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NOELLE S554.100 User Guide

1. NOELLE 554 100 User Guide 95 M Gaumard Simulators for Health Care Education Noelle 574 575 Labor Scenario Gabriella Uterine Rupture 96 User Guide NOELLE 5554 100 Repair anterior wall During surgery notice anterior uterine wall dehiscence Wait time 2 min dehiscence close abdomen Uterus double sutured and bleeding controlled Wait time 3 min Gaumard Simulators for Health Care Education Noelle 574 575 Labor Scenario Gail 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 NOELLE 554 100 User Guide 97 Gaumard Simulators for Health Care Education Noelle S574 575 Labor Scenario Gail Uterine Rupture lt p Physically place Noelle on ventilator _
2. Prep for c s Wait time 1 30 min Begin c s procedure Wait time 1 min 98 User Guide NOELLE 5554 100 Deliver Baby repair uterus Wait indefinitely Gaumard Simulators for Health Care Education Noelle 574 575 Labor Scenario Heidi Peripartum Hemorrhage Previa minutes 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 Branching e Se NOELLE 554 100 User Guide 99 Noelle S574 575 Labor Scenario Gaumard Heidi Simulators for Health Care Education 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 100 User Guide NOELLE 5554 100 Noelle S 574 575 Labor Scenario Gaumard Heidi Simulators for Health Care Education Peripartum Hemorrhage Previa i Deliver and inspect placenta Wait time 1 min Sedate and perform bimanual exploration W
3. S amp S Patient looking pale early signs of hemorrhage NOELLE 554 100 User Guide 109 A Gaumard Simulators for Health Care Education Noelle 574 575 Labor Scenario June Peripartum Hemorrhage PPH y Place PPH kit inside Noelle simulator Wait indefinitely Massage fundus page anesthesia for stat sedation bimanual exploration and massage 110 User Guide NOELLE S 554 100 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 ber f Gaumard Simulators for Health Care Education Noelle S 574 575 Labor Scenario Kelly Amniotic Fluid Embolism 35 40 minutes Kelly is a 34 yr old gravida 5 2 38 weeks She is scheduled for induction as her last baby weighed almost 10lbs and she experienced a severe shoulder dystocia with that delivery She has gained 43lbs with this pregnancy and her GTT is borderline Labor duration 25 minutes Scenario duration S amp S sudden onset of pain following ROM asks for epidural S amp S Patient says she is having trouble breathing vomits suddenly becomes non responsive Rush to OR for emergency c section Intubate ventila
4. 7 Restart the computer CONFIGURE THE VITAL SIGNS BROADCAST After the wireless ad hoc link is established between both computers complete next steps to configure the transmission of the vital signs information 1 Verify that both computers are connected to the GaumardNet network using Windows wireless connection menu If the computers are not connected select the GaumardNet network and click Connect manually 138 User Guide NOELLE S554 100 Currently connected to a Identifying GaumardNet No Internet access Wireless Network Connection 2 GaumardNet Connected ha simcenter Gaumard Guesthet 2WIRELS9 Santex Other Network Open Network and Sharing Center 2 Start the UNI control software 3 Onthe UNI menu bar click Monitors gt Configuration The HAL Virtual Monitor Setup window is displayed on the UNI menu bar click Monitors gt Configuration The HAL Virtual Monitor Setup window is displayed Virtual Monitor Setu up Configure and broadcast the simulator s vital signs over a wireless network Select the number of Gaumard Monitor computers that display this simulator s vital signs Also enter a name and description for each 1 monitor connection instance All sensors always ON Network Status connected Network Name GaumardNet Controller Name GMRD003 PC IP Type automatic Adapter Wireless Ne
5. NOELLE 554 100 User Guide 147 Cimi ilatare for Haoalth Caro Est iratinn olmuUlators for rieaiin Care Eaucation Contact Us On the web www Gaumard com Technical Support support gaumard com Sales and Customer Service sales gaumard com Phone Toll free in the USA 800 882 6655 Worldwide 01 305 971 3790 Fax 305 667 6085 Before contacting Tech Support you must 1 Have the simulator s Serial Number located in the left leg under the IM site 2 Benext to the simulator if troubleshooting is needed Gaumard Scientific 14700 SW 136 Street Miami FL 33196 5691 USA Office hours Monday Friday 8 30am 4 30pm EST GMT 5 4 Summer Time 148 User Guide NOELLE S554 100 Always dispose of this product and its components in compliance with local laws and regulations C The NOELLE simulation system is protected by US patent other Patents Pending Gaumard NOELLE HAL are trademarks of Gaumard Scientific Company Inc Gaumard Scientific Company 2014 Made in U S A All rights reserved NOELLE 554 100 User Guide 149
6. India Peripartum Hemorrhage Abruptio India is a 19 yr old gravida 2 37 weeks She arrives at hospital with her husband who says she fell down the stairs and she has been cramping and bleeding for about an hour During admitting interview husband answers all the questions and India doesn t make eye contact The nurse palpates uterus initiates fetal monitoring and starts a pad count Labor duration 25 minutes 104 User Guide NOELLE s554 100 Noelle 574 575 Labor Scenario Gaumard Inez Simulators for Health Care Education Peripartum Hemorrhage Abruption Inez is a 27 yr old primip 35 weeks She arrives at hospital one evening crying and doubled over in pain She is admitted to a birthing room and the nurse notices bright red blood on Inez s panties She is having very intense and close contractions Labor duration 10 minutes Scenario duration 18 minutes oan Reset birthing motor and attach PP uterus Wait time 3 min NOELLE 554 100 User Guide 105 4 Noelle 574 575 Labor Scenario Gaumard Inez Simulators for Health Care Education i Peripartum Hemorrhage Abruption AA Administer Pitocin manage bleeding and massage fundus Wait time 3 min 106 User Guide NOELLE 5554 100 Noelle S574 575 Labor Scenario G
7. On Apply Clear and Close Details Window Vital sign parameters can be edited or removed using the edit and remove parameter tabs User Guide 25 Enable the instant apply option and click the control to change the vital sign to a new value without the need to use Apply panel Vital signs undergoing change blink yellow STATUS DETAILS Throat Sound Volume stridor inspiratory 3 A palette item stores one or more vital sign settings into a single loadable object Use a palette item to update a set of vital signs quickly For example one palette item can be created to update all the cardiac parameters to a healthy state To create a new palette item set the values for the desired vital signs parameters using the details controls and click Save Cephalic v Airway v Breathing D D Cardiac EKG Sinus Heart Rate 75 bpm Circulation Enter a name for the palette a description and choose color code Click 26 User Guide NOELLE 554 100 Save to create the new palette Item Palette items are stored in the active profile Save as Palette Item Palette Item Name Healthy Heart cD Palette Item Description Sinus 74 bpm Heart Sound Normal Color Healthy O Care Required When the palette is needed click the Load button to select the palette from the library Respiration Rate 50 bpm Inspiration Percen
8. To simulate placenta previa with NOELLE place the placenta in the desired position to simulate the condition with the maternal side against the uterine wall or the cervical os Then position the fetus within the uterine cavity with the presenting part closest to the placenta External Version Version may be attempted by the care provider to rotate the fetus from a breech position into one permitting normal vertex presentation To practice version remove the abdominal cover and the fetus retract the delivery mechanism fully and insert the inflatable cushion Thoroughly lubricate the inside surface of the abdominal cover the fetus and the inflatable cushion 54 User Guide NOELLE S554 100 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 t
9. Irene Record 1of6 im d gt w mm 4 22 User Guide NOELLE 554 100 Clicking Start Scenario loads the appropriate scenario and starts it playing without the user having to do anything else with the control computer Notice that the position of the fetus should be selected before to click Start scenario as shown below TOTAL SCENARIOS 50 Scenarios selected 3 Scenario Name Scenario Description Alice is a 24 year old female weighing 170 30 mi Alyssa is a 23 year old primipara at term H Angela is a 31 year old grand multipara at Record 1of3 m Ky Load Scenano Preparing the actual simulator for delivery must be done before activating quick launch scenarios For complete information refer to the Working with Simulator section There is also a Favorites feature added to the quick launch program This feature allows users to reduce the number of scenarios highlighted to those within the categories that will be used most frequently E stLEcT 10 upare ravorrtes Enter text to seare Q 80 ORCeo SELECT A CLINICAL CONDITION TOTAL SCENARIOS 49 Scenarios selected 9 x Deli Norma Deilvery 3 Scenario Name Scenario Description E Variations on Normal 8 E Shoulder Dystocia 4 Elane Elane is a 23 year old gravida 1 0 at 37 B Breech 3 Eleanor Elenor is a 19 yr old post ictal patient ben i Preedampsia 3 Eri Erin i
10. baby is delivered NOELLE 554 100 User Guide 33 34 User Guide NOELLE 554 100 The ER is notified that EMS is about 4 minutes away with a 19 year old pregnant post ictal patient named Eleanor Her aunt found her convulsing in the bathroom and called 911 The aunt told the EMS providers that Eleanor was 8 months pregnant with her first baby and that it was a difficult family situation She added that Eleanor had just moved in with them and had not yet seen a doctor The paramedic reports to the ER physician by radio that the patient is responsive only to pain Her initial blood pressure is 180 120 The EMS crew applies a C collar and move her onto a backboard for transport The paramedic initiates ECG monitoring and does a genital exam before they move her She notes a small amount of vaginal bleeding The crew moves her to the ambulance and the paramedic starts an IV of LR and initiates oxygen 10L by non rebreather mask She monitors the ECG and VS during transport and also tilts the backboard about 152 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 Runs for approximately 20 minutes Instructor must place C collar on NOELLE simulator before beginning scenario During deliver
11. charged Refer to the Consumables and Replacement Parts section of this guide and contact customer service for more information Vein tubing contains latex which may cause allergic reactions Users allergic or sensitive to latex should avoid contact Discontinue use of this product and seek medical attention if an allergic reaction Occurs 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 addition make sure the battery is re charged at least once every 6 months even if the simulator is not being used otherwise permanent loss of capacity might occur BIRTH CANAL MAINTENANCE Rae 9 ae Ball point pens ink and markers CLEANING permanently stain the birth canal insert The simulator should be cleaned with a Do not wrap this or any other Gaumard cloth dampened with diluted liquid product in newsprint dishwashing soap If medical adhesives emanonihe Cine leant cone The birth canal insert can be cleaning by wipes DO NOT USE GOO GONE as the citric acid in the formula will cause wiping with a mild solution of soap and water After cleaning dust with talcum pitting of the var
12. 40 mmng x fhe tKORMiel ta GD Z Becca Becca is a young pregnant teen whois ivin 10min Lung Sounds Volume Uterine Rupture 1 R e i Hemorrhage 7 Becca Sedation Becca delivered preapitously and has CARDIAC E Post Partum Hemorrhage 5 Beth is a 16 year old gravida 2 0 at 37 gt 10mn S RecordSof49 WM 4 rewa Amniotic Fluid Embolism 3 gt Heart Sound Volume 2 normal 2 Preterm Labor 2 Load Scenario Start Scenario CIRCULATION Pulse Radial R On L On UTERUS HEM Vaginal Hemorrhage VIRTUAL MONITOR FETAL MONITOR PALETTE SCENARIO LABOR LAG SPEECH CPR PROVIDER ACTIONS LOG A A Uterine Hemorrhage Uterine Pressure 0 x m J b 1 t maa HOS e BOO PIP TOO rr Re TMS L ll MD O 0ncs 2 Q 4 ae CONNECTION TE SS Sim ulator wii not initialize util AE FL conne ct e d t O t h ec h arger or t h e b a tt er The communication indicator displays 6 l the status of the radio link between the is replaced with a fully charged spare tablet s USB RF module and the Internal battery duration is simulator Full bars indicate excellent approximately 2 hours communication i e normal operation The session timer displays the duration of the current session Click the timer to reset the clock or to start a new session Event entries in the text log are synchronized with the session timer The battery status indicator updates as
13. E eamecmecutanceene atumcbomawe 43 BB FS AU pIE aa EE E E EEO EA 43 CICOS ON i E T E 43 QD SECT ICS soriana a EA ies Oeb ben te tu saaieuaaboesierdaudeeeaboaas 45 SV SUSI eer ea tataceta aden scveasuaeaenmaneastensasmenteues A N 59 OEE tats ehe ott u segeadsc scare cites a ace aoe ets areca coast nore actos amma eames ea eet 59 Working With NOWDOMN cdivescioicatsvicinssuscccadencsudstessdeuswisiisineusxnccidcuetadsteaueetsuieuns 61 PMU AY Paar g teste E E A eae onsen 62 BROAN G cccbceaa tat caine A asus ncuaumeaean sian A 62 NOELLE 554 100 User Guide 3 UU AC erecta E teres ce crete EEA Rev tate EA creases AEA AE E 62 CAGE NUON AAP E EE E A E A E E EEE TE E 62 Eea E AAE E E EE AET A E N N AE A AAEN E ATT 63 VEIE a AEE E E E E A A E E 63 Saa A NEEE E EE E EE A A EE E E E E 63 ADENO oren E 64 Factory Preset Labor Scenarios cccssssccccceessecceccessececeaeeseccesseueceessuaseccessaeeceeesuaueceessuaaeceessagasses 65 TOON Oe AUIS SC Ci IOS a r rA E R O r O 129 Troubleshooting vce se sansadsceeayerpcaennieacoaneacesneescen socsakvsnnoesacesaenneuesounsavasanas vaeeneulesesqansaueseeavtancanmakensaomnes 132 Wireless IV OI sarees ee cease asec asa carter asnese en omarion EE apis EEA E 136 Selected Consumables and Replacements Parts cccccssssecccceseecccceesseccceseeeceeseeaseeeesauaseeeseeees 140 MAY MeV EY TAIE A ateace nee E E A E EEE A E E E E E E E E 146 Belair e a e E E E dete A E A E A tase E E E A E 148 Gimulators
14. Gaumard Beth simular we taucaftior 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 _ 70 User Guide NOELLE 5554 100 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 Ibs 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 NOELLE 554 100 User Guide 71 As G d Noelle Labor Scenario aumar E Simulators for Health Care Educatior Donna gt Breech Donna is a 20 year old gravida 4 2 at 31 weeks She weighs 180 Ibs She has had one elective abortion She has had prenatal care Labor duration 20 minutes 72 User Guide NOELLE 5554 100 l P Noelle Labor Scenario aumar f EE i i Elaine Preeclampsia Elaine is a 23 year old gravida 1 0 at 37 weeks She weighs 140 Ibs She has had prenatal care She complains of mind fro
15. Number of the simulator you are using Warning Streaming audio is disabled in generic mode simulator is checked Plug charger into the simulator Verify LED light on charger indicates 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 Connect the communication module to any USB port Close the software and try disconnecting the communication module for at least five seconds then plug it back in and restart the software Drivers not properly loaded Perform a full shutdown procedure on the tablet Is the communication indicator panel consistently yellow NOELLE 554 100 See solution above in section making reference to blinking communica tion indicator is consistently yellow Possible Cause Symptom Chest compressions are not Is the respiratory rate set to O min Set respiration rate to zero properly detected or not Chest compressions are only detected detected at all when the respiratory rate is set to O per minute 0 min Otherwise they are ignored Simulator is not connected Verify connection to the simulator All others See Calibration Wizard section inside User s Manual Newborn artificial ventilations Simulator is not connected Verify connection to the simulator are not properly detected or not detected at all Simulator no
16. SHALL BE LIABLE FOR ANY DIRECT INDIRECT CONSEQUENTIAL OR INCIDENTAL DAMAGES INCLUDING DAMAGES FOR LOSS OF BUSINESS PROFITS BUSINESS INTERRUPTION LOSS OF BUSINESS INFORMATION AND THE LIKE ARISING OUT OF THE USE OR INABILITY TO USE SUCH PRODUCT OR RELATED TO THIS AGREEMENT EVEN IF GAUMARD HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH DAMAGES GAUMARD SHALL NOT BE LIABLE TO YOU FOR ANY INDIRECT SPECIAL INCIDENTAL OR CONSEQUENTIAL DAMAGES OR LOST PROFITS ARISING OUT OF OR RELATED TO THIS AGREEMENT OR YOUR USE OF THE SOFTWARE AND OR THE RELATED DOCUMENTATION EVEN IF GAUMARD HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH DAMAGES IN NO EVENT SHALL GAUMARD S LIABILITY HERE UNDER IF ANY EXCEED THE PURCHASE PRICE PAID BY YOU FOR THE SOFTWARE ALL RIGHTS NOT EXPRESSLY GRANTED IN THIS LICENSE AGREEMENT ARE RESERVED BY GAUMARD 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 6 User Guide NOELLE 554 100 Care and Cautions NOELLE 554 100 User Guide 7 Overall Warnings Remember that damage caused by misuse is not covered by your warranty It is c
17. Status Connected connected Network Name onitor Setup ex IP Type Automatic Port 8001 E Configure and broadcast the simulator s vital signs over a wireless network Select the number of Gaumard Monitor computers that display this Controller Name GMRDO Show IP simulator s vital signs Also enter a name and description for each monitor connection instance Monitors 1 connected To connect both computers using a nk cna Network Status connected Network Name simcenter local internet network follow the steps controler Name GMRDOO3 Pc IP Type automatic below adapter y IP Port 1 Verify that both computers h ave applied Set Wirel ess Connected to Gaumard_Trainin 192 168 55 128 Network Dynamic Refer to UNI and Gaumard Monitors ees eae Ap If the communication has not been established please enter the name or IP network co nfigu ration sections address and port number selected on the controling computer Noelle for instructions Network Status Connected connected 2 Disconnect both computers to Network Name IP Type Aut tic am the GaumardNet network and a connect them to the local Show IP network manually using Windows wireless connection menu 3 Repeat the same steps listed above to connect the UNI NOELLE 554 100 User Guide 139 Selected Consumables and Replacements Parts Selected Parts List Contact Gaumard Scientific for a co
18. 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 NOELLE 554 100 User Guide 29 Scenario Labor Type History Name weighs 190 Ibs She has had obviously prolapsed cord Profound fetal prenatal care 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 Hemorrhage Helen is a 25 year old gravida Runs for 30 minutes FHT remain WNL 1 0 at 35 weeks She weighs Midline episiotomy is performed and the 180 Ibs She has had prenatal delivery is spontaneous The placenta care 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 Cesarean Irene is a 19 year old gravida Runs for 45 minutes Sterile soeculum Delivery 2 0 at 29 weeks She has had exam indicates a shortened cervix with a one spontaneous abortion cerclage in place Fluid is noted in the vaginal vault and ferning is positive Break through contractions occur and sterile speculum reveals cervical change Cerclage is removed Fetal heart tones remain stable throughout the short labor Sponta neous delivery occurs The female infa
19. The placenta features two removable placental fragments These fragments are attached to the body of the placenta with hook and loop fabric The labor activity window displays feedback data Reverse one or both fragments and attach them recorded by the force sensors The Activity on to the abdominal wall to cause one or both to Fetus window provides feedback on pull force remain affixed to the uterine wall after the uterine contractions fetus heart rate placenta is retrieved FETAL MONITOR x ji a i f Sesase cesses E ET HE UA SS titi oo f f f f i i Accel SSSSE0 CaGS05 CESSES SSSCSS SELES SSEESTSSEEREESESECESEESS Dea f i j Prolonged Accel TOCO Force 0 Live Labor Speed t 1X QUICK LAUNCH VIRTUAL MONITOR FETAL MONITOR Mentan aois LABOR AB SPEECH CPR PROVIDER ACTIONS Providers should carefully inspect the placenta to make sure it is complete and that no fragments have been retained If retained fragments are noted the provider must retrieve them using a gloved hand under appropriate sterile conditions NOELLE 554 100 User Guide 49 Warning Ensure that the birthing mechanism is completely retracted before allowing the provider to retrieve the placenta Do not attempt to retrieve the placenta or placenta fragments while the birthing mechanism is moving Do not turn off the simulator until the birthing mechanism has retracted to its ini
20. Tip Navigate to Menu gt File gt Profile from the menu bar to quickly change between profiles 2 Once the baby is connected and locked RS I I onto the mechanism position the baby to its initial birthing position The user has On the Load Labor Scenario window select the the choice of ROP LOP ROA LOA Alice labor from and click Load a Load Labor Scenario Select Scenario Last Modified 01 16 2013 07 52 42 01 16 2013 07 52 42 01 16 2013 07 52 42 01 16 2013 07 52 42 01 16 2013 07 52 42 01 16 2013 07 52 42 01 16 2013 07 52 44 01 16 2013 07 52 44 1 16 9012 NF S9 44 mW 3 On the labor tab select the fetal position that matches the bi rth i ng ba by s initial Alice is a 24 year old female weighing 170 pounds W Gain or Her significant other is Mike position on the simu lator 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 The labor is now loaded Save Labor q z Labor type Normal Alice Alice is a 24 year old female weighing 170 pounds Ro fe fp ff _ A 3 Before starting the labor increase the labor speed to complete the simulated labor in a fraction of the time NOELLE 554 100 User Guide 47 a aS i i i i I i i
21. damage Do not place silicone oil directly into the mouth and airway The nasogastric intubation feature is used for placement techniques only Fluids cannot be inserted through nasogastric tubes as internal damage will result 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 UNI s CPR trainer 62 User Guide NOELLE 5554 100 Cardiac Newborn is equipped with several realistic heart sounds which are tied to heart rates and selectable rhythms Circulation Newborn s software controlled umbilical pulse is blood pressure and heart rate dependent To install or the umbilical cord first turn the simulator off by clicking on File Exit on the UNI 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 Do not remove or install umbilical cord while Newborn is in ON Newborn s umbilical cord can be catheterized or injected with up to 2ccs 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 The
22. for Health Care Ediication VIGILI O Ui I IOAN vase LuUuuUvadUil 4 User Guide NOELLE 5554 100 End User License Agreement This is a legal agreement between you the end user and Gaumard_ Scientific Company Inc Gaumard This software is protected by copyright laws and remains the sole property of Gaumard By installing the GaumardUI simulation the Software media you agree to be bound by the terms of this agreement If you do not agree to the terms of this agreement promptly return the uninstalled media and accompanying items to Gaumard at the address indicated below 1 Grant of License Gaumard hereby grants to you an individual or institution the right to install and activate the Software on one computer for use with one Code Blue III 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 mat
23. li L 4 8 12 16 20 24 28 32 36 40 44 48 Q Labor Speed AS amp 22X 3 min Always secure the abdominal cavity on the abdomen prior to starting the labor mechanism for safety Click Play to start the labor scenario The green vertical bar on the labor graph moves to the right indicating the labor progress For more information about the labor graph and the labor stations go to the Labor section in the UNI software user guide 5 DESCENT 2 43 1 i 1 3 3 5 5 4 20 5 u 3 t5 15 4 8 12 1 6 2 24 28 32 36 40 44 48 52 56 60min DATA u i Labor Speed I He 43X 1 mn Release Baby The fetus produces heart sounds during the labor and delivery process Auscultate the abdomen to listen to the fetal heart sounds Alternatively enable the fetal heart rate sounds on the virtual monitor screen The first few centimeters of movement normally take about half the total delivery time The fetus rotates internally as it moves forward then after the head is delivered and again before the 48 User Guide NOELLE 5554 100 shoulders are delivered The provider may help the fetal head and shoulders through the vulva just as in real life or turn the fetus into its final position if necessary The lock and release mechanism built into the fetus is used to simulate the resistance felt when the fetus is pull
24. ventilations are measured and logged Programmable eclampsia Advanced birthing mechanism Programmable postpartum hemorrhage Birthing fetus with placentas and umbilical cords Full term intubatable newborn with cyanosis and umbilical pulse Chest compressions and ventilations are measured and logged Realistic heart and lung sounds Realistic crying Single large 23 inch touchscreen monitor with desktop controller and wireless communication to laptop Display up to 8 numeric values including HR ABP RR CO2 SpO2 temperature NIBP and time Select up to 5 dynamic waveforms including ECG II ABP respiration CO2 and pulse oximetry Fetal Heart Rate monitor Simulation transport case for electronic products FCC IC CE Certifications One year warranty extend to three years Installation and training available Terminology Apply In the context of a simulation to apply settings is to send details of the patient s condition to the simulator itself When settings are successfully applied NOELLE s condition should match that shown on the Status panel GaumarduUI 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 GaumardUI configuration includi
25. 1 at 37 weeks She weighs 145 Ibs She has had prenatal care She has STD Herpes Gloria is a 34 years old gravida 1 0 at 25 weeks She 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 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
26. Education Preeclampsia Erin is a 28 yr old 38 weeks admitted by her physician for preeclampsia She is stared on Magnesium sulfate per protocol induced with pitocin and her membranes are ruptured Light meconium staining is noted following AROM Labor duration 60 minuntes NOELLE 554 100 User Guide 91 4 Gaumard gt lImuta Oo realm Care taucation Noelle S574 575 Labor Scenario Faye 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 S amp S Prolapsed cord is protruding from the vaginal opening V E reveals double footling breech partially into vagina S i ia a amp P t Admit place bed in deep trendelenburg position cover extruded cord with warm NS gauze Culture placenta and send to lab Notify Priest for emotional care document according to facility requirements 92 User Guide NOELLE 5554 100 Noelle 574 575 Labor Scenario Gaumard Frances Simulators for Health Care Education Prolapsed Cord Frances is admitted into a small town hospital due to regular contrac
27. M sites NOELLE is outfitted with a convulsion mechanism that can be used in conjunction with scenarios preeclampsia for example NOELLE 554 100 User Guide 59 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 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 UNI and powerful audio video recording software in one control laptop 60 User Guide NOELLE 5554 100 Working with Newborn NOELLE 554 100 User Guide 61 Airway Newborn s airway can be intubated orally using LMA or endotracheal tubes and nasally using a nasogastric tube Procedure Recommended Device Size Intubation l Miller O Blade size Nasal Intubation 8 Fr catheter ETT 3 0 no cuff 6 Fr suction Oral Intubation catheter 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
28. NCHSCENARIO LABOR LAB SPEECH PROVIDER ACTIONS Elaine Elaine is a 23 year old gravida 1 0 at 37 weeks She Eleanor Elenor is a 19 yr old post ictal patient being transferr CLINICAL CONDITION Erin Erin is a 28 yr old 38 weeks admitted by her The scenarios are categorized by clinical condition to the left of this page i e shoulder dystocia cord prolapse etc Click on the drop down arrow to the TEOR right to read a scenario description SELECT TO UPDATE FAVORITES Record 1of6 i 4 TOTAL SCENARIOS 49 Scenarios selected 6 SELECT A CLINICAL CONDITION Scenario Name Scenario Description Gabriela Cesaran 19 year off Mexican grl has a vertical abdominal scar 19 year old Mexican girl has a vertical abdominal scar indicative of previous c section She says she has a child who is with her mother in Mexico city She is having painfull caontractions and suddenly Kimberly c_s becomes pale and diaphoretic while screaming and clutching her abdomen Her BP drops to 80 60 and W Normal Delivery 3 W Variations on Normal 8 E Shoulder Dystocia 4 E Breech 3 E Preeclampsia 3 Gai Haley Franane the fetus begins to brady down to 80 bpm This is a W Cesarean Delivery 6 E Cord Prolapse 4 Uterine Rupture 1 W Hemorrhage 7 E Post Partum Hemorrhage 5 W Amniotic Fluid Embolism 3 E Preterm Labor 2 VIRTUAL MONITOR FETAL MONITOR P Select the scenario type as show below
29. NOELLE Maternal and Neonatal Birthing Simulator 554 100 Gaumard Simulators for Health Care Education User Guide 14 11 1 Gaumard Scientific Company 2014 All Rights Reserved www Gaumard com NOELLE is an interactive educational system developed to assist a certified instructor It is not a substitute for a comprehensive understanding of the subject matter and not intended for clinical decision making NOELLE 554 100 User Guide Contents CONTENTS oisiiirinio eoii a ra a a a RAN 3 End User License Agreement s seosssssoscscscscscscssscscscsososcesscssscsosssososssssssossee 5 Care and Cautions sicoiir 7 VET AI ArII ier S 8 GE TEIN Starte ionin EE A EE Ei 11 OVE VEW anaana a vases A a A O oa vea an leats aan wermdoesieee 12 FEMINO O Yer cctissx cond T T O TT Gre ante Ge om ee 13 EQUIDIMENE Set UD issnin ce nbensedimecseesedecens 14 VER PASS OID Veneno ae E uty ceemuenadbauacs ous sonaedana E T E 15 NOELLE ROWER SUDDIY cirina a a a nauecnas a ai 15 NG WOON POW EN SUDD ensi A A 15 COMTO COMPUTE ia a E Geaennasioot cance guimeretegeaeaaye 16 WIC VIGIL Ol renmen a a a a hiancteameibiwotade 17 Working WEIN vaccinia wntdcces a aa a a a aa 19 Mitializme the SUT UO aa a a a N 20 DRES al ce E EE E N T er E E TE S EEE SE E E ne ee ee ee emer 20 OUI Ke LAUNE Mes a a a a a a a 22 SEALS DS e S COME e A E A E E E E A E T 24 MOE I CONG W DOM enron assasin i E a EA A 40 Working with NOELLE esiseina a aa 42 AIRWAY meroa E E
30. NR The Virtual Monitor Create ad hoc CONFIGURATION A Wireless Network window is displayed After the UNI control computer is 3 configured complete the next steps using the Create an ad hoc network tool included in Gaumard Monitors software Select Wireless Network Adapter If the wireless adapter is not listed first enable the adapter using the Windows network menu and then return to this window 1 On the virtual monitor computer click the Gaumard Clear previous network settings Clear Monitors icon to start the vital Create Ad Hoc Wireless Network signs software 1 Select Wireless Network Adapter 2 Click the V menu near the top left corner and select Create Ad Hoc Network 2 Wireless Network Name GaumardNet Apply Wireless Network Settings Set Dynamic IP NOELLE 554 100 User Guide 137 Enter a wireless network name case sensitive Use the same name entered in the controller computer GaumardNet is the required name for Windows 7 computers 2 Wireless Network Name 2 GaumardNet Apply Wireless Network Settings 5 Click Set Dynamic IP to set the wireless network dynamic Set Wireless Network Dynamic 6 Click Apply Wireless Network Settings to save the settings ASKAS GaumardNet Apply Wireless Network Settings Apply the new network settings and create the ad hoc wireless netwi he
31. OLE LIABILITY IS TO REPLACE THE DEFECTIVE MEDIA OR TO REPEAT THE ELECTRONIC TRANSMISSION PROVIDED THAT YOU NOTIFY GAUMARD IN WRITING OF SUCH DEFECT OR NOELLE 554 100 User Guide 5 DEFECTIVE TRANSMISSION AND RETURN THE DEFECTIVE MEDIA IF ANY DURING THE 30 DAY WARRANTY PERIOD B EXCEPT AND TO THE EXTENT EXPRESSLY PROVIDED IN PARAGRAPH A THE SOFTWARE AND ACCOMPANYING WRITTEN MATERIALS ARE PROVIDED ON AN AS IS BASIS WITHOUT ANY WARRANTIES OF ANY KIND INCLUDING BUT NOT LIMITED TO ANY IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR ANY PARTICULAR PURPOSE NO ORAL OR WRITTEN INFORMATION OR ADVICE GIVEN BY GAUMARD ITS DEALERS DISTRIBUTORS AGENTS OR EMPLOYEES SHALL CREATE A WARRANTY OR IN ANY WAY INCREASE THE SCOPE OF THIS WARRANTY AND YOU MAY NOT RELY ON ANY SUCH INFORMATION OR ADVICE GAUMARD DOES NOT WARRANT GUARANTEE OR MAKE ANY REPRESENTATIONS REGARDING THE USE OR THE RESULTS OF USE OF THE SOFTWARE OR WRITTEN MATERIALS IN TERMS OF CORRECTNESS ACCURACY RELIABILITY CURRENTNESS OR 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
32. age Error Bookmark not defined Warning Do not store the simulator with a discharged battery Re charge the system at least once every 3 months if the simulator is NOELLE Power not being used otherwise permanent loss of capacity might Supply occur Connect the power adapter labeled NOELLE to the power input located on NOELLE s right side NOELLE 554 100 User Guide 15 Newborn Power Warning Do not connect the simulator to Ethernet cards LAN networks or Supply unauthorized diagnostic equipment Connect the power adapter labeled Doing so may cause damage to the Newborn to the power input located on system Newborn s right side 1 Connect the communication cable Always operate Newborn with the to the USB communication module power supply connected Newborn is not equipped with an internal battery Control Computer The laptop computer is the simulator s control center Startup and control o 2 Connect the USB communication commands are sent from the Gaumard l module to an available USB port control software GaumardUl to the l l l and power on the laptop computer simulator using the wired a communication module shown in the next section Review all manufacturer warnings and procedural information included with the laptop s documentation before oo 3 Connect the communication cable continuing to the communications port located on the simu
33. ait time 2 30 min Increase pitocin fundal massage give Cytotec rectally Wait time 1 10 min Does bleeding stop Does bleeding NO stop YES Insert Bakri balloon Wait time 1 min NOELLE 554 100 User Guide 101 Noelle 574 575 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 102 User Guide NOELLE 5554 100 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 NOELLE 554 100 User Guide 103 Gaumard Simulators for Health Care Education Noelle S574 575 Labor Scenario
34. anosis level to a desired level by playing with the Set Max cyanosis level control NOELLE 554 100 User Guide 133 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 6 15 AM a Er jg 1 Bd Pr ll Os go 2 The speaker menu is displayed Click on the recording devices option Open Volume Mixer Playback devices Recording devices Sounds Volume control options _ r le ol 1 4 201 3 The sound properties window and recording tab are displayed Right click the microphone option and select properties 134 User Guide NOELLE S554 100 Select a recording device below to modify its settings K Microphone Realtek High Definition Audio ay Default Device Configure Speech Recognition Disable Show Disabled Devices Show Disconnected Devices Properties Set Default v 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 Microph
35. arranty is the sole and exclusive warranty provided by Gaumard for the accompanying Gaumard product and Gaumard hereby explicitly disclaims the implied warranties of merchantability satisfactory quality and fitness for a particular purpose Except for the limited obligations specifically set forth in this one year limited warranty Gaumard will not be liable for any direct indirect special incidental or consequential damages whether based on contract tort or any other legal theory regardless of whether Gaumard has been advised of the possibilities of such damages Some jurisdictions do not allow disclaimers of implied warranties or the exclusion or limitation of consequential damages so the above disclaimers and exclusions may not apply and the first purchaser may have other legal rights This limited warranty applies only to the first purchaser of the product and is not transferable Any subsequent purchasers or users of the product acquire the product as is and this limited warranty does not apply This limited warranty applies only to the products manufactured and produced by Gaumard This limited warranty does not apply to any products provided along with the Gaumard product that are 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 im
36. aumard Sin il tors for t altt Care Ed ulafors fo eg e Educatior Janie is a 23 yr old G 2 38 weeks She has experienced several bleeding episodes due to a low lying placenta She has been counseled about the potential for postpartum hemorrhage Her religious beliefs prohibit the administration of any blood products Labor duration 15 minutes Scenario duration 25 minutes T Reset delivery motor and insert postpartum uterus Wait time 3 min wy NOELLE 554 100 User Guide 107 Gaumard Noelle 574 575 Labor Scenario Janie Peripartum Hemorrhage PPH Simulators for Health Care Education ad 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 108 User Guide NOELLE S554 100 Noelle S 574 575 Labor Scenario June Peripartum Hemorrhage PPH Gaumard Simulators for Health Care Education June is a 31 yr old multip about to have her 5 baby She has had a normal pregnancy and she is planning natural childbirth She enters 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
37. bor progresses normally for about 6 hours but after 45 minutes of pushing patient is unable to bring vertex to perineum A vacuum extractor is necessary to bring the head to the perineum Patient is still unable to deliver McRobert s suprapubic pressure Woods and Rubin maneuvers fail Baby is finally delivered using Gaskin maneuver Note To run full scenario load Candice Admit from scenario tab To run dystocia drill only load Candice from labor tab Scenario runs for approximately 40 minutes Baby is delivered after basic shoulder dystocia maneuvers such as McRoberts and stiff arm suprapubic pressure Runs for approximately 45 minutes Instructor must set up baby for double footling breech delivery To skip resolution of contractions portion of scenario it is suggested that the instructor warp to around 20 minute mark on the timeline 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 Runs for approximately 30 minutes Frank breech position has been confirmed by real time U S Patient refuses Cesarean delivery Pinard maneuver must be utilized to bring the legs down MLE is performed and
38. e footling delivery or retract the legs for a frank delivery Remove plug in fetal head for breech delivery Removing plug reveals aperture for birthing mechanism NOELLE 554 100 User Guide 55 The Pinard or leg flip maneuver frees one leg then another The fetal arms may also require a similar maneuver during delivery 56 User Guide NOELLE S554 100 The fetal arms are delivered and the fetus rotated anteriorly to birth the head Postpartum Activity After delivery the uterus normally contracts reducing postpartum bleeding Under certain conditions contraction does not occur and hemorrhaging may continue Postpartum hemorrhaging can be simulated with the Noelle system via use of the 48 hour uterus Use the following steps to set the Noelle simulator for postpartum hemorrhage scenarios 1 Place the white Styrofoam block between the rails of the birth mechanism 2 Secure the uterus on the Styrofoam Velcro attachment to prevent it from moving or shifting Then insert the distal end of the uterus inside the cervix Warning Always ensure that the distal end of the uterus is inserted through the cervical opening of the birth canal until the cervix closes around the built in recess Failure to do so could result in liquid accumulating in the pelvic cavity and damage to the birthing mechanism 3 Connect the center hose to the air pressure port and then the latera
39. e of the 6 Position the fetal arms and legs as shown 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 7 Umbilical cord can be wrapped around the neck demonstrating a nuchal cord 5 Attach the umbilical cord to the baby route the cord so it does not bind in the mechanism and attach the placenta to the pelvic cavity using the Velcro fastener Note that the fetus has 2 receptacles at the perineum into which the matching pins located on the birthing mechanism are inserted 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 1 Position the baby so that its face is upward anterior Connect the baby to the birthing mechanism while the manikin 46 User Guide NOELLES554 100 is ON so that the electromechanical LOADING A LABOR SCENARIO mechanism allows the baby to be locked avaa ore prebuilt or S z a e A into place the Quick Start NOELLE Profile Click the Load Labor button to load a labor scenario
40. ed too early during the delivery The fetus is released from the birthing arm when the vertical progress bar reaches the end of the labor graph The release button displays Releasing to indicate that the fetus is unlocking ta onra E C 2 294 26 298 30 min 7 z a e y DATA sp l Smart U 0 eles cin 10 Sepa ee LABOR Ge ee Once the progress line reaches the end of the labor graph the birthing mechanism will push the fetus until the shoulders are delivered The mechanical process that simulates the end of stage 2 is transparent to a provider using standard techniques to deliver the fetus To prevent adding stress to the birthing arm 1 After the final push gently pull the fetus a few inches in line with the birthing arm to RESETTING THE DELIVERY MECHANISM AND RETRIEVING THE PLACENTA disengage the connectors After the delivery is complete click the reset 2 Once the fetus is disengaged complete the delivery using standard practices button to return the delivery mechanism to its initial position Avoid lifti lling the fet d whil EA TE an UE EE Seale pureed wea During the setup process the placenta may be it is still engaged to the birthing arm Doing so meas 598 ne ne positioned so that it requires both modest cord could make delivering the fetus difficult even if l ae traction and manual removal the fetus latching mechanism is unlocked
41. eless Network Adapter If the wireless adapter is not listed first enable the adapter using the Windows network menu and then return to this window 136 User Guide NOELLE S554 100 Clear previous network settings Clear Create Ad Hoc Wireless Network 1 Select Wireless Network Adapter 2 Wireless Network Name 2 GaumardNet Apply Wireless Network Settings Set Wireless Network Dynamic Set Dynamic IP 3 Enter a wireless network name case sensitive Use the same wireless network name to configure the Gaumard Monitors PC GaumardNet is the required name for Windows 7 computers 2 Wireless Network Name 2 GaumardNet Apply Wireless Network Settings 4 Click Set Dynamic IP to set the wireless network dynamic Set Wireless Network Dynamic EE TTT EE EEE 5 Click Apply Wireless Network Settings to save the settings Set Wireless Network Dynamic TTT EE EE 6 Restart the computer Clear previous network settings Clear Cr f A Monitor Selection 1 Select Wireless Network Adapter Comm setup Performance Keyboard 2 Wireless Network Name Toggle Cursor GaumardNet TTE IT Remote Access Via Network n Apply the new network settings and create the ad hoc wireless network Check for Updates H elp oon eaten Set Dynamic IP About Exit SAANEN DA ES E
42. elivery NOELLE 554 100 User Guide 77 Fl na oie 55 oo esa So a i a k o m e n e se a i ia S aaa a incl i 10 11 15 w p Ze areca ee 2 a 78 User Guide NOELLE 5554 100 Simulators for Health Care Education Noelle 574 575 Labor Scenario Alyssa 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 S amp S Comfortable excited about delivery S amp S Becoming more uncomfortable with ctx Admit patient Routine labs notify HCP of admission and status Set up delivery table and infant warmer configure bed for delivery Routine postpartum assessment support breast or bottle feeding efforts promote bonding NOELLE 554 100 User Guide 79 Noelle 574 575 Labor Scenario Angela Normal Labor Gaumard Simulators for Health Care Education 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 healt
43. emain within normal limits The baby earns good APGAR scores history of fast labors Variations on Beth is a 16 year old gravida Runs for 10 minutes Fetal descent is rapid Normal 2 0 at 37 weeks She has had Fetal baseline is maintained at 150 Nuchal one elective abortion She chord is evident and moderate bleeding is has had prenatal care noted immediately following delivery from a second degree perineal laceration The normal female infant is limp dusky and does not cry spontaneously Baby is hypothermic and tachypneic Angelica Variations on Angelica is a 31 year old Runs for 20 minutes Labor progresses Normal gravida 5 3 at 41 weeks She normally and fetal heart tones remain weighs 160 lbs She has within normal limits The normal infant experienced no prenatal earns good APGAR scores complications and has a 28 User Guide NOELLES554 100 Scenario Labor Type Name Cynthia Shoulder Dystocia ia i Cesarean Delivery r Cord Prolapse History 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 Ibs 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 Ibs She has had prenatal care She complains of mind frontal headache 3 tibial edema and 4 DTRs with 2 beats clonus are noted Francine is a 19 year old female gravida 2
44. erial You may not make this Software or copies thereof available in any manner or form or use copy or transfer the Software in whole or in part except as provided herein 3 Other Restrictions You may not rent or lease this Software to any other party You may not alter merge modify adapt reverse engineer decompile or disassemble the software or disclose the contents of this Software to any other party 4 Electronic Transmission of Software If you received the Software by electronic transmission or by Internet delivery by installation of the Software you acknowledge that you have read and understand this license agreement and agree to be bound by its terms and conditions 5 Term of Agreement The term of this Agreement and the license granted to you pursuant hereto shall commence upon installation of this Software This Agreement and the license granted herein may otherwise be terminated by Gaumard in the event that you are in breach of any provision of this 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 S
45. fter 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 McRobert s maneuver suprapubic pressure posterior arm sweep or elbow 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 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 52 User Guide NOELLE 5554 100 warp factor will adjust to the previous settings and the labo
46. g abdominal cover with bikini incision P N 575 029 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 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 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 NOELLE 554 100 User Guide 53 e Marginal placenta previa is when the edge of the placenta extends to the internal os where the uterus opens into the vaginal canal
47. ght 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 ab dominal cramps and has bright red vaginal bleeding 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 li
48. h 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 Perform V E admit patient to BR initiate continuous EFM S amp S feeling pain see en ohn a A Urge to push strong Notify z eh 80 User Guide NOELLE 5554 100 la l Noelle 574 575 Labor Scenario Gaumard Becca eee ae Variations on Normal Becca is a young pregnant teen who is living on the streets She is a heavy smoker and drug user She was seen twice in the Adolescent Clinic and referred to Social Services but she only saw the social worker once and did not go to the follow up appointment Labor duration 18 22 minutes S amp S Patient is screaming and uncooperative Prep for precipitous delivery support fetal head to prevent explosive delivery check for nuchal cord if possible check for intact placenta at delivery S amp S SROM followed by Becca pushing hard Program swithces to scenario tab automatically Stat Page anesthesia for sedation bimanual Instructor to reset birthing motor exploration for retained sedate for bimanual exploration secundes collect labs for tox Wa
49. he keyboard for manual entry and click the green checkmark to confirm the change To change patterns sounds and rhythms click on the specific control to display the library e g EKG rhythms throat sounds respiratory patterns etc es C a E G O e w sinus pause Multifocal atrial tachycardia MAT Atrial flutter Atrial fibrillation w PAC w PIC K Sour Junctional D gt Supraventricular tachycardia Temp list deg AVB w PVC uni w PVC multi w couplets Ee 2nd deg AVB Type I nnd dan AUN Tren TTY Click the slider control below the sound library to adjust the volume of the sounds Throat Sound Volume 2 Throat Sound Volume str normal none paren expiratory No changes will be made to the simulator s condition until the new settings are submitted using the Apply panel NOELLE 554 100 After the list of changes is created click NOW to update the vital signs instantly Alternatively click a trending timer to update numerical vital sign parameters e g heart rate blood pressure gradually Cephalic Airway Breathing Respiratory Rate 50 bpm Inspiration Percent 46 02 sat 30 Cardiac EKG Atrial fibrillation skip R s 0 min Circulation Uterus_Hem UA_FHR Custom Number 30 sec 1min 2 min 5 min 10 min
50. he buttocks are the presenting part and the baby s legs are flexed along the lower torso e Footling or incomplete breech occurs when one or both of the legs are the presenting part There are many differences in labor between the breech presentation and the vertex presentation During the descent the posterior hip encounters the pelvic floor and internal rotation takes place allowing the anterior hip to move beneath the pubic arch The anterior hip then delivers followed by the posterior hip the legs and the feet External rotation allows the shoulders to move into the maternal pelvis and internal rotation allows the shoulders to deliver Downward traction allows the 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 simulat
51. he key issue is standardized timing of symptom presentation A consistent repeatable simulation is essential for fair assessment of that care provider in relation to others and for the broader interpretation of results in the context of training validation studies When in doubt it is best to choose Prompt mode in which the facilitator will be given direct control of the responses as events are detected NOELLE 554 100 User Guide 131 Troubleshooting General Troubleshooting Guide Use the following table to find causes and solutions to a number of possible problems Symptom Communication never gets established or is lost blinking communication indi cator is consistently red Sound quality while streaming is poor Streaming audio does not work tab is not displayed UNI has set the power mode to STAND BY automatically Wired communication module not found message is displayed when UNI is started 132 User Guide Possible Cause Battery is discharged Communication Module is not detected Disconnected power plug Communication module RJ 45 Cable is not connected to the simulator All others Sound is too low or too loud Respiration and other undesirable sounds are heard by instructor Simulator is set to Generic Setup Options Environment menu The backup battery on the simulator is depleted Wired communication module is not connected Wired communication is module n
52. ill perform correctly As long as they do the scenario can simply be allowed to continue Naturally you must be prepared for what might happen to NOELLE when providers deviate from expectations The consequences of such deviations can sometimes be included in the scenario punctuated by Wait Indefinitely items In other cases the simulation will require more direct control by the facilitator via either the Palette or Details page 4 Choose auto response settings based on the scenario content and the objectives 130 User Guide NOELLE S554 100 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 T
53. ion 30 minutes Admit patient Routine labs notify HCP of admission and status Set up delivery table and infant warmer configure bed for delivery 66 User Guide NOELLE S554 100 Noelle Labor Scenario Alicia Variations on Normal Gaumard Simulators for Health Care Education Alicia is a 24 year old gravida 2 1 at 39 weeks She weighs 160 pounds She has had prenatal care She has not been using medications of any kind Labor duration 20 minutes NOELLE 554 100 User Guide 67 Noelle Labor Scenario Amy Variations on Normal Gaumard Simulators for Health Care Education 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 68 User Guide NOELLE S554 100 Noelle Labor Scenario Angelica Variations on Normal Gaumard Simulators for Health Care Education Angelica is a 31 year old gravida 5 3 at 41 weeks She weighs 160 lbs She has experienced no prenatal complications and has a history of fast labors Labor duration 20 minutes NOELLE 554 100 User Guide 69 As Noelle Labor Scenario
54. ion which may be on the order of about fifteen pounds The software will also give the instructor a graph that indicates applied force as the delivery mechanism is equipped with a strain gauge The student must stop traction when the simulated contraction ceases Repeat this procedure of waiting for the simulated contraction and providing traction during the contraction if and only if the fetus is moving down the birth canal with each contraction Leopold Maneuver To perform Leopold Maneuvers retract the birthing mechanism fully and remove the articulating birthing baby 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 Set abdominal cover into place felt under the abdomen cover Warning Do not enable the motorized birthing mechanism while performing this exercise Placing elevating pillow within simulator Lift fetus anteriorly using squeeze bulb until it can be felt under the cover Place fetus onto elevating pillow and lift fetus anteriorly using the squeeze bulb Shoulder Dystocia Shoulder dystocia is a dangerous condition defined in the NOELLE Guide as the arrest of NOELLE 554 100 User Guide 51 delivery of the fetal body a
55. ious materials powder comprising your simulator After exercise is completed DO NOT NOELLE is splash proof but not water leave birthing baby in contact with the proof Do not submerge or allow water birth canal POST PARTUM HEMORRHAGE CHECK LIST AND WARNINGS water or excessive dust o ee ts to enter the interior of the simulator Do not expose the tablet computer to eee Use only Gaumard s provided simulated blood Any other simulated blood NOELLE will only power on when brand containing sugar or any additive connected to the power supply may cause blockage and or interruption NEVER disconnect the communications of the vasculature system PSOE ME GAUME SONWAIS Always ensure that the distal end of the is running The software will halt and uterus is inserted through the cervical the module may be damaged opening of the birth canal until the cervix closes around the built in recess Failure to do so could result in liquid accumulating in the pelvic cavity and damage to the birthing mechanism Always position the simulator so post partum hemorrhage fluid flows away from the birth canal and the simulator itself Do not allow post partum hemorrhage fluid to puddle beneath the simulator or reach the lower back NOELLE 554 100 User Guide 9 At the end of every simulation always flush the system with distilled water to prevent clogging To prevent staining or molding always clean NOELLE using di
56. irway 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 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 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 Circulation Palpable bilateral radial pulses are blood pressure dependent 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 NOELLE 554 100 User Guide 43 2 Connect the syringe with tubing to one port Always purge the system with 70 isopropyl alcohol solution at the end of every simulation and the drain tube with clamp to the other port as shown 1 First locate the fill syringe with tubing and the drain tube wi
57. 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 120 User Guide NOELLE 5554 100 Newborn HAL Gaumard Simulators for Health Care Education Cynthia 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 NOELLE 554 100 User Guide 121 7 Newborn HAL Gaumard ss PERT a 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 122 User Guide NOELLE 5554 100 Newborn HAL Gaumard i 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 NOELLE 554 100 U
58. it time 2 40 min screen Use of Bimanual uterine massage and pitocin to maintain contractions Remove placental fragments Wait indefinitely NOELLE 554 100 User Guide 81 Gaumard Simulators for Health Care Education Noelle 574 575 Labor Scenario Bianca 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 a Attach EFM Notice variables turn patient e Wait time 3 30 min tie Check resolution of variables Goto labor Bianca Wait time 1 45 min 82 User Guide NOELLE 554 100 Noelle 574 575 Labor Scenario Gaumard Bianca Simulators for Health Care Education oe ose Variations on Normal NOELLE 554 100 User Guide 83 Gaumard Simulators for Health Care Education Noelle S 574 575 Labor Scenario Candice Shoulder Dystocia minutes Candice is a 19 r old multip She her boyf
59. l hose to the uterine hemorrhage fluid port inside the abdomen Use bimanual massage to shrink the boggy uterus into a smaller and firmer condition Adjust the uterine pressure using the control in the Details tab or a palette item Uterine pressure settings are also programmable into both linear and branching scenarios STATUS DETAILS UTERUS HEM Vaginal Hemorrhage f Uterine Hemorrhage i u A Uterine Pressure NOELLE 554 100 User Guide 57 Hemorrhaging Simulate cervix or birth canal hemorrhage complications with real fluid Follow the steps below to fill the hemorrhage fluid reservoir and start the hemorrhage Warning Prior to starting an exercise always position the simulator so the post partum hemorrhage fluid will flow away from the birth canal and the simulator itself Do not allow post partum hemorrhage fluid to puddle beneath the simulator or reach the lower back panel Failure to do so will result in damage to the simulator The hemorrhage fluid reservoir fill port is located behind the right knee Using the PPH Fill Kit Syringe fill the PPH reservoir with water or diluted Gaumard simulated blood mix The hemorrhage reservoir has a maximum capacity of 850 mL or approximately 15 fill kit syringes 58 User Guide NOELLE 5554 100 Warning Only use Gaumard provided simulated blood Any other simulated blood brand containing sugar or any addi
60. lator s right side Follow the steps below to connect the communication module to the simulator and the laptop computer GaumardUI controls only one simulator at a time To switch between NOELLE and Newborn first exit the GaumardUI software and reconnect the communications cable to the simulator you wish to control 16 User Guide NOELLE S554 100 Virtual Monitor The mobile virtual monitor system works with GaumardUI to display the vital signs of NOELLE birthing baby and Newborn Refer to the manufacturer s documentation included with the virtual monitor system components for important safety installation and start up information before turning on the computer for the first time VIRTUAL MONITOR WIRELESS CONNECTIVITY The control laptop and the all in one virtual monitor computer automatically establish an ad hoc wireless connection at startup The wireless connection allows the GaumardUI control software to send vital signs information to the Gaumard Monitors software To verify the wireless ad hoc connection click on the wireless icon located on the task tray To troubleshoot connection issues please go to page 132 Currently connected to T Unidentified network No Internet access Wireless Network Connection 2 a Connected A GaumardNet gaumard iA Other Network wall Open Network and Sharing Center After the wireless connection is established double click or tap the Gauma
61. luted soap and water Remove the birth canal and clean thoroughly 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 10 User Guide NOELLE S554 100 Getting Started NOELLE 554 100 User Guide 11 Overview The NOELLE 554 100 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 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 e Build team and technical competencies e Maternal vital signs monitor e Fetal heart tones and neonatal vital signs monitor e Set up and run OB emergency simulations for shoulder dystocia postpartum hemorrhage eclampsia umbilical cord prolapse breech vaginal delivery operative vaginal delivery neonatal resuscitation e IV arms for meds fluids e Intubatable airway with chest rise e Removable stomach cover 12 User Guide NOELLE S554 100 Chest compressions and
62. managing and creating new profiles refer to the digital UNI User Guide under Menu Help Instructional Manual UNI Interface The UNI software is used to control the simulator monitor the vital signs and evaluate the provider s performance The simulation technician or instructor carrying out the simulation operates the UNI software The UNI components and programming procedures are consistent throughout the Gaumard family of high fidelity simulators Some software controls and features covered in this guide may be hidden depending on the simulator s hardware configuration and optional upgrades UNI Noelle 57X 100 Q0000000 QUICK START NOELLE STATUS DETAILS QUICK LAUNCH aa gj oaeeo IOL Seizure none x ey 2 SELECT A CLINICAL CONDITION TOTAL SCENARIOS 49 Pupil Dilation R 5 t 5 x 7 Normal Delivery 3 Pupil Reaction R On 1 Onl x ry 3 Scenario Name Scenario Description Length t s W Variations on Normal 8 F Pupil Dilation Time 0 5 sec x eae ae E Shoulder Dystocia 4 l Alyssa Alyssa is a 23 year old primipara at term i fas ma i Throat Sound Volume Breech 3 Amy Amy is 19 years old and she weighs 160 b 30 mn E Preeclampsia 3 Angela Angela is a 31 year old grand multipara at 30min BREATHING ac Dell 6 02 sat eserean Delivery Angelca Angelica is a 31 year old gravida 5 3 at 41 20min l Etco2
63. model adjusts vital signs and skin color in response to ventilation effectiveness Set the physiological modeling state to deteriorate and 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 Modelrate 1 PAUSE physiological oxygenation modeling Modeled Therapy Improve Gain Reset IMPROVE adequate oxygen perfusion breathing gt v DETERIORATE compromised oxygen perfusion apnea Oxygen 0 Limin Epinephrine 0 04 gt mg Administer Healthy Mild Cyanosis Severe Cyanosis cose onocotd T majko CPR Monitor Effective Min E 4 Max Ventilation Range 30 65 VENTILATION COMPRESSION 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 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 sig
64. mplete list of consumables and replacement parts and their prices C Consumables R Replacements A Accessories U Upgrades M Factory Repair ONLY Item ID Name Type Description 555 100 001 R2 A C Virtual Monitor R Allin one computer 555 100 004L D Lower Left Arm Skin M Lower left arm skin cover Cover 555 100 004L L Lower Left Arm Skin Lower left arm skin cover Cover 555 100 004L M Lower Left Arm Skin Lower left arm skin cover Cover 555 100 004R D Lower Right Arm Skin Lower right arm skin cover Cover 555 100 004R L Lower Right Arm Skin Lower right arm skin cover Cover 555 100 004R M Lower Right Arm Skin Lower right arm skin cover Cover 555 100 007 D C Section Abdominal NOELLE stomach cover for C Section Exercises Cover dark color 555 100 007 L C Section Abdominal NOELLE stomach cover for C Section Exercises Cover light color 555 100 007 M C Section Abdominal NOELLE stomach cover for C Section Exercises Cover medium color 555 100 008 R2 D Abdominal Cover NOELLE stomach cover with foam insert dark color 555 100 008 R2 L Abdominal Cover NOELLE stomach cover with foam insert light color 140 User Guide NOELLE S554 100 Item ID Name Type Description 555 100 008 R2 M Abdominal Cover NOELLE stomach cover with foam insert medium color 555 100 010 Battery M Rechargeable battery S555 100 011 Battery Charger R Battery charger with label S555 100 013 Birthing Mechanism R Automatic Bir
65. n Preterm Labor Maria is a 30 yr old multip 27 weeks She has an 11 yr old and has been trying for more children She has had 2 miscarriages in the last 4 years and she lost both due to an incompetent cervix This time a McDonalds suture was placed 14 weeks Labor duration 15 minutes Give IV bolus apply EFM Wait time 5 min Ctx subside administer mag sulfate skip forward 24 hrs Wait indefinitely Call for help stat page physician Wait indefinitely 116 User Guide NOELLE S554 100 Newborn Flowcharts Gloria s Baby Helen s Irene s Baby a Francine s Baby NOELLE 554 100 User Guide 117 EEEE Newborn HAL esas re tor Vache ine Banin Alice s Baby Healthy baby Apply suction and O2 Wait Indefinitely for actions 118 User Guide NOELLE 5554 100 Gaurd Newborn HAL Sdalors Sor idih Cine Ecni 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 NOELLE 554 100 User Guide 119 EE Newborn HAL Simulators for Health Care Education Beth s Donna s Baby Baby
66. n was brought on by use of alcohol and cocaine Instructor must fill hemor rhage kit with fluids before running the scenario Runs for approximately 25 minutes Even though patient suffers heavy blood loss blood products are not to be used so alternative methods must be found Instructor must fill hemorrhage kit with fluids before running the scenario NOELLE 554 100 User Guide 37 Peripartum June is a 31 year old who is about Hemorrhage PPH to deliver her 5th baby She has had a normal pregnancy and plans natural childbirth and breastfeeding Her husband and oldest daughter attended the CBE refresher course and she has arranged for the 11 year old to attend the delivery Kelly Amniotic Fluid Kelly is a 34 year old gravida 5 2 Embolism 38 weeks She is scheduled for an induction due to problems with her last pregnancy That baby weighed almost 10 pounds and she had experienced a severe shoulder dystocia with the delivery She has gained 43 pounds with this pregnancy and her glucose tolerance test GTT is borderline An ultrasound a few days ago estimated current fetal weight at 3800 to 4000 grams Kelly s physician feels that her cervix is favorable so he has re commended an elective induction 38 User Guide NOELLE 5554 100 Full scenario runs approximately for 22 25 minutes PPH runs for 8 10 minutes Labor and delivery progress uneventfully Heavy bleeding begins immediately upon deliver
67. near or a branching postpartum section of the scenario Instructor must fill hemorrhage kit with fluids before running the scenario Patient Name Labor Type Peripartum Hemorrhage Abruption Peripartum Hemorrhage PPH History India is a 19 yr old gravida 2 37 weeks She arrives at hospital with her husband who says she fell down the stairs and she has been cramping and bleeding for about an hour During admitting interview husband answers all the questions and India doesn t make eye contact The nurse palpates uterus initiates fetal monitoring and starts a pad count Inez is a 27 yr old primip 35 weeks She arrives at hospital one evening crying and doubled over in pain She is admitted to a birthing room and the nurse notices bright red blood on Inez s panties She is having very intense and close contractions Janie is a 23 yr old G 2 38 weeks She has experienced several bleeding episodes due to a low lying placenta She has been counseled about the potential for postpartum hemorrhage Her religious beliefs prohibit the administration of any blood products Runs for approximately 25 minutes This scenario is a suspected spousal abuse case Patient has a central abruption of the placenta Instructor must fill hemorrhage kit with fluids before running the scenario Runs for approximately 18 minutes This scenario involves a precipitous delivery with heavy bleeding due to placental abruption Abruptio
68. ng 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 554 100 User Guide 13 Equipment Set up 14 User Guide NOELLE S554 100 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 NOELLE is equipped with an internal backup battery to maintain functionality in the event the power adapter is unplugged or the simulator is requires transportation from one room to another Always operate NOELLE with the power supply connected 2 Position the lower legs and insert the bolts Use the two provided The backup battery level is displayed on hexagonal wrenches to secure the GaumardUI status panel For more the knee bolts Do not over information about the battery indicator tighten refer to p
69. ng 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 554 100 User Guide 145 Warranty EXCLUSIVE ONE YEAR LIMITED WARRANTY Gaumard warrants that if the accompanying Gaumard product proves to be defective in material or workmanship within one year from the date on which the product is shipped from Gaumard to the customer Gaumard will at Gaumard s option repair or replace the Gaumard product This limited warranty covers all defects in material and workmanship in the Gaumard product except 1 Damage resulting from accident misuse abuse neglect or unintended use of the Gaumard product 2 Damage resulting from failure to properly maintain the Gaumard product in accordance 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 w
70. ns are starting to deteriorate Severe Cyanosis Pedi is blue apneic and vital signs are rapidly worsening 40 User Guide NOELLE S554 100 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 NOELLE 554 100 User Guide 41 Working with NOELLE 42 User Guide NOELLE S554 100 Airway management techniques can be practiced on NOELLE including BVM nasal oral intubation and suctioning Endotracheal tubes NG tubes and LMAs can be used Recommended Device Procedure i Size Intubation Blade size Miller 4 or MAC 3 5 Nasal Intubation 8 mm outer diameter max Oral Intubation ETT Fr7or7 5 Warning Do not introduce liquids when performing nasal and oral intubation Doing so can permanently damage the system Always lubricate tubing a
71. nt born earns good APGARs 30 User Guide NOELLE 5554 100 Patient Name Labor Type History Alyssa Normal Labor 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 Normal Labor 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 Variations on Becca is a young pregnant teen Normal 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 Variations on Bianca is a 16 year old gravida Normal 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 the teen clinic due to transportation issues 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 Simula
72. nt to OR for delivery insert FSE on fetal buttocks S amp S Patient and mother vehemently refuse to consent to C S AROM 88 User Guide NOELLE 5554 100 Gaumard Simulators for Health Care Education Noelle 574 575 Labor Scenario Variations on Normal minutes Elenor is a 19 yr old post ictal patient being transferred to the ER by EMS She was found convulsing in the bathroom According to relatives she is 81 2 months pregnant with her first baby She has been on an IV during transport and her BP is 180 120 Labor duration 20 S amp S Responsive only to pain with groans Vaginal bleeding S amp S Suffers tonic clonic seizure prolonged fetal Stat page on call OB attending Give Magnesium sulfate bonus bradycardia results 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 NOELLE S554 100 User Guide 89 4 Noelle S574 575 Labor Scenario K Gaumard Eleanor s ARENAEN eae Aa PERE a Variations on Normal 90 User Guide NOELLE 5554 100 Noelle 574 575 Labor Scenario Gaumard Erin Simulators for Health Care
73. ntal headache 3 tibial edema and 4 DTRs with 2 beats clonus are noted Labor duration 40 minutes NOELLE 554 100 User Guide 73 a G d Noelle Labor Scenario na t iwilicke Francine Cesarean Delivery 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 74 User Guide NOELLE 5554 100 Noelle Labor Scenario Gloria Cord Prolapse Gaumard simulators for Health Care Educatior Gloria is a 34 years old gravida 1 0 at 25 weeks She weighs 190 lbs She has had prenatal care Labor duration 10 minutes NOELLE 554 100 User Guide 75 Noelle Labor Scenario Helen Hemorrhage Gaumard Simulators for Health Care Educatio 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 76 User Guide NOELLE 5554 100 As Noelle Labor Scenario Gaumard Irene Simulators for Health Care Educatio Cesarean Delivery lrene is a 19 year old gravida 2 0 at 29 weeks She has had one spontaneous abortion Labor duration 45 minutes Admit patient Routine labs notify HCP of admission and status Set up delivery table and infant warmer configure bed for d
74. one 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 5 Click OK to save the changes to the 7 It might be necessary to re adjust volumes on the microphone the microphone settings to properties menu accommodate environment noise 6 Click OK to close the Sound properties window Recording Select a recording device below to modify its settings i Microphone Realtek High Definition Audio RZ Default Device Mh Set Defautt 7 NOELLE 554 100 User Guide 135 Wireless Network UNI generates the vital signs information displayed on the virtual monitor PC The information is transmitted through a wireless ad hoc connection between the two computers in real time The wireless settings are configured at the factory so no additional configuration is required Use the Create an ad hoc Wireless network tool to configure the wireless ad hoc link between the two computers Then configure the connection between UNI and the Gaumard Monitors software Complete the next steps using the Controller Create Ad Hoc Wireless Network tool built in to UNI software 1 From the menu bar go to Help gt Create ad hoc Wireless Network The Controller Create Ad hoc Wireless Network window is displayed 2 Select the Wir
75. one Downs Syndrome baby so she is very apprehensive An early U S and genetic studies showed this baby to be a normal female She has had several episodes of preterm contractions that resolved with LLP bed rest and oral hydration She began contracting again 3 hours ago and again tried LLP bed rest and oral hydration but the contractions have continued amp become stron ger 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 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 554 100 User Guide 39 Model Newborn The physiologic cyanosis
76. ot identified by the computer 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 7 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 Perform a full shutdown of the tablet NOELLE s internal battery is used for transportation Always use NOELLE connected to the charger Both simulators operate using a wired connection Connect the wired communication module to the simulator and restart UNI Close the UNI 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 volume at PC side is managed from PC s volume control Simulator sound volume is managed from PC s Microphone gain control Adjust microphone gain until simulator voice level equals user s voice intensity Always talk as close as possible to the microphone in order to improve quality Using a headset is recommended Since simulator s microphone has high sensitivity in order to capture the voice of providers it also captures all surrounded noises on or around the simulator This is normal and it is not a malfunction Make sure to select multiple simulator environment Setup Options gt Environment tab and enter the Serial
77. plied 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 146 User Guide NOELLE S554 100 1 Contact Gaumard and request authorization to return the Gaumard product Do NOT return the Gaumard product to Gaumard without prior authorization 2 Upon receiving authorization from Gaumard send the Gaumard product along with copies of 1 the original bill of sale or receipt and 2 this limited warranty document to Gaumard at 14700 SW 136 Street Miami FL 33196 5691 USA 3 Ifthe necessary repairs to the Gaumard product are covered by this limited warranty then the first purchaser will pay only the incidental expenses associated with the repair including any shipping handling and related costs for sending the product to Gaumard and for sending the product back to the first purchaser However if the repairs are not covered by this limited warranty then the first purchaser will be liable for all repair costs in addition to costs of shipping and handling 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
78. r will continue resulting in delivery of the baby It is very important that the students are aware of the Turtle Signs If for any reason the students fail to recognize the proper corrective procedures required the labor can be stopped completely and set up again The instructor can then add an unsatisfactory note to the log of the providers actions Normally the fetus is retained by the delivery mechanism so that it can be rotated but not delivered The facilitator can either turn off the dystocia mode to allow the baby to be delivered in the normal fashion or press the Release Baby button on the Labor tab This action unlocks the baby allowing 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 usin
79. rd Monitors icon on the virtual monitor s home screen f an Gaumard Monitors NOELLE 554 100 User Guide 17 The Gaumard Monitors software is now ready to receive vital signs information generated by the UNI control software Tum On FHR Beep EFM OFSE noms konge Continue to the next section to begin working with the UNI control software and the simulator 18 User Guide NOELLE S554 100 Working with UNI NOELLE 554 100 User Guide 19 Initializing the Simulator After reading the manufacturer s care and caution information press the power button to turn on the Tablet PC The UNI software initializes the simulator Double click the UNI icon on the tablet s home screen to start Al he fals Gaumard hoE w Nip as Gaumerd Monitors The simulator selection menu is shown Select Noelle and click Start UNI 2 22 18 0 ng simulators for Health Care Education Please select one simulator f IT fT TitoT A m RIAR 4 VING Rt PALES Fe a M AF NES T E T W i i rip S y T919 i eo 5 g a NOELLE 554 555 V Quick Start Noelle 20 User Guide NOELLE S554 100 The wireless link between UNI and the simulator is established within 1 minute The available profiles for each simulator will be displayed when the simulator is selected For more information about
80. respiratory drive That is if the patient s respiratory rate were changed from zero what sound would be heard Assuming that the lungs themselves are normal in this scenario you would choose normal for the lung sound setting Then as the scenario progresses if the patient starts breathing there will be no need to set the lung sound again It will already be set The same principle applies to the heart sound and other settings 2 Include notes to guide the facilitator during the simulation It is common for scenario designers especially those who act as facilitators to neglect the importance of notes in the scenario They think that they will remember the learning objectives patient history and other details at the time they are ready to conduct the simulation They usually don t especially when revisiting a scenario months after creating it When you add Wait and Wait Indefinitely steps to a scenario you have an opportunity to edit the item description Use this description field to hold notes to the facilitator Typically scenario designers 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 w
81. riend and their 3 yr daughter are homeless living in a car She has not seen a doctor and believes that she is about 8 months pregnant Her water broke yesterday and she is leaking moderately thick meconium fluid An ultrasound is performed to determine position and gestational age Labor duration 15 minutes Full scenario duration 23 25 S amp S Complains of tenderness in abdomen finds ctx very painful 84 User Guide 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 NOELLE 554 100 Admit to birthing room administer medication change position to relive variables Noelle S574 575 Labor Scenario Gaumard Candice Simulators for Health Care Education i 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 NOELLE 554 100 User Guide 85 G d Noelle 574 575 Labor Scenario poral eet Charlotte Simulators for Health Care Education Shoulder Dystocia Y Charlotte is a 31 yr old gravida 3 1 41 5 7 weeks Her physician stripped her membranes
82. ritical to understand and comply with the following guidelines 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 with the same precautions that would be used with a real patient Always keep clear of the birthing mechanism while the system is on Never operate the birthing mechanism without the tummy cover in place 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 8 User Guide NOELLE 554 100 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
83. s a 28 yr old 38 weeks admitted b Y4 Cesarean Delivery 6 E Cord Prolapse 4 i Gabnela Cesarean 19 year old Mexican girl has a vertical E Uterine Rupture 1 Enable the Favorites feature by clicking the start icon Then select the categories or scenario types to be stored under this feature Franane Franone is a 19 year old female gravida 2 NOELLE 554 100 User Guide 23 Status Details Controls The Status Details panel is used to monitor and control the simulator s vital signs The individual parameter controls displayed on the details tab provide the simplest method for controlling the simulator s vital signs sounds and features The Status Details tab displays the vital signs controls in a list format SYSTEMS LIST VIEW Bittorent x Seizure 1 v Coupling 0 Probability 0 Size Variability minimal AJU Accel Decel Intensity average Variables none The Status Details panel is used to monitor and control the simulator s vital signs The individual parameter controls displayed on the details tab provide the 24 User Guide NOELLE S554 100 simplest method for controlling the simulator s vital signs sounds and features To adjust numerical values click the slider control e g heart rate blood pressure respiratory rate etc 40 mmHg x Alternatively use t
84. ser Guide 123 a Newborn HAL Simiaions for Vieni Gen Eabocaiton Gloria 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 Indefinitely for action Begin PPV and chest compressions Wait Indefinitely for action Administer Epinephrine Wait Indefinitely for action 124 User Guide NOELLE S554 100 a Newborn HAL Simulators for Health Cave 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 NOELLE 554 100 User Guide 125 Newborn HAL Simulators for Health Care Education MAS Meconium Aspiration Syndrome Apply suction intubate and supply 100 O2 Wait Indefinitely for actions 126 User Guide NOELLE 5554 100 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 aspira
85. sider is the initial condition of the patient Create a Palette Item to describe this condition Make sure that this first step in the scenario is a complete state That is indicate some selection for each and every available setting on the Details page Remember that only the settings you specify will cause a change in NOELLE and all other settings will remain constant So by starting with a complete state NOELLE s condition will always be the same when the scenario starts regardless of what he was doing previously Likewise the transition duration of the first step in the scenario should be zero indicating that changes are applied immediately There is one point that can cause confusion and warrants further explanation It is an extension of the above discussion of partial states The issue is best illustrated through the following example Suppose that you are creating a Palette Item to start your scenario In this case you have decided that the patient will be apneic The question is How should the lung sounds be set NOELLE 554 100 User Guide 129 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
86. steps below in case the birth canal has the top of the birth canal insert and to be removed temporarily to adapt the push downward episiotomy kit 1 Insert your left hand at the 9 o clock position between the lower torso and the birth canal insert Slowly push inward Warning 4 Slowly pull the birth canal insert Do not pull the birth canal to towards you When the urine remove catheter tube is visible detach from the birth canal insert 2 Repeat instructions in step 1 with right hand at the 3 o clock position NOELLE 554 100 User Guide 143 5 Finally after removing the urine catheter tube gently remove the birth canal insert 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 2 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 3 Push the birth canal insert into position Place your hands on the lower half of the insert with your fingers holding the bag in place Steady the front of the insert with your thumbs Without removing the plastic orient the birth canal insert so that it is properly aligned 144 User Guide NOELLE 554 100 with the opening on the lower torso of the mannequin Gently begin to remove the polythene bag with one hand while holdi
87. t running Newborn simulator s chest Incorrect respiratory settings does not rise with artificial ventilation e g BVM Newborn s Low chest rise or Wrong force sensor reading no chest rise at all while breathing NOELLE s delivery baby is disengaged prematurely Wrong force sensor reading NOELLE s delivery baby does not release at delivery end Dystocia is ON when user is pulling the baby ae Motor is disoriented Initial fetus position was not specified on the software NOELLE s delivery mechanism doesn t come to its initial position when using the Reset button under the Labor tab or it makes a grinding noise when reaching the end of the rails Pre built scenarios do cannot Volume not set to user s criterion be loaded A sound is absent or is not Cyanosis intensity not set to user s heard at desired volume level criterion All others See Calibration Wizard section inside User s Manual Simulator must be powered on and respiratory rate set at 0 Respiration rate and inspiration percentage must be higher than O If problem persist shut down the simulator and restart the tablet Turn on the system then verify connection battery and lung settings When baby is pulled with more than 35 lbs of force to avoid damage the baby is released If user is not pulling the baby it means that Force Sensor is offset See the Calibration Wizard sec
88. tage 46 02 sat 30 Cardiac Select the palette item from the Load Palette Item menu and click Load Load Palette Item HR drop HR spike NORE inerrant Click the apply option to submit the changes Contraction Frequency 2 min Contraction Duration 70sec Contraction Intensity 70 mmHg Periodic Changes NOELLE 554 100 User Guide 27 NOELLE has a total of thirty six factory preset labor scenarios which were designed in conjunction with healthcare professionals The scenarios are divided into two separate profiles Below is information on the scenarios available under the quick start and NOELLE Advanced scenarios Normal Alice is a 24 year old gravida Runs for 30 minutes Labor progresses 2 1 at 39 weeks She weighs normally and fetal heart tones remain 170 pounds She has had within normal limits The normal male prenatal care She has not infant earns good APGAR scores been using medications of any kind Variations on Alicia is a 24 year old gravida Runs for 20 minutes Labor progresses Normal 2 1 at 39 weeks She weighs normally and fetal heart tones remain 160 pounds She has had within normal limits The normal infant prenatal care She has not earns good APGAR scores been using medications of any kind Amy Variations on Amy is 19 years old 1 0 at 40 Runs for 30 minutes Labor progresses Normal weeks She weighs 160 Ibs normally and fetal heart tones r
89. te stat page anesthesia and NICU personnel Turn patient LLP to resolve variables put O2 mask on patient discontinue Pitocin Give SQ Terbutaline to reduce ctx NOELLE 554 100 User Guide 111 Noelle S574 575 Labor Scenario Gaumard Kelly Simulators for Health Care Education Amniotic Fluid Embolism Perform emergency C section Wait time 3 min Electrical defibrilation Wait time 1 min Administer resuscitation per ACLS protocols Inspect placenta following delivery administer Pitocin to promote uterine ctx Full resuscitation Wait indefinitely Give blood products for DIC management stabilize patient transfer to ICU 112 User Guide NOELLE S554 100 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 NOELLE 554 100 User Guide 113 Noelle 574 575 Labor Scenario Gaumarad Kimberl
90. tes 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 NOELLE 554 100 User Guide 31 32 User Guide Candice Shoulder Dystocia Charlotte Shoulder Dystocia Breech Presentation NOELLE 554 100 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 Dana is a 24 yr old multip 29 weeks who was admitted because she began contracting Upon V E physician discovers that she is 4 5cm with bulging membranes She was given Terbutaline subQ and then transported to the regional medical center Full scenario runs for approximately 23 25 minutes Dystocia drill runs for 15 min La
91. th pinch clamp Fill the syringe with the desired fluid water or simulated blood 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 Tosimulate a patient with no accessible peripheral IV sites connect only the syringe Pull the plunger to create suction which will collapse the veins Disconnect the syringe tube from the arm port while maintaining suction The port will seal and the veins will remain collapsed 44 User Guide NOELLE s554 100 2 Lubricate the head and shoulders of the fetus Obstetrics e Ball point pens ink and markers permanently stain the birth canal insert e Do not wrap this or any other Gaumard product in newsprint e The birth canal insert can be cleaning by wiping with a mild solution of soap and water After cleaning dust with talcum powder e Store the unit in a cool dry place e After exercise is completed DO NOT leave birthing baby in contact with the birth canal e Always lubricate the birth canal prior to 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 554 100 User Guide 45 4 Attach placenta to either sid
92. the pregnancy She began cramping about 3 hours ago and decided to drive herself to the hospital when she began leaking clear fluid An admitting clerk helps her into a wheelchair and takes her to L amp D Cord Prolapse Frances is admitted into a small Runs for approximately 22 27 town hospital due to regular minutes Instructor must set up contractions 4 minutes apart _ prolapse cord prior to beginning and bloody show She labors scenario Instructor may disconnect without problems for about 4 NOELLE simulator from power outlet hours and then the fetus starts to and continue running scenario while brady down after SROM AV E _ transferring the NOELLE birthing reveals a prolapsed coed in the simulator to the OR vagina NOELLE 554 100 User Guide 35 Patient Name Labor Type Gabriella Uterine Rupture Uterine Rupture Peripartum Hemorrhage Previa Peripartum Hemorrhage Previa 36 User Guide NOELLE 554 100 History Gabriella is a young Hispanic woman who presents to a small hospital just across the Mexican border She is alone and speaks little English Her nurse is fluent in Spanish but Gabriella is very quiet and gives little information Gail is a 29 year old primip 35 weeks She was admitted to L amp D from the ER after being involved in car accident Both she and her husband Alan were seriously injured and she is on a backboard wearing a c collar to stabilize the spine Her ri
93. 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 cm E E E When the battery icon is depleted the The power button is located at the simulator is set to STAND BY mode bottom right corner of the UNI automatically to protect some of the software Toggle the power button to simulator s internal components set the simulator to stand by mode and then again to resume NOELLE 554 100 User Guide 21 Notice that one or more scenario types can be selected at the time and the list of scenarios on the right will display only the scenarios included on the selected categories Erter t to sere 0 0C00 TOTAL SCENARIOS 49 Scenarios selected 6 SELECT A CLINICAL CONDITION Normal Delivery 3 Scenario Name Scenario Description Length E Variations on Normal 8 E Shoulder Dystoda 4 Alce is a 24 year old female weighing 170 30min E Breech 3 i Alyssa is a 23 yr old primp at term Her hea 30min Quick Launch Preeclampsia 3 Angela s a 31 yr old grand mukp term i a E Sesaremn DENEY 6 Elane is a 23 year old gravida 1 0 at 37 The UNI interface opens up showing the zor lt Er E quick launch page for the scenarios This E Hemorhoge 7 lE passaii E Post Partum Hemorrhage 5 page IS used to CaS Il ly access the E Amnio
94. thing Mechanism 555 100 016 D Birth canal C Dark color 555 100 016 L Birth canal C light color 555 100 016 M Birth canal C Medium color 555 100 032 Automatic Boggy Uterus R Boggy Uterus for automatic PPH 555 100 033 Episiotomy Trainer Set R Episiotomy Trainer set with vulva insert 555 100 040 D Articulating baby R Articulating birthing fetus S555 100 040 L Articulating baby R Articulating birthing fetus 555 100 040 M Articulating baby R Articulating birthing fetus S555 100 048 Adult IV Filling Kit A Fluid dispensing syringe with filling tube S555 100 060 Simulator Transport Case R Soft storage and transport case with wheels S555 100 062 Shipping Cardboard Box R Box dimensions 60 x20 x30 for simulators with soft case 555 100 080 Simulated Blood Concentrate 555 100 081 Silicone Oil R Oil based Silicone lubricant 555 100 087 Wireless Streaming Audio Headset 555 100 207 Laptop PC R GUI Software included 555 100 310 Wireless keypads R Extra pack of five wireless keypads 555 100 EXW Two Year Extended A Extended warranty for years Two AND Three NOELLE 554 100 User Guide 141 Item ID Name Type Description S 555 100 INST In Service Training A Day of in service training and installation 142 User Guide NOELLE S554 100 Replacing Common Consumable and Replacement Parts Follow the instructions below to replace 3 Push inward on the birth canal the birth canal You may also use the insert Then place your thumbs on
95. tial position Never store the fetus inside the abdomen or leave the fetus in contact with the birth canal Vacuum Assisted Delivery Vacuum assisted delivery is a technique for the management of arrest during the second stage of labor Criteria for successful delivery include 1 cervical dilation is complete 2 cephalic presentation is confirmed 3 the fetal head is no more than 1 5 palpable above the pubic bone 4 effective uterine contractions continue 5 maternal expulsive efforts continue A soft skin scalp cover for the articulating baby is provided for vacuum assisted deliveries Warning The soft skin scalp cover is to be used during the process of a vacuum delivery only Do not allow the head to rest 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 50 User Guide NOELLE 5554 100 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 tract
96. tic Auid Embolism 3 miere ee E Preterm Labor 2 Load Senna Start Scots preprogrammed scenarios saved on nan emia E a Neale each profile Q e A A PO ne eect tent tte eee i OOE Click on one of the scenarios listed to TOTAL SCENARIOS 49 pianinai Scenario Name Scenario Description Length highlight it and the scenario can be E Variations on Normal 8 SELECT A CLINICAL CONDITION E Shoulder Dystoci 4 masanipun FF started immediately or loaded E Breech 3 Amy Amy is 19 years and she weighs 160 bs 30min E Preedampsia 3 Angela Angela is a 31 yr old grand mukp tem 30min z z E Cesarean Delivery 6 G asaan E ae w v Angelca Angelca is a 31 year old gravida 5 3 at 41 20min Rishon TOTAL SCENARIOS 49 Scenarios selected 6 Uterine Rupture 1 Becca Becca is a young pregnant teen who 5 ivi 10 mn E Hemorrhage 7 Becca Sedation Becca delvered precipitously and has Scenario Name Scenario Description E Post Partum Hemorrhage 5 Beth Beth is a 16 year old gravida 2 0 at 37 10mn 7 Bae Aice is a 24 year old female weighing 170 p ou e Recorda of49 We 4 bmw gt sh pe z ae E Amniotic Fl lism 3 en FANA SOO A 2 gt Alyssa Alyssa is a 23 yr old primp at term Her heath is E Preterm Labor 2 Load Scenario Start Scenario Angela Angela s a 31 yr old grand mukp term She tells t VIRTUAL MONTOR FETALMOMITOR PALETTE SCENARIO GRA
97. tion Wait Indefinitely for action NOELLE 554 100 User Guide 127 A Gaumard Simulators for Health Care Foucatio r Newborn HAL TTN Transient Tachypnea of the Newborn 128 User Guide Apply suction and deliver O2 Wait Indefinitely for action NOELLE 554 100 Tips on Creating Scenarios As described previously Palette items represent complete or partial groups of settings that have been stored as a single item We learned how applying partial states will hold constant all settings that are left unspecified Not only does it take time to customize the palette but a very large palette becomes difficult to navigate So it is desirable to minimize the number of Palette Items in each Profile To accomplish this an experienced facilitator tries to create items that are as generally applicable as possible and can thus be applied to a wide range of scenarios The key is to only include in your Palette Items the settings that are directly related to the physiological event represented by that Palette Item After reading the Details Palette 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 con
98. tion inside User s Manual and reset the force sensor to its default value Reset to Default Force button Try manual Release from button located on the left hand site corner under Delivery tab If baby releases then calibrate Force Sensor See the Calibration Wizard section inside User s Manual and reset the force sensor to its default value Reset to Default Force button When Dystocia On button is checked the baby is not released until checking Dystocia Off Reset the delivery motor by going to Setup Options menu NOELLE Features tab and then click on Labor Motor under Reset tab If delivery mechanism is at the very beginning in a way that it is compressing the rubber boots the grinding noise won t go away for a minute or so Should that be the case either let it go it won t break or simply move motor forward a few turns and then reset Lock the baby into the birthing mechanism and manually turn the 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 45 Select Quick Start Scenarios when starting the software To change profiles from within the UNI Go to File Profile menu and then select Modeled Scenarios Every sound has a volume control Adjust the volume control located on the status panel to reach the desired level Set Cy
99. tions 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 NOELLE 554 100 User Guide 93 a Noelle 574 575 Labor Scenario Gaumard Frances Simulators for Health Care Education Prolapsed Cord 7m i Perform c section delivery infant repair incision Wait indefinitely 94 User Guide NOELLE 5554 100 Gaumard Simulators for Health Care Education Noelle S574 575 Labor Scenario Gabriella Uterine Rupture 25 minutes Gabriella is a young Hispanic woman who presents at a small hospital just across the Mexican border She appears to be in late pregnancy and in active labor As the nurse helps her to bed she notices a midline abdominal scar Gabriella has had one prvious child in Mexico but shares no more information Labor duration 15 minutes Scenario duration S amp S Patient feels pain with ctx S amp S Vaginal bleeding extreme Pain pale diaphoretic Turn patient on side give O2 incresae IV rate Hit emergency button Rush patient to OR prep transfer to ER for emergency c section Wait time 3 min Notify nursery personnel
100. tive 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 To start the bleeding go to the Details tab and click the Hemorrhage feature icon to the active status Blue Then click the Apply NOW button to submit the change and start the hemorrhage UTERUS HEM Vaginal Hemorrhage X s S On Uterine Hemorrhage Off 60 Uterine Pressure To stop the hemorrhage click the control icon to black disabled and then click apply NOW If the uterus insert is connected to the uterine hemorrhage fluid port inside the abdomen activate the Uterine Hemorrhage option to start bleeding from the cervix UNI includes several built in labors preprogrammed with post partum hemorrhage activity For more information go to page 28 for more information Episiotomy Repair To perform episiotomy repair exercises remove the birth canal used during delivery and snap in the episiotomy holder into place Finally snap the episiotomy insert into the holder Use a 000 size suture and small curved needle to repair the surgical incision or repair For replacement episiotomy inserts part number information go to page 140 Systemic IM sites for placement exercises are located on both deltoids and quadriceps Warning Do not inject fluids into the I
101. twork Connection 2 lt refresh P 192 168 55 145 Port 8001 lt findavai 2 Connect Connected to 4 Set the adapter to Wireless network connection 5 Verify the network status and network name then click Connect to begin transmitting the vital signs information 6 Write down the Controller software to the Gaumard Name and Port number Monitors software 7 Start the Gaumard Monitors software on the virtual monitor PC Currenthy connected to 4 8 Click the V menu near the top jef Jih jo gaumard com eft co rner an tnen select Internet access Comm Setup The TCP Comm Setup window is Wireless Network Connection 2 A displayed simcenter Connected af E h Wireless Communication Setup Ez GaumardNet ki If the communication has not been established please enter the name or IP address and port number selected on the controling computer Gaumard GuestNet antl Noelle l Network Status Connected ooe Other Network nf Network Name i IP Type Automatic Port 8001 E Controller Name GMRDOO3 PC Show IP 9 Click Connect to accept the 4 Repeat the same steps listed incoming connection above to connect the UNI software to the Gaumard Wireless Communication Setup ES If the communication has not been established please enter the name or IP address and port number selected on the controling computer Monitors software Noelle Network
102. umbilical cord can be trimmed or clipped for simulations and is therefore considered a consumable item Cephalic Newborn displays central and peripheral cyanosis at various intensities healthy mild and severe Systemic Intramuscular Injection sites are located on both deltoids and quadriceps for placement and technique exercises 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 63 Appendix 64 User Guide NOELLE 5554 100 Factory Preset Labor Scenarios il a a e crete A Soue e iaaa E SS T d e n Da a a a oaa a D Saa NOELLE 554 100 User Guide 65 Noelle Labor Scenario Alice Normal Gaumard Simulators for Health Care Education Alice is a 24 year old female weighing 170 pounds Her OB history shows a gravida of 2 and a term of 1 She is currently 39 weeks pregnant and has one living child She has had prenatal care She has not been using medications of any kind Labor durat
103. y aN PET ae ne Te ae AFE Begin CPR Wait time 4 min Deliver baby perimortum c s Wait time 3 min 114 User Guide NOELLE 5554 100 Noelle 574 575 Labor Scenario Gaumard Madonna Simulators for Health Care Education Preterm Labor Madonna is a 41 yr old multip 31 weeks She has experienced difficult pregnancies and has one Downs Syndrome baby She has had several episodes of preterm contractions that resolved with LLP bed rest This time the bed rest and oral hydration are not resolving the contractions in fact they seem to be getting worse Labor duration 35 minutes Perform SSE to determine cervical status give Terbutaline SQ for tocolysis S amp S Patient is anxious and shaky she says her heart is racing Reassure patient about effects of beta mimetic drugs Give second dose of SQ Terbutaline for cessation of breakthrough ctx S amp S Patient is anxious and shaky Palpitations tachycardia and PVCs result from second dose of SQ Terbutaline Discontinue Terbutaline give 300ml IV bolus replace tocolytic drug with Procardia S amp S no adverse reaction to Procardia NOELLE 554 100 User Guide 115 Noelle S574 575 Labor Scenario Gaumard Maria Simulators for Health Care Educatio
104. y patient has tonic clonic seizure followed by tetanic contractions Fetal baseline drops to approximately 60 bpm SVD occurs very quickly Infant is cyanotic and limp and no respiratory effort is evident Baby is pronounced dead after 20 minutes of resuscitation Preeclampsia Erin is a 28 yr old 38 weeks ad Runs for approximately 60 minutes mitted by her physician for pree Upon induction of pitosin and rupture clampsia She is started on Mag of membranes instructor should tell nesium sulfate per protocol in participants to switch audio output on duced with pitocin and her mem fetal monitors to FSE tones branes are ruptured Light meco nium staining is noted following AROM Faye Cord Prolapse Faye is a 34 year old gravida 1 0 Runs for approximately 20 minutes 25 weeks gestation She had Prolapsed cord is protruding into the been involved with a married man vaginal opening Faye is put into deep and this unexpected and Trendelenburg position There is no unwanted pregnancy caused a palpable cord pulsation and FHTs are great deal of stress in her life not audible with Doppler Upon VE After much emotional upheaval fetus presents as double footling she decided to have the baby breech and is already partially into The affair ended and she is no birth canal Therefore baby has to be longer involved with the father of delivered vaginally Fetus is non the baby None of her family or _ viable friends are aware of
105. y of placenta Uterus remains atonic de spite Fundal massage and rapid pitosin infusion Patient s BP drops to 80 50 and uterus begins to clamp down following Cytotec rectal insertion Note Running full scenario requires retraction of motor mechanism and insertion of PPH kit following delivery To run PPH only load June PPH from the scenario tab Runs approximately for 35 40 minutes Shortly following SROM Kelly begins having mild variable decels that are associated with contractions Over the next few minutes variables become more severe Kelly vomits and begins gasping then suddenly becomes unresponsive Decels now have late characteristics She is given SQ Terbutaline and fetal baseline drops to 90 She is intubated and very difficult to ventilate Patient develops VFib and then arrests Baby is removed by emergency C Section Kelly remains on a ventilator Baby is limp and unresponsive and requires resuscitation and suffers repetitive Seizure activity Kimberly Amniotic Fluid Embolism Preterm Labor E Preterm Labor Kimberly is a 27 yr old multip 42 weeks She began having con tractions 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
106. yesterday and she began contracting during the night She is admitted in active labor Labor duration 40 minutes 86 User Guide NOELLE 5554 100 Noelle 574 575 Labor Scenario Gaumard Dana Simulators for Health Care Education Breech Presentation Dana is a 24 yr old multip 29 weeks who was admitted because she began contracting Upon V E physician discovers that she is 4 5cm with bulging membranes She was given Terbutaline subQ and then transported to the regional medical center Labor duration 45 minutes NOELLE 554 100 User Guide 87 Noelle 574 575 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 patie

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