Getting Started

Getting Started

Top  Previous  Next

Conventions:

 

In the early tutorials, essential mouse or keyboard input is indicated by a mouse icon.
Computer controls, items or windows are referred to in the text between ‘Less than’ and ‘Greater than’ symbols.
The terms ‘Click’ and ‘Select’ refers to usage of the left mouse button.

 

The tutorials are all viewable by clicking the <Notes> menu item of the <Inspector> window, however, it’s a good idea to print off the first few tutorials and work through them from a hard copy (In order to reduce constant switching between the various functions of the <Inspector> window).

 

‘Unsupervised’ tutorials (like this one) are designed to be run as ‘stand alone’ applications, whereas, ‘Supervised’ tutorials require input from the supervisory application and cannot be run in isolation.

 

The supervisory status of the tutorial is indicated at the top left-hand corner of the first page of the tutorial.

 

Okay, let’s get started.

 

The learning objective of this tutorial is to become familiarized with the basic elements of the MSE simulation environment.

 

Click on the <Start> <All Programs> <MSE ECMO Simulator > <MSE ECMO> menu item of the desktop.

 

You will be given the opportunity to start the application in one of three modes:

1.Unsupervised Simulation Mode
2.Supervised Simulation Mode
3.Maintenance Mode

 

Select <Unsupervised Simulation Mode> (the default selection) and click the <Start> button.

 

The system's three primary windows will appear. At the left-hand side of the screen is the <Inspector> window, to the right-hand side is the <Patient Monitor> and below this is the <Therapeutic Interface>.

 

Inspector Window:

The <Inspector> window is used to display textual or audio-visual information relating to the scenario and to allow the user to manipulate the virtual devices which can be used in the treatment of the patient.

 

Click the <Notes> menu item in the <Inspector> window.

 

The notes are normally used to outline the clinical history and findings of the patient in the current scenario. If more than one page is available, use the <Next> and <Prev> menu options of this window to navigate to other pages within the notes. In this instance, we have used the <Notes> to describe the conduct of the tutorial rather than to present the clinical picture of the patient.

 

Click the < Investigations > menu item in the <Inspector> window.

 

The <Investigations> menu item lists the investigations which are currently available for the patient. (Oxygenator Blood Gas Analysis is only available if an ECMO system is in use.)

 

Click the <Investigations><Arterial Blood Gas Analysis> menu item in the < Investigations > list.

 

The <Arterial Blood Gas Analysis> menu item displays the patient’s current blood gases and stores them as a blood gas report in the installation directory of the application.

 

Click the < Devices > menu item in the <Inspector> window.

 

The <Devices> menu item is used to visualise any of the 6 devices which are available to the user. These devices are a:

Ventilator,
VV or VA ECMO System,
ACT Monitor,
Nerve Stimulator,
Defibrillator and
Stethoscope.

 

Click the <Devices><Nerve Stimulator> menu item in the <Inspector> window.

 

Clicking on the <Devices><Nerve Stimulator> menu item displays the nerve stimulator.

 

Click the <TOF > button in the < Nerve Stimulator > window.

 

Clicking on the <TOF> button stimulates the ulnar nerve with a supramaximal, 0.5Hz ‘Train of Four’ and produces contraction of Adductor Pollicis (unless a muscle relaxant has been administered).

 

Click the <Resources > menu item in the <Inspector> window.

The <Resources> menu item lists the resources which are available for the current scenario. These resources can include: documents, videos, still images or websites.

 

Click the <Resources ><ELSO Homepage> menu item in the <Inspector> window.

 

This will take you to the ELSO website.

 

Click the <Help><Help Manual> menu item in the <Inspector> window.

 

The <Help Manual> opens a navigable version of the system’s user manual. If you want to reposition the <Inspector> window, place the mouse at the top right-hand corner of the window's title bar and drag it while holding down the left mouse button. The position of the window will be retained when you next start the application. Refer to the section entitled ‘Inspector' in the user manual for a complete description of the functionality of this window.

 

Patient Monitor:

The <Patient Monitor> is based on a modern physiological monitor and is used to display the patient's current vital signs. The patient who has been selected for this scenario is essentially normal.

 

Click the < Display > button in the < Patient Monitor > window.

 

Clicking the <Display> button on the Patient Monitor allows you to select the parameters which you want to view.

 

 

Check <ECG>, <Direct Arterial Pressure> and <Central Venous Pressure> in the <Display> window.

 

 

Click the < Display > button in the < Patient Monitor > window.

 

The <Display> window will now close, and the ECG, Direct Arterial Pressure and Central Venous Pressure waveforms will be displayed in the <Patient Monitor> window.

 

The parameters which can be displayed include:

ECG,
NIBP,
Direct Arterial Pressure
Central Venous Pressure,
SaO2,
SaO2 waveform,
BIS,
Temperature,
Capnographic Waveform and
Inspired and Expired Gas values.

 

If you want to reposition the <Patient Monitor>, place the mouse at the top right-hand corner of the monitor and drag it while holding down the left mouse button. The position of the window will be retained when you next start the application. Refer to the section entitled 'Patient Monitor' in the user manual for a complete description of the functionality of this window.

 

Therapeutic Interface:

The <Therapeutic Interface> window is used to administer drugs and or fluids to the patient. The interface has four 'tabbed' pages:

Bolus Drug,
Infusion Drug,
Fluids and
History.

 

To explore the effect of giving adrenalin to a normal patient:

 

Click the <Bolus Drug > tab in the <Therapeutic Interface> window.

 

Select <Adrenalin (100 mcg/ml)> from the list.

 

A new window will appear.

 

Slide the green slider until a dose of ~ 50 micrograms is indicated.

 

Click the <Give> button.

 

Observe the effect of the drug on heart rate, blood pressure and ectopic activity over the ensuing minutes.

 

Click on the <History> tab in the <Therapeutic Interface> window.

 

Clicking on the <History> tab allows you to review details of all of your therapeutic interventions. If you want to reposition the <Therapeutic Interface>, place the mouse at the top right-hand corner of the window and drag it while holding down the left mouse button. The position of the window will be retained when you next start the application. Refer to the section entitled ‘Therapeutic Interface' in the user manual for a complete description of the functionality of this window.

 

Click on the <View> menu item of the main window.

 

The three primary windows will be listed as menu items. Checking or unchecking any of these items will turn on or off their visibility.

Click on the <Tools> menu item of the main window.

 

Two menu items (<Load Scenario> and <Load Patient>) and will now appear. Selecting a new scenario from the list of available scenarios will load a new patient together with a completely new set of clinical notes, investigations and resources. In contrast, selecting a new patient from the list of available patients will load a patient with a different patho-physiological state, but the notes, investigations and resources will remain unchanged.

 

Finally, to close the system down:

Click on the <System><Exit> menu item of the main window.