SimMan Dfu
Contents
1. Screw driver Nut Driver Bolts for attaching optional wound modules to the body Maintenance Repair Kit consisting of Extra Pneumothorax Bladders Modeling Wax Talcum Powder IV Kit consisting of Blood Bags with IV Tubing 2 Simulated Blood Concentrate Hose Manikin Air and CO Supply Blood Pressure Measuring Kit Track Suit jacket and trousers addition some configurations contain the following Laptop computer USB Camera Simulated Patient Monitor USB Hub PDA Link Box A Connection Cables and Tubing may vary depending upon configuration Cable Link Box to Manikin 15 pin Cable Link Box to PC 9 pin Cable for Sounds PC to Link Box Additional items purchased separately Pressurized Air and CO source Compressor Unit or Regulator Unit Getting started To use your SimMan carefully follow the instructions provided in the Install Guide found in the peripheral box and this document Some configurations are delivered with pre installed software If your system Is not pre installed pay close attention to software set up Your SimMan will not operate correctly if the software is not properly installed Attaching the Legs Remove the belly by pulling gently on the bottom and place it aside 2 Remove the bag from the leg 3 Remove the cardboard packing tube from the threaded steel tube protruding from the upper end of the thigh Caution Do not allow tape or p2. SpO gt Probe The SpO finger probe provides enhanced realism for the care provider by simulating the use of an actual pulse oximetry probe When the probe cable is connected to the Link Box SpO will not be displayed until the probe is placed on one of the manikin s fingers means that light is blocked If the probe is not attached to the Link Box SpO will only be displayed automatically when selected by the operator through the instructor panel on the PC Blood system The blood system includes a blood bag with tubing that can be connected to the veins and be altered by varying the elevation of the blood bag Air and CO Source optional Option Compressor Unit If you have purchased Laerdal SimMan with a Compressor Unit attach one end of the double lumen tube into the compressor and the other to the right axillary side of the manikin Compressor Unit Clase 1 fe me Drain Clase Cx 2 O a C Parea Cr Output to Manikin 60 90 psi Open 3 CO ON Off Power Supply Start procedure Check that Power switch 4 is set to off position O 2 Plug power supply cable into plug 5 in Compressor panel 3 Plug power supply cable into power source 4 Connect CO supply to the Input CO connector using the black hosing attached optional feature 5 Check that Drain valve 1 is closed 6 Close Air valve 2 and CO valve 3 7 Push Power switch 4 to on position 1 the Compr
3. Set up from the view dropdown menu 3 Select the desired monitor configuration and click open to activate the new configuration Video recordings SimMan utilizes a webcam for recording the students performance during a scenario For a complete debriefing experience the recordings can be integrated into the debriefing guide To set up the camera for video recording follow the instructions provided in the Install Guide Be sure to note that the camera should be connected directly to a USB port on the back of the laptop Do not use the hub as this may cause interference Select the Video Recording Configuration from the Edit dropdown menu then make your selections and press ok Note Video will be stored on the hard drive of the instructors computer PDA remote control The PDA comes pre installed with some SimMan configurations If your PDA is pre installed turn the PDA on and select the SimMan Pocket icon from the Programs menu to start the PDA application If your PDA has not been pre installed refer to the SimMan SimBaby PDA User Guide located in the peripheral kit for complete installation instructions Maintenance Clean with mild soap and water DO NOT SUBMERGE MANIKIN Modules and all other parts should be drained and air dried thoroughly prior to storage Disinfectants should be used when appropriate All subcutaneous and intramuscular injection pads should be squeezed to e
4. of chest skin with modeling wax supplied with manikin by applying firmly with fingertip while stretching skin To replace Remove skin at torso sides 2 Lift the chest plate exposing its underside ENGLISH 4 Remove bladder from site cavity by pulling it from top side of chest plate hy r v 5 Insert new pneumo bladder into site cavity and reconnect to the inline hose connector by threading it through from top side of chest plate 6 Replace chest plate 7 Replace chest skin over torso and secure skin at the shoulders and both sides 8 Fill puncture marks on exterior of the chest skin with modeling wax supplied with manikin by applying firmly with fingertip while stretching skin Tension Pneumothorax Decompression Right Mid Axillary Site To repair vulcanizing contact cement is needed Remove skin at torso side 2 Remove flesh colored box from mid axillary side of manikin 3 Remove pneumo bladder from the box 4 Cover surface of pneumo bladder with vulcanizing contact cement not included 5 Allow to air dry completely 6 Fold bladder and replace in box return box to torso 7 Replace chest skin over torso and secure skin at the shoulders and both sides 8 Fill puncture marks on exterior of chest skin with modeling wax supplied with manikin by applying firmly with fingertip while stretching skin To replace Remove skin at torso side 2 Remove flesh colored box from mid axilla
5. outside the IntelliVue s features to mimic other patient monitor types as well SimMan is operated through a Software SWV which runs on a PC Interaction with the SW is done through a Graphical User Interface GUI where the various vital signs parameters are changed directly or through pre programmed scenarios The SW also allows automatic and manual logging of scenario events as well as video capture The events logged during a scenario can be shown in a debrief viewer together with video capture The log is synchronized with the video capture This allows the instructor to review both the log and actual performance during debriefing The debrief can also be stored for later review ENGLISH Items included The Laerdal SimMan includes the following main components Laerdal SimMan Manikin SimMan Software CD ROM Directions for Use SpO Pulse Oximetry Probe Set of Defibrillation Studs Hands Free Defibrillation Pacing Adaptors Heartstart and Physio Control Plates for Manual Defibrillation Replaceable Neck Skin Collars 6 Roll of Crico Thyroid Membrane Hy Tape 2 Chest Tube Insertion Modules 6 Interchangeable pupil set case containing 3 pairs of pupil inserts normal constricted dilated Airway Lubricant Upper Dentures one 1 non breakable installed and 3 breakable Replaceable Male and Female Genitalia with Urinary Connection Valves Tank Thigh Hardware Kit Tool Kit consisting of Pliers
6. saving as desired If you paused a running scenario click on the play p button from the main SimMan GUI to resume the simulation For more information on the Debrief viewer refer to the help files Halting the scenario When a scenario is running clicking the halt E symbol will put the scenario is manual mode The software will confirm that you want to stop the scenario After a yes response the word Halted will appear on the screen The scenario continues to run but all operations must be carried out manually by the instructor To fully stop and save a scenario click the debrief button When the debrief viewer appears choose Save As from the File dropdown menu Instructor Monitor Control Centre The instructor can manipulate the values of the monitor parameters from the Instructor Monitor Control Centre which can be found in the upper right quadrant of the main GUI Adjustments can be made to any of the physiologic values by pointing the mouse over the desired area and clicking Windows will open allowing the instructor to select and apply the desired changes and functions Configuring the Patient Monitor and Simulator and Creating Profiles General configurations for both the simulator manikin and patient monitor can be controlled via the GUI To configure Select Configure from the Edit dropdown menu 2 Select either the General or Patient Monitor tab 3 Double click on the ap
7. 307 Power cord UK w 380100 Link box 380901 Jacket 380902 Trousers 38 08 10 211 19050 Directions for Use Pad Set Shoulder and Hip 380201 Hardware set arms to torso 211 15350 Chest plate assy and shaft G2005 380420 Lung 211 15250 Shaft compression G2005 380446 Foam in chest 380460 Genitalia blank 380470 Belly plate assy 380471 Plug belly plate 380475 Pin pelvis 380480 Thrust assy cpl 38 0405 38 04 06 252090 Airway Lubricant 80 ml Bladder Assy Mid Clavicular Bladder Set Mid Axilliary 245 16750 Audio cable Pneumothorax Chest Pneumothorax Side 300 00750 Blood concentrate 4 Oz Accessories 210 01050 Compressor 230 240V 210 01150 Compressor 10V 381220 Regulator unit 381655 Carrying case manikin 245 18050 Transportation case peripherals 211 19550 Technical Service manual 38 1300 381850 Portability kit Pulse Oximetry Probe 38 04 35 2111 20050 SimMan Nursing Wound Breathing Bladder Module set 211 25050 SimMan Trauma Module set 381550 Bleeding control module set 210 00550 Forced air bleeding system w wounds 245 16350 Cable Assy Manikin Link Box 15 pin D sub _ 2 a T Ey 38 10 10 27 15 00 Tubing Assy Cable PC to Link Box Compressor Manikin 2 pin D sub Air CO ENGLISH A Laerdal helping save lives 2006 Laerdal Medical AS All rights reserved Printed in US N0207 rev E
8. Directions for Use helping save lives Cautions and Warnings Laerdal SimMan should be operated by trained personnel Do not introduce fluids into the torso area or left BP arm of the manikin as electronic components may become damaged Clean with mild soap and water DO NOT SUBMERGE MANIKIN Use on clean surface only AVOID FELT TIPPED MARKERS INK PENS ACETONE IODINE OR OTHER STAINING MEDI CATIONS AND PLACING THE MANIKIN ON NEWSPRINT OR INKED LINES OF ANY KIND Students should wash their hands prior to using the simulator and wear gloves when using the simulator Treat SimMan as you would a real patient Use of a defibrillator for training purposes represents an operational hazard equivalent to use of a defibrillator on a real patient since it involves the release of high levels of electrical energy into the training manikin Consequently All safety precautions for use of defibrillators must be followed as if the manikin were a patient Consult your defibrillator s User Manual Defibrillation should be performed on the defibrillation connectors only If defibrillation is performed over one or more of the ECG connectors high voltages may be present on the remaining connectors during the shock To prevent overheating do not provide more than three 3 defibrillator discharges max 360J in a sequence Do not exceed an average of two 2 defibrillator discharges per minute during the training session The manikin must n
9. Hy Tape and apply it over the opening to create simulated membrane 4 A tight seal will enhance actual feel and sound of crico thyroid membrane penetration Neck Skin Collar Lay a neck skin collar with dull side out into molded track around neck area of trainer and attach collar ends together 2 The collar is designed to provide multiple sites for needle and surgical techniques When a fresh site is needed rotate the collar IV Arm When excessive leaking occurs at the puncture sites a new vein and skin should be installed to reduce loss of fluid Ideally the skin and veins should be replaced near a sink To remove the arm Remove deltoid pad from arm Disconnect the attachment hardware arm using a screwdriver If replacing both skin and veins cut skin off and discard The thumb will detach with the skin new skins come standard with thumb installed 2 If the skin is not damaged and you wish to reuse it lubricate inside of skin with liquid detergent Beginning at the top of the arm roll the skin down and off arm and hand 3 Remove old veins and discard 4 Use acetone or equivalent to remove spots of old glue from vein grooves Dry and swab grooves with alcohol Place new veins along grooves extending both veins beyond arm at least Ocm 4 allowing room for connections Spot glue veins as needed We recommend using Vynabond or VLP from PDI Plasti Dip International PL 400 from Tremc
10. Shut off CO3 5 Jet ventilation TTJV requires a special connector available for purchase using part number 381201 Stop procedure Close Air valve Shut off Air and CO valve Shut off CO Operating software The SimMan Software serves as the instructor s tool for controlling the training scenario It requires the following a Type Dell b Processor Minimum Pentium M 1 8 GHz or better c Hard drive 60 GB minimum d RAM 512 MB minimum e System Windows XP Pro f Screen Dual Screen with min 1280 x 1024 g Mouse Two 2 button scroll wheel mouse h Other CD RW RS 232 serial port 2 4 USB ports Built in Ethernet LAN Internal Bluetooth Microphone input Headphone output For software installation see instructions included in the Install Guide The software features are a Training controls via computer keyboard mouse and or PDA b Extensive ECG library with variable rates and a range of extrasystole types c Variable pacemaker threshold external pacemaker training only d Control of manikin functions Airway complications Tension Pneumothorax Breathing BP NIBP and Arterial SpO simulation Temperature display e Auscultation sounds Lung Heart Bowel f Vocal sounds Numerous vocal sounds are available moan vomit cough etc Additional sounds can be recorded by the user Microphone option instructor may speak directly through the manikin s head speaker by using
11. Simulated Patient Monitor display and lung sounds The tidal volumes dynamically alter in line with the selected respiratory rate ENGLISH i Through the operating SW the instructor can activate respiration complications like Pneumothorax Breath sounds Decreased right and or left lung compliance Stomach Decompression Torso a Anatomically modeled from a human specimen the torso demonstrates normal anatomical surface landmarks b SimMan has correct anatomical landmarks for external chest compressions Chest compressions will produce carotid pulses as well as compression artifacts on the Simulated Patient Monitor ECG sites c Manikin is equipped with separate defibrillation and ECG monitoring connectors The system provides 3 lead ECG readings 4 connectors Caution The ECG connectors are designed for ECG monitoring only If defibrillation is attempted over any of the ECG connectors high voltages may be present on one or more of the uncovered connectors during the shock See the Cautions and Warnings section Defibrillation attempts via the ECG connectors will also damage the internal electronics requiring that they be replaced Defib sites d Manikin is equipped with two defibrillation connectors ECG signal can also be monitored across these connectors Instructor can Via appropnate keyboard or remote control command select the Ignore Defib function This determines if the defibrillation shoc
12. a microphone g Left right or bilateral lung obstruction h Pulse strength i Activity Log j Scenario Builder k Trend Editor Event Handler m Debriefing including activity log synchronized with video and monitor pictures PDA remote control A personal digital assistant or PDA is used as the remote control The PDA communicates with the software via Bluetooth A PDA User Guide is included in the peripheral kit Refer to this guide for additional information Simulated Patient Monitor The Simulated Patient Monitor is connected to the PC laptop It is a touch screen monitor that provides concise clinical feedback of physiological parameters All parameters are instructor activated with the ability to set a lower and higher alarm limit for every para meter shown on the monitor The monitor may be configured to display the desired parameters and curves and It Is possible to save and retrieve five 5 configurations Colors and curve trace speeds can also be changed The CO curve has by default a slower trace speed Because all information Is simulated rather than actual the parameters with the exception of ECG cannot be measured or displayed on clinical equipment For additional information refer to the software helpfiles The monitor provides the following output synchronized with all other clinical outputs Arterial blood pressure waveform CO and capnograph waveform Heart rate related to SpO BP with timed au
13. acking to pull on the wire or air tube extending from the steel tube 4 Open one Tank Thigh Hardware Kit 1008080 and place the hardware in a convenient spot 5 Gently feed the electrical wire and plastic air tube through the pelvis hole and into the pelvic cavity 6 Push the steel tube on the thigh as far as possible through the hole and into the pelvic cavity DO NOT PULL THE LEG BY THE ELECTRICAL WIRE OR PLASTIC AIR TUBE 7 Slide the flat washer from the hardware kit over the wire air tube and steel tube 8 Slide the spring from the hardware kit over the wire air tube and steel tube 9 Slide the thumb nut from the hardware kit over the electrical wire first and then over the air tube 10 Holding the thigh in a convenient position thread the thumb nut onto the steel shaft until the feel of the hip articulation is satisfactory 1 Attach the thigh air tube to the open connector on a similar air tube in the pelvis Right leg tube goes to the tube on the right side and left goes to left 2 Attach the thigh electrical connector to the open mating connector in the pelvis Right leg wire goes to the wire on the right side and left goes to left 3 Repeat with the other leg 4 Gently replace the belly To remove leg s reverse the procedure Link Box The Link Box connects the manikin to the computer Attach manikin cable to right lower side of manikin s torso and to the connector marked Manikin on th
14. beyond the end of the tube as with any direct intubation Laryngeal Mask Airway LMA The Laerdal SimMan will allow use of the LMA Classic LMA Unique and LMA Fastrach Although a 5 LMA may seal correctly the airway has been designed for use with a 4 LMA CombiTube The Laerdal SimMan will allow the use of the CombiT ube as it will successfully ventilate the patient We recommend the use of the CombiTube trainer as it will generally withstand multiple uses The CombiTube trainer is sized the same as a large adult CombiTube Although a small adult size Combi T ube may work with varying success the Combi lube trainer provides more cost effective training and reliability of function The instructor can cause any of the ventilation procedure to fail to ventilate by setting both right and left lung resistance to complete g Using the computer user interface or the PDA the following airway functions may be activated and deactivated Laryngospasm Posterior Pharyngeal swelling Tongue edema Trismus Decreased Cervical Range of Motion DCROM Can t Intubate Can Ventilate Can t Intubate Can t Ventilate Verbal response h The manikin simulates spontaneous respiration with the following features Chest rise and fall Variable breathing rate Apnea Variable pulse oximetry display Exhalation of air Exhalation of CO instructor controlled The variable respiratory rate is synchronized to the
15. e back of the Link Box 2 Connect serial cable to connector marked PC on the back of the Link Box and to serial port on back of your computer 3 Connect clear tubing from blood pressure cuff to the inlet marked BP cuff on the back of the Link Box 4 Connect the SpO cable to the SpO connector on the back of the Link Box 5 The audio cable has three ends Connect the RCA phono plug to the connector marked Audio input on the back of the link box The stereo jack with single wire shall be connected to the Simulated Patient Monitor and the stereo mini jack with double wire shall be connected to the computer s headphone output For illustrations please see the accompanying Install Guide If a wireless microphone is used the receiver should be connected directly to the Link Box connector marked Audio input instead of the audio cable described above pre defined vocal sounds will not be possible to use in parallel 6 Plug the Link Box AC power cable into a power supply I 10 240 V AC If you are using the Portability Kit attach to the 12 V DC input according to the Portability Kit instructions 7 Connect external speakers if used to connector marked Ext speaker on the back of Link Box USB Hub A USB hub is supplied with the system to provide additional USB ports Connect the USB Hub to one of the USB connectors at the back of the PC Attach the AC adapter to the USB Hub and to a wall outlet 110 or 230 240V AC
16. essor will start and run for approx 45 seconds to build up pressure in tank 8 When Compressor stops you can start to use the manikin Open the Air valve 2 and the CO valve 3 9 The Compressor will start and stop with different intervals depending on consumption of air Stop procedure Push Power switch 4 to off position 0 the Compressor will stop if it is running 2 Close Air valve 2 and CO valve 3 3 Open Drain valve and drain air out of system Warning Do not open Compressor box when energized dangerous voltage inside Only to be opened by authorized personnel Important If the Compressor Unit is stopped manually with the on off switch the air tank must be drained before restart ENGLISH Option 2 Regulator Unit If you have purchased Laerdal SimMan with the Regulator Unit attach one end of the double lumen tube to the Air CO out to Manikin outlet on the regulator and the other to the right axillary side of the manikin Regulator Unit Air in a4 5 8 bar 70 120 psi CO in AirfOO i Shut off Air ee Manikin Shut off CO Start procedure Close Air valve Shut off Air and CO valve Shut off CO 2 Connect Air supply 5 8 bar to the Air in connector using the blue hosing attached 3 Connect CO supply 4 6 bar to the CO in connector using the black hosing attached optional feature 4 Open Air valve Shut off Air and CO valve
17. f resealable bladders Needle decompression can be performed at Bilateral mid clavicular line 2nd intercostal space Right mid axillary line 5th intercostal space b Chest tube insertion can be simulated and exploration and cut can be made at left mid axillary line at 4th and 5th intercostal space Important We recommend a 22 or smaller gauge needle for decom pression of the chest Using a smaller gauge needle increases the longe vity of the chest skin and bladders The Chest Tube insertion module is located at the left mid axillary site This module allows chest tube insertion to be performed A cut can be made at left mid axillary line at the 4th and 5th intercostal space To replace the used Chest Tube insertion module simply remove from its location and add a new one with the opening positioned toward the shoulder Insert Pads a SimMan contains a left thigh pad gluteal gluteal ventro gluteal and right deltoid insert pads b The pads can be used for intramuscular and subcutaneous injection practice c These can be interchanged with optional trauma or nursing wound modules IM SC Injections The insert pads are foam filled and can be injected with fluids The foam is removable and should be squeezed out like a sponge and allowed to air dry immediately following the practice of these procedures Powdering foam pads with talcum powder eases reinsertion into the skin There are four sites for subcutaneous and
18. from one condition to the next may have multiple outcomes The various outcome alternatives have been defined in the scenario and triggered by pre defined events These events may be either automatically registered events such as time or a defibrillator shock or by manually entered events such as administration of drugs SimMan is delivered with a set of pre programmed scenarios Pre programmed or saved scenarios can be started paused halted or debriefed from the Scenario Control Center found in the lower left quadrant of the GUI To start a scenario Click Start Scenario 2 Select a simulation case to run To temporarily halt the scenario click on the pause II symbol To resume a simulation that has been paused click on the play gt symbol To halt a scenario click on the halt I symbol Before creating a new scenario it Is important to understand the difference between Events and Actions Events Things that happen outside of a scenario usually caused by students are called Events The ABC Miscellaneous Medication events in the main window are also called Scenario Events There are also Time Events caused by either of the two timers reaching a prede termined limit Actions In a scenario Actions are performed by the scenario For example changing a parameter value creating an airway complication and making vocal sounds are Actions performed by scenarios T
19. he interference by Reorienting or relocating the receiving antenna 2 Increasing the distance between the device and receiver 3 Connecting the device to an outlet on a circuit different from that to which the receiver is connected 4 Consulting the dealer or an experienced radio TV technician for help Latex The veins in the IV Arm and Pneumothorax bladders contain latex Users who suffer from latex allergy should take precautions while using or handling the latex parts by wearing non latex protective gloves Limited Warranty Please refer Laerdal Global Warranty or see www laerdal com Approvals The product is CE marked and in compliance with C essential requirements of council directive 89 336 EEC EMC directive Contents CAUTIONS AND WARNINGS 000 ee ee eee 2 INTRODUCTION 222462 5534e3e054 0060 600545355 ene Pee 3 EMS INCU EE os 2 eta sis b ho ners poe be mneeeesces 4 GETTING STARTED i 2nc2n0eteud ce enesdwateageahee aes 4 UN MISE o2 2 6c5sentaecaeseneeerene sales so oeuneds coats 7 MAINTENANCE 26044026526 2su si vereerectocensesceecs lI TROUBLESHOOTING 24 44 200 e00445044040 00e 00050 13 TECHNICAL DATA 0 ccc eee eens 13 PARTS ACCESSORIES LIST anannnn aana 14 Introduction SimMan is a full body adult manikin that allows the simulation of Basic and Advanced Life Support Skills and Assessment to develop both individual and team skills The simulator allows ob
20. intramuscular injections including right deltoid gluteal left thigh and ventro gluteal Using a 22 gauge or smaller needle increases the longevity of the skins Sounds The torso contains a number of hidden speakers that allow the real istic auscultation of sounds Lung Heart Bowel Abdominal distension Abdominal distension occurs with excessive ventilation while using Bag Valve Mask or if the esophagus Is intubated Urinary catheterization Interchangeable realistic genetalia make it possible to simulate female and male patients The genetalia is connected to a reservoir which can be filled with liquid during simulated catherization Arms Blood Pressure Arm Left Arm is a BP Arm with radial and brachial pulses and Korotkoff sounds The BP arm allows palpation and auscultation of a blood pressure that can be measured automatically on the Simulated Patient Monitor Auscultation gap can also be simulated Blood pressure settings are controlled using the computer or remote control These settings are also linked to the ECG function ality so if you are changing the rhythm from a perfusing rhythm to a non perfusing rhythm this will also be reflected on the blood pres sure settings which will be changed according to the new type of rhythm A non perfusing rhythm will also change breathing rate BR to zero When changing to a perfusing rhythm the blood pressure will remain at 0 0 until changed breathing rate can no
21. k results in conversion to a selected waiting rhythm Manual paddle adapters are supplied for use with manual defibrillators Caution Defibrillation must be performed only over the two defibrillation connectors See the Cautions and Warnings section e Connectors for external pacing are connected to the manikin s defibrillation connectors Patient pads should not be used as they do not guarantee sufficient contact The system has a variable pacing threshold and the ability to ignore pacing Pacing capture results In a pulse synchronized with the heart rate and the display of a paced rhythm on the Simulated Patient Monitor Pulses a SimMan has physiologically correct palpable pulses Bilateral carotid pulse Bilateral Dorsalis Pedis and Posterior Tibal pulses Bilateral femoral pulse Left radial pulse Left brachial pulse b The pulses are synchronized to the simulated ECG and when activated the external pacemaker upon capture c The pulse strength is dependant on the selected blood pressure but the strength of peripheral pulses can also be manually controlled to simulate a wider range of clinical conditions d Pulses once activated will remain on for approximately five 5 seconds before reactivation is required Important Care should be taken when palpating pulses Use of excessive force results the inability to feel pulse Pneumothorax a Tension pneumothoraces can be simulated through the inflation o
22. l values To change values in the Airway and Circulatory Control Center center section which includes a torso illustration by click directly on the parameter which is to be changed and select the new state or use the slider bars To change values in the Respiratory Control Center and Difficult Airway Control Center upper left corner select state or use the slider bars ENGLISH Semi automatic Automatic mode In Semi automatic Automatic mode the change to multiple vital signs parameter can be pre defined as trends These trends can then be activated one by one directly or multiple activated via the event handler function Trends allow the instructor to introduce physiologic situations into the simulation A brief overview is shown below for more information refer to the help files To use pre programmed or saved trends Select the Start Stop button located in the Trends box in the main window 2 Select the desired trend 3 Click the start button To build and save new trends Select Start Trend Editor from the Edit dropdown menu 2 Select the parameter to be included in the physiologic model of the trend you wish to design 5 ClIcK Ok Automatic mode creating and using scenarios In automatic mode scenarios which includes multiple alternative and consecutive changes to the vital signs can be pre defined The scenarios can be constructed so that the change
23. liminate excess water To prevent mildew and mold the foam filling should be soaked in a mild solution of bleach and water or a 1 Virkon solution Squeeze the solution out and allow the filling to air dry prior to reinsertion and storage Articulating parts will benefit from a light application of talcum powder prior to training sessions Powdering inside of chest skin with talcum powder decreases plastic sound Air filter in compressor should be replaced every two years Directions for replacement are part of the Technical Service manual A Technical Service manual is available for purchase using part number 21 1 19550 A general inspection should be conducted regularly Do not use the product if cables or tubings have signs of damage Store properly between teaching sessions If stored in hard cases disconnect cables and tubings and remove legs The different parts should be correctly positioned before closing the cases Tension Pneumothorax Decompression Bilateral Mid Clavicular Sites To repair vulcanizing contact cement is needed Remove skin at shoulder sides mid clavicular and remove bladder from site cavity 2 Cover the surface of the pneumo bladder with vulcanizing contact cement not included Avoid getting contact cement on chest plate 3 Allow to air dry completely 4 Replace bladder and chest skin over torso and secure skin at the shoulders and both sides 5 Fill puncture marks on exterior
24. n Carotid and pedal pulse Operating software The SimMan SW is started by clicking the SimMan icon on the computer desktop After entry of password optional and selecting a profile the SimMan starts up in the default mode which represents a patient in a healthy state If the web camera recording is enabled you will be prompted to start the recording For more information on this feature refer to the section on video recording later in this document or to the help files The operating software is controlled via a Graphical User Interface GUI The GUI displays an overview of the current status of simulated patient s vital signs the control functions for modifying these and a time based log of the events which has occurred during the scenario The patient simulator can be operated in three manners Manual mode Semi automatic mode Automatic mode Operating Modes Manual mode In manual mode the vital signs parameters are changed directly through changing the values one by one based on the desired change of the patient condition The various vital signs parameter can be changed directly on the GUI in the following ways For detailed description please see help files under Help in GUI s Program Menu Bar To change values in the Instructor Monitor Control Center upper right corner of the GUI click on the parameter and set the new values or rotate the mouse wheel while the cursor is over the numerica
25. o create a new scenario Choose Start Scenario Editor from the Edit dropdown menu 2 Click the new scenario button The scenario is constructed from a set of frames Each frame repre sents a state of the patient The scenario can only operate in a single frame at any given time The scenario moves to other frames as events specified in the Events field occur To control which frame the scenario moves to connection lines are drawn from each event box to the desired frame When the specified event occurs the scenario moves to the corresponding frame For a more detailed description refer to the software help files Saving Scenarios To save a new scenario Select File from the dropdown menu 2 Select Save 3 Enter the name of the scenario 4 Click the Save button To retrieve the file at a later time Click the Start Scenario button on the GUI 2 Select your saved scenario Debriefing during or after a scenario The debriefing function is available both during and after scenarios To activate the debrief view click on the Debrief button If you are currently running a scenario this action will automatically pause your running scenario and take you to the debrief screen After you have reviewed the log you can choose to save the debrief or return to the scenario without saving To exit select Exit from the file dropdown menu and follow the prompts to save or exit without
26. o or an equivalent To replace skin Roll top of skin down to the hand Spread liquid detergent generously over lower part of the arm Holding skin and arm with palms upward slide hand into skin working the skin over the fingers as with a glove Then roll the skin up the arm 2 Reattach arm when finished Troubleshooting Refer to www laerdal com for more information Technical data The product is CE marked and in compliance with essential requirements of council directive 89 336 EEC EMC directive ENGLISH 200 03050 i dhia 2 P e Pupils set LE GeY 381102 fa wi tit Fastener for Neck Skin Pa C pkg 10 2111 10050 211 10150 70 Head Assy Head Skin oe 200 00250 eeth Upper Rigid i polyester Cricothyroid Membrane Tape I roll 38 II 07 2 hl 0 gt Teeth Upper Soft Neck Skin pkg 6 vinyl 21 1 10250 Airway Complete 38 31 10 Chest Tube Insertion Modules pkg 6 38 02 00 Arm Assy blood pressure 38 07 00 IV arm right 38 02 10 Cuff Assy Blood Pressure 300 00150 2111 11050 Thigh Pad 1 Leg assy right w pedal pulses 38 04 10 Post set ECG defibrillation 211 112050 38 04 55 Leg assy left w Chest skin pedal pulses with chest drain 38 04 6l Kit Adult Female Genitialia w valves 31 20 29 38 04 62 Skin amp Vein Kit Adult Male IV arm Genitialia w valves NOT ILLUSTRATED 260305 Power cord US 260306 Power cord EUR P w 260
27. ot be in contact with electrically conducting surfaces or objects during defibrillation A flame supporting atmosphere for example with a high content of oxygen should be avoided during defibrillation The manikin chest must be kept dry Special attention should be taken when using IV Arm Urinary system or Bleeding Control Modules To prevent chest skin electrode pitting 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 manikin torso since this could damage the unit and might also present a possible hazard for the operator If a training session involves the administration of fluids and or drugs into the IV arm empty the arm immediately following the training session Do not allow the manikin s skin to come in direct contact with ink or photocopied paper as this can permanently stain the skin Avoid using colored plastic gloves when handling the manikin as they may also cause discoloration Do not introduce any fluids except airway lubricant in small amounts to lubricate the airway into the esophagus or trachea of the manikin This device generates uses and possibly radiates radio frequency energy If it is not installed and used in accordance with the instructions it may cause harmful interference to radio communi cations In that case the user is encouraged to attempt correction of t
28. propriate icon to enter submenus 4 Make desired changes 5 Select ok to initiate the change If you have changed the configuration the software will ask you whether or not you wish to save the changed configuration try it without saving or cancel the operation If you choose yes you will be asked to name the new profile you created A space is provided for additional comments To open a saved profile follow the steps shown above to open the configuration window then select Open profile Edit the Patient Monitor Set Up from the GUI The patient monitor can be edited to replicate different healthcare institutes and clinical environments thus increasing realism during scenarios To access the patient monitor set up Open the Edit dropdown menu 2 Select Edit Monitor Set up A window will open showing the standard patient monitor con figurations Refer to the help files for a detailed description of the different configurations Choose Monitor Set Up Using View The patient and the instructor monitor can be individually configured Click on View to show the dropdown menu The default settings shows Instructor Monitor checked indicating both displays are the same If different settings are required uncheck Instructor Monitor Patient Monitor To select the desired monitor configuration I Click view 2 Select Patient Monitor Setup or Instructors Monitor
29. ry side of manikin 3 Remove pneumo bladder from box 4 Disconnect bladder hose from in line hose connector 5 Remove bladder from site cavity 6 Insert new pneumo bladder into site cavity and reconnect to in line hose connector 7 Fold bladder and replace in box return box to torso 8 Replace chest skin over torso and secure skin at the shoulders and both sides 9 Fill puncture marks on exterior of chest skin with modeling wax supplied with manikin by applying firmly with fingertip while stretching skin Chest Drain Left Mid Axillary Site To replace chest tube insertion module Remove skin at torso side and left shoulder 2 Remove chest tube insertion module from mid axillary side of manikin 3 Insert new chest drain module 4 Replace chest skin over torso and secure skin at the shoulders and both sides Breathing Bladder To replace bladder Remove skin at torso sides 2 Lift out the chest plate 3 Fold the lungs upward 4 Remove foam part 5 Disconnect bladder tubing from nipple on manifold block e ia 6 Connect new bladder to same nipple 7 Replace foam lungs and chest plate 8 Replace chest skin over torso and secure skin at the shoulders and both sides Crico Thyroid Membrane Hy Tape Expose neck to visualize opening that has been molded in place of crico thyroid membrane 2 Remove used Hy Tape from opening 3 Cut a 4cm 1 strip of Crico Thyroid Membrane
30. servation and recognition of most vital signs which are used in emergency medicine either directly on the manikin itself or on the included simulated Patient Monitor When used correctly these features will support the students competence ability to reach the correct diagnosis based on active observation as opposed to being prompted by instructor cues The patient monitor also doubles as display for other functions such as display of 2 lead ECG and X rays The manikin allows for most relevant medical intervention to be performed according to their medical guidelines and protocols The Laerdal SimMan contains an advanced airway allowing for simulation of difficult airway management cases The anatomy can be changed during the scenario via remote control to indicate changes to the patient condition or as a response to students intervention Correct form and technique are required to perform direct laryngoscopy and endotracheal intubation Correct use of a variety of airway adjuncts will successfully ventilate the patient simulator SimMan is delivered with a set of normal pupils inserted in the head s eye sockets and a separate case containing 3 sets of replace ment pupils normal constricted dilated for simulation of various medical conditions The simulated patient monitor is a replication of the Philips IntelliVue patient monitor which includes the ability to set up the screen layout in various ways It also allows configuration
31. st maneuvers however the airway is open in all positions b A speaker located in the head allows the instructor to speak through the SimMan to simulate a patient or use pre defined vocal sounds c Upper dentures are replaceable Soft non breakable dentures are pre installed but can be replaced by a ngid breakable version for more realism d To change the pupils Open the eyelids wide take care not to rip the face skin Using the suction cup provided or the edge of your finger nail remove the pupil from the eye socket Replace with the pupil of your choice using the suction cup or press into place with your finger Neck a Bilateral carotid pulses b Airway access through simulated crico thyroid membrane c Decreased Cervical Range of Motion DCROM instructor controlled Airway Lungs and Airway Management a The airway Is instructor controlled to allow simulation of various airway complications including the failure of therapeutic airway devices b Ventilation can be performed using any of the following Bag Valve Mask devices Jet ventilation Ventilator c The system does not accept PEEP modes of ventilation d SimMan accepts a wide range of airway management devices and techniques Correct form and technique are required to perform direct laryngoscopy and endotracheal intubation Correct use of a variety of airway adjuncts will successfully ventilate the patient simulator Some examples are see notes belo
32. t be changed until blood pressure has been established IV Arm Right Arm is a Multi venous IV Arm allowing Cannulation Phlebotomy Drug administration Infusion The veins are self sealing allowing multiple uses however repetitive insertions in the same area will result in leakage sooner than if the cannulations had been spread over a wider area The venous system and the skin sleeve are both replaceable The IV arm can be used with simulated blood by attaching the sup plied IV bag tubing to one of the two latex vein openings near the top of the arm Using the supplied simulated blood concentrate mix the desired volume of simulated blood and add to the IV bag see procedure below Release simulated blood until it runs via the tubing into the arm and out the other latex vein Once fluid is running freely out of the second vein seal it using a clamp Using a 22 gauge or smaller needle for IV training increases the life of the IV arm skin If you want the student to infuse medicines attach a second IV bag for free flow Procedure for filling Blood Bag IV Bag Use a syringe to inject fluid into IV bag and fill to desired level Control flow of blood into arm via clamp Air and CO Source Compressed air is provided by a compressor or other type of pres surized air source via a regulator unit allowing many functions to take place Airway complications Spontaneous breathing Tension pneumothorax inflatio
33. tomatic updating and BP now function Respiratory rate Blood Temperature Peripheral Temperature SpO waveform and numerical display with audio output CVP waveform and numerical display output PAP and Wedge TOF TOF CO inOQ inN O in Anesthetic Agent etCO etN O et Anesthetic Agent Monitor trends 2 lead ECG with adjustable ST elevation and conduction on some rhythms X ray Calibrating the Patient Monitor Because the Simulated Patient Monitor uses touch screen technology it must be calibrated before use To calibrate the monitor a Double click the elo logo in the system tray in the lower right corner of the screen b Click on the Align button in the dialog box c If target indicators appear first on the instructor computer screen and not on the patient monitor press Esc or wart until they appear on the patient monitor d Touch each target as it appears on the Patient Monitor e Touch the green check mark after all targets have been touched USB Camera The USB Camera provides enhanced debriefing possibilities Video input is synchronized with the SimMan scenario log To set up the camera see Install Guide and Directions for Use included in your camera packaging Important Connect the camera via a USB port directly on the laptop Do not use the hub as this may cause interference In use Head a The head allows for performance of head tilt and jaw thru
34. w for information on sizing and precautions Oral nasal pharyngeal airways Endotracheal tubes nasal and oral Laryngeal Mask Airways Combi T ube Needle cricothyroidotomy Surgical cricothyroidotomy Retrograde intubation Fiberoptic procedures Light Wand intubation Bronchoscopy e The manikin has two lungs Intubation that is too deep will result in unilateral lung filling This usually occurs on the right side due to the accurate anatomical modeling of the tracheobronchial junction and bronchial tree f When airway adjuncts are used ventilation may be made more difficult by activating decreased lung compliance for either the right lung or left lung Activating decreased lung compliance for both lungs causes airway adjuncts to fail to ventilate Important Mouth to mouth nose mask ventilation should not be performed on SimMan The upper airways must be thoroughly cleaned and the lungs changed if these techniques are performed on the manikin Important Prior to using airway adjuncts spray the inside of the pharynx nostrils and all airway management devices to be inserted with a liberal amount of the provided airway lubricant Airway Adjuncts Sizing and Precautions ET Tubes While ET tubes as large as 8 5 may be used we recomm end the use of ET tube size 7 5 to extend the life of the simulator We also recommend the use of a malleable stylette Care should be taken that the stylette does not extend
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