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1. Bradycardia Respiratory Respiratory Rate Tachypnea Bradypnea 216 iStan CAE Healthcare Appendix A Parameter Descriptions Appendix A M se Parameter Descriptions The M se software has a number of parameters that control the physiological features of iStan The parameters are grouped by category Neurological Respiratory Cardiovascular Fluids and Sounds Each screen lists the Basic parameters by default However when the Basic Additional switch is activated additional parameters become available Click the Basic switch to see T Basic Additional Click the Additional switch to Additional parameters A return to the Basic parameters The Basic Additional Switch The following is a brief description of each parameter Each parameter description lists the default settings for the Stan D Ardman and Norma L Female patients as well as the ranges if available for all patients Neurological iStan can simulate a variety of neurological clinical indicators such as secretions and reactive eyes Neurological Parameters Appendix A Parameter Descriptions iStan A 2 Eyes Each eye has reactive pupils and eyelids that blink and close Eyes Pupil Diameter These parameters are used to control the diameter of the pupils in the eyes Each eye has reactive pupils and functional eyelids that blink Currently there are four pupil options that are used to control the dia
2. Information link M mmmEEEEE pn enone Uum Es Password Reset Th e Profi e Profile Preferences Information New Password Confirm Password pa n e The Account Profile Screen To change profile information enter the new information in the appropriate fields and click Update Profile when finished To reset a password enter the new password in the New Password field and re enter the new password in the Confirm Password field Click Change Password when finished IMPORTANT It you change your username or password you MUST use the new username and or password upon your next login You cannot access the system with the old username or password once it has been changed 125 Using M se iStan Favorite SCEs To access the Favorite SCEs panel click Favorite SCEs from the Account Profile screen All of the logged in user s favorite SCEs appear in the Favorite SCEs panel meti admin Email admin meti com Favorite SCEs ID admin Angina with Cardiac Arrest Food Poisoning Profile Information The Favorite SCEs link Medication Preferences Profile Preferences The Favorite SCEs panel The Add Favorites button The Account Profile Screen To add SCEs to the Favorite SCEs panel click Add Favorites The SCE Library appears Select the desired SCE and it automatically appears in the Favorite SCEs panel 126 CAE Healthcare Medication Preferences Using M se From the Medication Pref
3. 2 Locate the correct learning application file on the external storage device or the hard drive location where the SCE file is saved The file extension is mim 3 Select the file and click Select or Open 4 Refresh the screen by clicking the Home button in the M se software and then return to the Learning Modules panel The learning application appears on the Learning Modules panel and is available for use 107 Using M se iStan To delete a learning application from Muse 1 Select a learning application from the Learning Applications panel 2 Click the Remove button The Remove Learning Module warning appears Remove the Learning Module The associated SCEs and scenarios will be removed The Remove Learning Module Warning 3 Click Delete The learning application and all its SCEs are deleted NOTE Preconfigured learning applications cannot be deleted If a user attempts to delete them a failure message appears SCEs From the Content Management options click SCEs to access the SCEs panel The SCEs panel appears Learning Modules The SCEs link The Import SCEs button The SCEs Panel All user created SCEs are listed in the SCEs panel On the SCEs panel users can review copy delete import and export the SCEs they have created NOTE SCEs purchased from CAE Healthcare CANNOT be exported Click Import SCE to import an SCE from an external device or the hard drive location where the S
4. Do not allow excess fluids to flow on or into electronic parts CO Production System Care must always be taken when using high pressure equipment Do not disassemble or alter regulator Store CO canisters in dry location between 32 and 104 F 0 to 40 C Do not expose CO canister to heat above 140 F as rupture may occur Never point CO canister towards your face or someone nearby Use only CAE Healthcare specified CO canisters Wear protective gloves and eye protection when removing canister from regulator assembly Bleeding and Secretion System DO NOT modify the tank or any assembly component ALWAYS protect eyes skin and clothing against accidental exposure NEVER exceed 35 strokes while pressurizing the tank ALWAYS read and follow instructions for creating trauma fluids e g blood NEVER fill the tank with more than 6 liters 1 6 gallons of fluid After use ALWAYS release pressure and clean the tank DO NOT store liquids in the tank ALWAYS release tank pressure before servicing NEVER transport or ship in a pressurized and or full state or leave a pressurized tank unattended xi Cautions Warnings iStan Mannequin Do not disassemble factory assembled parts of the mannequin Do not clean the mannequin with chemical solvents Use water and a light soap solution only e Make sure that mannequin is set up on a stable sturdy work surface to avoid collapsing and causing injury to users iStan
5. 12 Place spring into housing 13 Screw the two halves together hand tight and then use the two wrenches to tighten the connection 14 Pump ten times to verify that the filter assembly has no leaks 15 Place the Overflow Bottle lid with umbilical attached into the wastewater bucket 16 Attach the blue and yellow connectors together at the other end of the umbilical This will flush the umbilical and wash any debris out Troubleshooting the Trauma Fill Tank Before making any repairs ALWAYS depressurize the tank remove all trauma solution and clean the tank Problem Solution Remove hose from tank and reinsert siphon tube 1 Thoroughly clean pump cylinder gasket or o ring and surrounding area and apply a light coating of silicone to pump gasket or o ring 2 Contact CAE Healthcare for service 3 Turn valve until it returns toa sealed position 1 Pump 25 to 35 times for best performance 2 Clean filter 3 Reconnect the overflow fitting 4 The Trauma Fill Tank works best with 1 gallon 3 6 liters of fluid inside If greater amounts of fluid are used tank may require additional pumps as fluid is transported to simulator 210 p CAE Healthcare iStan Care and Maintenance Handling CO Canisters Careful handling is required in the use of CO canisters Please read and follow all appropriate cautions and warnings For information on CO canister insertion see page 25
6. Lung Compliance Factor Left and Right These two parameters independently set the left and right lung compliance Lung compliance factor determines how easily the lungs inflate Low compliance factors less than 1 create stiff lungs requiring more pressure for expansion High compliance factors greater than 1 create loose lungs that easily inflate with less pressure Default 1 Range 0 15 10 00 Appendix A Parameter Descriptions iStan Venous CO Shift The Venous CO Shift parameter affects the partial pressure of CO in the venous blood Changing this parameter allows large and rapid shifts in total body CO concentration Increases in alveolar and arterial CO follow rapidly in a physiologically correct magnitude and time course This parameter is useful for giving a bolus of CO to the venous system The alveolar and arterial CO levels rise rapidly in response to the added carbon dioxide but soon returns to pre bolus levels as increased ventilation efforts work to eliminate the added CO Therefore the rise in CO levels is only transitory Default 0 mmHg Range 0 0 mmHg 60 0 mmHg Bronchial Resistance Factor Left and Right When using the Bronchial Occlusion parameter the rate of resistance can be set using the Left or Right Bronchial Resistance Factor parameters The rate of resistance can also be set to occur over time Default 1 cmH O Range 0 3 cmH O 1000 0 cmH O Alveolar Enflurane
7. Muse opens to the Home page by default 33 Using M se iStan Navigating the Home Page From the Home page users can run create edit search for and print SCEs The Home page can be accessed by clicking the Home button in the upper right corner of the Muse software or on any screen without a Home button by clicking the Return button in the upper left or right corner of the screen Anaphylaxis Holly Monroe Angina with Cardiac Arrest Bruce Stevens Anterior Myocardial Infarction ur responds to a report of Steve Johnson T a noticed COPD Exacerbation with Respiratory Fail tial assessment in State 1 Beginning Anaphylaxis RR in the 20s an Piu Cont COPD Patient rende Senokey e SCE to State 2 Mild Anaphylaxis if epi Epinephrine Administered In State 2 Mild Anaphylaxis the patient experiences increased respiratory ctrees The patient s HR is inthe 1108 The Home Page NOTE To activate a fullscreen view in Internet Explorer press F11 to toggle Internet Explorer s fullscreen mode 34 CAE Healthcare Using M se The SCE Selection Panel SCEs are process tools that enable the facilitator to execute a learning strategy using simulation Preconfigured CAE Healthcare SCEs provide an extensive overview and outline of the learning exercise and require minimal additional faculty development time for use Each SCE is comprised of a patient and up to four scenarios Availa
8. OR b Choose a route of administration to administer a custom dose The custom Jj dose options Morphine Intramuscular IM Intraosseous 10 Lmg iv 2 5 mg Iv 5 mg Iv 10 mg IV 15 mg IV 20 mg IV 1 mgio 2 5 mg 10 5 mg 10 10 mg IO 15 mg Io 20 mg IO 5 mg IM 10 mg IM The Medication Dose Menu 57 Using M se iStan The Custom Dose Administration menu appears The Administer button The Custom Dose Administration Menu 5 Enter the desired dose and click the Administer button The dose is applied and appears in the patient s physiology NOTE Not all medications affect the patient s physiology but all are logged 58 J CAE Healthcare Using Mise Using the Interventions Palette There are two ways to perform and or administer interventions using the Interventions palette using a Quick Link or using the complete Interventions menu Quick Links are preconfigured interventions that are made accessible in the Interventions palette for quick application Quick Links can also be created for the Conditions and Medications palettes To apply an intervention using the Quick Links in the Intervention palette click an Intervention Quick Link NOTE Not all interventions affect the patient s physiology but all are logged The Interventions Interventions button Bag Valve Mask Crystalloids intubated Quick Links Nasal Cannula Non Rebreather Mask The Interventi
9. Place a chest catheter in each side until no distilled water runs out If fluids were used for head secretions on the Neurological view of a preconfigured SCE click the Secretion Ears Mouth and Nose parameter and select Prime Continue until no distilled water runs out If Hemorrhage bleeding was used from the Fluids view of a preconfigured SCE turn both bleeding channels ON then connect the wound umbilical to each location until no distilled water runs out When all the water has emptied stop the SCE NOTE Once a month it is advised to flush the system with a 50 50 mix of distilled water and white vinegar to keep mineral and algae build up to a minimum Always flush with distilled water to remove any trace amounts of vinegar 205 iStan Care and Maintenance iStan Flushing the IV System 1 To purge fluid from the IV system 2 Connect an external empty 1 0 L IV bag to the Drain port on the simulator s right hip Connect a 60 mL syringe to IV Prime port and withdraw all fluid Slowly push 30mL of air into the Left Antecubital port Replace the cap Slowly push 30 mL of air into the Right Antecubital port Replace the cap oO Uu AB W Slowly push 60 mL of air into the IV Prime port and repeat 120 mL total Replace the cap N Slowly push 30 mL of air into Jugular IV port Replace the cap 8 Slowly push 30 mL of air into Femoral IV port Replace the cap 9 Using a 60 mL syringe withdraw
10. The Alveolar Enflurane parameter is used to simulate the presence of enflurane in the alveolar space without using real anesthetic vapors The enflurane percentage is input to the drug models to achieve the expected pharmacodynamic effects e 9 respiratory depression Default 0 Range 0 00 5 00 Alveolar Halothane The Alveolar Halothane parameter is used to simulate the presence of halothane in the alveolar space without using real anesthetic vapors The halothane percentage is input to the drug models to achieve the expected pharmacodynamic effects e g respiratory depression Default 0 Range 0 00 5 00 CAE Healthcare Appendix A Parameter Descriptions Alveolar Isoflurane The Alveolar Isoflurane parameter is used to simulate the presence of isoflurane in the alveolar space without using real anesthetic vapors The isoflurane percentage is input to the drug models to achieve the expected pharmacodynamic effects e g respiratory depression Default 096 Range 0 0096 5 0096 Alveolar Sevoflurane The Alveolar Sevoflurane parameter is used to simulate the presence of sevoflurane in the alveolar space without using real anesthetic vapors The sevoflurane percentage is input to the drug models to achieve the expected pharmacodynamic effects e g respiratory depression Default 096 Range 0 0096 8 0096 A 21 Appendix A Parameter Descriptions iStan Cardiovascular Basic Parameters Car
11. Using TouchPro Moving a Waveform or Numeric Display Waveforms and numerics can be moved on the screen to suit the user s needs To move a waveform or numeric click the desired waveform or numeric and drag and drop the display to a desired location A dragged waveform The TouchPro Display 137 Using TouchPro iStan Saving a Layout Once a layout has been configured it can be saved and reused To save a layout 1 Ensure the desired waveforms and numerics are in place 2 Click Settings The Settings menu appears 3 Click Save As The Save Layout window appears 4 Inthe Save Layout window in the Layout Name field enter a name for the layout Layout Name New Layout The Layout Name field The Save Layout Window 5 Click Save 6 Click the Close button to exit the Settings menu Saved layouts can be deleted from the Settings menu by dragging and dropping them in the Trash NOTE When a layout is saved it is available for use only with the current SCE To enable the layout for use with any other SCE enable the layout from the TouchPro Setup panel for the desired SCE 138 Using TouchPro Sounds All sounds can be silenced by clicking the Mute button in the bottom left corner of the TouchPro display The Mute Button To set up the audio for the TouchPro from the Settings menu click Audio Setup Audio Setup Pleth SpO2 The Audio Setup Menu From the Audi
12. Chest Compression Efficacy iStan Manual Control ECG monitor may be utilized None required See Pacing below for cardiac pacing disk locations and instructions None required None required CAE Healthcare Circulation Defibrillation Invasive Hemodynamic Monitoring Jugular Vein Distension Manual Blood Pressure Myocardial Ischemia Palpable Pulses Cardiovascular Features Normal and abnormal circulation e g hypovolemia hypervolemia and right left heart failure can be adjusted iStan supports operation with a variety of manual and automatic external defibrillators Various hemodynamic physiological indicators are registered and can be monitored The jugular veins can be distended for assessment Systemic blood pressure can be measured using the return to flow technique Korotkoff sounds can also be auscultated Myocardial oxygen supply and demand automatically influence the cardiac rhythm yielding response to hypoxemia Carotid brachial radial femoral popliteal posterior tibial and dorsalis pedis pulses can be palpated bilaterally and are synchronous with the cardiac cycle A pulse deficit automatically occurs if the systolic arterial blood pressure falls below specified thresholds None required but adjustable VIEW Cardiovascular PARAMETER S Systemic Vascular Resistance Factor Defibrillation can be simulated by the instructor VIEW
13. Closed Blink Speed Controls Choosing the Auto setting which is also the default setting sets the eyes in a blinking mode but allows the simulator to react to physiological changes that cause the eyes to close such as unresponsiveness or a comatose condition 152 CAE Healthcare Using iStan Though set in the Closed position the eyelids can still be manually opened for clinical inspection Additionally eyelids can be programmed scenarios to open and close spontaneously or can be fixed in the closed position Blinking frequency can be set at one of three speeds Normal the default Slow and Fast To adjust the blinking frequency click the desired option on the Neurological view 153 Using iStan iStan 154 Respiratory Features iStan s anatomically realistic upper airway provides for the opportunity to intubate as well as apply other airway interventions the patient while various clinical signs i e breath sounds chest excursion airway patency can be physically demonstrated A series of speakers inside the simulator can generate a range of breath and throat sounds used in patient assessment Respiratory Features Anatomy Physiology Clinical Interventions Patient Software Control Manual and Clinical Signs Monitoring and Scenarios Control Airway Management Alveolar and arterial gas Oxygen None required and Ventilation concentrations appropriately reflect administration input the effic
14. DIP switch position 6 on the handset determines if the iPhone microphone input or the standalone microphone input is enabled When DIP switch position 6 is set to the OFF position the standalone microphone jack is enabled for the standalone microphone provided by CAE Healthcare Figure 10 Handset and CAE Healthcare provided Microphone To use a microphone compatible with an iPhone three pole jack set DIP switch position 6 to ON Please note that an iPhone compatible microphone is not provided as part of the product package Any microphone with a common 3 5 mm input jack can be used with the handset when DIP switch position 6 is set to ON CAE Healthcare Appendix B Wireless Voice Link Special Handset Settings Advanced settings for the handset DIP switch are available iPhone microphone enable Base station volume control enable Noise reduction enable default Noise reduction disable Microphone gain control enable default Standalone microphone enable default Figure 11 Advanced DIP Switch Settings DIP switch settings are only refreshed when the handset is powered on To ensure the DIP switch changes take effect turn the power off and back on after making changes To enable noise reduction and minimize background noise in high ambient noise environments place the position 8 DIP switch in the ON position Battery Capacity Indicator The red power light flashes one time every second when the bat
15. 1 Click the Conditions button The Conditions menu appears Conditions are organized by system or all available conditions are listed under ALL CONDITIONS Close ALL CONDITIONS Cardiovascular Hemorrhage Neurologic Respiratory The Conditions Menu 2 Navigate the menus to find the desired condition Once the desired condition has been located click the condition s name from the list The condition is applied and affects the patient s physiology CAE Healthcare Using M se Using the Medications Palette There are two ways to administer medications using the Medications palette using a Quick Link or using the Medications menu Quick Links are preconfigured medications that are made accessible in the Medications palette for quick application Quick Links can also be created for the Conditions and Interventions palettes To set parameters using the Quick Links in the Medications palette click a Quick Link The medication is applied and appears in the patient s physiology NOTE Not all medications affect the patient s physiology but all are logged The c5 Medications Medications Acetaminophen button Albuterol Amiodarone A he dios Quick Links Atrovent Epinephrine 1 1 000 Epinephrine 1 10 000 Furosemide The Medications Palette NOTE Quick Links can only be added while creating or editing an SCE Or to apply a medication that is not set up as a Quick Link in the Medications palett
16. Cardiovascular Additional Parameters Cardiovascular Parameters Additional Perfusion Intensity The Perfusion Intensity parameter adjusts the brightness of the LEDs used to simulate both cyanosis and capillary refill The intensity may be adjusted for different ambient light conditions e g from completely dark indoor environments to bright outdoor settings As the intensity is adjusted toward 10096 the LEDs become increasingly profound in their intensity Default 4596 Range 096 10096 A 29 Appendix A Parameter Descriptions iStan Capillary Refill Big Toe Left and Right The Capillary Refill Big Toe parameter is used to simulate the capillary nail refill test done by blanching the nail bed When activated the nail bed refills based on the selection of less than or greater than three seconds The intensity of the capillary refill may be set with the Perfusion Intensity parameter At this time capillary refill is not linked with the physiological models Default Off Options Less than 3 seconds Greater than 3 seconds Off NOTE This parameter may not be used at the same time as the Cyanosis parameters Capillary Refill Thumb Left and Right The Capillary Refill Thumb parameter is used to simulate the capillary nail refill test done by blanching the nail bed When activated the nail bed refills based on the selection of less than or greater than three seconds The intensity of the capillary refill m
17. Deleting Scenario States To delete a state drag and drop the state into the Trash A dragged state The Trash The Scenario Designer States can be dragged and dropped to the Trash from the Graphical view or the Line Item view Deleted states remain in the Trash until you log out of the software or the Trash is cleared 97 Using M se iStan Deleting Parameters and Transitions To delete a parameter or transition from an active state drag and drop the desired parameter or transition into the Trash To drag a parameter click anywhere within the parameter To drag a transition click the yellow selection bar to the left of the transition Gee BE eA The yellow 2 selection bar a A dragged transition The fac Parameters and transitions can be dragged and dropped to the Trash from the Graphical view or the Line Item view The Scenario Designer Deleted parameters and transitions remain in the Trash until you log out of the software or the Trash is emptied 98 CAE Healthcare Using M se Saving the Scenario At any time during scenario creation or modification the scenario can be saved To save a scenario 1 Click the Scenario button in the upper left of the Scenario Designer The Scenario drop down menu appears LES 5ave Save As A Chi UD Rename The Scenario Drop Down Menu 2 To save the most recent version of a modified scenario click Save OR To save a modi
18. Emptyingth TEE ico PRODR DARE IER XU RERO EUR ETHOPAR RO OS OO RR 102 Administrative mtt 104 PAUSE p 104 System AGMIMISH ANON os arose QOO DDR AU Da ERG RIR DA On EG RDNQUDB o RONDIRGU 105 Accont TOT OPE NR NEM RR 124 I ng m 129 Accessing the TouchPro Somtware sivssssscssssssccsicssncesssstnesnsessdssnesnseostasnnensenstsensessenatacinionsnataceviens 129 Modifying the TouchPro Display P 131 Selecting a Preconfigured LayOut s ccsssssssssssccrssssssssssceransrssssseccranssecsssscesavosecsssscssasorecanecersassrenssecs 131 Changing a Waveform or Numeric Display ss ssssssssssssssssssssrssessseeessssseerssssssreessseeeenssssnreressseeesssseeeee 133 Adding d WAVE TIAN sien sine Reb vrl osnsats esterases tonaapnenbsnusaes pecnhdaseastisasaien 134 xvi CAE Healthcare Table of Contents Adding Numeric DISD AY scxcasSncssicson snipe deacidasnuit ected pati Reihen rd hue 136 Moving a Waveform or Numeric Display seen ttennntnnnnttennnttnnnnttnnnnncs 137 Saving a UA UM mI ENCEINTE a iaei 138 SUL 139 12 Lead 140 NIBP Cycling and Manual NIBP osssosossssesosocosossssosososossseseososososessssososososessosososososessosososss 142 A E E E E
19. Licensee consents to an injunction being issued against it restraining it from any further breach of such provision without derogation from any other remedy which CAE Healthcare may have in the event of such a breach 7 WARRANTY LIMITATION OF LIABILITY Z1 THE SOLE WARRANTIES PROVIDED BY CAE HEALTHCARE ARE LIMITED TO THE WARRANTIES PROVIDED IN THE HEPGTC ANY WARRANTIES PROVIDED ARE PERSONAL AND NOT TRANSFERABLE 7 2 CAE HEALTHCARE S LIABILITY SHALL IN NO CIRCUMSTANCES EXCEED THE LIMITATION OF LIABILITY INDICATED IN THE HEPGTC LIABILITY IF ANY SHALL BE SOLELY FOR DIRECT DAMAGES NOT TO EXCEED ON A CUMULATIVE BASIS THE AMOUNT PAID BY LICENSEE FOR THE PRODUCT End User License Agreement iStan 8 GOVERNING LAW 8 1 This Agreement shall be governed by subject to and interpreted according to the laws of the State of Florida U S A without regard to its conflict of law rules In all cases the Parties expressly exclude and waive the application of the United Nations Convention on Commercial Agreements for the International Sale of Goods 1980 Vienna Sales Convention as amended 8 2 The exclusive forum for the resolution of any and all disputes arising out of or in connection with this Agreement shall be a court of appropriate jurisdiction located in the State of Florida U S A Each Party hereby waives any right that it might otherwise have to object to such venue or seek dismissal of the action on the basis of forum non conveniens E
20. Pricing Structure T 194 Time atit Materials cease rco tide aoe toned a e e QNA NU 194 Lip i eee M 195 Step 1 Shut Down the SOLEO assi qusegicna m Muni nadar RENDER RUM ERU EH Hr eH 195 Step Power Off the Simulator i c iD errata TERI LR UY EHE R rie tL 195 Step 3 Clean the Simulator and the Fluid Systelin uucescseer reote retten 195 Maintenance Advice susci silvia YE PAY NEDRSENON EM ER NIB UMS IS ARUM S MAU VEN RUNI ERIS ERN ANNE 196 ESSET SIUE Ttt TO 196 BRU GG M AERE 196 Cae or Electronic EQUIDIRORI as ooa ra a agro PRU SEU DS up Mee Ud Feb teda itu 196 FAUNA AN LES S19 TT DN ERN 197 Rechargingithe SE Ls NN 197 Replacing th DOUGH oio teda url been RA o RR on RO DP Qu 198 Red cing Cervical DT UT NR E TET 199 Draining Condensation from the SimUlator cscsssssssssssssscssssssssssssescssecssnssesseccsnscsssecsnscsssseessecss 200 Connecting the ME MOSG icio abo brad ast diste bon esca de Rub DRM PRA da d 201 Cleaning the Simulator and the Fluid System 4 eere rene eere reete ener ntnen 202 Cleaning and Flushing After Use of Hemorrhage eene 202 Cleaning and Flushing After Blood Secretions eene nnn 203 Draining the On Board Clear Fluid System ss aseo PRORA QURE rdc Ro RR A 204 Flushing the Fluid System fot Storage scscixsssnc
21. Removing CO Canisters from the Regulator The following instructions will show you how to safely remove the CO canister from the regulator assembly for replacement or shipping CAUTION If unsure that CO canister is empty eye and hand protection must be worn to protect from release of freezing gas or liquid 1 Remove the CO regulator assembly from the simulator 2 While holding the regulator assembly firmly slowly unscrew the CO canister from the regulator There is a small relief hole in the side of the regulator from which any remaining CO will bleed If this should happen no harm will be done to system but it is rather noisy and the rapid release of CO gas can freeze the canister s surface and frostbite unprotected skin 3 Continue unscrewing the canister until it is free from the assembly 211 iStan Care and Maintenance iStan Important Canister Information The 16 Gram CO Canister with threaded neck is available at most Sports Equipment Retailers most often used for bicycle tire inflators We recommend purchasing Leland brand canisters P N 82122Z which are also available from CAE Healthcare Punctured canisters are considered to be empty No residue remains in the canister after use The steel used is a low carbon type which will turn to rust quickly if disposed in a landfill If your community requires recycling then place with normal household recycling CO Canisters are considered by the U S Depar
22. SCE Configuration 7 Preloaded Scenarios The SCE Editor The buttons in the upper right corner of the SCE Editor provide options for running the SCE generating a printable PDF of the SCE or returning to the Home page The Content Management SCE Configuration and Preloaded Scenario links in the left panel are used to review the SCE content and configuration and to view scenarios applied to the SCE 75 Using M se iStan Editing a Patient s Profile To edit the Patient Profile 1 From the SCE Editor in the Profile section click Edit Gunshot Wound The Edit button The SCE Editor Screen The Profile Editor appears Stan D Ardman II The Change Picture button The Save button The Profile Editor 2 Set the Patient s name age gender and weight by filling in the appropriate fields 3 Click the Change Picture button to change the patient s picture optional 4 Click Save IMPORTANT No part of the patient s profile can contain any special characters such as lt gt 76 J CAE Healthcare Using Mise Setting a Patient s Baseline To set the Patient s Baseline 1 From the SCE Editor click Baseline Gunshot Wound The Baseline button The SCE Editor Screen The Patient Baseline screen appears Patient Baseline The Complete button The Patient Baseline Screen 2 Set the Patient s baseline physiology by modifying the desired paramete
23. at any time during Licensee s normal business hours and upon reasonable prior notice the right to access to Licensee s premises to ensure that the use of the Product is done at all times in compliance with the terms and conditions of this License 2 6 CAE Healthcare reserves the right to embed a software security mechanism within the Product to monitor usage of the Product to verify Licensee s compliance with this Agreement as well as to control access to the Software through use of a a hardware lock device and or b a license administration software and or c a license authorization key collectively the Key 2 7 Some Products may provide Licensee with the option of saving and reproducing the images created by such Products Work during their use In this regard Licensee hereby recognizes that the entire rights title and interests in and to such Work remain the exclusive property of CAE Healthcare Licensee shall not modify such Work in any way whatsoever and shall not remove or alter any CAE Healthcare notices However Licensee is permitted to produce and reproduce such Work only for non commercial educational purposes 3 FEEDBACK Licensee agrees to provide CAE Healthcare from time to time with comments suggestions data information or feedback Feedback on the Product Licensee acknowledges and agrees that such Feedback may be freely used by CAE Healthcare at its sole discretion for the design development improvem
24. both the handset and base station should be set to the same frequency using the DIP switches located in the devices If the interference is too high the WVL firmware has the ability to change channels automatically to avoid interruption This process occurs simultaneously in both the handset and the base station without the need for user intervention The units revert back to the original frequency set on the DIP switches when both devices are restarted using the power switch Recommendations for Use To receive the best sound quality from the WVL please note the following recommendations Do not separate the WVL pair with more than two walls Use channels 0 through 11 for the best sound quality Use channels 12 through 31 if more than 12 simulators are present in one area B 2 p CAE Healthcare Appendix B Wireless Voice Link Wireless Voice Link Devices There are two unique devices that make up a WVL pair the handset device and the base station device The base station device is located inside the simulator while the handset device is battery powered and carried by the user The handset transmits voice input through a microphone to the base station receiver where it is transmitted to the speakers in the simulator s head The two different devices can be identified by their cases The handset device has a cover that extends over the length of the antenna Figure 1 The WVL Handset The base station device antenna is almost f
25. minimum e Adobe Flash Player 10 1 x x minimum Adobe Reader 9 x or higher Hardware Windows and Macintosh Intel Core Duo 2 0 GHz minimum e 2 GB DDR3 RAM minimum 8 GB Hard Drive space available e 1024x768 screen resolution minimum e USB 2 0 e Wireless 802 11b g n Ethernet card e 100BASE T Ethernet Adapter Macintosh Quicktime and Safari are registered trademarks of Apple Inc Windows Media and Internet Explorer are registered trademarks of the Microsoft Corporation in the United States and or other countries Firefox is a registered trademark of the Mozilla Foundation Adobe Flash Player is a trademark of Adobe Systems Inc 24 CAE Healthcare iStan Setup Optional Insert the CO Canister Some SCEs rely on the simulation of exhalation of CO The following instructions will show you how to safely install the CO canister in the simulator WARNING Careful handling including the use of hand and eye protection is required in the use of CO canisters Please read and understand all the important cautions and warnings on removing canisters as well as safety steps that must be used when handling CO canisters Use of CO Canisters Store the CO canisters in a dry location between 32 and 104 F 0 to 40 C Do not expose the CO canister to heat above 140 F as rupture may occur Never point the CO canister towards your face or someone nearby Use only CAE Healthcare specified CO caniste
26. sje New state p Collapse All cv Expand Alt Acute Ventricular Failure Both Acute Ventricular Failure Left Acute Ventricular Failure Right BP Hypertension BP Hypotension Cardiac Tamponade Chronic Hypertension Create l i ir Depam ranan or i meg k pamine Greater than or Equal meg kg Heart Rate Bradycardia COTO Hypotension Improves r D Meant Rate Tachycardia I Ir Time In State Greater than or Equal 360 vec k Idiopathic Hypotension GOTO Hypotension Worsens Patient Stability SS neve ve lar Failure Both Ventricular Failure Left Ventricular Failure Right S I E oue v om About User Guice Support A meti admin The Scenario Designer To add parameters to a state click the Parameters button within the state The Parameters button A State 92 J CAE Healthcare Using Mise The State Parameters screen appears T s The State E Parameters panel The Complete button The State Parameters Screen Click the various organs to change the views and then select the desired parameter Once a parameter has been selected it appears in the State Parameters panel on the right side of the screen Add as many parameters as needed Added parameters appear consecutively within the state Drag and drop to reorder as needed Click Complete to save and exit the State Parameters screen or click Back to exit without saving NOTE If the physiology o
27. 144 Configuring the TouchPro Software sssssssossssssosososossseseosososossssososososossssososososesessososososese 145 Changing the TouchPro Language sssesssosossssssosososossssssososososessososososossesososososssessososososese 146 Exiting the TouchPro SoftWale iin irish cipere FbR br Env 1E EN ERE ERI EE EH ERE ko M REDE PEE ERE 146 Using Stal 147 Lilp l lt fee 148 N urol gical Faatules send aipas amba fei wan pri iade in RE er APREU DEVE AY THEE RAD UR 151 n PEN RI ENERO NER ERR CE E 152 Respiratory Features inicie nir oraio envoi roS V Ed ROREM ERERE ES sdsvensenassivasosaceiesitasnvansesetions 154 Realistic Upper AWA ache OUR REOR PERDER CR RUNG RERO PI RUN AAT a 158 Cd nn TT 159 My M cen Sd rohan 159 Cricothyr tOM ida anre eR LEER ci Rit ot AG AME ge RAS LO XAR ARR rt EE 159 Tech atr Breakaway ISOS RO REGENDI NOREORREIRU AER AN ANO NL UD A 160 fig c A 164 ist SIS RP TIS URN ss nosttonsasvilonscsinvsaniwrsniancdvondassNoinasiuvausbonsanetoaitasansbatiwainast 163 xvii Table of Contents iStan MC APEUIO VAS CUNAN eem 164 LUST 166 bor Er prot 168 Manual Blood PEGS UT NR T 169 Korgtkofr Sounds 3 DRASES i oueaciamieitusk cn bin ERREUR padres atn pu FLOR Ecrire 170
28. 2 Locate the IO ports to be used To expose a Tibial IO insert carefully roll up the ankle skin on the desired side Pull the Tibial IO insert from the IO port until the priming tube can be accessed To expose the Sternum IO insert carefully pull back the chest skin The priming tube The IO Insert 3 Insert a 60 mL syringe into the priming tube of each IO port to be used 4 Pull the plunger until fluid begins to flow into the syringe 5 Replace the insert and return the skin to its normal position Fluids can now be aspirated from a correctly applied intraosseous infusion For information regarding cleanup after using the IV IO feature see pages 206 and 207 181 182 Using iStan iStan Sounds A variety of simulated sounds are available to enhance realism A patient must be running on iStan for any sounds to be available Speech Using speech in simulations can be achieved using the Vocal Sounds and Speech Sounds features on the software or by using an external microphone Vocal Sounds A variety of programmable vocal sounds are available Vocal sounds are male or female based on the gender of the active patient Vocal Sounds CAE Healthcare Using iStan To select a sound from the Vocal Sounds drop down menu click the Sounds button on the Run screen The Sounds panel appears Click Vocal Sounds and select the type of sound desired from the Vocal Sounds drop down menu Bowel Sounds Rr
29. 8 mmHg Range 0 0 mmHg 65 0 mmHg Neuromuscular Blockade NMB The pharmacokinetic and pharmacodynamic models based on the neuromuscular blocking agents administered and the time course of their injection automatically determines the degree of NMB For some educational applications however the instructor may wish to set a fixed degree of neuromuscular blockade that remains stable for an indefinite period This can be accomplished using the NMB parameter The default setting instructs the pharmacologic models to determine the degree of neuromuscular blockade based upon the drugs injected and their pharmacologic properties When a positive numeric value is assigned to this parameter the degree of NMB is set to that level For example 80 NMB causes the simulator to set the degree of NMB to 80 regardless of the presence or absence of neuromuscular blocking drugs Clinically the spontaneous tidal volume is markedly reduced Default Modeled Range 0 100 CAE Healthcare Appendix A Parameter Descriptions Temperature Body The temperature measured at the body surface can be set using this parameter and can be displayed on the Patient Status Display and TouchPro software The body temperature is not linked to the physiologic models However changes can be made on the fly or scripted using the Scenario Designer Default 36 5 C Range 32 0 C 42 0 C Temperature Blood The arterial blood temperature can be set
30. BP Diastolic 95 mmHg Temperature Body 38 0 C Respiratory Rate 23 breaths min Th e Transitions GOTO IF Dopamine Greater than or Equal 5 mcg kg arrow GOTO dl Hypotension Begins oeuse Hypotensonimprves The Available Hypotension Worsens States menu None The Scenario Designer 95 Using M se iStan The Available States menu appears listing all the available states 5 Select a state from the menu An orange connector line appears indicating that the states are now linked by a transition The orange ES connector d line The Scenario Designer ELSE Transitions An ELSE transition is used to transition to a state automatically when none of the other programmed transitions occur Before specifying an ELSE transition from a state the state must first contain at least one other transition To add an ELSE transition click ELSE in the original state The ELSE menu appears listing all the available states The ELSE button Q Rapid Trauma Assessment Pulsel Electrical Activity Edi esie The ELSE menu Unresponsive EXE eet The Scenario Designer 96 CAE Healthcare Using M se Select the desired state A black connector line appears indicating that the states are now linked by an ELSE transition Black connector line Time In Scenario Greater Than 30 secs Time In Scenario Greater Than 30 secs The Scenario Designer
31. Content Management privileges listed below Users with the System Management privilege can also view system settings back up and restore data and apply software updates User Management Users with the User Management privilege can manage all users and groups Content Management Users with the Content Management privilege can create and manage all SCEs Creating a New Group To create a new Group 1 From the Groups panel click New The Group Name field appears 2 Enter the name of the Group in the Group Name field 3 Click Create Group The group appears in the Groups panel Privileges can now be selected 4 Select the privilege s to be assigned to the Group 5 Click Save 118 WJ CAE Healthcare Using Mise Deleting a Group Groups can be deleted when they are no longer needed Once a Group is deleted all users who were affiliated with the Group are moved to the Deactivated Users Group To permanently delete a Group select the group to be deleted from the Groups panel and click Delete When the Group Deletion warning box appears click Yes Providing Access to Content Only To provide users with the ability to create and manage SCEs but not the ability to manage users or groups 1 Create a new group called Content Only 2 Assign the group the Content Management privilege Do NOT assign any other privileges to the group 3 On the User Accounts tab create or edit the desired users placing each user in the Con
32. Healthcare grants to Licensee and Licensee accepts a personal non exclusive non transferable license to use the Software and Data exclusively with the Product and with the computer on which this License appears 22 Except for the License granted herein CAE Healthcare grants no express or implied right under any patent copyright mask work right trademark know how or other intellectual property rights Without limiting the foregoing the Licensee shall not obtain any rights to CAE Healthcare s property or any part thereof by implication estoppel or otherwise Title to and full ownership of any trade secrets and other intellectual property rights related to the Product and components thereof shall remain with CAE Healthcare and if applicable its suppliers For clarification Licensee agrees that the source code for the Software is a trade secret of CAE Healthcare and only CAE Healthcare shall have the right to alter maintain enhance or otherwise modify the Software End User License Agreement iStan 2 3 Without limiting the foregoing or any other terms in this License Licensee shall and shall ensure that any person authorized to access the Product which are limited to Licensee s employees agents representatives medical staff and students Authorized Users a not copy save and except for normal back up and disaster recovery purposes provided such copy shall include CAE Healthcare s copyright and any other proprietary notic
33. M se Stopping the SCE Running SCEs can be stopped from the Run screen or the Home page To stop an SCE from the Run screen 1 Click Stop in the upper right corner of the screen The Stop Button The Stop the Simulation dialog box appears Stop the Simulation Do you want to stop the simulation The Stop The Simulation Dialog Box 2 Click Stop Simulation The SCE stops running and the Miise Home page is shown To stop an SCE from the Home page 1 Click the Stop button in the bottom left corner of the SCE Summary Panel The Stop Button The Stop the Simulation dialog box appears Stop the Simulation Do you want to stop the simulation The Stop The Simulation Dialog Box 2 Click Stop Simulation The SCE stops running IMPORTANT Always stop all running SCEs before logging out of Muse 72 iStan The Stop Simulation button The Stop Simulation button CAE Healthcare Using M se Developing SCEs Creating and editing SCEs are similar processes Once an SCE is created the steps for modifying the SCE are the same as those for editing a previously created SCE The processes of creating and editing SCEs each begin with a unique button on the Home screen Use the New SCE button to create a new SCE The New SCE Button The minimal requirements for creating a new SCE include selecting a Patient naming the SCE and saving the SCE Once the new SCE is created you can continue with the SCE dev
34. Recommended Clinical Supply Sizes on page 213 If color is desired place the desired amount of yellow food coloring in the Foley bag Urinary Catheritization The bladder for the simulated urine is accessed directly via the urethra From the Fluids view set the Urine Output to the maximum level 500 mL hr in the software until fluid flows through the catheter Urinary Output Urinary output can be controlled by adjusting the Urine Output parameter on the Fluids view Urine Output A Selecting Urine Output Changing the Simulator s Genitalia iStan comes with male and female genitalia To switch genitalia 1 Remove iStan s skin shorts 2 Pull apart the hook and loop fastener Velcro holding the genitalia w Loosen and remove the urethra connector This connection may be tight when genitalia are removed the first time Remove the genitalia Attach urethra tube to the urethra connector Attach the desired genitalia using the hook and loop fastener Velcro Soy Uv d Replace iStan s skin shorts 178 JW CAE Healthcare Using iStan Pharmacology System iStan supports pharmacological interventions through pre programmed pharmacokinetic and pharmacodynamic parameters that are established for more than 50 intravenous drugs Standard syringes and infusion devices can be utilized to administer medications and fluids through ports on the left and right arms Additionally medications and fluids c
35. Student ID admin meti Email Last Name admin admin meti com Password Confirm Password The user list Group Administrators Privileges System Management User Management The user fields Content Management The Edit button Th e Delete The New button button The User Accounts Panel NOTE User Accounts functions are available only to users with the User Management or System Management privilege 115 Using M se iStan Creating a User To create a new user 1 From the User Accounts panel click New The New Account Creation panel appears 2 In the New Account Creation panel enter the user s personal data and choose a password 3 Assign the user to a group by selecting a group from the Group menu NOTE A user can only be assigned to one group 4 Click Create The new user is created and the New Account Creation panel disappears Editing a User To edit a user s information or privileges 1 On the User Accounts panel select the user to edit 2 Click Edit The user fields become editable 3 Make the desired changes 4 Click Save Deleting a User To permanently delete a user from the User Accounts panel select a user and click Delete When the User Deletion Warning box appears click Yes The user account and the data associated with it are deleted However the administrative user deleting the account becomes the o
36. The following clinical supply sizes are recommended for use with the simulator Other sizes may cause damage and should not be used Clinical Supply Recommended Size Insertion only 213 Recommended Clinical Supply Sizes iStan 214 Zw CAE Healthcare Condition Guidelines for Programming iStan with M se Condition Guidelines for Programming iStan with M se This card is intended to help you select M se conditions to achieve desired vital signs within each programmed state All four conditions should be programmed into each state in the order presented below e Respiratory Desaturation e Cardiovascular Blood Pressure e Cardiovascular Heart Rate e Respiratory Respiratory Rate The M se software is physiologically driven When using multiple conditions e g Desaturation Hypertension Tachycardia Tachypnea physiological regulatory mechanisms such as the baroreceptor reflex and ventilatory control cause compensatory changes within parameters To achieve the desired vital sign select one condition level above greater or below less to achieve the desired physiological effect Respiratory Desaturation Desaturation SpO Value Cardiovascular Blood Pressure Hypertension Hypotension 120s 80s 100s 70s 130s 80s 100s 60s 215 Condition Guidelines for Programming iStan with M se Hypertension Hypotension 190s 110s 50s 30s 220s 120s 40s 30s Cardiovascular Heart Rate Tachycardia
37. To change the bleeding type size and or location this must be done during SCE creation Please refer to page 73 for directions on how to create an SCE When selected Bleeding registers an automatic loss of blood from the physiologic models with subsequent changes in hemodynamics Venous settings produce a continuous bleed at three user adjustable flow rates Arterial settings produce a pulsing flow based on the patient s heart rate at three user adjustable flow rates Blood loss occurs at a rate dependent on wound size and Mean Arterial Pressure MAP For instructions on filling the fluid reservoirs see page 27 Hematology Model The physiological model calculates hematocrit values i e percentage of total blood hemoglobin dynamically and continuously taking into account blood and fluid losses as well as the intravenous infusion of fluids such as whole blood packed red blood cells colloids and crystalloids Instructors can create patients with both normal and pathophysiological hematocrit levels In addition learners discover how administering various fluids affects hematocrit the oxygen carrying capacity of blood and the resulting patient response The following important assumptions were made in the design of the Hematology Model Blood is comprised of two components red blood cells and plasma Plasma is comprised of two components colloid and crystalloid The term colloid is used to describe substances that generate a cli
38. albumin Range 0 mL 4000 mL Crystalloid Infusion When used the Crystalloid Infusion parameter reflects an addition to the plasma volume without changing the red blood cell volume The term crystalloid is used to describe salt solutions for infusion i e normal saline dextrose in water and Ringer s Lactate Range 0 mL 4000 mL PRBC Infusion Packed red blood cells are a preparation of 70 red blood cells and 30 liquid plasma often administered in severe anemia to restore adequate levels of hemoglobin and red cells without overloading the vascular system with excess fluids Range 0 mL 4000 mL CAE Healthcare Appendix A Parameter Descriptions Whole Blood Infusion The term whole blood is used to refer to blood that has not been separated into its various components It represents a preparation of 4096 red blood cells and 6096 liquid plasma Range 0 mL 4000 mL Urine Output This parameter is used to control the urinary output Range 0 mL 500 mL Bleeding Ch 1 The Bleeding Ch 1 parameter is used to activate the site of bleeding Default Off Bleeding Ch 2 The Bleeding Ch 2 parameter is used to activate the site of bleeding Default Off A 41 Appendix A Parameter Descriptions iStan Sounds A variety of simulated sounds are available to enhance realism A patient must be running on iStan for any sounds to be available Bowel Sounds Bowel Sounds Normal Hypoactive Hype
39. all remaining air from the IV Prime port Replace the cap 10 Disconnect the external IV bag and evacuate all remaining air or fluids from the IV Drain port using a 60 mL syringe Replace the cap 11 If red fluid was used in the IV system proceed to steps 11 and 12 If red fluid was not used you do not need to proceed any further 12 Repeat the entire priming process using clear distilled water For instructions on priming the IV system see Permanent IV Access Ports on page 179 13 Repeat steps 1 through 9 206 p CAE Healthcare iStan Care and Maintenance Flushing the IO System After each use the IO systems should be flushed Only the sites that were used need to be flushed To purge fluid from the IO system 1 Connect an external empty 1 0 L IV bag to the Drain port on the simulator s right hip If red fluid was used to prime the IO system slowly push 60 mL of clear distilled water into the Jugular IV port 3 lowly push 60 mL of air into the Jugular IV port and replace the cap Locate the IO ports that were used To expose a Tibial IO insert carefully roll up the ankle skin on the desired side To expose the Sternum IO insert carefully pull back the chest skin Ensure the needle that was used for IO infusion is still connected to the IO insert Connect an empty 60 mL syringe to the IO needle If red fluid was used to prime the IO site inject 30 mL of clear distilled water in
40. and user information data should be backed up weekly 121 Using M se iStan Restoring Data Restore data when the backed up data needs to be replaced on the software Restoring data only restores the last backup and does NOT merge the backup data with the current data To restore backup data 1 On the System Settings panel click Restore Data Restore Data The Back Up Data Button The System Restore warning box appears stating that restoring data erases all current data and asks if you want to continue System Restore Warning Restoring data will permanently delete all current data Do you want to continue The System Restore Warning Box IMPORTANT Restoring data ERASES all current data and replaces it with the backed up data 2 Click Yes A select file dialog box appears 3 Locate the appropriate bak backup file to restore 4 Click Select The data is restored 122 J CAE Healthcare Using Muse Product Licensing To view product licensing information for your simulator or to enter a license key to activate your software click License Manager Error Log The Error Log is available for technicians and is used when diagnosing the Muse software IMPORTANT Do not clear the Error Log Localization To change the language of the Muse software 1 From the System Settings panel under the Localization heading Click Change Language The Change Language dialog box appears 2 Selec
41. are the bag attached IV arm or in two permanent access catheters administered via to the IV Drain located at the right jugular and left femoral the Medications and hose located on veins Interventions palettes the simulator s right hip IV IO Fluid IV fluids can be administered in the IV arm Administered IV fluids All administered Administration orin the two permanent access catheters must be set by the IV medications located at the right jugular and left femoral instructor are collected in veins Intraosseous IO sites are available at the bag attached the sternum and bilaterally at the tibia ee to the IV Drain hose located on the simulator s right hip PARAMETER S Colloid Infusion Crystalliod Infusion PRBC Infusion Whole Blood Infusion IV IO fluid administration can also be achieved by using the Intervention palettes 173 174 Using iStan iStan Bleeding iStan is capable of bleeding simultaneously at two sites The integrated hemorrhage system allows for the physical and modeled simulation of venous or arterial bleeding at moulaged wound sites at all four limbs as well as at the chest belly Blood loss is continuously reported to the physiological models The models respond to the reported blood loss with the appropriate cardiovascular and respiratory system changes to heart rate blood pressure and respiratory parameters Switch the desired control to On to enable the bleeding feature
42. base station must remain in the ON position Use this power switch to refresh DIP switch settings Do not turn the simulator off and on to refresh the DIP switch settings Preparing the Handset for Use To prepare the handset for use 1 Insert two AAA batteries into the battery compartment 2 Set the handset DIP switch positions 6 and 7 to OFF and position 8 to ON 3 Turn the power switch off and back on to ensure the DIP switch changes take effect Figure 8 DIP Switch Settings for the Handset While DIP switch positions 6 through 8 affect the handset and base station settings DIP switch positions 1 through 5 are used to set the radio frequency channel used for communication between the handset and the base station B 6 p CAE Healthcare Appendix B Wireless Voice Link Selecting the Radio Frequency Channel There are two ways to configure the radio frequency RF channel spacing The first method reduces channel to channel interference but allows only 12 channels to operate simultaneously in the same vicinity The second method increases the number of channels that can be used simultaneously to 20 channels However this method diminishes the channel to channel noise immunity All of the WVL pairs in the same vicinity must use channels from RF Channel Group 1 or RF Channel Group 2 and channels must belong to the same group The DIP switch determines the initial communication frequencies that the WVL pair use to commu
43. be performed on the defibrillation electrodes only If defibrillation is performed over any ECG electrode high voltage may be present on the remaining connectors during the shock This may also damage ECG circuitry To prevent overheating DO NOT provide more than three 3 defibrillation discharges in a sequence per minute during the training session maximum 200 joules with biphasic defibrillation and 360 joules with a monophasic defibrillation Avoid a large number of consecutive discharges For example 20 or 25 discharges without any recovery interval may damage the system Leave at least 20 minutes recovery period after a sequence of more than 10 consecutive discharges Avoid a large number of consecutive discharges For example 20 or 25 discharges without any recovery interval may damage the system Do NOT let the simulator come in contact with electrically conductive surfaces or objects during defibrillation A flame supporting atmosphere for example with a high content of oxygen should be avoided during defibrillation wg CAE Healthcare Using iStan Keep the simulator chest dry Special attention should be taken when using the urinary system or the chest tube feature To prevent pitting of the chest skin electrode do NOT apply conductive gel or conductive defibrillation pads intended for patient use Do NOT use cables or connectors having visible damage Do NOT spill fluids over any component inside the simulator tor
44. button The Choose Scenario Dialog Box J CAE Healthcare Using Muse 2 Click New The Scenario Designer appears displaying the new untitled scenario Untitled Scenario Cm Few state cotapse att expand a The Scenario Designer 85 Using M se iStan Editing a Scenario To edit a scenario 1 From the SCE Editor under the Pre Loaded Scenarios heading click the Add Scenario button Pre Loaded Scenarios The Add 4 Add Scenario Scenario button The Pre Loaded Scenarios Heading The Choose Scenario dialog box appears Scenarios lex Name Last Modified Anterior Myocardial Infarction 2011 09 12 09 38 39 COPD Exacerbation with Respiratory Fallure 2011 09 12 09 39 10 Elevated Heart Rate 2011 09 12 09 41 01 Scenarios Heroin Overdose 2011 09 12 09 39 41 Inferior Myocardial Infarction 2011 09 12 09 40 13 Organophosphate Exposure 2011 09 12 09 40 39 Es Add The Search utton Add New Q i e q x field The Choose Scenario Dialog Box 2 Select a saved scenario from the Choose Scenario Dialog Box The Search field can be used to search for a scenario to select 3 Click Add The scenario is added to the SCE and is listed on the SCE Editor beneath the Pre Loaded Scenarios heading 86 J CAE Healthcare Using Muse 4 Click the scenario s name under the Pre Loaded Scenarios heading The Scenario Designer appears displaying the selected scenario Anaphyl
45. button on the Run screen When the Sounds panel appears select Breath Sounds All Breath Sounds Bowel Sounds Normal Crackles i Diminished IM Fae Pleural Rub Breath Anterior Sounds Breath Anterior Upper Left Upper Right Click Breath Sounds 8 to access the Breath banal Sounds menu Lower Left Lower Right Vocal Sounds i 1 1 f Rhonchi Wheezing The Breath Sounds Menu Click any one of the Breath Sounds drop down menus that control one of four quadrants to change the type of sound Click and drag the slider for each location to adjust the volume By default Normal breath sounds are heard iStan ZW CAE Healthcare Using iStan Heart Sounds Heart sounds emanate from four speakers and are synchronized with the cardiac cycle Heart sounds can be auscultated over the left and right sternal border right lower sternal boarder and apex By default heart sounds are set to the Normal sound The following sounds are available Heart Sounds Normal S1 S2 Pan z ur Late Diastolic Murmur Heart sounds can be adjusted by clicking the Sounds button on the Run screen When the Sounds panel appears select Heart Sounds Bowel Sounds All Heart Sounds s4 Heart Mitral Sounds DE 53 and 54 Early Systolic Murmur Heart Pulmonic Sounds ieee Late Diastolic Murmur m Normal Breath Sounds 53 Mid Systolic Murmu
46. circulation and set the SpO at a fixed numeric value regardless of the oxygen applied Resetting to Modeled returns control of the underlying SpO to the physiological models 2 Default Modeled Range 096 10096 Neuromuscular Blockade NMB The degree of NMB is automatically determined by pharmacokinetic and pharmacodynamic models which are based on the neuromuscular blocking agents administered and the time course of their injection For some educational applications however the instructor may wish to set a fixed degree of neuromuscular blockade that remains stable for an indefinite period This can be accomplished using the NMB parameter The default value instructs the pharmacologic models to determine the degree of neuromuscular blockade based on the drugs injected and their pharmacologic properties When a positive numeric any other positive value is assigned to this parameter the degree of NMB is set to that level For example 8096 NMB causes the simulator to set the degree of NMB to 8096 regardless of the presence or absence of neuromuscular blocking drugs Clinically the spontaneous tidal volume is markedly reduced Default Modeled Range 096 10096 A 9 Appendix A Parameter Descriptions iStan Tidal Volume The Tidal Volume parameter is used to set the tidal volume to a given volume per breath Once Tidal Volume is set to a numeric value arterial oxygen and carbon dioxide values have no effect on the tidal
47. corresponding intrapleural volume to a value greater than 0 mL Values above 500 mL reduce the corresponding lung volume significantly Breath sounds are automatically diminished on the appropriate side due to decreased ventilation of the affected lung For information regarding cleanup after using the Chest Tube feature see page 202 162 CAE Healthcare Using iStan Needle Decompression To set up a Pheumothorax Needle Decompression enable the feature using the Needle Decompression parameter on the Respiratory screen Off Needle Decompression Needle Decompression Switch Select ON OFF to activate the feature Needle decompression can be performed bilaterally into the small hole located in the mid clavicular line of the second intercostal space Insert a needle until the hissing sound of the valve release is heard For supported needle size see Recommended Clinical Supply Sizes on page 213 Needle Decompression The Intrapleural Volume parameter can be used to allow intrapleural volume to accumulate Effective needle decompression immediately reduces the intrapleural volume The hissing sound stops when intrapleural volume is zero 163 Using iStan Cardiovascular iStan produces realistic heart sounds and a wide range of pathophysiologic conditions synchronized to the ORS complex of the ECG and audible with a standard stethoscope Anatomy Physiology and Clinical Signs 3 Lead or 5 Lead ECG Baro
48. display the patient s current NIBP click the Manual NIBP button The Manual NIBP button br min The TouchPro Display The current NIBP is displayed NOTE Manual NIBP can be used at any time during cycling However this turns off auto cycling 143 Using TouchPro iStan Patients To view the available Patients click the Settings button in the lower right corner of the TouchPro screen The Settings menu appears From the Settings menu click Patients to view the current Patient A Patients Stan D Ardman II The Available Patients NOTE When connected to the simulator the TouchPro only displays the active Patient 144 Using TouchPro Configuring the TouchPro Software The background color and alarm suspension time can be set from the TouchPro Configure panel To access the Configure panel 1 Click the Settings button in the bottom right corner of the TouchPro screen The Settings menu appears 2 From the Settings menu click the Configure button The Configure panel appears 3 From the Configure panel set the background color and alarm suspension time Background Color x m mH Alarm Suspension Time 20 secs 1 min 5 mins Indefinite The Configure Panel 4 Click the Exit button to exit the Configure panel when finished 145 Using TouchPro iStan Changing the TouchPro Language To change the language of the TouchPro software 1 Click the Settings button in th
49. heart rate For every 5 mmHg decrease in MAP the heart rate may increase by 2 beats per minute in an attempt to keep the MAP in check However there is a lower limit minimum pressure after which these controls are no longer effective Once the MAP reaches the baroreceptor minimum pressure there is no additional increase in heart rate if the pressure continues to fall For example should the pressure continue to fall the heart rate would not show a corresponding increase Default 72 mmHg Range 20 mmHg 160 mmHg NOTE It is important to set both the baroreceptor maximum pressure and the baroreceptor minimum pressure at the same time for the software to recognize the baroreceptor reset Left Ventricle Contractility Factor The Left Ventricle Contractillity Factor parameter adjusts the contractility of the left ventricle and has a direct effect on cardiac output and blood pressure Use this parameter to raise or lower the cardiac output Default 1 Range 0 10 5 00 Right Ventricle Contractility Factor The Right Ventricle Contractility Factor parameter adjusts the contractility of the right ventricle and has a direct effect on pulmonary artery pressure and an inverse effect on central venous pressure Use this parameter to raise or lower pulmonary artery pressure PAP or to change the central venous pressure CVP Default 1 Range 0 10 5 00 o CAE Healthcare Appendix A Parameter Descriptions Systemic Vascu
50. is used to create the pressure for the Trauma Fill Tank WARNING To prevent ejected pump assembly and or solution from striking and injuring you NEVER stand with your face or body directly over the top of the tank when pumping or loosening the pump To operate the pump and fill the reservoir a Ensure the yellow relief valve on the front of the tank is closed b Unlock the pump handle by turning counter clockwise Be careful not to loosen the pump from the tank C Stroke the pump handle up and down from 25 to 35 times to transport approximately 1 liter of fluid to the reservoir NEVER exceed 35 strokes while pressurizing the tank d Lockthe pump handle back into the pump assembly by turning clockwise e Watch the Overflow Bottle located on the tank assembly When liquid begins to appear in this bottle the reservoir is full Filling the 1 8 liter blood reservoir takes approximately 3 to 5 minutes while filling the 0 8 liter clear reservoir takes 1 to 3 minutes 29 iStan Setup iStan Step 4 Release Pressure from the Trauma Fill Tank Immediately release pressure from the tank by turning and holding the yellow pressure relief knob clockwise until all air pressure is gone If pressure will not release using the relief knob a Place a rag over the top of the tank and pump handle b While firmly pushing down on the pump handle slowly turn the handle counter clockwise WARNING NEVER leave a pressurized tank u
51. may be extended This action is recorded in the Events log and in the Simulation Session SpO Probe The SpO probe is integrated with the Patient Status Display and the physiological model SpO Probe The connection for the SpO probe is located on the left side of the simulator Instructions on connecting the SpO probe are shown on page 22 Cricothyrotomy To replicate a needle cricothyrotomy 1 Spray the silicone lubricant onto the airway adjunct prior to the simulation session 2 Locate the simulated cricothyroid membrane sealed with tape underneath the neck skin 3 Follow standard clinical techniques and palpate to find the cricothyroid space 4 Puncture the space through the neck skin of the patient simulator and into the tape membrane This puncture goes all the way through to the trachea simulating the clinical procedure Users must replace the tape that simulates the cricothyroid membrane after each cricothyrotomy A replacement neck skin airway lubricant and spools of tape are available in the Replacement Kit 159 Using iStan iStan Replacing the Cricothyrotomy Tape To replace the cricothyrotomy tape 1 Remove the old punctured tape completely from the cricoid feature and use alcohol an alcohol prep pad works well to clean the glue residue from the surface Allow to dry 2 Cutan approximately 2 25 inch 6 cm length of the double sided tape from the roll provided 3 Carefully remove t
52. moo yao lo L LES Oo b w mo LES Z v E BHL LES tia tige 12345 12345 tilt n i 12345 12345 EN NE v LEES E VEL o gt LEO DES E nao vo gt LES LES o ERI woo lam EET CES o vio tm ESI EET LEO DE v ERE P ESL EET E o T Un ENDO DES Z v ESI LES ENDO MED LES gt nC mo nC Z v CES m EET E v vio m pa cot m EH DES v EL PESE o un Figure 9 RF Channel Selection Methods For a complete list of the initial frequencies associated with the RF Channels see RF Channel Initial Operating Frequencies on page B 11 Appendix B Wireless Voice Link iStan B 8 Powering Up the WVL Pair To power up the WVL pair Power on the base station by turning on the simulator The base station power switch is in the on position by default Power on the handset by setting the power switch to the on position The red power light on each unit blinks when the unit is on Once both units are powered on and communicating with each other the green connection light flashes once every second If the green connection light fails to blink ensure both units are set to the same RF channel See Selecting the Radio Frequency Channel on page B 11 If you make changes to the DIP switch settings toggle the power switches of the handset and base station off and back on to ensure the changes takes effect Using the iPhone Standalone Microphone
53. more information see Reducing Cervical Motion on page 199 18 CAE Healthcare iStan Setup Step 4 Power on iStan f Carefully pull back the skin on iStan s left hip and move the protective foam aside g Locate the power toggle switch on the edge of the side plate h Flip the power switch to the ON position Flip the Power Switch from OFF to ON i Carefully return the skin and foam to its position covering the switch IMPORTANT You must wait three 3 minutes before proceeding to Step 5 while the simulator establishes a wireless network iStan can be operated continuously for seven to eight hours without recharging or running from a power source For instructions on recharging the battery see page 197 19 iStan Setup iStan Step 5 Power on the Instructor Workstation a Place the Laptop or Tablet Instructor Workstation near iStan in a convenient location b Connect the AC adapter to the Instructor Workstation and a surge protected power outlet optional NOTE If the Instructor Workstation is running on battery power ensure the battery is fully charged c Power on the Instructor Workstation Step 6 Connect to the Wireless Network Laptop Instructor Workstation Macintosh Option Once iStan and the Instructor Workstation are both powered on they automatically establish a wireless connection and when the Safari browser is opened the Muse software launches If the auto conn
54. on page B 8 On the WVL base station the dial serves as the volume control for the speakers inside the simulator Moving the dial toward the plus sign increases the volume Moving the dial toward the minus sign decreases the volume and setting On the handset pressing straight down on the volume dial in the center mutes the microphone B 4 CAE Healthcare Appendix B Wireless Voice Link Preparing the Base Station in the Simulator When using the base station in the simulator ensure the batteries are removed and the following items are attached Power cable Line out cable The DIP switch is located in the battery compartment of the base station Figure 5 DIP Switch Settings DIP switch settings Figure 5 Dip Switch Settings The base station should come already connected and installed inside the iStan Base Station inside iStan Figure 6 The Base Station Connected and Installed in iStan B 5 Appendix B Wireless Voice Link iStan To prepare the base station 3 Set the base station DIP switch positions 6 and 7 to OFF and 8 to ON 4 Turn the power off and on using the power switch on the outside of the base station to ensure the DIP switch changes take effect 5 Leave the power switch on the outside of the base station in the on position Figure 7 DIP Switch Settings for the Base Station NOTE Since the base station receives power from the simulator the power switch on the outside of the
55. pacing device IMPORTANT Before beginning the calibration be sure to select a minimum of 3 to 4 joule parameters ranging 50 360 Joules for Adult for the defibrillation calibration and up to 20 pace parameters ranging 20 180 mA for Adult for pacing calibration See Recommended Ranges on page C 10 for specific information regarding adult pediatric and baby simulators To begin the utility 1 Navigate to the Menu Bar at the top of the screen and click Go The drop down menu appears 2 Select Applications from the drop down menu Appendix C Defibrillation Calibration Utility iStan 3 Select the HPS Version 6 folder 4 From the HPS Version 6 folder select the Utilities folder 5 Click Defib Calibrator D Link Config bin Aug 18 2011 8 53 AM Leti laintib tb FixPermissions command AUG I8 ZUIT 8 53 AV 4 KB M5 MetroGnome Aug 18 2011 8 53 AM 388 MonitorCal Aug 18 2011 8 53 AM Click Defib Calibrator The Connect to Simulator window appears 6 Click on the desired simulator and click Connect to begin the calibration utility Connect to simulator Simulators iStan913 10 127 54 86 28997 Host 10 127 54 86 28997 Select Simulator and Click Connect p CAE Healthcare Appendix C Defibrillation Calibration Utility The Calibration Option window appears 7 Clickthe radio button next to Defibrillation Calibration or Pacing Calibration to select which type of calibration to p
56. patient record file types can be uploaded to M se e JPG or JPEG images GIF images PNG images e XPS images PDF documents MPEG videos MOV videos e MP3 audio files A single patient record file cannot exceed 20MB 113 Using M se iStan To upload a patient record 1 From Patient Records panel click Upload Patient Records A file selection window appears 2 Select the desired file and click Open or OK The file is uploaded and is now available to display in the TouchPro software M se can store up to 100GB of patient record files To ensure adequate space please delete patient records when they are no longer needed To delete a patient record 1 From the Patient Records panel select the patient record to delete 2 Click Delete The patient record is deleted and is no longer available to display in the TouchPro software Individual patient records can also be previewed renamed or exported by selecting the record and Clicking Rename Export or Preview For information about displaying patient records in TouchPro see Displaying Patient Records on page 44 114 CAE Healthcare Using M se User Accounts To access the User Accounts panel from the System Administration screen click the User Accounts button The User Accounts panel appears From the User Accounts panel users can create edit and delete users The User Accounts button First Name Full Name
57. pouvant provoquer un fonctionnement ind sirable de l appareil Any modifications made to this device without the express approval of CAE could void the user s authority to operate this equipment B 1 Appendix B Wireless Voice Link iStan What s Included The WVL package includes the following items Wireless Voice Link Handset 1 Olympus ME52W Standalone Microphone 1 AAA Alkaline Batteries 2 Quick Start Guide 1 How It Works The WVL is a radio pair that operates in the 2 4 GHz unlicensed radio band The handset communicates wirelessly with the base station located inside the simulator The base station converts the digitized microphone stream from the handset and outputs it via the base station to the headphone and line out jacks The output projects through the head speakers inside the simulator To accommodate multiple WVL pairs in close proximity each WVL is assigned two RF channels on which to operate The RF channels divide up the 2 400 2 4835 GHz spectrum in 80 single frequencies to prevent the WVLs from interfering with each other Due to the nature of the unlicensed 2 4 GHz band there may be other devices such as Wi Fi microwave ovens or Bluetooth radios operating in the 2 4 GHz band as well Therefore two channels are used to transmit the audio stream redundantly to avoid interference In case there is an interference in one channel the other can be used to extract the audio stream To operate correctly
58. programmed physiology Scenarios can be added to SCEs to enhance patient physiology To add a scenario to an SCE that is running 1 Click the Add Scenario button on the Run screen Scenarios s Add Scenario The Add Scenario Button The Choose Scenario dialog box appears 2 Select a scenario from the Choose Scenario Dialog Box The Search field can be used to search for a scenario to select 3 Click Add The scenario is added to the SCE and appears under the Scenarios heading on the Run screen Scenarios ge Add Scenario Anaphylaxis Beginning Anaphylaxis 00 00 03 An Added Scenario 47 Using M se iStan Changing Physiology The patient physiology can be adjusted while an SCE is running in two ways by using one of the physiological views on the Run screen to modify parameters or by using the Conditions Interventions and Medications palettes Using the Physiological Views From the Run screen users can select from six different views representative of various body systems and features Neurological Respiratory Cardiovascular Fluids TDCK Sounds 48 J CAE Healthcare To access each view click the appropriate organ icon or button For Neurological click the brain For Respiratory click the lung For Cardiovascular click the heart For Fluids click the droplet of blood For TDCK click the TDCK icon e For Sounds click the Sounds button From each view various parameters
59. remove red fluid The food color will stain more readily if left on for an extended period 3 Connect the blue and yellow connectors of an empty Trauma Fill Tank to the blue fill and yellow vent connectors on the right side of the simulator 4 Disconnect the Overfill Bottle from the Trauma Fill Tank 5 Using a haptic tube from the Inventory Kit connect the haptic tube to the Overfill Bottle port on the Trauma Fill Tank 6 Place the other end of the haptic tube into an empty bucket to collect the wastewater 7 Onthe Fluids view of a preconfigured SCE turn both bleeding channels to ON This setting turns on all valves to maximize the flow of the remaining blood mixture into the Trauma Fill Tank 8 Pressurize the Trauma Fill Tank by pumping no more than 20 times 9 Connect the wound umbilical s to the bleeding site s that were used keeping the ends in the wastewater bucket 10 When fluid stops flowing turn both of the bleeding channels to OFF 11 Disconnect the blue and yellow lines of the Trauma Fill Tank from the simulator 12 Rinse the Trauma Fill Tank thoroughly with distilled water 13 Using a Trauma Fill Tank with clear distilled water pump the distilled water into the simulator 14 Repeat steps 1 13 until waters flows clear 15 Optional To flush the chest tube lines with a chest or priming tube in place and an empty bucket to catch fluid from the Respiratory view of an SCE select Chest Tube Ena
60. should be operated in ambient temperatures below 104 degrees Fahrenheit 40 degrees Celsius Prolonged operation gt 4hrs in ambient temperatures greater than 104 degrees Fahrenheit 40 degrees Celsius may result in anomalous behavior and out of specification performance Donotintroduce foreign substances into the airway with the exception of small amounts of approved lubricant Only perform invasive procedures supported by the system as described in the applicable sections of the User Guide Donot pick the mannequin up by the limbs support head and leverage weight with torso It may be necessary to have the help of a second person to lift and move iStan xii p CAE Healthcare Table of Contents Table of Contents LiCGNSE COPYTIGIE sassssessssvicasussassessissserensscdascasasensusdsvonsasesnsnssaacessesssssieesaasiseesssasseasiaensessnssaansts i Declaration of Conformity sscsscsscsocsecssesesoossecenssnronasseonsetennaessnsesssccsassscensecsnaonssnavessensassesressnsens vi Specifications Mew n viii ELA Lupo f ss siis X Dr Mem 1 1 Weight DISPADUEIORIGo asas i sissisota ren aaas t un pM n nU 2 SKi E r A EE S Nie 2 Skeletal Structure RR 2 E E nes le evo EE E 2 Contained inthis User Guide ss cessccsccaccssssasiscucstacnsssonacin
61. the Update the Simulator window Click View Data to view the calibration information in a data log The calibration information window appears 0 0 163 20H516 40 879 60 1243 80 1595 100 1928 120 2290 140 2629 160 2960 180 30000 180 Calibration Information window Click Cancel to perform additional calibration or navigate back to the Reset option Click Update to save the current calibration data to the simulator C 8 o CAE Healthcare Appendix C Defibrillation Calibration Utility After clicking the Update button the Update Complete window appears Update complete Press Disconnect and restart the simulator for any changes to take effect or Continue to continue calibrating X Update Complete window 8 Click Disconnect to end the utility and reboot the simulator The simulator must be rebooted for the calibration to take effect and the simulator should not be turned off until the utility is closed Troubleshooting During the calibration process a Calibration Points Too Close Together error message may appear if the measurement parameters are too close in intervals In this instance there are three options available to move forward with the calibration e Click Ignore and the calibration process will proceed Click Show Errors to review the calibration pairs that are too close together Click Redo Calibration and use a different Joules mA amount C 9 Appendix C Defibrillation
62. the patient s underlying cardiac rhythm displayed on the Patient Status Display TouchPro software or physiological monitor To change the cardiac rhythm click the Cardiac Rhythm parameter and select the desired rhythm from the available list f a number appears following the cardiac rhythm on the list this overrides the heart rate to the rate indicated For cardiac rhythms without a number the Heart Rate Factor parameter can be used to independently control the heart rate Default Modeled Options Modeled Asystole Atrial Enlargement Left Atrial Enlargement Right Atrial Fibrillation Atrial Fibrillation HR 120 Atrial Fibrillation HR 80 Atrial Flutter with 2 1 AV Conduction Atrial Flutter HR 150 Atrial Tachycardia AV Block First Degree AV Block Second Degree Mobitz I AV Block Second Degree Mobitz II AV Block Third Degree Bundle Branch Block Incomplete Right Bundle Branch Block Left Bundle Branch Block Left with PVC 2596 Bundle Branch Block Right Hypercalcemia Hyperkalemia Hypertrophy Biventricular Hypertrophy Left Ventricular Hypertrophy Right Ventricular Hypocalcemia Hypokalemia Hypothermia Junctional Junctional HR 50 Long QT Syndrome Myocardial Infarction with LBBB Myocardial Infarction Anterior CAE Healthcare Appendix A Parameter Descriptions Myocardial Infarction Anterolateral Myocardial Infarction Inferior Myocardial Infarction Lateral Myocardial Infarction Posterior Myocardial Infar
63. to require at any time the performance by Licensee of any of the provisions hereof shall not be construed to be a waiver of such provisions nor in any way affect the validity of this License or any part thereof or the right of CAE Healthcare thereafter to enforce any such provision 9 4 No third party beneficiaries Nothing in this Agreement shall be construed as creating or giving rise to any rights for any third parties or any persons other than the parties to this Agreement 9 5 Notices Notices or communications pertaining to this Agreement must be given in writing and delivered to the addressee as indicated in the HEPGTC 9 6 Preamble Headings The preamble forms an integral part of this Agreement The division of this Agreement into Clauses Articles sections subsections and other subdivisions and the insertion of headings are for convenience of reference only and will not affect the construction or interpretation of this Agreement CAE Healthcare End User License Agreement 97 Severability If any one or more of the provisions of this License shall be held to be invalid illegal or unenforceable the validity legality or enforceability of the remaining provisions of this Agreement shall not in any way be affected or impaired thereby 9 8 Assignment and Succession Licensee may not assign or delegate this Agreement in whole or in part expressly or by operation of law without CAE Healthcare s prior written consent CAE Healthc
64. vna XAR PPIXHRRAR RE PEXERIGR II Xp E POCHE OPEN UL daaarna ER ERU sasia 24 Optional Insert the CO Camister s ccsccscsssscssssscnssscsesessscsncsssossscesencsecoscasencsesesensoncsssesenceness 25 xiv Zw CAE Healthcare Optional Prepare the Secretion System ssscsssscsssssssssssesssssssssssssssssssssssessssssssessssesssssesers 27 Using theTraumaiFill Tan SM cords T AEE RE EEE 27 Assembling the Trauma FAM TAE caca sit ninos rati lautete 28 Op rating the Trauma HITAN sso deri QYPE n a Ed PIU Ris 28 Using MUS 31 Starting the Application ausiiercciajansnnenilnnnumnanmuinninumiinnusiianamanen 31 Navigating the HOME Paljelsssesrviedinrado Div PREKE RED DR ERE ENDURO REDUX RR ERA GEH ERA 34 The SCE Selection MN vccseuaeona reece mang esas oranda dem enaades 35 THe SCELIBTAY ENNIO P 37 The SCESuiminaly Panel ostensa raro etin od dines Pd pne nO ERR ERR RM 39 Dlu pE dcc e 40 Running ASCE tn M M 41 Connecting to the SHTINITOI scaena ab inerti Mox norte eu beret iiaii 41 Using the Patient Stats Display usos epe tton o RP OY GR DRerUO RR OO ROI RD RR 42 The Event LOS iussione trt tia ede ERE p Rea rud E Ft EE O Run 44 Displaying Patient etoftls sas o o PO rRNA BAR EAR AURA DURU nA EIN SNA 44 AGG a Scenario to d ROMNING SCE ose Rp clases alee iene Rie Nm BERE 47 Changing PISO OO cssc eescivenorase desi EE EEEE ER 48 S CE
65. 0 38 23 SCE Healthy Adult Male Healthy Adult Male Healthy Adult Male Anaphylaxis Patient Stan D Ardman 11 Stan D Ardman 11 Stan D Ardman 11 Holly Monroe Simulation Events Simulation Events Simulation Events Simulation Events Simulation Events Physiological Data Physiological Data Physiological Data Physiological Data Physiological Data The History Screen By clicking the Simulation Events link of a Simulation Session users can view the entire log of the simulation and all the events that occurred during the SCE When the Physiological Data link of a Simulation Session is clicked users can view all the physiological data that occurred during the SCE On both the Simulation Events and Physiological Data screens there is an Export button that when clicked exports the data to a CSV file that can be stored on an external device 104 CAE Healthcare Using M se System Administration From the System Administration screen users can control and access Content Management User Accounts Groups Maintenance and System Settings To access the System Administration screen click the System Administration button from the Home page The System Administration Button The System Administration screen is displayed SCEs Base Patients Scenarios Healthy Adult Female n Norma Female Conditions Patient Records Healthy Adult Male n Stan D Ardenan 11 sie
66. 0 50 mix of distilled water and white vinegar to keep mineral and algae build up to a minimum Always flush with distilled water to remove any trace amounts of vinegar 204 p CAE Healthcare iStan Care and Maintenance Flushing the Fluid System for Storage When storing iStan for substantial periods of time make certain that all moisture has been removed from the system After draining the reservoirs flush the system with air using the following steps 1 Connect a clean and dry Trauma Fill Tank to both the yellow and blue connectors on the right side Unlock the Trauma Fill Tank s handle and stroke up and down 25 to 35 times to pressurize the tank This pressure air is transported to the on board reservoir 3 Lock the pump handle back into the pump assembly by turning clockwise After approximately one minute disconnect the Trauma Fill Tank 5 Connect a clean and dry Trauma Fill Tank to both the yellow and blue connectors 10 TI 12 13 on the left side Unlock the Trauma Fill Tank s handle and stroke up and down 25 to 35 times to pressurize the tank This pressure air is transported to the on board reservoir Lock the pump handle back into the pump assembly by turning clockwise After approximately one minute disconnect the Trauma Fill Tank If a chest tube was used flush that system by clicking Chest Tube Enable right or left from the Respiratory view of a preconfigured SCE and select Prime
67. 00 240VAC 50 60Hz Consumption Maximum 85W Charging Internal Battery 10 8V 60 watt hour lithium polymer rechargeable Run Time 2 to 4 hours Typical TouchPro Computer Please see your product s user guide for power specifications Replacement Fuse F1 DC Power In 8A 32VDC 250VAC 5 x 20mm IEC 601 27 2 2 Fast Acting Communications Simulator Network Wired 10 100 Ethernet or Wireless IEEE 802 11g Wireless Voice 537 MHz to 819MHz Country Specific Electrotherapy Defibrillation 20 to 360 joules Monophasic Biphasic Pacing 20ma to 180ma Air Supply When using the optional external compressed air kit in conjunction with the facility supply source and facility wall adapter Maximum pressure 50 psi to 120 psi Cautions Warnings iStan Cautions Warnings Please read and understand these cautions and warnings before you begin using the iStan system USE OF THIS EQUIPMENT IN AN UNSPECIFIED MANNER MAY IMPAIR DESIGNED PROTECTION Your safety is in your hands Be sure to follow the instructions on the proper setup breakdown and use of the iStan system SHOCK HAZARD Electrical Safety This product must be connected to an electrical outlet that is properly grounded Precautions should be taken so that grounding or polarization is not defeated Donot place defibrillator paddles on or adjacent to the ECG patient electrodes Contact between defibrillator paddles and the electrodes may cause injury t
68. 2 7920 24 hour Hotline 1 941 342 5605 Fax 1 941 342 5600 Email Address customerservice caehealthcare com Web URL www caehealthcare com CAE Healthcare Customer Service Canada Monday Friday from 8 00 a m to 5 00 p m ET Toll Free 1 877 223 6273 Email Address can service caehealthcare com CAE Healthcare Customer Service Europe Middle East and Africa EMEA Monday Friday from 8 00 a m to 5 00 p m CET Phone 49 0 6131 4950354 Fax 49 0 6131 4950351 Email Address international service caehealthcare com CAE Healthcare Customer Service UK and Ireland Monday Friday from 9 00 a m to 5 00 p m GMT Phone 44 0 800 917 1851 Email Address uk service caehealthcare com Principal hours of operation exclude holiday and non business days 192 p CAE Healthcare iStan Care and Maintenance Contract Period Warranty contracts are not ordinarily offered for periods of less than one year However multiple year warranty contracts may be arranged for up to an additional three years Discounts are available for purchase of multiple year contracts Limitations of Agreement Your exclusive remedy for any defective patient simulator is limited to the repair or replacement of the defective patient simulator CAE Healthcare may elect which remedy or combination of remedies to provide at its sole discretion CAE Healthcare shall have a reasonable time after determining that a defective material exists to re
69. 70 0 eg The System Administration Screen 105 Using M se iStan Content Management From the Content Management options users can manage learning applications SCEs Base Patients and Scenarios To access the Content Management options from the System Administration screen click Content Management The Content Management options appear The Content Management A button The Content Base Patients Management Scenarios options Conditions Patient Records Healthy Adult Male 5 Stan D Ardmas II 33 years old Mala 70 0 kg Stan Q Ar man 11 Healthy Soldier The System Administration Screen 106 CAE Healthcare Using M se Learning Modules From the Learning Modules panel learning applications can be installed or deleted When the Content Management button is selected the Learning Modules panel appears by default If another panel has been selected return to the Learning Modules panel by clicking the Learning Modules link The Learning Modules link scrs Base Patients BEES The Learning Conditions Applications Patient Records panel Female Healthy Adult Male 10 i Stan D Ardmaa 11 33 veers old 70 0 keg Stan Q Ar man 1 The Install Learning Ra ee ia The Remove Module button SEEE o button The Learning Modules Panel To install a learning application 1 Click Install Learning Module The Select file to upload dialog box appears
70. ACH PARTY HERETO IRREVOCABLY WAIVES TO THE FULLEST EXTENT PERMITTED BY APPLICABLE LAW ANY AND ALL RIGHT TO TRIAL BY JURY IN ANY LEGAL PROCEEDING ARISING OUT OF OR RELATING TO THIS AGREEMENT 8 3 Notwithstanding the foregoing if a party seeks injunctive proceedings to preserve confidentiality obligations or intellectual property rights then it is entitled to seek relief before the competent court body of any jurisdiction 9 MISCELLANEOUS 9 1 United States Government Customer If Licensee is the United States Government U S Government or a unit or agency of the U S Government the Software and Data are deemed to be commercial computer software and commercial computer software documentation respectively pursuant to DFAR Section 227 7202 and FAR Section 12 212 b as applicable Any use modification reproduction release performance display or disclosure of the Software and or Data by the U S Government or any of its units or agencies shall be governed solely by the terms of this License and the HEPGTC Any technical data provided by CAE Healthcare with the Product that is not covered by the above provisions is deemed to be technical data commercial items pursuant to DFAR Section 252 227 7015 a 9 2 Amendment This License may only be amended by the duly authorized representatives of CAE Healthcare 9 3 No Waiver The failure of CAE Healthcare to enforce at any time any of the provisions of this License or
71. AIN iStan s power ON OFF switch located in iStan s left hip is in the OFF position 2 Position iStan so that the battery compartment located in iStan s lower lumbar region is accessible 3 Lift the top layer of skin from the waist up to mid torso and remove the lower lumbar foam piece covering the compartment panel 4 Remove the panel to the battery compartment by loosening the thumbscrew hardware by hand 5 One byone carefully lay in each battery pack connecting each one to the nearest battery pack input cable The color of the battery pack cable wires should match those of the input connector Refasten the battery compartment cover tightening the thumbscrews Return the lumbar foam piece to its original location Carefully pull the top skin layer back into place 0 090 Plug in the external 20VDC 150W AC DC power supply into the nearest AC outlet The fast charge process lasts four to six hours and can only be done while iStan is powered down and the external power supply is plugged in 198 CAE Healthcare iStan Care and Maintenance Reducing Cervical Motion To reduce cervical motion 1 Remove the neck skin and pull the skin at the back of the head toward the front to expose the neck from the rear 2 Locate the neck joint at the base of the skull 3 Locate the steel cable attached to the back of the skull 4 Locate the U shaped plate at the end of the cable 5 Slide the U shaped plate onto t
72. CAE Healthcare Introduction Introduction As the worldwide leader in patient simulation technology and education CAE Healthcare is excited to introduce iStan With CAE Healthcare s proprietary human physiology model at its core iStan is designed to answer the need for a product that delivers more realism more clinical features and more flexibility than other simulators Simply put iStan is like no other simulator before it iStan iStan allows for the physical assessment of various clinical signs e g heart breath bowel sounds palpable pulses chest excursion airway patency etc that are dynamically modeled using mathematical algorithms of human physiology and pharmacology The simulator can be placed on standard operating room tables an ICU bed on the ground or even in a vehicle in the case of a simulated accident iStan can also be seated in an upright position In addition iStan has assessment airway cardiovascular genitourinary ACLS and trauma features that are familiar to CAE Healthcare customers plus many new specially designed features such as cyanosis and capillary refill trismus jugular vein distension SpO finger probe fluids on board bilateral autoinjection intraosseous sites flail chest and programmable speech Wireless and tetherless iStan takes simulation education to a new and exciting level of realism Introduction iStan Weight Distribution iStan is uniquely designed to emulate human
73. CE file is saved Click Export to export an SCE to an external device The SCE file extension is sce 108 wg CAE Healthcare Using Mise Base Patients From the Content Management options click Base Patients to access the Base Patients panel The Base Patients panel appears The Base Patients link The Import Patient button The Base Patients Panel All Patients are listed in the Base Patients panel From the Base Patients panel users can rename review delete and export Patients they have created by clicking the respective buttons next to each Patient Click Import Patient to import a Patient file from an external device or the hard drive location where the SCE file is saved Click Export to export a Patient file to an external device The Patient file extension is pat NOTE Preconfigured CAE Healthcare Base Patients CANNOT be exported 109 Using M se iStan Scenarios From the Content Management options click Scenarios to access the Scenarios panel The Scenarios panel appears Learning Modules SCEs Base Patients The Scenarios p link x J Last Updated 2013 04 03 12 30 50 Patient Records z Q Review COPD Exacerbabon with Respiratory Fatere O Last Updated 2013 04 03 12130158 Q Review Heart Failure w Pulmonary Lderna D Last Updated 2013 04 03 12 30 58 Q Review The Create The Import New Scenario Scenario button create new scenara button The Scenari
74. Calibration Utility iStan Recommended Ranges The following table contains the recommended biphasic ranges for defibrillation and pacing for Adult Pediatric and Baby simulators Simulator Defibrillation Pacing Current Adult iStan ECS 50 360 Joules 20 180 mA Pediatric PediaSIM 20 200 Joules 20 100 mA Baby BabySIM 10 40 Joules 10 40 mA CAE Healthcare caehealthcare com For more information about CAE Healthcare products contact your regional sales manager or the CAE Healthcare distributor in your country or visit caehealthcare com Tel 1 941 377 5562 or 866 233 6384 For customer service please contact CAE Healthcare Customer Service Headquarters United States and Latin America Monday Friday from 7 00 a m to 6 00 p m ET Phone 1 866 462 7920 Email customerservicegcaehealthcare com Customer Service Canada Monday Friday from 8 00 a m to 5 00 p m ET Phone 1 877 223 6273 Email can service caehealthcare com Customer Service Europe Middle East Africa India Asia and Australia Monday Friday from 8 00 a m to 5 00 p m CET Phone 49 0 6131 4950354 Email international service caehealthcare com Customer Service United Kingdom and Ireland Monday Friday from 9 00 a m to 5 00 p m GMT Phone 44 0 800 917 1851 Email uk service caehealthcare com 2013 CAE Healthcare 165K296200 v 2 1
75. Cardiovascular PARAMETER S Defib None required but adjustable VIEW Cardiovascular PARAMETER S Arterial Catheter Central Venous Catheter PA Catheter None required but adjustable VIEW Cardiovascular PARAMETER S Jugular Vein Distention None required None required but adjustable VIEW Cardiovascular PARAMETER S Ischemic Index Sensitivity Ischemic Index Averaging None required but adjustable VIEW Cardiovascular Using iStan See Defibrillation below for defibrillation disk locations and instructions Use of modified blood pressure cuff 165 Using iStan iStan Pulses Fourteen pulse locations are activated through sensors by touch Carotid 2 Brachial 2 Radial 2 Femoral 2 Popliteal 2 Posterior Tibial 2 Dorsalis Pedis 2 When a pulse is activated and when that pulse is no longer being palpated the action is recorded on the Events Log and in the Simulation Session for later review 166 Zw CAE Healthcare Using iStan Pulses are visible and can be controlled from any physiological view All pulses unless altered by an SCE are enabled by default To disable a pulse click the pulse location on the human form To enable a pulse click the pulse location again When a pulse is palpated the event is recorded on the Events Log and the Simulation Session for later review Activated pulse Deactivated pulse Pulses Active and I
76. Medications and Interventions Palettes The Conditions Medications and Interventions palettes on the Run screen enable the application of conditions medications and interventions during simulation Once applied conditions are reflected in the patient s physiology and logged All medications and interventions are also logged and most affect the patient s physiology Using the Conditions Palette Conditions are preprogrammed pathophysiological states that use one or more physiological parameters and are designed to enable you to create physiological changes on the fly There are two ways to apply conditions using the Conditions palette using a Quick Link or using the complete Conditions menu Quick Links are preconfigured conditions that are made accessible in the Conditions palette for quick application Quick Links can also be created for the Medications and Interventions palettes To set parameters using the Quick Links in the Conditions palette click one of the Quick Links The condition is applied and affects the patient s physiology The Conditions button Q Conditions Apnea BP Hypertension 2 ipotension Quick Links SUM Heart Rate Bradycardia Heart Rate Tachycardia Patient Stability The Conditions Palette NOTE Quick Links can only be added while creating or editing an SCE 53 54 3 1 Using M se iStan Or to apply a condition that is not set up as a Quick Link in the Conditions palette
77. NOT use any of the browser s navigational tools i e back and forward buttons while operating M se Starting the Application Once the simulator is powered on and the Instructor Workstation is connected to the simulator network the M se software can be launched To launch the software 1 Using the Laptop or Tablet Instructor Workstation launch the web browser e 9 Safari Internet Explorer The M se Start Screen appears EN TouchPro Patient Monitor The M se Start Screen 31 Using M se iStan 2 Select Miise The Login screen appears 3a User Guide Support The Mise Login Screen The links in the bottom left corner of the screen provide access to additional information about the software e Click the About link to access information about the Muse software version the type of simulator and the serial number Click the User Guide link to download the user guide English version To access the User Guide in other languages please visit www caehealthcare com and click the Support link Click the Support link for CAE Healthcare Support contact information Click the globe shaped Language icon in the bottom left corner to change the language of the M se software 32 J CAE Healthcare Using Mise 3 On the Login screen enter the Username admin and the Password admin in the appropriate fields to access Muse Username Password The Miise Login Fields
78. O The TouchPro software enables users to view patient physiology The software can be used from the Instructor Workstation or on another computer provided the computer has joined the simulator s wireless network IMPORTANT Only two TouchPro software screens can be open at a time Accessing the TouchPro Software Like the M se software the TouchPro software is compatible with computers that have touch screen capabilities To run the TouchPro software the Instructor Workstation must be connected to the simulator s network IMPORTANT An SCE must be running on the M se software for any physiological data to be displayed on the TouchPro software The TouchPro software can only show one Patient at a time To launch TouchPro from the Instructor Workstation 1 With the M se software running open a new tab in the web browser and go to the Home page of the web browser The M se Start Screen appears Ell TouchPro The TouchPro Patient Monitor Icon The M se Start Screen 2 Select the TouchPro icon 129 Using TouchPro iStan When TouchPro opens the simulated patient monitor appears br min The TouchPro Display NOTE The capnogram waveform is not displayed on the TouchPro software from the Instructor Workstation Capnogram information can be found on the clinical patient monitor if one is connected to the simulator 130 Using TouchPro Modifying the TouchPro Display The layout of the waveforms a
79. ORTANT Ensure pop up blocking is turned OFF in the web browser of the Instructor Workstation and any TouchPro workstations Consult the web browser s help menu for assistance NOTE The web browser window containing the patient record may be minimized initially If the window is not readily visible click the web browser icon on the Dock Macintosh Instructor Workstation or Taskbar Windows Instructor Workstation to locate the new window The Patient Records button turns red indicating that a patient record is being displayed The Patient Records Button 45 Using M se iStan The Start Displaying button at the bottom of the Patient Records list changes to a red Stop Displaying button Patient Records Patient record Normal Abdominal Ultrasound The Stop Displaying button The Patient Records List To stop displaying a patient record click Stop Displaying at the bottom of the Patient Records list To close the Patient Records list click the Patient Records button The list closes If a patient record is being displayed the Patient Record button remains red until the list is re opened and Stop Displaying is chosen NOTE Only one patient record can be displayed at a time For information about uploading patient records to Muse for selection from the Run screen see Patient Records on page 113 46 CAE Healthcare Using M se Adding a Scenario to a Running SCE SCEs incorporate scenarios that contain pre
80. PIDE Mete T PC A 170 Cardiac PACING sinks nera boc RO ROG SEDED dodi opo Pv PROUD RERO Gann 172 QI me ses siirrossa sioe 173 BEER oce airo Rb o pte an ad o one DRE DR RR Dv RO Tenge 174 Genitourinary SYSTEM ooo tto horrore pour doni ipte tache hock Lp RD 178 Pharmacology SYSTE 2 uscsasisoci n aeter pin peii thrive REL H vu ER PAY E rH REY 179 ID o m 182 yd HMM NM TM PP AA RE Ar A 182 lvi Oc 187 Breath SONAS NER aceteseeen ciate susnsecoctcot isles wo curiontenasideraeoteenatenetinnerenimiamueltotitinaen 188 Heart SOUS ossi Eo pU EAS Malet ick AARAU M BREUI Med 189 Bowel Sounds once us er PERRA AERA DEAE AR ls cat S LU ERU REP UR M dead 190 iStan Care and Maintenance 191 iStan Warranty Programs ssssisissssisissscsosisoscaitanseosoecsnanuiua sasoian OG DR UAE anesson ioi eadsnasa oinas 191 SUSCIPIT Met E S a 191 Units Out OF AGTEBINIBRE o on P EQUO dri re a a Ox ON OROND OU UO 191 How Rof giried loDi P pj 192 Contract Period PRISE EE T 193 Limitations OP Agreement asas caido cie pcd an RE B EH reto ud 193 Ret rn Materials AUDTIDEZOTIOEL ssec aret ue ES PHERE e et Bt diei ea a t t ei ds 193 System Software Upgrade Support e eeeeee eene eene retten rn eroe atn soa sna en sensns tosta se 194 xviii p CAE Healthcare
81. TER S Secretions Tearing Ears Nose Mouth Temperature Body and blood temperature measured can The response be set using these parameters and can be to clinical displayed on the Patient Status Display intervention must be controlled by the instructor VIEW Neurological PARAMETER S Temperature Body Blood 151 Using iStan iStan Eyes Each eye has reactive pupils and eyelids that blink and close The settings for Pupil Diameter are located on the Neurological view and accessed by select ing from the drop down menu for the appropriate eye Currently there are four pupil options that are used to control the diameter of the pupils in both eyes Modeled default Reactive Blown or a Fixed Pupil Size from 2mm to 8 mm Setting the Pupil Diameter to Reactive causes the pupils to re size in response to changes in light If both pupils are set to Reactive both pupils re size accordingly Other settings allow the user to fix one or both pupils to a specific size b Modeled P Modeled Reactive CERT m Modeled Auto Auto Ama amo 2 mm Blinking Blinking T inm matu i i is ae Closed Closed 4 mm Slow Normal Fast s mm 6 mm P No Pupil Diameter menu Jo gt 7mm 8mm Blown Altering Pupil Diameter The settings for Blink Control are located on the Neurological view gt Modeled B Modeled Auto Auto Blinking Blinking Closed
82. TME COTAUID A NCTA 63 Using the Event Recorder to Save States ciosszossnvecsxaveaacninsncesvnsavnnvessaveneacennsavennwusnnvalaiserdecineniianinecernns 65 Urea d New Patient uode paetos ton a pudo tuna sdb veor eU EUER RR a EUR rU mid 67 DD ERE EO EO 68 The Merc M OUO peti nee oin pent ed a toe pde d iren dies amu ie ins 69 Returning to The Home PAGE uccide ie rte perte eph ciunt rdi tuper cp cedent 71 Stopping TH SCE Sireenin ia E E edu E a n 72 Table of Contents XV Table of Contents iStan DEVEIODING SCES opa DURUM BORDURE DN CDU I IE DEDE 73 Creating S SCE RR TE TO 74 dog cet 75 Editinga Patients Profle oco da o RUD PA Er a eas BUD RARUS 76 Developing ScONANOS s avusoiioi VU PER RR REX KARR AID TUE SOUND CUP REED VI IURATI SG DUE 84 Creating New SCBITHEUE aciei ciel nq Sus sal nh RE aa 84 Editing a SCERamD cese coc REO un Ra a DR RR REOR laid De a UE 86 The Scenario Designe ua pde FOR ROM CUR QUU a AU EUM CHORO OD UA ORUR 87 Adding Scenario States ouiseussoccii epa e acriter DRE xU Rheno E AGREE pan e Nou 90 Modifying Scenario SEGEORs aerei ch degno cor Reit am dc ul ont Cents 91 Deleting Scenario SELES senes dep vor qoe rio kra oreste nu ond rae qid gp p RR Rete pond 97 Deleting Parameters and Tialislllols ucuusasnietosici oret Mud eE neri tease RA RE n 98 ESTRUM IET ECT 99 53000 States to the State DIDEADY od YO IR HOGYEDRQR PY ER GPS XOU EARN RUE 100
83. The Stop Simulation dialog box appears c Click the Stop Simulation button The Simulation stops and returns to the Home page d Click the Account Name in the lower right hand corner of the screen The Logout dialog box appears e Click Logout to exit the software To shut down the TouchPro software optional a Click the Settings button in the bottom right hand corner of the TouchPro screen b From the Settings menu click Shutdown A warning box appears asking if you want to exit c Click Shutdown Step 3 Power Off the Simulator 1 Carefully pull pack the skin on iStan s left hip and flip the power switch to the OFF position 2 Carefully pull the skin back into place for storage 195 iStan Care and Maintenance iStan Maintenance Advice Simple care and maintenance helps to ensure that iStan stays in good working condition Many problems are caused by inadequate or improper maintenance Perform a thorough check of the various components each time the simulator is used General Simulator Care Avoid the use of writing instruments and sharp objects near the patient simulator to prevent unattractive markings on or tears in the skin Lubricate airway adjuncts urinary catheters and chest tubes with silicone spray and NOT a water based lubricant prior to insertion A mild detergent and warm water will remove most marks and stains Gently rub the soiled area with a soft cloth Do NOT use ABRASIVE soaps or pad
84. Wireless Microphone The wireless receiver enables the user to communicate through the simulator using a microphone The clip on microphone is attached to a transmitter that may be attached toa belt or waistband The microphone is battery operated and has a power switch on the top to turn it on and off Wireless Voice Link The wireless voice link replaces the wireless microphone feature in iStan simulators with the serial number 852 and higher For more information about this feature see Appendix B Wireless Voice Link on page B 1 Trauma Fill Tanks Fluids are supplied to the simulator using a trauma fill tank Two tanks are supplied so that one tank may be used for distilled water and red food coloring for simulated blood and the other tank used for distilled water for clear fluids These tanks should be cleaned after use but even with cleaning it is best to dedicate one tank to simulated blood p CAE Healthcare Introduction Optional Equipment for iStan Additional components enable the iStan system to be customized to fit the specific needs of a wide variety of education environments Tablet Instructor Workstation The Tablet Instructor Workstation is an optional ruggedized tablet computer that can be used instead of the Laptop Instructor Workstation to run the M se software An additional M se license is provided with this option NOTE The Tablet Instructor Workstation cannot perform calibration utili
85. a Volume Loss The amount or rate of decrease in the plasma volume A given amount or rate of plasma loss decreases the plasma volume without changing the red blood cell volume Plasma Volume Loss refers collectively and generically to all plasma fluid losses including evaporative transcellular e g ascites pleural effusion bowel and third space losses Hematocrit The ratio of Red Blood Cell Volume to Total Blood Volume expressed as a percentage 175 176 Using iStan iStan Hemorrhage Setup The user determines the type and placement of the bleeding moulage for the lesson An optional Moulage Kit see page 10 can provide molded gunshot wounds broken and protruding bones amputations and an abdominal wound as well as theatrical components To decrease the likelihood of staining apply a thin coat of petroleum jelly to the area of bleeding Using one of the moulage wounds from the Moulage Kit 1 Secure the wound over the simulator using the integrated straps 2 Connect this haptic to the wound umbilical the hose running along the arm or leg downward from the red Bleeding Connector for each limb or abdomen The Bleeding Connectors for the legs can be found behind the skin on either side of the simulator at the hip The Bleeding Connector for the arms can be found protruding from the upper arm skins The Bleeding Connector for the abdomen is also located behind the skin on the right side of the simulator at the hip Look f
86. a secretions valve was added to the internal operations of iStan This valve can be found inside the left chest area and it is attached to the black router cover adjacent to the circuit breaker When iStan is shipped the valve is in the fully closed position Therefore the valve needs to be opened in order to achieve secretions The valve is very sensitive and only needs to be opened slightly If the secretions are too forceful adjust the valve accordingly Step 3 Ensure the Cervical Clip is Detached iStan includes a cervical clip that can be clipped to the inside of the neck to prevent the neck from turning or moving This feature is useful in certain specialized clinical scenarios However for normal use the clip should be removed To check whether the clip is in place turn iStan s head from side to side If the neck moves freely the clip is detached and no further action is needed If the neck does not move freely 1 Pull back the neck skin at the back of iStan s head 2 Feel behind the skin at the back of the neck for the metal clip The clip is permanently tethered to iStan by a metal wire 3 Once the clip has been located pull down until it detaches The neck skin GIU rF mm The Cervical Clip 4 Place the clip and the metal wire under the neck skin 5 Return the neck skin to its original position The clip can be replaced as needed by feeling for the groove in the neck and placing the clip in the groove For
87. acy of ventilation and oxygen by the instructor administration VIEW Respiratory PARAMETER S Fraction of Inspired o 2 Arterial Blood Gases PaO PaCO and pH are continuously None required but None required calculated and displayed when adjustable selected for the Patient Status Display VIEW Respiratory PARAMETER S O Consumption CO Production Factor Articulated Mandible Allows for jaw thrust when sensors None required in the lower jaw are grasped in a clinically appropriate manner Breakaway Teeth Upper front teeth can be dislodged None required See Breakaway if laryngoscopy is performed Teeth incorrectly Bronchial Occlusion Completely obstructs right and or left VIEW Respiratory None required mainstem bronchi simulating a lower airway obstruction e g mucus plug PARAMETER S This yields an inability to ventilate the Bronchial lungs Occlusion Chest Excursion Synchronized with ventilation None required None required spontaneous or mechanical Excursion depth proportional to tidal volume ZW CAE Healthcare Using iStan Respiratory Features Chest Tube Placement Chest tubes can be inserted bilaterally The instructor must see Chest tube into the mid axillary line of the fifth adjust the amount intercostal space Suction equipment of physiologic can be applied to withdraw fluid from intrapleural fluid the simulated intrapleural space present VIEW Respirato
88. an SCE are enabled by default To disable a pulse click the pulse location on the human form To enable a pulse click the pulse location again Click and hold a pulse location to adjust the pulse deficit A 38 CAE Healthcare Appendix A Parameter Descriptions Fluids The blood droplet provides a means of controlling the amount of fluid lost by or infused into the patient The amount of fluid to be lost or infused and the time frame during which the fluid loss or infusion takes place can be entered Fluid Parameters Urine Output Bleedi val 2 Fluid Loss Blood When used the Fluid Loss Blood parameter reflects a decrease in total blood volume Blood loss proportionally decreases both the red blood cell volume and the plasma volume according to the current hematocrit Range 0 mL 4000 mL Fluid Loss Plasma When used the Fluid Loss Plasma parameter reflects a decrease in plasma volume Plasma loss decreases the plasma volume without changing the red blood cell volume It refers collectively and generically to all fluid losses including evaporative transcellular bowel and third space fluid losses Range 0 mL 4000 mL A 39 Appendix A Parameter Descriptions iStan A 40 Colloid Infusion When used the Colloid Infusion parameter reflects an addition to the plasma volume without changing the red blood cell volume Colloids include modified fluid gelatin starch solutions dextran and human
89. an be administered through the permanent access catheters located at the right jugular and the left femoral veins Permanent IV Access Ports Permanent IV access ports are located at the left and right antecubital the right jugular and the left femoral veins The IV system must be primed before the IV ports can be used To prime the IV access ports 1 Verify caps are present on the Drain port and the Jugular IV Femoral IV Left and Right Antecubital IV Prime Sternum IO Prime and Left and Right Tibial IO Prime ports For information about locating the IO ports see Intraosseous Infusion on page 181 As you prime the system you will need to temporarily remove the caps from the Drain port and IV ports one at a time to drain and prime the lines Be sure to replace the cap on the port used after each step below All caps must be connected for air and fluid to move through the system properly 2 In preparation drain the fluid reservoir by connecting a 60 mL syringe to the Drain port on the right side of the simulator 3 Withdraw air and excess moisture from the reservoir until a vacuum is formed the plunger is difficult to pull 4 Connect a 60 mL syringe filled with distilled water to the Jugular IV port and prime the line with approximately 10 mL 5 Move the 60 mL syringe to the Left Femoral IV port and prime the line with approximately 10 mL 6 Move the 60 mL syringe to the Left Antecubital IV port and prime the line with
90. and Fast parameters control the eyelid blinking frequency Presently blinking frequency is not linked to the physiological models However the response can be done on the fly or scripted using the Scenario Designer Default Normal Secretions Tearing When activated the Secretions Tearing parameter is capable of producing tearing at the eyes Default No Secretions Secretions Ears When activated the Secretions Ears parameter is capable of producing clear secretions at the ears Default No Secretions Secretions Nose When activated the Secretions Nose parameter is capable of producing clear secretions at the nose Default No Secretions Secretions Mouth When activated the Secretions Mouth parameter is capable of producing clear secretions at the mouth Default No Secretions A 3 Appendix A Parameter Descriptions iStan A 4 Diaphoresis When enabled the Diaphoresis parameter is used to simulate the presence of diaphoresis on the forehead of the simulator At this time diaphoresis is not linked with the physiological models Default Disable Convulsions The Convulsions parameter is used to simulate the presence of convulsions They are either ON or OFF Default Off Intracranial Pressure ICP The ICP parameter is used to set the ICP displayed as a numeric value on the TouchPro monitor The base value is set at 8 mmHg This parameter is uninfluenced by physiological models Default
91. and the widget changes to reflect the new selection From the numeric widget menu you can also use the Set Color button to change the display color of the widget and the Set Alarm button to change the alarm settings for the selected widget 43 Using M se iStan The Event Logs During an SCE all software operations sensed by the simulator or entered manually e g virtual defibrillation are recorded by an event entry that appears on the screen The event entry notes what occurred and the time it happened Event Logs 00 01 27 Applied condition Bag Valve Mask 73 FiO2 00 01 18 Epinephrine 1 1 000 0 3 meg kg min IM Administered 00 00 00 SCE was started The Event Logs Event Logs can also be exported For more information see History on page 104 Displaying Patient Records Patient records can be uploaded to Muse and displayed in the TouchPro software while an SCE is running To display an uploaded patient record 1 From the Muse Run screen click the Patient Records button The Patient Records Button Z CAE Healthcare Using Mise The Patient Records list appears displaying all available patient records Patient Records Patient records Normal Abdominal Ultrasound The Start Displaying button Start Displaying The Patient Records List 2 Select a patient record from the list 3 Click Start Displaying The patient record is shown in a new TouchPro web browser window IMP
92. approximately 10 mL 179 180 Using iStan iStan 7 Move the 60 mL syringe to the Right Antecubital IV port and prime the line with approximately 10 mL 8 Using an empty 60 mL syringe connected to the IV Prime port located in the mid clavicular region withdraw trapped air from the system until the plunger is difficult to move 9 Connect a 60 mL syringe filled with distilled water to the IV Prime port and firmly inject all 60 mL This charges the system for Flash and fills a small bladder to support drawing blood samples NOTE For added realism if desired use distilled water tinted with red food coloring Intravenous fluids and medications can be administered by attaching the tubing from a standard IV solution set to the desired port If administering more than 100 mL connect an external IV bag to the Drain port in iStan s right hip to prevent overfilling the simulator For information regarding cleanup after using the IV IO feature see pages 206 and 207 p CAE Healthcare Using iStan Intraosseous Infusion iStan has three intraosseous IO sites one at the sternum and one on each tibia where the patient can be infused The IO system must be primed before the IO sites can be used Only the sites to be used need to be primed To prime the IO sites 1 Using the 60 mL syringe inject 30 mL of distilled water into the Jugular IV port For added realism if desired use distilled water tinted with red food coloring
93. are may assign this Agreement in whole or in part and or its rights and obligations in CAE Healthcare s sole discretion to any party This Agreement shall be binding upon and enure to the benefit of the parties hereto and their permitted successors and assigns Any assignment of this Agreement or any license granted herein in violation of the provisions of this Section shall be void 9 9 Entire Agreement This License constitutes the complete agreement of the parties with respect to the subject matter referred to herein and supersede any other agreements written or oral concerning the subject matter hereof 9 10 Language The parties declare that they have requested and hereby confirm their express wish that this License and related agreements and documents be drawn up in the English language and that any notification letter or any other communication from a party to the other pertaining thereto shall be solely in the English language End of License iStan Declaration of Conformity Application of Council Directive s Low Voltage Directive 73 23 EEC EMC Directive 89 336 EEC Standard s to which Conformity is declared EN61010 EN55011 EN61000 3 2 EN61000 3 3 EN61000 4 2 EN61000 4 3 EN61000 4 4 EN61000 4 5 EN61000 4 6 EN61000 4 8 EN61000 4 11 Manufacturer s Name Medical Education Technologies Inc Manufacturer s Address 6300 Edgelake Drive Sarasota FL 34240 U S A Type of Equipment Patient Care Sim
94. arterial oxygen or carbon dioxide levels In such situations the patient can only respond to arterial oxygen or carbon dioxide levels by adjusting the Tidal Volume parameter Default Modeled Range 4 breaths per minute 40 breaths per minute Respiratory Rate Factor The Respiratory Rate Factor parameter along with the Tidal Volume Factor parameter is used to change the baseline respiratory rate before the control of breathing and drug influences are taken into account A value of 2 doubles the baseline respiratory rate A value of 0 5 decreases the baseline respiratory rate by 50 Default 1 Range 0 01 6 00 TIP First decrease the respiratory gain factor to reduce the influence of the respiratory control mechanism on the respiratory rate and tidal volume o CAE Healthcare Appendix A Parameter Descriptions Shunt Fraction The Shunt Fraction parameter is frequently used to assist in desaturating a patient This parameter creates a physiologic bypass of the normal pulmonary circulation resulting in changes in O CO and anesthetic gases at the alveolar level Typically values of 0 1 to 0 4 are needed to create large alveolar arterial oxygen gradients sufficient to cause arterial hypoxemia Default 0 02 Range 0 00 0 50 TIP If the parameter is set high 0 5 the patient desaturates rapidly and responds to the administration of supplemental O SpO The SpO parameter is used to override the normal pulmonary
95. asath Caunde Click Vocal Sounds to access the Vocal Sounds menu he Sounds Vocal Sounds None Crying Gagging Gasping Groaning Long Loud Cough Long Soft Cough Wheezing Mumbling Vocal Sounds Menu Vocal Sounds play continuously when selected and are emitted immediately when selected from the Vocal Sounds drop down menu To stop playing one of the vocal sounds select None from the list 183 Using iStan iStan Speech Sounds Speech Sounds include a male or female voice that can utter pain rating indicators from 0 to 10 various phrases and a series of other utterances Unlike Vocal Sounds Speech Sounds only play once Speech Sounds 184 Zw CAE Healthcare Using iStan To play a Speech Sound click the Speech balloon A list of Soeech Sounds appears The Speech Sounds menu Select the desired sound The sound plays and the list disappears To replay the last sound click the Play button in the Speech balloon Loud cough Soft cough Short Loud Cough Short Soft Cough Scream Grunt Yes No Sometimes Ouch 10 9 8 7 8 My leg hurts My belly hurts My chest is tight I can t breathe Ow that hurts Zero One Two Three Four Five Six Seven Eight Nine Ten Sharp Pressure The Speech Sounds Menu 185 Using iStan iStan Wireless Voice Capability In addition to the pre programmed
96. ases the pulmonary vascular resistance while lowering the value decreases the vascular resistance Raising the parameter value is analogous to increasing the resistance to blood flow through the pulmonary vasculature Under such conditions the pulmonary artery pressure PAP and central venous pressure CVP increase due to back pressure through the right side of the heart Default 1 Range 0 10 10 00 Venous Return Resistance Factor The Venous Return Resistance Factor parameteradjusts the resistance between the extrathoracic and intrathoracic venous compartments Raising the value increases the resistance while lowering the value decreases the resistance With less blood returning to the heart there is a reduced volume entering the ventricles prior to ventricular contraction This results in a drop in the cardiac output and decrease in arterial blood pressures The heart rate increases due to feedback from the physiological control mechanisms in an attempt to maintain adequate blood pressures Default 1 Range 0 10 100 00 CAE Healthcare Appendix A Parameter Descriptions Baroreceptor Gain Overall Factor The Baroreceptor Gain Overall Factor parameteradjusts the influence of mean arterial pressure MAP on heart rate contractility systemic vascular resistance and venous capacity Use this parameter to adjust how vigorously the heart and vasculature respond to blood pressure changes The degree of increase in h
97. ate expands and additional options appear The state name The Expanded State 90 CAE Healthcare Using M se 3 Double click the state name By default new states are named State The Rename state window appears and contains a field for entering a new state name The Sta te The Save Name field button The Rename State Window 4 Enter a new state name NOTE When naming a Scenario State the state name may NOT exceed 127 characters Additionally scenario file and state names CANNOT contain any special characters such as 96 5 Click Save The state is renamed Modifying Scenario States Once a scenario state has been placed on the canvas it can be modified Additional parameters transitions and notes can be added Each state can contain multiple parameters and transitions Double click the state name to rename it The Collapse State button 145 mmHg 95 mmHg 38 0 C 23 breaths min Create A State Click the Collapse State button to minimize the state Double click the collapsed state to expand it 91 Using M se iStan Adding Conditions Interventions and Parameters Conditions and interventions can be added to states by dragging and dropping them from the Conditions menu to the desired state Adding a condition or intervention to a state The Conditions menu m se Hypotension scenario fea
98. ation Utility allows users to ensure the accuracy of their pacing and defibrillation device All simulators are calibrated for defibrillation and pacing prior to shipment however when using a new or different defibrillator e g switching between monophasic and biphasic running the calibration utility is necessary The following items are required to complete the calibration CAE Healthcare Simulator ECS PediaSIM BabySIM or iStan e Macintosh Instructor Workstation with HPS6 software Defibrillation Calibration Utility e AED Defibrillator Pacing Device Getting Started Before running the utility power on the simulator and allow three minutes for the simulator to fully power up prior to turning on the instructor workstation See iStan Setup on page 15 of this user guide for more information on how to power on iStan Once the simulator is on connect the defibrillation device cables or AED pads to the chest See Using iStan on page 147 of this user guide for instructions on how to connect defibrillator devices or AED pads to iStan After the defibrillation device is connected to the simulator turn on the device but do NOT start the HPS6 software application Setting Up the Calibration Utility When a defibrillator is being used for the first time with a simulator the pair should be calibrated to each other Running the calibration utility ensures that the Joule or mA values logged by the simulator match the defibrillation or
99. axis sere ad ES eem State py Collapse AM Expand All The Scenario Designer The Scenario Designer The Scenario Designer is accessed by creating or editing a scenario from the SCE Editor From the Scenario Designer scenario states can be added modified and deleted Anaphylaxis The T Scenario button The View P ha e buttons Canvas The New d State e button U The Scenario Designer The Scenario button is used to manage states and save the scenario The View buttons toggle between Scenario Designer views The New State button is used to add new states Once created states are displayed on the Scenario Designer canvas 87 Using M se iStan Scenario Designer Views The Scenario Designer has two views the Graphical view and the Line Item view The Graphical view allows users to map out scenario states The Line Item view places the states and transitions into a linear format The The Line Graphical x Scenario E E New State b Collapse All Y Expand All Item View View button button The Scenario Designer View Buttons Click the Graphical view button to utilize the Graphical View Anaphylaxis Lf oem ES New State jy Collapse Al w Expand AB Be The Collapse State button An expanded state P i The Graphical View From the Graphical View double click on any state to expand it and view all its components Click the Collapse Sta
100. ay be set with the Perfusion Intensity parameter At this time capillary refill is not linked with the physiological models Default Off Options Less than 3 seconds Greater than 3 seconds Off NOTE This parameter may not be used at the same time as the Cyanosis parameters Autoinjection The Autoinjection parameter is used to activate the mechanism on the lateral aspect of each thigh for autoinjector use Once activated simulating the injection by pressure on the lateral aspect of each thigh causes the immediate administration of atropine 2 mg intramuscularly An autoinjector mechanism should be used without a needle to avoid damaging the simulator Default Disable Options Disable Enable CAE Healthcare Appendix A Parameter Descriptions Baroreceptor Maximum Pressure Baroreceptor maximum pressure defines the mean arterial pressure MAP at which the baroreceptor inhibitory activity on the heart is maximal When a simulated patient s MAP increases above baseline pressure the baroreceptor response exerts greater inhibitory controls on the MAP e g reduction in heart rate in an attempt to return the MAP to the patient s baseline pressure However these controls have an upper limit and this maximum pressure is defined as the baroreceptor maximum pressure In other words as the MAP increases the physiological controls i e baroreceptor response work to bring the pressure back toward baseline primarily by redu
101. ay displayed on the Run screen click Patient Status Display under the SCE Configuration heading on the SCE Editor The Patient Status Display screen appears Patient Status Display Available Widgets Th e Ava i l a b l e Widgets panel Patient Status Display spaces The Patient Status Display Screen To modify the Patient Status Display drag and drop the desired waveform numeric or volume widgets from the Available Widgets panel to an available Patient Status Display space NOTE Waveforms occupy two spaces Once the desired widget is placed click the widget to change the physiologic parameter displayed 81 Using M se iStan Adding a Scenario from the SCE Editor SCEs incorporate scenarios that contain preprogrammed physiology Scenarios can be added to SCEs to enhance patient physiology When a scenario is added to an SCE from the SCE Editor the scenario becomes associated with the SCE and begins automatically when the SCE is run Click the Add Scenario button on the Run screen to add a scenario to an SCE that is running To add a scenario to an SCE from the SCE Editor 1 Click the Add Scenario button under the Preloaded Scenarios heading Pre Loaded Scenarios E Add Scenario The Add Scenario Button a CAE Healthcare Using M se The Choose Scenario dialog box appears Scenarios iex Name Last Modified Anterior Myocardial Infarction 2011 09 12 09 38 39 COPD Exacerbation w
102. ble Left and Chest Tube Enable Right to Prime When fluid stops flowing stop the SCE 202 p CAE Healthcare iStan Care and Maintenance Cleaning and Flushing After Blood Secretions To clean simulated blood from the simulator and fluid system 1 oN DW so 11 12 13 14 15 Wipe the simulator off immediately to remove red fluid The food color will stain more readily if left on for an extended period Connect the Trauma Fill Tank containing the red fluid to the blue fill connector on the right side but do not connect the yellow vent connection Turn the yellow pressure relief knob clockwise open on the Trauma Fill Tank Alternatively loosen the Trauma Fill Tank lid so that the tank is able to vent during the subsequent process From the Fluids view of a preconfigured SCE turn both bleeding channels to ON This setting turns on all valves to maximize the flow of the remaining blood mixture into the Trauma Fill Tank When fluid stops flowing turn both of the bleeding channels OFF Disconnect the Trauma Fill Tank from the simulator Rinse the Trauma Fill Tank thoroughly Pour approximately 16 ounces the size of the Overfill Bottle of clean distilled water into the tank Pump the distilled water into the simulator If a chest tube was used flush that system by clicking Chest Tube Enable right or left from the Respiratory view of a preconfigured SCE and select Prim
103. ble SCEs appear in the SCE Selection panel on the Home page The Search button The Clear button The Search field Running Now Recent Tabs Asthma Attack Norma L Female Food Poisoning Stan D Ardman II a Healthy Adult Female Norma L Female O Healthy Adult Male 1 The selected SCE Base SCEs a Healthy Soldier GI Stan a Hypertensive Patient Stanley A Wreck Page arrows Page The Open Library rd rd Open ubrary f New sce The SCE Selection Panel N v The New SCE button The SCE Selection panel has four tabs that access SCEs Running Now Recent Favorites and All Running Now tab Lists the SCEs that are currently running and is only available when at least one SCE is running e Recent tab Lists all the recently run or edited SCEs Favorites tab Lists all SCEs that have been selected as favorites and is only displayed after favorites have been selected To add a favorite SCE to your profile click the Add to Favorites button at the top of any SCE on the Home page Managing favorites is achieved in the Account Profile portion of the software All tab Lists all SCEs including user created SCEs and all SCEs from available learning modules To search for an installed SCE enter part of the name of an SCE in the Search field and click the Search button 35 Using M se iStan Click any SCE to select it Once an SCE is s
104. button below and your access to the Software and Data is prohibited 1 DEFINITIONS AND INTERPRETATION Ast The preamble forms an integral part of this License 1 2 Terms with a capital letter defined in the Preamble have the meaning indicated in the Preamble Whenever used in this License the following terms have the meaning set out below a Confidential Information means any and all scientific and technical information which is in the possession of or belonging to CAE Healthcare and relating to the Product including without limitation all Data Software trade secrets know how processes methodologies samples components analyses compilations guides and other information or documents prepared by CAE Healthcare its subsidiaries and affiliates and or their officers servants agents representatives employees or advisers which contain or are otherwise generated from or reflect any CAE Healthcare proprietary information whether or not covered by intellectual property rights or explicitly designated as confidential or proprietary which is disclosed by any means in written oral electronic or any other form b Purpose means the use of the Software and the Data solely for the operation and maintenance of the Product and the use of the Product solely as an educational tool 2 LICENSE 2 1 In consideration of Licensee s agreement and compliance with the terms and conditions contained in the HEPGTC and in this License CAE
105. can be viewed and adjusted Using Muse Brain f Heart j Lun of Vie 3 e 7 o 9 e i l e l la Blood droplet TDCK HEJ ee a Sounds button e LU Sounds J The Physiological Views 49 Using M se iStan To change a patient s physiology using the physiological view 1 Click the appropriate organ icon or button from the homunculus to select the appropriate physiological view 0 eceicxume zan D Aedes I The associated parameters The homunculus The Run Screen The associated parameters appear to the left of the homunculus 2 Locate the desired parameter 3 Select the parameter and set the new value 50 CAE Healthcare Using M se Parameters have varying controls such as sliders switches and menus In the image below the Heart Rate parameter is shown Within the Heart Rate parameter there are switches that toggle between Modeled and Override and Seconds and Minutes a slider that sets the beats per minute and it s an available field where the beats per minute value can be keyed in NEM UN Blood Pressure Modeled Heart Rate Modeled T i Heart Rate a Modeled L off ET d gt Peripheral e P Right Atrium f Pulmonary Deflated 4 The Heart Rate Parameter Once the parameter has been set it is reflected in the patient s physiology 51 Using M se iStan Types of Parameters There are two typ
106. censcasadescedtecnevcsanusissddesenenncasdecavaduseneveaseess 3 Eq ipm nt OVervieW correre RR HEPVERE FERE VEREFXNMENMRERUX KR URER OPERE FERRI TENE es aiaa iasa 4 Standard Components InVeltory ineei ERR m en nq ep DR ee 4 Optional Components Inventory ssesscsssssssesccsssesssssssssscsssssccssssessssccesssecssuccessuecssuuscsssecessuecsssecssuecessnscssseeessnees 5 iStariStandard EQqUIDITIEDL coser pn ON RE FXY QR NEGRA REX NEKRU RE EREXRER E EHE ORDRE sasaa sasas sessist 6 F ll B dy Wireless SITILEAEDE ooi qopixod sna P i pa EO Xe RR EO REPERIO Gnd P ONG 6 laptop Instrictor Workstati i sca quy xpo aide coti pe b RU rar eodd orto ERROR DRE 6 CU Canis tef iesene eeaeee uin onal nS Rud AR Urat MARS GR DNA SERRE 7 DIVTSTIIR GINE ER 7 Wireless MICRO ROO e a ete t Rd s i RD M ELA EUR Qd M QUERER ON MEE 8 Wireless Voice LINK eem 8 TII NC cc 8 xiii Table of Contents iStan Optional Equipment for iStan ssssessessossescosossesossessosososososososssssosessosososesososososososssssssosessosesseo 9 Tablet Instructor CU RR P 9 Trauma Disaster Casualty Kit TDCK successio ceerttir nitur te ed 9 Moulage MI e end tape acess fete a qae a dium MM Nd sai qu RA MESE 10 Stan Replacement Lithium Battery Pack soos dle RR REPAS GO NT GRO PROTON RU DR 10 ID 0 H 10 External Compressed Air NIL iususssieidopa periere copi
107. cing the heart rate For every 5 mmHg increase in MAP the heart rate may decrease by 2 beats per minute in an attempt to keep the MAP in check However there is an upper limit maximum pressure after which these controls are no longer effective Once the MAP reaches the baroreceptor maximum pressure there is no additional reduction in heart rate if the pressure continues to rise For example should the pressure continue to rise the heart rate would not show a corresponding slowing Default 112 mmHg Range 40 mmHg 220 mmHg NOTE It is important to set both the baroreceptor maximum pressure and the baroreceptor minimum pressure at the same time for the software to recognize the baroreceptor reset A 31 Appendix A Parameter Descriptions iStan Baroreceptor Minimum Pressure Baroreceptor minimum pressure defines the mean arterial pressure MAP at which the baroreceptor inhibitory activity on the heart is minimal When a simulated patient s MAP decreases below baseline pressure the baroreceptor response exerts inhibitory controls on the MAP e g increase in heart rate in an attempt to return the MAP to the patient s baseline pressure However these controls have a lower limit and this minimum pressure is defined as the baroreceptor minimum pressure In other words as the MAP decreases the physiological controls i e baroreceptor response work to bring the pressure back toward baseline primarily by increasing the
108. ction Septal Myocardial Ischemia Mild Myocardial Ischemia Moderate Myocardial Ischemia Moderate with PVC 1096 Myocardial Ischemia Severe Paroxysmal Junctional Tachycardia Paroxysmal Junctional Tachycardia HR 130 Pericarditis Premature Atrial Contraction Premature Ventricular Contraction 1096 Premature Ventricular Contraction 2596 Pulseless Electrical Activity Sinus Sinus Bradycardia Sinus Bradycardia HR 40 Sinus Tachycardia Sinus Tachycardia HR 120 ST Elevation with Chest Pain Torsade de Pointes Trifascicular Block Ventricular Fibrillation Coarse Ventricular Fibrillation Fine Ventricular Tachycardia Ventricular Tachycardia Pulseless Ventricular Tachycardia HR 151 Ventricular Tachycardia Pulseless HR 151 Wellen s Syndrome WPW Syndrome Left Lateral Pathway A 25 Appendix A Parameter Descriptions iStan Cyanosis Toes Left and Right The Cyanosis Toes parameter is used to simulate the presence of cyanosis in the nail beds of the toes The intensity of the cyanosis may be set with the Perfusion Intensity parameter At this time cyanosis is not linked with the physiological models Default Off NOTE This parameter may not be used at the same time as the Capillary Refill parameters Cyanosis Fingers Left and Right The Cyanosis Fingers parameter is used to simulate the presence of cyanosis in the nail beds of the fingers The intensity of the cyanosis may be set with the Perfusion Intensity pa
109. ctives instructor s notes that can be readily integrated into a lesson plan a specific curriculum or an educational program iStan Disaster Medical Readiness DMR Learning Application iStan Advanced Cardiac Life Support ACLS Learning Application iStan Cardiopulmonary Critical Situations Learning Application iStan Adult Nursing Learning Application iStan Tactical Medical Care Military TMC Learning Application iStan Emergency Medical Services EMS Learning Application The Program for Nursing Curriculum Integration for iStan The CAE Healthcare Program for Nursing Curriculum Integration PNCI focuses on the educational concepts and competencies of existing undergraduate nursing curriculums Developed in partnership with leading nursing schools the PNCI s foundation is the Integration Roadmap a four semester guide that identifies and charts opportunities for learning through simulation 14 CAE Healthcare iStan Setup iStan Setup The following pages will guide you through assembling and configuring iStan Below is a list of the steps required to prepare iStan for operation Setting Up iStan 15 iStan Setup iStan Before Beginning Setup Proper operation of the iStan simulation unit requires correct configuration Before setting up the system keep in mind these basic guidelines Understand the Cautions Warnings information located in the Introduction section of this User Guide Follow the seq
110. d associate records with the Patient Connecting to the Simulator After starting an SCE by clicking the Run button click Connect to connect to the simulator The Connect button is located in the upper right corner of the Run screen The Connect Button An SCE must be running before you can connect to the simulator 41 Using M se iStan Using the Patient Status Display On the Run screen there are widgets that display the patient s physiological status The Patient Status Display widgets can be changed to reflect the user s needs There are six available display spaces for the widgets Waveform widgets utilize two display spaces Patient Status Display a A The Setup button The Mute All dece tolo JL all button Widgets The Patient Status Display Widgets Use the Mute All button to mute all Patient Status Display alarms To adjust the widget layout click the Setup button 42 WJ CAE Healthcare Using Mise The Widget Setup menu opens displaying available widget types Waveform Numeric and Volume Widget Setup 1322 0 1322 0 The Widget Setup Menu Adjust the Patient Status Display layout by dragging a widget type from the Widget Setup Menu and dropping it over the Patient Status Display The new widget type replaces the old To change a Patient Status Display widget click the widget to be changed A list of available parameters appears Choose the desired option from the list
111. diovascular Parameters Basic A 22 CAE Healthcare Appendix A Parameter Descriptions Blood Pressure The Blood Pressure parameter is used to override the physiological modeling for blood pres sure The systolic and diastolic blood pressures can both be set to fixed numeric values regard less of interventions performed Resetting the parameter to Modeled returns control of the underlying Blood Pressure to the physiological models Default Modeled Range Systolic 20 mmHg 200 mmHg Diastolic 10 mmHg 200 mmHg Heart Rate The Heart Rate parameter is used to set the heart rate to a given fixed number of beats per minute Once the heart rate is set to a numeric value administered drugs or intravascular volume changes have no effect on the heart rate but continue to influence other components of the physiological models Use this parameter to fix or set the heart rate to a specific number Default Modeled Range 30 beats per minute 220 beats per minute Heart Rate Factor The Heart Rate Factor parameter is used to change the baseline heart rate before physiological controls are taken into account A value of 2 doubles the baseline heart rate while a value of 0 5 decreases the heart rate by 5096 Use this parameter to raise or lower the heart rate Default 1 Range 0 10 4 00 A 23 Appendix A Parameter Descriptions iStan A 24 Cardiac Rhythm The Cardiac Rhythm parameter is used to change
112. dition Group panel select a group 3 In the Conditions panel click the Add button The New Condition Name dialog box appears 4 Enter a name for the condition in the New Condition Name dialog box 5 Click Save The condition is added to the selected Condition category and group 6 From the Conditions panel select the new Condition 7 Click the Edit Parameters button The Parameters screen appears 8 From the Parameters screen select the desired Condition parameters 9 Click Complete The condition is saved with the selected parameters New condition categories and groups can also be added by clicking the Add button in the Condition Categories and Condition Groups panels Use the Delete and Rename buttons in each panel to delete or rename a Condition group or category NOTE CAE Healthcare Conditions groups and categories cannot be deleted or renamed 112 CAE Healthcare Using M se Patient Records Patient records can be uploaded to M se for display in the TouchPro software Once uploaded a patient record is available for use with any SCE Patient Records are managed from the Patient Records panel on the Content Management tab of the System Administration screen Comtent Management Learning Modules Upload Date 10 50 19 SCEs Base Patients Patient records Scenarios Conditions Preview z Rename Upload Patient Records Delete i Q er Export The Patient Records Panel The following
113. e 1 Click the Medications button Medications are organized by type and all available medications are listed under ALL MEDICATIONS 2 Navigate through the menus to locate the desired medication 55 Using M se iStan 56 3 Once the medication has been located click the medication s name from the list ALL MEDICATIONS Acetaminophen Activated Charcoal Adenosine Albuterol Alfentanil Amiodarone Aspirin Atrecunum Atropine Atrovent BiCarbonate Bretylium Calcium Chloride Captopril racurium d Tubocuranne 50 Diphenhydramine The All Medications Menu The Medication Dose menu appears displaying the pre defined does and custom does routes for the chosen medication The custom Jj dose options Q Morphine 1mgiv 2 5 mg iV Sma iv 10 mg Iv 15 mg IV 20 mg IV 1 mg io 2 5 mg 10 5 mg 10 10 mg IO 15 mg 10 20 mg iO 5 mg IM 10 mg IM The Medication Dose Menu The predefined dose options J CAE Healthcare Using Muse 4 Select a dose option This can be done one of two ways a Choose a pre defined dose Morphine Intramuscular IM Intravenou Intraosseo 1 mg IV 2 5 mg IV 5 mg IV 10 mg IV 15 mg IV EN 1 mg 10 2 5 mg 10 5 mg IO 10 mg 10 15 mg 10 20 mg 10 S mg IM 10 mg IM The Medication Dose Menu The predefined dose options The dose is applied and appears in the patient s physiology
114. e Place a chest catheter in each side until the distilled water runs clear Run until the distilled water runs clear If fluid remains in the system reconnect the Trauma Fill Tank containing the red fluid to the blue fill connector on the right side being sure not to connect the yellow vent connection Turn the yellow pressure relief knob clockwise open on the Trauma Fill Tank From the Fluids view of a preconfigured SCE turn both of the bleeding channels to ON When fluid stops flowing into the Trauma Fill Tank stop the SCE 203 iStan Care and Maintenance iStan Draining the On Board Clear Fluid System To remove fluid from the on board clear fluid system 1 Connect the blue connector of an empty Trauma Fill Tank to the blue fill connector on the left side of the simulator Do NOT connect the yellow connector of the Trauma Fill Tank to the simulator 2 Ensure the yellow pressure relief knob on the Trauma Fill Tank is open so that the tank is able to vent during the subsequent process 3 From the Fluids view of a preconfigured SCE turn both bleeding channels to ON This maximizes the flow of the remaining clear fluid into the Trauma Fill Tank 4 When fluid stops flowing turn both of the bleeding channels OFF 5 Disconnect the Trauma Fill Tank from the simulator 6 Empty the Trauma Fill Tank rinse thoroughly and allow the tank to dry NOTE Once a month it is advised to flush the system with a 5
115. e amount of time that has elapsed and bookmarks that have been created The Bookmark button creates a bookmark at the current point in the SCE The bookmark can be used later to return to this point in the SCE resetting the patient s physiology to what it was when the bookmark was created The Play button starts the SCE if it has been paused The Pause button pauses the SCE time The Fast Forward button accelerates the SCE time at a 4 1 ratio 63 Using M se iStan Using Bookmarks To create a bookmark click the Bookmark button An orange bookmark appears on the Timeline bar A bookmark The Timeline bar The Bookmark button 00 02 14 F Bookmark The SCE Time Controls To return to a bookmarked time in the SCE 1 Click the orange bookmark on the timeline The Return to Bookmark message appears Return to Bookmark Return the patient to Bookmark 3 at time 00 01 27 The Return button The Return to Bookmark Message 2 Click Return The SCE returns the selected point in the timeline NOTE The SCE time continues moving forward and does not reset to the bookmarked time CAE Healthcare Using M se Using the Event Recorder to Save States The Event Recorder can be used to save conditions interventions and parameter changes as states To save a state using the Event Recorder 1 Apply the desired conditions interventions and parameters 2 Click the Event Recorder button at the bottom o
116. e bottom right corner of the TouchPro screen The Settings menu appears 2 From the Settings menu click the Language Selection button The Language Selection panel appears 3 From the Language Selection panel select a language 4 Click Accept Language Selection English US French France Spanish Spain Chinese Traditional Chinese Simplified Polish Russian Korean Cancel Accept The Language Selection Panel The TouchPro software changes to the selected language Exiting the TouchPro Software To exit TouchPro 1 Click the Settings button from the bottom right corner of the TouchPro screen The Settings menu appears 2 From the Settings menu click Shutdown A warning box appears asking if you want to exit 3 Click Shutdown TouchPro shuts down and the M se Start Screen appears 146 p CAE Healthcare Using iStan Using iStan Once iStan has been set up see the Setup section the software has been loaded and an SCE started see the Using the Software section the simulator is ready for learner interventions From the Run screen the features of iStan can be accessed They are broken down into the following categories Neurological Respiratory Cardiovascular Fluids and Sounds Healthy Adult Male 00 09 32 Return Stan D Ardman i j f Bookmark Patient Status Displey amp X z L H i Albuterol amiodarone HIN e 8 i Av
117. e log for use during debriefing and can be used as a scenario transition The chest tube feature is primed and enabled using the Chest Tube Enable parameter located on the Respiratory view To prime the Chest Tube feature 1 Insert the chest tube into the simulator as far as possible 2 Onthe Respiratory view select the Prime option under Chest Tube Enable Left or Chest Tube Enable Right or both depending on need ch ees y hobum iras s st Tut Enable Left Chest Tube Enable 3 Once water begins to flow remove the tube 4 Prior to use select Enable under Chest Tube Enable Left or Chest Tube Enable Right or both depending on the location s utilized 161 Using iStan iStan Three additional parameters allow the user to set air flow and fluid rate as well as to determine the type of air leak Chest Tube Air Leak Flow determines the quantity of air that drains with the chest tube output Chest Tube Air Leak Type sets whether the leak is a pneumothorax or an air leak with the chest tube or the chest wall Chest Tube Flow specifies the rate at which fluid can be removed from the simulated pleural space via a chest tube drainage system All three parameters are located on the Respiratory view under Additional Parameters The Intrapleural Volume parameter allows intrapleural volume to accumulate for example as happens during pneumothorax hydrothorax and hemothorax To simulate a pneumothorax set the
118. e number is made smaller If not the patient s descent increases at a faster rate Default 0 99 Range 0 50 0 99 Aortic Valve Resistance Factor The Aortic Valve Resistance Factor parameter is used to adjust the resistance to blood flow across the aortic valve Increasing the value to greater than 1 corresponds to increased resistance to blood flow through the aortic valve Default 1 Range 1 1000 Mitral Valve Resistance Factor The Mitral Valve Resistance Factor parameter is used to adjust the resistance to blood flow across the mitral valve Increasing the value to greater than 1 corresponds to increased resistance to blood flow through the mitral valve Default 1 Range 1 1000 Pulmonic Valve Resistance Factor The Pulmonic Valve Resistance Factor parameter is used to adjust the resistance to blood flow across the pulmonic valve Increasing the value to greater than 1 corresponds to increased resistance to blood flow through the pulmonic valve Default 1 Range 1 1000 A 37 Appendix A Parameter Descriptions iStan Pulses The table below shows the defaults and ranges for the pulses and pulse deficits for iStan Pulse Default Range emis o 9 39 meae 8 O 9 39 mdaena o 9 39 moe ow mpiedpen w 9 29 DorsaisPedisoenct s 9 29 Posterior tibiaren 3 9 99 All pulses unless altered by
119. e simulator Once the defibrillation device indicates the shock has been administered typically a beep sound the Captured Defib Event window appears DefibCalibrator Captured defib event Con Enter the corresponding setting jode Cancel Set Are we finished Done Captured Defib Event window 2 Click Set and repeat Step 1 as many times as needed using different calibration parameters See Recommended Ranges on page C 10 for more information 3 After the desired calibration parameters have been measured and Step 2 of the last parameters had been completed click Done The Update the Simulator window appears Update the simulator Selecting Update will save current calibration data to the simulator Once the data has been written restart the simulator for any changes to take effect m 13K s View Data Cancel Update Update the Simulator window 4 Three options are available on the Update the Simulator window Click View Data to view the calibration information in a data log e Click Cancel to perform additional calibration or navigate back to the Reset option C 4 p CAE Healthcare Appendix C Defibrillation Calibration Utility Click Update to save the current calibration data to the simulator After clicking the Update button the Update Complete window appears Update complete Press Disconnect and restart the simulator for any changes to take ef
120. eart rate or vascular response is influenced by the baroreceptor gain overall factor For example when blood pressure falls the heart rate increases the arteries increase their vascular tone resistance and there is less pooling of the blood in the venous system all in an attempt to maintain adequate blood pressure A barorecptor gain overall factor value of less than 1 corresponds to baroreceptor depression A barorecptor gain overall factor value greater than 1 leads to a stronger response to MAP changes Default 1 Range 0 00 100 00 Baroreceptor Gain Cardiac Factor The Baroreceptor Gain Cardiac Factor parameter selectively adjusts the influence of mean arterial pressure MAP on the heart rate and contractility influencing how much the heart rate increases or decreases with changes in blood pressure Use this parameter to adjust how vigorously the heart responds to blood pressure changes A baroreceptor gain cardiac factor of less than 1 corresponds to baroreflex depression e g less heart rate response to MAP changes A value greater than 1 leads to a stronger response to MAP changes Default 1 Range 0 00 10 00 Baroreceptor Gain Peripheral Factor The Baroreceptor Gain Peripheral Factor parameter adjusts the influence of mean arterial pressure MAP on systemic vascular resistance and venous capacity influencing how much the vasculature responds to changes in blood pressure For example when blood pre
121. eating a New Patient When an additional patient with specific physiological characteristics is needed for repeated use anew patient can be created from the Run screen To create a new Patient 1 From the Home page run an SCE that has a Patient with the same gender as the Patient to be created 2 From the Run screen apply the desired conditions and set the necessary parameters 3 Once complete click the Patient button at the bottom of the Run screen The Patient Button The Patient pop up menu appears The Save button The Patient Pop Up Menu 4 Click Save The Save a copy of the Patient dialog box appears Save a copy of the Patient The Enter the Saves this patient s current physiologic state new patient The Save button The Save a Copy of the Patient Dialog Box 5 Enter aname for the new Patient in the Enter the new patient name field 6 Click Save The new Patient is saved and available for selection from the Base Patients Library when creating a new SCE 67 iStan Using Mise Resetting a Patient Resetting a Patient brings the Patient back to its original physiological state before any scenarios were applied or modifications were made Any running scenarios are paused However the SCE time is unaffected Additionally the reset appears in the Event Logs NOTE If baseline physiology settings have been selected they are removed when the Patient is reset To reset a Patient 1 W
122. ect does not occur perform the following steps a Click once on the AirPort icon A located at the top right hand corner of the screen b Select the iStan network The network is called iSTANXXX where XXX is the unit number c Enter the Password The password is istanxxx where xxx is the unit number The password is case sensitive eoo AirPort The selected AirPort network requires a password to join Wireless Security WPA Personal Hel Password eeesees __ Show password Remember password in my keychain Cancel OK k d Click OK The M se software can now be launched see Starting the Application on page 31 20 CAE Healthcare iStan Setup Step 6 Connect to the Wireless Network Tablet Instructor Workstation Windows Option Once iStan and the Instructor Workstation are both powered on they automatically establish a wireless connection and when the Internet Explorer browser is opened the M se software launches If the auto connect does not occur perform the following steps 1 Tapon the Wireless Network icon in the task bar 2 Select the iStan wireless network The network is called iSTANXXX and the network password is istanxxx where xxx is the unit number The password is case sensitive 3 Click the Connect button The wireless connection is established The M se software can now be launched using Internet Explorer 21 iStan Setup iStan Optio
123. edea ra da uU grep RR A Rete goi 11 Ait COMPTES SOT NN NER 11 Hands Free Training Ca Dl S uoa agp toscana dental te EEN 12 Stal Ed cati nal Development sssini issnin 13 tan learning ADPICatONS ooi EORR en a 14 The Program for Nursing Curriculum Integration for iStan eene 14 iStan Setup me 15 Before Beginning Eu mt sasni 16 Step 1 Place Stan in the Work ALeascississssscsnccisusesconccisesoncosecasnsessssevnsenenasseeavenennsasevebstaassneveiies 17 Step 2 Open the Secretions Valve ssssossessosossssoscsssosososososososssosossssossessssososososososssosososssssssse 18 Step 3 Ensure the Cervical Clip is Detached sesosesesososososssososseosossssossecsssososososososssososososssosee 18 Step 4 POWER on ISAM eee T 19 Step 5 Power on the Instructor Workstation sesesesosososososososseosossssoseseessososososososssssososssssssee 20 Step 6 Connect to the Wireless Network Laptop Instructor Workstation Macintosh Option 20 Step 6 Connect to the Wireless Network Tablet Instructor Workstation Windows Option 21 Optional Connect the SpO Probe eren eere eene ete tenn een tnn tenens tnn enn tonto tentent 22 Connect a TouchPro Computer to the Wireless Network Optional 23 System Redquiremienis ciionesonid
124. ediately begins to play in a continuous loop until None is selected A variety of programmable Vocal Sounds are available Vocal Sounds are male or female based on the gender of the active patient Vocal Sounds To select a sound from the Vocal Sounds drop down menu click the Sounds button on the Run screen The Sounds panel appears Click Vocal Sounds and select the type of sound desired from the Vocal Sounds drop down menu Default None NOTE The volume control slider may be used to adjust the amplitude of the sound The volume control slider is only enabled while connected to a simulator A 46 CAE Healthcare Appendix B Wireless Voice Link Appendix B Wireless Voice Link This information is intended to assist in preparing Wireless Voice Link WVL devices for use in conjunction with iStan Cautions and Warnings This device complies with part 15 of the FCC Rules and with Industry Canada licence exempt RSS standard s Operation is subject to the following two conditions 1 This device may not cause interference 2 This device must accept any interference including interference that may cause undesired operation of the device Cet appareil est conforme aux normes d Industrie Canada exempts de licence RSS s Son fonctionnement est soumis aux deux conditions suivantes 1 Cetappareil ne doit pas provoquer d interf rences 2 Cetappareil doit accepter toute interf rence y compris les interf rences
125. ee PaCO Set point on page B 14 for more information Default 100 00 mmHg Range 20 0 mmHg 100 0 mmHg PetCO PaCO Factor The PetCO PaCO Factor adjusts the end tidal CO relative to the PaCO At the default value of 1 PetCO very closely approximates PaCO When PetCO PaCO Factor is set at a value of 2 PetCO is approximately one half of PaCO PetCO depends on CO production and alveolar ventilation Because the alveolar dead space is not modeled physically in the hardware the responses to changes in mechanical ventilation settings may not be exact The use of the Onset feature e g onset over 1 minute is recommended for this parameter Default 1 Range 0 9 10 0 Respiratory Gain Factor The Respiratory Gain Factor determines how strong an influence arterial CO levels have on the simulated patient s tidal volume and respiratory rate Under default conditions value 1 when arterial CO levels rise the patient s respiratory rate and tidal volume show a transitory increase in an attempt to return the patient to the physiological control CO set point If the Respiratory Gain Factor is increased to more than 1 the patient has a more pronounced response while values less than 1 correspond to a blunted response Default 1 Range 0 00 10 00 Respiratory Quotient Respiratory Quotient is the rate of carbon dioxide production divided by the rate of oxygen consumption Changes to the Respiratory Quotient param
126. el of the base station by adjusting the handset volume dial The sound output from the simulator is noisy when the speaker is not speaking You can use the noise reduction feature by setting the handset DIP switch position 8 to ON The simulator voice output is cut off when the speaker is speaking quietly In this case there are three possible options Attempt to talk louder Increase the microphone gain Disable the noise reduction feature by setting the handset DIP switch 8 to OFF Specifications Frequency of operation 2 400 2 4835 GHz Wireless range 100 ft clear line of sight RF power output 0dBm Batteries 2 AAA Alkaline NiCd NiMH Lithium Handset battery life with base station on 25 hours with alkaline batteries Handset battery life with base station off 100 hours with alkaline batteries DC voltage input 5 VDC 0 2A Line out jack 3 5 mm Headphone iPhone jack 3 5 mm Standalone microphone jack 3 5 mm Mechanical dimensions with antenna 6 17 x 2 52 x 0 65 Mechanical dimensions without antenna 4 2 x 2 52 x 0 65 B 11 Appendix B Wireless Voice Link RF Channel Initial Operating Frequencies p pa e S hp das E hb pa pan o ho pa a 5 o pwa 4e O lp pae 4e s pes E b pas 4s iStan p CAE Healthcare Appendix C Defibrillation Calibration Utility Appendix C Defibrillation Calibration Utility The Defibrillation Calibr
127. el 5 Hemorrhage Channel 6 Colloid Infusion Crystalloid Infusion PRBC Infusion Whole Blood Infusion Cyanossis Fingers Arterial Catheter Central Venous Catheter PA Catheter PA Balloon Defib Pacing Current Urine Output Bleeding Pacing Rate Pacing Capture Threshold Cold Fluid Inject p CAE Healthcare Using iStan Additional parameters available are shown in the table below Additional Parameters Respiratory Rate Chest Tube Air Leak Type Right Tidal Volume Tidal Volume Factor pH Shift PEEP Chest Tube Enable Left Chest Tube Enable Right Chest Tube Flow Left Chest Tube Flow Right Chest Tube Air Leak Type Left Chest Tube Air Leak Flow Left Chest Tube Air Leak Flow Right O Consumption CO Production Factor PaCO Set point to E Ratio 1 X PetCO PaCO Factor Respiratory Gain Factor Respiratory Quotient Volume Rate Control Factor Chest Wall Capacity Chest Wall Compliance Factor Distended Chest Wall Compliace Factor Functional Residual Capacity Perfusion Intensity Capillary Refill Big Toe Left Capillary Refill Big Toe Right Capillary Refill Thumb Left Capillary Refill Thumb Right Jugular Vein Distension Baroreceptor Maximum Pressure Baroreceptor Minimum Pressure Left Ventricle Contractillity Factor Right Ventricle Contractility Factor Systemic Vascular Resistance Factor Venous Capacity Factor Extratho
128. elected it appears in the SCE Summary panel To run an SCE click Run in the SCE Summary panel to execute the SCE A running SCE appears in orange with an X icon Base SCEs are created by CAE Healthcare and represent base patient physiology Base SCEs have no associated scenarios and no physiological progressions The Lock icon indicates a locked SCE AN The Lock icon A E ealthy Adult Male Stan D Ardman II A Locked SCE Locked SCEs are installed by CAE Healthcare and cannot be deleted Base and preconfigured SCEs are locked Click the page arrows to view additional pages of installed SCEs To open the SCE Library click the Open Library button To create a new SCE click the New SCE button 36 J CAE Healthcare Using Mise The SCE Library Access SCEs from your library by clicking the Open Library button at the bottom of the SCE Selection panel The SCE Library appears The Learning Modules icon F Learning Modules Preconfigured SCEs 1 0 The Learning Modules menu n The SCEs icon The Close sce Library button doen fig New scen The SCE Library The Learning Modules menu is open by default The Learning Modules menu lists Base SCEs Preconfigured SCEs and all installed learning applications Click the desired learning application name to access its SCEs or click Base SCEs or Preconfigured SCEs The selected SCEs appear Clicking the SCEs icon reveals the SCEs m
129. elopment or edit it later Use the Review button to edit an existing SCE The Review Button 73 Using M se iStan Creating a New SCE Creating an SCE requires naming the SCE and selecting a Base Patient To create a new SCE 1 From the Home screen click New SCE The New SCE Button The Patients Palette appears Name Stan D Ardman II Age 33 years old Gender Male Weight 70 0 kg Aw create The Create button The Patients Palette 2 Select a patient from the palette and click Create The SCE Editor appears showing the Enter a name for the SCE dialog box e m button Name field The SCE Editor Screen 74 J CAE Healthcare Using Mise 3 Enter the name for the SCE NOTE The name of the SCE may NOT exceed 80 characters Additionally SCE file names CANNOT contain any special characters such as lt gt 4 Click Save Once the SCE is saved it is stored and can be edited and reviewed at any time including creating a Patient Profile and content determining settings and programming scenarios The SCE Editor The SCE Editor can be used to review preconfigured SCEs and to create or edit custom SCEs To access the SCE Editor click the Review button in the SCE Summary Panel or create a new SCE The SCE title Anaphylaxis k le The Return button The Print button The Run button Content Management Patient profile
130. ement on the pacing device e g 20 mA as first calibration parameter for Adult using the Current function See Recommended Ranges on page C 10 for more information 4 Click Start in the Configure Initial Pace Settings window The Calibrating Simulator Pacing window appears while 5 current samples are transmitted from the device to the simulator JZ CAE Healthcare Appendix C Defibrillation Calibration Utility Waiting for pace event 2 5 Are we finished Done Calibrating Simulator Pacing window Once the pacing device indicates the current has been administered the Captured Pace Event window appears 5 Enter the mA that was set on the pacing device and click Set Captured pace event Enter the corresponding setting 2o m Gre ED Are we finished Done a Captured Pace Event window Appendix C Defibrillation Calibration Utility iStan 6 Repeat Steps 1 through 5 as many times as desired using different calibration parameters each time See Recommended Ranges on page C 10 for more information When the desired number of calibration parameters are reached click Done The Update the Simulator window appears Update the simulator Selecting Update will save current calibration data to the simulator Once the data has been written restart the simulator for any changes to take effect View Data Cancel Update Update the Simulator window 7 Three options are available on
131. en O Consumption is increased and used with increased Shunt Fraction profound levels of hypoxia can be achieved Default 250 mL per minute Range 0 mL per minute 2000 mL per minute A 15 Appendix A Parameter Descriptions iStan CO Production Factor The CO Production Factor parameter allows for the manipulation of metabolic CO production to simulate a variety of pathophysiological conditions CO production is determined by the O Consumption and Respiratory Quotient settings A CO Production Factor value of 2 doubles the CO production while a value of 0 5 decreases the CO production by 5096 Default 1 Range 0 50 4 00 PaCO Set point The PaCO Set point parameter is a set point for PaCO The control of breathing model adjusts tidal volume and respiratory rate in order to bring the PaCO toward this set point Factors that influence the success of this control effort include baseline tidal volume baseline respiratory rate respiratory gain O consumption respiratory quotient lung compliances chest wall compliance bronchial resistances the presence of artificial airways in the simulator and the inspired gas mixture When the PaCO Set Point is set to a new value the physiological controls adjust the simulator s respiratory pattern in an attempt to attain the desired set point For example when the set point is raised from 40 to 50 mmHg there is a transitory decrease in respiratory rate and tidal volume as
132. ent marketing and commercialization of its products and services without any restrictions based on confidentiality or intellectual property rights 4 TERM AND TERMINATION 4 1 This License shall become effective as of the date of Your execution of this License and shall remain in effect until terminated as provided hereafter 4 2 This License terminates immediately upon termination of the HEPGTC 4 3 CAE Healthcare may terminate this License immediately upon written notice should Licensee CAE Healthcare End User License Agreement a fail to comply with any of the terms and conditions of this License b terminate or suspend its business make an assignment for the benefit of creditors or any proceedings are instituted by any party or against it seeking to declare it bankrupt or insolvent or seeking liquidation winding up reorganization arrangement adjustment protection relief or composition of its debts under any law relating to bankruptcy insolvency reorganization or relief of debtors or seeking the entry of an order for relief or the appointment of a receiver trustee or other similar official for it or for any substantial part of its property 44 Upon termination of this License Licensee agrees to immediately discontinue use of the Confidential Information and the Product and to return same to CAE Healthcare as well as any copies summaries or extracts thereof with any associated CD ROM s DVD keys dongles or
133. enu which lists all user created SCEs Clicking the Learning Modules icon again reveals the Learning Modules menu To open an SCE click the name of the SCE Click Close Library to exit the SCE Library 37 Using M se iStan Base SCEs Base SCEs are fundamental SCEs with no scenarios and no progression of events Each base SCE is designed to provide facilitators with a baseline to run simulations on the fly or as a physiological baseline from which to design their own SCEs To access a base SCE from the SCE Library choose Learning Modules then click Base SCEs The base SCEs are displayed and available for selection Preconfigured SCEs Preconfigured SCEs are training tools with scenarios and multiple states They are intended to be used for learner education and training To access a preconfigured SCE from the SCE Library choose Learning Modules then click the name of the SCE category The SCEs in the chosen category are displayed and available for selection 38 CAE Healthcare Using M se The SCE Summary Panel The SCE Summary Panel provides information about the selected SCE The Review button The Print SCE button can be used to generate a printable PDF of the selected SCE a Anaphylaxis Holly Monroe Age 21 years old WR Add To Favorites Gender Female Weight 70 0 kg 3 Base Nonma L Female Overview Your rescue squad responds to a report of a 21 year old female complaining of tr
134. erences panel users can import customized medication response files created in the Pharmacology Editor software To access Medication Preferences click Medication Preferences on the Account Profile screen The Medication Preferences panel appears The Medication Preferences link meti admin Email admin meti com ID admin Profile Information Favorite SCEs Profile Preferences Medication Responses Patient Group Medication Responses The Account Profile Screen The Medication Preferences panel To import medication response files click the Set button The select file dialog box appears Select the medication response file to be added and click Open or OK 127 Using M se iStan Profile Preferences From the Profile Preferences panel users can change the font size used in the software To access Profile Preferences click Profile Preferences on the Account Profile screen The Profile Preferences panel appears meti admin Email admin meti com Profile Preferences ID admin The Font Size P Normal Font size Profile Information menu Favorite SCEs Medication Preferences The Profil The Profile f rome Preferences re erences panel link The Account Profile Screen To change the font size click on the Font size selection The Font size drop down menu appears From the Font size drop down menu select Normal Small or Large 128 Using TouchPro UsiNG ToUCHPR
135. erform and click Calibrate Defib Calibrator Choose your calibration option 9 Defibrillation calibration Pacing calibration Choose Defibrillation calibration to configure the simulator defib subsystem Choose Pacing calibration to configure the simulator pacing subsystem Z S SSeS Disconnect Calibrate Choose the Defibrillation Calibration Option Running the Defibrillation Calibration Utility Before beginning the Defibrillation Calibration Utility it is important to have a minimum of 3 to 4 joule parameters to enter on the defibrillation device for calibration See Recommended Ranges on page C 10 for more information After choosing the Defibrillation Calibration option and clicking the Calibrate button the Configure Initial Defibrillation window appears Defib Calibrator Configure the initial defibrillation setting on the medical device then shock u el LA Waiting for defibrillation Are we finished Done Configure Initial Defibrillation window C 3 Appendix C Defibrillation Calibration Utility iStan To start the defibrillation calibration 1 Input the desired calibration parameter for Joule measurement on the defibrillation device e g 50 Joules as first calibration parameter for Adult Make sure that you as well as any bystanders are clear of the simulator and press Shock on the defibrillation device to administer the defibrillation to th
136. erial As quoted at time of repair Travel Priced at CAE Healthcare s fully burdened cost plus fee Principal period of on site support customer s local time is e Monday through Friday 8 00 AM to 5 00 PM customer s time zone e Holiday and non business days excluded e Support outside the principle period is billed at the premium rate hourly rate x 1 5 A minimum of 48 hours notice is required for scheduling an on site support call Urgent on site support with less that 48 hours notice will be charged at the premium hourly rate On site time is described as the time period commencing from arrival at customer site through departure from customer site 194 ZW CAE Healthcare iStan Care and Maintenance Breakdown After each use iStan should be properly disassembled and stored in a secure place To ensure that iStan remains in good working condition follow the prescribed CAE Healthcare breakdown procedures below These procedures are estimated to take less than 30 minutes Breakdown Steps Step 1 Clean the Simulator and the Fluid System If you used fluids to remove them the Muse software must be launched For detailed instructions on cleaning see page 202 Step 2 Shut Down the Software Shut down the Muse software and any optional TouchPro computers To shut down the Muse software on the Instructor Workstation a In the M se software click the Disconnect icon on the Run screen b Stop any running SCEs
137. ery PA Catheter The pulmonary artery pressure displayed on the Patient Status Display or TouchPro software is set using this parameter A non pulsatile zero pressure signal is emitted when the Atmosphere position is selected and can be used to simulate zeroing a pressure transducer This may also be used to remove the pulmonary artery pressure waveform if desired i e beginning of an SCE with an unmonitored patient The pulmonary artery catheter can be floated into position by sequencing through the right heart positions This may also be scripted into a scenario using the Scenario Designer Default Pulmonary Artery Options Atmosphere Intrathoracic Vein Right Atrium Right Ventricle Pulmonary Artery PA Balloon Inflation of the pulmonary artery catheter balloon is simulated by switching to the Inflated option of the PA Balloon parameter The appropriate pulmonary artery occlusion or wedge waveform is then displayed on the Patient Status Display or TouchPro software Default Deflated Options Deflated Inflated Defibrillation Defib The Defib parameter is used to simulate a specified amount of energy discharged via an external cardiac defibrillator Setting this parameter results in the characteristic spike in the ECG followed by a return to the pre defibrillation rhythm Defib has no direct effect on the electrical conduction system of the heart Thus synchronized cardioversion may be done on the fly or scripted
138. es indicated on the Software and Data ghost export or produce any derivative works from the Product or any part thereof not network the Product without CAE Healthcare s prior written approval or make it available for concurrent use b not sell attempt to sell or transfer unless in compliance with the HEPGTC sublicense encumber the Software or Data c not modify the Product in any way combine with other programs or reverse engineer screen scratch decompile or disassemble any Software nor otherwise attempt to create or derive the source code related thereto d not deface or remove any copyright or proprietary notices e not use the Product without the Key if provided with the Product or attempt to develop or develop any means or technology which would enable Licensee to bypass the use of the Key to operate the Product f prevent anyone other than Authorized Users from accessing or using the Product 9 not incorporate the Product in whole or in part to any product or service that Licensee would make available to a third party on a commercial basis or not 2 4 Notwithstanding anything else contained in this License in no event shall Licensee use the Product and or Confidential Information to enable support or otherwise aid Licensee or a third party to develop any product software or service competitive with any of CAE Healthcare s products 2 5 Licensee agrees to grant CAE Healthcare its agents and representatives
139. es of parameters numeric and discrete Once a parameter is selected and set the patient s physiology changes according to the model for that parameter Numeric Parameters Numeric parameters set either a measured value e g 20 mL or a multiplied value called a factor e g Heart Rate Factor 2 0 is two times the baseline Heart Rate Numeric parameters are changed by clicking in the relevant field and entering a new value in place of the existing one or using a slider to move through the range of parameter values until the desired numeric value is established Once a measured value is set that value overrides the physiologically modeled parameter value To return to a physiologically modeled value switch the slider in the parameter dialog from Override to Modeled Discrete Parameters Discrete parameters enable users to select one of two or more options Discrete parameters are changed by choosing the appropriate option using a drop down menu or toggle switch In the image below the Needle Decompression parameter is shown The Needle Decompression parameter is set using a discrete parameter switch that toggles between Off and On Needle Decompression Off The Needle Decompression Switch Once the parameter has been set it is reflected in the patient s physiology NOTE Not all changes to parameters affect the patient s physiology but all are logged 52 CAE Healthcare Using M se Using the Conditions
140. es to take effect on both the handset and the base station Check if the green connection light is flashing after turning the power off and back on each time to see if communication has been established between the base station and the handset I m experiencing static or dropouts in the simulator audio output Reduce the range between the base station and the handset Most likely the handset is out of range of the base station or there may be too many obstacles walls windows doors between the handset and the simulator Audio Problems The sound output from the simulator is low when using a microphone on my lapel Increase the microphone gain on the handset by moving the dial towards the plus sign DIP switch 7 must be in the OFF position for this to work I m hearing feedback from the microphone when am close to the simulator Decrease the microphone gain on the handset by moving the dial towards the minus sign DIP switch 7 must be in the OFF position for this to work A CAE Healthcare Appendix B Wireless Voice Link The sound output from the simulator is too high or too low The volume level is configured at the factory for optimal performance However if you want to adjust the volume level of the base station located inside the simulator set the handset DIP switch 7 to ON Remember to turn the handset power off and on after each DIP switch change After this step is complete you will be able to adjust the volume lev
141. esninnssusesnsnscsinssendsinsvassnceoosoceatoransnseokivorennsersnesitnsentvaseneses 205 ilz DPPud Ri C 206 Fl shing PDT eH 207 Cleaning the Trauma Fill Tank and the Umbilical eene eere 208 Cleaning the M line FATE aoo eiue ient bra bn sioner sereni reb ers de 209 Troubleshooting the Trauma Fill Tak cssssccvssessuacdnonassinscenwsavsusosasesouneosusssanarsuesdennusbouasscersiedernsassiniisuite 210 Table of Contents xix Table of Contents iStan Handling CO Canisters sssscsessssssssssnssnssssssscsssnssnssnssnssssssssssssssassasssssssssssssssssssssscssssssssssnees 211 Removing CO Canisters from the RGU NAN secant titel ista 211 Important Canister DONO s c trei re ESPERE AR NUR U MIrEQ ebl ev tu e tra ria 212 Related CAUTIONS WARNINDS adiecta m D pua ostendatur ru ue 212 Recommended Clinical Supply Sizes cernere eee e eene ee nennen enata esten ern ete tno 213 Condition Guidelines for Programming iStan with M se e eereeeereeeenenrnns 215 Appendix A M se Parameters Descriptions ssssssssssssssssssssscssssssssscssssesssssssssessassass A 1 Appendix B Wireless Voice Link sssccssssssssssssssssssssssssscssssssssscesssessessssssesssasssssassonssess B 1 Appendix C Defibrilation Calibration Utility csscsssssscssssscssssssssssssessessesssssesssssesees C1 XX p
142. esses the SCE Editor which can be used to review and edit SCEs Select the Run button to run the SCE 39 Using M se iStan Printing SCEs To print an SCE 40 1 From the Home page select the SCE to print The SCE summary panel appears Anaphylaxis Print SCE Holly Monroe 21 years old WR Add To Favorites Female 70 0 kg Norma L Female Overview Your rescue squad responds to a report of a 21 year old female complaining of trouble breathing She was eating dinner at a cookout when she noticed some tightness in her chest The cook came by asking if anyone wanted another shrimp burger She then told him she was allergic to shellfish She was proceeding to her car to retrieve an epinephrine auto injector when a wasp stung her This SCE consists of six states that manually transition During the initial assessment in State 1 Beginning Anaphylaxis the patient presents with early signs of anaphylaxis HR in the 90s BP in the 100s 50s RR in the 20s and SpO2 in the low 90s on room air She remains conscious The learner is expected to assess and manage the patient s airway breathing and circulatory status ABCs identify early signs of allergic reaction consider use of oxygen call for help with interventions consider early use of epinephrine and attach a cardiac monitor If more than 120 seconds elapses without administration of epinephrine the instructor should manually advance the SCE to State 2 Mild Anaphylaxi
143. eter adjusts the pulse pressure difference between systolic and diastolic pressures of the simulated patient s systemic blood pressure Increases in the compliance factor result in a decreased narrower pulse pressure while smaller values increase the pulse pressure Additionally when the pulse pressure increases as a result of a reduced compliance factor both systolic and diastolic pressures increase Conversely with a narrower pulse pressure higher compliance factor both the systolic and diastolic blood pressures also drop Default 1 Range 0 50 5 00 A 33 Appendix A Parameter Descriptions iStan A 34 Pulmonary Arteries Compliance Factor The Pulmonary Arteries Compliance Factor parameter adjusts the pulse pressure difference between systolic and diastolic pressures of the simulated patient s pulmonary blood pressure Increases in the compliance factor decrease narrow the pulse pressure while smaller values increase the pulse pressure Additionally when the pulse pressure increases as a result of a reduced compliance factor both systolic and diastolic pulmonary pressures increase Conversely with a narrower pulse pressure higher compliance factor both the systolic and diastolic pulmonary pressures also drop Default 1 Range 0 20 5 00 Pulmonary Vasculature Resistance Factor The Pulmonary Vasculature Resistance Factor parameter adjusts the baseline pulmonary vascular resistance Raising the value incre
144. eter alter the rate of carbon dioxide production relative to the rate of oxygen consumption Default 0 8 Range 0 50 1 10 A 17 Appendix A Parameter Descriptions iStan Volume Rate Control Factor Ventilatory responses to increased arterial carbon dioxide or decreased arterial oxygen may take the form of increased tidal volume increased respiratory rate or both The volume rate control factor determines these relative changes At a value of 1 increased and decreased ventilatory drive affect tidal volume and respiratory rate equally When volume rate control is greater than 1 increased or decreased minute ventilation is predominantly achieved by changes in tidal volume When the volume rate control factor is less than 1 ventilatory changes are affected primarily by changes in respiratory rate For example set the volume rate control factor to 0 1 and increase the shunt fraction to 0 4 to decrease the arterial O The patient responds to falling arterial oxygen levels with increased minute ventilation Increasing the respiratory rate with minimal increase in tidal volume produces this Default 1 mL Range 0 1 mL 10 0 mL Chest Wall Capacity The Chest Wall Capacity parameter sets the total combined intrapleural and lung volumes at which the chest wall is considered distended Also see Chest Wall Compliance Factor and Distended Chest Wall Compliance Factor Default 3900 Range 1500 3900 Chest Wall Compliance Fact
145. f any of the parameters conflicts the M se software reflects the physiology of the last parameter entered 93 Using M se iStan Adding Transitions To add a transition the scenario must have both an original state and a state that results from the transition To add a transition 1 Click the Create button in the original state The Create button A State Assessment Intervention Medications Physiology Scenario Vitals The Transitions Menu 2 Select the desired variable type For example if a transition based on the administration of medication is desired select Medications and then select the desired medication from the list J CAE Healthcare Using Mise Once a medication is selected The Medication Transition menu appears asking for the comparison type and transition value Comparison type Transition value The Accept button The Medication Transition Menu Follow the same steps to make selections from similar menus for the Assessment Intervention Physiology Scenario and Vitals variable types 3 Once the variable values e g comparison type and transition value have been selected click Accept The selected transition variable is listed beneath the original state on the Scenario Designer 4 From the Scenario Designer click the GOTO arrow beneath the new transition variable Eyes Blink Speed Fast BP Systolic 145 mmHg
146. f the M se screen IM Event Recorder The Event Recorder Button The Event Recorder appears displaying all events that have occurred since the start of the SCE Event Recorder Whole Blood Infusion 17 mL hr Events Bag Valve Mask 73 FiO2 The Edit button The Save State ME State Edit clear The Clear button The Event Recorder WARNING The Clear button deletes all recorded events This action cannot be undone 65 Using M se iStan 3 Review the list of events If you wish to remove any events from the state to be saved a Click Edit A Delete button appears next to each recorded event Event Recorder wi Events hole Blood Infusion 17 mL hr Delete buttons Bag Valve Mask 7356 FiO2 The Done button The Save State button rb SaveState Done Clear The Event Recorder b Click the Delete button next to each event to be removed The events are removed from the Event Recorder c Click Done The Delete buttons are hidden 4 Click Save State The New State Name window appears New State Name The Save button The New State Name Window 5 Enter a state name 6 Click Save The state is saved to the State Library and can be accessed via the Scenario Designer For more information about the State Library see Saving States to the State Library on page 100 66 J CAE Healthcare Using Mise Cr
147. fect or Continue to continue calibrating UU Continue Update Complete window 5 Click Continue to proceed with the Pacing Calibration and return to the main calibration screen OR Click Disconnect to end the utility and reboot the simulator The simulator must be rebooted for the calibration to take effect and the simulator should not be turned off until the utility is closed Running the Pacing Calibration Utility Before beginning the Pacing Calibration Utility it is important to determine the pace parameters to enter on the pacing device for calibration See Recommended Ranges on page C 10 for more information Choose your calibration option Defibrillation calibration 9 Pacing calibration Choose Defibrillation calibration to configure the simulator defib subsystem Choose Pacing calibration to configure the simulator pacing subsystem Disconnect Calibrate C 5 Appendix C Defibrillation Calibration Utility iStan Choose the Pacing Calibration Option To begin the pacing calibration 1 Click the radio button next to the Pacing Calibration option and clicking the Calibrate button The Configure Initial Pace Settings window appears Configure initial pace setting on the medical device then press start Start Are we finished Done 2 Setthe Rate on pacing device to 60 PPM 3 Input the desired calibration parameter for mA measur
148. fied scenario as a new scenario leaving the original scenario intact a Click Save As When Save As is clicked the Save Scenario dialog box appears The Enter Scenario name The Save field button The Save Scenario Dialog Box b Enter the name for the scenario in the Enter scenario name field c Click Save NOTE When naming a scenario the scenario name CANNOT exceed 128 characters Additionally scenario file names CANNOT contain any special characters such as V lt gt 99 Using M se iStan Saving States to the State Library Users can save states to the State Library for later use To save a state drag and drop the state to the States button A dragged state The States button The Scenario Designer The state is stored in the library 100 CAE Healthcare Using M se To access the State Library click the States button in the bottom right corner of the Scenario Designer States The States Button The State Library appears listing all saved states Hpertension Begins The State Library Click Conditions to exit the State Library 101 Using M se iStan Emptying the Trash To empty the Trash click the Trash icon in the lower left corner of the Scenario Designer Anaphylaxis Ce E Hres py cotapsean wi Eapana an The Trash icon The Scenario Designer 102 CAE Healthcare Using M se The Trash List appears Cardiac R
149. fluence other components of the physiological models For example with the tidal volume set to 600 mL in the adult simulator the tidal volume remains a constant set 600 mL even in the event of falling arterial oxygen levels In such situations the patient can only respond to arterial oxygen or carbon dioxide levels when the respiratory rate is adjusted Default Modeled Range 0 mL 2500 mL Tidal Volume Factor The Tidal Volume Factor along with the Respiratory Rate Factor parameter is used to change the baseline tidal volume before the control of breathing and drug influences are taken into account A value of 2 doubles the baseline tidal volume A value of 0 5 decreases the baseline tidal volume by 5096 Default 1 Range 0 10 4 00 TIP First decrease the respiratory gain factor to reduce the influence of the respiratory control mechanism on the respiratory rate and tidal volume Appendix A Parameter Descriptions iStan A 14 pH Shift The pH Shift parameter is used to create a metabolic acidosis or metabolic alkalosis under script control The default pH value displayed on the Patient Status Display or TouchPro software is dependent on respiratory arterial CO values Under default conditions PaCO 40 mmHg the pH is approximately 7 4 Rising arterial CO produces a subsequent drop in pH while falling arterial CO levels result in rising pH values To simulate pH changes with metabolic changes acidosis or al
150. h the cardiac cycle Heart Sounds Default Normal NOTE The volume control slider may be used to adjust the amplitude of the sound A 44 CAE Healthcare Appendix A Parameter Descriptions Microphone Volume Microphone Volume is used to adjust the volume of sound coming from the wireless microphone To increase or decrease the volume of the microphone and thus the patient s voice use the volume control slider Speech Sounds Speech Sounds include a male or female voice based on the gender of the active patient that can utter pain rating indicators from 0 to 10 various phrases and a series of other utterances Unlike Vocal Sounds Speech Sounds only play once Speech Sounds To play a Speech Sound click the Speech balloon A list of Speech Sounds appears Select the desired sound The sound plays once and the list disappears To replay the last sound click the Play button in the Speech balloon A 45 Appendix A Parameter Descriptions iStan Throat Sounds The Stridor throat sounds option from the simulator is selected using the Throat Sounds parameter The stridor is synchronized with ventilation of both lungs Default None NOTE The volume control slider underneath each area may be used to adjust the amplitude of the sound The volume control slider is only enabled while connected to a simulator Vocal Sounds To have the simulator emit the various vocal sounds select the one desired It imm
151. he neck joint 199 iStan Care and Maintenance iStan Draining Condensation from the Simulator As part of a regular preventive maintenance schedule condensation should be drained from the simulator Depending on environmental conditions moisture may condense inside the compressed air lines and tanks within the simulator It is recommended that this fluid be drained every 40 hours of operation In outside high humidity conditions the system should be drained more frequently To drain condensation 1 Locate the Condensation Drain Hose included with the inventory kit 2 Bring the hose and a small bucket to the simulator location 3 Separate the skin on the left side of the simulator at the hip to reveal a hose with the appropriate gray connector mate Bring to the outside for use in later steps 4 With help from assistants place iStan into a sitting position A 45 degree angle is fine 5 Turn iStan on but do not start the application Give enough time for the internal compressor to pressurize the system The pump will turn off automatically 6 Turn iStan off 7 Place the tubing end of the Condensation Drain Hose into the small bucket and then connect the gray fitting onto the simulators drain connector with a push and twist motion There will be a sudden release of pressure into the bucket Any condensation within the system will drain with this exhaust 8 Disconnect the Condensation Drain Hose from t
152. he paper backing and lightly stretch the newly revealed adhesive side of the tape over cricoid hole and down the far side of the cricoid feature Use the non stick paper backing to press the tape against the cricoid feature 4 Cuta2 5 to 3 0 inch 7 to 8 cm length of red tape and apply it over the cricoid feature and the tape Resealing the Membrane After a Puncture To reseal the cricoid feature apply a small piece of red tape over the punctured area This can be repeated a brief number of times but when the number of layers impedes the cricothyrotomy all existing tape must be removed and replaced with new tape Teeth with Breakaway Incisors iStan is equipped with Breakaway Teeth whose front incisors become dislodged with improper handling of a Laryngoscope The teeth are tied to the upper denture with a lanyard which prevents losing the teeth down the airway or misplacing them during storage 160 CAE Healthcare Using iStan Chest Tube A chest tube can be inserted at the mid axillary line of the fifth intercostal space on either side of the simulator For supported chest tube size see Recommended Clinical Supply Sizes on page 213 sing ordinary chest tube equipment fluid and air can be withdrawn from the pleural space The volume removed influences the patient s physiology to reflect improvement in pulmonary mechanics and gas exchange Chest Tube Placement Correct insertion of the chest tube is entered into th
153. he simulator 200 CAE Healthcare iStan Care and Maintenance Connecting the Air Hose The air hose can be connected to or disconnected from iStan at any time When the external air pressure is sensed the pump internal to iStan will turn off automatically When you want to make iStan mobile again simply disconnect the hose The optional External Air kit see page 11 consists of a flexible 30ft 9m hose attached to a preset air regulator and a fitting for air compressors and adapters for wall or tank air To connect the air hose 1 Connect the external air kit to a CAE Healthcare compressor using the Quick Coupler attached to the regulator Other compressed air sources will have their own adapters Locate the adapter for your compressed air source 2 Separate the skin on the left side of the simulator at the hip to reveal a hose with the appropriate gray connector mate Bring this hose to the outside for connection to the air hose 3 Mate the gray connectors with a push and twist motion 201 iStan Care and Maintenance iStan Cleaning the Simulator and the Fluid System NOTE A small bucket is recommended to collect wastewater during cleaning and flushing operations Cleaning and Flushing After Use of Hemorrhage To clean simulated blood from the simulator and fluid system 1 Remove any wound haptic s from the wound umbilical s and rinse with distilled water 2 Wipe the simulator off immediately to
154. hile running an SCE click Patient at the bottom of the Run screen The Patient Button The Patient pop up menu appears The Reset button The Patient Pop Up Menu 2 Click Reset The Reset the Patient dialog box appears stating that the patient s physiology will be reset to its state at load time and all running scenarios will be paused Reset the Patient This will reset the patient to the physiology at load time and pause all currently running scenarios The Reset button The Reset the Patient Dialog Box 3 Click Reset The Patient returns to its original physiological state at the start of the SCE 4 To resume any paused scenarios click the loaded scenario on the left side of the screen The Scenario Management pop up menu appears 5 From the Scenario Management pop up menu select Play The scenario is resumed 68 CAE Healthcare Using M se The Medication Monitor The Medication Monitor tracks the infusion of medication administered To activate the Medication Monitor from the Run screen click the Medication Monitor button in the bottom right portion of the screen The Medication Monitor Button The Medication Monitor appears as a movable box on the Run screen Medication Monitor The Close Medication rocuronium lt 0 0001 mg kg button name The Reset button Normalized effector site concentration The Medication Monitor The normalized effector site concentration
155. hythm Set Heart Rate Tachycardia The Empty Trash button F Empty Trash The Trash List Click Empty Trash to empty the Trash If you do not wish to delete the items listed they can be dragged back into the scenario at which time they are removed from the Trash Logging out of the software automatically empties the Trash IMPORTANT Items emptied from the Trash cannot be retrieved 103 iStan Using Muse Administrative Tools The Mise software has administrative tools that allow users to manage logs stored content users and system settings The administrative tools are accessed via the Administrative Tools buttons located on the Home page The History button The System a y The Account Administration d Profile button button The Administrative Tools Buttons Click the History button to view and manage simulation session logs Click the System Administration button to manage stored content user accounts groups and system settings Click the Account Profile button to manage and determine preferences for the active account History From the History screen users can view and export simulation session logs Each simulation session is listed with the Start Time the title of the SCE and the Patient s name In addition the Physiological Data and Simulation Events are available for review and export Start Time 2011 11 16 14 21 57 2011 11 16 13 06 27 2011 11 15 10 51 44 2011 11 15 1
156. iSta N with muse CAE Healthcare CAE Healthcare End User License Agreement CAE Healthcare iStan Simulator Software and User Guide THIS IS A LEGAL AGREEMENT PLEASE READ THIS DOCUMENT CAREFULLY The software you are about to access is provided to you pursuant to the purchase of the Product by the legal entity which employs you or which you represent the Licensee or You from CAE Healthcare This purchase of the Product is subject to CAE Healthcare s Healthcare Education Products General Terms and Conditions the HEPGTC and this End User License agreement License This License governs the grant of licenses for the software in object code only embedded in or bundled with the Product or required to operate the Product as the case may be Software as well as all related Product documentation and information Data supplied by CAE Healthcare either with or separately from the Product which items as indicated in the HEPGTC are not sold but licensed Acceptance of these terms and conditions must be without modification of any of the terms conditions and notices contained herein Consequently please be sure to read the terms of this License carefully If You agree to these terms conditions and other provisions in their entirety then click the ACCEPT button below If You do not accept these terms conditions and other provisions in their entirety without modification of any sort then click the DECLINE
157. iStan is assembled or disassembled make sure all components are properly handled and either removed from or placed into storage correctly iStan Warranty Programs General Information CAE Healthcare patient simulator products come with a one year Manufacturer s Warranty excluding batteries and consumables All warranties begin at date of shipment or CAE Healthcare installation You may upgrade your first year Warranty to an Enhanced Warranty and receive remedial and planned maintenance To prevent equipment downtime and delays after your warranty expires we encourage you to contract for extended maintenance services for all subsequent years Units Out of Agreement For units no longer under warranty requiring repairs the Time and Materials service plan will apply see Time and Materials section To place an out of warranty unit under a warranty contract CAE Healthcare reserves the right to have the patient simulator inspected by a CAE Healthcare approved technician at the customer s expense If necessary the unit would have to be repaired at the customer s expense prior to issuance of a warranty contract The repairs required as the result of the examination will be quoted on a time and material basis 191 iStan Care and Maintenance iStan How to Contact Customer Service CAE Healthcare Customer Service Headquarters United States and Latin America Monday Friday from 7 00 a m to 6 00 p m ET Toll Free 1 866 46
158. ions on how to join iStan s wireless network 3 From the Laptop Instructor Workstation that is connected to the iStan Network from the Apple menu click System Preferences From the System Preferences screen click Network Click Advanced Click TCP IP Next to the IPv4 Address header an IP Address is listed Write down the IP Address and click Cancel to close the Advanced screen Close the Network screen O ON OAU A From the web browser on the TouchPro computer enter the IP obtained in Step 6 into the browser s address field The M se Start screen appears The M se Start Screen For more information on how to use the TouchPro software please refer to page 129 23 iStan Setup iStan System Requirements If you are not using a TouchPro computer or Wireless Remote provided by CAE Healthcare please be sure to utilize a computer with wireless capability When operating the TouchPro or Muse software a computer with a Macintosh or Microsoft Windows operating system may be used To run the TouchPro or Muse software the computer used must meet the following minimum requirements Macintosh Operating System e Mac OS X10 5 8 minimum e Safari 5 x x or Firefox 10 ESR minimum Adobe Flash Player 10 1 x x minimum e Adobe Reader 9 x or higher Windows Operating System e XP Service Pack 2 Vista Windows 7 or Windows 8 Firefox 10 ESR Internet Explorer 8 or Safari 5 x x
159. is Shown next to each medication listing The Reset button is used to clear a medication from the physiological model and the Medication Monitor To close the Medication Monitor press the Close button in the upper right corner of the medication Monitor window 69 Using M se iStan Resetting a Medication To reset a medication from the Medication Monitor click the Reset button on the Medication Monitor The Reset Medication dialog box appears asking you to confirm that you wish to reset the medication Reset Medication Reset the medication rocuronium The Reset button The Reset Medication Dialog Box The medication is cleared from the model and from the Medication Monitor With continuous infusions the amount infused goes back to zero but the infusion continues To stop the infusion you must select the medication from the medication library and set the infusion rate to zero 70 J CAE Healthcare Using Muse Returning to the Home Page To exit the SCE and return to the Home page click the Return button Return The Return Button The SCE continues running and the Home page appears To return to the SCE from the Home page click the Continue button in the SCE summary panel of the running SCE Anaphylaxis WP Print SCE Holly Monroe 21 years old Add To Favorites Female 70 0 kg Norma L Female Overview Your rescue squad responds to a report of a 21 year old female complaining of
160. ith Respiratory Fallure 2011 09 12 09 39 10 Elevated Heart Rate 2011 09 12 09 41 01 Scenarios l Heroin Overdose 2011 09 12 09 39 41 Inferior Myocardial Infarction 2011 09 12 09 40 13 Organophosphate Exposure 2011 09 12 09 40 39 The Add The Search button field The Choose Scenario Dialog Box 2 Select a saved scenario from the Choose Scenario Dialog Box The Search field can be used to search for a scenario to select 3 Click Add The scenario is added to the SCE and is listed on the SCE Editor beneath the Pre Loaded Scenarios heading For information about editing scenarios see Editing a Scenario on page 86 83 Using M se iStan Developing Scenarios The Scenario Designer allows users to create and edit scenarios To access the Scenario Designer create a new scenario or choose an existing scenario to edit Creating a New Scenario To create a new scenario 1 From the SCE Editor under the Pre Loaded Scenarios heading click the Add Scenario button Pre Loaded Scenarios The Add Scenario button The Pre Loaded Scenarios Heading The Choose Scenario dialog box appears Scenarios lex Name Last Modified Anterior Myocardial Infarction 2011 09 12 09 38 39 COPD Exacerbation with Respiratory Fallure 2011 09 12 09 39 10 Elevated Heart Rate 2011 09 12 09 41 01 Heroin Overdose 2011 09 12 09 39 41 Inferior Myocardial Infarction 2011 09 12 09 40 13 Organophosphate Exposure 2011 09 12 09 40 39 The New
161. kalosis the pH Shift value is a mathematical addition to or subtraction from the displayed pH value to that which is desired Default 0 Range 0 50 0 50 Positive End Expiratory Pressure PEEP The PEEP parameter specifies the amount of positive end expiratory pressure applied during mechanical ventilation Setting this parameter results in clinically appropriate intrathoracic pressures and hemodynamic responses PEEP must be set both in the software and on the ventilator Default 0 cmH O Range 0 0 cmH O 25 0 cmH O Chest Tube Enable Left and Right The Chest Tube Enable parameter is used to activate the chest tube hardware in the simulator The Prime option has no physiologic impact Instead it is used to prepare the feature by allowing fluid to flow through the apparatus thereby removing air from the line When a chest tube is placed into the simulator this is sensed and recorded in the Event Log It is also possible to have a scenario transition on chest tube placement which can be scripted using the Scenario Designer Default Disable NOTE The Chest Tube and Needle Decompression features cannot be enabled simultaneously o CAE Healthcare Appendix A Parameter Descriptions Chest Tube Flow Left and Right The Chest Tube Flow parameter is used with the chest tube feature of the simulator The Chest Tube Flow specifies the rate at which fluid can be removed from the simulated pleural space via a chest t
162. lar Resistance Factor The Systemic Vascular Resistance Factor parameter adjusts the baseline systemic vascular resistance Raising the value increases the systemic vascular resistance while lowering the value decreases the vascular resistance Raising the parameter value is analogous to increasing the resistance to blood flow through the systemic vasculature Under such conditions the arterial blood pressure ABP increases and the heart rate may decrease due to feedback from the physiological control mechanisms Default 1 Range 0 10 10 00 Venous Capacity Factor The Venous Capacity Factor parameter adjusts the volume of blood contained in the unstretched venous system without an increase in venous pressure Raising the value decreases the venous capacitance vasodilatation and decreased vascular tone while lowering the value increases the venous capacitance vasoconstriction and increased vascular tone The volume of blood in the venous system has an inverse relationship to the blood pressure Lowering the value is analogous to a shift in blood from the venous system to the arterial system and this shift when coordinated with increased systemic vascular resistance results in an increase in blood pressure arterial blood pressure ABP pulmonary artery pressure PAP and central venous pressure CVP Default 1 Range 0 10 100 00 Systemic Arteries Compliance Factor The Systemic Arteries Compliance Factor param
163. lood pressure reading using the return to flow technique An Attached Modified Blood Pressure Cuff Store the modified blood pressure cuff with the system for future use 169 170 Using iStan iStan Korotkoff Sounds 5 phases Korotkoff sounds can be auscultated on the left arm To auscultate Korotkoff sounds 1 Place the stethoscope on the left arm just above the brachial pulse 2 Let the cuff pressure drop slowly by opening the valve on the bulb slightly 3 Monitor the pressure displayed on the cuff gauge All five phases should be recognized Phase I Clear repetitive tapping sounds Systolic Phase Il Longer beats with some swishing sounds Phase III Crisp more intense rhythm sounds Phase IV Muffled less distinct sounds Phase V Sounds disappear completely Diastolic Defibrillation iStan is designed to safely absorb the energy discharged from manual and automatic defibrillators Standard defibrillation energy levels should be used for positive learning reinforcement and to avoid negative training transfer However use of a defibrillator for training purposes represents an operational hazard equivalent to use of a defibrillator on a real patient Consequently ALL SAFETY PRECAUTIONS for the use of defibrillators MUST BE FOLLOWED as if the simulator were a patient Consult the specific defibrillator s User Manual for further information The following cautions should be observed Defibrillation should
164. lothing against accidental exposure After use ALWAYS release pressure and clean the tank ALWAYS release tank pressure before servicing DO NOT modify the tank or any assemble component DO NOT store liquids in the tank NEVER transport or ship in a pressurized and or full state NEVER leave a pressurized tank unattended NEVER fill the tank with more than 6 liters 1 6 gallons of fluid NEVER exceed 35 strokes while pressurizing the tank 27 iStan Setup iStan Assembling the Trauma Fill Tank Careful assembly of the Trauma Fill Tank helps to ensure proper operation Step 1 Connect the Trauma Fill Tank Umbilical to the Tank Assembly To connect the umbilical to the Trauma Fill Tank a Insert the pink siphon tube approximately 1 2 inch into the pink hose insert Otherwise the tank will pump only air b Lubricate with silicone or water the black o ring on the pink hose insert c Push into the threaded tank nipple until fully sealed d Screw the hose nut onto the threaded tank nipple and firmly hand tighten Step 2 Attach the Overflow Bottle to the Tank Assembly To attach the Overflow Bottle to the Trauma Fill Tank a Connect the umbilical male connector to the female bottle lid fitting b Clip the bottle to the tank using the attached carabiner mechanism Operating the Trauma Fill Tank Be careful to complete the following steps correctly to ensure proper use and maintenance of the iStan and its periphe
165. m CAE Healthcare iii is independently developed by Licensee provided it is not in whole or in part related to the Product and iv is obtained by Licensee in good faith and on a non confidential basis and without a use restriction from a third party who lawfully obtained and disclosed such information However Confidential Information does not come within the foregoing exceptions merely because features of it may be found separately or within a general disclosure in the public domain 5 3 Licensee agrees to be responsible for enforcing the terms of this Section 5 and to take such action legal or otherwise to the extent necessary to cause anyone having access to the Confidential Information to comply with the terms and conditions set forth herein including all actions that Licensee would take to protect its own trade secrets and confidential information but with not less than reasonable care Licensee shall be responsible and indemnify defend and hold harmless CAE Healthcare for any default caused by any such persons 6 IRREPARABLE HARM 6 1 Licensee acknowledges that the Software and Data constitute a special irreplaceable asset of great value to CAE Healthcare and that a breach in any way of any of Licensee s obligations under Sections 2 License and 5 Non Disclosure hereof would cause serious and irreparable harm to CAE Healthcare which may not be adequately compensated for in damages If the Licensee breaches any of such provisions
166. management techniques In the process of performing these techniques improperly or aggressively the upper airway can be damaged While such damage may be readily apparent manifested as a leak in the breathing circuit during connection to a ventilator it may not be obvious during spontaneous or bag and mask ventilation Because damage can occur occasional visual inspection of the airway is recommended Using the light of a laryngoscope blade or a flashlight visually examine both the upper and lower airway While tears in the upper airway resulting from intubation may be obvious needle holes in the lower bronchus resulting from techniques such as transtracheal jet ventilation may not be readily apparent If damage to the airway is found small cuts or tears may be reparable However for permanent repair of damaged simulators contact CAE Healthcare Customer Service Recharging the Battery The battery should be recharged after approximately seven to eight hours The iStan battery will NOT charge while the unit is in operation To recharge the battery connect the power adapter to the receptacle inside the skin on iStan s left hip Note that the power adapter connection is keyed Care must be taken so that the adapter is properly oriented the flat side of the connector is on top when the connection is made Recharging should take approximately five hours 197 iStan Care and Maintenance iStan Replacing the Battery 1 BE CERT
167. meter of the pupils in both eyes Modeled Reactive Blown or a Fixed Pupil Size 2 mm to 8 mm When the Eyes are set to Reactive the pupils re size in response to changes in lighting condition If both pupils are set to Reactive both pupils re size in a consensual manner If the Eyes are set to Modeled the pupil size is driven by the pharmacology of morphine In this mode the baseline pupil size is 4 7 mm With increasing effector site concentration of morphine the pupils constrict up to a maximum constriction of 2 8 mm A dose of 4 6 mg of morphine results in 50 of the maximum effect a pupil size of 3 75 mm The reactivity to light is absent for this option and is only available in the Reactive mode Presently when the Modeled option is selected only morphine has an effect on pupil size The pupillary response to other drugs can be made on the fly or scripted using the Scenario Designer Other settings allow the user to fix one or both pupils to a specific size Default Reactive CAE Healthcare Appendix A Parameter Descriptions Eyes Blinking In Auto mode the eyelids are normally blinking under the following conditions Minute Ventilation is greater than 1500 mL SpO is greater than 7096 and neuromuscular blockade NMB is less than 3096 The Blinking and Closed settings allow the user to have one or both eyes either blinking or closed and override the automatic response Default Auto The Slow Normal
168. n Conditions Medications and Interventions buttons are available To navigate through available conditions and interventions click the Conditions Medications and Interventions buttons The Conditions Setup screen appears Q Medications e Interventions d Quick Links ALL CONDITIONS Cardiovascular Hemorrhage BP Hypertension Neurologic Apnea BP Hypotension Respiratory 2 Desaturation Heart Rate Bradycardia Heart Rate Tachycardia Patient Stability The Condition Setup Screen To create a Quick Link drag and drop the desired choice s from the Conditions Medications or Interventions palette to the list of Quick Links Click the minus sign to remove a Quick Link from the SCE 79 Using M se iStan Modifying the TouchPro Setup Use the TouchPro Setup link to access the TouchPro Setup panel From the TouchPro Setup panel TouchPro layouts can be enabled or disabled for the selected SCE When a layout is enabled it is available to be used in the TouchPro software with the selected SCE When a layout is disabled it is unavailable to be used in the TouchPro software with this SCE Click the On Off switch next to a layout to enable or disable it nd TouchPro Pre selected Layout EMS ED Telemetry The On Off switch ICU Arterial Line Only ICU OR NO CVP ICU OR The TouchPro Setup Panel 80 J CAE Healthcare Using Mise Patient Status Display To configure the Patient Status Displ
169. n designed to keep valuable information at your fingertips Before using the system follow the step by step instructions included in the iStan Setup section The Using the Software section provides instructions on the use of the various software features as well as how to create and save a new SCEs Using iStan includes information on how the simulator and software components work and the functionality that each supports Various clinical interventions are explained in this section along with how these interventions isolate critically important learning objectives In addition a description is provided of the CAE Healthcare preconfigured patients as well as detailed instructions on how to develop and save your own patients We encourage you to follow the iStan care and maintenance guidelines found in the iStan Care and Maintenance section as this will ensure that your system is functioning optimally Warranty details as well as clean up and care information are included in this section making it a very important part of keeping your system in good working condition Introduction iStan Equipment Overview iStan has been designed to be used in any learning environment iStan s standard features are easily integrated into a laboratory setting or remote locations Standard Components Inventory iStan comes with all the necessary equipment for establishing an educational simulation center Standard Equipment Detailed de
170. nactive A pulse deficit occurs when the systolic arterial blood pressure falls below the threshold indicated in the table below Palpable Pulse Thresholds 60mmHg 80mmHg 80mmHg 90mmHg 80mmHg 167 Using iStan iStan 3 Lead or 5 Lead ECG A 3 lead or 5 lead ECG is emitted from the appropriate positions for display on a standard monitor A contact is available on iStan s chest for each of five cables Five ECG leads are available 5 Lead ECG Sites The simulator generates a normal sinus ECG as well as a broad range of abnormalities such as myocardial ischemia sinus tachycardia and bradycardia ventricular fibrillation and asystole The hemodynamic response to the arrhythmias is physiologically correct Myocardial oxygen balance and cardiac ischemia automatically influence the cardiac rhythm resulting in a realistic and automatic response of the rhythm to hypoxemia The degree of influence can be controlled or completely overridden by the instructor 168 CAE Healthcare Using iStan Manual Blood Pressure Blood pressure can be taken manually on the left arm Non invasive blood pressure monitoring techniques can be used by attaching the standard cuff modified with a T fitting and adapters The extension from the T fitting is connected to the hose located inside the left upper arm skin Connecting the Blood Pressure T Fitting Connect the T fitting extension to the hose and take the noninvasive b
171. nal Connect the SpO Probe To connect and attach the SpO probe a Lift the skin on iStan s left side and locate the SpO jack in the simulator c Place the SpO probe on iStan The probe is now integrated into the physiological model 22 CAE Healthcare iStan Setup Connect a TouchPro Computer to the Wireless Network Optional The CAE Healthcare TouchPro computer comes pre configured for use with iStan If you wish to supply your own computer to run the TouchPro software the additional computer must meet the system requirements on page 24 and must join the iStan network prior to use The iStan simulator and Instructor Workstation form a local area network with static IP addresses To incorporate an additional computer to run TouchPro the computer s network properties must be configured to join the iStan network The help of your system administrator or CAE Healthcare Customer Service may be needed to configure the network properties The steps below outline how to obtain the IP address that accesses the TouchPro software on the TouchPro computer The Instructor Workstation MUST be connected to the iStan network prior to performing the steps below See pages 20 and 21 for instructions on how to connect to iStan s Wireless Network 1 Power on the computer to be used for the TouchPro software 2 Using this computer join the iStan network See pages 20 and 21 or contact your system administrator for instruct
172. nattended Step 5 Disconnect the Trauma Fill Tank Umbilical from the Simulator Step 6 Clean the Simulator and Fluid System When the simulation is completed and the Trauma Fill Tank has been disconnected remove the fluids and clean the simulator see Cleaning the Simulator and the Fluid System on page 202 Step 7 Clean the Trauma Fill Tank Before storing the Trauma Fill Tank make sure the equipment is clean see Cleaning the Trauma Fill Tank and Umbilical on page 208 Step 8 Store the Trauma Fill Tank After cleaning the Trauma Fill Tank assembly should be stored securely for future use a Allow the interior of the tank to dry by loosening the pump assembly Do NOT leave the pump assembly out of bottle however because dust will contaminate the system b Loosely wrap the Trauma Tank Umbilical around the neck of the tank to protect it c Store all components in a clean dry area 30 CAE Healthcare Using M se UsiNG M SE The M se software is a browser based application that can communicate directly with the simulator With the software users can run SCEs create scenarios and SCEs import and export educational content and perform administrative functions NOTE For optimal M se performance no other software programs should be open while M se is running IMPORTANT Only one M se application window or tab and one TouchPro window or tab can be used per Instructor Workstation at a time IMPORTANT Do
173. nd numeric data shown on the TouchPro software can be customized The TouchPro software can show up to six waveforms plus an additional four numeric readouts Selecting a Preconfigured Layout There are five preconfigured CAE Healthcare Layouts ICU Arterial Line Only preconfigured with waveform and numeric readouts for ECG Lead II ECG Lead V ABP Pleth and a numeric readout for Body Temperature EMS ED Telemetry preconfigured with a waveform and numeric readout for ECG Lead Il and numeric readouts for SpO and noninvasive blood pressure NIBP ICU OR No CVP preconfigured with waveform and numeric readouts for ECG Lead Il ECG Lead V ABP PAP and Pleth and numeric readouts for NIBP Thermodilution C O Blood Temperature and Body Temperature ICU OR preconfigured with waveform and numeric readouts for ECG Lead II ECG Lead V ABP PAP CVP and Pleth and numeric readouts for NIBP Thermodilution C O Blood Temperature and Body Temperature Saturation Pulse preconfigured with numeric readouts for SpO and pulse 131 Using TouchPro iStan To select a preconfigured layout click Settings select the layout from the Layouts panel and click the Close Settings button The Close Settings button The Layouts ICU Arterial Line Onl panel 3 ICU OR NO CVP 3 ICU OR Saturation Pulse e Save Layout Da Audio Setup NIBP Cycling The TouchPro Settings Menu NOTE Preconfigured layo
174. nically significant colloid osmotic pressure for example fresh frozen plasma albumin and hetastarch The term crystalloid is used to describe salt solutions for infusion for example normal saline dextrose in water and Ringer s Lactate The mixing of blood and its various constituents is instantaneous and homogeneous In other words one liter of crystalloid administered intravenously equilibrates immediately and homogeneously throughout the entire circulation CAE Healthcare Using iStan This initial Hematology Model does not yet distinguish between the differing clinical effects of colloids versus crystalloids For example osmotic pressures and capillary leakage rates are not taken into account Likewise fluid kinetics and how fluids distribute within the circulation the interstitial and intracellular spaces are also not presently modeled In the Hematology Model the following model variables definitions and relationships have been established Red Blood Cell Volume The volume of red blood cells within the circulation Plasma Volume The volume of plasma within the circulation Total Blood Volume The volume of blood i e Red Blood Cell Volume 4 Plasma Volume within the circulation Blood Volume Loss The amount or rate of decrease in the total blood volume A given amount or rate of blood loss proportionally decreases both the Red Blood Cell Volume and the Plasma Volume according to the current hematocrit Plasm
175. nicate when the power of the base station and handset is first turned on If there is too much interference at the initial channel the WVL pair changes frequency automatically and continues operating The WVL pair repeats this process automatically as needed and changes frequencies when interference is too high Multiple WVL pairs can be set to the same initial frequency However setting different initial frequencies helps the WVL pairs quickly find a stable operating frequency For example if there are 12 or fewer simulators in the same vicinity set all of the WVL pairs to use channel 0 of RF Channel Group 1 To give unique initial RF frequencies assign each WVL pair to its own RF channel with the settings found in CH 0 through CH 11 If you have 13 to 20 simulators in the same vicinity set all of the WVL pairs to use channel 12 of RF Channel Group 2 To give unique initial RF frequencies assign each WVL pair to its own RF channel with the settings found in CH 12 through CH 31 RF Channel Group 1 RF Channel Group 2 N d cv 2 MR 45 234 1 o I eo DEO CER Z vw LE L uC o T a DEO BENED ET C nO C o NO wi PED vM o A e EDO DES v LEES L LEES Oo N ENDO vio vio LE EE mo nom wo PEEL LEE mo nen Z Ma EN EET o BE CES CERE AED ini o xr N mmo ER w LES CE Pm o co O vo vo PEEL LES o c ol vi wo PED ESL Oo I w
176. nk or wall air using the kit s hose and fittings When connecting to wall air the kit attaches to the customer s wall adapter The internal pump turns off automatically when external compressed air is sensed The External Compressed Air Kit includes a flexible 30ft 9m hose attached to a preset air regulator a fitting for air compressors and adapters for wall or tank air product AIR 006 Air Compressor An air compressor product AIR 003 designed for quiet operation is available for same room use and an alternative air compressor product AIR 002 is available for situations where the compressor resides in a location such as a storage room set apart from the simulator Both Air Compressors are AC powered and include a regulator and an air hose with the appropriate connector fitting A 220VAC 50 Hz version of the Quiet In Room Air Compressor product AIR 004 is also available 11 Introduction iStan Hands Free Training Cables Hands Free Training Cables connect to most popular defibrillators and cardiac pacing units and take the place of non reusable electrode pads Three different cable designs are available to support the most popular defibrillation and pacing equipment Each cable kit includes posts that attach to the defibrillator or pace locations on iStan Physio Control Medtronic Inc product ACC 005 Zoll Zoll Medical Corporation product ACC 006 Philips Koninklijke Philip
177. nt is out rinse the outside of the element and then the inside Then take a 60 mL syringe filled with distilled water and shoot the water through the open end of the element repeating this process five to six times This will back flush the filter element and dislodge any trapped particles Wipe down the filter spring with a soft lint free cloth Place a paper towel or soft cloth on a hard surface Tap the open end of the long female filter housing on the hard surface to knock out any large debris While holding the female housing with the open end pointed downward use the syringe to shoot distilled water in the housing and rinse any remaining debris out then wipe down the inside of housing with a soft lint free cloth 8 Pour approximately 16 ounces of clean distilled water into the Trauma Fill Tank 9 Aim the short hose with the male fitting toward a wastewater bucket and 10 pump one time This should flush the hose and the male fitting clear of any remaining debris Stop the flow by turning the pressure relief valve Wipe down the inside of the male filter housing iStan Care and Maintenance 209 iStan Care and Maintenance iStan 11 While holding the female housing with the open end up place the filter element with the open end down into the housing Using the tip of your finger or a small soft instrument e g the eraser end of a pencil to gently apply pressure to the filter element and push into place
178. o mounting surface to secure this assembly to the tray A properly installed assembly will have the CO canister sloping down toward the rear of the mannequin d Carefully reposition the foam and pull the skin back over the simulator to its original location Once the canister and regulator assembly is in place CO is measurable with a disposable ET CO detector during patient exhalations Based on the training environment a CO canister may last from 10 minutes rapid breathing to 25 minutes See Handling CO Canisters on page 211 26 CAE Healthcare iStan Setup Optional Prepare the Secretion System ONLY distilled water or distilled water containing food coloring should be used with the secretion system A mixture of no more than 29 mL 1 oz red food coloring with 3 8 liters 1 gallon of distilled water should be used to create blood The blood mixture should be created in advance in a separate distilled water container NOTE The higher the ratio of food coloring the greater the possibility of staining Using the Trauma Fill Tank The Trauma Fill Tank provides the means by which the simulated blood is transported to the on board blood reservoir CAUTIONS and WARNINGS Carefully follow all instructions for using the Trauma Fill Tank Pay particular attention to the following cautions and warnings ALWAYS read and follow instructions for creating trauma fluids e g blood ALWAYS protect eyes skin and c
179. o Setup window select a waveform to set it as the pulse sound Once a waveform is selected the Audio Setup window automatically closes Clicking the Mute button from the Audio Setup window mutes all alarms Click the Mute button again to return the alarms to their original state 139 Using TouchPro iStan 12 Lead ECG To view a 12 lead ECG report click the 12 Lead ECG button at the bottom of the TouchPro screen The 12 Lead ECG Button The report appears The Close button aR La oo MFSESASESTS C Rh pt AW ima EEEN d 4 il r A L TA ETA J i i EHE as ux ee uc ud ee a dad aee Buc L L 5 The Print button A 12 Lead ECG Report The report can be printed or saved by clicking the Print button in the bottom right corner of the 12 lead ECG report To close the report click the Close button IMPORTANT Prior to saving the report as a PDF or printing to a network printer the print presets must be adjusted The page orientation must be set to Landscape and the margins must be set to 25 inches on all sides These settings vary in location depending on the operating system i e Macintosh or Windows To save the report to a PDF file on a Macintosh Instructor Workstation 1 From the 12 lead ECG report screen click the Print button located in the bottom right corner of the 12 lead ECG report 2 Select the Save As PDF option 3 The report saves as a PDF on the Macintosh Inst
180. o the user and damage to the equipment Always use the supplied power cords Do not substitute Operate the system from a power source with the following rating 115VAC 50 60 hertz cycles per second e g North America Japan 230VAC 50 60 hertz cycles per second e g Europe Do not allow excess fluids to flow on or into electronic parts Donotattempt to disassemble the simulator or service any of the electrical components other than the changing of fuses Always remove the power cable and have simulator turned off when replacing fuses e Replace F1 with a 32VDC 250VAC 5 x 20mm IEC 60127 2 2 fast acting fuse rated for 8 amperes Always use the supplied power adapter to charge or run simulator from AC Latex Warning CAE Healthcare simulators incorporate latex into their design When performing certain maintenance procedures the latex can become exposed Users with latex sensitivity should take necessary precautions when handling the simulator while performing those procedures o CAE Healthcare Cautions Warnings General Use Warnings Electrical System Operate the system from a power source with the following rating 115VAC 50 60 hertz cycles per second e g North America Japan and 230VAC 50 60 hertz cycles per second e g Europe Do not operate the iStan system in rain Apply water to the mannequin only in accordance with the supported clinical procedures identified in this User Guide
181. ons Palette Once an Intervention is selected a menu appears with available options for the selected Intervention Click the desired option to select it The intervention is applied and appears in the patient s physiology The Bag Valve Mask Crystalloids Interventions options Intubated A selected Non Rebreather Mask intervention The Selected Intervention Options NOTE Quick Links can only be added while creating or editing the SCE 59 Using M se iStan Or to apply an intervention that is not set up as a Quick Link in the Interventions palette 1 Click the Interventions button The Interventions menu appears Interventions are organized by type or all available interventions are listed under ALL INTERVENTIONS Close Electrical Therapy Fluids Invasive Procedures The All Interventions Menu 2 Navigate through the menus to find the desired intervention 3 Once the desired intervention has been located click the intervention s name from the list Q ALL INTERVENTIONS Bag Valve Mask Cardioversion Biphasic Cardioversion Monophasic Chest Tube Flow Rate Colloids Crystalloids Defibrillation Biphasic Defibrillation Monophasic Fraction of Inspired Oxygen FiO2 Intubated Nasal Cannula The All Interventions Menu The Intervention Options menu appears showing the available options for the selected intervention 60 WZ CAE Healthcare Using Mise 4 Click the desired o
182. opine I Fpinapheine 1 10 000 Scenarios Add Scenario f vent lege 00 00 00 SCE mas started Medication Monitor meti admin The Run Screen 147 Using iStan iStan Parameters The M se software has a number of parameters that control the physiological features of iStan The parameters are grouped by category Neurological Respiratory Cardiovascular Fluids and Sounds Each screen lists default Basic parameters However when the Basic Additional switch located on the Run screen is activated more parameters become available Click the Basic switch to Additional to see more parameters The Basic Additional Switch Below is a table that lists all of the Basic iStan parameters Eyes Pupil Size Eyes Blink Speed Secretions Tearing Secretions Ears Secretions Mouth Diaphoresis Convulsions NMB Temperature Body Temperature Blood Swollen Tongue Airway Occluder Laryngospasm Needle Decompression Bronchial Occlusion Respiratory Rate Respiratory Rate Factor Shunt Fraction SpO NMB Tidal Volume Flail Chest Intrapleural Volume Left Intrapleural Volume Right Trismus Fraction of Inspired O 2 Basic Parameters Fluid Loss Blood Fluid Loss Plasma Blood Pressure Heart Rate Heart Rate Factor Cardiac Rhythm Cyanosis Toes Hemorrhage Channel 1 Hemorrhage Channel 2 Hemorrhage Channel 3 Hemorrhage Channel 4 Hemorrhage Chann
183. or This Chest Wall Compliance Factor parameter describes the interaction of the chest wall with the lungs The Chest Wall Compliance Factor parameter defines the volume pressure relationship in the normal operating lung volumes Once distended however the chest wall rapidly becomes much less compliant i e much stiffer and resistant to further inflation Default 1 Range 0 15 10 00 A 18 o CAE Healthcare Appendix A Parameter Descriptions Distended Chest Wall Compliance Factor The Distended Chest Wall Compliance Factor parameter along with the Chest Wall Compliance Factor parameter describes the interaction of the chest wall with the lungs The Chest Wall Compliance Factor parameter defines the volume pressure relationship in normal lung volumes Once distended however the chest wall rapidly becomes much stiffer and resistant to further inflation Also see Chest Wall Compliance Factor The Distended Chest Wall Compliance Factor parameter must be set to a low value for increased intrapleural volumes to result in elevated inspiratory pressures with positive pressure ventilation Also see Intrapleural Volume Vol Left or Intrapleural Volume Vol Right parameters Default 1 Range 0 10 10 00 Functional Residual Capacity The Functional Residual Capacity parameter sets the combined left and right lung volume remaining at the end of a normal spontaneous exhalation Default 2300 mL Range 500 mL 4000 mL
184. or a male shut off fitting marked with a red label Hemorrhage Control The bleeding rates at moulaged wound sites are monitored for effective hemorrhage control therapy e g hemostat tourniquet Data from the physiological blood models is recorded in the physiologic logs for use during debriefing For information regarding cleanup after using the Hemorrhage feature see page 202 p CAE Healthcare Using iStan Tourniquet Application A tourniquet may be applied to stop the flow of blood The wound umbilical contains an 18 inch section of soft tubing that allows the use of a tourniquet to stop the flow of blood Use the included tape to hold the hose in the correct location for tourniquet usage For added realism the simulator should be dressed in clothing that can be torn to conform with the type of injury being demonstrated Bleeding moulages and the wound umbilical should be concealed under the victim s clothing with only the wound showing Applying a Tourniquet To stop bleeding apply the tourniquet between the wound and heart 177 Using iStan iStan Genitourinary System The simulator allows for the insertion of urinary catheters and excretion of urine with a flow rate that is controlled by the instructor Urinary Catheterization Prior to use ensure the clear secretions tank is full Catheterize the simulator using a standard urinary catheter lubricated with silicone spray For supported cathether size see
185. os Panel All Scenarios are listed in the Scenarios panel From the Scenarios panel users can rename review delete import and export Scenarios they have created by clicking the respective buttons within each scenario Locked Scenarios can only be reviewed Users can also create new scenarios from the Scenarios screen by clicking the Create New Scenario button Click Import to import a scenario file from an external device or the hard drive location where the SCE file is saved Click Export to export a scenario file to an external device The scenario file extension is mss NOTE Preconfigured CAE Healthcare scenarios CANNOT be exported 110 CAE Healthcare Using M se Conditions From the Content Management options click Conditions to access the Conditions Editor The Conditions Editor appears Learning Modules SCEs Th e Base Patients Conditions EE link The Rename button The Delete button the Add baton B M The Conditions Editor The Edit Parameters button All conditions can be viewed in the Conditions panel by selecting their associated categories and groups from the Condition Categories and Condition groups panels 111 Using M se iStan From the Conditions Editor users can create new Conditions to be used in SCEs To create a new condition 1 From the Condition Categories panel select a category NOTE Conditions CANNOT be added to the Interventions category 2 From the Con
186. other devices as may be directed by CAE Healthcare At CAE Healthcare s request Licensee shall promptly provide a written certificate signed by an officer of Licensee confirming that such items have been returned to CAE Healthcare or destroyed as so directed by CAE Healthcare 45 The following shall survive and continue in full force and effect notwithstanding any termination of this License the obligations of Licensee under Sections 2 License 5 Non Disclosure as well as any other clauses which by their nature and context are intended to survive 5 NON DISCLOSURE 5 1 Licensee agrees to keep this License and all Confidential Information obtained hereunder in strict confidence and shall only disclose same a to Authorized Users solely for the Purpose and provided such access to the Product conforms at all times to the terms and conditions governing the use of the Product contained herein or b if required to be disclosed by law and only to the extent of such disclosure and limited to the purpose requested with prior notice to CAE Healthcare to permit it to seek an appropriate remedy to prevent the disclosure or alternatively to agree to the terms of such disclosure 5 2 The obligations of confidentiality use and non disclosure referred to in this Section 5 shall not apply to information which i is or becomes publicly available through no fault of Licensee ii was already in the rightful possession of Licensee prior to its receipt fro
187. ouble breathing She was eating dinner at a cookout when she noticed some tightness in her chest The cook came by asking if anyone wanted another shrimp burger She then told him she was allergic to shellfish She was proceeding to her car to retrieve an epinephrine auto injector when a wasp stung her im Print SCE The Print button The Add to Favorites button The SCE This SCE consists of six states that manually transition During the initial assessment in State 1 Beginning Anaphylaxis the patient presents with early signs of anaphylaxis HR in the 90s BP in the 100s 50s RR in the 20s and SpO2 in the low 90s on room air She remains conscious The learner is expected to assess and manage the patient s airway breathing and circulatory status ABCs identify early signs of allergic reaction consider use of oxygen call for help with interventions consider early use of epinephrine and attach a cardiac monitor If more than 120 seconds elapses without administration of epinephrine the instructor should manually advance the SCE to State 2 Mild Anaphylaxis If epinephrine is administered the SCE is advanced to State 5 Epinephrine Administered In State 2 Mild Anaphylaxis the patient experiences increased respiratory distress The patient s HR is in the 110s chi TES The SCE Summary Panel The Add to Favorites button adds the SCE to your Favorites list Content Summary The Run button Clicking the Review button acc
188. pacing signals from 20 to 200 mA in increments of 10 Three parameters can be used to simulate pacing within the software Pacing Capture Threshold determines the minimum pacing current necessary to pace the heart Pacing Current simulates a specific amount of current discharged by an external cardiac pacemaker Pacing Rate determines the cardiac rate when the Pacing Current is at or above the Pacing Capture Threshold All three parameters are located on the Cardiovascular view p CAE Healthcare Using iStan Fluids Many of iStan s fluids such as Bleeding IV Fluid Administration and Urine Output can be managed from the Fluids view Fluids Anatomy Clinical Interventions Patient Software Control Manual Physiology and Monitoring and Scenarios Control Clinical Signs Bleeding Two simultaneous bleeding sites may be VIEW Fluids See Secretion used Bleeding is linked to physiology and System may take place at all four limbs as well as the chest belly IV Access The right and left arms of the simulator None required See Permanent provides intravenous access locations IV Access Ports IV Medication Bolus injections are administered utilizing Administered IV All administered Administration standard syringes while continuous IV medications mustbe IV medications infusions can be administered using infusion set by the instructor are collected in devices Injections can be administered in the Medications
189. pair or replace defective material CAE Healthcare s replacement material will be manufactured from new and or serviceable parts CAE Healthcare s agreement applies to repaired or replaced materials for the balance of the applicable period of the original warranty or ninety days from the date of shipment of a repaired or replaced material whichever is longer CAE Healthcare warrants its LABOR for 30 days or the balance at the applicable period of the original warranty whichever is greater CAE Healthcare shall not be liable under this warranty for incidental or consequential damages or in the event of any unauthorized repairs or modifications have been made or attempted or when the product or any part thereof has been damaged by accident misuse or abuse This warranty does not cover normal wear and tear staining discoloration or other cosmetic irregularities that do not impede or degrade product performance Any damage or malfunction as a result of the installation of software or hardware not authorized by CAE Healthcare will be repaired under the Time and Materials service plan see Time and Materials section CAE Healthcare s warranty does not cover products that have been received improperly packaged altered or physically damaged Products will be inspected upon receipt Some states in the USA do not allow the exclusion or limitations of incidental or consequential damages so the limitations above may not apply to you This warranty gi
190. parameter is used to simulate changes in the FiO such as would occur with the administration of supplemental oxygen Use this parameter to simulate supplemental oxygen Default 2196 Range 096 10096 A 11 Appendix A Parameter Descriptions iStan Respiratory Additional Parameters Respiratory Parameters Additional CAE Healthcare Appendix A Parameter Descriptions Respiratory Rate The Respiratory Rate parameter is used to set the respiratory rate to a given number of breaths per minute Once set arterial oxygen and carbon dioxide values have no effect on the resulting respiratory rate but continue to influence other components of the physiological models The patient continues to breathe at the set number of breaths per minute regardless of the arterial oxygen or carbon dioxide levels For example when the respiratory rate is set to 10 breaths per minute the respiratory rate remains at 10 breaths per minute regardless of arterial oxygen or carbon dioxide levels In such situations the patient can only respond to arterial oxygen or carbon dioxide levels by adjusting the Tidal Volume parameter Default Modeled Range 4 breaths per minute 40 breaths per minute Tidal Volume The Tidal Volume parameter is used to set the tidal volume to a given volume per breath Once tidal volume is set to a numeric value arterial oxygen and carbon dioxide values have no effect on the tidal volume but continue to in
191. ption Face Mask Room Air 50 FiO2 60 FiO2 The Intervention Options The intervention is applied and appears in the patient s physiology Transitioning Scenario States from the Run Screen To move between scenario states from the Run screen 1 Click the desired scenario Anaphylaxis Beginning Anaphylaxis 00 00 11 A Scenario The Scenario Management pop up menu appears and all available states are listed Scenarios s Add Scenario Anaphylaxis nari Begining Anaphylaxis Show Scenario Fee a gt Beginning Anaphylaxis 00 00 04 Scenari Mild Anaphylaxis sterted Moderate Anaphylaxis 00 00 00 S Severe Anaphylaxis Epinephrine Administered Condition Improves The Scenario Management Pop Up Menu 2 Select the desired state The scenario proceeds to the selected state The scenario can also be paused or continued by selecting the Pause and Play options from the Scenario Management Pop Up menu 61 Using M se iStan Transitioning Scenario States from the Scenario Screen To move between scenario states from the Scenario Screen 1 From the Run screen click the desired loaded scenario The Scenario Management pop up menu appears Scenarios a Add Scenario Anaphylaxis Show Scenario The Show Scenario option Begining Anaphylaxis TEPIS Beginning Anaphylaxis 00 00 04 Sc Mild Anaphylaxis Moderate Anaphylaxis eas Severe Anaphylaxis Epinephrine Administered Condition Improve
192. pulses patient voice genitourinary features and airway management features The simulator is rechargeable using the Power Cord provided See page 197 for instructions on recharging the battery Laptop Instructor Workstation The Laptop Instructor Workstation is a computer that utilizes M se Software to operate as the main simulation control center Instructors control the simulation session from the Workstation by using SCEs that meet their learning objectives IMPORTANT All CAE Healthcare computer components are preconfigured for use with the iStan system There are no software installation or configuration steps required Only approved CAE Healthcare applications should be installed or run on the iStan computer system p CAE Healthcare Introduction CO Canisters Four CO canisters are included with iStan for use with a disposable ETCO detector Inventory Kit iStan comes with a number of accessories and replacement components Included in the Inventory Kit are iStan Start Up Kit Quick Start Chart and Setup Map Priming syringe Roll 4 ft of VHB tape and roll of 2 inch wide red tape for cricothyrotomy Cricothyrotomy replacement skin BP adapter kit Silicone lubricant iStan priming tube iStan ECG posts Pacing Defibrillation disks Condensation drain Wound umbilical assembly NIBP Adaptor Chest Tube prime tubing Female genitalia CO Cartridge Kit VGA Mini Adapter Introduction iStan
193. r Late Systolic Murmur Pan Systolic Murmur Throat Sounds Click Heart Sounds to access the Heart Sounds menu gt Normal The Heart Sounds Menu Click the Heart Sounds drop down menu to change the type of sound Click and drag the slider to adjust the volume 189 Using iStan 190 Bowel Sounds Learners can auscultate bowel sounds over each of four intestinal quadrants the Upper Right Upper Left Lower Right and Lower Left The sounds can be independently set in each anatomical region to Normal Hypoactive Hyperactive or None bowel sounds are absent Bowel sounds can be adjusted by clicking the Sounds button on the Run screen When the Sounds panel appears select Bowel Sounds All Bowel Sounds Normal reath Sounds e M Hypoactive A Hyperactive LUQ Bowel Sounds ITE YESH None WI LLQ Bowel Sounds RLQ Bowel Sounds Vocal Sounds ee Click Bowel Sounds to access the Bowel Sounds menu Normal The Bowel Sounds Menu Click and drag the slider for each location to adjust the volume Normal bowel sounds are present by default iStan Click any one of the Bowel Sounds drop down menus that each control one of four quadrants to change the type of sound p CAE Healthcare iStan Care and Maintenance iStan Care and Maintenance Maintaining iStan requires careful treatment of the electronic and mechanical components Each time
194. racic Arteries Elastance Intrathoracic Arteries Elastance Pulmonary Arteries Elastance Pulmonary Vasculature Resistance Factor Venous Return Resistance Factor Baroreceptor Gain Overall Factor Baroreceptor Gain Peripheral Factor Chest Compression Efficacy 149 Using iStan iStan Additional Parameters Lung Compliance Factor Tamponade Volume Left Ischemic Index Sensitivity Lung Compliance Factor Ischemic Index Averaging Right Aortic Valve Resistance Venous CO Shift Factor Left Bronchial Resistance Mitral Valve Resistance Right Bronchial Factor Resistance Pulmonic Valve Alveolar Enflurance Resistance Factor Alveolar Halothane Alveolar Isoflurane Alveolar Sevoflurane 150 p CAE Healthcare Using iStan Neurological Features iStan can simulate a variety of neurological clinical indicators such as secretions and reactive eyes Neurological Features Anatomy Clinical Interventions Patient Software Control Manual Physiology and Monitoring and Scenarios Control Clinical Signs Each eye has reactive pupils and functional The response eyelids that blink and close to clinical intervention must be controlled by the instructor VIEW Neurological PARAMETER S Eye Controls Clear fluid can be secreted from the nose The response See Secretion mouth or ears to clinical System intervention must be controlled by the instructor VIEW Neurological PARAME
195. ractive and absent bowel sounds None are selected using this parameter Independent control of the type and volume of bowel sounds may be selected in each anatomical region To affect the bowel sounds simultaneously in all anatomical regions select All Bowel Sounds and the desired sound Default Normal NOTE The volume control slider underneath each area may be used to adjust the amplitude of the sound The volume control slider is only enabled while connected to a simulator A 42 CAE Healthcare Appendix A Parameter Descriptions Breath Sounds Normal and abnormal breath sounds are selected using this parameter Breath sounds are independently synchronized with ventilation of the left and right lungs Independent control of the type and volume of breath sounds may be selected in each anatomical region Breath Sounds Locations To affect the breath sounds simultaneously in all anatomical regions select All Breath Sounds and the desired sound Default Normal NOTE The volume control slider underneath each area may be used to adjust the amplitude of the sound The volume control slider is only enabled while connected to a simulator A 43 Appendix A Parameter Descriptions iStan Heart Sounds Normal and abnormal heart sounds are selected using this parameter Sounds can be set for all four quadrants or mitral aortic pulmonic and tricuspid sounds can be set independently Heart sounds are synchronized wit
196. rals Step 1 Pour the Fluid into the Trauma Fill Tank Pour the desired amount of fluid into the Trauma Fill Tank being careful to NOT to exceed 6 liters 1 6 gallons of fluid NOTE The left thigh tank is smaller 0 8 liters and used for clear fluids urine diaphoresis tears and ear nose and mouth secretions The right thigh tank is larger 1 8 liters and used for blood chest tube drainage Four 4 liters of simulated blood provides enough fluid to fill the right thigh reservoir twice The amount of blood used in a training session will vary with the patient the wounds simulated and the learner s experience 28 CAE Healthcare iStan Setup Step 2 Connect the Trauma Fill Tank Umbilical to the Simulator Attach the tank s umbilical to the simulator by matching and connecting the fittings labeled in blue and yellow a For clear fluids separate the skin on the left side of the simulator at the hip to reveal a bundle of hoses For blood the hoses can be located by separating the skin on the right side of the simulator at the hip b Locate the blue FILL hose and yellow VENT hose c Connect the FILL with the blue label and VENT with the yellow label hoses to the CAE Healthcare tank Connections are male to female Connect the Vent Hose Connect the Fill Hose Both connections must be made for correct operation Step 3 Pressurize the Trauma Fill Tank and Fill the Reservoir An integrated hand pump
197. rameter At this time cyanosis is not linked with the physiological models Default Off NOTE This parameter may not be used at the same time as the Capillary Refill parameters Arterial Catheter The arterial pressure displayed on the Patient Status Display or TouchPro software is set using this parameter A non pulsatile zero pressure signal is emitted when the Atmosphere position is selected and can be used to simulate zeroing a pressure transducer This may also be used to remove the arterial pressure waveform if desired The Left Ventricle position is useful for simulating cardiac catheterization procedures or for demonstrating left ventricular end diastolic pressure and its relationship to pulmonary artery occlusion wedge and central venous pressure Default Peripheral Artery Options Atmosphere Peripheral Artery Left Ventricle Central Venous Catheter The venous pressure displayed on the Patient Status Display or TouchPro software is set using this parameter A non pulsatile zero pressure signal is emitted when the Atmosphere position is selected and can be used to simulate zeroing a pressure transducer This may also be used to remove the central venous pressure waveform if desired i e beginning of an SCE with an unmonitored patient Default Intrathoracic Vein Options Atmosphere Extrathoracic Vein Intrathoracic Vein A 26 CAE Healthcare Appendix A Parameter Descriptions Pulmonary Art
198. receptor Reflex Cardiac Pacing Cardiac Rhythms Chest Compression 164 Cardiovascular Features Clinical Interventions Patient Monitoring and Scenarios ECG waveforms can be viewed on a standard monitor and or on the Patient Status Display Normal and abnormal cardiac rhythms are linked to patient physiology e g blood pressure cardiac output Cardiovascular system automatically compensates for changing hemodynamic conditions Transthoracic cardiac pacemaker can be used with iStan Pacing results in appropriate physiological changes in blood pressure and cardiac output The desired arrhythmia can be selected Effective chest compression results in artificial circulation cardiac output central and peripheral blood pressures palpable pulses and CO return Software Control None required specific rhythms can be selected VIEW Cardiovascular PARAMETER S Cardiac Rhythm None required but adjustable VIEW Cardiovascular PARAMETER S Baroreceptor Maximum Pressure Baroreceptor Minimum Pressure The instructor can set the level at which electrical capture and mechanical capture occur VIEW Cardiovascular PARAMETER S Pacing Current Pacing Rate Pacing Capture Threshold The response to clinical intervention must be controlled by the instructor VIEW Cardiovascular PARAMETER S Cardiac Rhythm None required but adjustable VIEW Cardiovascular PARAMETER S
199. rs Do not remove cannister from regulator base until empty Canister end becomes punctured when screwed into regulator base Never ship the CO canister attached to the regulator assembly Assembly of the CO Regulator Care must always be taken when using high pressure equipment Do not disassemble or alter regulator Dry completely if the regulator becomes wet Discontinue use of this equipment if leakage or visible damage is evident Insertion of the CO Canister To insert the CO canister a Locate the regulator shipped in the inventory bag b While holding the regulator firmly carefully screw the CO canister into the regulator as far as it will go The final turns will puncture the CO canister which is necessary for correct operation 25 iStan Setup iStan CAUTION Do not loosen the canister once it has been screwed into the regulator assembly until the contents are exhausted and pressure relieved CAUTION Unscrewing the canister before it is empty results in the sudden release of all high pressure gas with a possibility of liquid CO spray Unprotected skin could receive freezing burns a Lift the skin and move the foam at the simulator s right midsection and locate the CO pneumatic umbilical hose inside the side tray b Attach the blue CO pneumatic umbilical hose to the connection on the regulator L a c Place the CO canister regulator and hoses inside the simulator Use the Velcr
200. rs 3 Click Complete When the SCE begins the Patient presents with the selected baseline settings 77 Using M se iStan Content Management SCE Content is entered from the SCE Editor using the Overview Background Preparation and Notes buttons under the Content Management heading Content Management Overview Background Preparation Notes The Content Management Buttons Each button accesses a screen that allows users to enter information for the chosen section Overview Background Preparation or Notes Click the Edit button of each section on the SCE Editor to access a rich text editor that enables data entry IMPORTANT Text can be copied and pasted into the fields from TextEdit or Notepad only Biz lela E The Rich Text Editor Click Save when all data for the field has been entered 78 WJ CAE Healthcare Using Mise SCE Configuration Setting up the Conditions the TouchPro software and the Patient Status Display is achieved by clicking the buttons under the SCE Configuration heading in the SCE Editor SCE Configuration Condition Setup TouchPro Setup Patient Status Display The SCE Configuration Buttons Condition Setup Screen and Creating Quick Links Click Condition Setup to access the Condition Setup screen From the Condition Setup screen conditions medications and interventions can be preconfigured for the SCE creating Quick Links On the Condition Setup scree
201. ructor Workstation 140 Using TouchPro To save the report to a PDF file on a Windows Instructor Workstation 1 From the 12 lead ECG report screen click the Print button located in the bottom right corner of the 12 lead ECG report The Print dialog box appears 2 From the drop down menu select Microsoft XPS Document Writer 3 The report saves on the Windows Instructor Workstation To print a report 1 From the 12 lead ECG report screen click the Print button located in the bottom right corner of the 12 lead ECG report 2 Select the appropriate network printer NOTE A network printer must be configured in order to appear as an option 3 Click the Print button The report prints to the designated network printer 141 Using TouchPro iStan NIBP Cycling and Manual NIBP When non invasive blood pressure NIBP is displayed the patient s NIBP can be updated at specified intervals using NIBP Cycling or the current NIBP can be displayed immediately using the Manual NIBP button To set the patient s NIBP to be updated at regular intervals from the Settings menu click NIBP Cycling The NIBP Cycling menu appears From the NIBP Cycling menu select the desired interval for the cycling and click Start NIBP Cycling SSS 2 0 mins 3 0 mins 5 0 mins 10 0 mins 15 0 mins 30 0 mins 60 0 mins Custom Cycling The NIBP Cycling Menu Custom cycling is also available 142 Using TouchPro To
202. ry PARAMETER S Chest Tube Enable Left Chest Tube Enable Right Chest Tube Flow Left Chest Tube Flow Right Chest Tube Air Leak Type Left Chest Tube Air Leak Type Right Chest Tube Air Leak Flow Left Chest Tube Air Leak Flow Right Cricothyroid Membrane Allows needle cricothyrotomy None required See transtracheal jet ventilation Cricothyrotomy retrograde wire techniques and cricothyrotomy Esophagus Lower Esophageal intubation results in None required None required Esophageal Sphincter gastric distension and the absence of Enelctomach breath sounds chest excursion and CO output Exhaled CO Measure the presence or absence of co Flail Chest Abnormal mobility and loss of normal The instructor can None required chest wall movement can present on set the level at the lower right side of the thoracic which electrical wall capture and mechanical capture occur VIEW Respiratory PARAMETER S Flail Chest Laryngospasm Closes vocal cords and prevents VIEW Respiratory None required intubation and ventilation When used with posterior pharynx swelling PARAMETER S creates a can t intubate can t Laryngospasm ventilate scenario 155 Using iStan 156 Needle Decompression Posterior Pharynx Swelling Pulse Oximetry Realistic Upper Airway Oropharynx Nasopharynx and Larynx Spontaneous Self Regulating Breathing Symmetric and Asymmetric Lung Ventilation Tongue S
203. s The Scenario Management Pop Up Menu 2 From the menu select Show Scenario The Scenario screen appears displaying the scenario The Jump to ees ae a C g The Close State button Window wna Anata B 5 Button e Selected state yx 7 States The Scenario Screen At the top of this screen the Scenario Time and State Time are visible Additionally users can pause and continue playing the scenario by clicking the Pause and Play buttons on the Scenario Management pop up menu which is still visible on the left side of the screen 62 WZ CAE Healthcare Using Muse 3 Click the Jump to State button The Jump to State menu appears displaying the available states e Beginning Anaphylaxis Mild Anaphylaxis Moderate Anaphylaxis Severe Anaphylaxis Epinephrine Administered Condition Improves The Jump to State Menu 4 Select the desired state The scenario transitions to the selected state and the state is highlighted on the Scenario screen NOTE Double click on the states to expand to the full view 5 Click the Close Window button to return to the Run screen SCE Time Controls The SCE time controls are located at the top of the Run screen The Fast Forward The Timeline bar button The Pause button The Play The Bookmark button button 00 00 29 B Bookmark qD ie The SCE Time Controls The Timeline bar shows th
204. s Prior to using moulage of any kind CAE Healthcare suggests the application of a very light coating of petroleum jelly followed by a light dusting of baby powder to the simulator s skin This application makes cleaning the skin easier If any of the trauma genitourinary or IV features of the iStan system have been used flush out the simulator as described in the following pages Failure to flush the systems may cause problems for the system during attempts at future use Storage When in regular use iStan s breakdown procedure and general cleanup should be sufficient to prepare the simulator for storage In addition be certain to follow these instructions Storage temperature should not exceed 122 F 50 C or fall below 41 F 5 C If a soft sided simulator case is being used the simulator should lay flat The simulator should NEVER be stored or shipped with fluids in the system CAE Healthcare also recommends storing the simulator with a cervical collar in place to protect the neck Care of Electronic Equipment Do NOT use any of the computer components associated with this system for any other use Do NOT connect the computer components to any network of any kind Install any CAE Healthcare software updates as soon as they become available 196 p CAE Healthcare iStan Care and Maintenance Airway Inspection iStan is equipped with an anatomically accurate airway that supports the practice of difficult airway
205. s If epinephrine is administered the SCE is advanced to State 5 Epinephrine Administered In State 2 Mild Anaphylaxis the patient experiences increased respiratorv distress The patient s HR is in the 110s ru Review kb Run The SCE Summary Panel 2 From the SCE summary panel click the Print SCE button A PDF of the selected SCE appears in a new browser window The Print SCE button 3 Save the PDF to an external storage device to print from another computer OR To print from the Instructor Workstation consult your network administrator for assistance connecting to a printer 4 When finished saving or printing the PDF close the browser window containing the PDF to return to M se WJ CAE Healthcare Using Mise Running an SCE To run an SCE from the Home screen select an SCE and click the Run button The Run screen can also be accessed from the Scenario Designer or SCE Editor by clicking the Run button near the top of the screen The Run Button The Run screen appears Patient Records The Connect button The Stop button Physiological display widgets a V o Condition Ju de Medications and v un Interventions Scenarios 7 palettes Event Log E The Event Recorder The Run Screen From the Run screen users can manage the SCE perform interventions view physiological status and events save events as states save the Patient an
206. s achieved Default Off Needle Decompression Left and Right The Needle Decompression parameter is used to activate the Needle Decompression hardware in the simulator to relieve a pneumothorax in the simulator This causes a rush of air to be heard on successful decompression The amount of decompression is automatically subtracted from the Intrapleural Volume set Default Off NOTE The Chest Tube and Needle Decompression features cannot be enabled simultaneously A 7 Appendix A Parameter Descriptions iStan A 8 Bronchial Occlusion Turning on the Bronchial Occlusion parameter completely obstructs the right or left bronchi simulating a lower airway obstruction e g mucus plug Improper intubation creates a mainstem occlusion yielding an inability to ventilate the lungs However the right and left bronchi are not occluded individually Default Off Respiratory Rate The Respiratory Rate parameter is used to set the respiratory rate to a given number of breaths per minute Once set arterial oxygen and carbon dioxide values have no effect on the resulting respiratory rate but continue to influence other components of the physiological models The patient continues to breathe at the set number of breaths per minute regardless of the arterial oxygen or carbon dioxide levels For example when the respiratory rate is set to 10 breaths per minute the respiratory rate remains at 10 breaths per minute regardless of
207. s Electronics N V product ACC 007 12 p CAE Healthcare Introduction iStan Educational Development IStan Basic and Advanced courses offer learners at all levels in depth instruction in the setup operation development of scenarios and maintenance related to the use of iStan The iStan Basic course provides learners with an overview of the system and its components as well as an introduction to patient creation and scenario design iStan Basic two days at CAE Healthcare facility iStan Basic On Site two days at learner defined facility iStan Basic On Site Physician Instructor two days at learner defined facility with physician led instruction The iStan Advanced course builds upon the concepts introduced in the prerequisite Basic course After a quick review of the Basic course Advanced instruction spends the majority of the two days providing learners with the ability to design patients and scenarios that can be used immediately upon completion of the course iStan Advanced two days at CAE Healthcare facility iStan Advanced On Site two days at learner defined facility iStan Advanced On Site Physician Instructor two days at learner defined facility with physician led instruction 13 Introduction iStan iStan Learning Applications CAE Healthcare Learning Applications enhance the use of the simulator by providing preprogrammed scenarios and corresponding support documentation i e course obje
208. scriptions of this equipment can be found in the section iStan Standard Equipment see page 6 As you would with any shipment cross check this inventory with your CAE Healthcare packing invoice to verify that all components have been received CAE Healthcare Introduction Optional Components Inventory Optional equipment is available to accommodate special customer requirements For example options like an air compressor and the Trauma Disaster Casualty Kit TDCK enable instructors to create real life scenarios at authentic locations Optional Equipment Detailed descriptions of this equipment can be found in the section Optional Equipment for iStan see page 9 Contact CAE Healthcare Customer Service at 866 462 7920 if there are any questions or if optional equipment is needed Introduction iStan iStan Standard Equipment The design of the iStan system allows students to focus on the patient simulator while giving instructors the ability to create an endless number of possible clinical situations Full Body Wireless Simulator All patient assessments and clinical interventions are played out on the iStan mannequin which represents a human patient At 5 feet 10 inches 177 5 cm in height and weighing 124 pounds 56 kg iStan is fully operational in the supine lateral prone and seated positions The simulator offers features like arm pronation and supination breath heart and bowel sounds palpable
209. so This could damage the system and may also present a possible hazard for the operator When using a manual defibrillator the ECG can be monitored via the defibrillator paddles Coarse ventricular fibrillation and high rate ventricular tachycardia cardiac rhythms are automatically recognized as shockable rhythms With each defibrillation the iStan automatically records the amount of energy discharged and the time defibrillation was performed The simulated patient response to defibrillation is determined by the scenario script or instructor intervention Thus cardioversion is not automatically determined by the physiological models The minimum electrical charge recognized by the circuitry within the simulator is 20 joules Monophasic and Biphasic defibrillators can be used with either paddles or hands free connectors For paddle placement on the chest the simulator has two anterior defibrillation disks which can be unscrewed leaving threaded connections if required Disks for defibrillation are located on the left side of the chest as well as to the right of the sternum Defibrillation Sites The Defib parameter is available for virtual defibrillation The Defibrillation parameter is located on the Cardiovascular view 171 172 Using iStan iStan Cardiac Pacing A standard transthoracic cardiac pacemaker can be connected to the simulator using the anterior contacts The software automatically detects and responds to
210. speech any response can be transmitted through the speakers using the wireless microphone Wireless Microphone The microphone volume can be adjusted on the microphone itself using the volume control The microphone volume is also controlled via the Vocal Sounds menu For more information on the Vocal Sounds menu please see page 182 Wireless Voice Link If a wireless voice link package was included with the iStan simulator see Appendix B Wireless Voice Link on page B 1 for additional instructions 186 ZW CAE Healthcare Using iStan Throat Sounds Stridor throat sounds can be enabled using the software Throat sounds can be adjusted by clicking the Sounds button on the Run screen When the Sounds panel appears select Throat Sounds Click Throat Sounds to access the Throat Sounds menu Throat Sounds Heart Sounds None Stridor Vocal Sounds The Throat Sounds Menu Click the Throat Sounds drop down menu to change the type of sound Click and drag the slider to adjust the volume 187 Using iStan 188 Breath Sounds Breath sounds are independently synchronized with ventilation of the left and right lungs Fourteen speakers eight anterior and six posterior provide breath sounds that can be auscultated Each of the four quadrants of the torso can be set independently to produce a particular breath sound Breath Sounds Breath sounds can be adjusted by clicking the Sounds
211. ssure falls the arteries increase their vascular tone resistance and there is less pooling of the blood in the venous system in an attempt to maintain adequate blood pressure A factor of less than 1 corresponds to baroreflex depression e g less systemic vascular resistance response to MAP changes A value greater than 1 leads to a stronger response to MAP changes Default 1 Range 1 00 10 00 A 35 Appendix A Parameter Descriptions iStan Chest Compression Efficacy The Chest Compression Efficacy parameter is used to determine the effectiveness of the chest compression administered by the caregiver The 100 setting indicates that chest compressions are completely effective while the 0 setting prevents them from having any effect on intrathoracic pressure Default 100 Options 100 0 Tamponade Volume The Tamponade Volume parameter is used to set the amount of fluid or blood that is building up in the space between the myocardium and the pericardium causing a cardiac tamponade Default 0 mL Range 0 mL 500 mL Ischemic Index Sensitivity The Ischemic Index Sensitivity parameter determines the relative sensitivity of the simulated patient to myocardial ischemia A lower ischemic index sensitivity value corresponds to less sensitivity to an unfavorable oxygen supply demand ratio i e poor oxygenation with high heart rate A patient with a low value is less sensitive to poor oxygenation takes longer to go in
212. t a language from the dialog box 3 Click Accept The Mise user interface changes to the selected language NOTE Only the English version of the User Guide is available via the software regardless of the Muse language selection To access the User Guide in other languages please visit www caehealthcare com and click the Support link 123 Using M se iStan Account Profile From the Account Profile screen users can view update and reset personal profile information Users can also view and add favorite SCEs from this screen Click the Account Profile button to access the Account Profile features The Account Profile Button The Account Profile screen appears meti admin Email admin meti com Profile Information ID admin First Name meti LastName admin Emal admin meti com Favorite SCEs 10 admin Medication Preferences Password Reset Profile Preferences New Password Confirm Password The Account Profile Screen 124 J CAE Healthcare Using Mise Profile Information From the Account Profile screen the Profile Information panel appears by default If another panel has been selected click Profile Information to return to the Profile Information panel From the Profile Information panel users can change their profile information and reset their passwords meti admin Email admin meti com Profile Information ID admin First Name meti The Profile wine a
213. te button to collapse an expanded state 88 CAE Healthcare Using M se Click the Line Item view button to utilize the Line Item view The Expand Collapse arrow An expanded state The Line Item View From the Line Item View click the Expand Contract arrow to the left of any state to expand it and view all its components Click the arrow again to collapse the state 89 Using M se iStan Adding Scenario States When beginning to create a new scenario the canvas is blank Scenario states can be created by dragging and dropping conditions medications and interventions from their respective menus on the right side of the Scenario Designer to the canvas Drag and drop a condition onto the canvas to create a state decnpsionapsrenn e BP Hypotension Cardiac Rhythm Set Cardiac Tamponade Heart Rate Bradycardia Heart Rate Tachycardia Patient Stability Pulses Ventricular Failure Both Ventricular Failure Left Ventricular Failure Right The Scenario Designer Canvas Or a new empty state can be added using the New State button To add a new state using the New State button 1 Click the New State button on the upper left side of the Scenario Designer afe New State The New State Button A new state appears A New State 2 From the Graphical View double click the new state or from the Line Item View click the Expand Collapse arrow to the left of the state to expand it The st
214. tent Only group 119 Using M se System Settings iStan From the System Settings panel users can manage the System Configuration Data Management and Product Licensing of the Mise software To access the System Settings panel from the System Administration screen click System Settings The System Settings panel appears System Configuration Disk Space 217 16 GB available 73 free System Time Tue Apr 16 11 34 00 GMT 0400 2013 Data Management l Back Up Data j Restore Data Product Licensing License Manager Error Log View Error Log n Export Localization Change Language The System Settings Panel System Settings The System Settings button The System Settings panel NOTE System Settings functions are available only to users with the System Management privilege 120 ZW CAE Healthcare Using Mise System Configuration Under System Configuration Disk Space and System Time are displayed Data Management The Data Management feature allows users to back up data to an external device Users can also restore the backup data Backing Up Data Back up data to protect and store content and user data To back up data 1 On the System Settings panel click the Back Up Data button Back Up Data The Back Up Data Button A Save dialog box appears 2 Select a location to save the backed up data 3 Click Save IMPORTANT To protect content
215. tery capacity is good When the battery capacity is nearly depleted the red power LED flashes twice in quick succession every second This indicates the batteries need to be replaced To get the most battery life out of the handset the handset should be powered down when it is not in use B 9 Appendix B Wireless Voice Link iStan Troubleshooting CAE Healthcare Customer Service is available to help with iStan problems should they arise However sometimes you can speed up the customer service process by performing diagnostics before calling and eliminating some problems on your own with the help of the following instructions Power Problems The red power light on the handset does not flash when power switch is turned on Check that the batteries are inserted correctly Install a fresh set of batteries if needed The red power light on my base station is not flashing when the simulator is powered on Check that the cables from the simulator are installed in the base station correctly Communication Problems The simulator and handset are turned on but the green connection light is not blinking Verify that DIP switch positions 1 through 5 are all set to OFF which is the default position set in the simulator base station and handset at the factory If you have modified this setting verify positions 1 through 5 on the handset and the simulator base station are the same Be sure to turn the power off and back on for the chang
216. the physiological controls attempt to drive the PaCO toward 50 mmHg When the PaCO reaches the new set point the simulator s respiratory rate and tidal volume should return to normal values Default 40 mmHg Range 20 0 mmHg 70 0 mmHg to E Ratio 1 X The I to E Ratio 1 X parameter sets the inspiratory expiratory I E ratio for spontaneous ventilation At the default setting the time for exhalation is twice that of inhalation Default 2 Range 0 0 7 0 PaO Set point The PaO Set point parameter is a set point for PaO When PaO is below the set point value progressive stimulation of spontaneous minute ventilation occurs Both tidal volume and respiratory rate rise which under appropriate conditions results in PaO moving closer to the CAE Healthcare Appendix A Parameter Descriptions set point Factors that influence this control effort include baseline tidal volume baseline respiratory rate respiratory gain O consumption respiratory quotient lung compliances chest wall compliance bronchial resistances the presence of artificial airways in the simulator and the inspired gas mixture Minute ventilation is not affected for PaO above the set point For example if PaO Set point is set to 100 mmHg and PaO drops to 90 mmHg ventilatory stimulation occurs When the PaO reaches the new set point the simulator s respiratory rate and tidal volume are again controlled to maintain PaCO at the PaCO set point s
217. ties The Laptop Instructor Workstation is needed to perform these functions Additionally the Tablet Instructor Workstation and the Laptop Instructor Workstation cannot be used at the same time M se content is not shared between the Tablet and Laptop Instructor Workstations IMPORTANT All CAE Healthcare computer components are preconfigured for use with the iStan system There are no software installation or configuration steps required Only approved CAE Healthcare applications should be installed or run on the iStan computer system Trauma Disaster Casualty Kit TDCK The TDCK adds to the fidelity of a training session by providing the means to add a continuous flow of blood from the simulator while using the Moulage Kit to give a realistic look to the injury or condition product TF 005 Introduction iStan Moulage Kit The Moulage Kit may also be ordered separately The kit provides the materials needed to create wounds on iStan product 4MODS 999 iStan Replacement Lithium Battery Pack Under normal usage a battery pack should last up to two years Tool Kit To simplify common adjustments and periodic repairs CAE Healthcare has put together a kit containing tools selected for use with the simulator product TOL 001 10 CAE Healthcare Introduction External Compressed Air Kit The External Compressed Air Kit gives the user the ability to connect iStan to a CAE Healthcare compressor ta
218. tment of Transportation to be Other Regulated Materials Domestic ORM D Ground shipping containers must be clearly marked with this label CO Canisters are LR considered hazardous material when offered for air transportation so different rules apply Contact carrier for details and instructions Related CAUTIONS WARNINGS CONSUMER ORM D CO Canister Store the CO canisters in a dry location between 32 and 104 F 0 to 40 C Do not expose the CO canister to heat above 140 F as rupture may occur Never point the CO canister towards your face or someone nearby Use only CAE Healthcare specified CO canisters CO Regulator Assembly Care must always be taken when using high pressure equipment Do not disassemble or alter regulator Dry completely if the regulator becomes wet Discontinue use of this equipment if leakage or visible damage is evident Use of Equipment Canister end becomes punctured when screwed into regulator base and therefore should not be removed until empty Unscrewing canister before it is empty will result in sudden release of all high pressure gas with a possibility of liquid CO spray Unprotected skin could receive freezing burns Wear protective gloves and eye protection when removing canister from regulator assembly Remove CO canister from regulator assembly when shipping simulator 212 7 DAE heaken Recommended Clinical Supply Sizes Recommended Clinical Supply Sizes
219. to the needle 8 Inject 30 mL of air into the IO needle 9 Disconnect the external IV Bag and evacuate all remaining air or fluids from the IV 10 11 Drain port using a 60 mL syringe Replace the cap Remove the needle from the IO insert Replace the insert and return the skin to its normal position 207 iStan Care and Maintenance iStan Cleaning the Trauma Fill Tank and the Umbilical To prolong the life of the Trauma Fill Tank assembly and the fluid reservoirs wash and flush the tank and connections after each use with clean distilled water NOTE A small bucket is recommended to collect wastewater during cleaning and flushing operations Do NOT store liquids in the Trauma Fill Tank If simulated blood mixtures are stored in the tank they may clog the system when they dry and possibly damage seals filter and other components 1 Remove and rinse the Overflow Bottle 2 Remove and rinse the pump assembly 3 Rinse the tank to remove all traces of the simulated blood 4 Pour 480 mL 16 oz of distilled water into the tank and reinstall the pump assembly The Overflow Bottle holds 16 ounces vi Place the Overflow Bottle lid with umbilical attached into the wastewater bucket 6 Attach the fill blue labeled and vent yellow labeled fittings together at the other end of the umbilical 7 Pump the tank 25 times while making sure the wastewater is going into the bucket 8 Allow the tank to empt
220. to the death spiral and therefore survives longer Default 0 45 Range 0 10 5 00 Model Driven ECG Rhythm Ischemic Index 1 The patient s response to myocardial ischemia may be altered using the Ischemic Index Sensitivity parameter found on the Cardiovascular view To make the patient less sensitive to ischemia lower the value below the default setting To make the patient more sensitive increase the value above the default setting These changes are then reflected in the Patient s Ischemic Index as shown in the table above A 36 CAE Healthcare Appendix A Parameter Descriptions Ischemic Index Averaging Ischemic index averaging determines how quickly myocardial ischemia develops in the presence of an unfavorable oxygen supply demand ratio or how rapidly it resolves when myocardial oxygenation becomes favorable By decreasing the averaging time i e value toward 0 5 ischemia has a faster onset if there is a poor oxygen supply to the heart or a faster resolution with favorable oxygenation Increasing the averaging time i e value toward 0 99 means ischemia takes longer to develop or longer to resolve Use this parameter to speed up the recovery from the model driven death spiral By setting the parameter to 0 5 a patient pulls out of the death spiral at a faster rate than with a setting of 0 99 However the favorable conditions i e better oxygenation and or lower heart rate must exist before th
221. trouble breathing She was eating dinner at a cookout when she noticed some tightness in her chest The cook came by asking if anyone wanted another shrimp burger She then told him she was allergic to shellfish She was proceeding to her car to retrieve an epinephrine auto injector when a wasp stung her This SCE consists of six states five that manually transition and one State 5 that transitions automatically During the initial assessment in State 1 Beginning Anaphylaxis the patient presents with early signs of anaphylaxis HR in the 90s BP in the 100s 50s RR in the 20s and SpO2 in the low 90s on room air She remains conscious The learner is expected to assess and manage the patient s airway breathing and circulatory status ABCs identify early signs of allergic reaction consider use of oxygen call for help with interventions consider early use of epinephrine and attach a cardiac monitor If more than 120 seconds elapses without administration of epinephrine the instructor should manually advance the SCE to State 2 Mild Anaphylaxis If epinephrine is administered the SCE is advanced to State 5 Epinephrine Administered In State 2 Mild Anaphylaxis the patient experiences increased respiratory distress The patient s HR is in the m 110s BP is 100s 50s and SpO2 is in the 80s on room air The learner is expected to continue to assess patient s The Continue Bos jl ips j Continue button The SCE Summary Panel 71 Using
222. ube drainage system As the chest tube drains the volume is automatically subtracted from the set amount of Intrapleural Volume Default 50 mL per minute Range 0 mL per minute 50 mL per minute Chest Tube Air Leak Type Left and Right The Chest Tube Air Leak Type parameter is used to set the type of air leak present in the simulated patient This can be either a pneumothorax or an air leak in the chest tube itself or from the chest wall When Pneumothorax is selected the amount of drainage both air and fluid removed from the simulator is automatically subtracted from the set amount of intrapleural volume When Chest Tube Air Leak is selected the amount of air mixed in the drainage being removed from the simulator will not be automatically subtracted from the set amount of intrapleural volume Thus only the fluid being drained from the chest tube affects the intrapleural volume This parameter is designed to be used with Chest Tube Air Leak Flow Default Pheumothorax Chest Tube Air Leak Flow Left and Right The Chest Tube Air Leak Flow parameter is used with the chest tube feature and determines how much air drains with the chest tube output This parameter should be used in conjunction with Chest Tube Air Leak Type Default 0 mL per minute Range 0 mL per minute 50 mL per minute O Consumption The O Consumption parameter is used to change the rate of consumption of oxygen and production of carbon dioxide Wh
223. ue iStan see Needle decompression None required See Oprional Connect the SpO probe p CAE Healthcare Using iStan Respiratory Features None required None required None required 157 158 Using iStan iStan Realistic Upper Airway The upper airway of iStan is designed to allow for intubation and laryngoscopy Oral and nasal intubation can be performed using a variety of airway devices including LMAs endotracheal tubes nasal pharyngeal airways and oropharyngeal airways For supported sizes see Recommended Clinical Supply Sizes on page 213 Intubation Sensors detect right mainstem intubation and the action is recorded in the Events log and in the Simulation Session In addition the simulator exhibits a right unilateral chest rise and the appropriate physiological changes result Intubation incorrectly applied into the esophagus causes abdominal distension IMPORTANT Airways can be damaged by improper insertion of an airway adjunct e g endotracheal tube To protect the airway lubricate the adjunct prior to insertion using the silicone spray provided Use ONLY the provided SILICONE SPRAY to lubricate the adjunct NEVER use a water based lubricant because of resulting residue damage CAE Healthcare Using iStan Articulated Mandible An articulated mandible permits jaw thrust so when sensors in the lower jaw are grasped in a clinically appropriate manner the mandible
224. uence of steps carefully Complete all steps in order and Do not power on any components until instructed in the text KEEP all original shipping materials including the BOXES warranty and repair items must be return shipped to CAE Healthcare in their original packaging Because shipping materials should be stored and retained be sure that all protective packing materials and unused ancillary computer parts are secured as well If unpacking iStan for the first time careful use of a box cutter protects both the packaging and the product 16 ZW CAE Healthcare iStan Setup Step 1 Place iStan in the Work Area Select a work area with enough room for all equipment providing ample space for easy access to the simulator At least a 10 x 12 3 meter x 4 meter work area is recommended for movement of learners and positioning of components around the simulator iStan and the Instructor Workstation may all be operated from their batteries allowing for wireless use In a lab environment make sure that a multi plug AC power outlet exists within the workspace to recharge the simulator and its powered components Before placing the simulator on a surface be certain that surface can easily support 200 pounds NEVER lift the simulator by the LIMBS Leverage the torso of the simulator and support the head while lifting 17 iStan Setup iStan Step 2 Open the Secretions Valve With the v2 enhancements of iStan
225. ulator iStan Model No iStan 100 the undersigned hereby declare that the equipment specified above conforms to the above Directive s and Standard s United States of America May 20 2008 Signature Carlos Moreno Full Name IN ET Jj Vice President of Engineering Medical Education Technologies Inc Position vi CAE Healthcare vii Specifications iStan iStan Specifications Size Mannequin Simulator 72 Hx 22 W x 12 D 183cm x 56cm x 30cm Instructor Workstation 1 Hx14 1 W x 9 6 D 2 5cm x 36cm x 24cm Weight Mannequin Simulator 124lbs 56kg Instructor Workstation 5 4lbs 2 5kg Environmental Requirements Ambient Temperature Range Mannequin Simulator Operation 40 F to 104 F 4 C to 40 C Storage 40 F to 122 F 4 C to 50 C Relative Humidity 0 to 90 noncondensing Instructor Workstation Operation 50 F to 95 F 10 C to 35 C Storage 13 F to 113 F 24 C to 45 C Relative Humidity 0 to 90 noncondensing Maximum Altitude Instructor Workstation Maximum operating altitude 10 000 ft Maximum storage altitude 15 000 ft Maximum shipping altitude 35 000 ft viii o CAE Healthcare Specifications Power Mannequin Simulator AC Input AC 90 240VAC 50 60Hz Consumption Maximum 150W Charging 100W nominal Internal Batteries 16 8V 100 watt hour lithium ion rechargeable Run Time 7 to 8 hours Typical Instructor Workstation AC Input AC 1
226. ully exposed Figure 2 The WVL Base Station B 3 Appendix B Wireless Voice Link iStan Physical Features The following features are located on the top of the WVL devices Headphone jack Used to plug in headphones or an iPhone compatible headphone microphone combination Microphone jack Used to plug in a standalone microphone Red power light Indicates when the unit is powered on by blinking Also indicates when the Mute button is activated by solidly staying on Green connection light Indicates an RF link connection between the handset and base station by blinking Red power light Green connection light Microphone jack Headphone jack Figure 3 WVL Front View The following features are located on the side of the WVL devices Battery compartment Houses two AAA batteries and the DIP switch DC power jack Accommodates a 5VDC 0 2A power source ON OFF switch Turns WVL handset power on or off Line out jack Connects the WVL to the simulator s audio amplifier Volume mute dial Controls microphone gain and microphone mute on the handset See Special Handset Settings on page B 8 Batter y Line out compartment EV 02A exo c Volume mute dial Handset ON OFF switch Volume mute dial Base Station Figure 4 WVL Side View On the WVL handset the volume mute dial controls the microphone volume or mutes the microphone See Special Handset Settings
227. using the Scenario Designer Default 0 Joules Range 0 Joules 360 Joules A 27 Appendix A Parameter Descriptions iStan A 28 Pacing Current The Pacing Current parameter is used to simulate a specified amount of current discharged via an external cardiac pacer Setting this parameter results in the characteristic pacing signal on the ECG waveform when the pacing current is at or above the capture threshold Also see Pacing Capture Threshold Default 0 mA Range 0 mA 200 mA Pacing Rate The Pacing Rate parameter determines the cardiac rate in beats minute when the pacing current is at or above the pacing capture threshold Also see Pacing Current and Pacing Capture Threshold Default 80 beats per minute Range 0 beats per minute 119 beats per minute Pacing Capture Threshold The Pacing Capture Threshold parameter determines the minimum pacing current necessary to pace the heart via an external cardiac pacer Also see Pacing Current Pacing current values below the pacing capture threshold have no effect on the patient s heart rate Default 50 mA Range 0 mA 119 mA Cold Fluid Inject The Cold Fluid Inject parameter is used to simulate the injection of 10 mL iced saline into the pulmonary artery catheter The appropriate Thermodilution waveform and cardiac output measurement are then displayed on the Patient Status Display or TouchPro software CAE Healthcare Appendix A Parameter Descriptions
228. using the Temperature Blood parameter The arterial blood temperature can then be displayed on the Patient Status Display and TouchPro software Note that changes in arterial temperature may alter the shape of the standard oxyhemoglobin dissociation curve As temperature increases or pH decreases more oxygen is released from hemoglobin and thus the patient s saturation decreases The inverse is also true Default 37 C Range 32 0 C 42 0 C A 5 Appendix A Parameter Descriptions iStan Respiratory Basic Parameters Respiratory Parameters Basic A 6 o CAE Healthcare Appendix A Parameter Descriptions Swollen Tongue This parameter is used to create two degrees of tongue swelling Semi Swollen and Swollen The Not Swollen setting returns the tongue to its normal anatomic state Default Not Swollen Range Not Swollen Semi Swollen and Swollen Airway Occluder Using the Airway Occluder parameter swelling of the posterior oropharynx can be activated to obstruct the view of the larynx and prevent intubation but allow mask ventilation of the patient s lungs thereby creating a cannot intubate can ventilate scenario Default Off Laryngospasm Use the Laryngospasm parameter to simulate a laryngospasm A laryngospasm actuator closes the patient s vocal cords and prevents both ventilation and intubation When activated with the Airway Occluder parameter a cannot ventilate cannot intubate crisis scenario i
229. uts must be enabled in the Muse TouchPro Setup for the currently running SCE to be accessible in the Layouts panel For more infomation about enabling preconfigured layouts see Modifying the TouchPro Setup on page 80 132 Using TouchPro Changing a Waveform or Numeric Display Waveforms and numeric displays can be changed to suit the user s needs To change a waveform or numeric display 1 Click the waveform or numeric to be changed The Wave Vital Selection menu or the Numeric Vital Selection menu appears displaying all the available waveforms or numerics Wave Vital Selection ECGI ECG II ECG III ECG V1 ECG V2 ECG V3 ECG V4 ECG V5 ECG V6 ECG aVL ECG aVR ECG aVF Pleth Capnogram Blank Set Alarm Set Color Set Scale The Wave Vital Selection Menu 2 Select the desired waveform or numeric The new waveform or numeric is reflected on the screen From the Wave Vital Selection menu the alarm color and scale can be set for the waveform using the Set Alarm Set Color and Set Scale buttons From the Numeric Vital Selection menu the color and alarm for the numeric can also be established using the Set Color and Set Alarm buttons 133 Using TouchPro iStan Adding a Waveform The TouchPro software supports up to six waveforms To add a waveform 1 Click the Settings button in the bottom right corner of the TouchPro display The Settings Button The Settings menu opens and the Add Wa
230. veform and Remove Waveform buttons appear 2 Click the plus button in the location above which you want the empty waveform to appear An empty waveform field appears The Add Waveform An empty and Remove waveform Waveform field buttons The TouchPro Display Settings 3 Click the empty waveform field 134 Using TouchPro The Wave Vital Selection menu appears Wave Vital Selection ECGI ECG II ECG III ECG V1 ECG V2 ECG V3 ECG V4 ECG V5 ECG V6 ECG aVL ECG aVR ECG aVF ABP PAP CVP Pleth Capnogram Blank Set Alarm SetColor Set Scale The Wave Vital Selection Menu 4 Select the desired waveform from the Wave Vital Selection menu The new waveform is reflected on the screen 135 Using TouchPro iStan Adding a Numeric Display The TouchPro software contains four numeric display fields All four numeric display fields are located on one row beneath the waveform displays When fewer than four numeric readouts are being displayed the remaining fields are blank To add a numeric to a blank display field 1 Click a blank numeric display field A blank numeric field The TouchPro Display The Numeric Vital Selection menu appears Numeric Vital Selection ABP TAxial TBlood TBody CVP C O EtCO2 HR ICP MAP Set Color The Numeric Vital Selection Menu 2 Select the desired numeric The new numeric vital display is reflected on the screen 136
231. ves you specific legal rights and you may also have other rights which vary from state to state Return Materials Authorization RMA No product may be returned directly to CAE Healthcare without first contacting CAE Healthcare for an RMA number If it is determined that the product may be defective you will be given an RMA number and instructions for product return An unauthorized return e g one for which an RMA number has not been issued will be returned at your expense Authorized shipments are to be shipped prepaid to the address on the RMA Your original box and packaging materials should be kept for storing or shipping your product To request an RMA please contact Customer Service 193 iStan Care and Maintenance iStan System Software Upgrade Support Customers with current warranty contracts are entitled to receive upgrades to applications software previously purchased Installation of the system software is the user s responsibility The System Software Upgrades Support includes software upgrades for base software and purchased optional software modules This does not apply for major upgrades or technological enhancements pply J pg g Pricing Structure Time and Materials For those systems not under agreement service will be provided as required on a Time and Material basis Description In House On Site CAE Healthcare s prevailing Technical Support labor rate with a minimum of four hours labor Mat
232. volume but continue to influence other components of the physiological models For example with the tidal volume set to 600 mL in the adult simulator the tidal volume remains a constant set 600 mL even in the event of falling arterial oxygen levels In such situations the patient can only respond to arterial oxygen or carbon dioxide levels when the respiratory rate is adjusted Default Modeled Range 0 mL 2500 mL Flail Chest When enabled Flail Chest is used to simulate the characteristic appearance of the abnormal mobility and loss of normal chest wall movement due to trauma This feature is only present on the lower right side of the thoracic wall Default Disable Intrapleural Volume Vol Left and Right The Intrapleural Vol parameters allow intrapleural volume to accumulate for example as happens during pneumothorax hydrothorax or hemothorax To simulate a pneumothorax set the corresponding Intrapleural Vol to a value greater than 0 mL Values more than 1500 mL reduce the corresponding lung volume significantly The breath sounds are automatically diminished on the appropriate side due to decreased ventilation of the affected lung Default 0 Range 0 mL 2500 mL CAE Healthcare Appendix A Parameter Descriptions Trismus The Trismus feature is used to simulate the presence of masticatory muscle spasm leading to difficulty opening the mouth Default Disable Fraction of Inspired O FiO This
233. weight distribution This means that when iStan is lifted certain components e g head respond in similar fashion to the way human muscles react to support themselves when lifted This design allows learners to gain an understanding of how to lift and move a real person Skin Modeled from a cast of a real person the skin of iStan truly acts looks and feels like real human skin right down to the goose bumps cutis anserina Small pores on iStan s forehead have the ability to secrete clear fluid simulating diaphoresis Skeletal Structure Designed from the inside out CAE Healthcare has created the first patient simulator truly based around a human like skeletal structure a revolutionary development in itself But iStan also closely mimics the anatomical workings of the human body at a level of realism not possible with other simulators Spine neck arms and hips all mimic the degrees of movement of a real person Wireless iStan is fully wireless and battery operated for amazing portability and versatility p CAE Healthcare Introduction Contained in this User Guide This User Guide has been designed for quick access to information on how to use and maintain your iStan system Please make sure that you read and follow the Cautions Warnings on the pages preceding the Table of Contents This is for your safety and your learner s safety as well as for the protection of your simulator Each subsequent section has bee
234. welling Swollen Semi Swollen Not Swollen Respiratory Features Decompression of a pneumothorax can be performed bilaterally by inserting a needle at the midclavicular line of the second intercostal space Obstructs view of larynx to prevent intubation but allows mask ventilation can t intubate can Oventilate scenario Oxyhemoglobin saturation SpO automatically correlates with the oxygen concentration in the lungs and the intrapulmonary shunt fraction Allows direct laryngoscopy oral and nasal intubation and use of specialty airway devices Senses if ET tube is correctly inserted Normal tidal breathing and pathophysiological conditions such as atelectasis pneumothorax asthma and COPD Tracheal pathophysiologic conditions such as pneumothorax Hinders but does not prevent intubation The instructor must adjust the amount of physiologic intrapleural air present VIEW Respiratory PARAMETER S Needle Decompression Intrapleural Vol Left Intrapleural Vol Right VIEW Respiratory PARAMETER S Airway Occluder None required but adjustable VIEW Respiratory PARAMETER S SpO Shunt Fraction None required None required but adjustable VIEW Respiratory PARAMETER S Respiratory Rate Respiratory Rate Factor etc None required but adjustable VIEW Respiratory PARAMETER S Chest Wall Compliance Factor VIEW Respiratory PARAMETER S Swollen Tong
235. wner of any SCEs scenarios or patients created by the user being deleted i e the SCEs scenarios and patients created by the deleted user are moved to the deleting user s account 116 J CAE Healthcare Using Mise Groups Users are assigned to groups to define access privileges To access the Groups panel from the System Administration screen click Groups The Groups panel appears Content Management User Accounts roups System Settings The Groups tab Groups Privileges Educators Deactivated Users The Groups panel The New button The Delete M Save button button The Groups Panel NOTE Groups functions are available only to users with the User Management or System Management privilege From the Groups panel users can create new groups delete groups and assign privileges to groups In the Groups panel three groups appear by default e Administrators e Educators e Deactivated Users Each default group has privileges assigned 117 Using M se iStan Privilege System The Mise software has three different privileges System Management User Management Content Management User Management and Content Management can be assigned independently or combined The System Management privilege contains all privileges System Management Users with the System Management privilege have access to all features of the M se software including the benefits of the User Management and
236. y completely the remaining air pressure will purge the fluid from the lines 9 Reinstall the lid onto the Overflow Bottle and place the bottle back onto the tank assembly 10 Remove the pump assembly and pour any remaining fluid out of the tank Then reinstall the pump 11 Disconnect the fill and vent fittings from each other and wrap the Trauma Tank Umbilical around the neck of the tank Always depressurize the tank remove trauma fluid and clean the tank before performing maintenance The pump assembly may need periodic lubrication Call CAE Healthcare Customer Service for details if the pump loses the ability to create pressure squeaks loudly or is difficult to move 208 p CAE Healthcare Cleaning the In Line Filter To clean the In line filter T 2 Disconnect the umbilical from the Overflow Bottle lid Using two 3 4 or adjustable wrenches separate the halves of the filter by holding the top nut end towards tank stable and turning the bottom Be sure to capture the spring as the halves are separated Female Body End Towards Tank Male Body Filter Element Remove the filter element from the female half by placing a screwdriver between the top edge of the filter element and the female housing and gently prying the filter Once the filter breaks loose do the same on the opposite side This should allow you to turn the housing over and have the filter element fall out Once the filter eleme

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