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Meti HPS User Manual

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Summary of Contents for Meti HPS

  • Page 3: License/Copyright

    License Grant (a) Restricted License METI grants you, the user, a non-exclusive license to use one copy of the Software un- der the terms and conditions stated herein. You agree that all beta releases, upgrades, enhancements, maintenance releases, patches, bug-fixes or other modification to the...
  • Page 4 You agree and acknowledge that METI provides evaluation Software solely for demon- stration purposes and not for long-term use. On your accepted order and payment of the applicable fee, METI will provide a key or other mechanism to you for conversion of an evaluation-limited license to a non-evaluation full restricted license.
  • Page 5 (a) METI owned Software METI warrants to you that, in the case of any Software it has identified as its own property, the Software will substantially conform to the applicable METI specifications in effect at the date of installation and for a period that is consistent with the warranty offered or extended with the purchase of a simulation system.
  • Page 6 All third party proprietary Software is supplied with the benefit of warranties, if any, of- fered by the third party owners and reproduced by METI. TO THE FULLEST EXTENT PERMITTED BY LAW, METI DOES NOT ITSELF WARRANT THIRD PARTY PROPRI-...

  • Page 9: Specifications

    Specifications HPS Specifications Size Mannequin 5ft, 11inches (180cm) Instructor Workstation 18.5” H x 19.1” W x 7.4” D (46.9cm x 48.5cm x 18.9cm) Lab Rack 51”H x 22”W x 31”D (130cm x 60cm x 78cm) Weight Mannequin/Simulator 75lbs (34kg) Lab Rack...
  • Page 10 ® Specifications Power Rack & Mannequin AC Input: AC 100 – 120VAC, 50/60Hz Consumption: Approx. 400W (NOTE: The METI transformer kit is supplied for 220VAC users.) Instructor Workstation AC Input: AC 100 – 240VAC, 50/60Hz Electrotherapy Defibrillation Monophasic viii...

  • Page 11: Cautions/Warnings

    General Use Warnings Electrical System and HPS Rack • Do not drop, step on, or stack anything on the HPS rack. • Do not clean the HPS Lab Rack front panel with chemical solvents. Use water and a light soap solution only.
  • Page 12 • Latex is contained within the HPS Mannequin in the vein assembly of the right arm (i.e., IV arm). Should you need to replace any portion of the vein assembly please take the necessary precautions.

  • Page 13: Table Of Contents

    METI HPS ....................1.1 Contained in this User Guide ..............1.2 Equipment Overview ................. 1.4 Human Patient Simulator - HPS Standard Components Inventory .. 1.4 Human Patient Simulator - HPS Optional Components Inventory ... 1.4 Health Science HPS Standard Components Inventory ....1.5 Health Science HPS Optional Components Inventory ......
  • Page 14 METIVision ..................1.18 ® METI FX ................... 1.19 Hands-Free Training Cables ............1.20 HPS Learning Modules and Training Courses ........ 1.21 HPS Learning Modules .................1.21 HPS Training Courses ................1.22 HPS Setup ��������������������������������������������������������������������������������������������������2�1 Before Beginning Setup ................2.2 Step 1: Place the Simulator in the Work Area ........... 2.3...
  • Page 15 Step 9: Ensure All Gas Supplies Are Turned off ........2.12 Step 10: Turn on Patient Monitors ............2.12 Step 11: Power on the HPS Lab Rack ............ 2.13 Step 12: Power on and Log Into the Instructor Workstation ....2.14 Step 13: Launch the HPS6 Software .............
  • Page 16 ® Table of Contents Using the Patient Toolbar Icons ............3.7 Save ....................3.7 Stop ....................3.7 Logs ....................3.8 The Event Log ..................3.9 The Physiologic Data Log ..............3.10 The Drug Log ..................3.11 The Logs Folder ................3.12 Detach Tab ..................3.12 Recorder ..................
  • Page 17 Table of Contents Playing Scenarios ................3.29 Opening a Scenario ................3.29 Understanding the Scenario Script ............3.31 Navigating Between States ............. 3.33 Closing Scenarios ................3.34 Working with Multiple Scenarios ............. 3.34 Switching Scenarios ................3.34 Repeating Scenarios ................3.34 Editing Scenarios ................3.35 Modifying Existing Scenarios ............
  • Page 18 The Drugs Tab ................. 3.69 The Fluids Tab ................. 3.70 The Cardiovascular Tab ..............3.71 The Respiratory Tab ................ 3.72 Using HPS ......................4.1 Patient Profiles ................... 4.2 20-year-old with Spontaneous Pneumothorax ......... 4.4 20-year-old with Tension Pneumothorax .......... 4.4 26-year-old with 7 min Fresh Water Submersion ......
  • Page 19 Table of Contents Mr. Reen L. Stone ................4.18 Mrs. Una Goodeye ................4.20 Orthostatic Granny ................4.21 Soldier ..................... 4.22 Soldier with Gun Shot Wound ............4.22 Soldier with Land Mine Injury ............4.23 Soldier with Snake Bite Injury ............4.23 Standard Child ................
  • Page 20 ® Table of Contents Reactive Eyes .................. 4.39 Wireless Voice Capability ..............4.41 Metabolic Features .................. 4.42 Bowel Sounds ................. 4.42 Airway ...................... 4.43 Realistic Upper Airway ..............4.44 Variable Upper/Lower Airway Resistance ........4.45 Airway Occluder ...................4.45 Laryngospasm ..................4.46 Tongue Edema (Swelling) ..............4.47 Bronchial Occlusion ................4.48 PEEP ....................4.49...
  • Page 21 Table of Contents Invasive Hemodynamic Monitoring ..........4.60 Baroreceptor Reflex ................ 4.63 Circulation ..................4.65 Controlling Fluids .................4.65 Hematology Model ................4.67 Adjusting Contractility ................4.68 Manual Blood Pressure ..............4.69 Korotkoff Sounds (Five Phases) ............4.70 Genitourinary System ................4.71 Setting up Fluid for Use with the Genitourinary (GU) System ..4.71 Priming the GU System ..............
  • Page 22 ® Table of Contents Pharmacology System ................4.88 Priming the IV System ..............4.89 IV Access ..................4.90 Permanent IV Access Ports ............4.90 Monitoring Patients ................. 4.91 Waveform Display Parameters ............4.91 Accessing the Waveform Display ............ 4.92 Modifying the Waveform Display ............ 4.94 Viewing NIBP ..................4.94 Setting Up NIBP to Cycle ..............4.94 Changing the Layout ...............
  • Page 23 The Anesthesia Delivery System ............... 7.2 Hardware Setup Instructions ..............7.3 Step 1: Set Up External Components ..........7.3 Step 2: Set Up the Anesthesia Delivery System in the HPS Lab Rack ................... 7.4 Step 3: Start the HPS6 Software ............7.5 Operation ....................
  • Page 24 Difficult Airway Management ............8.12 Cannot Intubate, Cannot Ventilate ..........8.13 Spontaneous Pneumothorax ............8.14 Near Drowning ................8.17 HPS Care and Maintenance ................9.1 HPS Warranty Programs ................9.1 General Information ................9.1 Units Out of Agreement ..............9.1 How to Contact Customer Support ............
  • Page 25 Step 1: Clean the Simulator and the Fluid System ......9.5 Step 2: Shut Down the Software ............9.5 Step 3: Power Off the HPS Lab Rack ..........9.5 Step 4: Power Off the Clinical Monitor ..........9.6 Step 5: Turn Off All Gases ..............9.6 Maintenance Advice ..................
  • Page 26 ® Table of Contents Repairing Cuts and Abrasions to the Mannequin ......9.15 Using the IV Arm Kit ................ 9.16 Replacing the IV Arm Skin ..............9.16 Replacing the IV Arm Veins ..............9.16 Drug Recognition Barcode Labels ..........9.16 Index �������������������������������������������������������������������������������������������������������10�1 Appendix A - Macintosh Fundamentals ������������������������������������������������������11�1 Appendix B - Shortcut Keys ����������������������������������������������������������������������11�5 Appendix C - Drug Integration �������������������������������������������������������������������11�9...

  • Page 27: Introduction

    As the worldwide leader in patient simulation technology and education, Medical Education Technologies, Inc. (METI) is excited to introduce the Human Patient Simulator (HPS). With METI’s proprietary human physiology model at its core, the HPS is designed to automatically determine patient responses to user interventions in real time.

  • Page 28: Contained In This User Guide

    This User Guide has been designed for quick access to information on how to use and maintain the HPS system. Please be sure to read and follow the Cautions and Warnings on the pages preceding the Table of Contents. This is for the safety of users as well as for the protection of the simulator.
  • Page 29 Introduction The Drug Recognition System section includes usage and orientation content to use this feature of the HPS system. This section also includes content pertaining to the use of the bar code reader. The Anesthesia and Scavenging section applies to users with the optional anesthesia package.

  • Page 30: Equipment Overview

    Introduction Equipment Overview The METI HPS is comprised of three main components - the HPS Lab Rack, the Instructor Workstation and the HPS mannequin. There are two configurations for the HPS: the Human Patient Simulator - HPS and the Health Science HPS.

  • Page 31: Health Science Hps Standard Components Inventory

    Introduction Health Science HPS Standard Components Inventory Health Science HPS Standard Equipment HPS Mannequin HPS Lab Rack Instructor Workstation Waveform Display Application and Flat Panel Monitor Wireless Microphone and Receiver Replacement Kit METI Transformer Kit (International Users Only) Diagnostic Peritoneal Lavage...

  • Page 32: Hps Equipment

    The Umbilical Assembly is about 12 feet (4 meters) long and is made up of two bundled systems - the fluidic/pneumatic pigtail and the electrical pigtail. The large square electrical connector attaches to the back of the HPS rack, while each of the fluidic/ pneumatic hoses attaches to labeled ports on the back of the rack.

  • Page 33: Hps Lab Rack

    Introduction HPS Lab Rack The HPS Lab Rack is the hub of communication, power and pneumatics for the HPS system. It contains a central power supply, an Ethernet switch, lung bellows and other essential components that drive the simulator’s physical responses.

  • Page 34: Front Panel

    ® Introduction Front Panel The front panel, located behind the front door of the Lab Rack, is partially covered by two large black plates. To access all the components of the front panel, remove the black plates by unscrewing the six screws holding the top plate in place and the four screws holding the bottom plate in place.
  • Page 35 Introduction Bellows - Provide the lung functionality of the HPS system. Mass Flow Controllers (MFCs) - Control the flow of O , CO and N O to the mannequin. Ethernet Switch - Provides the communication link between the Instructor Workstation and the MUSE. (See MUSE below.) Power Relay - Delays the power to the gas analyzer by seven seconds.

  • Page 36: The Back Of The Rack

    The following components can be accessed from the back of the rack: Flow Meter - Measures the flow of the fluid to the chest tube and pericardiocentesis features of the HPS. Drug Recognition System* - Uses two glass syringes and four pistons to measure the volume displaced when drugs are given and to push fluid to the collection bag.
  • Page 37 Bar Code Reader Ports - Provides communication between the Bar Code Reader and the Lab Rack. Probe Port - Provides communication between the OxSim and the Lab Rack. Exhaust Port - Used for scavenging of anesthetic gases. *Optional for Health Science HPS Drug Recognition Flow Meter System MUX 6...

  • Page 38: Instructor Workstation

    When appropriately applied to a syringe, each label uniquely identifies the drug and concentration to the HPS system using the barcode reader - or Stopcock Manifold. The Stopcock Manifold electrically connects to the back of the rack and to the IV access ports on the patient mannequin.

  • Page 39: Oxsim

    Monitor Interface Wireless Microphone and Receiver The wireless microphone and receiver are used for the patient voice feature of the HPS system. The receiver is housed inside the rack. The wireless microphone includes an adjustable lapel clip, volume control and mute.

  • Page 40: Replacement Kit

    ® Introduction Replacement Kit The Replacement Kit includes the IV Arm Kit, Trauma Features Kit, Airway Kit and Genitourinary (GU) Kit. The items contained in each kit are listed below. IV Arm Kit • Venous Tubing Splicing Kit • 140 mL syringe and IV solution sets Trauma Features Kit •...

  • Page 41: Meti Transformer Kit

    Optional for Human Patient Simulator - HPS, not included with Health Science HPS The Anesthesia Delivery System is optional for the Human Patient Simulator - HPS configuration. It can be installed in the HPS Lab Rack and allows for the use and detection of real anesthetic agents (product #HPS-300).

  • Page 42: Trauma/Disaster Casualty Kit (Tdck)

    Introduction Trauma/Disaster Casualty Kit (TDCK) Optional for Human Patient Simulator - HPS and Health Science HPS The TDCK adds to the fidelity of a training session by providing the means to add the automatic, software-controlled flow of blood, mucous and secreted fluids from the mannequin (product #TF-005).

  • Page 43: Meti Tool Kit

    PediaSIM Plug and Play Mannequin Optional for Human Patient Simulator - HPS and Health Science HPS The optional PediaSIM Plug and Play Mannequin can interface with either of the HPS models to simulate the unique physiology of a pediatric patient (product #HPS-016).

  • Page 44: Metivision

    METIVision is a fully integrated, digital audio-visual management system that is data- synchronized in real-time for use with METI simulators. METIVision is the only solution available with the capability to not only capture and store simulation data, but to also broadcast and review any medical simulation exercise using METI simulators.

  • Page 45: Meti Fx

    METI FX Optional for Human Patient Simulator - HPS and Health Science HPS METI takes realism to the next level with METI FX, a realistic set for advanced moulage wound simulation and special effects. METI FX includes incredibly lifelike wounds that accurately replicate muscle, tissue and subcutaneous fat and reflect the true physical nature of a wound and its treatment.

  • Page 46: Hands-Free Training Cables

    ® Introduction Hands-Free Training Cables Optional for Human Patient Simulator - HPS and Health Science HPS 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.

  • Page 47: Hps Learning Modules And Training Courses

    Respiratory Education Simulation Program (RESP) Learning Module 2 (EDU-064) Respiratory Education Simulation Program (RESP) Learning Module 3 (EDU-067) Patient-Centred Acute Care Training (PACT) Simulation Learning Module (EDU- 070) Perioperative Management Learning Module (EDU-075) Beginning in 2010, METI Learning Modules will be available for HPS with Müse software. 1.21...

  • Page 48: Hps Training Courses

    HPS. The HPS Basic course provides learners with an overview of the system and its components, as well as an introduction to patient creation and scenario design.

  • Page 49: Hps Setup

    HPS Setup HPS Setup The following pages guide you through assembling and configuring HPS. Below is a list of the steps required to prepare HPS for operation. Setting Up HPS Place the Simulator in the Work Area Connect the Umbilical Assembly...

  • Page 50: Before Beginning Setup

    Because shipping materials should be stored and retained, be sure all protective packing materials and unused ancillary computer parts are secured. If unpacking HPS for the first time, careful use of a box cutter protects both the packaging and the product.

  • Page 51: Step 1: Place The Simulator In The Work Area

    NEVER lift the mannequin by the LIMBS. Leverage the torso of the simulator and support the head while lifting. NOTE: If you are operating the HPS outside of the United States, you need to include the supplied transformer in your power configuration.

  • Page 52: Step 2: Connect The Umbilical Assembly

    This is the umbilical assembly. The Umbilical Assembly Attach the pin-fitting assembly on the electrical pigtail to the back of the HPS Lab Rack, being careful not to bend any of the pins. Electrical pigtail...
  • Page 53 HPS Setup Attach the Pneumatic Left and Pneumatic Right hoses to the labeled ports on the back of the HPS Lab Rack. Pneumatic Left hoses Pneumatic Right hoses Attaching the Pneumatic Left and Pneumatic Right Hoses Attach the Left Lung and Right Lung hoses to the labeled ports on the back of the HPS Lab Rack.

  • Page 54: Step 3: Connect The Gases

    Ensure the supply pressure of all gas tanks and the Compressed Air tank are set to 50 psig/345 kPa. Connect Compressed Air to the labeled port on the back of the HPS Lab Rack. Connect Oxygen (O ) to the labeled port on the back of the HPS Lab Rack.
  • Page 55 Place the Instructor Workstation at the location where it will be used. Connect one end of the Ethernet cable to the Instructor Workstation. Connect the other end of the Ethernet cable to the HPS Lab Rack. Connecting the Ethernet Cable to the HPS Lab Rack...

  • Page 56: Step 5: Connect The Oxsim (Optional)

    ® HPS Setup Step 5: Connect the OxSim (Optional) Connect the OxSim cable to the PROBE port on the back of the rack. Connect the OxSim cable to the PROBE port Connecting the OxSim cable to the Back of the Rack Ensure there is no battery in the OxSim and the power switch is in the position (away from the red dot).
  • Page 57 HPS Setup Connect the other end of the OxSim cable to the OxSim. Connect the OxSim cable to the OxSim Connecting the OxSim Cable to the OxSim NOTE: It is recommended that the OxSim be secured to a patient monitor, anesthesia machine, equipment rack or other secure surface using a hook-and-loop fastener such as Velcro.

  • Page 58: Step 6: Connect Clinical Monitors (Optional)

    Connecting the Monitor Interface to the Back of the Rack Connect the standard monitor cables to the six labeled sections at the remaining end of the Monitor Interface. The monitor now interfaces with the HPS as it does with a real patient.

  • Page 59: Step 7: Connect The Waveform Display Monitor To The Instructor Workstation (Optional)

    Place the monitor on a sturdy work surface near the head of the bed and unfold the monitor base. (Placing the monitor on top of the HPS Lab Rack works well.) Connect the Apple cable adapter (dongle) to the video cable. Tighten the thumbscrews on the video cable to secure the connection.

  • Page 60: Step 8: Configure The Waveform Display For External Sound (Optional)

    The system is now configured to display the Waveform Display software on the external monitor. Step 9: Ensure All Gas Supplies Are Turned off Before proceeding, ensure all gas supplies connected to the HPS Lab Rack are turned off. Step 10: Turn on Patient Monitors Turn on all patient monitors.

  • Page 61: Step 11: Power On The Hps Lab Rack

    Step 11: Power on the HPS Lab Rack Turn on the power switch located in the lower left corner on the front panel of HPS Lab Rack. If you are using the HPS Portable Rack, the power switch is located on the left corner of the transit case containing the computer.

  • Page 62: Step 12: Power On And Log Into The Instructor Workstation

    After the OS X operating system loads, a small Users window appears, displaying two choices - Administrator and HPS User. Select HPS User. The Login window opens, displaying the Password field. Enter hps in the Password field. Click Log In or press the return key on the keyboard.

  • Page 63: Software

    HPS Setup Step 13: Launch the HPS Software Launch the HPS software by clicking the HPS6 Launcher icon in the Dock. HPS6 Launcher Icon The Patient Palette appears, indicating that the software is running. The Patient Palette 2.15...

  • Page 64: Step 14: Activate The Gas Supplies

    ® HPS Setup Step 14: Activate the Gas Supplies Remove any artificial airway devices from the HPS mannequin. Open the Compressed Air tank. Ensure the supply pressure is set to 50 psig/345 kPa. Open the O , CO and N O (optional) air tanks.

  • Page 65: Step 15: Open A Patient In The Hps6 Software

    Standard Man. Double-click A new Patient Window opens for Standard Man. Patient Window For more detailed instructions on opening a patient in the HPS software, see pages 3.2 to 3.4 in the HPS Software Features section of this User Guide. 2.17...

  • Page 66: Step 16: Connect To The Mannequin

    An available simulator List of Available Simulators Connect at the bottom of Select your HPS simulator and double-click or click the drawer. Once connected, the software says Connected, and the mannequin begins breathing, blinking and exhibiting pulses. For more detailed instructions on connecting to the mannequin, refer to page 3.15 in the HPS Software Features section of this User Guide.

  • Page 67: Hps Software Features

    HPS Software Features HPS Software Features Starting the Application Power on the Instructor Workstation (refer to page 2.14 of the HPS Setup section for details). After the OS X operating system loads, a small Users window appears, displaying two choices - Administrator and HPS User.

  • Page 68: Patient Start Up

    The Patient Palette The toolbar icons (New, Open, Show and Stop) represent options that are also available on the HPS menu bar. The Show and Stop icons are disabled until a Patient file is opened. Patient files can also be opened using the menu options or the shortcut keys found on...

  • Page 69: Opening A Patient File

    Opening a Patient File Use the drop-down menu to navigate to the desired Patient file. Click the Patients icon to navigate directly to METI preconfigured Patients. Click the Home icon to navigate to the top-level directory. Once you have located the desired Patient file, click on the file to select it and click the Open icon or double-click the file name to start the patient and open the Patient window.

  • Page 70: Locating Patient Files

    Open Locating Patient Files Creating a New Patient To create a new patient, click the New icon and select the Untitled HPS Patient option. The New icon Creating a New Patient The Patient Palette indicates the system is preparing the untitled HPS patient based on the underlying patient, HPS.

  • Page 71: Using The Patient Menu

    HPS Software Features Using the Patient Menu The Patient menu located on the menu bar also contains the options for opening and creating new patients. The Menu Bar Several of these options can be used as alternatives to the buttons and icons on the Patient Palette and the Patient window.

  • Page 72: Utilizing Shortcut Keys

    ® HPS Software Features Utilizing Shortcut Keys Many options shown in the HPS menu bar offer shortcut key alternatives that are displayed to the right of the option’s name. Save As... Option with Shortcut Keys For example, the Save As option is performed by simultaneously selecting the Shift, Command ( ) and S keys, represented by the symbols on the right.

  • Page 73: Using The Patient Toolbar Icons

    When the Save icon is clicked, the current version of the patient file OVERWRITES (replaces) the previous version. Preconfigured patients, such as Stannette, cannot be overwritten in HPS user mode, so selecting Save prompts a warning requiring the patient to be saved to the User/Shared directory as a new patient file.

  • Page 74: Logs

    ® HPS Software Features Logs Clicking the Logs icon opens the Logs Drawer at the bottom of the Patient window. The Logs Drawer The buttons on the Logs Drawer provide access to the Event Log, Physiologic Data Log and Drug Log. The menu option for showing the Logs Drawer is found under the Window menu in the menu bar.

  • Page 75: The Event Log

    HPS Software Features The Event Log The Event Log displays a chronological list of events that are time-stamped based on the simulated running time of the patient in hours, minutes and seconds. The Event Log Parameter modifications and some user interventions, such as defibrillation or pacing, are listed in the Event Log, which also document if the intervention was initiated by the user or resulted from a change specified in a running scenario.

  • Page 76: The Physiologic Data Log

    ® HPS Software Features The Physiologic Data Log The Physiologic Data Log lists more than 20 different physiological parameters and is updated every five seconds and recorded based on the simulated time of the patient in hours, minutes and seconds.

  • Page 77: The Drug Log

    HPS Software Features The Drug Log The Drug Log records all drugs administered to the patient, either as a bolus, via an infusion or autoinjected. Bolus dose logs display when the drug was given, the drug’s name, the dose amount administered and the origin of the dosage (e.g., User or Scenario).

  • Page 78: The Logs Folder

    ® HPS Software Features The Logs Folder The Logs folder holds the data files from each of the logs for every patient session. Located in the HPSVersion6 folder, the Logs folder is accessed by navigating the Mac OS X drive.

  • Page 79: Recorder

    Assessment), then the active option is displayed in the new window. Multiple tabs can be detached and used to isolate specific controls. The menu option for detaching tabs is under the Window menu in the HPS menu bar. Recorder Clicking the Recorder icon in the Patient toolbar opens the Event Recorder, a separate window that initially displays a list of the patients opened during the current session.

  • Page 80: Patient Time

    ® HPS Software Features Patient Time The Patient Time display keeps track of the simulation time. By default, the digital readout records and presents real time. Pause Fast Forward Simulation Time Play Patient Time Three buttons appear to the right of the readout showing icons for the Pause, Play and Fast Forward functions.

  • Page 81: Connection Icons

    HPS Software Features Connection Icons The two connection icons, Disconnect and Connections, appear on the right side of the Patient toolbar. Clicking the Connections icon opens the Connect to Simulator drawer. Connections icon Connect to Simulator drawer Connection Icons and Connect to Simulator Drawer A list of available simulators appears in the Connect to Simulator drawer.

  • Page 82: Viewing The Heads Up Display (Hud)

    ® HPS Software Features Viewing the Heads Up Display (HUD) The Heads Up Display (HUD), located on the left side of the Patient window, displays 28 selected patient parameters that register the patient’s physiological condition. The Heads Up Display (HUD)
  • Page 83 HPS Software Features HUD Parameters Parameter Name Units Notes Heart Rate bpm (beats/ min) Mean Arterial Pressure mmHg C.O. Cardiac Output lpm (liters/ min) Pulse Oximeter Saturation Hematocrit Determined dynamically based on blood and fluid losses and intravenous infusion of colloids, crystalloids, packed red blood cells...

  • Page 84: The Ischemic Index

    When an unfavorable oxygen supply/demand ratio occurs, myocardial ischemia follows. The lower the Ischemic Index, the greater the myocardial ischemia. The Ischemic Index is derived through the underlying HPS models and cannot be measured clinically. Favorable supply/demand ratios (slower heart rates, higher blood oxygenation levels)

  • Page 85: Working With Tabs

    HPS Software Features Working with Tabs Beneath the toolbar on the right side of the Patient window is a series of tabs that provide access to the physiological controls used during a simulator exercise. The Seven Tabs The tabs display seven different categories offering varying functionality:...

  • Page 86: Numeric And Discrete Parameters

    ® HPS Software Features Numeric and Discrete Parameters On the Condition, Cardiovascular and Respiratory tabs, parameter settings provide a large number of alternatives creating a wide range of physiological responses. There are two types of parameters: Numeric - set either a measured value (e.g., 20 mL) or a multiplied value (e.g., Heart Rate Factor 2.0 is two times the baseline Heart Rate)
  • Page 87 HPS Software Features The new parameter values immediately begin to affect the patient’s physiology. Depending on the parameter and its settings, changes can be dramatically instantaneous or can take place more slowly over time. Changes to values can take place gradually (Onset) over...
  • Page 88 ® HPS Software Features These parameters all have a default setting of -1 that signals the software to perform physiological changes based on the models without instructor intervention. In the example below, setting the Fixed Heart Rate to -1 means the heart rate automatically rises when the selected patient becomes hypovolemic.

  • Page 89: Saving Data

    HPS Software Features Saving Data Patient information can be saved locally on the hard drive or transferred to external storage via a CD or a USB memory device. Files are created in a simple text (TXT) format. Consequently, transferred files can be printed on any computer (PC or Mac) that has printing capability.

  • Page 90: Saving To A

    ® HPS Software Features Saving to a CD To save to a CD-ROM: Insert a blank CD in the CD drive on the front of the Instructor Workstation. A dialog box appears with a field highlighted by default for labeling the CD.

  • Page 91: Saving To A Usb Memory Device

    HPS Software Features Trash icon on the Dock. When the CD file is over the Drag the CD file to the Trash, the icon changes to a Burn CD icon. A dialog box appears with the options to Burn, Cancel or Eject.

  • Page 92: Printing Files

    Click Save to save the screenshot as a PDF. HPS files are saved in a text (TXT) format, so either a PC or Macintosh system can be used to print the files.

  • Page 93: Tabs

    HPS Software Features Tabs Patient physiology and background is created and controlled through the HPS6 software using the patient parameter settings in tabbed sections that organize all of the various parameters by system and functionality. The Simulation Tab The Simulation tab appears when the patient file is opened. This tab provides basic information about the patient such as the patient’s name, history and photograph.

  • Page 94: The Scenario Tab

    ® HPS Software Features The Scenario Tab Selecting the Scenario tab opens a window providing the tools needed to create or play patient scenarios that duplicate clinical situations by automatically simulating patient responses to a series of events. Choose the Player or...

  • Page 95: Playing Scenarios

    HPS Software Features Playing Scenarios Any patient may be selected for any available scenario; however, patients with pre- established conditions may not work well with scenarios anticipating a patient with a different physiological status. For example, selecting a patient with profound neuromuscular blockade for a scenario expecting a spontaneously breathing patient does not yield the results expected by the scenario author.
  • Page 96 HPS Software Features In the Open file window: Locate the folder that contains the scenarios using the navigational pull-down at the top of the window. (The preconfigured scenarios are located in the HPS Scenarios folder.) Select the desired scenario file.

  • Page 97: Understanding The Scenario Script

    HPS Software Features Understanding the Scenario Script When a scenario appears, the states that comprise the scenario appear in the Scenario panel. The name of the active scenario appears in the Opened Scenarios drop-down The states that comprise The name of the active...
  • Page 98 ® HPS Software Features Select a state’s Events or Transitions heading to see the events or transitions for that particular state. Selecting the Events and Transitions headings reveals the state’s events and transitions Expanding Events and Transitions States may contain any number of events and/or transitions.

  • Page 99: Navigating Between States

    Navigating Between States Generally, scenarios are designed with states that begin at the top and end at the bottom. The preconfigured scenarios included with HPS are designed in this fashion. However, scenarios can be created that intentionally skip or repeat states, often depending on the nature of the intervention.

  • Page 100: Closing Scenarios

    ® HPS Software Features Closing Scenarios Scenarios run until closed. To close a scenario, select the Close option from the Scenario menu. Select Close to close the scenario Closing a Scenario Even though a scenario has closed, the physiological changes made to the patient during the scenario remain.

  • Page 101: Editing Scenarios

    HPS Software Features Editing Scenarios In addition to the 12 preconfigured scenarios, new or revised scenarios can be created and saved using the Scenario Editor. To create or edit a scenario: Editor option from the Show menu at the top of the Scenario tab.

  • Page 102: Modifying Existing Scenarios

    ® HPS Software Features Modifying Existing Scenarios Either to permanently change or to create a new version of an existing scenario, in the Scenario Editor: Open an existing scenario by selecting the Open or Open Recent option from the Scenario menu.
  • Page 103 HPS Software Features Selecting the Open Recent option displays the most recently used (with a limit of 10) scenarios as options. Opening a Recently Used Scenario The scenario file opens in the Scenario Editor. When the opened scenario appears, options become active for adding, editing and saving states, events and transitions on the Scenario menu.

  • Page 104: Developing New Scenarios

    ® HPS Software Features Developing New Scenarios To create a new scenario in the Scenario Editor, select New from the Scenario menu. Opening a New Scenario The new scenario initially displays only an Untitled name and a blank Scenario panel.

  • Page 105: Adding, Editing And Deleting States

    HPS Software Features Adding, Editing and Deleting States Scenarios are organized by the states that are simulated with the patient as diagnoses and interventions take place. As organizing structures, states by themselves do not cause changes to the patient’s physiology. Those occur based on the events and transitions defined for the state.
  • Page 106 ® HPS Software Features Select NewState to display the Events and Transitions headings and to activate the Change state name to field in the lower panel. Displaying a New State Enter the new name in the Change state name to field and click Apply.
  • Page 107 HPS Software Features After creating the state, events and transitions are added to define the state. (Please refer to page 3.42 for more information on adding events and page 3.55 for more information about adding transitions.) Additional states in the scenario are added in order and cannot be moved.

  • Page 108: Adding, Editing And Deleting Events

    ® HPS Software Features Adding, Editing and Deleting Events Events set the specific parameters that take place when the state is active. An event may alter a parameter (e.g., Increase the Heart Rate Factor), administer a drug (bolus or infusion) or trigger the move to a new destination within the scenario.

  • Page 109: Set" Events

    HPS Software Features There are six different options for new events: New “Set” Event New “Bolus” Event New “Call” Event New “Go To” Event New “Infusion” Event New “Multiply” Event Each of these options has a unique purpose and different parameter settings.
  • Page 110 ® HPS Software Features To establish a “set” event: Select the appropriate state. Choose New “Set” Event from the New Event option of the Scenario menu. Selecting a New “Set” Event The phrase set ? to ? appears beneath the Events heading of the selected state.
  • Page 111 HPS Software Features value field by entering a Depending on the nature of the parameter, change the new value or by selecting a value from a pull-down list. Selecting a Value for the Parameter Once the correct value is selected or entered, click Apply.

  • Page 112: Bolus" Events

    ® HPS Software Features “Bolus” Events A “bolus” event is used to administer a drug bolus within the scenario. For example, the event give bolus of epinephrine 1000 mcg in an active state automatically administers 1000 mcg of epinephrine to the patient, irrespective of any user input or the patient’s physiology.
  • Page 113 HPS Software Features Using the pull-down list, select the appropriate drug from the list and complete the give bolus of field. Depending on the drug selected, the measurement field displays a measurement of either mg or mcg (milligrams or micrograms).

  • Page 114: Call" Events

    ® HPS Software Features “Call” Events A “call” event includes the events and transitions of one state within another state. In other words, a call State B event added to State A makes the events and transitions of State B a part (or subroutine) of State A. In this way, the use of a “call” event allows states to be used multiple times without the necessity of redefining their events and transitions.

  • Page 115: Go To" Events

    HPS Software Features Using the pull-down list, select the appropriate state from the list to complete the call field. Click Apply. The new “call” event appears under the Events heading of selected state. New “Call” Event A “Call” Event “Go To” Events A “go to”...
  • Page 116 ® HPS Software Features go to ?. The lower panel changes to display the go to field. Select Choosing a State to Go to from the Selected State Using the pull-down list, select the appropriate state from the list to complete the go to field.

  • Page 117: Infusion" Events

    HPS Software Features “Infusion” Events An “infusion” event is used to administer a drug infusion (or to stop a drug infusion) within the scenario. Once an infusion is administered, it continues to run until stopped either through an additional event in the scenario or user intervention. Infusions are set at an infused rate (mcg/min) or as a normalized infusion (mcg/kg/min).
  • Page 118 ® HPS Software Features Using the pull-down list, select the appropriate drug from the list to complete the infuse field. Complete the infusion dosage by entering an amount in the dosage field and selecting a rate of infusion (e.g., mcg/min or mcg/kg/min) from the measurement pull-down list.

  • Page 119: Multiply" Events

    HPS Software Features “Multiply” Events A “multiply” event is used to apply a factor to a numerical parameter that increases or decreases the existing value of that parameter. Unlike a “set” event, which can multiply the default value of a numerical parameter, the “multiply” event factors against the patient’s current physiological values.
  • Page 120 ® HPS Software Features multiply ? to ?. The lower panel changes to display three fields, beginning Select with the multiply field. Choosing the Parameter to be Multiplied multiply field by selecting the parameter. Using the pull-down list, complete the Choose only numerical parameters that may be factored.

  • Page 121: Adding, Editing And Deleting Transitions

    HPS Software Features Adding, Editing and Deleting Transitions Transitions are conditional expressions (if X, then Y) that direct the scenario based on preestablished contingencies. The first part of the expression (the “if” phrase) establishes the contingency while the second part (the “then” phrase) defines the action to be taken.
  • Page 122 ® HPS Software Features if ? = ? then go to ?. Select Selecting the Condition The lower panel changes to display five fields, beginning with the if field. Using the pull-down list, select the desired condition from the if field.
  • Page 123 HPS Software Features Select the relationship from the pull-down list to the right of There are six available relationships. Condition Relationships Symbol Meaning equal to not equal to ≠ > greater than greater than or equal to ≥ < less than less than or equal to ≤...
  • Page 124 ® HPS Software Features Drug Units Drug Units Drug Units Adenosine Esmolol Nitroglycerin mg/kg mg/kg mcg/kg Alfentanil mcg/kg Etomidate mg/kg Nitroprusside mcg/kg Amiodarone Fentanyl Norepinephrine mg/kg mcg/kg mcg/kg Atracurium mg/kg Flumazenil mg/kg Pancuronium mg/kg Atropine mg/kg Glycopyrrolate mg/kg Phentolamine mg/kg...

  • Page 125: Defibrillation Transitions

    HPS Software Features Complete the action expression by entering or selecting information for each of the fields. Completing the Transition Apply. Click The new transition appears under the Transitions heading of the selected state. Defibrillation Transitions When creating automated transitions using the Defibrillation variable, note that, after defibrillation, the system takes up to three seconds for the values to return from the sensed value (e.g., 360 Joules) to the original value of zero.

  • Page 126: Editing Transitions

    ® HPS Software Features Editing Transitions Once a transition has been created, it can be modified by selecting the transition in the Scenario panel and altering both the parameters and their values. Transitions are edited in the same manner in which they are created.

  • Page 127: Copying Events And Transitions

    HPS Software Features To cut and paste an event or transition into a different location: Select the event or transition. Choose the Cut option from the Edit menu [or use the Command ( ) + X shortcut keys]. The event or transition disappears from its original location.

  • Page 128: Saving Scenarios

    ® HPS Software Features Saving Scenarios To use the scenario with any patient, the scenario file must be named and saved. Modified preconfigured files must be renamed before they can be saved. Renamed preconfigured scenarios and user-created scenarios can be overwritten, so multiple saves can be performed on those scenarios as changes are made.
  • Page 129 HPS Software Features Selection field. Enter the name for the scenario in the The full file path for a scenario or patient is limited to a maximum of 104 characters. For example: /Users/Shared/subdirectory1/subdirectory2/PuleslessVentricularFibrillationWithAED If a longer file path name is created, the scenario cannot be saved.

  • Page 130: Using The Event Recorder

    ® HPS Software Features Using the Event Recorder The Event Recorder records parameter changes made to the active patient. These recorded changes can subsequently be added to a scenario as events. By observing the physiological changes to the patient, modifications to the parameter values can be made using the Event Recorder prior to adding those events to the scenario.
  • Page 131 HPS Software Features Record icon. Click the Click Record Starting to Record The status field shows that the Event Recorder is recording. A red blinking circle appears in the Stop icon while events are recorded. Set the new parameters, observing the physiological changes in the patient.

  • Page 132: Managing Events In The Event Recorder

    ® HPS Software Features Managing Events in the Event Recorder Events and closed patient files can be deleted from the Event Recorder. To remove an event, select the event and either press the delete key or click the Clear icon. To clear all the events from an active patient, select the patient file and either press the delete key or click the Clear Events icon.

  • Page 133: Copying Recorded Events To A Scenario

    To copy a recorded event to a scenario using the Copy and Paste commands: Select the event to be moved in the Event Recorder. Copy option from the HPS Edit menu [or use the Command ( Choose the C shortcut keys]. The event is copied onto the unseen clipboard.

  • Page 134: The Condition Tab

    ® HPS Software Features The Condition Tab Selecting the Condition tab opens a window that provides a means of changing parameter settings that control patient conditions related to assessment, ICP, sounds and trauma. By default, Assessment is selected in the Show pull-down menu located above a panel with a list of Parameters and a panel with settings for those parameters.

  • Page 135: The Drugs Tab

    HPS Software Features The Drugs Tab Selecting the Drugs tab opens a window that provides a means of administering medications from the Instructor Workstation. Based on normal clinical practices, medications may be given as a bolus, an infusion or as an infusion based on the patient’s weight in kilograms (normalized infusion).

  • Page 136: The Fluids Tab

    ® HPS Software Features The Fluids Tab Selecting the Fluids tab opens a window that provides a means of controlling the amount of fluid lost by or infused into the patient. The upper panel provides scrollable access to the various fluid parameters and the bottom panels display the controls for entering the amount of fluid to be lost or infused and establishing the time frame during which the fluid loss or infusion takes place.

  • Page 137: The Cardiovascular Tab

    HPS Software Features The Cardiovascular Tab Selecting the Cardiovascular tab opens a window providing a means of changing parameter settings that control patient conditions related to the cardiovascular system. Catheters is selected in the Show menu located above the Parameters panel and the panel with the settings for those parameters.

  • Page 138: The Respiratory Tab

    ® HPS Software Features The Respiratory Tab Selecting the Respiratory tab opens a window providing a means of changing parameter settings that control patient conditions related to the respiratory system. Airway is selected by default in the Show menu, which also contains options for Lung and Respiratory Control.

  • Page 139: Using Hps

    Using HPS Using the HPS Once the HPS has been set up, the software has been loaded and a patient started and connected the simulator is ready for learner interventions. The Patient Window Changes to the patient’s physiology can be manifested in the simulator and on the Waveform Display using the software accessed on the Patient window.

  • Page 140: Mr. Reen L. Stone

    ® Using HPS Patient Profiles An unlimited number of unique patient profiles are possible for the HPS, which comes with 31 patient profiles already configured that can provide a baseline for modified or customized patients: 20-year-old with Spontaneous Pneumothorax 20-year-old with Tension Pneumothorax...
  • Page 141 Using HPS Standard Man Narcotized Standard Man Relaxed Stannette Stannette Preeclampsia Truck Driver Truck Driver Pre-clamp Truck Driver Pre-unclamp...

  • Page 142: Year-Old With Spontaneous Pneumothorax

    ® Using HPS 20-year-old with Spontaneous Pneumothorax Narrative Paramedics are called to a sporting event and find a 20-year-old physically fit male complaining of sudden onset of severe shortness of breath. The patient reports no significant medical history or medications, but does complain of pain in the right chest.

  • Page 143: Year-Old With 7 Min Fresh Water Submersion

    Using HPS 26-year-old with 7 min Fresh Water Submersion Narrative Paramedics are called to a fresh water lake to treat a 26-year-old male who was submerged for seven minutes. Initial assessment reveals the patient to be pulseless and apneic, with a laryngospasm and cold skin. The electrocardiograph shows ventricular fibrillation.

  • Page 144: Year-Old With Alcoholic Cardiomyopathy

    ® Using HPS 50-year-old with Alcoholic Cardiomyopathy Age and Gender 50-year-old male History of End-state alcoholic cardiomyopathy cardiac transplant Present Illness Past Medical Alcoholism - cardiomyopathy, no GI bleed or abnormal clotting studies No know drug allergies History 50-pack year smoking history...
  • Page 145 Using HPS Laboratory, HCT: 32 % Electrolytes: Within normal limits Radiology and Chest X-ray: Pulmonary edema Other Relevant ECG: Sinus tachycardia at 105 bpm, ST segments baseline Studies Narrative The patient is a 50-year-old man in the Medical Intensive Care Unit awaiting cardiac transplantation.

  • Page 146: Year-Old With Gi Bleeding

    ® Using HPS 50-year-old with GI Bleeding Narrative An EMS Paramedic unit is called to a house and finds a 50-year-old woman who is complaining of nausea and vomiting for the last hour. Emesis is reported to be copious with bright red blood in it. Dizziness is associated with standing.

  • Page 147: Year-Old With Internal Bleeding

    Using HPS 61-year-old with Internal Bleeding Age and Gender 61-year-old male History of 6-month history of malaise and jaundice Serology consistent with hepatitis C Present Illness Underwent liver biopsy 6 hours ago Now with abdominal pain Past Medical Relatively healthy until eight months ago as above...

  • Page 148: Year-Old With Acute Atrial Fibrillation

    ® Using HPS 62-year-old with Acute Atrial Fibrillation Narrative Paramedics are called to the home of a 62-year-old male who is complaining of sudden onset of palpitations and anxiety. Initial assessment reveals a blood pressure of 102/76, pulse rate of 180, with normal respiration and skin examination.

  • Page 149: Year-Old With Chf & Pulmonary Edema

    Using HPS 67-year-old with CHF and Pulmonary Edema Narrative Paramedics are called to the house of a patient with shortness of breath and chest pain. The patient states difficulty breathing, which has been increasing for the last six hours. Medical history includes high blood pressure, two previous myocardial infarctions and cigarette smoking at two packs per day.

  • Page 150: Year-Old With Septic Shock

    ® Using HPS 72-year-old with Septic Shock Age and Gender 72-year-old male History of Transferred from a nursing home because of increasing confusion. Present Illness Past Medical Alzheimer’s disease Chronic mild hypertension, on no medications History No known drug allergies...
  • Page 151 Using HPS Narrative The patient is a 72-year-old man who was transferred from a nursing home due to increasing mental confusion. He is confused at baseline due to Alzheimer’s disease, but is ordinarily conversant and responsive. At transfer, he was still speaking, though incoherently. Over the last two hours, he has become progressively less communicative and now only moans.

  • Page 152: Dr. Iven Fast

    ® Using HPS Dr. Iven Fast Name, Age and Dr. Iven Fast, 50-year-old male Gender History of Inebriated, combative patient who, two hours ago, was in a motor vehicle collision sustaining a chest contusion and a compound fracture of the left Present Illness femur.
  • Page 153 Using HPS Narrative The patient is a 50-year-old inebriated man, who, two hours ago, was in a motor vehicle collision. He has a chest contusion and a compound fracture of the left femur. He has good pulses in his right leg but no palpable pulses in his lower left leg.

  • Page 154: Mr. Outta Joint

    ® Using HPS Mr. Outta Joint Name, Age and Mr. Outta Joint, 30-year-old male Gender History of Dislocated shoulder 30 minutes ago while helping to transport a piano. Last ate three hours ago Present Illness Past Medical Denies tobacco use...
  • Page 155 Using HPS Narrative A 30-year-old, muscular, healthy man comes for the reduction of a dislocated shoulder. He has eaten three hours ago, the dislocation occurred 30 minutes ago while he helped with the transport of a piano. Medical history, physical examination and lab data reveal nothing of anesthetic significance except that he is overweight (102 kg at 5’9”), and the patient’s wife reports that he...
  • Page 156 ® Using HPS Mr. Reen L. Stone Name, Age and Mr. Reen L. Stone, 60-year-old male Gender History of Developed acute flank pain last evening Present Illness Past Medical Hypertension, long-standing, variable control on enalapril Coronary artery disease, with previous Q-wave myocardial infarction History No chest pain for past year.
  • Page 157 Using HPS Narrative A 60-year-old truck driver comes for a percutaneous nephrostomy. The patient gives a history of multiple kidney stones, has had previous uneventful anesthetics for lithotripsy. A history of hypertension, a previous Q-wave MI of undetermined age and a 100-pack/year history of smoking complicated the picture.
  • Page 158 ® Using HPS Mrs. Una Goodeye Name, Age and Mrs. Una Goodeye, 75-year-old female Gender History of Decreased vision left eye due to cataract Scheduled for extraction and intra-ocular lens placement Present Illness Past Medical Good health History Past Surgical/...

  • Page 159: Orthostatic Granny

    Using HPS Orthostatic Granny Narrative Paramedics are called to attend to a grandmother complaining of abdominal pain of four hours duration. Initial assessment reveals mild systemic hypertension, pulse in the mid to upper 80s. The electrocardiogram shows sinus rhythm with a right bundle branch block.

  • Page 160: Soldier

    ® Using HPS Soldier Narrative The soldier is typically free from chronic disease requiring ongoing medical care and slightly larger than the 70 kg standard man used in civilian scenarios. Because he is involved in intense physical activity, the soldier’s basal metabolic rate is higher than a civilian counterpart.

  • Page 161: Soldier With Land Mine Injury

    Using HPS Soldier with Land Mine Injury Narrative The patient is a 26-year-old soldier who stepped on a low intensity land mine. He sustained bilateral below-the-knee amputations. In addition, he has sustained 20 to 30 small puncture wounds to the upper thigh, arms, pelvis and abdomen from mine shrapnel and bone fragments.

  • Page 162: Standard Child

    ® Using HPS Standard Child Narrative Junior is a healthy 6 year-old child with a height of 115 cm and a weight of 20 kg. Past medical history is completely unremarkable, with developmental milestones achieved at appropriate ages. There are no drug allergies, no routine medications and no previous surgical procedures.

  • Page 163: Standard Man

    Using HPS Standard Man Name, Age and Stan D. Ardman (“Standard Man”, “Stan”), 33-year-old male Gender History of Otherwise healthy adult with compound ankle fracture requiring open reduction and internal fixation Present Illness Past Medical None No known drug allergies...

  • Page 164: Standard Man Narcotized

    ® Using HPS Standard Man Narcotized Name, Age and Stan D. Ardman (“Standard Man”, “Stan”), 33-year old male Gender History of Otherwise healthy adult with compound ankle fracture requiring open reduction and internal fixation Present Illness Past Medical None No known drug allergies...

  • Page 165: Standard Man Relaxed

    Using HPS Standard Man Relaxed Name, Age and Stan D. Ardman (“Standard Man”, “Stan”), 33-year old male Gender History of Otherwise healthy adult with compound ankle fracture requiring open reduction and internal fixation Present Illness Past Medical None No known drug allergies...

  • Page 166: Stannette

    ® Using HPS Stannette Name, Age and Stannette, 29-year-old female Gender History of 40-week intra-uterine pregnancy Uncomplicated prenatal course Present Illness Past Medical No known drug allergies Denies tobacco, alcohol and IV drug use History Past Surgical/ None No family history of anesthetic problems...

  • Page 167: Stannette Preeclampsia

    Using HPS Stannette Preeclampsia Name, Age and Stannette Preeclampsia, 32-year-old female Gender History of 36-week intra-uterine pregnancy Uncomplicated, normotensive prenatal course until today Present Illness BP in the prenatal clinic was 160/95 Past Medical None No known drug allergies History...

  • Page 168: Truck Driver

    ® Using HPS Truck Driver Name, Age and Truck Driver, 61-year-old male Gender History of Referred for surgical repair of infra-renal abdominal aortic aneurysm Present Illness Past Medical Allergy: Penicillins cause hives and wheezing Hypertension: Essential hypertension for 20 years. Currently taking enalapril...
  • Page 169 Using HPS Physical General: Healthy adult Weight, Height: 100 kg, 6’0” Examination Vital Signs: HR 76 bpm, BP 180/97 mmHg, RR 14 br/min, Sp O Airway: Upper and lower dentures, FROM neck, 3 fb oral opening, 3 fb mandible, MC 2 Lungs: Distant bilateral breath sounds but equal Heart: Regular rate and rhythm.

  • Page 170: Truck Driver Pre-Clamp

    ® Using HPS Truck Driver Pre-clamp Name, Age and Truck Driver, 61-year-old male Gender History of Referred for surgical repair of infra-renal abdominal aortic aneurysm. Present Illness Past Medical Allergy: Penicillins cause hives and wheezing Hypertension: Essential hypertension for 20 years. Currently taking enalpril...
  • Page 171 Using HPS Physical General: Healthy adult Weight, Height: 100 kg, 6’0” Examination Vital Signs: HR 86 bpm, BP 151/77 mmHg, CVP 1, PA 26/17, PAOP (wedge) 9, CO 4.9 (With lungs mechanically ventilated and sufficient oxygen concentration) Airway: Upper and lower dentures, FROM neck, 3 fb oral opening, 3 fb...

  • Page 172: Truck Driver Pre-Unclamp

    ® Using HPS Truck Driver Pre-unclamp Name, Age and Truck Driver, 61-year-old male Gender History of Referred for surgical repair of infra-renal abdominal aortic aneurysm. Present Illness Past Medical Allergy: Penicillins cause hives and wheezing Hypertension: Essential hypertension for 20 years. Currently taking enalpril...
  • Page 173 Using HPS Physical General: Healthy adult Weight, Height: 100 kg, 6’0” Examination Vital Signs: HR 85 bpm, BP 125/75 mmHg, CVP 0, PA 15/10, PAOP (wedge) 6, CO 3.0 (With lungs mechanically ventilated and sufficient oxygen concentration) Airway: Upper and lower dentures, FROM neck, 3 fb oral opening, 3 fb...

  • Page 174: Developing A New Patient

    However, the initial underlying physiology of the new patient is that of Standard Man, the healthy, preconfigured patient. An Untitled HPS Patient To complete the patient, new information needs to be added and the physiology changed (if desired).

  • Page 175: Adding A Photograph

    Using HPS Adding a Photograph If desired, load a picture file (e.g., TIFF, JPEG, GIF) onto the laptop, select the file from the desktop, drag the file to the Image box to the left of the patient’s name and re- lease the file.

  • Page 176: Altering An Existing Patient

    ® Using HPS Altering an Existing Patient Any existing patient, either Standard Man, one of the other preconfigured patients or a previously saved user-defined patient, can be changed to display a different name, background or physiology. The original file for a preconfigured patient cannot be overwritten, so a new file name must be created for edited versions of the preconfigured patients.

  • Page 177: Auditory And Ocular Physiological Signs

    Using HPS Auditory and Ocular Physiological Signs The HPS simulator has reactive eyes and wireless voice capability that allows the simulator, with instructor support, to answer learner questions via a speaker system and microphone. Reactive Eyes Each eye has functional eyelids that blink and reactive pupils that can be set to speci- fied diameters or to adjust to changes in light or morphine.
  • Page 178 ® Using HPS Setting Blink Control Choosing the Automatic 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 and comatose condition.

  • Page 179: Wireless Voice Capability

    Microphone Volume option located under the Assessment menu on the Condition tab. Adjusting Microphone Volume The patient must be connected to the HPS simulator for any volume adjustment to be effective. The wireless microphone and receiver are factory-configured to use the same channel.

  • Page 180: Metabolic Features

    Choose the sound and the volume for each quadrant or for all four quadrants using the pull-down menu and slider bar beneath that quadrant’s description. The patient must be connected to the HPS for any volume adjustment to be effective. The Bowel Sounds parameter is located on the Condition tab beneath the Assess- ment menu.

  • Page 181: Airway

    Using HPS Airway The HPS mannequin’s anatomically realistic upper airway provides for the opportunity to intubate and apply other airway interventions to the patient, while various clinical signs (e.g., breath sounds, chest excursion, airway patency) can be physically demonstrated. Airway Features...

  • Page 182: Realistic Upper Airway

    Using HPS Realistic Upper Airway The upper airway of the HPS is designed to allow for intubation and laryngoscopy. Oral and nasal intubation can be performed using a variety of airway devices, including endotracheal tubes (7.5-8.0 cm), nasal-pharyngeal airways (30 mm) and oropharyngeal airways (90 mm).

  • Page 183: Variable Upper/Lower Airway Resistance

    Using HPS Variable Upper/Lower Airway Resistance Airway interventions can be necessitated and complicated by a number of variables. Located in the Airway menu found under the Respiratory tab are five parameters that affect ventilation and intubation. Airway Occluder Swelling of the posterior oropharynx (airway occluder) can be activated to obstruct the view of the larynx and prevent intubation, but allow mask ventilation of the patient’s...

  • Page 184: Laryngospasm

    ® Using HPS Laryngospasm A laryngospasm actuator closes the patient’s vocal cords and prevents both ventilation and intubation. When activated along with the Airway Occluder, a “cannot ventilate, cannot intubate” crisis scenario is achieved. Selecting Laryngospasm Activate the Laryngospasm option in the Airway menu by clicking On. The Laryngospasm option is set by default to Off.

  • Page 185: Tongue Edema (Swelling)

    Using HPS Tongue Edema (Swelling) Tongue swelling can be activated to varying degrees (moderate or severe). Selecting Swollen Tongue After selecting the Swollen Tongue parameter from the Airway menu, choose either the Swollen (for severe swelling) or Semi-swollen option by clicking the corresponding button.

  • Page 186: Bronchial Occlusion

    ® Using HPS Bronchial Occlusion Bronchial Occlusion completely obstructs the right and left bronchi, simulating a lower airway obstruction (e.g., mucus plug). Improper intubation creates a mainstem occlusion, yielding an inability to ventilate the lungs. Setting Bronchial Occlusion After selecting the Bronchial Occlusion parameter from the Airway menu, choose either the Both, Left or Right lung option and click Occluded.

  • Page 187: Peep

    Using HPS 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. Setting PEEP After selecting the PEEP option from the Airway menu, use either the slider bar or enter an amount in the rate field to establish the rate of pressure before clicking Set.

  • Page 188: Cricothyrotomy

    Breakaway Teeth The HPS comes with two upper denture plates: one with a complete set of teeth and the other with front Breakaway Teeth that can become dislodged with improper handling of a laryngoscope.

  • Page 189: Pulmonary

    Using HPS Pulmonary The HPS uses physical and mathematical models to achieve an extremely accurate simulation of respiration. The mannequin’s lungs produce carbon dioxide and react realistically to intubation and pathophysiologic states. The patient’s chest rises and falls synchronously with the inflationary state of the underlying lungs.

  • Page 190: Breath Sounds

    Choosing Breath Sounds The Breath Sounds parameter is located on the Lung menu beneath the Respiratory tab. In addition to the Normal sounds, HPS patients are capable of emitting three additional sounds: • Wheezing •...

  • Page 191: Lung Parameters

    In addition to offering settings for volume and pressure in the lungs, these parameters also allow for the administration of certain anesthetics. When the software is not connected to an HPS adult simulator, the FiO parameter may be used to simulate the administration of oxygen to a virtual patient.

  • Page 192: Respiratory Control Parameters

    ® Using HPS Respiratory Control Parameters The patient’s respiratory drive can be controlled through a set of options located on the Respiratory Control menu found on the Respiratory tab. Selecting the Respiratory Control Menu Respiratory Control parameters include: • Production Factor •...

  • Page 193: Cardiovascular

    Using HPS Cardiovascular The HPS produces realistic heart sounds and a wide range of pathophysiologic conditions synchronized to the QRS complex of the ECG and audible to a standard stethoscope. Cardiovascular System Anatomy, Clinical Interventions, Patient Monitoring Software Control Manual Control Physiology and and Scenarios.

  • Page 194: Pulses

    ® Using HPS Pulses The HPS has 12 palpable pulses: • Carotid (2) • Brachial (2) • Radial (2) • Femoral (2) • Popliteal (2) • Pedal (2) The Pulses menu is located under the Cardiovascular tab. Pulses A pulse deficits occurs when the systolic arterial blood pressure falls below the threshold indicated at the bottom of the screen.

  • Page 195: Heart Sounds

    Using HPS Heart Sounds Heart sounds can be set by choosing a sound type and adjusting the volume using the slider. Choosing Heart Sounds By default, heart sounds are set at a normal sound at a rate of less than or equal to 80 beats per minute.

  • Page 196: 5-Lead Ecg

    Using HPS 5-Lead ECG A 5-lead ECG is emitted from the appropriate positions for display on a standard monitor. A contact is available on the HPS mannequin’s chest for each of five cables. ECG contacts ECG Contacts 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.

  • Page 197: Myocardial Ischemia

    Using HPS Myocardial Ischemia A myocardial ischemia rhythm from moderate to severe can be set using the Cardiac Rhythm Override parameter located under the Heart menu on the Cardiovascular tab. In addition, the Ischemic Index Sensitivity parameter, also located on the Heart menu, can be used to set the relative sensitivity of the patient to myocardial ischemia.

  • Page 198: Invasive Hemodynamic Monitoring

    ® Using HPS Invasive Hemodynamic Monitoring The invasive hemodynamic monitoring package provides the capability to measure and monitor: • Arterial blood pressure • Left ventricular pressure • Central venous pressure • Right arterial pressure • Pulmonary artery pressure • Pulmonary artery occlusion (wedge) pressure •...
  • Page 199 Using HPS Catheter: Arterial can simulate zeroing a pressure transducer using the Atmosphere selection or cardiac catheterization procedures using the Left Ventricle selection. Selecting Catheter: Arterial The arterial pressure displayed on the Waveform Display is set using this parameter. Catheter: Central Venous can simulate zeroing a pressure transducer using the Atmosphere selection.
  • Page 200 ® Using HPS Catheter: Pulmonary Artery can simulate zeroing a pressure transducer using the Atmosphere selection. Selecting Catheter: Pulmonary Artery The pulmonary artery pressure displayed on the Waveform Display is set using this parameter. Inflation of the pulmonary catheter balloon is simulated by selecting the Balloon Inflated option on the PA Catheter Balloon Inflation (wedge) parameter.

  • Page 201: Baroreceptor Reflex

    Using HPS Baroreceptor Reflex The HPS simulator’s cardiovascular system automatically compensates for changing hemodynamic conditions. The Baroreceptor Gain (Overall) Factor adjusts the influence of mean arterial pressure (MAP) on heart rate, contractility, systemic vascular resistance and venous capacity. Use the Baroreceptor Gain (Overall) Factor to adjust how vigorously the heart and vasculature respond to blood pressure changes.
  • Page 202 ® Using HPS To adjust how vigorously the vascular responds to blood pressure changes, adjust the Value of the Baroreceptor Gain (Peripheral) Factor parameter located under the Systemic menu. Selecting Baroreceptor Gain (Peripheral) Factor The Baroreceptor Maximum Pressure and Baroreceptor Maximum Pressure parameters define the mean arterial pressure (MAP) at which baroreceptor inhibitory activity on the heart is at its maximum and minimum.

  • Page 203: Circulation

    Using HPS Circulation Circulation can be affected by blood or plasma loss, the infusion of fluids or changes to the contractility of the left or right ventricles. Controlling Fluids Selecting the Fluids tab opens a window that provides a means of controlling the amount of fluid lost by or infused into the patient.
  • Page 204 ® Using HPS There are six parameters on the Fluids tab that affect circulation. Fluid Parameters Affecting Circulation Fluid Event Use/Effect Fluid Loss Volume (Blood) 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.

  • Page 205: Hematology Model

    Using HPS 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.

  • Page 206: Adjusting Contractility

    ® Using HPS Adjusting Contractility Cardiac output and blood pressure can be adjusted using the Contractility Factor: Left Ventricle and Contractility Factor: Right Ventricle parameters. Contractility Factor: Left Ventricle Contractility Factor: Right Ventricle The Contractility Factor parameters are located under the Heart menu on the Cardiovascular tab.

  • Page 207: Manual Blood Pressure

    Non-invasive blood pressure monitoring techniques can be used by attaching the standard cuff modified with a T-fitting and adapters. To modify a standard cuff for use with the HPS mannequin: Take a standard cuff and cut the hose that connects to the pressure gauge.

  • Page 208: Korotkoff Sounds (Five Phases)

    Connecting to Mannequin Non-invasive blood pressure may now be taken using the return-to-flow technique Store the modified blood pressure cuff with the HPS system. Korotkoff Sounds (Five Phases) Korotkoff sounds can be auscultated on the left arm. To auscultate Korotkoff sounds, Place the stethoscope on the left arm, just above the brachial pulse.

  • Page 209: Genitourinary System

    Attach the desired genitalia (male or female) to the mannequin. Hang a bag of distilled water on one of the available hooks on the back side of the HPS Lab Rack. To simulate urine, you may add 1.5 to 2 mL of yellow food coloring to the water.
  • Page 210 ® Using HPS Close the hood and re-secure the lever in the up position. Close the hood Peristaltic tubing Closing the Hood Casing Pull open the black clips on each side of the GU Pump and carefully thread the tubing into place. Start with the right side and repeat on the left.
  • Page 211 Using HPS Attach the GU hose from the Umbilical Assembly to the GU tubing. GU hose Attaching the GU Hose Connect the remaining end of the peristaltic tubing to the IV bag. Connect tubing to IV bag Connecting the Peristaltic Tubing to the IV Bag...

  • Page 212: Priming The Gu System

    ® Using HPS Priming the GU System Catheterize the patient mannequin with a 14 to 16 gauge urinary catheter lubricated with silicone spray using standard clinical procedure. Open the roller clamp on the GU supply source bag. Fluids tab in the HPS6 software, then Turn on the urine output by selecting the setting the Urine Output value to the maximum level (500 mL/hr).

  • Page 213: Advanced Cardiac Life Support (Acls) System

    Using HPS Advanced Cardiac Life Support (ACLS) System The HPS includes several realistic Advanced Cardiac Life Support (ACLS) System mod- ules offering advanced hands-on skills acquisition in airway management and ventila- tion, chest compression, as well as the use of defibrillators and transthoracic cardiac pacers.

  • Page 214: Airway Management

    ® Using HPS Airway Management The HPS simulator is capable of recognizing oxygen when it is administered to the mannequin. The administration is recorded in the Physiologic Data Log and affects physiological parameters. When the HPS6 software is not connected to a simulator, oxygen administration to the...

  • Page 215: Chest Compression

    Using HPS Chest Compression The HPS supports normal hand placement and standard compression techniques. The effectiveness of chest compression can be controlled using the Chest Compression Efficacy parameter located on the Trauma menu beneath the Condition tab. Chest Compression Efficacy When Chest Compression Efficacy is set to 0%, chest compressions have no effect on intrathoracic pressure.

  • Page 216: Cardiac Arrhythmias

    ® Using HPS Cardiac Arrhythmias The patient’s underlying cardiac rhythm can be set using the Cardiac Rhythm Override parameter located on the Heart menu beneath the Cardiovascular tab. Cardiac Rhythm Override Certain settings indicate rhythms that have a corresponding fixed heart rate shown by parentheses.

  • Page 217: Defibrillation

    Using HPS Defibrillation The HPS 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.
  • Page 218 ® Using HPS For paddle placement on the chest, the simulator has two anterior defibrillation disks, which can be unscrewed leaving threaded connections if required. Defibrillation Disks Defibrillation Disks Monophasic defibrillators can be used with paddles or hands-free connectors. The Defibrillation parameter is available for virtual defibrillation.

  • Page 219: Cardiac Pacing

    Using HPS Cardiac Pacing A standard transthoracic cardiac pacemaker can be connected to the simulator using the anterior and posterior contacts. To use this feature, attach the metal defibrillation/ pacing disks to the contacts by screwing them into place. Once the disks are in place, attach the pacing pads from a standard transthoracic cardiac pacer to the mannequin at the site of the disks.

  • Page 220: Trauma System

    ® Using HPS Trauma System The HPS simulator is equipped with a number of features specific to trauma care. The following provides a general overview of each feature. Trauma System Anatomy, Clinical Interventions, Patient Software Control Manual Control Physiology and...

  • Page 221: Chest Tube

    Attach the IV solution set to the IV bag, ensuring the clamp is closed. Hang the bag on the back of the HPS Lab Rack. Trauma hose on the Connect the hose from the IV solution set to the white Umbilical Assembly at the back of the HPS Lab Rack.
  • Page 222 Chest Tube Enable parameter to Disabled. Remove the chest tube priming hose from the mannequin. Open the back of the HPS Lab Rack to expose the Trauma Flowmeter. It is the black box attached to the back of the rack.

  • Page 223: Pericardiocentesis

    Attach the IV solution set to the IV bag, ensuring the clamp is closed. Hang the bag on the back of the HPS Lab Rack. Connect the hose from the IV solution set to the white Trauma hose on the Umbilical Assembly at the back of the HPS Lab Rack.

  • Page 224: Needle Decompression

    Using HPS Needle Decompression To set up a Pneumothorax Needle Decompression, enable the feature using the Needle Decompression option on the Trauma menu under the Condition tab. The Needle Decompression Parameter Select Enable 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.

  • Page 225: Diagnostic Peritoneal Lavage

    Ensure the Diagnostic Peritoneal Lavage abdominal cavity is inserted in the abdomen area of the HPS mannequin. The cavity is a removable lobe with a small fluid reservoir. A slit sealed with red tape in the lower portion of the cavity leads to the reservoir.

  • Page 226: Pharmacology System

    ® Using HPS Pharmacology System The HPS supports pharmacological interventions through pre-programmed pharma- cokinetic 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 veins on the left and right arms.

  • Page 227: Priming The Iv System

    IV line IV Line Attach an empty IV drain bag to the DRUG REC OUT line of the Pneumatic Left umbilicus on the back of the HPS Lab Rack. DRUG REC OUT line Drug Rec Out Tube 4.89...

  • Page 228: Iv Access

    ® Using HPS Unclamp the IV solution set attached to the source bag, allowing the water to flow into the mannequin and prime the veins. The mannequin is fully primed when liquid flows into the IV drain bag with no air bubbles.

  • Page 229: Monitoring Patients

    Using HPS Monitoring Patients The Waveform Display provides a visual reading of key cardiovascular parameters. The display can be customized to suit the needs of a given scenario. Waveform Display Parameters There are eight parameters available that may be displayed as waveforms. When the waveforms for one or more ECG leads are displayed, the Heart Rate appears to the right of first ECG lead.

  • Page 230: Accessing The Waveform Display

    ® Using HPS Accessing the Waveform Display If the optional Waveform Display Monitor has been correctly powered on (see pages 2.11 and 2.12), the Waveform Display software automatically launches with the HPS6 software when login is completed for the Instructor Workstation (see page 2.14).
  • Page 231 Using HPS In most cases, only one simulator is available. Once a simulator is chosen, select a patient from the Patients menu. Selecting a Patient The Patients menu contains a list of all patient files currently running. If no patient is running, open a patient file from the Patient Palette.

  • Page 232: Modifying The Waveform Display

    ® Using HPS Modifying the Waveform Display The default configuration can be modified to change or customize the layout, suspend or reset alarms and change or mute the audio. Viewing NIBP Initially, the NIBP panel appears with no (--- / ---) value. To take an isolated reading of the current, noninvasive blood pressure, select the NIBP option from the View menu.
  • Page 233 Using HPS If a different time interval than those shown on the menu is desired, select the Custom cycle period option to activate the NIBP Setup dialog, which provides fields for setting any whole number value in seconds, minutes or hours.

  • Page 234: Changing The Layout

    At any one time, the Waveform Display can show up to six waveforms plus an additional four numeric readouts. There are five preconfigured METI Layouts: EMS-ED-Telemetry - preconfigured with a waveform and numeric readout for ECG Lead II and numeric readouts for SpO and noninvasive blood pressure (NIBP).

  • Page 235: Customizing The Layout

    Using HPS Customizing the Layout To customize the Waveform Display layout, select the Edit Custom Layouts option from the Layouts menu. Selecting Edit Custom Layouts The Waveform Display Layout Editor appears, displaying the current layout. This layout can then be modified by selecting waveform/numeric or numeric parameters for the various panels.
  • Page 236 ® Using HPS To change the settings on a waveform/numeric panel (one of the top six panels): Click the panel to edit. A menu with 10 options appears. Select the appropriate menu option: Select one of the options. Select Blank if the display is to leave an unused space for the panel.

  • Page 237: Saving A Customized Layout

    Using HPS Saving a Customized Layout To save the new format once changes are complete: Layout Name field. Highlight the name in the Enter the name of the new layout. Save Layout. Click The customized layout now appears listed among the Custom Layouts in the Available Layouts panel on the right.

  • Page 238: Changing The Audio

    ® Using HPS Changing the Audio The Waveform Display includes an audio feature with a choice of clinical monitoring sounds. To choose a setting, open the Edit menu and click Audio to access the sound options. Selecting the Audio Menu All settings are synchronized with the patient’s heartbeat.

  • Page 239: Setting The Alarms

    Using HPS Setting the Alarms The Waveform Display includes an alarm feature that registers a two-tone (high-low) sound when patient parameter readings fall below or exceed a specified minimum or maximum setting. The alarm feature can be turned on (the default) or off by selecting the option from the Alarms menu located beneath Edit on the menu bar.
  • Page 240 ® Using HPS Alarm Settings Parameter Units Minimum Default Maximum Alarm Sound Range Heart Rate 40 to 160 Two-Tone/ High-Low ABP (Sys) mmHg 70 to 180 Two-Tone/ High-Low ABP (Dia) mmHg 20 to 110 Two-Tone/ High-Low PAP (Sys) mmHg 10 to 40...

  • Page 241: Wireless Remote Control

    Airport for use with the Remote Control. The Airport is a local area wireless networking device that sits on top of the HPS Lab Rack and acts as a relay for information between the Remote Control and the computer components. To configure the Airport, plug the supplied Ethernet cable from the back of the Airport into the Ethernet port labeled #2 on the back of the rack.

  • Page 242: Turning On The Remote Control

    ® Remote Control Turning On the Remote Control Ensure all other components of the HPS system, including the HPS Lab Rack, Instructor Workstation, gases and monitors, are connected and powered on. Power on the Remote Control. The Power Button The Power Button Click the HPS6 Launcher in the Dock.

  • Page 243: Using The Remote Control

    Remote Control or the Instructor’s Workstation. Using the Remote Control The Remote Control laptop is configured with the same powerful METI HPS6 software as the Instructor’s Workstation. All of the definitions and software usage instructions included throughout this User Guide apply to the Remote Control system as well.

  • Page 244: Turning Off The Remote Control

    ® Remote Control Turning Off the Remote Control When shutting down the HPS system, the Remote Control should be shut down first using the following instructions. Click the Stop icon in the Patient Palette or the Patient Window Stop Icons...

  • Page 245: Drug Recognition

    The components of the Drug Recognition system are described below. Labels Labels representing a wide range of drugs are supplied with the HPS. The barcode on each label identifies the drug and concentration to the HPS system. The labels should be applied to 10 mL, 20 mL, or 50 mL syringes, with the barcode oriented toward the needle end of the syringe and the graduations on the syringe still visible.

  • Page 246: Stopcock Manifold

    Drug Recognition System, and the barcode reader is the mechanism used to identify drugs administered. Drug data read by the barcode reader is communicated from the Stopcock Manifold to the HPS Rack via an electrical cable connected to the back of the rack.

  • Page 247: Drug Recognition Syringe Pump Mechanism

    Drug Recognition Syringe Pump Mechanism The Drug Recognition System’s syringe pump mechanism is located inside the rear access panel of the HPS rack. It measures the flow rate of the injected bolus, which is used to calculate the dose administered.

  • Page 248: Setup

    Drug Recognition Inventory BARCODE Secure the electrical connection on the Stopcock Manifold to the READER serial port on the back of the HPS Lab rack, firmly tightening the screws. Connecting to the Back of the Rack With the manifold oriented so the barcode reader is to your right and the stopcock mechanism is to your left, attach one of the IV access site lines labeled DRUG REC IN to the Stopcock Manifold at the nine o’clock position.
  • Page 249 Attach an empty IV bag and stake set to the DRUG REC OUT port on the Left Pneumatic Umbilical connector on the rear panel of the HPS rack. Ensure the clamp on the stake set is open. Attaching the Fluid Reservoir Place the IV bag on the floor.

  • Page 250: Operation

    Once setup is complete, a bolus dose of any drug included in the Drug Recognition Barcode sheets can be administered using the steps outlined below. Ensure the entire HPS system is connected and powered on and the HPS software is connected to the mannequin. (Refer to pages 2.1 through 2.18 in the HPS Setup section of this User Guide for complete instructions.)

  • Page 251: Troubleshooting The Stopcock

    Return the stopcock lever to the OFF or six o’clock position. An audible beep from the HPS Lab Rack confirms that the dose has been recognized by the system. A window displaying the drug type, concentration and dose appears on the Instructor Workstation and Wireless Remote Control.

  • Page 252: Cleanup

    Flush the system with one liter of distilled water. Ensure the IV reservoir bag in the rear of the HPS rack has enough room to hold one additional liter of fluid. Replace the IV supply with a 1 liter IV bag of distilled water.

  • Page 253: Anesthesia And Scavenging

    (MAC) and appropriate wash-in and wash-out. In order to control the direct exchange of anesthetic vapor in the HPS lungs, a supply of anesthetic is controlled just as analogous supplies of oxygen and carbon dioxide are controlled to create oxygen consumption and carbon dioxide production.

  • Page 254: The Anesthesia Delivery System

    The Anesthesia Delivery System consists of a number of basic components located in the HPS Lab Rack. The system is housed behind the glass door of the rack. A syringe loaded into a syringe pump provides a reservoir for the supply of volatile anesthetic required by the system.

  • Page 255: Hardware Setup Instructions

    Anesthesia and Scavenging Hardware Setup Instructions In most cases, the Anesthesia Delivery System is set up by a METI technician during your HPS installation. You may also follow the instructions below to set up the Anesthesia Delivery System yourself. Step 1: Set Up External Components Locate all of the following items (included with the Anesthesia Delivery System): •...

  • Page 256: Step 2: Set Up The Anesthesia Delivery System In The Hps Lab Rack

    Delivery System consists of a syringe pump, a vaporizer and associated pneumatic tubing. Find the HPS internal vaporizer. It is a 6-inch cylindrical copper block located on the left side of the HPS Lab Rack. Next to the vaporizer is a 1/8” hose labeled MFC OUT with quick-connects.

  • Page 257: Step 3: Start The Hps6 Software

    Operation Once the Anesthesia Delivery System is configured, its operation is automatic and requires no user intervention. Dispense anesthesia to the HPS as you would to a normal patient. Cleanup Use the following cleanup steps after each simulation session in which the anesthetic vaporizer system is used.

  • Page 258: Other Considerations

    HPS mannequin to the HPS Lab Rack. The gases are then exhausted from the HPS system and must be scavenged. A scavenging port is located on the rear panel of the HPS Lab Rack for this purpose. In order to scavenge HPS exhaust gases: Locate the Scavenging fitting and tubing included with the HPS system.

  • Page 259: Pediasim

    The PediaSIM mannequin can interface with either of the HPS configurations (the HPS or the Health Science HPS) using a simple plug-and-play interface To use the PediaSIM mannequin, simply set up the HPS simulator according to the instructions provided in the Setup section of this User Guide, substituting the PediaSIM mannequin for the HPS adult mannequin.

  • Page 260: Patient Profile

    ® Patient Profile Patient Profile The METI HPS6 software comes with one preconfigured pediatric patient called Standard Child. Using this baseline patient as a starting point, you can create your own patients and scenarios to help isolate critical learning modules.

  • Page 261: Preconfigured Pediatric Scenarios

    Preconfigured Pediatric Scenarios Preconfigured Pediatric Scenarios Use the following information to help you build your learning sessions using the Preconfigured Pediatric Scenarios. Different scenarios can be run using the same patient and a given scenario can be run on different patients. However, the clinical results may not always be appropriate. For example, selecting a patient with profound neuromuscular blockade for a scenario that requires a spontaneously breathing patient will not proceed as anticipated.

  • Page 262: Hypotension - Hemorrhage

    PediaSIM ® ® Preconfigured Pediatric Scenarios Hypotension - Hemorrhage The states in this scenario allow the instructor to create a graded hemorrhage in 110 mL blood loss increments. The scenario runs with any patient, but the Standard Child patient profile tolerates loss of the approximately 250 mL without significant changes in arterial blood pressure or heart rate.

  • Page 263: Tachycardia & Hypertension

    Preconfigured Pediatric Scenarios Tachycardia & Hypertension Acute tachycardia develops when the instructor sequences to the Tachycardia & Hypertension state. The peripheral pulse remains strong, and a blood pressure determination indicates hypertension. The facilitator should describe a “lite anesthesia” (i.e., concomitant increase in surgical stimulation) situation to learners and use this scenario in conjunction with the Tachycardia &...

  • Page 264: Tachycardia & Hypotension

    PediaSIM ® ® Preconfigured Pediatric Scenarios Tachycardia & Hypotension Acute tachycardia develops when the instructor sequences to the Tachycardia & Hypotension state. The radial artery pulse is absent. Measurement of the arterial blood pressure reveals hypotension. A hypovolemic mechanism is used by the simulator’s physiologic models to create this clinical situation.

  • Page 265: Bradycardia & Normotension

    Preconfigured Pediatric Scenarios Bradycardia & Normotension Acute bradycardia develops when the instructor sequences to the “bradycardia & normotension” state. We use this scenario in conjunction with the Bradycardia & Hypotension scenario to exemplify certain limitations of the automatic non-invasive blood pressure monitor and to emphasize the importance of monitoring using clinical skills (e.g., palpation of peripheral pulses).

  • Page 266: Bradycardia & Hypotension

    PediaSIM ® ® Preconfigured Pediatric Scenarios Bradycardia & Hypotension Acute bradycardia develops when the instructor sequences to the Bradycardia & Hypotension state. Learners should immediately assess blood pressure. Palpation of the radial artery reveals loss of pulsation, indicating hypotension. The carotid artery pulse remains palpable.

  • Page 267: Epidural - Sympathectomy

    Preconfigured Pediatric Scenarios Epidural - Sympathectomy In this scenario, beginning anesthesia learners administer an epidural. When the instructor sequences to the Begin Sympathectomy state, a sympathectomy is modeled with successive decreases in systemic vascular resistance and increases in venous capacitance. Heart rate slows due to the block of cardiac accelerator innervation. This scenario uses automatic transitions to move from the Begin Sympathectomy, Mild Sympathectomy, Moderate Sympathectomy and Severe Sympathectomy states, with changes occurring every 60 seconds.

  • Page 268: Epidural - High Spinal

    PediaSIM ® ® Preconfigured Pediatric Scenarios Epidural - High Spinal In this scenario, beginning anesthesia learners administer an epidural. When the instruc- tor sequences to the Begin Sympathectomy state, a sympathectomy is modeled. The scenario automatically transitions from the Begin Sympathectomy, Mild Sympathec- tomy, Moderate Sympathectomy and Severe Sympathectomy states, with changes occurring every 60 seconds.
  • Page 269 Preconfigured Pediatric Scenarios State 4 Moderate sympathectomy Events Venous capacity factor: 1.25, Onset 1.00 Heart rate factor: 0.70, Onset 1.00 Baroreceptor gain (overall) factor: 0.90, Onset 1.00 Resistance factor: Systemic vasculature: 0.70, Onset 1.00 Fixed neuromuscular blockade: 80.00 percent, Onset 1.00 Transitions IF (Time in state) >...

  • Page 270: Difficult Airway Management

    PediaSIM ® ® Preconfigured Pediatric Scenarios Difficult Airway Management This scenario begins in the Baseline state, with the simulated patient ready for induction of general anesthesia and tracheal intubation. After induction drugs are administered, the instructor sequences to the second state, Obstruct Laryngeal Visualization.

  • Page 271: Cannot Intubate, Cannot Ventilate

    Preconfigured Pediatric Scenarios Cannot Intubate, Cannot Ventilate This scenario begins in the Baseline state, with the simulated patient ready for induction of general anesthesia and tracheal intubation. After induction drugs are administered, the instructor sequences to the second state, Completely Obstructed Airway.

  • Page 272: Spontaneous Pneumothorax

    PediaSIM ® ® Preconfigured Pediatric Scenarios Spontaneous Pneumothorax Discipline EMT/Paramedic Target Audience • EMT/Paramedic Students and Practitioners • Nursing Students and Practitioners • Respiratory Therapy Students and Practitioners • Cardiopulmonary Technology Students and Practitioners Narrative Description Paramedics are called to a sporting event and find a six-year-old physically fit male complaining of sudden onset of severe shortness of breath.
  • Page 273 Preconfigured Pediatric Scenarios During transport, patient shows increasing agitation and difficulty breathing. Re-assessment reveals: • Blood pressure 55/30 • Pulse 145 • Respiration 42, shallow, labored, lung sounds absent on right with hyperresonance to percussion on right. • Skin color: cyanotic •...
  • Page 274 PediaSIM ® ® Preconfigured Pediatric Scenarios Spontaneous Pneumothorax States, Events and Transitions State 1 Initial Assessment Events Ischemic index sensitivity: 0.01 Shunt fraction: 0.35 Chest wall compliance factor, distended: 0.10 Lung compliance factor (right): 0.30 Intrapleural volume (right): 230.00 Respiratory rate factor: 3.00 Heart rate factor: 1.45 Transitions None...

  • Page 275: Near Drowning

    Preconfigured Pediatric Scenarios Near Drowning Discipline EMT/Paramedic Target Audience • EMT/Paramedic Students and Practitioners • Nursing Students and Practitioners Narrative Description An EMS paramedic unit arrives at the beach to see lifeguards performing CPR on a near drowning victim. The victim is unconscious and very difficult to ventilate. Bystanders state that the victim was in the water for at least five minutes before the rescuers were able to reach him.
  • Page 276 PediaSIM ® ® Preconfigured Pediatric Scenarios Sequence of Events Initial assessment of victim reveals: • Initially able to ventilate with bag mask • Bradycardia • Unresponsive to noxious stimuli Advanced assessment of victim reveals: • Hypotension • Sinus bradycardia • Laryngospasm •...
  • Page 277 Preconfigured Pediatric Scenarios Near Drowning States, Events and Transitions State 1 Baseline Events None Transitions None State 2 Create pathology Events Volume: -325.00ml, Onset 5.00 Cardiac rhythm override: Sinus bradycardia: 40 Temperature: Arterial (blood): 32.00°C Temperature: Body (esophageal): 32.00°C Fixed neuromuscular blockade: 100.00 percent Ventricular contractility factor (left): 0.50 Transitions IF (Time in state) >...
  • Page 278 PediaSIM ® ® Preconfigured Pediatric Scenarios State 8 Cold de-fibrillation Events None Transitions IF (Time in state) > (5.00 seconds) GOTO (hypothermia v-fib) State 9 Warm de-fibrillation Events Cardiac rhythm override: Sinus bradycardia Ventricular contractility factor (left): 1.00 Transitions None State 10 ------------------- Events...

  • Page 279: Hps Care And Maintenance

    For units no longer under warranty requiring repairs, the Time and Materials service plan applies (see Time and Materials section). To place an out-of-warranty unit under a warranty contract, METI reserves the right to have the patient simulator inspected by a METI-approved technician at the customer’s expense.

  • Page 280: How To Contact Customer Support

    Monday - Friday from 8:00 a.m. to 5:00 p.m. CET Phone +49 (0) 6131 38075 20 +49 (0) 6131 174 74705 Internet Address: international.support@meti.com METI Customer Support UK and Ireland Monday - Friday from 9:00 a.m. to 5:00 p.m. GMT Phone +44 (0)800-917-1851 Internet Address: uk.support@meti.com Principal hours of operation exclude holidays and non-business days.

  • Page 281: Limitations Of Agreement

    METI warrants its LABOR for 30 days or the balance at the applicable period of the original warranty, whichever is greater.

  • Page 282: System Software Upgrade Support

    ® HPS Care and Maintenance 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.

  • Page 283: Breakdown

    If using a Wireless Remote Control, quit the HPS6 application using the same steps described above for the Instructor Workstation. Step 3: Power Off the HPS Lab Rack Turn off the main power switch at the bottom of the front panel of the HPS Lab Rack.

  • Page 284: Step 4: Power Off The Clinical Monitor

    ® HPS Care and Maintenance Step 4: Power Off the Clinical Monitor Turn off the clinical monitor (if used). Step 5: Turn Off All Gases Turn off all gases used with the simulator.

  • Page 285: Maintenance Advice

    HPS Care and Maintenance Maintenance Advice Simple care and maintenance helps to ensure the HPS simulator 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.

  • Page 286: Checking The Airway

    HPS mechanical lung. Regulation of the supply pressure to the second backpressure is accomplished by a manual pressure regulator located on the I/O panel at the rear of the HPS equipment rack. The backpressure should be adjusted to 27 PSI.

  • Page 287: Removing The Chest Skin

    HPS Care and Maintenance Removing the Chest Skin From time to time, certain maintenance steps require the removal of the chest skin. Ensure this is done with care. To remove the chest skin: Disconnect any ECG monitoring leads and unscrew the defibrillation and/or pacing disks from the mannequin chest plate.

  • Page 288: Replacing The Chest Tube Foam Inserts

    ® HPS Care and Maintenance Replacing the Chest Tube Foam Inserts The chest tube foam inserts can be replaced as needed. To replace the chest tube foam inserts: Make sure the chest tube feature has been drained ( For information on draining the chest tube, refer to page 9.11).

  • Page 289: Maintaining Trauma Features

    HPS Care and Maintenance Maintaining Trauma Features Follow the steps below to clean and flush the trauma features after each use: Draining the Chest Tube The following instructions provide details on how to drain the chest tube feature and how to replace the chest tube foam inserts.

  • Page 290: Draining The Pericardiocentesis Feature

    ® HPS Care and Maintenance Draining the Pericardiocentesis Feature To drain and flush the pericardiocentesis trauma feature: Ensure the HPS6 software is running and a patient is connected to the simulator. TRAUMA IN hose at the back of the rack.

  • Page 291: Replacing The Needle Decompression Tape

    Ensure the HPS Lab Rack is powered on. Flush the system with one liter of distilled water. Ensure the IV reservoir bag in the rear of the HPS rack has enough room to hold one additional liter of fluid. Replace the IV supply with a 1 liter IV bag of distilled water. Prime the bulb of the IV stake and ensure flow has started.

  • Page 292: Maintaining The Gu System

    Complete the following steps to ensure proper performance during subsequent simulator exercises: Ensure the HPS Lab Rack is powered on. Ensure the HPS6 software is running and a patient is connected to the simulator. Ensure a Foley catheter is inserted in the mannequin’s genitalia and a urine collection bag with ample room for fluid is attached to the catheter.

  • Page 293: Repairing Cuts And Abrasions To The Mannequin

    Repairing Cuts and Abrasions to the Mannequin Cuts and abrasions to the HPS mannequin can be repaired easily using readily available materials. Perform the following steps if a cut is found: Clean the area around the cut thoroughly using alcohol swabs or liquid alcohol and cotton balls.

  • Page 294: Using The Iv Arm Kit

    Replace the skin over the mannequin’s arm. Drug Recognition Barcode Labels Eventually, barcode labels become worn. Their life is extended if they are kept as dry as possible. Contact METI Customer Support for replacements. 9.16...
  • Page 295 Index Index Chest Skin, 4.87, 9.9, 9.10, 9.12 Closing a Scenario, 3.34 Collapse All, 3.32 Adding Events, 3.42 Condition Tab, 3.13, 3.21, 3.65, 3.68, 4.39, Adding Transitions, 3.55 4.40, 4.41, 4.42, 4.57, 4.77, 4.84, 4.86, Adding New States, 3.39 9.11 Adjusting Discrete Parameters, 3.20 Connections, 2.18, 3.15, 4.80, 9.9 Adjusting Numeric Parameters, 3.20...
  • Page 296 Go to, 3.33, 3.43, 3.49-3.50, 3.58, 3.60, 11.7 Names and States, 3.31 Heads Up Display (HUD), 3.16 Navigating Between States, 3.33 Health Science HPS, 1.5, 1.6, 1.7 Needle Cricothyrotomy, 4.43, 4.50 Heart, 4.57 Needle Decompression, 3.68, 4.82, 4.86, 9.13 Heart Sounds, 3.68, 3.71, 4.55, 4.57 New and Open Icons, 3.2...
  • Page 297 Index Opening a Saved Scenario for Editing, Respiratory Control, 3.21, 3.65, 3.72, 4.54 3.35, 3.36-3.37 Respiratory Tab, 3.20, 3.21, 3.65, 3.72 Opening a Scenario, 3.29-3.30 Running Multiple Patient-Scenario Opening a State, 3.40 Combinations, 3.30, 3.34 OxSim, 1.4, 1.13, 2.1, 2.8-2.9 Saving a Patient, 3.7, 3.23-3.26 Palpable Pulse Thresholds, 4.56 Saving a Scenario, 3.62-3.62...
  • Page 298 ® Index Trauma, 1.14, 3.68, 4.82-4.87, 9.7, 9.11- 9.13 Trauma Disaster Casualty Kit (TDCK), 1.4, 1.5, 1.11, 1.16, 2.3 Umbilical Assembly, 1.6, 2.1, 2.4, 8.1 View Menu, 4.94 Waveform Alarms, 4.101-4.102 Waveform Audio Features, 4.100 Waveform Display, 1.4, 1.5, 1.11, 1.12, 2.1, 2.11-2.12, 4.55, 4.60, 4.61, 4.62, 4.77, 4.91-4.102, 9.5, 11.2 Waveform Display Parameters, 4.91...
  • Page 299 Appendices Appendix A - Macintosh Fundamentals The Macintosh desktop configured for the Instructor Workstation displays all the functionality needed to operate the HPS6 software. Applications can be accessed either by opening the Mac OS X window or by using the shortcuts assigned to the Dock. Opening the Mac OS X Window The icon for the Mac OS X system hard drive is located initially in the upper right corner of the desktop.
  • Page 300 The HPS6 Launcher To launch the HPS6 application, click the HPS6 Launcher icon located in the Dock. Once the software is loaded, the HPS menu bar appears at the top of the window indicating that the HPS6 application is running.
  • Page 301 Appendices Working with Windows A window is the main, rectangular area in which application elements are displayed. The elements in a window vary from application to application. There is almost no limit to the number of windows that can be open on the desktop at one time, but only one window at a time is active.
  • Page 302 ® Appendices Switching between Windows To make a window active, click anywhere on an inactive window. The new active window moves to the foreground and title bar or the active window is highlighted. This action does not close any windows, but all other windows on the desktop remain inactive.
  • Page 303 The keyboard can be used to access the functionality of many of the menu options available with the HPS software. HPS Graphical User Interface (GUI) Shortcut Keys The shortcut keys appear on the HPS menu beside their corresponding option with the command key ( ) and the shift key ( ) displayed by their symbols along with the character assigned as a shortcut.
  • Page 304 ® Appendices HPS Text Shortcut Keys Several shortcut keys have been provided for quick access to the functionality involved in the editing of the text used to create the patient’s history. Command Shortcut Keys Functionality Edit Menu - Undo the last keystroke.
  • Page 305 Appendices Scenario Shortcut Keys Additional shortcut keys are provided for quick access to the functionality involved in creating and editing scenarios. All these options are located on the Scenario menu available under the Scenario tab. Command Shortcut Keys Functionality Scenario Editor - Create a new scenario. Scenario Editor and Player - Open an Open existing scenario.
  • Page 306 ® Appendices Useful Macintosh Windows Controls Macintosh systems with Expose’ provide users with the means of opening and navigating between windows by using shortcut keys. To see all open windows, hold down the F9 key. To see all the windows open in the current application, hold down the F10 key. To hide all the open windows to see the desktop, hold down the F11 key.
  • Page 307 Export a drug profile to the Pharmacology Editor for modification When a new drug list is imported into the HPS software for either one patient or the whole system, the existing default drug file for the patient or the system is overwritten.
  • Page 308 Modifying System Drug Responses No patient file should be running when the system drug responses are being modified. To integrate a modified drug list into the HPS software system-wide, select the Modify System Drug Responses option from the HPS Drug Responses command menu.
  • Page 309 Appendices The Modify System Drug Responses dialog box displays the path and file information for the HPS system’s existing drug file. The Modify System Drug Responses Dialog Box To locate the new drug file, click Browse to activate the Open navigational dialog box.
  • Page 310 NOTE: This option is only available on the Instructor Workstation. To change the drug response for a specific patient, select the Open Patient for modification option from the HPS Drug Responses menu. Selecting Open Patient For Modification The Open patient navigational directory appears.
  • Page 311 Appendices The Patient Drug Response Editor appears, displaying the name of the patient, the patient file path and a field for the new drug response profile. The patient’s name appears above the path to the patient’s file name Click Browse to locate the new drug file The Patient Drug Response Editor To establish or change the patient’s specific drug responses, locate and enter the appropriate drug file into the Patient drug response profile field by clicking Browse.
  • Page 312 ® Appendices The Patient Drug Response Editor now displays the drug file and its path. Click the Save icon The drug file path appears in the Patient drug response profile field Path to New Drug File Click the Save icon to set the drug response profile to the selected drug file. The Save successful notice appears The new drug file appears in the Patient drug response profile field...
  • Page 313 Using the Pharmacology Editor To launch the Pharmacology Editor, double-click on the Pharmacology Editor icon. The icon may initially (for Mac installations) be located in the HPS folder. If desired, drag the icon to the desktop or to the dock for future access.
  • Page 314 ® Appendices Setting a Default Drug File When the Pharmacology Editor is initially launched, no default drug file has been established. A Set Default Drug File dialog box automatically appears. Click Yes to set up a default drug file The Set Default Drug File Dialog Box Click Yes on the Set Default Drug File dialog to activate the Preference dialog.
  • Page 315 Appendices Understanding the Drug List When the default drug file opens, the Drug List appears containing the drugs defined in that file. The default drug file opens as “untitled” on the title bar of the Drug List dialog box The drugs defined for the selected drug file appear in the Drug List list box The lower portion of the window is inactive until a drug is selected or added...
  • Page 316 ® Appendices The Drug List Toolbar The Drug List Toolbar is located beneath the title bar at the top of window. The Drug List Toolbar The toolbar contains icons that provide the functionality needed to create, edit and remove drugs from the list. Most of this functionality can also be found in the Pharmacology Editor’s menu bar.
  • Page 317 Appendices Drug Name The Drug Name column on the left-hand side of the Drug List lists all the drugs available in the selected drug file. Drug Status The Status column on the right-hand side of the Drug List displays a category that describes whether the drug has been newly created (Generated), created but not validated (Generated [ Invalid ]), created from an original default drug (Modified) or remains in its default state (Default).
  • Page 318 ® Appendices Drug Administration Method, Labeling and Barcode Information The lower portion of the Drug List window becomes active when a drug is selected. Selecting a Drug The settings help to define the selected drug within the software. Data Units - The option buttons in this box allow the user to set the drug measurement to either ug/kg (micrograms per kilogram) or mg/kg (milligrams per kilogram).
  • Page 319 Appendices Units determines drug’s administration methods and the respective units of measure that appear within the HPS system. At least one method must be assigned to each drug in order for the drug to be available for administration. An asterisk (*) or a blank entry in one of these fields disables this drug in that specific administration method.
  • Page 320 ® Appendices Loading a Drug File To load a drug file, click the Open icon on the Drug List toolbar or select the Open command from the File menu. The Open icon Locating the Open Icon Once the Open command or the Open icon is selected, the Open dialog box appears, displaying the navigational tools needed to locate the drug file.
  • Page 321 Once these screens are configured and verified, the modified drug becomes part of a newly defined set of drugs that can then be saved as a new drug file (with an MST extension). This drug file can then be used in the HPS software to modify specific drug responses.
  • Page 322 ® Appendices Editing a Drug’s PharmacoKinetics Double-click on the drug name in the Drug List window or select the drug name and click the Edit Drug icon on the toolbar. Select the drug to be modified from the list and click the Edit Drug icon Or, double-click on the drug name...
  • Page 323 Appendices ToolTips can be activated for the Drug Profile Screen by checking the Show Tool Tips box of the Preference box. The PharmacoKinetics tab allows for the user to specify the order of the kinetic data as First, Second or Third. Once the order of the kinetics has been selected, data can be entered in any of these three sets: Base-Set - these parameters reflect the inverse time constants and amplitudes of exponentials that can be fitted to plasma concentration data following a bolus...
  • Page 324 ® Appendices The Clinical Set Units of Parameter Description Measure Half time of the fastest decaying phase, usually reflecting distribution Half time of the slower decaying phase, usually reflecting distribution Half time of the slowest decaying phase, reflecting slow elimination for third order pharmacokinetics (L/kg)/min Clearance from the plasma...
  • Page 325 Appendices When Check is clicked, a verification appears in blue in the field above the button. A verification appears in blue or an error description appears in red when Check or Apply is clicked The PharmacoKinetics Data Check If an error in data entry has occurred, the field displays a description of the computation error in red.
  • Page 326 The magnitude of the effect on neuromuscular blockade (NMB) is specified by entering the dose that results in 95% (single) twitch height depression at the adductor pollicis (ED95). ED95 has to be bigger than the threshold dose. In METI patient simulators, neuromuscular blockade automatically reduces the force of the respiratory muscles, so no separate respiratory effect has to be entered.
  • Page 327 0 (zero) indicates that the dosage brings the value of the effect to zero. Clicking Check at the bottom of the screen computes the direct drug effect on ventilation as well as the indirect effect on the control of breathing and transforms the data into the parameters used by the HPS software. 11.29...
  • Page 328 Clicking Check at the bottom of the screen computes the direct drug effect on cardiovascular system and the indirect on the baroreflex control of blood pressure and transforms the data into the parameters used by the HPS software. 11.30...
  • Page 329 Once these screens are configured and verified, the drug that has been created becomes part of a newly defined set of drugs that can then be saved as a new drug file (with an MST extension). This drug file can then be used in the HPS software to modify specific drug responses.
  • Page 330 Users may install the Pharmacology Editor on any system, but since printers cannot be connected to HPS workstations to ensure proper functionality and performance of the HPS software, specific procedures apply to both HPS and non-HPS workstations. Saving on Non-HPS Workstations...
  • Page 331 Appendices Saving with the HPS System If the Pharmacology Editor is installed on the Instructor Workstation, drug profiles can still be saved on the system in the same way that they are saved on an external system. However, if the user wishes to print or to store the files elsewhere, the files must be saved either to a CD or to a USB memory device.
  • Page 332 ® Appendices Saving to a USB Memory Device To save to a USB memory device: Insert the USB memory device into an available USB port on the Instructor Workstation. An icon appears on the desktop indicating that the memory device has been recognized.
  • Page 333 The Pharmacology Editor has three print options accessed by selecting the Print command from the File menu. NOTE: The Instructor Workstation with the proprietary HPS system should NOT be connected to a printer. To print from the Instructor Workstation, save the file as a PDF (discussed below) and copy the PDF file to either a CD or a USB memory device (discussed above) and transfer the file to a printer-ready system.
  • Page 334 ® Appendices A Sample Drug Profile A Sample Drug Profile Screen The Drug Profile and Drug Profile Screen options are available only when the Drug Profile screen is active. 11.36...
  • Page 335 Appendices Saving as a PDF for Printing (for Mac) Printing should not be performed from the Instructor Workstation. Instead, transfer the needed files to a CD or USB memory device and insert the CD or memory device into a computer with printing capabilities. If the Pharmacology Editor has been installed on a Mac, select the appropriate option from the Pharmacology Editor Print command menu.
  • Page 336 ® Appendices Order of Kinetics The Pharmacokinetic information that must be provided for the drug profile to be valid is described in more detail earlier in this section, but the tables below show the fields that have to be completed for the first, second and third order of kinetics. First Order Base-Set Clinical-Set...
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