit Lab Re
202. nition arm This includes calibration purging draining IV infusion Set Med Id and injecting fluids Failure to do so will permanently damage the simulator and void the warranty Do not attempt to fill IV system without the drain connector in place Always leave the drain port connected when injecting fluids into the system 3 Leave the drain tube clamp opened and depress the syringe until all air has been pushed from the IV Use only Gaumard s provided simulated blood system and fluid runs from the drain Any other simulated blood brand containing sugar or any additive may cause blockage and or interruption of the vasculature system Always flush the IV system with distilled water at the end of every simulation 4 To simulate a patient with no accessible peripheral IV sites connect only the syringe Pull the plunger to create suction which will collapse the veins Disconnect the syringe tube from the arm port while maintaining suction The port will seal and the veins will remain collapsed 153 NOELLE S574 575 576 User Guide Obstetrics Normal Labor and Delivery Birth Canal Maintenance Ball point pens ink and markers permanently stain the birth canal insert Do not wrap this or any other Gaumard product in newsprint The birth canal insert can be cleaning by wiping with a mild solution of soap and water After cleaning dust with talcum powder Store the unit in a cool dry place After exercise
203. not wish to be involved Labor duration 30 minutes S amp S Agitated uncooperative FHTs are above the umbilicus S amp S Patient and mother vehemently refuse to consent to C S AROM SA aia Admit patient Routine labs notify HCP of admission and status Order real time U S to determine fetal position Attempt to get patient consent for c s transfer patient to OR for delivery insert FSE on fetal buttocks 225 NOELLE S574 575 576 User Guide Gaumard Simulators for Health Care Education Noelle S574 575 Labor Scenario Eleanor Variations on Normal Automatic Mode minutes Elenor is a 19 yr old post ictal patient being transferred to the ER by EMS She was found convulsing in the bathroom According to relatives she is 8 months pregnant with her first baby She has been on an IV during transport and her BP is 180 120 Labor duration 20 S amp S Responsive only to pain with groans Vaginal bleeding S amp S Suffers tonic clonic seizure prolonged fetal bradycardia results 226 Magnesium sulfate bonus Stat page on call OB attending Give during seizure give another Magnesium sulfate bonus Employ safety measures Prep for precipitous delivery following tetanic ctx Hang pitocin
204. noted in the vaginal vault and ferning is positive Breakthrough contractions occur and Sterile speculum reveals cervical change Cerclage is removed Fetal heart tones remain stable throughout the short labor Spontaneous delivery occurs The female infant born earns good APGARs NOELLE Advanced Patient Nama Labor Type Alyssa Normal Labor Angela Becca Bianca Candice Charlotte Normal Labor Variations on Normal Variations on Normal Shoulder Dystocia Shoulder Dystocia History Alyssa is a 23 year old primip at term She has received prenatal care in a multidisciplinary practice Her general health is good and she has experienced no prenatal complications She wants to have an unmedicated natural birth Angela is a 31 year old grand multip Even though she has had only a_ few contractions she came in anyway because she has a history of rapid labors Becca is a young pregnant teen who is living on the streets She is a heavy smoker and drug user She was seen twice in the Adolescent Clinic and referred to Social Services but she only saw the social worker once and did not go to the follow up appointment The extremely precipitous delivery and patient s agitated State should point participants to order tox screen to check for illicit drug use Bianca is a 16 year old gravida 2 1 She had an elective abortion at age 13 She lives with her 17 year old boyfriend and has no contact with her family She has b
205. ns o a Hooper monn srs src 0 erson A oreesa soono weren so monsen Oo NOELLE S574 575 576 User Guide mmo mine me os DO A E Audio 8 Video Recording S575 206 RF Module LN Radio Frequency Module with USB connector Wireless Streaming Audio S575 300 U Upgrade EE Wireless streaming audio upgrade Automatic Drug Recognition Automatic drug recognition feature includes S575 401R L A Drug Recognition ES AS drug recognition right arm replacement light S575 600 Automatic Physiologic Control ES Physiologic modeling feature for NOELLE S575 EXW Two Year Extended Warranty EX Extended warranty for years Two AND Three S575 INST In Service Training ES Day of in service training and installation C Consumables R Replacements A Accessories U Upgrades M Replace in Miami Factory ONLY 258 Replacing Common Consumable and Replacement Parts Birth Canal Follow the instructions below to replace the birth canal You may also use the steps below in case the birth canal has to be removed temporarily to adapt the episiotomy kit Remove birth canal 1 2 3 Insert your left hand at the 9 o clock position between the lower torso and the birth canal insert Slowly push inward WARNING Do not pull the birth canal to remove Repeat instructions in step 1 with right hand at the 3 o clock position Push inward on the birth canal insert Then place your thumbs on the top of the birth canal insert and push downward
206. nursery personnel 231 NOELLE S574 575 576 User Guide 232 g A Gaumard Simulators for Health Care Education Noelle 574 575 Labor Scenario Gabriella Uterine Rupture Automatic Mode l During surgery notice anterior uterine wall dehiscence Wait time 2 min Repair anterior wall dehiscence close abdomen Uterus double sutured and bleeding controlled Wait time 3 min NOELLE 574 575 576 User Guide Gaumard Simulators for Health Care Education Noelle S574 575 Labor Scenario June Peripartum Hemorrhage PPH Automatic Mode June is a 31 yr old multip about to have her 5 baby She has had a normal pregnancy and she is planning natural childbirth She enters the hospital in active labor The family is very excited as they know this baby is a boy Labor duration 15 minutes Scenario duration 22 25 minutes S amp S Abdominal and low back pain with ctx S amp S Patient looking pale early signs of hemorrhage 233 NOELLE S574 575 576 User Guide Gaumard Simulators for Health Care Education Noelle S574 575 Labor Scenario June Peripartum Hemorrhage PPH Automatic Mode 234 y Place PPH kit inside Noelle simulator Wait indefinitely Massag
207. o devote an entire profile to one particular Subject area or even one particular scenario To create a user made profile click on the New Profile button on the right panel Manage Enter a name for the new profile followed by a description To include scenarios and palettes from other profiles click the applicable check box For security enable PIN protection which will require a user to enter a four digit key before loading the protected profile 20 Finally click create to save the new profile To import and export profiles navigate to page 118 Create New Profile PIN Enable PIN O security Enter PIN Re Enter PIN Winter Session Profile Description Include contents of Default Include contents fa of Quick Start Noele 574 575 7 OR g Copy current profile NOELLE S574 575 576 User Guide Environment The GaumardUl environment is used by the facilitator as the simulation command center In addition to managing NOELLE s functionality and vital signs the facilitator can evaluate student training and act as the voice for the simulator This powerful combination of tools provides the facilitator with an indispensable tool for simulation training and testing The Status Panel The Status panel is visible along the left edge of the GUI window at all times Information about the battery level signal strength volume controls levels and state of vitals is shown in real time Vital
208. o far away from the simulator Sound is too low or too loud Respiration and other undesirable sounds are heard by instructor Make sure that LED indicator on AC adapter goes through the sequence described in its label usually red or orange after plugging it and then green when charge is completed If LED does not go through label s indications then Check plug connection making sure it is all the way in NOELLE should always be plugged in while being operated The birth mechanism is power intensive and will drain the battery quickly Make sure you are using the appropriate AC adapter labeled with its simulator name If you have more than one simulator in your facility make sure that your computer is properly set up to control the simulator that you wish to control Go to Options on the Setup pull down menu and check the Environment preferences Set the Environment to multiple and match the serial to the simulator Get simulator closer to computer or move away from obstructions Maintain clear line of site between the RF module and simulator Keep the RF module in an upright position Try changing the RF channel by going to the menu for Setup gt Options gt Environment gt Select Auto change to channel number from 1 11 Select a different channel see Options and more section When more than one simulator is in the vicinity assign one channel for each Streaming audio can t reach a
209. o medications and will have the CNM attending her delivery Labor duration 30 minutes 221 NOELLE S574 575 576 User Guide Gaumard Serres bow Heath ae boat Labor Scenario Becca Variations on Normal Automatic Mode Becca is a young pregnant teen who is living on the streets She is a heavy smoker and drug user she was seen twice in the Adolescent Clinic and referred to Social Services but she only saw the social worker once and did not go to the follow up appointment Labor duration 18 22 minutes S amp 5 SROM followed by Becca pushing hard 222 Prep for precipitous delivery support fatal head to present explosive delivery check Tor nuchal cord if possible check Tor Stat Page anesthesia for sedation bimanual exploration for retained secundes collect labs for iox Screen Use of Blranaal uberine massage and pilecin to maintain contractions NOELLE S574 575 576 User Guide Noelle S574 575 Labor Scenario Gaumard Candice Simulators for Health Care Education Shoulder Dystocia Automatic Mode Candice is a 19 r old multip She her boyfriend and their 3 yr daughter are homeless living in a car She has not seen a doctor and believes that she is about 8 months pregnant Her water broke yesterday and she is leaking moderately thick meconium fluid An ultrasound is performed to determine position and gestational age Labor duration 15 minutes Ful
210. o the default auto state Respiration Pattern Eres Rate a k JO change Pfr spiration Auto Fo Efra Volume Auto ml 29 NOELLE 574 575 576 User Guide Manual Input the value of the parameter manually The model automatically adjusts related physiological values Respiration Pattern reso Rate 17 E inspiration Auto Oia Volume Auto Airway Appearance Breathing The A B vertical details tab includes the airway appearance and breathing controls Outlined below are notable controls available in this section Airway Appearance Patient s Info Upper Airway Sound Setrures Name Noelle Eyes Pupils C Enable Ran Time sec Gestional Age 40 w O Enable Ran Age 27 y Heght 65 0 n Breathing Respiratory Pattern Lung Condition v Weight 187 4 b Respiration Pattern 02 Saturabon End Tidal CO Eyes State v ineei ors ear bom Os mero EJs mene echange oO OS ALt teo p excoz O charge Di spiravon via Total 02 level iei wa Total CO2 level vw 2 nm ico Volume t m LA sa Left Lung Right Lung weeks pregnant Sounds v Sounds she has had 0 3 New Edt Load Note Auto means Ta vital s ato lt oGoled Dy modes Cick Y Dutton to howd fias vita to Current Oxygen saturation can be changed by adjusting one of the following four parameters Click on the question mark button to view a brief description of the four options 02 Saturatio
211. oa O iii 167 FACTORY PRESET LABOR CENAR OS o e eno duet adn 168 Manual Mode FIOWEN TS A A A ai 168 QUICK SAS COn O rt AE ciar 168 NOE LU PS apc cases arch acacia case cic eee hae ice ate cado ala 181 PUTO AUC MOJSTF OWEN Sonata esl ears eet datecode re ate tea RA EAN 220 Quick Star NOELLE Modeling cuca ac de eS 220 VIDS ONG ICAUNO SOCOM AMOS saat tet acetal it datictee aldo es 239 PLE STRUCTURE tt 240 TROUBLE SHOOTIN tia a loo lid idolo 241 General THOUDIESMOOUNG EII td cedo 241 TARO SC Sr O ate get Pb Stel Md il tt a ata 247 Micr phon BOOSEIOF Streaming AU CIO td odds decos 248 Connecting TO th Gaumard MONOS iio 250 Configuring the Wireless ad hoc Network fercce2scsacutvceccedses sce MavecadusineegaNedexesuaengic aN arnadiaunccgaNeancnsldioseademecieaase 251 Connecting GaumardUI to the Gaumard Monitors software oocccccnccccccoonncnnnnccnnnonnnnonononononannnnnnnonononnnnnnnnononnnnns 252 Wireless Ad hoc Connection Settings Windows XP c ccscssssesesesesesvevevecececececececeueecevevevevavavavevererersecevevevevavaneeeres 254 SELECTED CONSUMABLES AND REPLACEMENTS PARIS tae dni de do los gon diel Len di Ln 257 Selecionar LIS ennn a a ada 257 Replacing Common Consumable and Replacement Parts ccococonncnnccoconnonnocononnonnonononnonnononanennnnnnnanons 259 A aieeueres 259 Replacino COMMON CONS UMA OS ti a en odias lab 260 WARRANT I are E E A oto ne od geen ain esaide pete Lun ane ah EA 266 CONTAC O A ot ne rea 267 NOE
212. ocia place the fetal baby in the ROA position Activate the delivery mechanism moving the fetus down the birth canal until the fetal head is delivered Simulate dystocia by clicking the Turn ON Dystocia button on the Labor Tab Once the dystocia mode is active the fetal traces will automatically convert to real time mode and with each subsequent contraction there will be a Turtle Sign Students must use the various maneuvers including fetal manipulation to deliver the baby Once the students perform all of the appropriate maneuvers required by the instructor the dystocia mode can be deactivated by clicking on the Turn OFF Dystocia button Once the dystocia mode is off the fetal traces and labor warp factor will adjust to the previous settings and the labor will continue resulting in delivery of the baby It is very important that the students are aware of the Turtle Signs If for any reason the students fail to recognize the proper corrective procedures required the labor can be stopped completely and set up again The instructor can then add an unsatisfactory note to the log of the providers actions Normally the fetus is retained by the delivery mechanism so that it can be rotated but not delivered The facilitator can either turn off the dystocia mode to allow the baby to be delivered in the normal fashion or press the Release Baby button on the Labor tab This action unlocks the baby allowing st
213. oe a Amiodarone Cordarone 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 Dose Onboard Administer 0 05ug kg 0 48 sd 0 2ug kg 0 02 sd 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 Increase the warp factor to speed up the effect of a medication on the patient model Warp Factor aa 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 eS CB A Onboard Administered 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 ns oP uae DARIA a factor gt l 65 NOELLE 574 575 576 User Guide Right click on the drug entry to show the drug effect menu 0 0133 ug kg 00 04 48 Unselect Curren
214. on Team Logging see the previous section of this guide on Logging Evaluation Form The evaluation tool assists facilitators in reporting and assessing provider interaction using a questionnaire form A completed evaluation form can then be stored as a digital document or printed for distribution Gaumard Facilitator Using built in evaluation templates 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 L 5 cear at Evaluation Nan EIA Forceps Delivery On Site Review Postpartum Hemorrhage Shoulder Dystocia 110 NOELLE 574 575 576 User Guide Enter the name of the facilitator performing the review in the On Site Reviewer field Evaluation Form A Load template Eclamptic Seizure xj Print GoToEdit Mode Evaluation Name Eclamptic Seizure On Site Reviewer James C Date 08 08 2011 1 Problems Identified Complete the form by first entering the written response in the Problems Identified field and selecting the applicable multiple choice responses throughout 1 Problems Identified Eclamptic Seizure 2 Provider Tas
215. on what you are calibrating Calibration Chest Compressions The values from the last compressions user calibration are shown below Press START and do 5 lo correct chest compressions one at a time 2 ha following the text cue 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 1 The wizard prompts you with a 1 Perform one correct chest compression 3 A green filled oval indicates that the chest compression was successfully recorded 4 The wizard prompts you with a 2 5 Perform a second correct chest compression 6 A green filled oval indicates that the chest compression was successfully recorded 7 Continue the same process to finish the calibration 119 NOELLE S574 575 576 User Guide At the end of the calibrating session the wizard shows the average peak depth and duration values for the procedure If you feel you performed the procedures correctly click the Save button Otherwise press the Back button to repeat the calibration Notice that you can go back abort or cancel at any time during the procedure Blood Pressure Cuff Blood pressure cuff calibration should be performed only when the Korotkoff sounds do not match the systolic and diastolic values set from the computer To calibrate place the blood press
216. or can quickly log actions from the Provider Actions section of the log page To assign the entry to a particular provider or to the team in general the instructor may utilize the Team Logging feature The following is an example of an unassigned Action entry 00 07 24 Action Assess responsiveness Applied Changes An Applied log entry occurs automatically every time a change is applied to the physiological condition of the simulator In other words each time changes are applied to the simulator from the Details page the Palette page or from a Scenario a log entry similar to the following is created 00 04 01 Applied 00 30 Details Rhythm Sinus Cardiac event 0 HR 80 105 NOELLE 574 575 576 User Guide Detected Events Each time one of the various sensors within the simulator detects a provider action it is automatically logged as a Detected entry These actions include intubation BP cuff placement artificial ventilations chest compressions and electrical therapy pacing defibrillation cardioversion inappropriate shock The following example shows a detected log entry after a provider attempts to defibrillate 00 03 26 Detected defibrillation Shock 2 300 Joules Evaluations Evaluations are added by the facilitator clicking on the Satisfactory or Unsatisfactory buttons on the Evaluation panel The Evaluation panel is present at the bottom of the screen next to the clocks panel and
217. orm SSE to determine cervical status give Terbutaline SQ for tocolysis Reassure patient about effects of beta mimetic drugs Give second dose of SQ Terbutaline for cessation of breakthrough ctx Discontinue Terbutaline give 300ml IV bolus replace tocolytic drug with Procardia 237 NOELLE S574 575 576 User Guide Noelle S574 575 Labor Scenario Gaumard Maria Simulators for Health Care Education Preterm Labor Automatic Mode Maria is a 30 yr old multip 27 weeks She has an 11 yr old and has been trying for more children She has had 2 miscarriages in the last 4 years and she lost both due to an incompetent cervix This time a McDonalds suture was placed 14 weeks Labor duration 15 minutes Give IV bolus apply EFM Wait time 5 min Ctx subside administer mag sulfate skip forward 24 hrs Wait indefinitely Call for help stat page physician Wait indefinitely 238 NOELLE S574 575 576 User Guide Tips on Creating Scenarios Thinking in Terms of Palette Items 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 palett
218. ossible or desirable to determine the responses before the simulation begins Different environments and applications call for different settings 239 NOELLE S574 575 576 User Guide Loosely structured teaching and practice is usually best done with the auto response settings in Prompt mode Responses must be triggered by a vigilant facilitator Though it is slower and requires more attention the benefit of Prompt over other modes is that the simulation can be allowed to go in any direction and it will be possible to choose the response on a case by case basis Tightly structured teaching and assessment requires a higher degree of automation For such applications most facilitators choose Auto mode for the auto response settings The key issue is standardized timing of symptom presentation A consistent repeatable simulation is essential for fair assessment of that care provider in relation to others and for the broader interpretation of results in the context of training validation studies When in doubt it is best to choose Prompt mode in which the facilitator will be given direct control of the responses as events are detected File Structure Advanced users may find it helpful to understand the GaumardUl 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 Ej Desktop My Documents E 4 My Computer e Lo
219. out of the birth canal by gently pulling in line with the birthing mechanism Pulling the baby upward or downward in contrast to the birthing mechanism s linear trajector may bend the motor arm and cause damage to the birthing mechanism Labor Activity As labor progresses the simulator will detect manipulations performed on the fetus by the care providers Activity on the fetus prompts the Activity on Fetus window to appear on the tablet screen providing the instructor with feedback on pulling force uterine contractions torque on the baby twisting force and shoulder position The instructor can evaluate the providers in terms of pulling in or out of sync with uterine contractions The labor activity is a beneficial tool for the instructor as excessive forces applied to the fetus by care providers during delivery can lead to brachial plexus injuries All of these values will be given in real time and they will be recorded by the graphical interface for further analysis Peak Force measurement of how hard the provider is pulling the fetus Can be displayed in lbs or Newton Uterine Activity contractions generated by NOELLE Peak Torque measurement of the torque induced as the provider rotates the fetus negative readings represent counter clockwise rotation and positive values represent clockwise rotation Cardinal Movement the angular position of the baby is measured in degrees taking into account that O d
220. own in this dialog box Descend only with contractions If checked this option configures the motor to descend ONLY when there is a contraction 82 NOELLE S574 575 576 User Guide Run Begins a labor and initializes the birthing mechanism The red bar on the left of the labor screen turns green when labor scenario is running WARNING Do not initialize the birthing mechanism until reading Working with NOELLE and Care and Cautions sections of this guide for important information on preparing NOELLE for delivery On first revision birthing mechanisms always adjust the motor arm before every delivery to prevent the power cable from wrapping around the motor arm First revision systems can be identified by the warning label located atop of the labor mechanism Never operate the birthing mechanism without the tummy cover in place Labor Control Enable Smart Labor 10 g sec gt Descend only with contractions Pause Run Reset Pause This button pauses the labor Reset This button will reset the motor to the initial position and also reset the labor scenario to its initial conditions The reset button is enabled only when a labor is paused If a labor is running this button will be grayed out To troubleshoot the motor mechanism navigate to page 241 Dystocia The dystocia controls will be activated only if the last point on the descent curve is lower than the dystocia threshold set on the Options
221. part and bloody show She labors without problems for about 4 hours and then the fetus starts to brady down after SROM A V E reveals a prolapsed coed in the vagina Labor duration 20 minutes Scenario duration 22 27 minutes 229 NOELLE S574 575 576 User Guide Noelle 574 575 Labor Scenario Gaumard Frances Simulators for Health Care Education Prolapsed Cord Automatic Mode Perform c section delivery infant repair incision Wait indefinitely 230 NOELLE S574 575 576 User Guide Noelle S574 575 Labor Scenario Gaumard Gabriella Simulators for Health Care Education Uterine Rupture Automatic Mode Gabriella is a young Hispanic woman who presents at a small hospital just across the Mexican border She appears to be in late pregnancy and in active labor As the nurse helps her to bed she notices a midline abdominal scar Gabriella has had one prvious child in Mexico but shares no more information Labor duration 15 minutes Scenario duration 25 minutes S amp S Patient feels pain with ctx S amp S Vaginal bleeding extreme Pain pale diaphoretic SS Turn patient on side give O2 incresae IV rate A gt Hit emergency button Rush patient to OR prep transfer to ER e for emergency c section Wait time 3 min Notify
222. port Lab Template Lipid Panel Cholesterol HDL LDL Triglycerides Report Name Lab 01 Description Above normal range Cholesterol LDL Cholesterol Input the results of the tests on the Value column Values above the normal range specified will be displayed in bold Include any comments associated with the test performed Finally click Save from the top right menu to create the lab report Description Above normal range Cholesterol LDL Cholesterol Lipid Panel Female Variable Normal Range HDL Cholesterol mg dL 35 00 85 00 Cholesterold HDL Ratio 0 00 4 40 7 Care required Lipid Panel Male Variable Normal Range HDL Cholesterol mg dL 29 00 71 00 Cholesterol HDL Ratio Ratio 0 00 4 90 Lipid Panel Both Variable Normal Range Cholesterol mg dL 0 00 199 00 LDL Cholesterol mg dL 0 00 129 00 Triglycerides mg dL 30 00 200 00 40 NOELLE S574 575 576 User Guide The newly created lab report will be listed on the Lab Reports list Lab reports can be sorted by name template and description sent status or colors Details Palette Lab Scenario Labor Speech Log Gaumard Lab Reports Name Template Description Sent Create New Lab Report Healthy 2 OB Blood test Healthy Levels View Ww Sortby Color Selected Item Healthy Neonate Blood test Healthy Levels James Metabolic Panel Session 1 Susan Lipid Panel
223. r allow water to enter the interior of the simulator Do not expose the tablet computer to water or excessive dust Set Up NEVER disconnect the communications module while the GaumardUl software is running The software will halt and the module may be damaged Birth Canal Maintenance Ball point pens ink and markers permanenily stain the birth canal insert Do not wrap this or any other Gaumard product in newsprint The birth canal insert can be cleaning by wiping with a mild solution of soap and water After cleaning dust with talcum powder Store the unit in a cool dry place After exercise is completed DO NOT leave birthing baby in contact with the birth canal Post partum hemorrhage check list and Warnings Use only Gaumard s provided simulated blood Any other simulated blood brand containing sugar or any additive may cause blockage and or interruption of the vasculature system At the end of every simulation always flush the system with distilled water to prevent clogging Always position the simulator so post partum hemorrhage fluid flows away from the birth canal and the simulator itself Do not allow PPH fluid to puddle beneath the simulator or reach the lower back To prevent staining or molding always clean NOELLE using diluted soap and water Remove the birth canal and clean thoroughly Electrical Therapy There are inherent dangers in the use of some medical devices For simulations that i
224. r information on troubleshooting this feature refer to the troubleshooting guide in the Appendix IV Medication Infusion if factory installed IV medication infusion calibration is only performed when the infusion rate is inaccurate as shown on the drug tab The system is calibrated from the factory To re calibrate the IV medication infusion functionality of the drug recognition arm follow the steps below WARNING The simulator must be powered on when working with the drug recognition arm This includes calibration purging draining IV infusion Set Med Id and injecting fluids Failure to do so will permanently damage the simulator and void the warranty 1 Locate the drug recognition fill kit and attach the drain hose to the black output port Place the end of the drain tube inside a container lower than the arm in order to siphon the fluids in the next steps 2 Next attach a prefilled syringe with clean water to the white port 123 NOELLE S574 575 576 User Guide 4 Goto the Setup menu and click on Calibration Remote Access Via Network Auto Responses Set Med ID Scan RF Channels 5 The Calibration dialog box is displayed Select IV Medication Infusion and click Next 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 calibra
225. rameters TOCO Contraction Intensity Contraction Frequency min Contraction Duration sec O No Contractions E O Mid Resting Tone mmHg O Moderate O Strong Coupling Probability Size O WPC mmHg i lt Select FHR pattern and dick button to generate spontanerous FHR change FHR Baseline bpm Variability Accel Decel Intensity Y Episodic Changes Y Periodic Changes Variable Changes UA The instructor can generate a uterine contraction at any time by clicking the UA button the contraction will have the same duration and intensity settings applied on the status viewer FHR Generate a fetal heart rate acceleration or deceleration at any time by selecting one of the options in the drop box below the button and then clinking on the button 27 NOELLE 574 575 576 User Guide Automatic Mode When operating in automatic mode the physiologic model calculates physiologic responses from student interaction facilitator input drug administration chronic conditions and programed environmental factors The automatic mode is an upgrade option and requires an activation code to enable Navigate to File gt Profiles to change between operating modes Physiologic Model NOELLE s OB circulation physiologic model is composed of 3 components the maternal female pregnancy model fetal model and neonate Full term model During simulation the materna
226. ransfer current fetal data Clicking on F N Setup displays the Fetal Neo Link Information connection window Enter a port number for this connection and click connect Fetal Neo Link Information fF Adapter Wireless Network Connection Controller IP 10 0 0 1 Port 8080 Connected to 10 0 0 2 Click find available to automatically find an open port Newborn HAL Preemie Tablet Automatic Mode Enabling the Fetus Neonate Link from the options menu displays the following drop down menu Access the F N setup menu on Newborn HAL Preemie HAL tablet us oO CA B C 0 Adv gt AL User Interface SN B8505004 MEDS PROFILE 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 Controler 1P port aosd Connect NOELLE S574 575 576 User Guide 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 Using the Neo Link Fetal vital information will now be sent automatically to the newborn tablet when a labor scenario is complete The Data Received window will prompt the facilitator to accept the incoming neonatal vital information from the NOELLE model Click
227. ration follow the steps below CAUTION Oxygen saturation is calibrated to match a specific oximeter Repeatability is accomplished when using the same oximeter and sensor Even if the oximeter is interchanged with another one from the same brand and model the reading might not coincide To avoid reading discrepancies calibrate this feature each time before using a different oximeter or sensor Disclaimer Co Oximeters that in addition to reading oxygen saturation also read carbon monoxide SpCO and methemoglobin SpMet are not compatible with this simulator NOELLE S574 575 576 User Guide 1 Make sure that the oximeter is turned off Place the 4 A message box is displayed requesting you to turn oximeter sensor all the way into the index finger the oximeter ON making sure the finger is at the center covering the emitting and sensing element Oximeter Information 2 Go to Setup gt Calibration and select Oxygen Saturation Click Next Calibration Calibration Wizard Welcome to the Manikin s calibration wizard Proceed only after i a you have reviewed the calibration section in the user manual 5 Now turn on the oximeter and click OK on the Please select the function you would like to calibrate dialog box Chest Compressions 6 The oxygen saturation calibration dialog box is displayed for 98 Calibration Artificial Ventilation Blood Pressure Cuff Left Oxygen Saturation Cali
228. ratory Rate ES breaths mi change aspiratory Time ulation Rhythm eart Rate beats min dd Y a Click on the down arrow to access sound types and rhythms Upper Airway Sound Resp Pattern nor a None spiratory Rate stridor inspiratory breaths min stridor expiratory C change stridor biphasic 25 NOELLE 574 575 576 User Guide Click on the feature control button to enable blue or disable black features such as hemorrhage chest rise and eye reaction Some feature controls may not be available depending on the simulator configuration For more information about the simulator s features navigate to the Working with NOELLE section of this guide A Hemorrhage Uterine oR hemorrhage Uterine P Apply Panel After the settings are selected in the details area changes are submitted using any of the apply buttons located near the bottom of the page Please note that settings not specified will remain unchanged Click the NOW button to change the simulators condition instantly Alternatively click a trending time to gradually increase or decrease to the numerical value specified e g heart rate blood pressure in the time allotted The right most button can be customized to any transition time you require by clicking the part of the button labeled Edit Some settings are applied immediately such as cardiac rhythm and breathing p
229. re on the Virtual monitor computer NOELLE S574 575 576 User Guide 6 Click on the menu labeled V located on the upper left corner and click Monitor Selection Noelle Monitor Selection WiFi Ethernet RF Controller Check for Updates Help About Exit 7 From the Monitor Selection menu select the applicable simulator screen and click OK to save the settings Pediatric Hal 5 Year 2 Noelle Pediatric Hal 1 Year Noelle and Newborn Hal Newborn Hal Noelle and Premie Hal Monitors distribution pT Premie Hal po Return to the V menu and select Comm setup option to access the TCP Comm Setup window If the communication has not been established please enter the IP address and port number selected on the controlling computer GaumardUl Hal Enter the IP and port selected on the controlling computer Controller IP 0 0 0 0 Port 8001 9 Input the Controller IP address and port number as previously noted on GaumardUl s Virtual Monitor Setup window 253 NOELLE S574 575 576 User Guide Monitor selection NOELLE If the communication has not been established please enter the IP address and port number selected on the controling computer GaumardUl Noelle Enter the IP and port selected on the controlling computer Controller IP 10 0 0 1 Port 8001 If the communication has not been established please enter the IP address and por
230. ree f Only descend during contractions Station 10 speech a speechfvitals 2 Check ROT LOT delivery gt L 5 Contraction Response The contraction response feature makes your labor simulation more realistic When enabled this feature can automatically make changes to the maternal vital signs or add speech palettes during the contraction Contraction Response Enable Contraction Response 84 NOELLE 574 575 576 User Guide Pain controlled The changes made are There are two kinds of patients that you can simulate patients and patients with uncontrolled pain different depending on the selection speech or speech vitals Maternal Vital Signs Changes Audio Palettes think I m having No Changes be et contractions Ouch Ahhh Please need something for the pain Please give me an epidural Increase HR BP and RR Speech vitals Simulates a patient that is pain controlled Simulates a patient that is NOT pain controlled The changes are applied only during the length of the contraction At the end of a contraction the maternal vital signs if changed adjust back to the previous setting When a contraction response is applied the changes are recorded in the Log page Pain controlled patient 00 00 44 Contraction Response Speech Contractions 00 00 56 Applied 00 00 Palette alice02 Details ContractionFreq 4 min Contrac
231. reme Pain pale diaphoretic Turn patient on side give O2 incresae IV rate y Hit emergency button Rush patient to OR prep transfer to ER for emergency c section Wait time 3 min Notify nursery personnel j 4 Gaumard Simulators for Health Care Education Noelle S574 575 Labor Scenario Gabriella Uterine Rupture NOELLE S574 575 576 User Guide Repair anterior wall During surgery notice anterior uterine wall dehiscence Wait time 2 min dehiscence close abdomen Uterus double sutured and bleeding controlled Wait time 3 min 199 NOELLE S574 575 576 User Guide Noelle S574 575 Labor Scenario Gaumard Gail Simulators for Health Care Education Uterine Rupture Gail is a 29 year old primip 35 weeks She was admitted to L amp D from the ER after being involved in car accident Both she and her husband Alan were seriously injured and she is on a backboard wearing a c collar to stabilize the spine Her right humerus is fractured and seat belt marks are visible across the abdomen Labor duration 18 20 minutes Establish EFM await cervical x ray results Wait time 1 45 min Remove collar and backboard Wait time 4 00 min Call for emergency c s Wait time 40 sec
232. represents a complete or partial physiological state The Palette page displays all of the Palette Items in the active profile Each profile has its own separately customizable Palette Create Palette Items with the Details page as described previously Details Palette Scenario Lab Labor Speech Log Description Admission Transitional Labor Second stage Delivery Stage 1 Active Stage 1 Transition Stage2 Stage3 Admission Transitional Labor Second stage Delivery Admission Amy 5 Apply NOW 10sec 30sec imin 2min 5min 10 00 min Apply Palette Items using the buttons at the bottom of the page exactly as changes to NOELLE s condition are applied on the Details page Change NOELLE s vital signs and symptoms instantly by clicking to select a Palette Item and clicking the NOW button Alternatively create a gradual transition in physiological state with one of the other Apply buttons Palette Items can be sorted with the View buttons found on the right side of the page Editing existing Palette Items is simply a matter of selecting the item you wish to modify and clicking the Edit button You will be automatically be taken to the Details page and the settings that comprise the selected Palette Item will be displayed Change them as desired and click the Save as Palette Item button Many of the functions related to Palette Items are also available by clicking the
233. rian Gabriella Uterine Rupture 19 year old Mexican girl has a vertical abdominal scar indicative of previous c section She says she has a child who is with her mother in Mexico city She is having painfull caontractions and suddenly becomes pale and diaphoretic while screaming and clutching her abdomen Her BP drops to 80 60 and the fetus begins to brady down to 80 bpm This is a uterine rupture scenario Maria PTL Maria Preterm Labor Maria is 30 yr old multip 27 weeks She s had 2 miscarriages in the last 4 years due to an incompetent cervix For this pregnancy she had a McDonald s suture placed 14 weeks She is admitted c o abdominal cramping Kelly resuscitation Amniotic Fluid Kelly has suffered an AFE in stage 2 labor She Embolism is rushed into OR for emergency c section and placed on a ventilator She codes as the c s is being performed and needs full resuscitation 50 NOELLE 574 575 576 User Guide Scenario Quick Launch Use the scenario quick launch window to start scenarios with a single click The Quick Launch window displays all the scenarios saved in the current profile Linear Scenario Quick Launch Click the scenario button to start the scenario Quick Launch Details Palette Scenario Labor Lab Speech Log Scenario After the scenario button is clicked GaumardUI will automatically start the scenario Becca delivered precipitously and has retained Becca Sedation secundes Nam
234. riella is a young Hispanic woman who presents to a small hospital just across the Mexican border She is alone and speaks little English Her nurse is fluent in Spanish but Gabriella is very quiet and gives little information June is a 31 year old who is about to deliver her Sth baby She has had a normal pregnancy and plans natural childbirth and breastfeeding Her husband and oldest daughter attended the CBE refresher course and she has arranged for the 11 year old to attend the delivery Kelly is a 34 year old gravida 5 2 38 weeks She is scheduled for an induction due to problems with her last pregnancy That baby weighed almost 10 pounds and she had experienced a severe shoulder dystocia with the delivery She has gained 43 pounds with this pregnancy and her glucose tolerance test GTT is borderline An ultrasound a few days ago estimated current fetal weight at 3800 to 4000 grams Kelly s physiccian feels that her cervix is favorable so he has recommended an elective induction NOELLE S574 575 576 User Guide Overview Runs for approximately 25 minutes Shortly after admission patient clutches her abdomen and fetal baseline bradys down to the 80s Patient becomes very pale and diaphoretic BP drops to 80 60 and pulse is 120 She suffers heavy vaginal bleeding Patient is rushed for emergency C Section Baby is limp and severely depressed needs to be intubated and ventilated To run Caesarian only load Gabriella Ca
235. ry 6 months even if the simulator is not being used otherwise permanent loss of capacity might occur because of self discharge Tablet Computer The touchscreen tablet computer and the GaumardUl software serve as the simulators control center Two tablets are included with the system one to control each simulator respectively Startup and control commands from the GaumardUl software are sent wirelessly to the simulator using the RF communication module shown in the next section Please refer to the computers documentation for important usage and safety information before powering on the tablet computer for the first time Using the stylus 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 15 NOELLE S574 575 576 User Guide Calibrating the stylus To work with the GaumardUl 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 The 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 t
236. s 574 575 and 576 Please use the table below to identify which features are standard and which ones are optional in your NOELLE model before you complete reading Section Il The content of this table is subject to change without prior notice Please contact Gaumard Scientific for the most current information Legend Y Yes O Optional Category NOELLE 574 575 576 Airway intubation Airway Airway sounds Nasal intubation Breathing Pulmonary ventilation BVM mechanical Cardiac Cephalic Automatic blood pressure Bilateral IV Arms Circulation Bilateral pulses Carotid Brachial Radial Virtual blood pressure Breech birth Caesarean delivery External version Leopold Maneuver Normal Labor and delivery Placenta delivery 146 NOELLE S574 575 576 User Guide Category NOELLE 574 575 576 Intramuscular injection sites Systemic Oxygen saturation Urinary Catheterization CT CIN CT ICI The content of this table is subject to change without prior notice Please contact Gaumard Scientific for the most current information 147 NOELLE S574 575 576 User Guide Airway Nasal and Oral Intubation Airway management techniques can be practiced on NOELLE including BVM nasal oral intubation and suctioning Endotracheal tubes NG tubes and LMAs can be used Use the Sellick maneuver if needed to bring the vocal folds into view aca ar Recommended Device Size ale erade Miller 4 or MAC 3 5 size
237. s Networks Change Windows Firewall settings Open Network Connections jj 8 47 aM The Wireless Network Connection dialog box opens Select the link that says Change advanced settings located on the bottom left of this dialog box This will open a new dialog box reheat Helam Connect hn Choose a wireless network Chek an ibem in bhe bet below bo connect bo a para me 4 5 When the Wireless Network Connection Properties dialog box is displayed select the Wireless Networks tab Locate the Advanced button located on the lower right and click it l Wireless Network Connection Properties General Wireless Networks Advanced W Use Windows to configure my wireless network settings Available networks To connect to disconmect from or find out more information about wireless networks in range click the button below View Wireless Networks Prefered networks Automatically connect to available networks in the order listed below Move Up eve down down Add Bemove Properties Advanced Learn about setting up wireless network configuration In the Advanced dialog box select Computer to computer ad hoc networks only Make sure the check box on the bottom is NOT selected By selecting this option the computer will not try to connect to and access point within the facility but t
238. s available for the automatic operating mode are e Default Modeling includes one palette with healthy vital signs e Meds Profile This profile contains fifty two pre programmed drugs to be used on simulations e Quick Start NOELLE Modeling Contains eleven linear scenarios twenty two labor scenarios and one branched scenario It is recommended that you use the Quick Start NOELLE profile which was created in conjunction with experienced healthcare instructors and working medical professionals lt contains prebuilt labor scenarios for birth simulation and post partum complications For many applications it serves a convenient starting point that can be customized to fit most simulation objectives Once the operating mode and profile is selected click Load to continue For more information on the items included on the Quick Start profile navigate to page 168 To change profiles from inside the GaumardUl environment select Profiles from the File pull down menu Creating a new profile Profiles are used to organize and protect software settings As you begin to customize NOELLE it will become clear how profiles can best serve your needs For example e It may be appropriate to assign one profile to each user of your NOELLE system e Others may choose to create a profile dedicated to a specific academic course which might be taught by multiple instructors e For the most detailed exercises it is sometimes useful t
239. s far as normal data having a range of up to 150 ft line of sight between simulator and PC Keep Tablet PC as steady as possible with a clear line of sight to simulator to get the best possible range Keep RF module in a Upright position Sound volume at PC side is managed from PC s volume control Simulator sound volume is managed from PC s Microphone gain control Adjust microphone gain until simulator voice level equals user s voice intensity Always talk as close as possible to the microphone in order to improve quality Using a headset is recommended Since simulator s microphone has high sensitivity in order to capture the voice of providers it also captures all surrounded noises on or around the simulator This is normal and it is not a malfunction NOELLE S574 575 576 User Guide Streaming audio does Single simulator is Make sure to select multiple simulator environment not work checked under Setup gt Options gt Environment tab and enter the Serial Setup Options menu Number of the simulator you are using Warning Streaming audio does not work when Single simulator is checked Streaming audio is an optional feature in NOELLE GaumardUl has set The battery on the simulator Plug AC adapter into the simulator Verify LED light on the power mode to is depleted charger indicates charging status STAND BY NOELLE should always be plugged in while being automatically operated The birth mechanis
240. s into the right forearm IV region The value of the total amount injected will be shown below this value might not give exactly 20 ml Once finished click OK Next gt After a few seconds the Finish button will be enabled and the oval will default back to gray Calibration Calibration For Right Forearm IV Medication Please inject 20 ml of fluids into the right forearm IV region The value of the total amount injected will be shown below this value might not give exactly 20 mi Once finished click OK 9 Click Finish to save the new calibration Factory Settings 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 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 Blood Pressure Cuff Oxygen Saturation 2 TV Medication Infusion lt Back Next gt 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 Each time that one of these sensors is clicked a message will appear at the bottom left of the screen notifying the
241. s remain within normal limits not been using medications of any The normal infant earns good APGAR scores kind A Variations on Amy is 19 years old 1 0 at 40 LL sanior Pees hommally my Norme weeks She weighs 160 Ibs and fetal heart tones remain within normal limits i i The baby earns good APGAR scores Angelica is a 31 year old gravida 5 3 Variati at 41 weeks She weighs 160 Ibs Runs for 20 minutes Labor progresses normally ariations on e Mee ae ists Angelica Neral She has experienced no prenatal and fetal heart tones remain within normal limits complications and has a history of The normal infant earns good APGAR scores fast labors Runs for 10 minutes Fetal descent is rapid Fetal Beth is a 16 year old gravida 2 0 at baseline is maintained at 190 Nuchal chord S en vident and moderate bleeding is noted immediately Variations on 3 weeks She has had one elective Beth following delivery from a second degree perineal Normal abortion She has had prenatal zx laceration The normal female infant is limp dusky care and does not cry spontaneously Baby is hypothermic and tachypneic Runs for 30 minutes Labor progresses normally and fetal heart tone baseline remains within normal limits Patient is unable to fully crown Vacuum AS extractor is required to deliver the head Shoulder Shoulder Cynthia is a 31 year old gravida 3 1 a Cynthia Dystocia at 41 weeks She weighs 170 Ibs dystocia is encountered and McRoberts and
242. se ae Warp Factor 1 3 Sodium Nitroprusside Nitropress Nipride i _ Manage Drug List Sotalol Sotacor Betapace Tenecteplase TNKase Tirofiban Aggrastat ml Rate ml min O Start Vasopressin Pitressin E Verapamil Isoptin Calan Rate L min starto 0 Peak Time 00 02 00 EC50 0 0001mg dl 63 NOELLE 574 575 576 User Guide A brief description is displayed at the top of the window The half life peak time and drug concentration are listed in addition to the standard and over dose dosages Drug Route D se Adenosine Adenocard v mg W Push Onboard Administer Drug Properties Description Half Life 00 00 10 Peak Time 00 00 25 EC50 0 0355mg dl Treats paroxysmal supraventricular tachycardia Note Initial dose is 6mg if no effect is observed in 2 minutes an additional 12mg may be administered This 12mg dose may be repeated one more time after 10 minutes if no effect is observed Common drug Standard Dose Adenosine SD 6mg N Over Dose Adenosine OD 30mg Enter the dose units route and rate if applicable and click the Administer button Drug Route Adenosine Adenocard IV Push 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
243. sign parameters such as heart rate lung sounds and respiratory controls are highlighted in yellow while undergoing change Battery Status all y Signal Strength Breathing Resp Pattern ut Rate 21 bpm In 27 Lung Sounds L nor Li O2 Sat 99 EtCO2 32 mmHg Circulation Cardiac Rhythm Heart Rate 80 bpm Sinus Arrhythmia Heart Sound Blood Pressure 110 66 mmHg Volume Controls Value undergoing change Inactive feature Korotkoff S L R Absent Pulses Radial BL UE Temperature 98 6 F Seizures 21 NOELLE 574 575 576 User Guide Click the arrow to expand the viewer and access status entries for Other Uterine Activity and Fetal Heart rate Additional features only available to Automatic Mode will also be listed in the status viewer status oa UF UA Cont Interval 5 min Cont Duration 40 sec IUPC 40 mmHg UA Baseline 8 Coupling O Probability O Size FHR Auto Baseline 140 bpm a Variability Accel Decel Intensity Circulation RA 100 RV 100 LA 100 LV 100 E Circu ara atory Vessel Diameter Fetal O2 Level ae Normal e Blood Volume 6750 ml Cord Compression o normai E rasa eL er aiis E A Amb Pressure 1 00 ATM con normar Seen Head Compression Inspire 02 21 Fetal Bleed OSat 99 Hemorrhage sn ee Inspire CO2 0 PH 7 39 esneree 1 Mone EtCO 33 mmHg l Shunt Flow 12
244. simulates a vital signs monitor attached to the patient The vital signs information is sent through the ad hoc wireless network from the facilitators tablet to the computer running the Gaumard Virtual Monitor software Configuration Use the Monitors drop down menu to enable disable sensors on the virtual monitor screen share files program custom scalars and configure the connection between the GaumardUI and Gaumard Virtual Monitor software For detailed instructions on how to configure and connect the Gaumard Vital Signs Monitors refer to page 252 Sensors This tool allows you disable any of the waveforms present in the vital signs monitor ECG Leads F File sharing 5pO2 Probe b Custom numbers NIBP Cuff Configuration Resp Monitor Capnography ABP cannula UA r Fr 8 6 F FHR Select any of the waves that you will like to display and select ON If you want to turn any of them off click OFF The vital signs monitor defaults to All On Some sensors 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 NOELLE 574 575 576 User Guide Another way to control the sensors is to go to Monitors gt Sensors gt Window ECG Leads 5p02 Probe File sharing Custom numbers NIBP Cuff Thermometer Resp Monitor Capnography ABP cannula CV
245. splay Recommended Channel over the channel bar with the best measured signal The other bars will only display a Double Click to Select Channel message gt Channel Strength J 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 134 Communication info 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 GaumardUl contains four options Modeling Patient Reset Model Import Between Patients and Auto Log Setting Modeling Patients Reset Model Import Between Patents Auto Log Settings Modeling Patient This option allows you to create a new patient or load an already existing one Reset Model Import Between Patients Auto Log Settings To create a new patient go to Modeling Modeling Patient new patient The following dialog box is displayed Mother Age Height cm v E Stage Information Weight Weight gain vw S2 Latent 51 Actve 1 Transiton Stage 2 Staged Significant Other Maternal Info Respiratory status e Cardiac status 0 Spont Abortions 0 Elective Abortions Preterm 0 Y Living
246. systole 34 NOELLE 574 575 576 User Guide Palette Items 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 43 Creating Palette Items 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 You will be prompted to name the palette specify a description and color code Click Save to create the new palette Item Palette Item Name Palette Item Description H Normal Vital Signs o Healthy O Critical 2 Care Required D Other Navigate to the Palette tab to view a collection of all the palette items in the current profile Breathing resp Pattern normal Respiratory Rate 3 beeaths mn change Inspiratory Time Heart Rate Blood Pressure Absent Pulses Heart Sound beats mn O chance Systolic Masok mmHg O Radial Right normal v 120 80 change O Radial Left Sinus Arrhythmia Other Temperate 1E Seizures none Eyes State 10 binky min Pup s O Enable Rin gt ame B Enable Ren 35 NOELLE 574 575 576 User Guide Palette The second level of control is the Palette tab page Each item on the Palette
247. t Effect Effect Off Standard Dose 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 Fluid amp Gas 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 Volume ml min StatIV Oxygen Concentration L min Stato 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 02 You can pause the administration at any time by clicking Stop Fluids amp Gas Saline Volume ml min Lo Startiv Oxygen Concentration 100 L min 66 NOELLE 574 575 576 User Guide Drug list manager 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 m Rate Concentration Rate Care Provided Select a drug from the Medication List and click edit to view the medication s properties gt Add New Medication New Medication Medication Response Medication List Epinephrine Primatene Adrenalin EC50 0 0095 mg dl Concentration that produc
248. t number selected on the controling computer GaumardUl Noelle Enter the IP and port selected on the controlling computer Controller IP 10 0 0 1 Port 8001 Newborn Enter the IP and port selected on the controlling computer Controller IP 10 0 0 2 E Port 8001 If the communication has not been established please enter the IP address and port number selected on the controling computer GaumardUI Noelle Enter the IP and port selected on the controlling computer Controller IP 10 0 0 1 ES Port 8001 11 On GaumardUl s Virtual Monitor Setup window the connection status will also display connected OF Noelle 574 575 Virtual Monitor Setup Select the number of monitors that will be used with this manikin Also you can name each monitor with an appropiate description O All sensors always ON except tor Swan Ganz Adapter Wireless Network Connection Controller IP 10 0 0 1 Port 8001 Connected to 10 0 0 3 Stop Wireless Ad hoc Connection Settings Windows XP Follow the steps below to create an ad hoc network and configure static IP addresses on Windows XP computers 1 Locate the wireless connection icon on the bottom right corner of your desktop Wireless connection icon 254 2 Right click over the icon A menu appears Select View Available Wireless Networks from the options on the menu Disable Status Repair View Available Wireles
249. te Chest Compressions Artificial Ventilation Blood Pressure Cuff Oxygen Saturation 2 IV Medication Infusion 6 Select the arm to calibrate and click next Calibration IV Medication Infusion Please select the arm you would like to calibrate Y Manikin s RIGHT forearm The calibration information box is a reminder that the IV vasculature must be filled with fluid before continuing Calibration Information 124 7 Follow the instructions and insert 20 ml of fluids in the forearm using the fill syringe Remember to keep the drain tube connected throughout the calibration process Calibration Calibration For Right Forearm IV Medication Please inject 20 ml of fluids into the right forearm IV region The value of the total amount injected will be shown below this value might not give exactly 20 ml Once finished click OK 8 The value in the middle of the window will begin to update as you slowly insert the fluid After inserting 20 mL click OK Calibration Calibration For Right Forearm IV Medication Please inject 20 ml of fluids into the right forearm IV region The value of the total amount injected will be shown below this value might not give exactly 20 mi Once finished click OK The word Done will flash in the middle of the window and the oval will fill green temporarily Calibration Calibration For Right Forearm IV Medication Please inject 20 ml of fluid
250. te response to blood loss The rate of blood loss can be monitored on the status panel in real time by clicking on the advanced tab To treat the patient during the hemorrhage event navigate to the Drugs tab and administer saline solution or blood Click the stop button to deactivate the software model bleeding complication To stop the bleeding from the post partum hemorrhage system click the Hemorrhage control to inactive black and hit an apply button Hemorrhage Hemorrhage Uterine Pres Stop Bleeding rate 2100 ml min Uterine Rupture Wound Size l Uterine Activity Fetal Heart Rate The U F vertical tab includes uterine activity and fetal heart rate controls While all the uterine activity controls are handled by the facilitator just like in the manual operating mode some fetal heart rate controls are handled by the fetal physiologic model Unique to the automatic mode are the following controls e Head compression e Cord compression e Fetal movement e Fetal O Level e Placenta previa e Bleed 32 NOELLE 574 575 576 User Guide Advanced The Adv vertical tab includes advanced cardiac circulatory respiratory and environment controls All the controls in this page are unique to the modeling mode Cardiac Right Heart Chambers Left Heart Chambers Regurgitation Tricuspid Pulmonary Regurgitation Mitral Aortic Resistance v v Resistance i v Contractility Contract
251. ted to L amp D Note Instructor must place tight nuchal cord on fetus during set up Candice Admit Candice Shoulder Dystocia Candice is 19 yr old multip Approximately 8 months pregnant No PNC Ruptured gt 24 hrs Meconium Variables Probable chorioamnionitis Frances section Frances Cord Prolapse Frances was found to have a cord prolapse following SROM during labor The fetus began to brady down but stabilized back to 120 bpm when the head was displaced Gabriella Cesarian Gabriella Uterine Rupture 19 year old Mexican girl has a vertical abdominal scar indicative of previous c section She says she has a child who is with her mother in Mexico city She is having painful contractions and suddenly becomes pale and diaphoretic while screaming and clutching her abdomen Her BP drops to 80 60 and the fetus begins to brady down to 80 bpm This is a uterine rupture scenario Uterine Rupture Gail is a 29 yr old primip 35 weeks She and her husband Alan were in a head on collision at an intersection She is transferred to L amp D from the ER strapped to a back board with her neck stabilized with a c collar She has a fractured right humerus and there is bruising from the seatbelt across her abdomen She is in great pain but the condition of the fetus needs to be established stat before she can be given pain meds 48 NOELLE S574 575 576 User Guide Haley Peripartum Haley is a 33 yr old gravida 2 35 weeks Hemorrhage This
252. tely 15 minutes and it is a Maria Preterm Labor miscarriages in the last 4 years and she tocolysis emergency Patient has reaction to lost both due to an incompetent cervix overmedication of magnesium sulfate This time a McDonalds suture was placed 14 weeks 98 Automatic Mode Quick Start NOELLE Modeling Patient Name Labor Type Alyssa Becca Candice Demaris Normal Labor Variations on Normal Shoulder Dystocia Breech Presentation History Alyssa is a 23 year old primip at term She has received prenatal care in a multidisciplinary practice Her general health is good and she has experienced no prenatal complications She wants to have an unmedicated natural birth Becca is a young pregnant teen who is living on the streets She is a heavy smoker and drug user She was seen twice in the Adolescent Clinic and referred to Social Ser vices but she only saw the social worker once and did not go to the follow up appointment The extremely precipitous delivery and patients agitated state should point participants to order tox screen to check for illicit drug use Candice is a 19 year old multip She and her boyfriend and 3 year old daughter are homeless and currently living in a car She has not seen a doctor but believes that she is about 8 months pregnant Demaris is a young Hispanic teen who has received prenatal care in the Adolescent OB clinic She kept the pregnancy a secret as long as was possible and
253. ter 10 10 10 1 Click once in the subnet mask field to auto populate the correct address Leave all other fields blank and click OK to save the changes and return to the Network and Sharing Center window Tou can gel IP setos ase sutomabcaly if your network supports this capabdity Otherwise you mped to ask your network administrator for the approcriabe F settings Obtain an PP address automatically Use the folowing IP address IP address Subnet mask NOELLE S574 575 576 User Guide Configuring the Wireless ad hoc Network After each computer is configured with a unique static IP address follow the steps below to create the ad hoc wireless network The following steps are performed identically on the GaumardUl tablet and the virtual monitor computer 1 On Network and Sharing Center and select Set up a new connection or network Change adapter settings ENG2 PC Internet Change advanced sharing This computer settings View your active networks You are currently not connected to any networks Change your networking settings Set up a new connection or network Set up a wireless broadband dial up ad hoc or VPN connection or set up Le Connect to a network Select Set up a wireless ad hoc computer to computer network and click Next to continue Y Y set Up 2 MA Network a Choose a connection option ES Set up a new network configure a new router or access point he paniens q connect
254. th Care Education as Variations on Normal 186 NOELLE S574 575 576 User Guide Gaumard Simulators for Health Care Education Noelle S574 575 Labor Scenario Candice Shoulder Dystocia minutes Candice is a 19 r old multip She her boyfriend and their 3 yr daughter are homeless living in a car She has not seen a doctor and believes that she is about 8 months pregnant Her water broke yesterday and she is leaking moderately thick meconium fluid An ultrasound is performed to determine position and gestational age Labor duration 15 minutes Full scenario duration 23 25 S amp S Complains of tenderness in abdomen finds ctx very painful Turn patient LLP to resolve variables Wait time 2 30 min Check that variables have resolved Wait time 3 min Go to Labor Candice Wait time 2 min Admit to birthing room administer medication change position to relive variables 187 NOELLE S574 575 576 User Guide Gaumard Simulators for Health Care Education Noelle S574 575 Labor Scenario Candice Shoulder Dystocia 188 Perform Suprapubic pressure McRoberts Woods and Rubin maneuvers Alleviate Dystocia with Gaskin maneuver Titrate pitocin to maitain uterine contractions give
255. th the same name simply power down any other computer configured with the same network name during this step and try again 4 Windows will advise if the network is successfully completed by displaying a ready message and a summary of the network s properties Click Close and restart the computer The GaumardNet network is ready to use This network will appear in the list of wireless networks and will stay active until everyone disconnects from it Give the network name and security key if any to people you want to connect to this network Wireless network name GaumardNet Network security key unsecured 252 Verifying the ad hoc wireless connection Window 7 systems do not automatically connect at startup To establish a connection to the ad hoc wireless network navigate to the wireless icon located at the bottom right corner of the screen select the ad hoc network name and click connect Because the computers are connecting to each other both systems must be powered on Currently commected Lo Ne nbernel accen Wireless Netwcak Connection 2 Aa GaumardNet Connected Connecting GaumardUl to the Gaumard Monitors software GaumardUl sends all the vital signs information to the Gaumard Monitor software over the wireless ad hoc connection configured in the previous section Follow the guide below to establish the connection between the programs CAUTION To avoid connection issues always
256. the volume control located on the status panel to reach the desired level Set Cyanosis level to a desired level by playing with the Set Max cyanosis level control Set pupil dilation level properly by following procedure described in the manual under section Options and more see Tolerances Tab Try the Set to Ambient Light feature under Options Tolerances see Manual section Options and more If it doesn t work then try increase decrease sensitivity feature under same tab The simulator must be calibrated with the oximeter instrument that is going to be used including the Pulse Oximeter Sensor Oximeter sensors cannot be swapped even with oximeters of the same brand and model An oximeter that includes carbon monoxide and or methemoglobin sensing is being used These will not work with NOELLE Oximeter has been placed on the Drug Recognition arm This arm does not have the Oxygen Saturation feature Make sure to slide the pulse oximeter probe all the way into the simulator s finger Ensure the emitter part the red light of the probe is on the nail side of the finger If it is believed that the probe is properly placed it means that it was not properly placed when calibration was performed and re calibration is necessary See O2Sat calibration section for more info A 2 discrepancy between value set and oximeter reading for O2Sat values above 80 and 3 below 80 should be expect
257. this button also enables you to select where the scenario should go after the path is finished playing Copy This button allows the user to copy the entire path You can paste it to a different node or paste it in the same node to duplicate it a Delete E This button allows the user to delete any undesired path F NOELLE 574 575 576 User Guide 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 drugs 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 a large 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 Heart Association Administering medications Medications are administered to the patient model by either of the following methods e Using the Drug Recognition Arm The drug recognition arm detects tagged syringes preprogrammed with a medication type and concentration When this method of administration is used sele
258. tionDurat 40 sec 00 00 59 Contraction Response Speech Epidural 00 01 11 Contraction Response Speech Aahh 00 01 21 00 01 30 Contraction Response Speech Epidural 00 01 33 Applied 00 00 Palette alice04 Details HR 70 RR 19 Contraction Response Speech Ouch ES iit 00 01 12 Applied 00 00 Palette alice03 Details RR 23 OSat 97 ContractionFreq 3 min ContractionDurat 70 sec Contraction gt L im No pain controlled patient 00 00 41 Contraction Response Decrease HR BP RR 9 during contraction 00 00 42 Contraction Response Decrease HR BP RR 9 during contraction 00 00 55 Applied 00 00 Palette alice02 Details ContractionFreq 4 min ContractionDurat 40 sec 00 00 57 Contraction Response Speech Epidural Increase HR BP RR 12 during contraction 00 00 58 Contraction Response Decrease HR BP RR 9 during contraction 00 01 07 Contraction Response Speech Aahh Increase HR BP RR 12 during contraction 00 01 08 Contraction Response Decrease HR BP RR 9 during contraction 00 01 11 J iil Applied 00 00 Palette alice03 Details RR 23 OSat 97 ContractionFreq 3 min ContractionDurat 70 sec Contraction __ gt lt E 85 NOELLE 574 575 576 User Guide Descent Curve The descent curve represents the position of the fetal head relative to the ischial spines in centimeters from 5 cm to 10 cm station The
259. to a wireless ceso a hidden network or e a new wir Sonnet to a ee u di or VPN con Je Setup a dial up connection pay onnect to the Internet using a dial up connection The next screen provides some information about the ad hoc connection click Next G G oy Set Up an Ad Hoc m Set up a wireless ad hoc network An ad hoc network sometimes called a computer to computer network is a temporary network used for sharing files presentations or an Internet connection among multiple computers and devices Computers and devices in ad hoc networks must be within 30 feet of each other If you re currently connected to a wireless network you might be disconnected when you set up this network 251 NOELLE S574 575 576 User Guide 1 In the Network name SSID field type GaumardNet Network names are case sensitive and must be typed identically on all the computers that will belong to this ad hoc network LE dx Set Up an Ad Hoc Netwo Give your network a name and choose security options Network name GaumardNet Security type No authentication Open v Help me choose Security key Hide characters 2 Ensure the security type is No authentication Checkmark Save this network then click Next Give your network a name and choose security options Network name GaumardNet Security key Hide characters J Save this network Cancel If the system warns of another network wi
260. to bring the legs down MLE is performed and baby is delivered Runs for approximately 20 minutes Instructor must place C collar on NOELLE simulator before beginning scenario During delivery patient has tonic clonic seizure followed by tetanic contractions Fetal baseline drops to approximately 60 bpm SVD occurs very quickly Infant is cyanotic and limp and no respiratory effort is evident Baby is pronounced dead after 20 minutes of resuscitation Patient Name Erin Faye Frances Gabriella Gail Labor Type Preeclampsia Cord Prolapse Cord Prolapse Uterine Rupture Uterine Rupture History Erin is a 28 yr old 38 weeks admitted by her physician for preeclampsia She is started on Magnesium sulfate per protocol induced with pitocin and her membranes are ruptured Light meconium staining is noted following AROM Faye is a 34 year old gravida 1 0 25 weeks gestation She had been involved with a married man and this unexpected and unwanted pregnancy caused a great deal of stress in her life After much emotional upheaval she decided to have the baby The affair ended and she is no longer involved with the father of the baby None of her family or friends are aware of the pregnancy She began cramping about 3 hours ago and decided to drive herself to the hospital when she began leaking clear fluid An admitting clerk helps her into a wheelchair and takes her to L amp D Frances is admitted
261. tocolytic drug with Procardia S amp S no adverse reaction to Procardia 2009 Gaumard Scientific All rights reserved 218 NOELLE 574 575 576 User Guide Gaumard Simulators for Health Care Education Noelle S574 575 Labor Scenario Maria Preterm Labor Maria is a 30 yr old multip 27 weeks She has an 11 yr old and has been trying for more children She has had 2 miscarriages in the last 4 years and she lost both due to an incompetent cervix This time a McDonalds suture was placed 14 weeks Labor duration 15 minutes Give IV bolus apply EFM Wait time 5 min Ctx subside administer mag sulfate skip forward 24 hrs Wait indefinitely Call for help stat page physician Wait indefinitely 219 NOELLE S574 575 576 User Guide Automatic Mode Flowcharts Quick Start NOELLE Modeling Values in parenthesis indicate vitals controlled by the Automatic Mode feature Values in bold signify changes in the values throughout the stages Scenario Name Labor Type ICI II IIA AT e JO mt 220 NOELLE S574 575 576 User Guide Noelle S574 575 Labor Scenario Gaumard Alyssa Simulators for Health Care Education Normal Labor Automatic Mode Alyssa is a 23 yr old primip at term Her health is generally good and she has experienced no prenatal complications She wishes to receive n
262. tware comes preloaded with a set of commonly used drugs Each of these drugs has a default dosage unit and a default route for administration which can be overwritten by just typing over it For example Adenosine has the default dosage unit of mg and the default route is IVP intravenous push In order to enter an administered dose 6 mg of adenosine via IVP the facilitator need only enter the text ad which prompts the software to automatically search the drug list and display the best match if any 107 NOELLE 574 575 576 User Guide After a drug has been selected the action of clicking on the dose text field the units and route fields with the default values for that particular drug are filled automatically Medication Dose Drug Units Route r _ The facilitator then enters the dose and clicks on the Administered button prompting the event to be recorded in the log Following the example suppose the dose entered was 6 00 05 43 Action Medication Administered Adenosine 6 mg IVP Team Logging The Team Logging feature allows the facilitator to designate which member of the team performed a particular action The Team Logging section is right above the Provider Actions section on the Log page Session Title Providers Before beginning a session the facilitator can add the names of all providers in the team to the team log This is done by clicking on the Add button and filling i
263. udents to pull the baby through the birth canal Cesarean Delivery Cesarean birth is the delivery of the fetus through an abdominal and uterine incision A Cesarean delivery also called a C section may be performed as a result of breech presentation pre term or dysfunctional labor fetal distress prolapsed umbilical cord placenta previa placental abruption or a variety of other abnormalities Demonstrate a C section using NOELLE by unfastening the snaps just above the pubic bone and birthing the baby between the tummy cover and the pubic bone An optional abdominal cover is available if the Instructor wishes to demonstrate midline or bikini incisions Delivery mechanism fully retracted and inflatable cushion inserted 159 NOELLE S574 575 576 User Guide NOELLE C section delivery using abdominal cover with bikini incision P N S575 029 WARNING Do not enable the motorized birthing mechanism while performing this exercise 160 Prolapse of the Umbilical Cord Prolapse of the umbilical cord is a dangerous complication which involves the presence of the umbilical cord in the birth canal in front of the presenting fetal part This condition may occur as a result of breech presentation transverse lies a small fetus an overly long cord a placenta placed low in the uterus or other abnormalities If the cord is observed in the birth canal ahead of the presenting part gloved fingers should be insert
264. um Hemorrhage Shoulder Dystocia Category Umbilical Cord Prolapse Multiple Choice Entry 6 Vacuum Delivery 116 New Session Reset Session Clock save Report Print Report Import Export Profile This option allows you to change your current profile The profile window is displayed Noelle 574 575 Profiles Select Operating Mode Manual Automatic Profile Description Default Manage The profiles dialog box displays the available profiles A software restart is not necessary to switch between profiles New Session Clicking New Session in the file menu will e Clear any loaded playing scenario e Clear any loaded playing palette e Reset vital signs to normal values e Clear out log page e Restart the session clock NOELLE S574 575 576 User Guide The session clock is located at the bottom of the dialog box Clocks Transition remaining 00 00 00 The shortcut key for staring a new session is Ctrl N Reset Session Clock 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 facilitator can also reset the session clock by clicking on the Session button next to the session time Clocks Transition remaining 00 00 00 06 04 52 Save Report This option allows you to save all the information recorded in the log page as
265. ure cuff on the arm you wish to calibrate right or left Remember to connect the cuff s Luer lok connector to the simulator s shoulder Select which arm you will like to calibrate Calibration Blood Pressure Cuff Please select the arm you would like to calibrate Manikin s RIGHT arm Factory calibrated Manikin s LEFT arm Factory calibrated You will then be prompted to set the BP cuff to a certain pressure hold that pressure constant and press the OK button Follow the text cue on the screen and repeat the procedure for each pressure level until Done is displayed Calibration BP Left Arm Set the pressure on the cuff to the value shown Hold that value constant and click the OK button 120 For example if calibrating the left arm The wizard prompts you with 0 mmHg Set the pressure on the BP cuff to O i e cuff valve open 1 Click the OK button 2 A green filled oval indicates that the value was successfully set The wizard then prompts you with 20 mmHg Click the OK button A green filled oval indicates the value was successfully set 3 4 Set the pressure on the BP cuff to 20 mmHg 5 6 7 Continue the same process to finish the calibration Once the prompt reads Done go back and calibrate another function or click the Finish button to close the calibration wizard Oxygen Saturation if factory installed To calibrate the oxygen satu
266. urosemide Lasix Dose 40 mg At time Results At time 02 12 51 Max Interaction Effect 22 07 Alpha 1 68 Compared to Additive individual drug effect reduced by 39 70 ii Time min Adding an Interactor 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 EC50 0 0001mg dL Interactors Remove Remove All Drug List Captopril Capoten Interactor Data Half Life 01 54 00 Peak Time 01 00 00 SD 25mg OD 75mg ECS0 0 0240mg dL 72 NOELLE S574 575 576 User Guide 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 Select the interactor and click Edit Interactors Captopril Capoten Sodium Nitroprusside Nitropress 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 hzl Max Alpha 0 75 lsobologram plasma concentration pi DE TE ar a E E E T B a E a z a E E o 100 1350 200 Naloxone Narcan mg dL 10 6 73 NOELLE S574 575 576 User Guide Test Panel Th
267. ust be utilized to bring the legs down MLE is performed and baby is delivered 99 NOELLE S574 575 576 User Guide Patient Name Labor Type Eleanor Faye 100 Preeclampsia Cord Prolapse History The ER is notified that EMS is about 4 minutes away with a 19 year old pregnant post ictal patient named Eleanor Her aunt found her convulsing in the bathroom and called 911 The aunt told the EMS providers that Eleanor was 8 months pregnant with her first baby and that it was a difficult family Situation She added that Eleanor had just moved in with them and had not yet seen a doctor The paramedic reports to the ER physician by radio that the patient is responsive only to pain Her initial blood pressure is 180 120 The EMS crew applies a C collar and moves her onto a backboard for transport The paramedic initiates ECG monitoring and does a genital exam before they move her She notes a small amount of vaginal bleeding The crew moves her to the ambulance and the paramedic starts an IV of LR and initiates oxygen Y 10L by non rebreather mask She monitors the ECG and VS during transport and also tilts the back board about 15 to the left with a blanket roll to decrease vena caval compression Eleanor has no further seizure activity during transport but her BP remains consistently 180 110 The ER notifies L amp D about the patient and asks that an OB nurse come to the ER to assist Faye is a 34 year old gravida 1 0
268. vice is connected to the tablet first select and open the evaluation document saved in the previous step MIA gt Libraries Documents Evaluations Organize y Open v Share with v Print E mail Burn New fold Fr Favorites Documents library Evaluations A Libraries eal Eclamptic Seizure Session 3 xps Es Documents 112 NOELLE 574 575 576 User Guide In the XPS Viewer navigate to the file menu and select print s Eclamptic Seizure Session 3 xps XPS Viewer Permissions Signatures Ctrl 0 Ctrl 5 Ctrl P Properties Alt Enter Exit Alt F4 a El ptic Seizu On Site Reviewer James C Date 08 08 2011 Select the printer device from the list box and click print Select Printer ta Add Printer jm Canon IR C4080 C4580 PCL5c p E Pinto Page Range 9 Al Number of copies Selection Current Page Pages 1 3 _ Collate Enter either a single page number or a single a 22 333 page range For example 5 12 Creating new evaluation templates Each evaluation is based on an evaluation template Facilitators can create new evaluation templates to tailor specific assessments Template design and creation is done in the evaluation form edit mode To enter the edit mode toggle the Go To button located on the top right of the evaluation form window In edit mode enter the name of the evaluation template in the Evaluation Name field Evaluation Form Loa
269. which can decrease overall clarity For optimal clarity adjust the microphone volume to 100 and the microphone boost to 10 Click OK to save the changes to the volumes on the microphone properties menu Click OK to close the Sound properties window Select a recording device below to modify its settings Microphone Realtek High Definition Audio Default Device Set Default v 249 NOELLE S574 575 576 User Guide 7 It might be necessary to re adjust the microphone settings to accommodate environment noise Connecting to the Gaumard Monitors To establish a connection between the Gaumard Virtual Monitor software and GaumardUl both computers must be connected to the same network ad hoc network The section below describes in detail how to configure the ad hoc wireless settings and establish a connection between the Gaumard computer systems Follow the guide when troubleshooting connection issues Vital sign information is sent and updated from the GaumardUl software via Wi Fi ad hoc network connection and not from the simulator or the RF communication module Procedure overview for each computer e Configuring Static IP addresses e Configuring the Network SSID name e Verifying the ad hoc connection Configuring the computer static IP Perform the steps below to assign a static IP addresses to the Gaumard Virtual Monitor computer and the GaumardUl tablet Please note that each computer requires a unique static
270. with Gaumard product instructions including failure to property clean the Gaumard product and 3 Damage resulting from a repair or attempted repair of the Gaumard product by anyone other than Gaumard or a Gaumard representative This one year limited warranty is the sole and exclusive warranty provided by Gaumard for the accompanying Gaumard product and Gaumard hereby explicitly disclaims the implied warranties of merchantability satisfactory quality and fitness for a particular purpose Except for the limited obligations specifically set forth in this one year limited warranty Gaumard will not be liable for any direct indirect special incidental or consequential damages whether based on contract tort or any other legal 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
271. wns Syndrome baby so she is very apprehensive An early U S and genetic studies showed this baby to be a E EINS IO Nave ee eee TEAL NONS normal female She has had several to the drug and contractions break Madonna Preterm Labor l through about 30 minutes later Another episodes of preterm contractions that dose of Terbutaline is given and her resolved with LLP bed rest and oral hydration ie i reaction is worse and contractions break She began contracting again 3 hours ago and th ress rough yet again Eventually she s given again tried LLP bed rest and oral hydration Procardia which resolves the contractions but the contractions have continued amp and does not give adverse reactions become stronger Runs for approximately 35 minutes Patient starts having contractions and is given SQ Terbutaline to stop contractions NOELLE is a 27 year old female weighing Runs for approximately 60 minutes 155 pounds W Gain 25 Her significant other is Hal Her OB history shows a Gravida of 1 a term of 0 a preterm of 0 and that she is currently 40 weeks pregnant she has had 0 spontaneous abortions 0 elective abortions NOELLE and 0 living children She has had no prenatal care She has been currently using no medications of any kind Her medical records show she has no previous history Her treatment history includes none 102 Speech Prerecorded Sounds NOELLE has over 90 pre recorded expressions which can
272. y of the anterior shoulder with a finger inserted into the birth canal to free the arm Upward traction allows the posterior shoulder to deliver and the posterior arm is freed in the same manner After the delivery of the shoulders the fetal head delivers in a flexed or heads up position Although it is possible for a vaginal delivery of breech presentations once a breech presentation has been confirmed a Cesarean is often performed to lower the risk of infant mortality due to cord prolapse or birth asphyxia To simulate breech presentations with the NOELLE retract the birthing mechanism fully remove the cover in the fetal head insert the birthing mechanism into the fetal head and place the fetal legs in either an extended position to simulate footling delivery or retract the legs for a frank delivery 161 NOELLE S574 575 576 User Guide Remove plug in fetal head for breech delivery Frank delivery The Pinard or leg flip maneuver frees one leg then another The fetal arms may also require a similar maneuver during delivery 162 The fetal arms are delivered and the fetus rotated anteriorly to birth the head Placenta Delivery The placenta supplied with NOELLE may be positioned so that it births spontaneously or requires either modest cord traction or manual removal In addition note that the placenta is designed with two removable placental fragments These fragments are attached to the body of
273. your hardware documentation for details This should improve the volume of the microphone used for streaming audio Microphone Boost Windows 7 Use the instructions below to increase the streaming audio volume The Headset must be connected to the tablet in order to adjust the microphone volume properties In addition adjust the recording control on the headset s physical control to high 1 2 Right click on the speaker icon located on the bottom right corner of the laptop s taskbar 8 15 AM a Er jg i Ba Pw all 72011 The speaker menu is displayed Click on the recording devices option Open Volume Mixer Playback devices Recording devices Sounds Volume control options ana eRe I a lt apm 3 The sound properties window and recording tab are displayed Right click the microphone option and select properties Select a recording device below to modify its settings Microphone Realtek High Definition Audio Default Device Configure Speech Recognition Disable Show Disabled Devices Y Show Disconnected Devices Properties NOELLE S574 575 576 User Guide From the microphone properties sub menu select the Levels tab Use the microphone control to decrease and increase the recording volume For an additional increase in recording volume use the microphone boost control Microphone Boost 8 Microphone boost increases volume and saturation

NOELLE S574/S575/S576 User Guide

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