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NOELLE S554.100 User Guide

1. 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 162 NOELLE S554 100 User Guide Noelle S574 575 Labor Scenario Gaumard Kimberly Simulators for Health Care Education AFE Kimberly is a 27 yr old multip 42 weeks She began having contractions at home and now they are becoming stronger She is excited to be finally going into labor By the time the nurse completes admission Kimberly is requesting pain meds as her labor is progressing quickly Labor duration 25 minutes Scenario duration 30 minutes 163 NOELLE 9554 100 User Guide Gaumard Simulators for Health Care Education Noelle S574 575 Labor Scenario Kimberly AFE 164 Begin CPR Wait time 4 min y Deliver baby perimortum c s Wait time 3 min NOELLE S554 100 User Guide 7 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
2. 143 NOELLE S554 100 User Guide Noelle S574 575 Labor Scenario Gaumard Frances Simulators for Health Care Education Prolapsed Cord Perform c section delivery infant repair incision Wait indefinitely 144 NOELLE S554 100 User Guide 4 Noelle S 574 575 Labor Scenario aumard Salt for Health Care Education Gabriel la Uterine Rupture 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 gt S amp S Vaginal bleeding extreme Pain pale diaphoretic Turn patient on side give O2 incresae IV rate Vv Hit emergency button Rush patient to OR prep transfer to ER 0 for emergency c section Wait time 3 min Notify nursery personnel 145 NOELLE S554 100 User Guide 4 Gaumard Simulators for Health Care Education Noelle S574 575 Labor Scenario Gabriella Uterine Rupture 146 Repair anterior wall During
3. 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 94 NOELLE specific options Configure NOELLE specific features Envromnent corea tores op Oe Reset Labor Force Display 0 ss 44 89 155 Fetal Monitor Paper Speed 1cm min 2cm min 3 cm min OK j 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 86 Labor force display Set the threshold for the labor force display To read more about the labor force display go to Page 58 Fetal Monitor paper Speed Use this feature to adjust the speed of the fetal monitor paper on the FHR monitor screen Single Vital Monitors You can display Gaumard Monitors using one monitor To do so select the checkbox use single monitor for maternal vitals and fetal traces When you enable this checkbox the Maternal Vitals Fetal Monitor control is shown in the GUI These controls enable you to change the display on the vital signs monitor Options Once a Palette is applied load to Details Tab O Use AV System Start AV Automatically on Scenario Start Output Log Events to Windows Log F Use single monitor for materna
4. 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 NOELLE S554 100 User Guide Noelle S574 575 Labor Scenario Gaumard Kelly Simulators for Health Care Education aa 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 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 gt i 7O Give SQ Terbutaline to reduce ctx Rush to OR for emergency c section Intubate ventilate stat page anesthesia and NICU personnel 161 NOELLE 9554 100 User Guide Noelle S574 575 Labor Scenario Gaumard Kelly Simulators for Health Care Education Amniotic Fluid Embolism
5. 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 a ee o ee Reported Log CPR 73 NOELLE S554 100 User Guide 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 each training session the session title and facilitator fi
6. NOELLE S554 100 User Guide Calibration Chest Compressions Please select the type of calibration you would like to do Normal Calibration You will be asked to ig perform based on your criteria Providers 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 on what you are calibrating Calibration Chest Compressions The values from the last compressions user calibration are shown below Press START and do 5 correct chest compressions one at a time following the text cue Finish The facilitator should follow the text cue on the screen to perform just ONE compression or ventilation at a time until prompted for the next one For example if calibrating chest compressions The wizard prompts you with a 1 Perform one correct chest compression A green filled oval indicates that the chest compression was successfully recorded The wizard prompts you with a 2 5 Perform a second correct chest compression 83 NOELLE S554 100 User Guide 6 A green filled oval indicates that the chest compression was successfully recorded 7 Continue the same process to finish the calibration At the end of the calibrating session the wizard shows the average peak depth and duration values for the proce
7. The Gaumard Virtual monitors must be connected before using the file sharing feature To verify the connection navigate to PAGE 91 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 Platelets Differential A Selected Item Cholesterol HDL LDL Triglycerides Anion Gap Albumin Alkaline Phos Caldum Chorid For newborn and premie 24 NOELLE S554 100 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 EIS Edit Lab Results Template Single Entry Remove Rename insert l A d y Add Delete Allowed value range is displayed in Value column It won t be visible when entering data Categories are used to group a series of tests in a lab report From the Category box click Add to name and create a category Then click OK to save the new category HIE Edit Lab Results Template Name Lipid Panel Description Cholesterol HDL LDL Triglycerides Category Single Entry Remove Rename insert AD Lv add Delete HE Category Name Lipid Panel Female Comment Use the Single Entry menu to add a test under the category previously created E Edit Lab Results Template Na
8. 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 S554 100 User Guide Ventilations are too shallow Waveform peaks do not reach the green zone 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 Noelle Features 2 Ventilations and Compressions Compressions per minute Compression Ventilation Ratio Only Ventilations Ventilations per minute 93 NOELLE S554 100 User Guide 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 Beca
9. NOELLE S554 100 User Guide Circulation 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 WARNING Do not attempt to fill IV system without the drain connector in place Always leave the drain port connected when injecting fluids into the system Use only Gaumard s provided simulated blood Any other simulated blood brand containing sugar or any additive may cause blockage and or interruption of the vasculature system Always purge the system with 70 isopropyl alcohol solution at the end of every simulation 1 First locate the fill syringe with tubing and the drain tube with pinch clamp Fill the syringe with the desired fluid water or simulated blood 97 NOELLE S554 100 User Guide 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 3 Leave the drain tube clamp opened and depress the syringe until all air has been pushed from the IV system and fluid runs from the drain 4 To simulate a patient with no accessible peripheral IV sites connect only the syringe Pull the plunger to create suction which will collapse the veins Disconnect the syringe tube from the arm
10. Log Lab Reports Name Description Healthy 2 Healthy Levels Healthy Levels Session 1 Session 4 Simulation 1 High levels 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 01 11 36am Above normal range Cholesterol LDL Cholesterol HDL Cholesterol mg dL 35 00 85 00 Cholesterold HDL Ratio 0 00 4 40 0 00 199 00 0 00 129 00 30 00 200 00 The preview window also allows the printing of results for distribution and archiving To make changes click Close and then edit Send to monitor Begin by selecting the report from the lab reports list Lab Reports ETT Template Description Healthy 2 OB Blood test Healthy Levels Healthy Neonate Blood test Healthy Levels Metabolic Panel Session 1 labor tpidPal Abovenomalrange Choesteral LOL Cholesterol CBC DIFF High levels High levels Click the Send to Monitor button to transfer the lab report to the Virtual Monitors Selected Item 28 NOELLE S554 100 User Guide 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 Noelle Ask for The lab report will open using the system s de
11. NOELLE S554 100 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 ll S amp S Suffers tonic clonic seizure prolonged fetal bradycardia results Stat page on call OB attending Give Magnesium sulfate bonus Employ safety measures during seizure give another Magnesium sulfate bonus Prep for precipitous delivery following tetanic ctx Hang pitocin infusion following placental delivery to encourage uterine contraction 139 NOELLE S554 100 User Guide Fy Noelle S574 575 Labor Scenario br 5 Gaumard Eleanor Simulators for Health Care Educatior Variations on Normal 140 NOELLE S554 100 User Guide 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
12. 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 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 185 NOELLE S554 100 User Guide 1 In the Network name
13. Pattern normal y Left Lung Sound normal Right Lung Sound normal Respiratory Rate OSat EtCO2 a breaths min O mmHg Inspiratory Time 33 change pratory 33 28 change change Circulation Rhythm Sinus Ma Heart Rate Blood Pressure Absent Pulses Heart Sound beats min a enki 5 80 Os daw Systolic Diastolic mmHg Radial Right normal 114 80 O change O Radial Left Sinus Arrhythmia Other Temperature F Seizures none Eyes State 120 blinks min Y Pupils L O Enable Rxn Time sec Hemorrhage Uterine Pres i O Enable Rxn q ee Ge Ge ee 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 De
14. Speech 1 00 01 complaint Feel dizzy P Additem Add Scenario 2 Copy Remove Addpath 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 To add a key event to a node first click the Add path button then the edit button located on the right z l Edit 2 Deteriorate ee 3 00 01 3 O gt wait 02 00 No changes are made to mankin ca ca et Delete Speech 1 00 01 confusion What happened Cardo Drop 01 00 HR 15 BP 10 OSat 5 MY fod L 7 Copy Additem AddScenano Copy Remove Add path vr 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 In this example the provider will have the option to administer Atropine Key events Selected A Move Rename Delete 9 Action ma Linked Action Defibrillation Shock 200 H Joules Cardioversion Shock 100 Joules Non Sync Shock Joules External Pacing aia OK Cancel 1 Start Bradycardia 2 Deteriorate 3 Interventions 4 Atropine 5 Epinephrine 6 Dopamine 8 Pace Previous End 43 NOELLE S554 100 User Guide The facilitator added a total
15. 3 2 1 0 1 2 3 5 add Point 6 7 10 12 13 A MU A A i NN PON IE a IEA aL a SES es IE AAA a OA a es a O IE a SE EAS mo gt 54 NOELLE S554 100 User Guide 5 4 3 2 1 D 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 Transition min sec 59 59 Max Item Description Transitional Labor 55 NOELLE S554 100 User Guide 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 Edit Palette Item Remove Palette Item 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 st
16. 40 mmHg Resp Pattern male 8 Rate 13 bpm In 33 mant 02 Sat 98 0 Prob 0 Size Rate 13 bpm In 33 eee oe ee Variability O2Sat 98 Circulation Ns Cardiac Rhythm Accel Decel Intensity Etco2 40 mmHg Son average Spontaneous Changes HeartRate 70 bpm r Periodic Changes Circulation Blood Pressure 120 80 mmHg i Cardiac Rhythm pm Other Temperature 37 5 C Parameter Heart Rate 80 bpm undergoing change Blood Pressure 120 80 mmHg Other Temperature 37 5 C Seizures Hemorrhage Uterine Hemorrhage UPO Active inactive feature indicator 17 NOELLE S554 100 User Guide Communication indicator The communication indicator shows the status of the link between the computer and the simulator The indicator is clear when no attempts to communicate with the simulator are being made for example when the wired communication module is not connected to the computer or the if system is in STAND BY mode Status of oo Y status s all W Backup battery indicator The battery status indicator updates as the backup battery in the simulator is used The exclamation mark indicator is shown when there is no communication with the simulator and the program cannot retrieve battery information from the simulator EPEE a Volumes The volume levels for sound features on the simulator are adjusted on the Status Panel Click on the volume level indicator next to each sound level
17. 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 INCLUDING DAMAGES FOR LOSS OF BUSINESS PROFITS BUSINESS INTERRUPTION LOSS OF BUSINESS INFORMATION AND THE LIKE ARISING OUT OF THE USE OR INABILITY TO USE SUCH PRODUCT OR RELATED TO THIS AGREEMENT EVEN IF GAUMARD HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH DAMAGES GAUMARD SHALL NOT BE LIABLE TO YOU FOR ANY INDIRECT SPECIAL INCIDENTAL OR CONSEQUENTIAL DAMAGES OR LOST PROFITS ARISING OUT OF OR RELATED TO THIS AGREEMENT OR YOUR USE OF THE SOFTWARE AND OR THE RELATED DOCUMENT
18. Gaumard product in accordance with Gaumard product instructions including failure to property clean the Gaumard product and 3 Damage resulting from a repair or attempted repair of the Gaumard product by anyone other than Gaumard or a Gaumard representative This one year limited warranty is the sole and exclusive warranty provided by Gaumard for the accompanying Gaumard product and Gaumard hereby explicitly disclaims the implied warranties of merchantability satisfactory quality and fitness for a particular purpose Except for the limited obligations specifically set forth in this one year limited warranty Gaumard will not be liable for any direct indirect special incidental or consequential damages whether based on contract tort or any other legal 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 wi
19. Guide Noelle Labor Scenario 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 123 NOELLE S554 100 User Guide Noelle Labor Scenario Francine Cesarean Delivery Gaumard Simulators for Health Care Educatior Francine is a 19 year old female gravida 2 1 at 37 weeks She weighs 145 lbs She has had prenatal care She has STD Herpes Labor duration 10 minutes 124 NOELLE S554 100 User Guide Gaumard Simulators for Health Care El Noelle Labor Scenario Gloria Cord Prolapse 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 125 NOELLE 554 100 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 126 NOELLE S554 100 User Guide Noelle Labor Scenario Educate Irene Cesarean Delivery Gaumard Simulators for Health Care Irene is a 19 year old gravida 2 0 at 29 weeks She has had one spontaneous a
20. How would you rate teamwork during this delivery emergency 5 Communication Good Perfect N A Overall Communication Rating Orient new members SBAR Transparent thinking Directed communication Closed loop communication 6 Situational Awareness Overall Situational Awareness Rating After the evaluation template design is complete click Save at the top of the window Evaluation Form Load template g Save Gear 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 g Save Clear Delete Breech Vaginal Delivery Edamptic Seizure Forceps Delivery On Site Reviey Postpartum Hemorrhage Shoulder Dystocia Evaluation Nan Category Umbilical Cord Prolapse Multiple Choice Entry 6 Vacuum Delivery 80 Monitors Help Profile New Session Reset Session Clock Save Report Print Report Import Export Profile This option allows you to change your current profile The profiles dialog box displays the available profiles A software restart is not necessary to switch between profiles New Session Clicking New Session in the file menu will e Clear any loaded playing scenario e Clear any loaded playing palette e Reset vit
21. Note that the fetus has 2 receptacles at the perineum into which the matching pins located on the birthing mechanism are inserted 99 NOELLE S554 100 User Guide 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 heart tones speaker inside the fetus There will be one actuation of the locking mechanism when the articulating baby is inserted which is normal WARNING Never operate the birthing mechanism without the tummy cover in place 100 Position the baby so that its face is upward anterior Connect the baby to the birthing mechanism while the manikin is ON so that the electromechanical mechanism allows the baby to be locked into place 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 A Mute Listen Talk Gaumard 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 Tip Navigate to File gt Profile from
22. On this section the instructor is able to play any of the custom phrases by either typing on the text box or clicking on the menu option Once a phrase is selected it can be played as the manikin s voice or deleted Prerecorded Speech I m scared My head hurts My name is More If the instructor wishes to play any of the Simulator s prerecorded speech phrases he will need to click on the More button located on the bottom right corner of the Speech page e At any time the user can change the sound volume for sending and receiving To change volume at simulator s end change the tablet s microphone gain To change volume on the tablet use the speaker volume control e See troubleshooting section in the manual for more info NOELLE S554 100 User Guide 69 NOELLE S554 100 User Guide Log The Log page allows the facilitator Instructor or tablet operator to keep track of every event during a session lt 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 ae o Emergency Reported Airway Circulation Log CPR 00 02 45 Chris Action Call for assistance 00 02 52 Chris Action Call for a
23. Response Pe rf O O pal Lor Breech Descend only with contractions O de Station O speech speech vitals 2 O Check ROT LOT delivery 2 ROP edit Lop O Pause Run Reset Labor Time 00 04 54 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 7 8 49 NOELLE S554 100 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
24. Runs for approximately 20 minutes Pro lapsed cord is protruding into the vaginal opening Faye is put into deep Trendelen burg 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 Runs for approximately 22 27 minutes Instructor must set up prolapse 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 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 branchin
25. 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 re E Set Up an Ad Hoc Netwo e Give your network a name and choose security options Network name GaumardNet Security type No authentication Open Help me choose Security key E Hide characters 2 Ensure the security type is No authentication Checkmark Save this network then click Next Give your network a name and choose security options Network name GaumardNet Security type No authentication Open X Help me choose Security key Hide characters J Save this network Cancel If the system warns of another network with the same name simply power down any other computer configured with the same network name during this step and try again 4 Windows will advise if the network is successfully completed by displaying a ready message and a summary of the network s properties Click Close and restart the computer The GaumardNet network is ready to use This network will appear in the list of wireless networks and will stay active until everyone disconnects from it Give the network name and security key if any to people you want to connect to this network Wireless network name GaumardNet Network security key unsecured 186 Verifying the ad hoc wireless connection Window 7 systems do not automatical
26. Tobacco C Illegal Drug Use Other Term 0 Elective Abortions Preterm 1 Living Children Gestational Age Prenatal care C Rx Drugs C Allergies C Anemia O Diabetes O Heart Disease O Hytertension Fetal Info C Tuberculosis Group B Strep O Infectious Diseases O Decreased No fetal movement O sti C Previous C S O 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 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
27. 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 ContractionFreg 4 min ContractionDurat 40 sec 00 01 16 Applied 00 00 Palette alice03 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 gt 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 J Favorites
28. a corresponding entry on the Status Panel displaying real time information Additional controls can be accessed by clicking on the vertical tab located on the left of the screen Controls on the details tab vary from simulator to simulator GaumardUl will automatically detect features and upgrades installed on the simulator and display the corresponding controls Changing Vitals Set the changes on the available fields and use the Apply panel located at the bottom of the Details tab area to submit GaumardUl only sends updated vital information to the simulator settings not specified will remain unchanged Outlined below are common control behaviors 19 NOELLE S554 100 User Guide Click or tap slider control to quickly adjust numerical values using the track pad Alternatively use the keyboard to manually type a numerical value Breathi Resp Pattern Respiratory Rate EA piratory Time ulation Rhythm B i Rate 2b beats fn min Resp Pattern nor pa none espiratory Rate stridor inspiratory 9 breaths min stridor expiratory change stridor biphasic Click on the feature control button to enable blue or disable black features such as hemorrhage chest rise and crying Then click Apply to commit the state ay Hemorrhage Uterine P oh nemorhage Uterine P For more information about the simulator s features navigate to the Working with NOELLE Newborn s
29. 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 AdenKEIE 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 go Dose Units PP Drug Route mo 18 vr x toner 72 NOELLE S554 100 User Guide 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 CAER Tear Before beginning a session the facilitator can add the names of all providers in the team to the team log This is done by clicking on the Add button and filling in the Add Provider name field Edit Provider color A
30. 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 one point that can cause confusion and warrants further explanation It is an extension of the above discussion of partial states The issue is best illustrated through the following example Suppose that you are creating a Palette Item to start your scenario In this case you have decided that the patient willbe 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
31. and description click the node s Unique Identifier number Click Save to apply changes Node Properties Unique Identifier ji Description Bradycardial 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 ee er TE Load Scenario Goto Normal Scenario Start Bradycardia o E 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 Time limit End 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 Path Go to point 42 NOELLE S554 100 User Guide Configure the countdown timer and the go to point for the default path Click OK to save Set Time Limit min sec 59 59 Max Go to 2 Deteriorate Node 1 is now configured to continue to Node 2 as indicated by the path s time limit 1 Start Bradycardia a 3 gt Bradycardia 00 00 RR 10 HR 45 2nd deg AVB
32. and export profiles navigate to Page 82 Create New Profile Profile Name PIN security Profile Description Enter PIN Re Enter PIN Include contents of Default Include contents OR lw of Quick Start Noele 574 575 Copy current profile NOELLE S554 100 User Guide The Environment The GaumardUl environment is used by the facilitator as the simulation command center In addition to managing the simulator s functionality and vital signs the facilitator can evaluate student performance and act as the simulator s voice This powerful combination of tools provides the facilitator 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 Backup battery level information signal strength volume levels and vitals are displayed in real time Vital sign parameters such as heart rate blood pressure and respiratory rate are highlighted in yellow while undergoing change Click the arrow to expand the viewer and access status entries for Other Uterine Activity and Fetal Heart rate Some status panel entries might not be visible depending on the simulator s hardware configuration Expanded Automatic Mode Status a Y Battery Panel apc More en Expand Signal Strength Cont Frequency 5 min i Breathi i Breathing Breathing F cont nuraton 0 sec IUPC
33. 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 delivery of the anterior shoulder with a finger inserted into the birth canal to free the arm Upward traction allows the posterior shoulder to deliver and the posterior arm is freed in the same manner After the delivery of the shoulders the fetal head delivers in a flexed or heads up position Although it is possible for a vaginal delivery of breech presentations once a breech presentation has been confirmed a Cesarean is often performed to lower the risk of infant mortality due to cord prolapse or birth asphyxia To simulate breech presentations with the NOELLE retract the birthing mechanism fully remove the cover in the fetal head insert the birthing mechanism into the fetal head and place the fetal legs in either an extended position to simulate footling delivery or retract the legs for a frank delivery Remove plug in fetal head for breech delivery Attach the fetal head to the birthing mechanism NOELLE S554 100 User Guide Frank delivery i Y The Pinard or leg flip maneuver frees one leg then another The fetal arms may also require a similar maneuver during delivery The fetal arms are delivered and the fetus rotated anteriorly to birth the head Place
34. are located on both deltoids and quadriceps WARNING Do not inject fluids into the IM sites 109 NOELLE S554 100 User Guide Other Seizures NOELLE is outfitted with a convulsion mechanism that can be used in conjunction with scenarios preeclampsia for example 2 Hemorrhage Ute O Uterine Hemorrhage 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 For information on how to setup Gaumard Monitors with GUI please refer to the Appendix Micro optional The Micro system is an all in one debriefing and simulator control solution for facilitators working in a lab or mobile environment The system combines GaumardUl and powerful audio video recording software in one control laptop 110 NOELLE S554 100 User Guide Working with Newborn NOELLE S554 100 User Guide Airway Newborn s airway can be intubated orally using LMA or endotracheal tubes and nasally using a nasogastric tube Procedure Recommended Device Size Intubation Blade Miller 0 size Nasal Intubation 8 Fr catheter ETT 30 f 6 E l To remove the umbilical cord first turn the simulator Oral Intubation 3 0 no cuff r
35. arm sweep or eloow knee delivery The McRobert s maneuver causes pelvic tilt that helps release the fetal shoulder from behind the pubic bone Suprapubic pressure may also release the fetal shoulder 104 To demonstrate shoulder dystocia place the fetal baby in the ROA position Activate the delivery mechanism moving the fetus down the birth canal until the fetal head is delivered Simulate dystocia by clicking the Turn ON Dystocia button on the Labor Tab Once the dystocia mode is active the fetal traces will automatically convert to real time mode and with each subsequent contraction there will be a Turtle Sign Students must use the various maneuvers including fetal manipulation to deliver the baby Once the students perform all of the appropriate maneuvers required by the instructor the dystocia mode can be deactivated by clicking on the Turn OFF Dystocia button Once the dystocia mode is off the fetal traces and labor warp factor will adjust to the previous settings and the labor will continue resulting in delivery of the baby 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
36. available USB port and power on the Micro computer Connect the Ethernet cable to the communications port located on the simulator s right side NOELLE S554 100 User Guide Virtual Monitor The mobile virtual monitor system works with GaumardUl to display the vital signs of NOELLE birthing baby and Newborn Equipment installation Refer to the manufacturers documentation included with the virtual monitor system components for important safety installation and start up information before turning on the computer Virtual monitor wireless Connectivity The Micro laptop and the all in one virtual monitor computer automatically establish a Wi Fi connection at startup To establish the connection first power on the Micro laptop followed by the virtual monitor computer The simulator s vital signs are generated by the GaumardUl software and sent to the Gaumard Monitors software via Wi Fi To verify the connection between the computers click on the wireless icon located on the task tray The wireless network name is randomly generated at the factory To troubleshoot connection issues please navigate to page 181 Currently connected to Mo Internet access Wireless Network Connection 2 GaumardHet gaumard Other Network 13 NOELLE S554 100 User Guide Gaumard Monitors After the Wi Fi connection is established double click or tap the Gaumard Monitors icon located on the virtual monitor s home
37. can link a labor scenario to a postpartum scenario This allows the software to automatically start the post partum scenario upon delivery of the fetus and completion of the labor scenario To view the Stage information while a labor is in progress click on the label for the corresponding labor stage Refer to Page 115 for more information 47 NOELLE S554 100 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 C Enable Smart Labor 10 sec _ Descend only with contractions Pause Run ON OFF Station 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 lan Load Labor Scenario Patient Information Alice is a 24 year old female weighing 170 pounds W Gain NA Her significant other is pStchatent 51 Actve S1 Transition Stage 2 stages Maternal Info 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 Mike Her OB history shows a gravida of 2 a term of 1 a preterm of 0 and that she is currently 39
38. 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 tocolytic drug with Procardia S amp S no adverse reaction to Procardia 2009 Gaumard Scientific All rights reserved 165 NOELLE S554 100 User Guide Noelle S574 575 Labor Scenario Gaumard Maria Simulators for Health Care Education Preterm Labor Maria is a 30 yr old multip 27 weeks She has an 11 yr old and has been trying for more children She has had 2 miscarriages in the last 4 years and she lost both due to an incompetent cervix This time a McDonalds suture was placed 14 weeks Labor duration 15 minutes Give IV bolus ap
39. experienced several bleeding though patient suffers heavy blood loss episodes due to a low lying placenta blood products are not to be used so She has been counseled about the alternative methods must be found potential for postpartum hemorrhage Instructor must fill hemorrhage kit with Her religious beliefs prohibit the fluids before running the scenario administration of any blood products June is a 31 year old who is about to Full scenario runs approximately for 22 25 deliver her 5th baby She has had a minutes PPH runs for 8 10 minutes Labor normal pregnancy and plans natural and delivery progress uneventfully Heavy childbirth and breastfeeding Her bleeding begins immediately upon delivery husband and oldest daughter attended of placenta Uterus remains atonic despite the CBE refresher course and she has Fundal massage and rapid pitosin infusion arranged for the 11 year old to attend Patients BP drops to 80 50 and uterus the delivery begins to clamp down following Cytotec rectal insertion Note Running full scenario requires retraction of motor mechanism and insertion of PPH kit following delivery To run PPH only load June PPH from the scenario tab Kelly is a 34 year old gravida 5 2 38 Runs approximately for 35 40 minutes weeks She is scheduled for an Shortly following SROM Kelly begins induction due to problems with her last having mild variable decels that are pregnancy That baby weighed almost associated wi
40. features available on your simulator FIXED Noelle Setup Enter the Serial Number from the Noelle simulator that THIS computer will control SN on RF Module M 0000001 Can t find Serial Number 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 The shock panel is a floating window used for simulating electrical therapy It can also be used in conjunction with auto responses For more information navigate to page 87 Environment General Noelle Features Log Other Auto Save E Enable Log Auto Save Auto save every 10 Session Timer E Reset session timer once scenario is started Electrical therapy Panel Show defibrillation cardioversion pacer panel Stand by warning A Warn the first time trying to apply settings when system is on Stand By mode Units 9 International System SI Imperial If the Electrical therapy panel is enabled a new control will be accessible from the top right of the screen OMV PM Mute Listen Tak Gaumard Legend Oo or Use this control to bring focus to the floating shock pace control window Close sync 50 100 150 200 300 360 7 a _ _ _ _ L L At any moment the shock pace window can be moved or closed while rem
41. fluid An admitting clerk helps her into a wheelchair and takes her to L amp D Frances is admitted into a small town hospital due to regular contractions 4 minutes apart and bloody show She labors without problems for about 4 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 acci dent Both she and her husband Alan were seriously injured and she is ona backboard wearing a c collar to stabilize the spine Her right humerus is fractured and seat belt marks are visible across the abdomen 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 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
42. for Health Care Education i Peripartum Hemorrhage Previa Heidi is a 25 yr old primip 35 weeks She has experienced several mild bleeding episodes during pregnancy and is known to have a low lying placenta She arrives in L amp D complaining of abdominal cramps and has bright red vaginal bleeding Labor duration 30 minutes Labor duration 35 45 minutes Is scenario Branching 149 NOELLE 9554 100 User Guide 150 Gaumard Simulators for Health Care Educatior Noelle S574 575 Labor Scenario Heidi 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 NOELLE 554 100 User Guide Noelle S574 575 Labor Scenario Gaumard Heidi Simulators for Health Care Educatior Peripartum Hemorrhage Previa 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 Does bleeding stop YES YES Insert Bakri balloon Wait time 1 min 2008 Gaumard Scientific All rights reserved NO 151 NOE
43. head rotation selection box to expand the fields The first two rows allow you to set where in the delivery curve the two rotations occur The software will not allow an overlap of the rotations the stations specified for Rotation 2 will always be values greater than those specified for Rotation 1 further down the curve Each head position has two pairs of fields one pair each for Rotation 1 and Rotation 2 The provider can set the arc of the rotation to be as shallow or complete as desired Please remember that the zero point in the arc will always be at the top of the head position rotation box between ROA and LOA Below is an expanded view of the Edit control z 6 O 0 e O These settings will be retained until either altered again or the Reset button is pressed Reset will return all stations and arcs to factory defaults E o 5 so O E gs 50 ca ch Ile AE 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 i AN o D 3 ie edt wo OU Ae ala e 4 4 z gt i i i i Rotate baby Both of these arrows allow the instru
44. identified by the computer for at least five seconds then plug it back in and restart the software is displayed when Is the communication indicator panel See solution above in section making reference to blinking com consistently yellow munication indicator is consistently yellow Chest compressions are not Is the respiratory rate set to 0 Set respiration rate to zero properly detected or not min Chest compressions are only detected at all detected when the respiratory rate is 181 NOELLE S554 100 User Guide set to 0 per minute 0 min Otherwise they are pol Simulator is not connected Verify connection to the simulator All others See Calibration Wizard section inside User s Manual Newborn artificial Simulator is not connected Verify connection to the simulator ventilations are not properly detected or not detected at All others See Calibration Wizard section inside User s Manual all Simulator not running Simulator must be powered on and respiratory rate set at 0 Newborn simulator s chest Incorrect respiratory settings Respiration rate and inspiration percentage must be higher than 0 does not rise with artificial If problem persist shut down the simulator and restart the tablet ventilation e g BVM Turn on the system then verify connection battery and lung settings Newborn s Low chest rise Wrong force sensor reading When baby is pulled with more than 35 lbs of force to avo
45. in the NOELLE Advanced profile go to the Scenario tab and Click on Load Scenario On the Newborn software load the Quick Start Profile Details Palette Scenario Lab Labor Speech Log Gaumard Add to scenario A 30 NOELLE S554 100 User Guide 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 oe AAA Setar June suffers PPH following svd of healthy baby boy June PPH Name Description Es 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 gt Ee pent semnar 31 NOELLE S554 100 User Guide Scenario Controls Scenarios are controls are located at bottom of the Scenario page The same way a music player plays songs the Scenario plays palette items Intuitively the facilitator can play stop pause skip or repeat items as appropriate The Scenario Position Indicator points to the current item and shows the cur
46. is accessible at all times Team Logging allows the facilitator to evaluate individual providers with a single click For example if provider Chris performed a procedure satisfactorily the Evaluation entry would be 00 07 43 Chris Evaluation Care Provided SATISFACTORY Speech When the facilitator makes NOELLE speak by pressing buttons on the Speech page an entry into the text log is automatically generated 00 18 10 Speech Urgency Don t touch me Notes Notes can be entered 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 Circulation Vagalmaneuver Attac electrodes Check for pulses nc ttm CCC Log CPR The buttons are categorized into five groups Emergency Reported Airway Breathing Circulation and Medication Any time the facilitator clicks one of the buttons a time stamped log entry is generated documenting the action For example if the Assess responsiveness button is click
47. 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 manner or form or use copy or transfer the Software in whole or in part except as provided herein 3 Other Restrictions You may not rent or lease this Software to any other party You may not alter merge modify adapt reverse engineer decompile or disassemble the software or disclose the contents of this Software to any other party 4 Electronic Transmission of Software If you received the Software by electronic transmission or by Internet delivery by installa
48. 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 GaumardUl folder on the desktop of the tablet Make sure you enable it for file sharing This can be done by doing a right click over the folder selecting Properties and then enable sharing Add to this folder any kind of files that you wish to share with your students or providers a ai Gaumard UI The File Sharing Setup menu is used to manage shared files 89 NOELLE S554 100 User Guide Files in the Gaumard_Ul 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 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 Add 9 Remove A yellow icon will be shown on the top left of the screen once a file is shared This will inform the provider that a file is available for viewing Click on the NOELLE button to br
49. suction OFF by clicking on File Exit on the GaumardUl catheter software or set the manikin on STAND BY mode The replacement of the umbilical cords should also be done while the manikin is turned off or set on STAND BY mode WARNING Always lubricate tubing airway and nasal opening prior to performing any nasal or oral intubation Failure to do so will make intubation very difficult and is likely to result in damage WARNING Do not remove umbilical cord while Newborn is in operation Do not place silicone oil directly into the mouth and airway Cephalic The nasogastric intubation feature is used for Newborn displays central and peripheral cyanosis at placement techniques only Fluids cannot be various intensities healthy mild and severe inserted through nasogastric tubes as internal damage will result Syste m C Intramuscular Injection sites are located on both deltoids and quadriceps for placement and technique exercises Breathing Control the breathing and lung sounds synchronized with selectable breathing patterns Use a BVM which will seal around the mouth and nose The ribs have normal anatomic landmarks and the lungs permit an adequate chest rise Normal CPR procedures can be followed with aid of GaumardUl s CPR trainer Cardiac Newborn is equipped with several realistic heart sounds which are tied to heart rates and selectable rhythms Circulation N
50. the menu bar to quickly change between profiles Labor Control E Enable Smart Labor 10 ser gt E Only descend during contractions On the Load Labor Scenario window select the Alice labor from and click Load Last Modified 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 Scenaric ab Time Information Labor duration 30 B Save Labor Load Labor Labor Control Drystocia Contraction E Enable Smart Labor 10 sec 2 ON OFF E Enable Co E Only descend during contractions Pause Run eset Station NOELLE S554 100 User Guide The labor mechanism will descend as indicated by the green vertical progress bar and descent curve TT Cat Geet To Go Ty CO To enc Tes Station 4 a a Speed a Pause Run Reset ic Alice 60 80 100 120 140 164 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
51. 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 Runs for approximately 30 minutes Simulates 8 hour labor without complications resulting in SVD over intact perineum Baby is vigorous and earns good APGARS Runs for approximately 30 minutes Simulates normal labor and delivery of grand multip resulting in shorter labor duration Runs for approximately 18 22 minutes Following ROM nurse must support fetal head to prevent explosive delivery Patient has retained secundes therefore bimanual exam is required Safety Note Instructor is required to reset motor before allowing learner to perform bimanual exam Runs for approximately 30 minutes La3 25 Note To run full scenario load Bianca at Admit from scenario tab Instructor has to set up fetus with Nuchal chord prior to running scenario Full scenario runs for approximately 23 25 minutes Dystocia drill runs for 15 min Labor progresses normally for about 6 hours but after 45 minutes of pushing patient is unable to bring vertex to perineum A vacuum extractor is necessary to bring the head
52. to Ventricular fibrillation Click NO to re check the Cardiac Rhythm in one minute Click CANCEL to stop checking every minute the Cardiac Rhythm 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 parameters TOCO Contraction Intensity a Contraction Frequency min Contraction Duration sec No Contractions O mid Resting Tone mmHg Moderate Cc y O Strong A Coupling Probability Size pc mmHg i lt Select FHR pattern and dick button to generate spontanerous FHR change FHR Baseline bpm Variability Accel Decel Intensity v Episodic Changes x 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 an
53. to adjust Soft Power and Standby The standby button is located on the bottom right corner of the GaumardUl software Use the standby mode to save backup battery power between exercises The simulator will establish a connection less than one minute after resuming from standby The connection bars will confirm the link between the controller computer and the simulator The wired communication module must be connected when resuming from stand by 18 NOELLE S554 100 User Guide Details From the Details tab facilitators can manually control the simulator s vitals enable disable features and create palette items later used to build scenarios Changing controls directly from the details page is the simplest form of control available to the facilitator Quick Launch Details Palette Scenario Labor Lab Speech Log Legend Gear Settings LoadPaletteltem SaveasPaletteltem on Off Breathing Resp Pattern lo Respiratory Rate OSa _ 9 breaths min change O change EtCO2 _ mmHg U i EE z A Inspiratory Time change y Circulation Rhythm R Heart Rate Blood Pressure beats min change Systolic Diastolic mmHg change Other Temperature C Seizures g Hemorrhage Uterine Pres O Uterine Hemorrhage _ D Vital controls are divided in several categories For each vital control on the details tab there is
54. 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 e o Erin is a 28 yr old 38 weeks ad mitted by her physician for preeclamp sia She is started on Magnesium sulfate per protocol induced with pitocin and her membranes are ruptured Light meconium staining is noted following AROM Baby is pronounced dead after 20 minutes of resuscitation Runs for approximately 60 minutes Upon induction of pitosin and rupture of membranes instructor should tell participants to switch audio output on fetal monitors to FSE tones 63 NOELLE S554 100 User Guide Patient Name Faye Cord Prolapse Cord Prolapse Gabriella Uterine Rupture Uterine Rupture Haley Peripartum Hemorrhage Previa Peripartum Hemorrhage Previa 64 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
55. wish to modify and clicking the Edit button You will be automatically be taken to the Details page and the settings that comprise the selected Palette Item will be displayed Change them as desired and click the Save as Palette Item button Many of the functions related to Palette Items are also available by clicking the second mouse button usually the right button while the pointer is positioned over an Item Note that when using the tablet computer this is best done by holding the stylus button while tapping the screen For more information on customizing the Palette see the Tips on Palette Item and Scenario Creation section of the Appendix at the end of this guide 23 NOELLE S554 100 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 Template Description Sent 1 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
56. year old gravida 5 3 at 41 weeks She weighs 160 los She has experienced no prenatal complications and has a history of fast labors Beth is a 16 year old gravida 2 0 at 37 weeks She has had one elective abortion She has had prenatal care Cynthia is a 31 year old gravida 3 1 at 41 weeks She weighs 170 lbs Donna is a 20 year old gravida 4 2 at 31 weeks She weighs 180 los She has had one elective abortion She has had prenatal care Elaine is a 23 year old gravida 1 0 at 37 weeks She weighs 140 los She has had prenatal care She complains of mind frontal headache 3 tibial edema and 4 DTRs with 2 beats clonus are Below is information on the scenarios available Runs for 30 minutes Labor progresses normally and fetal heart tones remain within normal limits The normal male infant earns good APGAR scores Runs for 20 minutes Labor progresses normally and fetal heart tones remain within normal limits The normal infant earns good APGAR scores Runs for 30 minutes Labor progresses normally and fetal heart tones remain within normal limits The baby earns good APGAR scores Runs for 20 minutes Labor progresses normally and fetal heart tones remain within normal limits The normal infant earns good APGAR scores Runs for 10 minutes Fetal descent is rapid Fetal baseline is maintained at 150 Nuchal chord is evident and moderate bleeding is noted immediately following delivery from a second degree per
57. 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 r You Rene bo 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 Computer 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 S554 100 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
58. 4 100 User Guide Defibrillation Shock Prompt Pe de Auto so Setting at Joules Shocks au Convert to NSR 75 bpm BP 120 80 The Load Palette Item window is displayed Highlight the desired palette and click Load Add Palette Item Palette Lab Transition Healthy RE Q muti min sec ue aj 08 08 elaine02 elaine03 59 59 Max Item Description Normal Vitals Wait Indefinitely Go to Labor ses ca 88 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 i ae dh Auto Setting at 2 Joules Shocks Monitors The optional Virtual Signs Monitor computer simulates a vital signs monitor attached to the patient The vital signs information is sent through the Wi Fi wireless network from the facilitators tablet to the computer running the Gaumard Virtual Monitor software File Setup Monitors Help Sensors Status ol File sharing Custom numbers 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 GaumardUl and Gaumard Virtual Monitor software For detailed instructions on how to configure an
59. 554 100 User Guide Gaumard Simulators for Health Care Education Noelle S574 575 Labor Scenario Dana Breech Presentation Dana is a 24 yr old multip Y 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 137 NOELLE S554 100 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 Labor duration 30 minutes Admit patient Routine labs notify HCP of admission and status Order real time U S to determine fetal position S amp S Agitated uncooperative FHTs are above the umbilicus Attempt to get patient consent for c s transfer patient to OR for delivery insert FSE on fetal buttocks S amp S Patient and mother vehemently refuse to consent to C S AROM 138
60. 555 100 087 Wireless Streaming Audio Headset 190 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 4 5 NOELLE S554 100 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 191 NOELLE S554 100 User Guide 5 192 Push the birth canal insert into position Place your hands on the lower half of the i
61. ASSI Adapter Local Area Connection refr Controler F 10 1 1 1 Conmected to 10 1 1 20 NOELLE S554 100 User Guide To properly configure this window and the virtual monitors software refer to the Appendix on page 184 91 NOELLE S554 100 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 Chest compressions will not provide feedback to the instructor if the cardiac rhythm is set to a healthy state and ventilations will only be reported if the respiration rate is set to zero The CPR evaluator feature provides real time feedback on the providers compression and ventilation performance EE 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 I E 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 compression 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 92 Compression and ven
62. ATION 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 S554 100 User Guide Care and Cautions NOELLE S554 100 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 attempt to intubate without lubricating the airway adjunct with silicone lubricant provided Failure to do so will make intubation very difficult and is likely to result in damage When simulating drug administration via endotracheal tube providers must use an empty syringe Passing liquids into the trachea or esophagus may cause internal damage Mouth to mouth resuscitation without a barrier device is not recommended as it will contaminate the airway Treat the simulator wit
63. File name Alicia Save as type Labor Scenarios A y 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 Monitors A V Help Options Auto Responses Calibration Use the calibration window to calibrate features and to reset sensors the simulator Calibration Calibration Wizard Welcome to the Manikin s calibration wizard Proceed only after you have reviewed the calibration section in the user manual Please select the function you would like to calibrate Chest Compressions Artificial Ventilation 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
64. Gaumard Simulators for Health Care Education NOELLE S554 100 User Guide Maternal and Neonatal Birthing Simulator NOELLE is an interactive educational system developed to assist User Guide 12 3 1 a certified instructor lt is not a substitute for a comprehensive O Gaumard Scientific Company 2012 understanding of the subject matter and not intended for clinical All Rights Reserved decision making www Gaumard com NOELLE S554 100 User Guide NOELLE S554 100 User Guide Contents CONTENTS 2 arios 3 END USER LICENSE AGREEMENT 2 02 c0ccscccceensceeescecssnscsenscnenscnenscnensencnsnscnenscnenscnensenensenensescnensenensenensensess 5 GARE AND CAUTIONS 0 ai 7 OVERALL AAN INS o den e medi 8 CETTING STARTED a AS 9 DA A Ace bee tet OI celia Accent 10 TERMINOL DC a a EE ee oe de eee aad 10 EQUIPMENT SE UP ronen dias 11 ECOGAS SETOV onea a aii dao e o a S 12 POW CT OUDOVA A N 12 CONTONCOMDULO A A A ti 12 E AAA A A A A N 13 WORKING WITH GAUMARDU 0000 Zi a o ea e ETEN 15 TALI ZING THESIMULA TOR a a aiii 16 EI SOM TOTO MON Us A A A A A E E AEA 16 THE ENMRONMEN sssscecoususesare teanoue E useanatcatanctvantseusieumbaraieensbcnatoatasatvanieseie smear E 17 BDO e ws ee o e e o o eee 19 PO tt ee eee ee weer 23 12 1 E AMENEIRO SORES Rena ee a ld 24 AAA A A A A N 30 919 A NI IA ON 46 Ue NN A II ceases Oeccieelh 67 A A 68 LO a delta E E E NE DAA rh Dt te a en a ico eten aa 70 E ECN wl ONT AR RoR eI A RETO NA TO A Ry 75 ME
65. Indefinitely for action Begin PPV and chest compressions Wait Indefinitely for action Administer Epinephrine Wait Indefinitely for action 174 NOELLE S554 100 User Guide Newborn HAL Gaumard Simulators for Health Care Education Helen s Irene s Baby This baby is born with a severe asphyxia that has to be treated immediately After ventilations and EPI have been given the baby s vitals go towards a good outcome Begin PPV Compressions and Epinephrine Wait Indefinitely for actions 175 NOELLE 554 100 User Guide Newborn HAL Gaumard Simulators for Health Care Education MAS Meconium Aspiration Syndrome Apply suction intubate and supply 100 O2 Wait Indefinitely for actions 176 NOELLE S554 100 User Guide Newborn HAL Gaumard Simulators for Health Care Education RDS Newborn with mild Respiratory Distress Syndrome gets a pneumothorax after oxygen is given Administer Oxygen Wait indefinitely for action Apply needle aspiration Wait Indefinitely for action 177 NOELLE 554 100 User Guide 4 Newborn HAL Gaumard Simulators for Health Care Education TIN Transient Tachypnea of the Newborn Apply suction and deliver O2 Wait Indefinitely for action 178 NOELLE S554 100 User Guide Tips on Creating Scen
66. LLE 554 100 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 152 NOELLE S554 100 User Guide Gaumard Simulators for Health Care Education Noelle S574 575 Labor Scenario Haley Peripartum Hemorrhage Previa y Move to OR to deliver baby Wait indefinitely Requires PRBCs Wait time 2 20 min 153 NOELLE S554 100 User Guide A 154 Gaumard Simulators for Health Care Education Noelle S574 575 Labor Scenario India Peripartum Hemorrhage Abruptio India is a 19 yr old gravida 2 37 weeks She arrives at hospital with her husband who says she fell down the stairs and she has been cramping and bleeding for about an hour During admitting interview husband answers all the qu
67. Le ag _ Chris scz SCZ File gt 3 Libraries gt 3 Homegroup gt 1 Computer D Cu Network 4 File name y 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 GaumardUl 82 Make sure that you have the correct file type selected qj 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 Export File Type Labor Scenario 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 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 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 ES Save As ES Libraries Documents v ES O O U E
68. NUS ce a a e Guero eaeaien tas 81 A a a E A 81 SEUD CACA O a a a el eee eee 83 SS AAA A A O A A A OE EOE OEE AEN 89 e RN ip abs 92 PR E A TAS O IS RS SS RS TO IN AN AAN 94 A Met 0 Slat saat aan seta PU ates atlas E Weel uasG E eal Sind ua altos niet scata ami 95 WORKING WITH NOELLE aaa a asta ded etic ei ces beget aa ited dee lee oases 96 A A 97 Nasar ana OI UDI a a o PE CPR E A E ETE 97 BREA INC to AE ias 97 FUMONSV VEN MAIN a a ed AS 97 Ed E PRA RS AR RT A A O RET TEN A O AS TAN BSP SINO ANN 97 GAS y APA CO eee A Nata its oN a eg ated 97 PAV A Oe Ee OES a Tae Te IN 97 A A SREY E I A NER SEE a ee N 99 NOTE Me lofa A A A RSP NE Tg EE eee ea 99 NOELLE S554 100 User Guide VACUNAS SO DAN aaah os ease dae ote ence eee 102 ESOPO Maneuver st crs el eek ee aN tr Ne Bh Sc ea eh tail lel kal 103 A A 104 A A A A needa 104 PIOIADSE OF HE INDICA CO a a odos 105 AY A A O A 105 External VOM li dnd od 105 e A 106 ASS soreer Tusa a Telit Tepiielns a e a a 107 FOS UI AITELIAT ACUSA E 108 Posl Farum FICTION SD sustos idad do idol iden i taatiuurvas meds Sistas 108 EI SIOPOI II REDA sad Oi 109 YO TENG ip ra NA SIL Geant eects SI esta ame 109 OTHE hela Sih ines re a eth eae etc a as Ge ead ee Ge ee ot Gee cement 110 Wiley SlIOMS MONOT sist aoe etd esl eect occa ec eds lee eaten cameo gee 110 WORKING WITH NEWBORN sscvisticreccowsencussiecueceuadatna dde A Eaa aa a aia a a aad ead 111 RIRN AV oar T E E E E T aaaet et oe eoaaet 112 BREATHAN seach E a et
69. The same principle applies to the heart sound and other settings 2 Include notes to guide the facilitator during the simulation It is common for scenario designers especially those who act as facilitators to neglect the importance of notes in the scenario They think that they will remember the learning objectives patient history and other details at the time they are ready to conduct the simulation They usually don t especially when revisiting a scenario months after creating it When you add Wait and Wait Indefinitely steps to a scenario you have an opportunity to edit the item description Use this description field to hold notes to the facilitator Typically scenario designers 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 contr
70. a ek ak ta ale a a EEE 112 CARD e ote a ee a a 112 CIRCULA NON en E IN E I E E CRN a E E ere ee 112 DEPARA Ctd der eee ee 112 STE MIC leds ados 112 e o oo O yet tuaen a Aa ancaate at oues 113 APPRENDI Sipe re te eae Mee nO rae a e la 114 FACTORY PRESET LABOR SCENARIOS uretra ici iii 115 Newborn TAO WO AS dd 167 HPS ONGREATING SCENARIOS suitactaicidboa earn da 179 MPF SOS TIN ai ii A cc dia 181 General TrOUDIESNOOUNO GUIDE usiana AT E A ee 181 Mioroohone Boost Windows e ele led 183 Gonnecting TO the Gaumard MONO ic 184 El e O A A A NO 188 SELECTED CONSUMABLES AND REPLACEMENTS PARTS sssssssecceeeeeceeeeseeeeeeeeeseeeeseceeeeesesaeaeeeceeseessaaaeeeeeees 189 SE kay Gemeente mor ee ORO NT Mtoe T eee ner Cnt Mate ai gCeee een Cee Taney Meter are Ren cena Meroe 189 Replacing Common Consumable and Replacement Parts cccooconccnnccccoononnocononnnnnonononnnnnnnonanonnnonnnannnns 191 WARRANTY erected taal cheese aN Ae lo Rhett ELO IN ous 193 CONTACT US bois O apace da 194 NOELLE S554 100 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
71. aby 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 99 Follow the guidelines below when releasing the baby from the birthing mechanism To troubleshoot any additional issues please navigate to page 181 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 WARNING Guide the baby out of the birth canal by gently pulling in line with the birthing mechanism Pulling the baby upward or downward in contrast to the birthing mechanism s linear trajector may bend the motor arm and cause damage to the birthing mechan
72. ack devices Recording devices Sounds Volume control options Pra saya 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 Set Default w NOELLE S554 100 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 Microphone boost increases volume and saturation which can decrease overall clarity For optimal clarity adjust the microphone volume to 100 and the microphone boost to 10 Click OK to save the changes to the volumes on the microphone properties menu Click OK to close the Sound properties window Select a recording device below to modify its settings Microphone Realtek High Definition Audio Default Device mo Set Default v 183 NOELLE S554 100 User Guide 7 lt 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 Mon
73. actice 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 105 NOELLE S554 100 User Guide 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 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 106 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
74. ages 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 56 NOELLE S554 100 User Guide This information was assigned when the scenario was created ce Stage Information Maternal Info Respiratory status mal Cardiac status Pain Bleeding Membranes Dilation Station gt E Fetal Info Decreased No fetal movement me Release Baby This button activates the release mechanism on the baby which allows either the providers to disengage the baby or the instructor to connect the baby Time Information ROA Save Labor Load Labor Labor duration 30 30 min Warp Factor 21 approx 1 min Labor Control Dystocia Contraction Response Doheny Position O NM ROT El Enatie SmartLabor 10 co 8 O ON OFF Enable Contraction Response Eas e M i ee O Pause Run Reset ROP edit LOP Alice Labor Time 00 28 50 ee en Se ES en en Snr Se ns ed Sen ns es 1 4 DESCENT ae eee Baz A TUT A SOG LTE ETE After clicking on the Release Baby button as shown below the system will take a few seconds to send the release commands to the simulator Releasing 57 NOELLE S554 100 User Guide Locking Mechanism Once the baby is plugged into the motor arm the locking mechanism acts twice to secure the birthing b
75. ain 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 Respiration and other undesirable Since simulator s microphone has high sensitivity in order to capture sounds are heard by instructor the voice of providers it also captures all surrounded noises on or around the simulator This is normal and it is not a malfunction Simulator is set to Generic Make sure to select multiple simulator environment Setup Options Environment menu Setup gt Options gt Environment tab and enter the Serial Number of the simulator you are using Warning Streaming audio is disabled in generic mode simulator is checked Streaming audio does not The backup battery on the simulator Plug charger into the simulator Verify LED light on charger indicates work tab is not displayed is depleted charging status NOELLE should always be plugged in while being operated The birth mechanism is power intensive and will drain the backup battery quickly Reconnect Newborn to the charger GaumardUl has set the Wired communication module is not Connect the communication module to any USB port power mode to STAND BY connected automatically Wired communication Wired communication is module not Close the software and try disconnecting the communication module module not found message
76. aining accessible by clicking the button above NOELLE S554 100 User Guide Log Assign a color code for each of the log entry categories and click OK to save Options Color Code Log Events Applied Details Log CPR Tracheal Intubation Compression Ventilation Defibrillation Cardioversion j Pacing BP cuff e Speech OK Cancel CPR Options In this tab you can e Select the number of desired compressions per minute e Specify the compression ventilation ratio Select number of ventilations per minute if the Only Ventilations button is selected Options Environment General Newborn Hal Add Ons Neonate Features olerances Other ventilations and Compressions Compressions per minute Compression Ventilation Ratio Only Ventilations ventilations per minute 85 NOELLE S554 100 User Guide Other The first option Once a Palette is applied load to Details Tab is useful for facilitators who want to keep track of the latest parameters that were updated using the Details Tab Options Environment General Noelle Features Log Others E Once a Palette is applied load to Details Tab E Use AV System Start AV Automatically on Scenario Start Output Log Events to Windows Log F Use single monitor for maternal vitals and fetal traces Link Respiration sensor to ECG Leads sensors
77. al signs to normal values e Clear out log page e Restart the session clock The session clock is located at the bottom of the dialog box Clocks Transition remaining 00 00 00 The shortcut key for staring a new session is Ctrl N NOELLE S554 100 User Guide 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 a text file Clicking on it brings up the Save As dialog box a Save As CO dd Reports Organize v New folder gt YY Favorites Name Date modified Type No items match your search gt A Libraries gt 2 Homegroup gt 1 Computer D Cu Network File name Report1 Save as type Text files txt a Hide Folders Select the desired name and path and click Save 81 NOELLE S554 100 User Guide The shortcut key for saving a report is Ctrl S For a sample report look at the figure below E Report 1 Notepad i pu 02 11 2011 01 38 12 Session Facilitator Providers Team Alice is
78. ame description and color code and click Save Save as Palette Item Palette Item Name Healthy Palette Item Description Normal Vital Signs Color Healthy Care Required O 22 NOELLE S554 100 User Guide Palette The second level of control is the Palette tab page Each item on the Palette represents a complete or partial physiological state The Palette page displays all of the Palette Items in the active profile Each profile has its own separately customizable Palette Create Palette Items with the Details page as described previously Details Palette Scenario Lab Labor Speech Log Description 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
79. amp S feeling pain Urge to push strong Perform V E admit patient to BR initiate continuous EFM Notify HCP of imminent delivery NOELLE S554 100 User Guide Noelle S574 575 Labor Scenario Gaumard Becca Simulators for Health Care Educatior g 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 gt Prep for precipitous delivery support fetal head to prevent explosive delivery check for nuchal cord if possible check for intact placenta at delivery S amp S SROM followed by Becca pushing hard gt n illo Program swithces to scenario tab automatically SS 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 indefinitel
80. are baby to either ROA LOA LOP and ROP Then synchronize the baby s position in the womb with the labor position icon located on the labor tab page 99 NOELLE s delivery Select Quick Start Scenarios when starting the software mechanism doesn t come to To change profiles from within the GaumardUI Go to File Profile menu and then select Modeled Scenarios its initial position when using the Reset button under the Labor tab or it makes a grinding noise when reaching the end of the rails Pre built scenarios do Volume not set to user s criterion Every sound has a volume control Adjust the volume control located cannot be loaded on the status panel to reach the desired level A sound is absent or is not Cyanosis intensity not set to users Set Cyanosis level to a desired level by playing with the Set Max heard at desired volume criterion cyanosis level control level 182 Microphone Boost Windows 7 Use the instructions below to increase the streaming audio volume The Headset must be connected to the tablet in order to adjust the microphone volume properties In addition adjust the recording control on the headset s physical control to high 1 Right click on the speaker icon located on the bottom right corner of the laptop s taskbar 8 15 AM a Er g ul de a aan 2 The speaker menu is displayed Click on the recording devices option Open Volume Mixer Playb
81. arios 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 palette becomes difficult to navigate So it is desirable to minimize the number of Palette Items in each Profile To accomplish this an experienced facilitator tries to create items that are as generally applicable as possible and can thus be applied to a wide range of scenarios The key is to only include in your Palette Items the settings that are directly related to the physiological event represented by that Palette Item 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
82. art Breathing O cyanosis P Inactive Lung Front Upper Left Check Modules Lung Front Upper Right Check Single Module O Compression O Compressor Ventilation Check Ali Volumes For more information go to the Appendix 95 NOELLE S554 100 User Guide Working with NOELLE 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 Procedure Recommended Device Size Intubation Blade size Miller 4 or MAC 3 5 LMA Size 4 8 mm outer diameter max Nasal Intubation Oral Intubation ETT Er7 or75 WARNING Do not introduce liquids when performing nasal and oral intubation Doing so can permanently damage the system Always lubricate tubing airway and nasal opening prior to performing any nasal or oral intubation Breathing Software controlled breathing patterns Kussmaul s Cheyne Stokes Biot s Apneustic apnea and normal 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 CPR Use a normal size adult BVM which will seal around the mouth and nose The ribs have normal anatomic landmarks and the lungs permit an adequate chest rise Normal CPR procedures can be followed with aid of GaumardUI s CPR trainer
83. as events are detected 180 NOELLE S554 100 User Guide Troubleshooting General Troubleshooting Guide Use the following table to find causes and solutions to a number of possible problems Communication never gets established or is lost Battery is discharged If NOELLE s backup battery is completely discharged connect the charger and wait 20 minutes to power on the simulator Leave the simulator connected while in use blinking communication indicator is consistently red NOELLE should always be plugged in while being operated The birth mechanism is power intensive and will drain the battery quickly Newborn must be plugged in to the charger during use Communication Module is not Perform a full shutdown of the tablet detected Disconnected power plug NOELLE s internal battery is used for transportation Always use NOELLE connected to the charger Communication module RJ 45 Cable Both simulators operate using a wired connection Connect the wired is not connected to the simulator communication module to the simulator and restart GaumardUI All others Close the GaumardUl software and unplug the USB communication module for at least 5 seconds then plug it back in Restart the software and wait for initialization Sound quality while Sound is too low or too loud Sound volume at PC side is managed from PC s volume control streaming is poor Simulator sound volume is managed from PC s Microphone g
84. be used with this manikin Also you can name each monitor with an appropiate description O Al sensors aways ON i except tor Swan Ganz Adapter Wireless Network Connection Controler IP 10 0 0 1 Port 8001 Connected to 10 0 0 3 Stop Diagnostics The Diagnostics window can be accessed by going to the Help menu and selecting Diagnostics This window is very useful for troubleshooting because it gives the user feedback on all of the working modules inside the simulator The user can click on the button that says Check All Modules and the software checks which modules are responding 188 GaumardUI Version 1 24 11 0 Diagnostics Info SN J0000001 File Audio Mechanical Other Legend Throat voice Umbilical cyanosis C Active Heart Breathing cyanosis P Inactive Lung Front Upper Left Check Modules Lung Front Upper Right Check sone Pressure Compression Compressor Ventilation Also check individual modules by clicking on the module to highlight Notice that the name of the module is displayed on the right column Now click on the Check Single Module button Other Legend O ECG ECG 2 Active Module O Trachea Intubation Inactive selected Check Modules Eyelids Right Pupil Dilation Left Pupil Dilation Active modules report light blue and inactive modules report black If there is a specific module that fails to respond plea
85. bortion Labor duration 45 minutes Admit patient Routine labs notify HCP of admission and status Set up delivery table and infant warmer configure bed for delivery 127 NOELLE 554 100 User Guide NOELLE Advanced 128 Scenario Name Labor Type p en eenaton Demre en eematon Em iia o e frome oR fon ee pa perronen en indenter free ter norte enmon Poema NOELLE S554 100 User Guide 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 129 NOELLE S554 100 User Guide 130 Gaumard Simulators for Health Care Education Noelle S574 575 Labor Scenario Angela Normal Labor 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
86. cally transitions to a labor scenario 39 NOELLE 554 100 User Guide Newborn Factory Preset Scenarios These scenarios in the Quick Start Newborn profile when the Newborn software is activated There are eleven linear scenarios Scenario Name Alice s Baby Healthy baby Asphyxia Scn Baby has an asphyxia attack and the providers need to give ventilations to help bring back the vitals to a healthy state Baby is born with a mild asphyxia that needs attention Once ventilations start the baby s vitals go to a healthy state Scenario Description Beth s Donna s Baby Male infant with central cyanosis limp flaccid and requires immediate resuscitation No Cynthia s Baby spontaneous movement of right arm is noted Stat CXR reveals a fractured right clavicle and right pneumothorax This baby is born with moderate asphyxia and will require CPR and oxygen to bring the Eanes Bany vitals to a healthy state This baby was born through a C Section and is responsive but need some attention after a while all vitals go to a healthy state Gloria s Bab This baby is born with mild asphyxia but no matter how good the interventions are this y disastrous intrapartum complication results in neonatal death This baby is born with a severe asphyxia that has to be treated immediately after ventilations and EPI have been given the baby s vitals go towards a good outcome Meconium aspiration syndrome Newborn with mild Respira
87. cator 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 NOELLE S554 100 User Guide Scenario Auto Responses The scenario auto responses feature assists facilitators in automating electrical therapy responses during a scenario First click on the shock panel icon located near the top right of the screen to access the virtual Shock Pace panel If the shock panel button is not displayed go to Setup gt Options gt General and checkmark Show defibrillation cardioversion panel R Shock Panel E Shock Pace Panel Gaumard Y Go to Branching Scenario Click on the Scenario Auto Responses button to access and configure the auto response feature Quick Launch Details Palette Scenario Model Lab Log Healthy baby Alice s Baby During a wait indefinitely palette the auto response feature will advance the scenario to the next palette item in response to the following interventions External Pacing Defibrillation Shock During shockable rhythms only Cardioversion Shock Non sync Shock Scenario Alice s Baby automatic res
88. ctor to rotate the baby to any desired position while the delivery is in progress 50 NOELLE S554 100 User Guide Delivery Position Rotate baby gt O Breech 2 3 C Check ROT LOT delivery als gt 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 10 sec El C Descend only with contractions 2 Pause Run Reset When the Smart Labor is activated the window circled in red below is displayed Smart Labor Activated alice02 6 CODINA ANNAN AAA Hl 60 10 0 120 140 160 180 200 220 240 26 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
89. cuments Organize A Open v Share with w Print E mail Burn New fold Fr Favorites Documents library Evaluations Libraries SS pa Eclamptic Seizure Session 3 xps Open Ctrl 0 Save a5 Ctrl 5 Print Ctrl P Properties Alt Enter Exit Alt F4 On Site Reviewer James C Date 08 08 2011 a FP Page Range All Number of copies 1 K Selection Current Page Pages 13 Enter either a single page number or a single aj 22 pE page range For example 5 12 77 NOELLE S554 100 User Guide 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 Load template save cear ote Evaluation Name Vacuum Delivery On Site Reviewer Evaluation Name Vacuum Delivery On Site Reviewer Category Remove meet 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 cho
90. d connect the Gaumard Vital Signs Monitors refer to page Error Bookmark not defined Sensors This tool allows you disable any of the waveforms present in the vital signs monitor Newborn HALO MOES User Interface SN J0000001 QUICK START NOELLE SpO2 Probe File sharing ECG Leads d Custom numbers Resp Monitor b E Thermometer Configuration NIBP Cuff gt de ABP cannula Cap Refill Time ON Capnography OFF STAT Breathing ja Resp Pattern Breathing Respiratory R All ON All OFF Window Rate 40 bpm In 20 O change 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 S554 100 User Guide Another way to control the sensors is to go to Monitors Sensors Window 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
91. d is performed to determine position and gestational age Labor duration 15 minutes Full scenario duration 23 25 minutes S amp S Complains of tenderness in abdomen finds ctx very painful Admit to 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 134 NOELLE S554 100 User Guide Noelle S574 575 Labor Scenario Gaumard Candice Simulators for Health Care Education Shoulder Dystocia Perform Suprapubic pressure McRoberts Woods and Rubin maneuvers Alleviate Dystocia with Gaskin maneuver Titrate pitocin to maitain uterine contractions give Tylenol for pain antibiotic therapy 2009 Gaumard Scientific All rights reserved 135 NOELLE S554 100 User Guide G q Noelle S574 575 Labor Scenario ee 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 NOELLE S
92. d monitor the provider s intervention effectiveness using the CPR monitor window The model speed can be controlled through the Model warp factor which goes from 1 to 5 1 representing real time Details Palette Lab Model Scenario Log Gaumard Physiological Modeling State Model rate 1 PAUSE physiological oxygenation modeling Modeled Therapy 5 Improve Gain Reset IMPROVE adequate oxygen perfusion breathing C 4 Oxygen DETERIORATE compromised oxygen perfusion apnea 0 wv Limin Epinephrine on Go uaa Healthy Mild Cyanosis Severe Cyanosis dose onboard 0 mg kg Therapy can also be indicated on Log page CPR Monitor Effective Min E Ventilation Range 30 Physiological Modeling State Pause Model will pause at the current state Improve Model trend to a healthy state Once the model reaches the complete Healthy state the model will go to Pause mode Deteriorate Model will trend to a severe cyanotic state If ventilations given to the neonate are of correct depth and between 40 and 60 per minute the vital signs will improve Otherwise they will continue to deteriorate Cyanosis Levels The facilitator can quickly jump to any of the three points in the state of the model Healthy Pedi is pink with adequate oxygenation Mild Cyanosis Pedi is bluish and vital signs are starting to deteriorate Severe Cyanosis P
93. d then clinking on the button lisis Decel Prolonged Accel cpisodi roonged Dece y 21 NOELLE S554 100 User Guide Palette Items A Palette item stores several vital parameters in a single container Use palette items to quickly change multiple parameters at once For example a facilitator may choose to create a palette item that stores all the vital parameters of a healthy patient Then at any moment in the simulation quickly return to a healthy state by loading the palette item Palette items are also used to build scenarios as covered on page 30 As part of the scenario building process a facilitator will first create a series of individual palette items which represent physiological states The scenario feature then automates the loading of palettes in succession to simulate patient recovery or complications A collection of palette items are included in the quick start profile Click the Load Palette button to load a prebuilt palette item Select a palette item from the list and click Load Finally click apply to submit the changes Breathing Resp Pattern normal Respiratory Rate OSat _ 20 9 breaths min o 9 change change EtCO2 _ 9 mmHg Inspiratory Time 33 40 change Creating Palette Items To create a Palette Item adjust the vital parameters and features on the Details tab and click the Save as Palette Item button near the top of the page Enter the palette s n
94. dition 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 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 a healthcare provider Scenario a saved sequence of physiological states which flow like a play list Scenarios provide a level of automation that unburdens the facilitator and allows standardized presentation of symptoms Scenario Item a Palette Item that is part of a scenario Scenario Items may also represent a fixed delay period Wait or a pause Wait Indefinitely NOELLE S554 100 User Guide Equipment Set up NOELLE S554 100 User Guide Leg Assembly Follow the steps below to install the lower legs Always remove the lower legs when transporting NOELLE inside the protective case 1 Remove the fixed bolts from the knee joints using the hexagonal wrench included 2 Position the lower legs and insert the bolts Use the two provided hexagonal wrenches to secure the knee bolts Do not over tight
95. dure 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 Factory Settings Use the factory settings menu to restore sensors to the factory calibration A factory reset will over ride any calibrations performed by the facilitator Make sure that when you are restoring the sensors to the factory settings that no one is practicing chest compressions or ventilations Any of these actions may interfere with the reset Each time that one of these sensors is clicked a message will appear at the bottom left of the screen notifying the user of the status of the reset OK or TRY AGAIN Should the sensor not respond please refer to the troubleshooting guide or contact Customer Support At the end of calibrating a function the Calibration Wizard resets the simulator for the changes to take effect and displays the message Done If the wizard displays the message Can t reset it simply means that the new calibration values will take effect next time you start the software If the changes need to take immediate effect simply close the GaumardUI software wait one minute for the simulator to turn off and then start the GaumardUl software again NOELLE specific censors The options below are specific to the NOELLE simulator Remove the birthing baby from the birt
96. e Variable Normal Range HDL Cholesterol mg dL 29 00 71 00 Cholesterol HDL Ratio Ratio 0 00 4 90 Lipid Panel Both Variable Normal Range Cholesterol mg dL 0 00 199 00 LDL Cholesterol mg dL 0 00 129 00 Triglycerides mg dL 30 00 200 00 Allowed value range is displayed in Value column It won t be visible when entering data Once a new format is created it will be listed on the Lab Format section at the bottom of the Lab tab Use the buttons on the left panel to edit or delete lab formats Lab Template Template Description Mew Template CBC DIFF Platelets Differential A Selected Item Lipid Panel Cholesterol HDL LDL Triglycerides E E E kel lll 4 Metabolic Panel Anion Gap Albumin Alkaline Phos Calcium Choride Neonate Blood test For newborn and premie Delete Y AA 26 NOELLE S554 100 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 Hames 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 CBC DIFF E Template Description Metabolic Panel Neonate Blood test OB Blood test PPT Report Name Prothrombin Time Provide a Report Name Report Time and Descrip
97. e weighs 160 lbs She has experienced no prenatal complications and has a history of fast labors Labor duration 20 minutes 119 NOELLE S554 100 User Guide G q 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 120 NOELLE S554 100 User Guide Noelle Labor Scenario Gaumard Cynthia Simulators for Health Care Education 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 Suprapubic pressure McRoberts Woods and Rubin maneuvers Alleviate Dystocia with Gaskin maneuver 121 NOELLE S554 100 User Guide 4 Noelle Labor Scenario Gaumard Donna Simulators for Health Care Educatior 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 122 NOELLE S554 100 User
98. ear 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 116 NOELLE S554 100 User Guide 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 117 NOELLE S554 100 User Guide 118 Gaumard Simulators for Health Care Education Noelle Labor Scenario Amy Variations on Normal 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 NOELLE S554 100 User Guide Gaumard Simulators for Health Care Education Noelle Labor Scenario Angelica Variations on Normal Angelica is a 31 year old gravida 5 3 at 41 weeks Sh
99. ection of this guide 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 by clicking the part of the button labeled Edit Some settings are applied immediately such as cardiac rhythm and breathing pattern while numerical settings such as heart rate and respiratory rate can trend 20 NOELLE S554 100 User Guide As transitions are applied the trend countdown 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 Session 17 31 21 N Ventricular Tachycardia When cardiac rhythm is maintained at Ventricular Tachycardia for one minute the following prompt dialog box will be displayed Ventricular Tachycardia x 1 minute has passed since the patient is in Ventricular tachycardia A do you wish to degrade
100. ed when the session clock reads 00 07 24 the following entry is automatically generated 00 07 24 Action Assess Responsiveness Special Buttons Some provider action buttons are accompanied by a special option button The first special button lets the facilitator be a log actions in more detail For example if the button Assess breathing is clicked the following entry is created 71 NOELLE S554 100 User Guide 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 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 Alrway Response When the extubate button is the following entry is created 00 01 28 Action Extubate cough Medications The Medications section allows for quick and easy logging of drug administration including dosage and route The software comes preloaded with a set of commonly used drugs Each of these drugs has a default dosage unit and
101. edi is blue apneic and vital signs are rapidly worsening Modeled Therapy Improve Gain Moving this slider will help increase or decrease the cyanotic response to ventilations Oxygen By selecting an oxygen rate the baby will improve faster with proper ventilation Flow On must be selected to activate the oxygen response Epinephrine Select the desired epinephrine dose and then select Administer Immediately the heart rate of the Newborn should rise and the dose on board should start diminishing over time The dose should be enough to increase the heart rate a small percentage in order to help the oxygen delivery in the system therefore helping improve the neonate with proper ventilation Reset By selecting Reset the oxygen flow and the epinephrine dose onboard will be eliminated 67 NOELLE S554 100 User Guide Speech Prerecorded Sounds NOELLE has over 90 pre recorded expressions which can be initiated with a single click on the Speech page The collection of speech and other sounds was chosen to cover a wide range of simulated emergencies Details Palette Lab Scenario Labor Speech Log Complaint History Pulse in CA WU asma See So nauseated EE Feel diferen Stomach hard Hada drink Swollen all Havent seen a Hat my tummy Team nse ere Confusion ee I dont isaac Worst Prev
102. elds 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 ma ten A Emergency Reported Airway Breathing Circulation 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 Evaluation j j n Power of Patricia n Satisfactory Note lt Add to log ON Standard evaluations satisfactory or not are given context by their position in the log relative to detected and observed provider actions The following example illustrates this idea 00 03 12 Patricia Action Shoulder dystocia 00 03 20 Chris Action Shoulder dystocia Suprapubic pressure 00 03 30 Chris Action Shoulder dystocia McRoberts maneuver 00 03 37 Patricia Action Shoulder dystocia McRoberts maneuver 00 03 52 Patricia Evaluation Care Provided Satisfactory The evaluation panel is part of the team logging system described previously When a particular provider is selected log entries generated via the Evaluation panel will be prefaced with the provider s name For more information on Team Logging see the previous section of this
103. en Power Supply Connect the AC adapter labeled NOELLE to the power input located on NOELLE s right side Always operate NOELLE with the power supply connected 12 The NOELLE is equipped with an internal backup battery for transporting during scenarios Always reconnect NOELLE to the charger after arriving to the designated simulation area The backup battery level is displayed on the GaumardUl status panel For more information about the battery indicator refer to page 18 Newborn is not equipped with an internal battery WARNING Do not store the simulator with a discharged battery Re charge the system at least once every 3 months if the simulator is not being used otherwise permanent loss of capacity might occur Control Computer Control commands are sent to the simulator via a wired USB communication module Follow the steps below to connect the wired communication module to the simulator and the control laptop computer GaumardUl controls only one simulator at a time To switch between NOELLE and Newborn first exit the GaumardUl software and reconnect the communications cable to the simulator you wish to control WARNING Do not connect the simulator to Ethernet cards LAN networks or unauthorized diagnostic equipment Doing so may cause damage to the system 1 2 3 Connect the Ethernet cable to the USB communication module Connect the USB communication module to an
104. enabled this feature can automatically make changes to the maternal vital signs or add speech palettes during the contraction Contraction Response AF Enable Contraction Response There are two kinds of patients that you can simulate Pain controlled patients and patients with uncontrolled pain The changes made are different depending on the selection speech or speech vitals Maternal Vital Signs Audio Palettes Changes Simulates a think I m having patient that is contractions pain controlled No Changes Ouch Ahhh Please need Simulates a Increase HR something forthe patient that is BP and RR pain Please NOT pain give me an controlled epidural Speech vitals The changes are applied only during the length of the contraction At the end of a contraction the maternal vital signs if changed adjust back to the previous setting 53 NOELLE S554 100 User Guide 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 ContractionDurat 40 sec 00 00 59 Contraction Response Speech Epidural 00 01 11 Contraction Response Speech Aahh 00 01 12 Applied 00 00 Palette alice03 Details RR 23 OSat 97 ContractionFreq 3 min ContractionDurat 70 sec Contraction 00 01 21 Con
105. eshold While in dystocia mode a Turtle Sign will occur with each uterine contraction Dystocia ON OFF i Station 7g C The dystocia controls are disabled when the last point on the descent curve is less than the indicated dystocia station In the example below dystocia controls are disabled because the last point is less than seven the current dystocia station Labor Control i Contraction Response Delivery Position Enable Smart Labor 10 on Sabie Graken Rotate a O Or ROT Breech gt Only descend duri tracti alla J sighing 7 H speech 0 speechfvitals Check ROT LOT delivery 2 a E Pause Run Reset Alyssa Labor Time 00 00 00 52 NOELLE S554 100 User Guide In the example below shoulder dystocia and turtle signs begin station 10 Labor Control Dystocia Contraction Response piir A Hp Q ROT Enable Smart Labor 10 gt sec gt ON 20 Enable Contraction Response e n a ree Only descend during contractions cm 1 speech 0 speechfvitals o Pause Run Reset Check ROT LOT delivery gt nor MM uc Labor Time 00 00 00 ARA CUTE AT l AEA CAT 60 860 100 120 140 160 180 200 220 240 260 280 30 0 min Contraction Response The contraction response feature makes your labor simulation more realistic When
106. estions and India doesn t make eye contact The nurse palpates uterus initiates fetal monitoring and starts a pad count Labor duration 25 minutes NOELLE S554 100 User Guide 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 155 NOELLE 554 100 User Guide Noelle S574 575 Labor Scenario Gaumard Inez Simulators for Health Care Education Peripartum Hemorrhage Abruption Administer Pitocin manage bleeding and massage fundus Wait time 3 min NOELLE S554 100 User Guide Gaumard Simulators for Health Care Education Noelle S574 575 Labor Scenario Janie Peripartum Hemorrhage PPH 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 durati
107. etworking settii ii Set up a new connec 184 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 twork and Internet Network Connec tions x Wi sea re k Connection 2 Introlid K alll reso kas 300 AGN Select Internet Protocol Version 4 TCP IPv4 to highlight it and click Properties H Wireless Network Connection 2 Properties Connect using E tel WiFi link 5300 AGN This connection uses the following items o Client for Microsoft Networks El Virtual PC Network Filter Driver 2 005 Packet Scheduler El File and Printer Sharing for Microsoft Networks i Intemet Protocol Version 6 TCP IP v6 Sa Intemet Protocol Version 4 TCPY IPy4 wi Link Layer Topology Discovery Mapper 1 0 Driver at Link Layer Topology Discovery Responder Ga onto ra pal Control Protocol Intemet Protocol The default wide area network protocol that provides communication across diverse interconnected networks 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
108. ewborn s software controlled umbilical pulse is blood pressure and heart rate dependent Newborn s umbilical cord can be catheterized or injected with up to 2ccs The umbilical cord can be trimmed or clipped for simulations and is therefore considered a consumable item To fill the umbilical cord with fluid inject any of the three blood vessels with 2 cc of water using the fill syringe For catheterization use a 6 Fr urethral round tip catheter lubricated with silicon oil 112 Other Vital Signs Monitor The Virtual Signs Monitor simulates a vital signs monitor attached to Newborn The vital signs are synchronized through a wireless network between the facilitator s tablet and the computer running the monitor Each trace can be customized independently of each other users can set alarms time scales boundaries and grid options In addition it allows the facilitator to display lab reports x rays and other files on the virtual monitor screen for use by the provider 17 03 57 NOELLE 554 100 User Guide 113 NOELLE 554 100 User Guide Appendix 114 NOELLE 554 100 User Guide Factory Preset Labor Scenarios Quick start Scenarios mise rin on eet or eos rin nm bem rn orm Os CN E IEC IE COIN ret o reee AN A CL El IEA E ICI 115 NOELLE S554 100 User Guide Noelle Labor Scenario Alice Normal Gaumard Simulators for Health Care Education Alice is a 24 y
109. f the page look and behave just like traditional and software based media players Scenarios let the facilitator automate most of the changes to the simulators s condition so their attention can remain on the providers actions The scenario system can also provide standardization of the patient s presentation of symptoms For fair assessment of providers and any research application such standardization is key For tips on planning and creating scenarios go to page 179 NOELLE linear scenarios simulate pre partum and postpartum events Scenarios that incorporate the labor mechanism are loaded using the Labor tab page 46 In the example below the simulation exercise begins during the admission process and continues onto the delivery when the scenario reaches the last item on the list Linear Scenarios 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 AAA AAA peras 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 check that variables resolve Labor 2 continue routine care Candice Using Factory Preset Scenarios While operating
110. fault application Lab 01 y normal range Cholesterol LDL Cholesterol Lipid Panel Female Variable Normal Range L 35 00 85 00 00 4 40 Lipid Panel Both Variable Normal Range Cholesterol mag dL LDL Cholesterol ma di 0 00 129 00 Tnglycerides mg dl 30 00 200 00 Once the report is sent the letter Y will be present on the Sent column Use the Stop Sharing button on the right panel to remove any items on the Gaumard Monitor file list Lab Reports am Template Description a ae Healthy 2 OB Blood test Healthy Levels View Healthy Neonate Blood test Healthy Levels Sort by Color James Metabolic Panel Session 1 f FET PENES AAA a TS Selected Item APIO a AL PONT cat vere ES Ol E e E tab0oi Lab 01 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_Ul folder on the tablets home screen For information on how to access other files from the Gaumard Monitor screen navigate to page 89 29 NOELLE S554 100 User Guide Scenarios The most advanced method of controlling the system is to build a Scenario a sequence of Palette ltems and delay periods Scenarios can be linear or branching as covered in the following section Think of a scenario as a playlist of palette items Consistent with this analogy scenario controls at the bottom o
111. first few centimeters of movement normally take about half the total delivery time The baby rotates internally as it moves forward after the head is delivered and before the shoulders are delivered The fetus is turning and the head is crowning 101 NOELLE S554 100 User Guide 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 102 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 e Dystocia E Enable Smart Labor 10 sec E ON OFF Fl Only descend during contractions Save Labor Pause Run Reset 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
112. g postpartum section of the scenario Instructor must fill hemorrhage kit with fluids before running the scenario NOELLE S554 100 User Guide Peripartum Hemorrhage Peripartum Hemorrhage Abruption Peripartum Hemorrhage PPH Peripartum Hemorrhage PPH Amniotic Embolism Fluid India is a 19 yr old gravida 2 37 Runs for approximately 25 minutes This weeks She arrives at hospital with her scenario is a suspected spousal abuse husband who says she fell down the case Patient has a central abruption of the stairs and she has been cramping and placenta Instructor must fill hemorrhage kit bleeding for about an hour During with fluids before running the scenario admitting interview husband answers all the questions and India doesn t make eye contact The nurse palpates uterus initiates fetal monitoring and starts a pad count Inez is a 27 yr old primip Y 35 weeks Runs for approximately 18 minutes This She arrives at hospital one evening scenario involves a precipitous delivery with crying and doubled over in pain She heavy bleeding due to placental abruption is admitted to a birthing room and the Abruption was brought on by use of alcohol nurse notices bright red blood on Inez s and cocaine Instructor must fill hemor panties She is having very intense rhage kit with fluids before running the and close contractions scenario Janie is a 23 yr old G 2 38 weeks Runs for approximately 25 minutes Even She has
113. guide on Logging 74 NOELLE S554 100 User Guide Evaluation Form The evaluation tool assists facilitators in reporting and assessing provider interaction using a questionnaire form A completed evaluation form can then be stored as a digital document or printed for distribution Facilitator 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 Save Clear Delete Breech Vaginal Delivery Evaluation Nar ETE Forceps Delivery On Site Reviey Postpartum Hemorrhage Shoulder Dystocia Vacuum Delivery Enter the name of the facilitator performing the review in the On Site Reviewer field Evaluation Form Load template Eclamptic Seizure dear Evaluation Name Eclamptic Seizure On Site Reviewer James C 1 Problems Identified Complete the form by first entering the written response in the Problems Identified field and selecting the applicable multiple choice responses throughout 1 Problems Identified Eclamptic Seizure 2 Provider Tasks and Performance Calls for additional help Nursing
114. h the same precautions that would be used with a real patient Always adjust the motor arm prior to every delivery Always keep clear of the birthing mechanism while the system is on Never operate the birthing mechanism without the tummy cover in place NOELLE IV arm 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 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 NOELLE in a cool dry place Extended storage above 85 degrees Fahrenheit 29 Celsius will cause the simulator to soften and slowly warp It is acceptable to operate NOELLE at an ambient temperature of 95 degrees Fahrenheit 35 Celsius Do not store the simulator with a discharged battery It is good practice to re charge the battery at the end of every simulation session In addi
115. he facilitator can quickly log actions from the Provider Actions section of the log page To assign the entry to a particular provider or to the team in general the instructor may utilize the Team Logging feature The following is an example of an unassigned Action entry 00 07 24 Action Assess responsiveness Applied Changes An Applied log entry occurs automatically every time a change is applied to the physiological condition of the manikin In other words each time changes are applied to the manikin from the Details page the Palette page or from a Scenario a log entry similar to the following is created 00 04 01 Applied 00 30 Details Rhythm Sinus Cardiac event 0 HR 80 70 NOELLE S554 100 User Guide Detected Events Each time one of the various sensors within the manikin detects a provider action it is automatically logged as a Detected entry These actions include intubation BP cuff placement artificial ventilations chest compressions and electrical therapy pacing defibrillation cardioversion inappropriate shock The following example shows a detected log entry after a provider attempts to defibrillate 00 03 26 Detected defibrillation Shock 2 300 Joules Evaluations Evaluations are added by the facilitator clicking on the Satisfactory or Unsatisfactory buttons on the Evaluation panel The Evaluation panel is present at the bottom of the screen next to the clocks panel and
116. her membranes are ruptured Light meconium staining is noted following AROM Labor duration 60 minuntes 141 NOELLE S554 100 User Guide Gaumard Simulators for Health Care Educatior S amp S Prolapsed cord is protruding from the vaginal opening V E reveals double footling breech partially into vagina Faye A Noelle S574 575 Labor Scenario Cord Prolapse 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 Admit place bed in deep trendelenburg position cover extruded cord with warm NS gauze Culture placenta and send to lab requirements document according to facility Notify Priest for emotional care 142 NOELLE S554 100 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
117. hing mechanism before continuing Reset Force sensor Reset the force sensor if the labor activity is displaying incorrect force readings 84 First remove the baby from the birthing arm and allow the motor arm to remain free for 30 seconds While the birthing arm is free click reset the force sensor button to record the current state as zero force Reset Uterine Pressure Disconnect the uterus from the pressure port and click reset to restore the calibration to factory default Reset Labor Motor Recalibrate the position of the birthing mechanism on the track Always remove the birthing baby prior to recalibrating the birthing mechanism position Options The GaumardUl has several options that can be preset by the instructor Monitors Help Calibration onions OC Auto Responses NOELLE specific options include NOELLE Features Newborn specific options include Newborn Add Ons and Neonate Features Environment If the FIXED button is selected the simulator s serial number must be entered in the text box If you cannot find the serial number first connect to the simulator using GENERIC and then press on the button that says Can t find Serial Number and follow the instructions Environment General Noelle Features Log Other 7 GENERIC Find and establish a connection with Noelle Please switch to FIXED once connected a FIXED The software will enable controls for
118. ice Yes No Multiple choice Disagree Neither Agree or Disagree Agree Multiple choice Unacceptable Poor Average Good Perfect 2 Category Information Problem Description Evaluation Name On Site Reviewer Category 1 Problem description 78 NOELLE S554 100 User Guide 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 Highlight the Provider tasks and performance category and then click Add from the Multiple Choice Entry menu On Site Reviewer Category Multiple Choice Entry 2 1 Problem Description 2 Provider Tasks and performance Enter the multiple choice information in the entry fields Category Multiple Choice Entry 2 Add Remove it de WA fad o ee A 1 Problem Description 2 Provider Tasks and performance Physician Provider introduces themselves to the patient 79 NOELLE S554 100 User Guide Repeat the previous steps to add more categories questions and multiple choice options Category Multiple Choice Entry 2 e
119. id or no chest rise at all while damage the baby is released If user is not pulling the baby it means breathing that Force Sensor is offset See the Calibration Wizard section inside User s Manual and reset the force sensor to its default value Reset to Default Force button NOELLE s delivery baby is Wrong force sensor reading Try manual Release from button located on the left hand site corner disengaged prematurely under Delivery tab If baby releases then calibrate Force Sensor See the Calibration Wizard section inside User s Manual and reset the force sensor to its default value Reset to Default Force button NOELLE s delivery baby Dystocia is ON When Dystocia On button is checked the baby is not released until does not release at delivery checking Dystocia Off end when user is pulling the baby Motor is disoriented Reset the delivery motor by going to Setup Options menu NOELLE Features tab and then click on Labor Motor under Reset tab If delivery mechanism is at the very beginning 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 Initial fetus position was not specified Lock the baby into the birthing mechanism and manually turn the on the softw
120. ida 1 0 at 35 weeks She weighs 180 lbs She has had prenatal care Cesarean Delivery Irene is a 19 year old gravida 2 0 at 29 weeks She has had one spontaneous abortion NOELLE S554 100 User Guide 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 noted in the vaginal vault and ferning is positive Breakthrough contrac
121. ineal laceration The normal female infant is limp dusky and does not cry spontaneously Baby is hypothermic and tachypneic Runs for 30 minutes Labor progresses normally and fetal heart tone baseline remains within normal limits Patient is unable to fully crown Vacuum extractor is required to deliver the head Shoulder dystocia is encountered and McRobert s and suprapubic pressure maneuvers are required Male infant is centrally cyanotic limp and flaccid and requires immediate resuscitation Stat CXR reveals a fractured right clavicle and right pneumothorax Runs for 20 minutes Labor progresses quickly and breech is delivered by the nurse Meconium is noted The preterm female baby cries weakly with stimulation but color and tone are poor She is transferred to the nursery for stabilization and continuing care 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 Scenario Labor Type History Name Pf Cesarean Delivery o Cord Prolapse Francine is a 19 year old female gravida 2 1 at 37 weeks She weighs 145 lbs She has had prenatal care She has STD Herpes 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 grav
122. ing down the selection of available files Once a file is selected it will automatically open on the Gaumard Monitor screen Custom Numbers Use the custom numbers tool to add a new parameter such as glucose level or platelet count to NOELLE s virtual monitor Fie Setup Sensors File sharing Configuration On clicking the Custom numbers option the following window is displayed Custom Numerical Parameters on Monitor s 90 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 fat i Dy Hematocrit sl 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 Load Remove Hematocrit Yo Glucose mg dl update Enter the amount to be displayed in the virtual monitors and click update update Have the student or provider close one of the parameters currently displayed by the virtual monitor by clicking on the button of the value to be removed and selecting Close Now the new custom number has a display slot Click on the button and select Other Choose the value to display O O O FE os a fl al Time Glucose Do the same for as many new values as p
123. ion if and only if the fetus is moving down the birth canal with each contraction Leopold Maneuver To perform Leopold Maneuvers retract the birthing mechanism fully and remove the articulating birthing baby Place the elevating 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 NOELLE S554 100 User Guide Placing elevating pillow within simulator Place fetus onto elevating pillow and lift fetus anteriorly using the squeeze bulb 103 NOELLE S554 100 User Guide 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
124. ious ey wats Worst herse ac A Reply Ni ana a 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 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 68 Please verify that the simulator is connected by serial number on the Setup gt Options gt Environment FIXED field to access the more button Streaming Voice 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 maniki
125. is complete 2 cephalic presentation is confirmed 3 the fetal head is no more than 1 5 palpable above the pubic bone 4 effective uterine contractions continue 5 maternal expulsive efforts continue A soft skin scalp cover for the articulating baby 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 Always remove and store the soft skin after simulation is complete Vacuum assisted delivery may be practiced with the NOELLE simulator using a vacuum cup available from a number of suppliers Vacuum assist device attaches to fetal scalp between fontanelles Await the next contraction that may be simulated by asking NOELLE to bear down and have the student apply steady traction perpendicular to the plane of the cup Some vacuum assisted delivery devices are equipped with a means for measuring the amount of traction which may be on the order of about fifteen pounds The software will also give the instructor a graph that indicates applied force as the delivery mechanism is equipped with a strain gauge The student must stop traction when the simulated contraction ceases Repeat this procedure of waiting for the simulated contraction and providing traction during the contract
126. ism Labor Activity As labor progresses the manikin will detect manipulations performed on the fetus by the care providers Activity on the fetus prompts the Activity on Fetus window to appear on the tablet screen providing the instructor with feedback on pulling force uterine contractions torque on the baby twisting force and shoulder position The instructor can evaluate the providers in terms of pulling in or out of sync with uterine contractions The labor activity is a beneficial tool for the instructor as excessive forces applied to the fetus by care providers during delivery can lead to brachial plexus injuries All of these values will be given in real time and they will be recorded by the graphical interface for further analysis Peak Force measurement of how hard the provider is pulling the fetus Can be displayed in lbs or Newton Uterine Activity contractions generated by NOELLE Peak Torque measurement of the torque induced as the provider rotates the fetus negative readings represent counter clockwise rotation and positive values represent clockwise rotation Cardinal Movement the angular position of the baby is measured in degrees taking into account that 0 degrees corresponds to the fetus facing upwards with the shoulders horizontal 58 NOELLE S554 100 User Guide Export Data to Desktop exports labor force data to an Excel file Use the data to make graphs to study trends and perfor
127. ition Position a 6 wr Dystocia Enable Smart Labor 110 jio sec 2 ON OFF O Enable Contraction Response E E peach E C Descend only with contractons station 9 O speech speechivitals 2 F check ROT LOT delvery 2 edit S Pause Run Reset Alice peer H os a a A a E A A A E A T DESCENT SBSLRKLEA Loewe 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 Dwstocia C Enable Smart Labor 10 sec ON OFF ne Station 9 Pause Run Station 46 NOELLE S554 100 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 cm Stage Information Weight 170 Weight gain pounds Stctatent 51 Active 51 Transition Stage 2 Stages Significant Other Mike Maternal Info Respiratory status OB History Cardiac status Gravida Spont Abortions Pain Bleeding Membranes Dilation Station C Alcohol C
128. itor 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 IP address 1 Locate the wireless connection icon on the bottom right corner of the computer screen 8 15 AM 1 4 2011 _ a Re al 4 2 Click the wireless icon and select Open Network and Sharing Center from the options on the menu Open Network and Sharing Center 2 lalala 1 40 PM 3 In the Network and Sharing Center window click Change adapter settings from the left hand panel Control Panel Home P View your basic networ Manage wireless networks A Change adapter settini nge adapter settings ENG2 PC Change advanced sharing This computer settings View your active networks Change your n
129. l repair costs in addition to 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 193 NOELLE S554 100 User Guide 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 4 Summer Time Gaumard Scientific Company 2012 All rights reserved Gaumard NOELLE HAL are trademarks of Gaumard Scientific Company Inc Patented Other Patents Pending Always dispose of this product and its components in compliance with local laws and regulations C 194
130. l vitals and fetal traces Mv M Mute ken tak Gaumard Legend Ooo or Saveas Palette Item 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 Options Newborn specific The following options are specific to the Newborn control software Neonate Features Configure Newborn features available in the Newborn software Set pulse strengths for normal Sync Vitals when left blank Sync Leg BP to Arm Sync Postductal OSat to Preductal Tolerances This tab is used to select the tolerance and intensity of both chest compressions and ventilations Options Environment General Newborn Hal Add Ons Neonate Features CPR Options Other CPR Intensity Tolerances Artificial ventilation intensity evaluation tolerance J 10 Chest compression intensity evaluation tolerance Y 10 CPR Rate Tolerances Artificial ventilation rate evaluation tolerance Y 10 Chest compression rate evaluation tolerance y 10 x Caneel Auto Responses The GaumardUI Module software can be configured to respond to electrical therapy when changes are applied using the detail list NOELLE S554 100 User Guide Monitors CPR Help Auto Responses he Auto resp
131. le and click Load to continue e Quick Start NOELLE Contains a total of twelve labor scenarios e NOELLE Advanced Contains fourteen linear scenarios twenty two labor scenarios and one branched scenario e Quick Start Newborn contains a total of eleven scenarios For more information on the items included on the Quick Start profiles navigate to Page 115 To change profiles from inside the GaumardUI environment select Profiles from the File menu Profiles are used to organize and protect software settings As you begin to customize NOELLE it will become clear how profiles can best serve your needs For 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 16 e For the most detailed exercises it is sometimes useful to devote an entire profile to one particular subject area or even one particular scenario To create a user made profile click on the New Profile button on the right panel Manage Rename 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 Finally click create to save the new profile To import
132. lood 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 Do not overfill the reservoir Enabling post partum hemorrhage To manually enable the PPH feature go to the Details tab and click the hemorrhage feature icon blue active Hemorrhage Uterine Pres 30 Uterine Hemorrhage Then click the Apply NOW button to start the hemorrhage To stop the hemorrhage click the control icon to black disabled and then click apply NOW Recall that when the uterus insert is connected to the hemorrhage port inside the abdomen the instructor can simulate hemorrhaging from the cervix Hemorrhage Uterine Hemorrhage Uterine Pres NOELLE S554 100 User Guide Several built in labors are preprogrammed with post partum hemorrhage activity Go to page 60 for more information 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 Episiotomy repair modules snap into birth canal 000 sized sutures are recommended to extend the life of the repair modules Systemic Intramuscular injection sites IM sites for placement exercises
133. ly 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 connected Lo PSF io Internet accens Wireless Neha Connection 2 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 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 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 con
134. mance patterns Slider The slider at the bottom of this screen lets you rewind the strip to see the previous graph data e Activity on fetus Activity started 00 22 26 A ee ee EERE EE SEEEEE SEEEE i I i HU TEEN il ITIL Export Data to Desktop HHHH Peak Force 62 93 newtons Uterine Activity 64 rm Peak Torque 2 0 m Cardinal Movement 1400 Ha N 59 NOELLE S554 100 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 under the quick start and NOELLE Advanced scenarios Quick Start Scenarios Scenario Labor Type Name a k Variations on Amy Variations Normal Variations Normal Normal 60 Variations Normal Shoulder Dystocia Breech Preeclampsia History Alice is a 24 year old gravida 2 1 at 39 weeks She weighs 170 pounds She has had prenatal care She has not been using medications of any kind Alicia is a 24 year old gravida 2 1 at 39 weeks She weighs 160 pounds She has had prenatal care She has not been using medications of any kind Amy is 19 years old 1 0 at 40 weeks She weighs 160 lbs Angelica is a 31
135. me Liquid Panel Description Cholesterol HDL LDL Triglycerides Category Single Entry Add Remove Rename Insert CA v Lipid Panel Female Variable 25 NOELLE S554 100 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 Hel Add Insert Entry Name HDL Cholesterol Precision Normal Range Minimum 35 00 Maximum Allowed Range Minimum aim A ee 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 1 Edit Lab Results Template Name Lipid Panel Description Cholesterol HDL LDL Triglycerides Category Single Entry add Remove Rename Insert A v add Delete Lipid Panel Female Variable Normal Range HDL Cholesterol mg dL 35 00 85 00 Cholesterold HDL Ratio 0 00 4 40 Lipid Panel Mal
136. n 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 amp Streaming Voice Output Gain Mute O Listen O Talk Push toTalk es 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 manikin without user intervention The voice activation threshold can be adjusted The Mic Threshold is used to adjust how sensitive the microphone is to the user s voice The higher the threshold the less sensitive the microphone is and vice versa For instance if the threshold is set to high users must speak loudly for the microphone to detect the audio Voice Recorder The instructor is able to record his her own speech phrases at any time Once the instructor clicks on the Rec button the software automatically starts capturing everything that is said into the microphone Voice Recorder mes Stop Press Stop to finish recording Use the Enter Audio Name window to name the speech phrase Enter Audio Name Enter a name and click OK The phrase will now be accessible under the Prerecorded Speech menu Prerecorded Speech
137. n HAL Gaumard DS Simulators for Health Care Education Cynth la S Baby Male infant with central cyanosis limp flaccid and requires immediate resuscitation No spontaneous movement of right arm is noted Stat CXR reveals a fractured right clavicle and right pneumothorax Perform ventilations and needle decompression Wait Indefinitely for actions Perform fluid resuscitation Wait Indefinitely for action 171 NOELLE 554 100 User Guide Newborn HAL Gaumard Simulators for Health Care Education Elaine s Baby This baby is born with moderate asphyxia and will require CPR and oxygen to bring the vitals to a healthy state Administer 100 O2 with bagging Wait Indefinitely for actions 172 NOELLE 554 100 User Guide i Newborn HAL Gaumard Simulators for Health Care Education Francines S Baby This baby was born through a C Section and is responsive but needs some attention after a while all vitals go to a healthy state Warm baby apply suction and administer O2 Wait Indefinitely for actions 173 NOELLE 554 100 User Guide Newborn HAL Gaumard o Simulators for Health Care Education G loria S Baby This baby is born with mild asphyxia but no matter how good the interventions are this disastrous intrapartum complication results in neonatal death Begin PPV Wait
138. nal vital signs monitor Fetal heart tones and neonatal vital signs monitor Set up and run OB emergency simulations for shoulder dystocia postpartum hemorrhage eclampsia umbilical cord prolapse breech vaginal delivery operative vaginal delivery neonatal resuscitation Genuine NOELLE Simulator IV arms for meds fluids Intubatable airway with chest rise Removable stomach cover Programmable eclampsia Advanced birthing mechanism Programmable postpartum hemorrhage Birthing fetus with placentas and umbilical cords Newborn e Full term intubatable newborn with cyanosis and umbilical pulse e Chest compressions and ventilations are measured and logged e Realistic heart and lung sounds e Realistic crying Simulated vital signs monitor e Single large 23 inch touchscreen monitor with desktop controller and wireless communication to laptop e Display up to 8 numeric values including HR ABP RR CO2 SpO2 temperature NIBP and time e Select up to 5 dynamic waveforms including ECG II ABP respiration CO2 and pulse oximetry e Fetal Heart Rate monitor Other e Simulation transport case for electronic products e FCC IC CE Certifications e One year warranty extend to three years e Installation and training available 10 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 con
139. nsert with your fingers holding the bag in place Steady the front of the insert with your thumbs Without removing the plastic orient the birth canal insert so that it is properly aligned with the opening on the lower torso of the mannequin Gently begin to remove the polythene bag with one hand while holding the insert in place with the other as pictured below It is easier to start at the top then work down the sides towards the bottom Place one hand towards the bottom of the birth canal insert when pulling out the bottom portion of the polythene bag With the birth canal insert in place pull the post partum hemorrhage tube through the hole in the bottom of the birth canal insert as shown in the picture This is to position the hemorrhage tube in the correct location The birth canal insert is now ready for normal use NOELLE S554 100 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
140. nta 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 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 107 NOELLE S554 100 User Guide 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 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 n
141. 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 noda O gt wait 02 00 No changes are made to manikin 00 01 confusion What happened 01 00 HR 15 BP 10 OSat 5 El Epinephrine copy Remove Add path gt E Dopamine Linked Action Key Events A linked 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 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 te
142. of preterm contractions that resolved with LLP bed rest and oral hydration She began contracting again 3 hours ago and again tried LLP bed rest and oral hydration but the contractions have continued become stronger Maria is a 30 yr old multip 27 weeks She has an 11 yr old and has been trying for more children She has had 2 miscarriages in the last 4 years and she lost both due to an incompetent cervix This time a McDonalds suture was placed 14 weeks Fluid Kimberly is a 27 yr old multip Y 42 Runs for approximately 30 minutes In this scenario patient has an AFE and resuscitation efforts are in vain Fetus is delivered via perimortem C section Runs for approximately 35 minutes Patient starts having contractions and is given SQ Terbutaline to stop contractions She begins to have unfavorable reactions to the drug and contractions break through about 30 minutes later Another dose of Terbutaline is given and her reaction is worse and contractions break through yet again Eventually she s given Procardia which resolves the contractions and does not give adverse reactions A run for approximately 15 minutes and it is a tocolysis emergency Patient has reaction to overmedication of magnesium sulfate NOELLE S554 100 User Guide Model Newborn The physiologic cyanosis model adjusts vital signs and skin color in response to ventilation effectiveness Set the physiological modeling state to deteriorate an
143. ol by the facilitator via either the Palette or Details page 4 Choose auto response settings based on the scenario content and the objectives 179 NOELLE S554 100 User Guide As you ve seen auto responses can be used to free the facilitators attention They also enhance realism by presenting instant reactions to the care providers On the other hand sometimes it is not possible or desirable to determine the responses before the simulation begins Different environments and applications call for different settings Loosely structured teaching and practice is usually best done with the auto response settings in Prompt mode Responses must be triggered by a vigilant facilitator Though it is slower and requires more attention the benefit of Prompt over other modes is that the simulation can be allowed to go in any direction and it will be possible to choose the response on a case by case basis Tightly structured teaching and assessment requires a higher degree of automation For such applications most facilitators choose Auto mode for the auto response settings The key issue is standardized timing of symptom presentation A consistent repeatable simulation is essential for fair assessment of that care provider in relation to others and for the broader interpretation of results in the context of training validation studies When in doubt it is best to choose Prompt mode in which the facilitator will be given direct control of the responses
144. on 15 minutes Scenario duration 25 minutes Reset delivery motor and insert postpartum uterus Wait time 3 min 157 NOELLE S554 100 User Guide 158 Gaumard Simulators for Health Care Education Noelle S574 575 Labor Scenario Janie 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 NOELLE S554 100 User Guide Noelle S574 575 Labor Scenario June Peripartum Hemorrhage PPH Gaumard Simulators for Health Care Education June is a 31 yr old multip about to have her 5 baby She has had a normal pregnancy and she is planning natural childbirth She enters the hospital in active labor The family is very excited as they know this baby is a boy Labor duration 15 minutes Scenario duration 22 25 minutes S amp S Abdominal and low back pain with ctx S amp S Patient looking pale early signs of hemorrhage 159 NOELLE S554 100 User Guide 160 Gaumard Simulators for Health Care Education Noelle S574 575 Labor Scenario June Peripartum Hemorrhage PPH y Place PPH kit inside Noelle simulator Wait indefinitely
145. ons of each palette item One can manipulate the scenario items with the Selected Item group of buttons on the right side of the page Most of these functions are also available by right clicking on scenario items When using the stylus hold the stylus button and tap the screen to do a right click 38 NOELLE S554 100 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 Palette File tab helend4 A 59 59 Max Item Description cil Select labor scenario from the a pulldown menu below ireneo4 irene ireneo irened5 ireneb 6 respiratory allergy Resting Alice Wait Alicia Wait Indefinitely Amy Angelica Beth Cynthia Donna a Elaine Add Cancel Francine Gloria Upon reaching the Go to Labor palette the software will automatically begin the labor scenario named Alice Name Transition Description Start State 00 20 Asthma Sinus respiratory allergy 04 00 wheezing difficulty exhaling tongue edema Closed airway 00 00 all difficult airway actuators on Wait Indefinitely sos Hold in current state until action is taken Resting 01 00 Normal Vitals cototabor ee ee WARNING Prepare the simulator for delivery before using a linear scenario that automati
146. onses configured from the set up menu respond to electric therapy administered when a scenario is not in progress This type of auto response is referred to as a Non Scenario Automatic Responses Non scenario automaticresponses settings alloff All Prompt o Display warning when non shockable AlAuto cardiac rhythm is shocked External Pacing Defibrillation Shock Cardioversion Shock Non Sync Shock O Prompt ma O Prompt ES O Prompt SK O Prompt ES Auto 4 Auto gt Auto SN Auto DA Setting Setting Setting Setting Capture at at at at apa mo Dades poom Ds oom Sos Y OCI OCI JOCI convert to NSR convert to NSR degrade to K 75 bpm BP a 75 bpm BP e ventricular 120 80 120 80 fibrillation to paced rhythm cot 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 Click on the palette button to program a specific palette to be applied after the electrical therapy 87 NOELLE S55
147. 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 75 NOELLE S554 100 User Guide Once the evaluation is completed click the Print button located at the top right corner of the screen plate Eclamptic Seizure on Name Eclamptic Seizure To save the finished evaluation as digital document select Microsoft XPS Document writer and click Print lt is recommended that documents are first saved as XPS files before being printed into hard copies Microsoft XPS Document Writer F Print to file Preferences e Find Printer Page Range All Number of copies 1 H Selection Curent Page Pages 4 Collate Save the file as O Documents Evaluations v 4 Organize Y New folder Evaluations Libraries Es Documents a Music i Pictures F Videos No items match your search Ft Favorites Documents library Arrange by Folder E Computer r Filename Eclamptic Seizure Session 3 xps X Save as type XPS Document xps Hide Folders sve 76 NOELLE S554 100 User Guide Printing an evaluation If a print device is connected to the tablet first select and open the evaluation document saved in the previous step gt Evaluations ee gt Libraries Do
148. 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 Labor Always lubricate the fetus and the birth canal before every delivery Failure to do so will result in damage to the birthing mechanism and the birth canal Do not pull the baby upward in contrast to the birthing mechanism s linear trajectory Doing so can bend the motor arm and cause damage to the birthing mechanism NOELLE S554 100 User Guide Getting Started NOELLE S554 100 User Guide Overview The NOELLE S554 100 is a comprehensive package of simulator technology scenario based training and performance measurement and debriefing tools designed to build competencies needed to help manage OB emergencies Highlights e Prepare for OB emergencies evaluate and report on training and clinical outcomes e Full size NOELLE maternal and neonatal birthing simulator with eclampsia and hemorrhage capabilities e Mobility allows training to be in L D and postpartum units Build team and technical competencies Mater
149. ot 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 108 3 At the top of the uterus connect the center hose to the air pressure port Should the instructor wish to use the tummy with the inflatable bladders the tummy can be connected to the extra port on the air hose 4 Connect the lateral hose to the hemorrhage port inside the abdomen 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 Use bimanual massage to shrink the boggy uterus into a smaller and firmer condition Post Partum Hemorrhage Noelle can hemorrhage real fluid from the cervix or birth canal Follow the guide below enable the post partum hemorrhaging feature WARNING 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 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 850 mL or approximately 15 fill kit syringes WARNING Only use Gaumard provided simulated b
150. own in this dialog box Descend only with contractions If checked this option configures the motor to descend ONLY when there is a contraction 51 NOELLE S554 100 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 Labor Control Enable Smart Labor 10 g sec z C Descend only with contractions Pause Run eset 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 181 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 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 thr
151. ply EFM Wait time 5 min sulfate skip forward 24 hrs Wait indefinitely Ctx subside administer mag physician Call for help stat page Wait indefinitely 166 NOELLE S554 100 User Guide Newborn Flowcharts Quick Start Newborn Alice s Baby Asphyxia Beth s Dona s Baby Cynthia s Baby Elaine s Baby Gloria s Baby Helen s Irene s Baby E Francine s Baby 167 NOELLE 554 100 User Guide 168 Gaumard Simulators for Health Care Education Newborn HAL Alice s Baby Healthy baby Apply suction and O2 Wait Indefinitely for actions NOELLE S554 100 User Guide Newborn HAL Gaumard Simulators for Health Care Education Asphyxia Baby has an asphyxia attack and the providers need to give ventilations to help bring back the vitals to a healthy state Apply suction and O2 Wait indefinitely for actions Ventilate and perform chest compressions Wait indefinitely for actions 169 NOELLE 9554 100 User Guide Newborn HAL Simulators for Health Care Education Beth s Donna s Baby Baby is born with a mild asphyxia that needs attention Once ventilations are started the baby s vitals go to a healthy state Begin PPV Wait Indefinitely for action 170 NOELLE S554 100 User Guide i Newbor
152. ponses settings Display warning when non shockable O cardiac rhythm is shocked External Pacing Defibrillation Shock Cardioversion Shock Non Sync Shock nan smm DON co MDN n ON a Prompt cio a Prompt a Prompt a Prompt Auto D Auto SEN Auto 7 NA Auto 5 SY Setting Setting Setting at at at 8 E Joules 4 2 9 Joules 4 2 Joules Shocks gt Shocks Shocks advance to next advance to next advance to next scenario item only scenario item only scenario item only when at WAIT when at WAIT when at WAIT en o The three auto response detection modes are defined below e Off The software does not respond to the electric therapy e Prompt The software detects the electrical therapy and prompts the facilitator if the scenario should proceed to the next palette e Auto The software detects the electrical therapy and compares it to the joules or shock threshold configured by the facilitator If the electrical therapy is equal to or greater than the threshold specified the scenario will automatically continue without prompting the facilitator 33 NOELLE S554 100 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 Palet
153. port while maintaining suction The port will seal and the veins will remain collapsed 98 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 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 1 Lubricate the fetal head and shoulders plus the inside of the birth canal insert using the silicone oil provided WARNING Always lubricate the fetus and the birth canal before every delivery Failure to do so will result in damage to the birthing mechanism and the birth canal NOELLE S554 100 User Guide Attach the umbilicus to the placenta gt s S We AGE 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
154. red to high school while her mother cares for the baby The baby s father will not accept any responsibility and does not wish to be involved The ER is notified that EMS is about 4 Runs for approximately 20 minutes minutes away with a 19 year old instructor must place C collar on NOELLE pregnant postictal patient named cimulator before beginning scenario Eleanor Her aunt found her con puring delivery patient has tonic clonic vulsing in the bathroom and called 911 seizure followed by tetanic contractions The aunt told the EMS providers that Fetal baseline drops to approximately 60 Eleanor was 81 2 months pregnant with bpm SVD occurs very quickly Infant is her first baby and that it was a difficult cyanotic and limp and no respiratory effort family situation She added thatlis evident Eleanor had just moved in with them and had not yet seen a doctor The paramedic reports to the ER physician by radio that the patient is responsive only to pain Her initial blood pressure is 180 120 The EMS crew applies a C collar and move her onto a backboard for transport The para medic initiates ECG monitoring and does a genital exam before they move her She notes a small amount of vaginal bleeding The crew moves her to the ambulance and the paramedic starts an IV of LR and initiates oxygen 10L by non rebreather mask She monitors the ECG and VS during transport and also tilts the backboard about 15
155. referred for display The figure below shows three new values Glucose level hematocrit and TSH levels along the bottom of the display Delete any parameter by clicking Remove Custom Numerical Parameters on Monitor s ims ahaa Hematocrit On Glucose E Hematocrit 52 al Off On Off Glucose Save any list of added custom numbers by clicking on the Save button After clicking this button the Save As window is displayed r Save As _ a CIO m profiles Custom Numbers v Search Custom Numbers p Organize v New folder Favorites Date modified No items match your search Libraries 2 Homegroup Computer cl Network 4 File name Glucose Hematocrit Save as type Custom Scalars files csc Hide Folders 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 Resoratory Rate Ca PARA Soo WE Morii SL Select the number of monitors that wil be used with the mankin Ako you can name each monitor with an approplate description a Keep in mind that Noele s vital signs and fetal monitor are considered fh _ rt together as 1 monitor D Al sensors aways ON S
156. rent status of the scenario The following paragraphs describe in detail the behavior of each button and indicator The Scenario Position Indicator YVV An unfilled triangle means that the scenario is stopped When the Play button is clicked the item pointed by the indicator is be played A rapidly blinking triangle means that the scenario is playing the item to which the indicator is pointing A slowly blinking triangle means that the scenario is paused at the item to which the indicator is pointing The Scenario Buttons y i 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 When clicked once the Stop button halts the scenario at the end of the currently playing item When clicked a second time the scenario is stopped immediately For example if the currently playing item has a transition of 1 00 minute and the Stop button is pressed when it has 0 10 seconds left the scenario will be halted at the end the transition i e in 10 seconds If the Stop button is clicked again within those remaining 10 seconds the scenario stops immediately The Next button advances the indi
157. s below While operating under a Quick Start Profile go to the Scenario tab and Click on Load Scenario Details Palette Scenario Lab Labor Speech Log Gaumard Scenario Auto Responses eee 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 Go to Branching June suffers PPH following svd of healthy baby boy June PPH Name Transition Description gt uez 00 00 early signs of hemorrhage Wait Indefinitely ba allow time for instructor to place PPH kit in Noelle simulator June 3_1 1 00 10 hemorrhaging 01 30 increase Pit give methergine cath bimanual exploration 01 00 Bimanual fundal massage 00 30 Give Cytotec rectally 00 45 fundus firms up 01 00 recovering Edit Palette mM a re sca 36 NOELLE S554 100 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 Airway Upper Airway Sound normal Y O Laryngospasm Breathing Resp
158. screen The Gaumard Monitors software is now ready to receive vital signs information once GaumardUl is initialized Continue to the next section to begin working with the simulator and the GaumardUl control software 14 NOELLE S554 100 User Guide Working with GaumardUl NOELLE S554 100 User Guide Initializing the simulator After reading the care and cautions information included with the system components power on control computer Following a brief loading screen the simulator selection screen is shown Select the simulator connected to the communication module and click start The simulator will power on in approximately 30 seconds To troubleshoot startup issues go to page xxx GaumardUl controls one simulator at a time To switch between NOELLE and Newborn first exit the GaumardUl software and reconnect the Ethernet cable to the simulator you wish to control User Profile Menu Each profile stores an independent library of customizable palettes scenarios and options settings Changes made to items in one profile do not affect items stored in others The Quick Start profile was created in conjunction with experienced healthcare instructors and working medical professionals The Quick Start NOELLE profile contains prebuilt labor scenarios for birth simulation and post partum complications lt serves a convenient starting point and it can be customized to fit most simulation objectives Select a profi
159. scription H Normal Vitals Color a Healthy O Critical Care Required O Other 2 After creating all your palettes go to the Scenario tab Gaumard emma 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 37 NOELLE S554 100 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 Q mas min sec 59 59 Max Add Palette Item Item Description Normal Vitals 5 Repeat the previous step to add more palettes wait times speech or labs Details Palette Lab Scenario Labor Speech Log Gaumard Clear Load Scenario Save Scenario ScenarioAuto Responses ELLA 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 a Hold in current state until action is taken Resting 01 00 Normal Vitals ee w a m cee 6 Begin the scenario by pressing play Watch the vital signs adjust according to the specificati
160. se contact customer support ensure that the module that is unresponsive is not specific to an Add On feature that is not installed on your simulator NOELLE 554 100 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 fmm name ope oe ES R amewa S555 100 007 D C Section Abdominal Cover C NOELLE stomach cover for C Section Exercises dark color S555 100 007 L C Section Abdominal Cover NOELLE stomach cover for C Section Exercises light color S555 100 007 M C Section Abdominal Cover C NOELLE stomach cover for C Section Exercises medium color ES n poe soraa cor anran aor A ON A AA ECN fonera ECN EC E n paeran mean E E ES E E ENS E E n reaa E rrenan IN E E NN E O NS 189 NOELLE S554 100 User Guide CT name ype ween 555 100 062 Shipping Cardboard Box Box dimensions 60 x20 x30 for simulators with soft case 8555 100 080 Simulated Blood Concentrate 8555 100 081 Silicone Oil R Oil based Silicone lubricant S555 100 207 Laptop PC EM GUI Software included S555 100 310 Wireless keypads RO Extra pack of five wireless keypads 555 100 EXW Two Year Extended Extended warranty for years Two AND Three Warranty 555 100 INST In Service Training Day of in service training and installation C Consumables R Replacements A Accessories U Upgrades M Replace in Miami Factory ONLY 9
161. 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 inserted and the presenting part lifted off the cord to relieve pressure from the cord This procedure must be maintained until the prolapse has been resolved either by termination of the compression of the cord or until delivery of the fetus by C section NOELLE S554 100 User Guide 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 pr
162. ssistance additional staffing 00 03 12 Patricia Action Shoulder dystocia 00 03 20 Chris Action Shoulder dystocia Suprapubic pressure 00 03 30 Chris Action Shoulder dystocia McRoberts maneuver 00 03 37 Patricia Action Shoulder dystocia McRoberts maneuver 00 03 52 Patricia Evaluation Care Provided Satisfactory 00 04 02 Chris Action Manage bleeding The Log page consists of four different areas from bottom to top the text log provider action buttons 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 manikin during the session T
163. surgery notice anterior uterine wall dehiscence Wait time 2 min dehiscence close abdomen Uterus double sutured and bleeding controlled Wait time 3 min NOELLE S554 100 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 147 NOELLE 554 100 User Guide Gaumard Simulators for Health Care Educatior Noelle S574 575 Labor Scenario Gall 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 148 Deliver Baby repair uterus Wait indefinitely NOELLE S554 100 User Guide Noelle S574 575 Labor Scenario Gaumard Heidi Simulators
164. te Scenario Labor Lab Speech Log Scenario Bm e te mm After the scenario button is clicked GaumardUl will automatically start the scenario Becca delivered precipitously and has retained Becca Sedation secundes Name Transition Description 00 00 Delivery 00 40 instructor to reset birthing motor 02 00 sedate for bimanual exploration Wait Indefinitely eee remove placental fragments Becca 3 postpartum 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 99 for important information on preparing NOELLE for delivery Labor Scenario ROA Py oe oe 34 NOELLE S554 100 User Guide After the position is set click on the labor scenario to start Labor Scenario ROA LOA GaumardUl will automatically start the labor scenario and switch to the labor tab O Station 10 speech speech vitals ROT LOT delivery cle Pause o Run Reset edit Lo Alyssa Labor Time 00 01 29 H DESCENT z a o an ne o ee eee a a ee ey E 35 NOELLE S554 100 User Guide 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 step
165. ter 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 187 NOELLE S554 100 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 GaumardUI E Port 8001 p Connect Noelle Enter the IP and port selected on the controlling computer Controller IP 10 0 0 1 Monitor Selection NOELLE and Newborn HAL If the communication has not been established please enter the IP address and port number selected on the controling computer GaumardUI Noelle Enter the IP and port selected on the controlling computer Controller IP 10 0 0 1 TE 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 controlling computer GaumardUI Noelle HS Enter the IP and port selected on the controlling computer Controller IP 10 0 0 1 E Port 8001 11 On GaumardUl s Virtual Monitor Setup window the connection status will also display connected Noele 574 575 Virtual Monitor Setup Select the number of monitors that will
166. th contractions Over the next 10 pounds and she had experienced a few minutes variables become more severe shoulder dystocia with the severe Kelly vomits and begins gasping delivery She has gained 43 pounds then suddenly becomes unresponsive with this pregnancy and her glucose Decels now have late characteristics She tolerance test GTT is borderline An is given SQ Terbutaline and fetal baseline ultrasound a few days ago estimated drops to 90 She is intubated and very current fetal weight at 3800 to 4000 difficult to ventilate Patient develops VFib grams Kelly s physician feels that herland then arrests Baby is removed by cervix is favorable so he has recom emergency C Section Kelly remains on a mended an elective induction ventilator Baby is limp and unresponsive and requires resuscitation and suffers repetitive seizure activity 65 NOELLE 8554 100 User Guide Amniotic Embolism Preterm Labor o Preterm Labor 66 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
167. th the Gaumard product that are manufactured by third parties For example third party products such as computers desktop laptop tablet or handheld and monitors standard or touch screen are not covered by this limited warranty Gaumard does not provide any warranty express or implied with respect to any third party products Defects in third party products are covered exclusively by the warranty if any provided by the third party Any waiver or amendment of this warranty must be in writing and signed by an officer of Gaumard In the event of a perceived defect in material or workmanship of the Gaumard product the first purchaser must 1 Contact Gaumard and request authorization to return the Gaumard product Do NOT return the Gaumard product to Gaumard 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 al
168. 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 students to pull the baby through the birth canal Cesarean Delivery Cesarean birth is the delivery of the fetus through an abdominal and uterine incision A Cesarean delivery also called a C section may be performed as a result of breech presentation pre term or dysfunctional labor fetal distress prolapsed umbilical cord placenta previa placental abruption or a variety of other abnormalities Demonstrate a C section using NOELLE by unfastening the snaps just above the pubic bone and birthing the baby between the tummy cover and the pubic bone An optional abdominal cover is available if the Instructor wishes to demonstrate midline or bikini incisions Delivery mechanism fully retracted and inflatable cushion inserted NOELLE C section delivery using abdominal cover with bikini incision P N S575 029 WARNING Do not enable the motorized birthing mechanism while performing this exercise Prolapse of the Umbilical Cord Prolapse of the umbilical cord is a dangerous complication which involves the presence of the umbilical cord in the birth canal in front of the presenting fetal part This condition may occur as a result of breech presentation transverse lies a
169. tilation 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 LC 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 Rate Rate of compressions in real time Ct Compression time Average length of each compression in seconds LC Last Compression Time elapsed since the last compression performed Ventilation Data Rate Ventilation rate in real time PIP approx Peak Inspiratory Pressure Ti Time Inspiration I E Inspiratory Expiratory Ratio PEEP approx Positive end expiratory pressure 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 reference 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 Environment General oe Add Ons a 2 Ventilations and Compressions 100 Compressions per minute
170. tion In addition select a condition color tag for the lab report on the right panel Color tags aid the sorting of lab reports on the report list window Edit Lab Report Lab Template Lipid Panel dear cancel Cholesterol HDL LDL Triglycerides Color Healthy O Critical Care O Other Report Name Lab 01 Report Time 11 15am Description Above normal range Cholesterol LDL Cholesterol Input the results of the tests on the Value column Values above the normal range specified will be displayed in bold Include any comments associated with the test performed Finally click Save from the top right menu to create the lab report Description Above normal range Cholesterol LDL Cholesterol Lipid Panel Female Variable Normal Range HDL Cholesterol mg dL 35 00 85 00 Cholesterold HDL Ratio 0 00 4 40 E 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 27 NOELLE S554 100 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
171. tion 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 The simulator should be cleaned with a cloth dampened with diluted liquid dishwashing soap If medical adhesives remain on the skin clean with alcohol wipes DO NOT USE GOO GONE as the citric acid in the formula will cause pitting of the various materials comprising your simulator NOELLE is splash proof but not water proof Do not submerge or allow water to enter the interior of the simulator Do not expose the tablet computer to water or excessive dust Set Up NOELLE will only power on when connected to the power supply 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 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 simulator 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
172. tion 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 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 S554 100 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
173. tions occur and sterile speculum reveals cervical change Cerclage is removed Fetal heart tones remain stable throughout the short labor Spon taneous delivery occurs The female infant born earns good APGARs 61 NOELLE S554 100 User Guide NOELLE Advanced Normal Labor Normal Labor Patient Name Alyssa Angela Variations Normal Becca Variations Normal Bianca Shoulder Dystocia Candice Charlotte Shoulder Dystocia O on Alyssa is a 23 year old primip at term She has received prenatal care in a multidisciplinary practice Her general health is good and she has experienced no prenatal complications She wants to have an unmedicated natural birth Angela is a 31 year old grand multip Even though she has had only a few contractions she came in anyway because she has a history of rapid labors Becca is a young pregnant teen who is living on the streets She is a heavy smoker and drug user She was seen twice in the Adolescent Clinic and referred to Social Services but she only saw the social worker once and did not go to the follow up appointment The extremely precipitous delivery and patient s agitated state should point participants to order tox screen to check for illicit drug use Bianca is a 16 year old gravida 2 1 She had an elective abortion at age 13 She lives with her 17 year old boyfriend and has no contact with her family She has been inconsistent with appointments at
174. 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 minutes shoulder McRoberts pressure runs for approximately 40 Baby is delivered after basic dystocia maneuvers such as and stiff arm suprapubic NOELLE S554 100 User Guide Breech Dana Is a 24 yr old multip 29 weeks Runs for approximately 45 minutes Presentation who was admitted because she began contracting Upon VE physician discovers that she is 4 5cm with bulging membranes She was given Terbutaline subQ and then transported to the regional medical center Breech Presentation Demaris is a young Hispanic teen who has received prenatal care in the Adolescent OB clinic She kept the Instructor must set up baby for double footling breech delivery To skip resolution of contractions portion of scenario it is suggested that the instructor warp to around 20 minute mark on the timeline Runs for approximately 30 minutes Frank breech position has been confirmed by real time U S Patient refuses Cesarean pregnancy a secret as long as was delivery Pinard maneuver must be utilized possible and did not attend any to bring the legs down MLE is performed childbirth classes Her plan is to return and baby is delive
175. tory Distress Transient Tachypnea of the Newborn Francine s Baby Helen s Irene s Baby 40 NOELLE S554 100 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 the 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 changes are made to manikin O Atropine A gie 4 E Epinephrine Ace 01 00 HR 15 BP 10 OSat 5 E gt 5 E Dopamine a ico En gt 6 ea deen z Addnode p i o sw Q 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 p gt mo o a h n 41 NOELLE S554 100 User Guide To edit the node name
176. traction Response Speech Ouch 00 01 30 Contraction Response Speech Epidural 00 01 33 Applied 00 00 Palette alice04 Details HR 70 RR 19 E IKI lt iil gt 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 3 00 01 08 Contraction Response Decrease HR BP RR 9 during contraction A 00 01 11 Applied 00 00 Palette alice03 Details RR 23 OSat 97 ContractionFreq 3 min ContractionDurat 70 sec ContractionI__ g i EJ gt 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 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 aa
177. troller 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 software on the Virtual monitor computer NOELLE S554 100 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 compu
178. use 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 94 NOELLE S554 100 User Guide Help The help menu has four options Instruction Manual About GaumardUl Check for Updates and Diagnostics Instruction Manual Instruction Manual allows you to view a soft copy of the entire simulator help manual About GUI This window gives you the version of the software you are currently using and also the firmware version Simulators for Health Care Education Gaumardul Version 1 20 8 0 Armware 1 25 Copyright 2011 Gaumard Scientific Co www gaumard com ok If updates are not available the Install button is disabled and the following dialog box is displayed Diagnostics Use this feature as a troubleshooting tool gt GaumardUl Version 1 24 11 0 Diagnostics Info SN J0000001 File Audio Mechanical Legend O Throat voice Umbilical cyanosis C Active O He
179. 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 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 48 NOELLE S554 100 User Guide Labor Time This timer represents the time on the labor curve AA ROA LOA Save Labor Load Labor Labor duration 30 min Warp Factor approx 1 min Labor Control Dystocia Contraction Response Delivery Position O Enable Smart Labor 10 sec 2 ON OFF Enable Contraction
180. xt in the node display Edt Path Key events Pacing gt 40 mA Linked Action O Defibrillation Shock DO Cardioverston Shock O Non Syne Shock External Pacing Go to 8 Pace 44 NOELLE S554 100 User Guide Node 1 of a Cardiac Arrest branching scenario with Model Medication and Electrical Therapy paths added i Initial assessment v e VFib 1 00 00 V fib a fe a E gt 3 Adenosine SD IV Push la Ey B Addin adscerano copy Remove ada pain gt nani gt End Path Controls Once a path is opened for any node you can edit copy or delete the path using the buttons below Edit a E Delete El This button allows you to add remove or change the order of actions in a specific path Clicking on this button also enables you to select where the scenario should go after the path is finished playing 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 This button allows the user to delete any undesired path 45 NOELLE S554 100 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 ltems with delay periods corresponding to a labor curve Gaumard ar sand anton 09 30 30 8 min Warp Factor 1 1 gl approx 30 min e Labor Control Response Delvery Pos
181. y 131 NOELLE S554 100 User Guide Noelle S574 575 Labor Scenario Gaumard f Simulators for Health Care Education B lanca 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 ae Attach EFM Notice variables turn patient Wait time 3 30 min tie Check resolution of variables Goto labor Bianca Wait time 1 45 min 132 NOELLE S554 100 User Guide Noelle S574 575 Labor Scenario Gaumard Bianca Simulators for Health Care Education ee Variations on Normal 133 NOELLE S554 100 User Guide Noelle S574 575 Labor Scenario Gaumard Candice Simulators for Health Care Education Shoulder Dystocia Candice is a 19 r old multip She her boyfriend and their 3 yr daughter are homeless living in a car She has not seen a doctor and believes that she is about 8 months pregnant Her water broke yesterday and she is leaking moderately thick meconium fluid An ultrasoun

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