Getting Started with SimMan 3G in the Simulation Lab

1. Get key from ED Admin Office for sim lab door.
2. For equipment, prepare the following sizes, if needed:
   1. Adult laryngoscope handle and blades.
   2. #7.5 or #8.0 ETT for orotracheal intubation
   3. #7.0 or #7.5 ETT for nasotracheal intubation.
   4. Bougie
   5. Laerdal airway lubricant
   6. Adult, #5,  Laerdal®-style resuscitator mask with resuscitator bag
   7. # 4 LMA or King LT®
   8. #37 F Combitube®
   9. For interosseous tibial access:  EZ IO G3 angiocath or 25mm angiocath
   10. For urinary catheter:  14 or 16 french
   11. 50 cc syringe with luer lock for urine insertion
   12. 40 cc of blood or more for IV arm priming with blood (luer lock)
   13. For IV access:  18 Gauge or smaller (20 gauge is best)
   14. 20 gauge needle for needle decompression
   15. Choose the soft or hard teeth
   16. Choose the pupil size
   17. Close compressor in right leg (pull up)
   18. Turn on manikin.  Wait 2 minutes until manikin blinks and breathes (this step is essential before proceeding further)
   19. Turn on instructor interface laptop.
       1. The password is stated above the password box.
       2. Click on the “Laerdal Simulation Home” icon, if this doesn’t automatically boot up
       3. 
       4. Click on the “LLEAP instructor application” icon in the top left of the screen
       5. 
       6. Choose “Sim Man 3G” (not “Virtual Manikin”)
       7. Make sure the network shows connection to the simulator network
       8. We do not use debriefing software, so skip this step.
       9. Click the centre icon next, which is “Manual Mode”
       10. Now choose “Healthy Patient 3G”.  Next you should see the instructor interface with a grey “Gingerbread Man” in the centre.
       11. At the patient monitor, turn on the monitor with the centre button on the monitor console.
       12. Choose “Sim Monitor Interface” icon, if the monitor does not autoboot to the monitor program
       13. Choose “Healthy Patient 3G” (not “Virtual Manikin”)
       14. Wait for the monitor to flash up with waveform and digit fields for HR and rhythm, SpO2, arterial line BP, PA pressures, P_ETC0₂.  The actual vitals will not yet be displayed.
       15. Back at the instructor laptop, press the “space bar”  or press the “>” to begin the instructor-driven manual scenario.
       16. During your scenarios, as your student asks for vitals, have them apply the various leads and then touch each pertinent area of the monitor screen to begin the real-time display of those vitals.  SpO₂ will not be enabled until the probe is placed on the manikin.

 

 

Items a Student can order from the Monitor:

A 12-lead ECG:

-Will be based on current 3-lead rhythm and rate that you have chosen.

Wedge

-Will wedge (PCWP) and then re-set on automatically to pre-set PA pressure

X-Ray

Once student orders the X-Ray from the patient monitor, the instructor interface will give the prompt for the instructor to choose an X-Ray.  Click “Add Files”, “Favorites”, and then “Default/Radiology File”.  Finally, choose the file and then “Open”.  Be sure to end by clicking “Transfer to the learner’s monitor”, and the student will now see the film.

Labs

Will ask you to choose the labs, but there are no files in the instructor laptop at this time.  We can begin making files that are .txt, .hml, .htm, or .pdf, and save them on the laptop or a memory stick for future use.

Multimedia

SOUNDS

From the monitor, to choose sounds:

Click “Sounds” on bottom right of the instructor interface.  The instructor can first choose “repeat” to keep repeating the sound that has been recorded.

“Vocal sounds”, at this time, include cough, difficulty breathing, moan, and vomit.  Can choose “More Sounds” which will give you “Default Vocal Sounds” (a list of many different common patient sentences or sounds); but, be sure to press the stop key between each sound in order to reset the computer for the next choice.

You can become the voice of the manikin by choosing “Tools” at the top of the screen, and then “Voice Conference Application”.  Using this application, not only can you become the voice of the manikin, but you can utilize the microphones in the ears of the manikin to listen to the student, if you are situated in a separate room during the scenario.

“Body sounds” include heart, left lung, right lung, and the four quadrants of the abdomen.  Choose “More Body Sounds” if you want to change (or customize) heart sounds, lung, or bowel sounds; or, if you want to decrease or increase volume.  “Auscultation Focus” will shut down extraneous sounds for 30 seconds while the student tries to hear lung and heart sounds.  Anteriorly, there are 3 speakers on the right chest and four on the left, (not all on the left are for lung sounds).  The “More body sounds” reminds you where to listen for each heart valve and cues you as to which speaker the particular valve can be heard from during the auscultation of the manikin.

Click “Circulation and Fluids” on the bottom right of the instructor interface to increase or decrease intensity of palpable pulses.

Click “Airway and Breathing” on the bottom right of the instructor interface to alter airway and breathing status of the patient.  The instructor can manipulate airway resistance on right or left; however, this is “all or nothing”.  So, if you increase airway resistance on the right, you will notice no breath sounds on that side and no chest rise.  There does not seem to be an “in between”; so, “O” is normal and “1” is ‘Extreme” airway resistance.  All of the settings can be found on pages 65 and 66 of the manual.

Click “Eyes” section to change how open or closed the eyelids are, as well as the number of times the patient will blink.

The “Vital Signs” section includes:  ECG, SpO2, ABP, PAP, PAWP, CVP, PetCO2, NIBP, Pulse, Peripheral Temp, Blood Temp, CO, ICP, RR, Train of Four, Oxygen inhaled, oxygen exhaled, nitrous oxide, and anesthetic agent.  These can be manipulated by clicking on the waveform or the digit field to change the value.

The “Cardiac Controls” can be found on the top right.  Here, you can change the rhythm and rate and you can also toggle between two rhythms (like v-fib and Sinus Bradycardia, if student is expected to defibrillate successfully).  The instructor can set the energy threshold for defibrillation and the pacing threshold.

The “Common Learner Events” area is in the centre of the instructor interface.  In this area, you can use quick clicks of the mouse to document what the student is doing at any given time.  For example, clicking on the right arm gives such choices as “checks cap refill”, “inserts IV”, or “Procures arterial blood gas”.  If the instructor clicks on the right arm and chooses “Procures arterial blood gas”, this action will be documented to the bottom left of the screen, under the “Simulation control session log”.  The instructor can also use the quick “common learner events” choices at the top left to help document student actions during the scenario.

The instructor can use the “Add comment” feature at any time to type in an observation to the session log (for the debriefing later) that is not easily found under “common learner events”.  Some events are documented in the session log automatically by the computer, such as “head tilt, chin lift” as well as “pulse palpated”.

Shutting down sequence:

1.  Turn off the patient monitor.  From the “Main Setup” button on the bottom right of the screen, press the down arrow and choose “Shutdown Monitor”.
2. Press “Really Shutdown”
3. Under “Start” key, press “Shut down”
4. Exit the instructor interface, saving information, if desired.
5. Turn off the instructor laptop.
6. Turn off the manikin
7. Important* Open the compressor (found in the right leg) by pressing the lever downward.  This allows the manikin to air out when not in use, decreasing condensation.

 

If moving the manikin, be sure to place a collar on the neck to prevent excessive stretch of wires placed in the neck of the manikin.