CAE Healthcare WVL WIRELESS VOICE LINK User Manual 2

CAE Healthcare, Inc. WIRELESS VOICE LINK 2

Contents

User Manual 2

125Using METImanUsing METImanOnce METIman has been set up (see the Setup section) and the software has been launched (see the Using the Software section), the simulator is ready for learner interventions. The features of METIman are broken down by Neurological, Respiratory, Cardiovascular, Gastrointestinal and Genitourinary systems.The Run Screen
126Using METImanNeurologicalThe clinical features that can be controlled from the Neurological Assessment view are Blinking Eyes, Reactive Pupils, Convulsions, Neuromuscular Block, Body and Blood Temperature and Speech. To access the Neurological view, from the Run screen, click the brain on the human form.The Neurological ViewNeurological parametersClick the brain to access the Neurological view
127Using METImanEyesThe pupil diameter, pupil reactivity, blinking and blink speed of the simulator’s eyes can be controlled from the software. Click the Reactive drop-down menus of each eye to determine reactivity: Reactive, Non-Reactive, Pinpoint or Blown. Click Auto to have the eyes blink while the patient is conscious. Click Closed to close the eyes. Click Blinking to force the eyes to be open and blinking regardless of patient consciousness. These features can be controlled on both eyes.Click Slow, Normal or Fast to control the blink speed.ConvulsionsMETIman simulates convulsions when the feature is activated on the software. To activate the Convulsions feature, click the Convulsions switch. The Convulsions feature is activated when On appears. To deactivate the convulsions feature, click the switch again. The feature is deactivated when O appears. Neuromuscular BlockadeTo manually adjust the Neuromuscular Blockade (NMB: Set), click NMB. The NMB slider appears. Set the percentage by dragging the arrow up or down. Click Accept to exit and save the changes. Body TemperatureTo control a patient’s body temperature, click Temperature: Body. The Body Temperature slider appears. Set the body temperature by dragging the arrow up or down. Click Accept to exit and save the changes. Blood TemperatureTo manually control a patient’s blood temperature, click Temperature: Blood. The Blood Temperature slider appears. Set the temperature by dragging the arrow up or down. Click Accept to exit and save the changes.
128Using METImanHead Secretions (Prehospital Only)Secretions of the eyes, nose and mouth are manually controlled with a gravity feed. NOTE: An IV bag is needed for each site in use.To use the head secretion features: Using a 60 mL syringe, prime the line of the desired secretion by injecting uid 1. into the NOSE, MOUTH or EYES port on METIman’s left shoulder until uid emerges from the secretion sites.Set up the IV pole near the simulator.2. Fill an IV bag with the clinically appropriate uid. Use distilled water only, with 3. food coloring, if desired.Hang the IV bag on the IV pole.4. Ensure the roller clamp is closed and insert the IV spike into the IV bag.5. Connect to the simulator by attaching the end of the IV spike set tubing to the 6. NOSE, MOUTH or EYES port on the simulator’s left shoulder. (Repeat for each site necessary.) METIman Prehospital’s Left ShoulderOpen the clamp and allow uid to ow into the simulator. 7. Keep the IV bag attached. Adjust the ow rate manually using the roller clamp.8. NOTE: Cleanup is very important when using simulated uids. Please refer to the Care and Maintenance section for directions on uid removal. The NOSE, MOUTH and EYES ports
129Using METImanRespiratoryMETIman Prehospital’s Respiratory system is comprised of the airway management, spontaneous breathing and ventilation features. On METIman Nursing, various clinical signs such as breath sounds, chest excursion and airway patency can be physically demonstrated. A series of speakers inside each simulator can generate a range of breath and throat sounds used in diagnosing conditions. To access the Respiratory parameters of METIman, on the Run screen, click the lung on the human form. The respiratory parameters appear on the Run screen. The Respiratory ViewClick the lung to access the Respiratory viewRespiratory parameters
130Using METImanAirwayVarious clinical signs such as breath sounds, chest excursion and airway patency can be physically demonstrated. A series of speakers inside the simulator can generate a range of breath and throat sounds used in diagnosing conditions. METIman Prehospital’s anatomically realistic upper airway provides for the opportunity to intubate the patient as well as apply other airway interventions. In addition, the METIman Prehospital airway was designed to be a dicult airway that teaches learners to use the best technique when encountering clinical situations with real patients. The airway is best visualized when using the Sellick maneuver, which is performed when a patient is undergoing the intubation procedure.The METIman Nursing airway has the ability to produce secretions to allow for suctioning.
131Using METImanAirway FeaturesAnatomy, Physiology and Clinical Signs Clinical Interventions, Patient Monitoring and Scenarios. Software Control Manual ControlRealistic Upper Airway (Oropharynx, Nasopharynx and Larynx) (Prehospital only) Allows direct laryngoscopy, oral and nasal intubation and use of specialty airway devices. Simulator detects and responds appropriately to right mainstem intubation. Endobronchial intubation results in unilateral chest excursion and breath sounds.None required. None required.Trachea, Left and Right Mainstem Bronchi (Prehospital only)Tracheal intubation results in bilateral chest excursion and breath sounds. None required. None required.Airway Management and VentilationAlveolar and arterial gas concentrations appropriately reect the ecacy of ventilation and oxygen administration.Oxygen administration input by the instructor.VIEW: RespiratoryNone required.Gastric Distention(Prehospital only)Esophageal intubation results in gastric distension and the absence of breath sounds, chest excursion and CO2 output.None required. None required.Breakaway Teeth(Prehospital only) Upper front teeth can be dislodged if laryngoscopy is performed incorrectly. None required. See Breakaway TeethTongue Edema (On/O)Hinders, but does not prevent, intubation. VIEW: Respiratory None required.Posterior Pharynx Swelling (Prehospital only)Obstructs view of larynx to prevent intubation, but allows mask ventilation “can’t intubate, can ventilate” scenario.VIEW: Respiratory None required.Laryngospasm(Prehospital only)Closes vocal cords and prevents intubation and ventilation. When used with posterior pharynx swelling, creates a “can’t intubate, can’t ventilate” scenario.VIEW: Respiratory None required.Cricothyroid Membrane Allows needle cricothyrotomy, transtracheal jet ventilation, retrograde wire techniques and cricothyrotomy.None required. See Cricothyrotomy,
132Using METImanSwollen TongueThe swollen tongue feature is activated on the Respiratory view by setting the Swollen Tongue switch to Swollen.Posterior Pharynx Swelling (Prehospital Only)Swelling of the posterior oropharynx (posterior airway occlusion) can be activated to obstruct the view of the larynx and prevent intubation, but allow mask ventilation of the patient’s lungs, thereby creating a “cannot intubate, can ventilate” scenario. Click the Airway Occluder switch to activate the feature.
133Using METImanRealistic Upper Airway (Prehospital Only)The upper airway of METIman Prehospital is designed to allow for intubation and laryngoscopy. Oral and nasal intubation can be performed using a variety of airway devices, including LMAs (3), endotracheal tubes (6.5 mm to 7.5 mm), nasal-pharyngeal airways (30 mm) and oropharyngeal airways (90 mm).IntubationThe simulator detects and responds appropriately to right mainstem intubation, and an event is recorded in the Event Log.Intubation incorrectly applied into the esophagus causes abdominal distension.IMPORTANT Airways can be damaged by improper insertion of an airway adjunct (e.g. endotracheal tube). To protect the airway, lubricate the adjunct prior to insertion using the silicone spray provided.Use ONLY the provided SILICONE SPRAY to lubricate the adjunct. NEVER use a water-based lubricant because of resulting residue damage.
134Using METImanLaryngospasm (Prehospital Only)A laryngospasm actuator closes the patient’s vocal cords and prevents both ventilation and intubation. Click the Laryngospasm switch to activate the feature.Teeth with Breakaway Incisors (Prehospital Only)METIman Prehospital is equipped with Breakaway Teeth whose front incisors become dislodged with improper handling of a laryngoscope. The teeth are tied to the upper denture with a lanyard, which prevents losing the teeth down the airway or misplacing them during storage.
135Using METImanAirway Secretions (Nursing Only)METIman Nursing allows for suctioning of uids from the airway using a manual feed. Ensure all uids have been removed from previous uses before each new use to prevent overlling. Tracheostomy SuctionTo use the airway secretion feature, inject up to 40 mL of clinically appropriate colored uid into the AIRWAY FILL port on METIman Nursing’s left shoulder. METIman Nursing’s Left ShoulderThe trachea is now ready to be suctioned. Using the proper clinical technique, insert the suction catheter (14 Fr) until resistance is encountered at the bifurcation. Withdraw and apply suction. Fluid can be suctioned over a distance of approximately 4 cm distal to the bifurcation.NOTE: Use only distilled water with food coloring, if desired. NOTE: Cleanup is very important when using simulated uids. Please refer to the Care and Maintenance section for directions on uid removal.The AIRWAY FILL port
136Using METImanCricothyrotomyCricothyrotomy can be simulated on METIman. Before performing a needle cricothyrotomy, the Cricothyrotomy plug must be removed, and a 2.25-inch (6-cm) length of red tape from the roll provided must be placed over the hole.To replicate a needle cricothyrotomy:Spray the silicone lubricant onto the airway adjunct prior to the simulation 1. session. To prevent damage to the simulator, always spray silicone lubricant into the airway.Locate the simulated cricothyroid membrane sealed with tape underneath the 2. neck skin.Follow standard clinical techniques and palpate to nd the cricothyroid space. 3. Puncture the space through the neck skin of the patient simulator and into 4. the tape “membrane.” This puncture goes all the way through to the “trachea,” simulating the clinical procedure. Users must replace the tape that simulates the cricothyroid membrane after each 5. cricothyrotomy.NOTE: Replacement components are available in the Inventory Kit.NOTE: When ventilating through a surgical airway, the Laryngospasm feature must be deactivated, or the chest rise is not observed.NOTE: When nished using the Cricothyrotomy feature, replace the Crichothyrotomy plug.Replacing the Cricothyrotomy TapeRemove the old, punctured tape completely from the cricoid feature and use alcohol to clean the glue residue from the surface. (An alcohol prep pad works well.) Allow to dry.Cut an approximately 2.25-inch (6 cm) length of the double-sided tape from the roll provided.Carefully remove the paper backing and lightly stretch the newly revealed adhesive side of the tape over the cricoid hole and down the far side of the cricoid feature. Use the non-stick paper backing to press the tape against the cricoid feature.Cut a 2.5-inch to 3-inch (7 cm to 8 cm) length of red tape and apply it over the cricoid feature and the tape.
137Using METImanResealing the Membrane After a PunctureTo reseal the cricoid feature, apply a small piece of red tape over the punctured area. This can be repeated a brief number of times, but when the number of layers impedes the cricothyrotomy, all existing tape must be removed and replaced with new tape.
138Using METImanPulmonaryMETIman uses both physical and mathematical models to achieve an extremely accurate simulation of respiration. METIman’s chest rises and falls, mimicking inspiration and expiration. METIman Prehospital’s lungs also react realistically to intubation as well as to pathophysiologic states. Pulmonary SystemAnatomy, Physiology and Clinical SignsClinical Interventions, Patient Monitoring and Scenarios.Software ControlManual ControlSpontaneous BreathingNormal tidal breathing and pathophysiological conditions such as atelectasis, pneumothorax, asthma and COPD.None required, but adjustableVIEW: RespiratoryNone required.Exhaled CO2 (Prehospital only)Measure the presence or absence of CO2 during positive pressure ventilation.None required. CO2 canister is insertedPneumothorax or HemothoraxIncrease in intrapleural volume, leading to asymmetrical breathing.None required, but adjustableVIEW: RespiratoryCONTROL: Intrapleural Volume (Left or Right)None required.Chest Excursion Synchronized with ventilation (spontaneous or positive pressure ventilation). Excursion depth proportional to tidal volume.None required. None required.Breath Sounds Normal and abnormal breath sounds are independently synchronized with ventilation of the right and left lungs. Breath sounds can be auscultated over anterior and posterior anatomic locations.None required, but adjustableVIEW: SoundsNone required.Bronchial OcclusionCompletely obstructs right and/or left mainstem bronchi, simulating a lower airway obstruction (e.g. mucus plug). This yields an inability to ventilate the lungs and asymmetric chest excursion.VIEW: Respiratory None required.Pulse Oximetry Oxyhemoglobin saturation (SpO2) automatically correlates with the oxygen concentration in the lungs and the intrapulmonary shunt fraction.None required, but adjustableSpO2 probe is attached.Arterial Blood Gases PaO2, PaCO2 and pH are continuously calculated, and the Patient Status Display can be congured to show them.None required, but adjustableNone required.Venous Blood Gases PvO2 and PvCO2 are continuously calculated, and the Patient Status Display can be congured to show them.None required, but adjustableNone required.
139Using METImanPulmonary SystemNeedle Decompression (Prehospital Only)Decompression of a pneumothorax can be performed bilaterally by inserting a needle at the midclavicular line of the second intercostal space.The instructor must adjust the amount of physiologic intrapleural air present.VIEW: RespiratoryCONTROL: Needle Decompression, Intrapleural Vol: Left, Intrapleural Vol: RightSee Needle Decompression setup,.Needle Decompression (Prehospital Only)Needle decompression can be performed bilaterally into a small hole located in the midclavicular line of the second intercostal space using a 14-gauge needle. To enable the Needle Decompression feature, activate the switch for the appropriate side(s). From the Respiratory view, turn the desired Needle Decompression switch to On.Needle Decompression SwitchNeedle DecompressionWhen a needle is inserted in the second intercostal space, along the midclavicular line, air is released while intrapleural volume is present. Needle Decompression and Chest TubeWhen using the METIman Prehospital system, the Needle Decompression and Chest Tube features can be enabled simultaneously. Intrapleural volume will decrease when both are in use.
140Using METImanBronchial Occlusion (Prehospital Only)When bronchial occlusion is enabled, unilateral chest excursion is observed during spontaneous breathing or positive pressure ventilation. To stop airow to the bronchi, creating a bronchial occlusion, the switch for the appropriate side(s) must be activated. From the Respiratory view, turn the desired Bronchial Occlusion switch to On.Bronchial Occlusion SwitchRespiratory RateTo adjust the respiratory rate manually, from the Respiratory view, click Respiratory Rate. The Respiratory Rate slider appears. Set the rate by dragging the arrow up or down. Click Accept to exit and save the changes. The switch is now orange, indicating a change has been made. To return to the programmed physiologic model, click the switch and turn the Override switch to Modeled.Respiratory Rate ParameterPulse OximetryTo adjust the SpO2 percentage manually, from the Respiratory view, click SpO2. The SpO2 slider appears. Set the rate by dragging the arrow up or down. Click Accept to exit and save the changes. The switch is now orange, indicating a change has been made. To return to the programmed physiologic model, click the switch and turn the Override switch to Modeled.SPO2 ParameterThe SpO2 probe is integrated with the TouchPro (optional) and the physiological model. The connection for the SpO2 probe is located on the left side of the simulator. The SpO2 probe must be connected for pulse oximetry data to be displayed.CO2 Exhalation (Prehospital Only)Whether supplied via a portable canister or from an external source, the simulator exhales CO2 during positive pressure ventilation.NOTE: An optional regulator kit must be purchased to use CO2 from an external source.To use the CO2 Exhalation feature, connect the CO2 canister to the CO2 canister socket or connect the external source on the simulator’s right shoulder, and METIman Prehospital exhales CO2 gas. There are approximately 15 minutes of CO2 gas available once the canister is connected.
141Using METImanPositive Pressure VentilationWhen positive pressure ventilation is administered, the process is automatically detected by the simulator, and the physiologic model is sensitive to the volume administered.Gastric Distention (Prehospital Only)During esophageal intubation or overly aggressive bag valve mask ventilation, gastric distention occurs. Gastric distention is relieved by putting pressure on the abdomen.Chest Tube: METIman PrehospitalMETIman Prehospital has the ability to simulate chest tube drainage. The Chest Tube sites are located bilaterally in the fth intercostal space. Use only a 28 Fr chest tube. Ensure all uids have been removed from previous uses before each new use to prevent overlling. Please refer to the Care and Maintenance section for directions on uid removal. To simulate continuous chest tube drainage:Insert the METIman Priming Tube in the Chest Tube site.1. Set up the IV pole near the simulator.2. Fill an IV bag with the clinically appropriate uid. Use distilled water only, with food 3. coloring if desired.Hang the IV bag on the IV pole.4. Ensure the roller clamp is closed and insert the IV spike into the IV bag.5. Connect to the simulator by attaching the end of the IV spike set tubing to the 6. corresponding CHEST TUBE port (LEFT or RIGHT) on the simulator’s right shoulder. METIman’s Right ShoulderOpen the clamp and allow uid to ow into the simulator until uid is seen in the METIman 7. Priming Tube.Chest Tube ports
142Using METImanOnce uid appears in the METIman Priming Tube, remove the METIman Priming 8. Tube. The simulator is ready for chest tube insertion.Keep the IV bag attached and adjust the ow rate manually using the roller clamp.9. The chest tube must be fully inserted for the uid to ow.Chest Tube InsertionNOTE: Cleanup is very important when using simulated uids. Please refer to the Care and Maintenance section for directions on uid removal. When the Chest Tube feature is used on METIman Prehospital, the simulator automatically detects the tube insertion and creates a log entry.On METIman Prehospital, if a small volume of uid is needed to simulate proper chest tube insertion, the internal reservoir may be lled. To insert a small amount of uid into the Chest Tube reservoir:Insert the METIman Priming Tube in the Chest Tube site.1. Using a 60 mL syringe lled with clinically appropriate uids, inject the contents 2. into the CHEST TUBE port (LEFT or RIGHT) until uid is seen in the METIman Priming Tube. Use distilled water only, with food coloring, if desired.Remove the METIman Priming Tube.3. Inject the remaining contents of the syringe into the 4. CHEST TUBE port. Remove the syringe.5. Chest Tube and Needle DecompressionThe Chest Tube and Needle Decompression features can be enabled at the same time on the METIman Prehospital system. Intrapleural volume will decrease when both are in use.
143Using METImanChest Tube: METIman NursingMETIman Nursing has the ability to simulate chest tube drainage. The Chest Tube sites are located bilaterally in the fth intercostal space. Use only a 28 Fr chest tube. Ensure all uids have been removed from previous uses before each new use to prevent overlling. Please refer to the Care and Maintenance section for directions on uid removal. To simulate continuous chest tube drainage:Insert the METIman Priming Tube in the Chest Tube site.1. Set up the IV pole near the simulator.2. Fill an IV bag with the clinically appropriate uid. Use distilled water only, with 3. food coloring if desired.Hang the IV bag on the IV pole.4. Ensure the roller clamp is closed and insert the IV spike into the IV bag.5. Connect to the simulator by attaching the end of the IV spike set tubing to 6. the corresponding CHEST TUBE port (LEFT or RIGHT) on the simulator’s right shoulder.METIman’s Right ShoulderOpen the clamp and allow uid to ow into the simulator until uid is seen in the 7. METIman Priming Tube.Once uid appears in the METIman Priming Tube, remove the METIman Priming 8. Tube. The simulator is ready for chest tube insertion.Keep the IV bag attached and adjust the ow rate manually using the roller clamp.9. The chest tube must be fully inserted for the uid to ow.NOTE: Cleanup is very important when using simulated uids. Please refer to the Care and Maintenance section for directions on uid removal.Chest Tube ports
144Using METImanCardiovascularWith METIman’s Cardiovascular system, users can replicate the clinical signs associated with cardiac activity, including palpable pulses, heart sounds and electrical activity. Cardiovascular SystemAnatomy, Physiology and Clinical SignsClinical Interventions, Patient Monitoring and Scenarios.Software ControlManual ControlHeart Sounds Normal and abnormal heart sounds are synchronized to the cardiac cycle and audible to a standard stethoscope. Heart sounds can be auscultated over the left and right upper sternal border, right lower sternal border and apex.None required; specic sounds can be selected.VIEW: CardiovascularNone required.5-Lead ECG ECG waveforms can be viewed on a standard monitor and/or on the TouchPro Patient monitor. Normal and abnormal cardiac rhythms are linked to patient physiology (e.g. blood pressure, cardiac output).None required; specic rhythms can be selected.ECG monitor may be utilized.Myocardial IschemiaMyocardial oxygen supply and demand automatically inuence the cardiac rhythm, yielding response to hypoxemia.None required, but adjustable.None required.Palpable Pulses Carotid, brachial, radial, femoral, popliteal, posterior tibial and dorsalis pedis pulses can be palpated bilaterally and are synchronous with the cardiac cycle. A pulse decit automatically occurs if the systolic arterial blood pressure falls below specied thresholds. None required, but adjustable.VIEW: Available on all views on the Run screenNone required.Non-Invasive Blood Pressure MeasurementSystemic blood pressure can be measured using the return-to-ow technique. Korotko sounds can also be auscultated.None required. Use of modied blood pressure cu.
145Using METImanTo access the Cardiovascular parameters of METIman, on the Run screen, click the heart on the human form. The cardiovascular features appear on the Run screen.The Cardiovascular View (Prehospital)Click the heart to access the Cardiovascular viewPulsesCardiovascular parameters
146Using METImanPulses: METIman PrehospitalMETIman Prehospital has 14 pulse sites that are activated by touch.Carotid (2)• Brachial (2)• Radial (2)• Femoral (2)• Popliteal (2)• Posterior Tibial (2)• Dorsalis Pedis (2)• NOTE: The Dorsalis Pedis and Posterior Tibial pulses are controlled together. The left and right Carotid pulses are also controlled together.Pulses are visible and can be controlled from any physiological view. To disable a pulse, click the pulse location on the human form. To enable a pulse, click the pulse location again.Pulses: METIman Prehospital – Active and InactiveActivated pulseDeactivated pulse
147Using METImanPulses: METIman Nursing METIman Nursing has 14 pulse sites that are activated by touch.Carotid (2)• Brachial (2)• Radial (2)• Femoral (2)• Popliteal (2)• Posterior Tibial (2)• Dorsalis Pedis (2)• NOTE: The left and right Carotid pulses are controlled together.Pulses are controlled from the Cardiovascular view only. All pulses, unless altered by an SCE, are enabled by default. To disable a pulse, click the pulse location on the human form. To enable a pulse, click the pulse location again.Pulses: METIman Nursing – Active and InactiveActivated pulseDeactivated pulse
148Using METImanBlood PressureMETIman supports non-invasive blood pressure measurements, and systolic and diastolic readings can be obtained and manipulated through the software.Systolic and Diastolic Blood PressureTo manually adjust the systolic and/or diastolic blood pressure:From the Cardiovascular view, click the parameter of desired blood pressure. 1. Set the pressure by dragging the arrow up or down. 2. Click 3. Accept to exit and save the changes. The switch is now orange, indicating a change has been made. To return to the programmed physiologic model, click the switch and turn the 4. Override switch to Modeled. Non-Invasive Blood Pressure MeasurementBlood pressure can be taken manually on either arm. Non-invasive blood pressure (NIBP) monitoring techniques can be used by attaching the standard cu modied with a T-tting and adapters.To modify a standard blood pressure cu:Cut the blood pressure cu tube approximately 9 cm from the cu. 1. Insert the barbed end tubing connectors into the cut ends of the blood pressure 2. cu tubes.
149Using METImanSecure the tubing connectors with cable ties. 3. An Attached Tubing ConnectorAttach the blood pressure adapter to the connectors.4. An Attached Blood Pressure Cu Adapter
150Using METImanTo get a blood pressure reading, connect the extension from the T-tting on the blood pressure cu adapter to either of the NIBP ports on METIman’s left and right shoulders. METIman Prehospital’s Left ShoulderMETIman Nursing’s Left ShoulderMETIman’s Right ShoulderNIBP RIGHT portNIBP LEFT portNIBP LEFT port
151Using METImanConnect the T-tting extension to the hose.Take the non-invasive blood pressure reading using the return-to-ow technique.Attached Blood Pressure CuAt appropriate cu pressures, Korotko sounds are produced, and the radial pulse disappears.
152Using METImanHeart RateTo manually adjust the heart rate, from the Cardiovascular view, click Heart Rate. Set the rate by dragging the arrow up or down. Click Accept to exit and save the changes. The switch is now orange, indicating a change has been made. To return to the programmed physiologic model, click the switch and turn the Override switch to Modeled.Five-Lead ECGOn METIman, a 5-lead ECG is emitted from the appropriate positions for display on a standard monitor. A contact is available on METIman’s chest for each of the ve cables. 5-Lead ECG SitesThe simulator generates a normal sinus ECG, as well as a broad range of abnormalities such as myocardial ischemia, sinus tachycardia and bradycardia, ventricular brillation and asystole. The hemodynamic response to the arrhythmias is physiologically correct. Myocardial oxygen balance and cardiac ischemia automatically inuence the cardiac rhythm resulting in a realistic and automatic response of the rhythm to hypoxemia. The degree of inuence can be controlled or completely overridden by the instructor.Five-Lead ECG sites
153Using METImanCardiovascular Interventions/TherapyMETIman can simulate chest compressions and three types of electrical therapy: debrillation, cardioversion and pacing. Realistic Cardiovascular InterventionsAnatomy, Physiology and Clinical SignsClinical Interventions, Patient Monitoring and Scenarios.Software ControlManual ControlChest CompressionEective chest compression results in articial circulation, cardiac output, central and peripheral blood pressures, palpable pulses, and CO2 return.None required, but adjustable.None required.Cardiac MonitoringThe desired arrhythmia can be selected. The response to clinical intervention must be controlled by the instructor.VIEW: CardiovascularNone required.Debrillation METIman supports operation with a variety of manual and automatic external debrillators.Debrillation can be simulated by the instructor under the Interventions paletteVIEW: CardiovascularSee Debrillation below for debrillation disk locations and instructions.Cardiac Pacing Transthoracic cardiac pacemaker can be used with METIman. Pacing results in appropriate physiological changes in blood pressure and cardiac output.None required. See Pacing below for cardiac pacing disk locations and instructions.
154Using METImanChest CompressionsMETIman supports normal hand placement and standard compression techniques, and chest compressions can be performed. METIman can detect the compressions, and the physiology responds accordingly.Debrillation and CardioversionManual debrillation and cardioversion can be performed on METIman. Additionally, debrillation and cardioversion are available virtually through the software. METIman is designed to safely absorb the energy discharged from manual and automatic debrillators. Standard debrillation energy levels should be used for positive learning reinforcement and to avoid negative training transfer.Debrillation SitesHowever, use of a debrillator for training purposes represents an operational hazard equivalent to use of a debrillator on a real patient. Consequently, ALL SAFETY PRECAUTIONS for the use of debrillators MUST BE FOLLOWED as if the simulator were a patient. Consult the specic debrillator’s user manual for further information.Debrillation sites
155Using METImanThe following cautions should be observed:Defibrillation should be performed on the defibrillation electrodes only. If defibrillation • is performed over any ECG electrode, high voltage may be present on the remaining connectors during the shock. This may also damage ECG circuitry.To prevent overheating, do NOT provide more than three (3) defibrillator discharges • (maximum 200 joules with a biphasic defibrillator) in a sequence. Do NOT exceed an average of two (2) defibrillator discharges per minute during the training session. Avoid a large number of consecutive discharges. For example, 20 or 25 discharges • without any recovery interval may damage the system.Do NOT let the simulator come in contact with electrically conductive surfaces or • objects during defibrillation. A flame-supporting atmosphere, for example, with a high content of oxygen, should be avoided during defibrillation.Keep the simulator’s chest dry. Special attention should be taken when using the urinary • system or the chest tube feature.To prevent pitting of the chest skin electrode, do NOT apply conductive gel or • conductive defibrillation pads intended for patient use.Do NOT use cables or connectors having visible damage.• Do NOT spill fluids over any component inside the simulator torso. This could damage • the system and may also present a possible hazard for the operator.When using a manual defibrillator, the ECG can be monitored via the defibrillator • paddles. Coarse ventricular fibrillation and high-rate ventricular tachycardia cardiac rhythms are automatically recognized as “shockable” rhythms.With each defibrillation, the METIman automatically records the amount of energy • discharged and the time defibrillation was performed. The simulated patient response to defibrillation is determined by the scenario script or instructor intervention. Thus, cardioversion is not automatically determined by the physiological models.The minimum electrical charge recognized by the circuitry within the simulator is 20 • joules.For paddle placement on the chest, the simulator has two anterior defibrillation disks, • which can be unscrewed, leaving threaded connections, if required.Biphasic defibrillators can be used with either paddles or hands-free connectors.• PacingPacing can be achieved virtually by selecting the appropriate intervention in the Interventions palette. A standard transthoracic cardiac pacemaker can be connected to the simulator using the anterior contacts. The simulator automatically detects and responds to pacing signals (from 20 mA to 200 mA, in increments of 10).
156Using METImanSubclavian Catheter (Nursing Only)The Subclavian Catheter feature allows for cleaning and dressing practice. When using the Subclavian Catheter feature, users can infuse up to 50 mL of distilled water in the line. Subclavian CatheterNOTE: Cleanup is very important when using simulated uids. Please refer to the Care and Maintenance section for directions on uid removal.Intramuscular InjectionMETIman allows for the administration of a deltoid intramuscular (IM) injection. Injection sites are located on both of METiman’s arms. Use only a 20- to 22-gauge needle.Intramuscular Injection
157Using METImanIV CannulationVeins for the IV Cannulation feature are located in the dorsum of the hands, forearms and antecubital region of the arms. Use only a 20- to 22-gauge needle. To simulate realistic ashback, the system must be primed prior to use. Ensure all uids have been removed from previous uses before each new use to prevent overlling. Please refer to the Care and Maintenance section for directions on uid removal. IV CannulationTo prime the IV access ports, connect a 60 mL syringe lled with distilled water (with clinically appropriate food coloring if desired) to the IV FILL port on METIman’s right shoulder and rmly inject all 60 mL. This primes the arms and charges the system for Flashback and Venipuncture support.WARNING: If a ash does NOT occur, do NOT inject any uid and remove the needle immediately. Repeat the priming directions and ensure you have injected the needle properly and into the simulated vein.METIman’s Right ShoulderFluids and medications can be administered intravenously. Approximately 50 mL of uid may be infused. To support infusion of larger volumes, connect an empty IV bag or other receptacle to the IV DRAIN port located on METIman right shoulder.NOTE: Cleanup is very important when using simulated uids. Please refer to the Care and Maintenance section for directions on uid removal.IV FILL and IV DRAIN ports
158Using METImanFluidsMETIman is capable of bleeding simultaneously at two sites from an internal tank. Arterial and venous bleeding can be simulated. Venous settings produce a continuous bleed at three user-adjustable ow rates. Arterial settings produce a pulsing ow synchronized with the cardiac cycle at three user-adjustable ow rates. The ow rate is determined by the selected bleeding vessel size and the blood pressure. In addition, the simulator features auto-sensing of hemorrhage control (e.g., tourniquet application or direct pressure).Bleeding results in an automatic loss of blood from the physiologic models with subsequent changes in hemodynamics. Blood loss occurs at a rate dependent on wound size and Mean Arterial Pressure (MAP).Setup must be completed before using the bleeding feature.To enable bleeding, on the Run screen, click the blood droplet. The Fluids view appears. The Fluids ViewSimulated blood MUST be removed from the simulator after each use. Failure to remove simulated blood from the simulator can void the warranty. For instructions on how to clean the simulator after using the Bleeding feature, please refer to the Care and Maintenance section for directions on uid removal.Click the blood droplet to access the Bleeding viewBleeding parameters
159Using METImanHemorrhage SetupThe user determines the type and placement of the bleeding moulage for the lesson. An optional Moulage Kit can provide molded gunshot wounds, broken and protruding bones, amputations and an abdominal wound as well as theatrical components.To decrease the likelihood of staining, apply a thin coat of petroleum to the area of bleeding.To use one of the moulage wounds from the Moulage Kit:Secure the wound over the simulator using the integrated straps.1. Connect the wound haptic to the one of the moulage ports located on METIman’s 2. right shoulder (UPPER MOULAGE) or right hip (LOWER MOULAGE).METIman’s Right ShoulderMETIman’s Right HipEnable 3. Bleeding: Upper or Bleeding: Lower on the Fluids view of the Müse software, as desired. Hemorrhage ControlWhen bleeding is controlled (e.g., hemostat, tourniquet), the action is detected and logged, and the physiology responds accordingly. UPPER MOULAGE portLOWER MOULAGE port
160Using METImanTourniquet ApplicationA tourniquet may be applied to stop the ow of blood.The wound umbilical contains an 18-inch section of soft tubing that allows the use of a tourniquet to stop the ow of blood. For added realism, the simulator should be dressed in clothing that can be torn to “conform” with the type of injury being demonstrated. Bleeding moulages and the wound umbilical should be concealed under the victim’s clothing with only the wound showing.Tourniquet ApplicationFluid Loss BloodTo manually control a patient’s blood loss, from the Fluids view, click the Fluid Loss Blood parameter. The Fluid Loss Blood slider appears. Set the amount of blood loss by dragging the arrow up or down. Click Accept to exit and save the changes. Fluid Loss PlasmaTo manually control a patient’s plasma loss, from the Fluids view, click the Fluid Loss Plasma parameter. The Fluid Loss Plasma slider appears. Set the amount of Plasma loss by dragging the arrow up or down. Click Accept to exit and save the changes.
161Using METImanGastrointestinal METIman produces realistic bowel sounds. In addition, on METIman Nursing, gastric lavage, gavage and suction can be administered. Gastrointestinal Gavage, Lavage and Suction (Nursing Only)METIman Nursing has a gastric reservoir that allows for simulated gavage, lavage and gastric suction. Before each use, ensure the reservoir has been drained completely. The reservoir should be primed with 60 mL of uid before performing gastric suction (see Gastric Suction on page 162 for more information). A maximum of 100 mL of uid may be added to the gastric reservoir once the reservoir is primed. Gavage (Nursing Only)To perform gastrointestinal gavage, ensure the reservoir is empty and infuse uid according to procedure using a 14 Fr nasogastric tube. NOTE: Cleanup is very important when using simulated uids. Please refer to the Care and Maintenance section for directions on uid removal.NOTE: Ice the nasogastric tube if extra rigidity is needed for insertion.Lavage (Nursing Only)To perform gastrointestinal lavage, ensure the reservoir is empty and infuse uid normally using a 14 Fr nasogastric tube. Fluids can then be removed according to proper clinical procedure. Gastric LavageNOTE: Cleanup is very important when using simulated uids. Please refer to the Care and Maintenance section for directions on uid removal.NOTE: Ice the nasogastric tube if extra rigidity is needed for insertion.
162Using METImanGastric Suction (Nursing Only)To perform gastric suction, the reservoir must be primed prior to use. To prime the gastrointestinal reservoir, attach a syringe with a luer-lock extension set (provided) and inject 60 mL of distilled water into the GASTRIC FILL port on the simulator’s left shoulder.METIman Nursing’s Left ShoulderFluids can then be removed according to procedure using a 14 Fr nasogastric tube.NOTE: Cleanup is very important when using simulated uids. Please refer to the Care and Maintenance section for directions on uid removal.The GASTRIC FILL port
163Using METImanGenitourinary SystemMETIman may be congured with either male or female genitalia, either of which allows for the insertion of a urinary catheter. The genitourinary system also provides for the excretion of urine.Urinary CatheterizationCatheterize the simulator using a standard 16-Fr urinary catheter lubricated with silicone spray.Urinary CatheterizationThe bladder for the simulated urine is accessed directly via the urethra.
164Using METImanSimulating Urine OutputMETIman allows urinary catheterization and simulation of urinary output. Ensure all uids have been removed from previous uses before each new use to prevent overlling. Please refer to the Care and Maintenance section for directions on uid removal. To simulate continuous urinary output:Set up the IV pole near the simulator.1. Fill an IV bag with the clinically appropriate uid. Use distilled water only, with food 2. coloring if desired.Hang the IV bag on the IV pole.3. Ensure the roller clamp is closed and insert the IV spike into the IV bag.4. Connect to the simulator by attaching the end of the IV spike set tubing to the 5. GU port on the simulator’s left shoulder. METIman Prehosptial’s Left ShoulderMETIman Nursing’s Left ShoulderThe GU portThe GU port
165Using METImanOpen the clamp and allow uid to ow into the simulator. There is a reservoir 6. inside the simulator that lls up with the uid. Keep the IV bag attached. Adjust the ow rate manually using the roller clamp.7. Catheterize the simulator using a 16-Fr urinary catheter lubricated with silicone 8. spray. The urinary catheter must be fully inserted for the uid to ow.NOTE: Cleanup is very important when using simulated uids. Please refer to the Care and Maintenance section for directions on uid removal. If a small volume of uid is needed to simulate proper urinary catheterization in a eld location, the internal reservoir may be lled. To ll the genitourinary reservoir, attach a syringe with a Luer-lock extension set (provided) and inject 60 mL of distilled water into the GU port on the simulator’s left shoulder.Changing the Simulator’s GenitaliaMETIman comes with male and female genitalia.To switch genitalia:Pull apart the Velcro holding the genitalia. 1. Loosen and remove the urethra connector. This connection may be tight when 2. genitalia are removed the rst time.Remove the genitalia.3. Attach urethra tube to the urethra connector.4. Attach the desired genitalia using the Velcro.5.
166Using METImanSoundsA variety of simulated sounds are available to enhance realism. A patient must be running on METIman for any sounds to be available. SpeechSpeech can be added to simulations using the Vocal Sounds and Speech Sounds features on the software or by using an external microphone. Vocal SoundsA variety of programmable vocal sounds are available. Vocal sounds are male or female based on the gender of the active patient. Vocal SoundsNoneAudible WheezingCryingGaggingGaspingGroaningLong loud coughLong soft coughMumbling
167Using METImanTo select a sound from the Vocal Sounds drop-down menu, click the Sounds button on the Run screen. The Sounds panel appears. Vocal Sounds MenuClick Vocal Sounds and select the type of sound desired from the Vocal Sounds drop-down menu. Vocal Sounds play continuously when selected and are emitted immediately when selected from the Vocal Sounds drop-down menu. To stop playing one of the vocal sounds, select None from the list.
168Using METImanSpeech SoundsSpeech Sounds include a male or female voice that can utter pain rating indicators from 0 to 10, various phrases and a series of other utterances. Unlike Vocal Sounds, Speech Sounds only play once. Speech SoundsLoud CoughSoft CoughShort Loud CoughShort Soft CoughScreamGrunt“Yes”“No”“Sometimes”“Ouch”“My leg hurts”“My belly hurts”“My chest is tight”“I can’t breathe”“Ow, that hurts”“0” through “10” - Pain Ratings“Sharp”“Pressure”“Aching”“Dull”“Stabbing”
169Using METImanTo play a Speech Sound, click the Speech balloon. A list of Speech Sounds appears. The Speech Sounds MenuSelect the desired sound. The sound plays, and the list disappears. To replay the last sound, click the Play button in the Speech balloon.The Speech Sounds menu
170Using METImanWireless Voice CapabilityIn addition to the pre-programmed speech, any response can be transmitted through the speakers using the wireless microphone. Wireless MicrophoneThe microphone volume can be adjusted on the microphone itself using the volume control. Wireless Voice LinkIf a wireless voice link package was included with the METIman simulator, see Appendix B - Wireless Voice Link on page B-1 for additional instructions.
171Using METImanThroat SoundsStridor throat sounds can be enabled using the software. Throat sounds can be adjusted by clicking the Sounds button on the Run screen. When the Sounds panel appears, select Throat Sounds. The Throat Sounds MenuClick the Throat Sounds drop-down menu to change the type of sound. Click and drag the slider to adjust the volume.
172Using METImanBreath SoundsBreath sounds are independently synchronized with ventilation of the left and right lungs. Fourteen speakers, eight anterior and six posterior, provide breath sounds that can be auscultated. Each of the four quadrants of the torso can be set independently to produce a particular breath sound.Breath SoundsNormalCracklesDiminishedGurglingPleura RubRhonchiWheezingClick any one of the Breath Sounds drop-down menus that each control one of four quadrants to change the type of sound. Click and drag the slider for each location to adjust the volume. A patient must be running on a METIman simulator for any sounds to be available. By default, Normal breath sounds are heard.Breath sounds can be adjusted by clicking the Sounds button on the Run screen. When the Sounds panel appears, select Breath Sounds. The Breath Sounds Menu
173Using METImanHeart SoundsHeart sounds emanate from four speakers and are synchronized with the cardiac cycle. Heart sounds can be auscultated over the left and right sternal border, right lower sternal boarder and apex.By default, heart sounds are set to the Normal sound. The following sounds are available:Heart SoundsNormal S1-S2S3S4S3 and S4Early Systolic MurmurMid Systolic MurmurLate Systolic MurmurPan Systolic MurmurLate Diastolic MurmurHeart sounds can be adjusted by clicking the Sounds button on the Run screen. When the Sounds panel appears, select Heart Sounds. The Heart Sounds MenuClick the Heart Sounds drop-down menu to change the type of sound. Click and drag the slider to adjust the volume.
174Using METImanBowel SoundsLearners can auscultate bowel sounds over each of four intestinal quadrants: the Upper Right, Upper Left, Lower Right and Lower Left. The sounds can be independently set in each anatomical region to Normal, Hypoactive, Hyperactive or None (bowel sounds are absent).The Bowel Sounds MenuBowel sounds can be adjusted by clicking the Sounds button on the Run screen. When the Sounds panel appears, select Bowel Sounds. Click any one of the Bowel Sounds drop-down menus that each control one of four quadrants to change the type of sound. Click and drag the slider for each location to adjust the volume. Normal bowel sounds are present by default.
175Care and MaintenanceCare and MaintenanceMaintaining METIman requires careful treatment of the electronic and mechanical components. Each time METIman is assembled or disassembled, make sure all components are properly handled and either removed from or placed into storage correctly.
176Care and MaintenanceMETIman Warranty ProgramsGeneral InformationCAE Healthcare patient simulator products come with a one-year Manufacturer’s Warranty (excluding batteries and consumables). All warranties begin at date of shipment or CAE Healthcare installation. You may upgrade your rst year Warranty to an Enhanced Warranty and receive remedial and planned maintenance. To prevent equipment downtime and delays after your warranty expires, we encourage you to contract for extended maintenance services for all subsequent years.Units Out of AgreementFor units no longer under warranty requiring repairs, the Time and Materials service plan will apply (see Time and Materials section).To place an out-of-warranty unit under a warranty contract, CAE Healthcare reserves the right to have the patient simulator inspected by a CAE Healthcare-approved technician at the customer’s expense. If necessary, the unit would have to be repaired at the customer’s expense prior to issuance of a warranty contract.The repairs required as the result of the examination will be quoted on a time and material basis.
177Care and MaintenanceHow to Contact Customer ServiceCAE Healthcare Customer Service Headquarters - United States and Latin America Monday - Friday from 7:00 a.m. to 6:00 p.m. ET Toll Free +1 (866) 462-7920 24-hour Hotline +1 (941) 342-5605 Fax +1 (941) 342-5600 Email Address: customerservice@caehealthcare.com Web URL: www.caehealthcare.comCAE Healthcare Customer Service - Canada Monday - Friday from 8:00 a.m. to 5:00 p.m. ET Toll Free +1 (877) 223-6273 Email Address: can.service@caehealthcare.comCAE Healthcare Customer Service - Europe, Middle East and Africa (EMEA) Monday - Friday from 8:00 a.m. to 5:00 p.m. CET Phone +49 (0) 6131 4950354 Fax +49 (0) 6131 4950351 Email Address: international.service@caehealthcare.comCAE Healthcare Customer Service - UK and Ireland Monday - Friday from 9:00 a.m. to 5:00 p.m. GMT Phone +44 (0)800-917-1851 Email Address: uk.service@caehealthcare.comPrincipal hours of operation exclude holiday and non-business days.
178Care and MaintenanceContract PeriodWarranty contracts are not ordinarily oered for periods of less than one year. However, multiple-year warranty contracts may be arranged for up to an additional three years. Discounts are available for purchase of multiple-year contracts.Limitations of AgreementYour exclusive remedy for any defective patient simulator is limited to the repair or replacement of the defective patient simulator. CAE Healthcare may elect which remedy or combination of remedies to provide at its sole discretion. CAE Healthcare shall have a reasonable time after determining that a defective material exists to repair or replace defective material. CAE Healthcare’s replacement material will be manufactured from new and/or serviceable parts. CAE Healthcare’s agreement applies to repaired or replaced materials for the balance of the applicable period of the original warranty or ninety days from the date of shipment of a repaired or replaced material, whichever is longer. CAE Healthcare warrants its LABOR for 30 days or the balance at the applicable period of the original warranty, whichever is greater.CAE Healthcare shall not be liable under this warranty for incidental or consequential damages, or in the event of any unauthorized repairs or modications have been made or attempted, or when the product, or any part thereof, has been damaged by accident, misuse or abuse. This warranty does not cover normal wear and tear, staining, discoloration or other cosmetic irregularities that do not impede or degrade product performance. Any damage or malfunction as a result of the installation of software or hardware, not authorized by CAE Healthcare, will be repaired under the Time and Materials service plan (see Time and Materials section).CAE Healthcare’s warranty does not cover products that have been received improperly packaged, altered or physically damaged. Products will be inspected upon receipt.Some states in the USA do not allow the exclusion or limitations of incidental or consequential damages, so the limitations above may not apply to you. This warranty gives you specic legal rights and you may also have other rights, which vary from state to state.Return Materials Authorization (RMA)No product may be returned directly to CAE Healthcare without rst contacting CAE Healthcare for an RMA number. If it is determined that the product may be defective, you will be given an RMA number and instructions for product return. An unauthorized return, e.g., one for which an RMA number has not been issued, will be returned at your expense. Authorized shipments are to be shipped prepaid to the address on the RMA. Your original box and packaging materials should be kept for storing or shipping your product. To request an RMA, please contact Customer Service.
179Care and MaintenanceSystem Software Upgrade SupportCustomers with current warranty contracts are entitled to receive upgrades to applications software previously purchased. Installation of the system software is the user’s responsibility.The System Software Upgrades Support includes software upgrades for base software and purchased optional software modules.**This does not apply for major upgrades or technological enhancements.**Pricing StructureTime and MaterialsFor those systems not under agreement, service will be provided as required on a Time and Material basis:Description In-House On-SiteTechnical Support As quoted at time of repairCAE Healthcare’s prevailing labor rate with a minimum of four hours laborMaterial As quoted at time of repair As quoted at time of repairTravel N/A Priced at CAE Healthcare’s fully burdened cost plus feePrincipal period of on-site support (customer’s local time) is:Monday through Friday, 8:00 AM to 5:00 PM (customer’s time zone)• Holiday and non-business days excluded• Support outside the principle period is billed at the premium rate (hourly rate x 1.5)• A minimum of 48 hours notice is required for scheduling an on-site support call. Urgent on-site support with less that 48 hours notice will be charged at the premium hourly rate.On-site time is described as the time period commencing from arrival at customer site through departure from customer site.
180Care and MaintenanceBreakdownAfter each use, METIman should be properly disassembled and stored in a secure place. To ensure that METIman remains in good working condition, follow the prescribed CAE Healthcare breakdown procedures below. These procedures are estimated to take less than 30 minutes.Breakdown Steps12Stop All Running SCEsClean the Simulator and the Fluid System3Shut Down the Software4Power o the SimulatorStep 1: Stop All Running SCEsStop any running SCEs using the Stop button in the upper right corner of the Müse software for each SCE.Step 2: Clean the Simulator and the Fluid SystemRefer to the Maintenance Advice on the following pages for detailed instructions.Step 3: Shut Down the SoftwareTo shut down the Müse software:Click the Account Name in the lower, right-hand corner of the screen. The Logout/1. Shutdown dialog box appears. Click 2. Logout to exit the software, or click Shutdown to shut down the computer.To shut down the TouchPro software (optional):Click the 1. Settings button from the bottom, right-hand corner of the TouchPro screen.From the Settings menu, click 2. Shutdown. A warning box appears asking if you want to exit.Click 3. Shutdown.
181Care and MaintenanceStep 4: Power O the SimulatorCarefully pull back the skin on METIman’s left hip and hold the power switch for two 1. seconds. The light on the button begins to blink, indicating shutdown is in progress. After approximately 30 seconds, the light is o, and shutdown is complete. If the simulator fails to shut down when the above steps are performed correctly, hold the power button for ve seconds to force the system to power oCarefully put the skin back into place for storage.2. Maintenance AdviceSimple care and maintenance helps to ensure that METIman 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. Failure to follow these guidelines can lead to damage not covered by warranty.General Simulator CareAvoid the use of writing instruments and sharp objects near the patient simulator to prevent unattractive markings on or tears in the skin.Lubricate airway adjuncts, urinary catheters and chest tubes with silicone spray (NOT a water-based lubricant) prior to insertion. A mild detergent and warm water will remove most marks and stains. Gently rub the soiled area with a soft cloth. Do NOT use ABRASIVE soaps or pads.Prior to using moulage of any kind, CAE Healthcare suggests the application of a very light coating of petroleum jelly, followed by a light dusting of baby powder, to the simulator’s skin. This application makes cleaning the skin easier.If any of METIman’s uid systems have been used, ush out the simulator as described in the following pages. Failure to ush the systems may cause damage to the simulator.StorageWhen in regular use, METIman’s breakdown procedure and general cleanup should be sucient to prepare the simulator for storage.In addition, be certain to follow these instructions:Storage temperature should not exceed 122° F (50° C) or fall below 41° F (5° C).• If a soft-sided simulator case is being used, the simulator should lie flat.• The simulator should NEVER be stored or shipped with fluids in the system.• 
182Care and MaintenanceCare of Electronic EquipmentInstall any CAE Healthcare software updates as soon as they become available.Airway InspectionMETIman is equipped with an anatomically accurate airway that supports the practice of dicult airway management techniques. In the process of performing these techniques improperly or aggressively, the upper airway can be damaged. Because damage can occur, occasional visual inspection of the airway is recommended. Using the light of a laryngoscope blade or a ashlight, visually examine the airway. While tears in the upper airway resulting from intubation may be obvious, needle holes in the lower trachea resulting from techniques such as transtracheal jet ventilation may not be readily apparent. If damage to the airway is found, small cuts or tears may be reparable with silicone adhesive. However, for permanent repair of damaged simulators, contact CAE Healthcare Customer Service.Replacing the BatteryAfter approximately four hours of use, the simulator’s battery must be removed to be recharged or replaced with a charged battery. WARNING : When handling METIman’s batteries, be sure to adhere to all the cautions and warnings.To replace the battery:Unzip the chest skin.1. Unzipping the Chest Skin
183Care and MaintenanceLift the abdominal insert.2. Lifting the Abdominal InsertRemove the abdominal support.3. Removing the Abdominal SupportRelease the Velcro battery tie-down.4. Releasing the Battery Tie-Down Remove the abdominal supportRelease the Velcro battery tie-down
184Care and MaintenanceDisconnect the battery leads.5. Disconnecting the Battery Leads Remove the uncharged battery.6. Removing the Battery Insert a charged battery and ax the battery tie-down.7. Connect the battery leads and replace the abdominal support, ensuring both 8. ends are secure in the slits.Replace the abdominal insert and chest skin.9. Recharging the BatteryThe battery should be recharged after approximately four hours of use.To recharge the battery, disconnect and remove the battery from the simulator and connect to the external charger provided. WARNING: When handling METIman’s batteries, be sure to adhere to all the cautions and warningsRemove the uncharged batteryDisconnect the battery leads
185Care and MaintenanceRecharging should take approximately four hours.IMPORTANT: Never recharge the battery while it is connected to METIman. Draining Condensation from the SimulatorAs part of a regular preventive maintenance schedule, condensation should be drained from the simulator. Depending on environmental conditions, moisture may condense inside the compressed air lines and tanks within the simulator. It is recommended that this uid be drained every 40 hours of operation. In outside, high-humidity conditions, the system should be drained more frequently. To drain condensation:Locate the Condensation Drain Hose included with the Inventory Kit. 1. Condensation Drain HoseBring the hose and a small bucket to the simulator location.2. Locate the 3. EXTERNAL AIR port on METIman’s left shoulder.With assistance, place METIman into a supine position.4. Power on METIman. Do NOT launch the Müse software. 5. Allow 60 seconds for the internal compressor to pressurize the system.6. Power down METIman. 7. With assistance, raise the left leg 45 degrees.8. Place the tubing end of the Condensation Drain Hose into the small bucket and 9. then connect the tting onto the simulator’s drain connector. There will be a sudden release of pressure into the bucket. Any condensation within the system drains with this exhaust.Disconnect the Condensation Drain Hose from the simulator. 10.
186Care and MaintenanceCleaning the Simulator and the On-Board Bleeding SystemNOTE: A small bucket is recommended to collect wastewater during cleaning and ushing operations.To clean and maintain the simulator and On-Board Bleeding system:Remove and clean the wound haptics.1. Connect the beige-colored “ll” connector from the Trauma Fill Tank to the hip, but 2. do not connect the white “vent” connection. Open the yellow Pressure Relief knob clockwise on the Trauma Fill Tank or loosen 3. its Fill Lid so the tank is able to vent during this draining process.With the wound umbilicals in place, put the ends of both wound umbilicals into a 4. wastewater bucket. From the Müse home screen, click the 5. System Administration button in the top right of the screen. From the Maintenance screen, click 6. Flush System. The uid begins to drain.Verify both channels produce a high, steady ow. 7. When uid stops owing from either wound umbilical, detach the Fill Tank from 8. the simulator. When uid stops owing from the lower wound umbilical, detach from the 9. simulator. When uid stops owing from the upper wound umbilical, detach from the 10. simulator.Click 11. Done on the Maintenance screen. The uids are now drained. Empty the wastewater bucket. 12. Rinse out the Trauma Fill Tank and ll with approximately 1 liter of clean, distilled 13. water. Pump this uid into the simulator14. .Repeat Steps 3 through 7 and 9 through 15 until the uid exiting the simulator 15. runs clear.Empty the Fill Tank and dry the wound umbilicals with a towel before storage.16. NOTE: It takes two to three minutes for this nal ush.Once a month, it is advised to ush the system with a mix of 50% distilled water and 50% white vinegar to keep mineral and algae buildup to a minimum. Always perform the steps for Flushing the Simulator afterward to remove vinegar.
187Care and MaintenanceCleaning the Trauma Fill Tank To prolong the life of the Trauma Fill Tank assembly and the uid reservoirs, wash and ush the tank and connections after each use with clean distilled water.NOTE: A small bucket is recommended to collect wastewater during cleaning and ushing operations.Do NOT store liquids in the Trauma Fill Tank. If simulated blood mixtures are stored in the tank, they may clog the system when they dry and possibly damage the seals, lter and other components.Remove and rinse the Overow Bottle.1. Remove and rinse the Pump Assembly.2. Rinse the tank to remove all traces of the simulated blood.3. Pour 480 mL (16 oz) of distilled water into the tank and reinstall the Pump 4. Assembly. (The Overow Bottle holds 16 ounces.)Place the Overow Bottle lid with umbilical attached into the wastewater bucket.5. Attach the ll (blue-labeled) and vent (yellow-labeled) ttings together at the 6. other end of the umbilical.Pump the tank 25 times while making sure the wastewater is going into the 7. bucket.Allow the tank to empty completely (the remaining air pressure will purge the 8. uid from the lines.Reinstall the lid onto the Overow Bottle and place the bottle back onto the tank 9. assembly.Remove the Pump Assembly and pour any remaining uid out of the tank. Then, 10. reinstall the pump.Disconnect the ll and vent ttings from each other and wrap the Trauma Tank 11. Umbilical around the neck of the tank.Always depressurize the tank, remove trauma uid and clean the tank before performing maintenance. The pump assembly may need periodic lubrication. Call CAE Healthcare Customer Service for details if the pump loses the ability to create pressure, squeaks loudly or is dicult to move.
188Care and MaintenanceCleaning the In-Line FilterTo clean the in-line lter:Grasp both ends of the in-line lter and twist counterclockwise.1. Pull apart both ends of the lter to separate.2. Remove the blue lter cone from the encasement. Do NOT remove the black 3. rubber seal. Using a 60 mL syringe with distilled water, push uid from the outside of the blue 4. lter cone to the inside, removing all debris. Repeat process until all debris is removed. 5. Re-assemble the in-line lter, ensuring the black rubber seal is in place at the base 6. of the blue lter cone. The In-Line Filter
189Care and MaintenanceTroubleshooting the Trauma Fill TankBefore making any repairs, ALWAYS depressurize the tank, remove all trauma solution and clean the tank.Problem Cause SolutionTank can be pressurized, but only air comes out.Siphon tube has detached from insert.Remove hose from tank and reinsert siphon tube.Pressure does not build up. No uid is transported to simulator.(1) Pump assembly not sealed tightly into tank or(2) Damaged pump cylinder gasket or o-ring or(3) Tank pressure relief valve is set to “open.”(1) Thoroughly clean pump cylinder gasket or o-ring and surrounding area and apply a light coating of silicone to pump gasket or o-ring.(2) Contact CAE Healthcare for service.(3) Turn valve until it returns to a “sealed” position.Simulator ll time is too long (more than 5 minutes).(1) Not enough strokes applied to create pressure or (2) The in-line lter is dirty or (3) The umbilical is disconnected at Overow Bottle or (4) Too much uid in ll tank.(1) Pump 25 to 35 times for best performance.(2) Clean lter.(3) Reconnect the overow tting.(4) The Trauma Fill Tank works best with 1 gallon (3.6 liters) of uid inside. If greater amounts of uid are used, tank may require additional pumps as uid is transported to simulator.
190Care and MaintenanceEmptying and Flushing the Chest Tube ReservoirRemoving uids from the Chest Tube reservoir and the Chest Tube system requires the same steps. To empty the Chest Tube reservoir or ush the Chest Tube system, have a chest tube and a basin to catch uid in place. Use a syringe to slowly push air through the appropriate CHEST TUBE port until only air ows through the chest tube.Flushing the IV LinesTo ush the IV lines:Connect an empty IV bag to the 1. IV DRAIN port.Using a syringe, slowly push air into the 2. IV FILL port. The uid drains out of the IV DRAIN port.Continue to push air until empty.3. Emptying the Genitourinary ReservoirTo empty the Genitourinary reservoir, have a catheter in place and a basin to catch uid. Use a syringe to slowly push air through the GU port until only air ows through the catheter. Emptying the Head Secretions Lines (Prehospital Only)To remove uid from the Head Secretions lines, connect a syringe to the NOSE port and vacuum out uid until empty. Repeat this process for the MOUTH and EYES ports.Emptying the Airway Secretions Reservoir (Nursing Only)To empty the Airway Secretions reservoir, connect a 60 mL syringe to the AIRWAY FILL port and vacuum out uid until empty.Flushing the Subclavian Catheter (Nursing Only)When ushing the Subclavian Catheter, the catheter must be in place.To ush the Subclavian Catheter: Connect an external drain to the 1. IV DRAIN port and place a basin to catch uid.Using a syringe, slowly push air into the2. IV FILL port. The uid drains out of the IV DRAIN port.Continue to push air until empty.3. Using the same syringe, push air through the Subclavian Catheter until empty. 4.
191Care and MaintenanceHandling CO2 Canisters (Prehospital Only)Careful handling is required in the use of CO2 canisters. Please read and follow all appropriate cautions and warnings. Removing CO2 Canisters from the RegulatorThe following instructions describe how to safely remove the CO2 canister from the regulator assembly for replacement or shipping.CAUTION: If unsure that CO2 canister is empty, eye and hand protection must be worn to protect from release of freezing gas or liquid.Remove the CO1. 2 regulator assembly from the simulator.While holding the regulator assembly rmly, slowly unscrew the CO2. 2 canister from the regulator. There is a small relief hole in the side of the regulator from which any remaining CO2 will bleed. If this should happen, no harm will be done to system, but it is rather noisy and the rapid release of CO2 gas can freeze the canister’s surface and cause frostbite to unprotected skin.Continue unscrewing the canister until it is free from the assembly.3.
192Care and MaintenanceImportant Canister InformationThe 16 Gram CO2 Canister with threaded neck is available at most sports equipment retailers - most often used for bicycle tire inators. We recommend purchasing Leland brand canisters (P/N 82122Z), which are also available from CAE Healthcare.Punctured canisters are considered to be empty. No residue remains in the canister after use. The steel used is a low carbon type, which rusts if disposed in a landll. If your community requires recycling, then place with normal household recycling. CO2 Canisters are considered by the U.S. Department of Transportation to be “Other Regulated Materials - Domestic” (ORM-D). Ground shipping containers must be clearly marked with this label. CO2 Canisters are considered hazardous material when oered for air transportation, so dierent rules apply. Contact carrier for details and instructions.Related CAUTIONS/WARNINGSCO2 CanisterStore the CO•  2 canisters in a dry location between 32° and 104° F (0 to 40°C).Do not expose the CO•  2 canister to heat above 140° F, as rupture may occur.Never point the CO•  2 canister towards your face or someone nearby.Use only CAE Healthcare specified CO•  2 canisters.CO2 Regulator AssemblyCare must always be taken when using high-pressure equipment.• Do not disassemble or alter regulator.• Dry completely if the regulator becomes wet.• Discontinue use of this equipment if leakage or visible damage is evident.• Use of EquipmentCanister end becomes punctured when screwed into regulator base and therefore • should not be removed until empty.Unscrewing canister before it is empty will result in sudden release of all high-pressure • gas with a possibility of liquid CO2 spray. Unprotected skin could receive freezing burns.Wear protective gloves and eye protection when removing canister from regulator • assembly. Remove CO•  2 canister from regulator assembly when shipping simulator.
193Condition Guidelines for Programming METImanCondition Guidelines for Programming METImanThis card is intended to help you select Müse conditions to achieve desired vital signs within each programmed state. All four conditions should be programmed into each state in the order presented below. Respiratory: Desaturation• Cardiovascular: Blood Pressure• Cardiovascular Heart Rate• Respiratory: Respiratory Rate • The Müse software is physiologically driven. When using multiple conditions (e.g., Desaturation + Hypertension + Tachycardia + Tachypnea), physiological regulatory mechanisms such as the baroreceptor reex and ventilatory control cause compensatory changes within parameters. To achieve the desired vital sign, select one condition level, above (greater) or below (less), to achieve the desired physiological eect.Respiratory: DesaturationDesaturation SpO2 ValueReset 98%High 90s 96-97%Mid 90s 94-96%Low 90s 91-93%High 80s 87-90%Mid 80s 84-86%Low 80s 80-83%High 70s 77-80%Mid 70s 74-77%Low 70s 69-71%Less than 70 <69%
194Condition Guidelines for Programming METImanCardiovascular: Blood PressureHypertension HypotensionReset 110s/70s Reset 110s/70sIncreased 120s/80s Decreased 100s/70sPre-Borderline 130s/80s Pre-Borderline 100s/60sBorderline 140s/90s Borderline 90s/50sMild 150s/90s Mild 80s/40sModerate 160s/100s Moderate 70s/40sSevere 170s/100s Severe 60s/30sProfound 190s/110s Profound 50s/30sExtreme 220s/120s Extreme 40s/30s
195Condition Guidelines for Programming METImanCardiovascular: Heart RateTachycardia BradycardiaReset 70s Reset 70sIncreased High 70s Decreased Mid 60sElevated 80s Pre-Borderline Low 60sPre-Borderline 90s Borderline Mid 50sBorderline 100s Intermediate Low 50sIntermediate 110s Mild High 40sMild 120s Moderate Mid 40sModerate 130s Severe Low 40sSevere 140s Extreme Mid 30sSupra 150s Acute Low 30sProfound 160sExtreme 170sAcute High 170s
196Condition Guidelines for Programming METImanRespiratory: Respiratory RateTachypnea BradypneaReset 11 Reset 11Increased 15 Increased 10Elevated 18 Intermediate 9Borderline 20 Mild 7Intermediate 22 Moderate 6Mild 25 Severe 5Moderate 28 Profound 3Severe 31 Extreme 2Profound 33Extreme 36
A-1Appendix A – Parameter DescriptionsAppendix A – Müse Parameter DescriptionsThe Müse software has a number of parameters that control the physiological features of METIman The parameters are grouped by category: Neurological, Respiratory, Cardiovascular, Fluids and Sounds. The following is a brief description of each parameter. Each parameter description lists the default settings for the Stan D. Ardman II and Norma L. Female patients as well as the ranges, if available, for all patients.NeurologicalMETIman can simulate a variety of neurological clinical indicators, such reactive eyes and convulsions. Neurological ParametersEyes: Pupil SizeEy es: Blink SpeedConvulsionsICPNMBTe mperature: BodyTe mperature: BloodEyesEach eye has reactive pupils and eyelids that blink and close.
A-2Appendix A – Parameter DescriptionsEyes: Pupil DiameterThese parameters are used to control the diameter of the pupils in the eyes. Each eye has reactive pupils and functional eyelids that blink.Currently, there are four pupil options that are used to control the diameter of the pupils in both eyes: Reactive, Non-Reactive, Pinpoint or Blown.When the Eyes are set to Reactive, the pupils re-size in response to changes in lighting condition. If both pupils are set to Reactive, both pupils re-size in a consensual manner.The Non-Reactive, Pinpoint and Blown settings allow the user to x one or both pupils to a specic size. The Non-Reactive setting xes pupils to a normal size, the Pinpoint setting xes pupils in the pinpoint position and the Blown setting xes pupils in the blown position. Default: ReactiveEyes: BlinkingIn Auto mode, the eyelids are normally blinking under the following conditions: Minute Ventilation is greater than 1500 mL, SpO2 is greater than 70% and neuromuscular blockade (NMB) is less than 30%. The Blinking and Closed settings allow the user to have one or both eyes either blinking or closed and override the automatic response. Default: AutoThe Slow, Normal and Fast parameters control the eyelid blinking frequency. Presently, blinking frequency is not linked to the physiological models. However, the response can be done “on the y” or scripted using the Scenario Designer. Default: NormalConvulsionsThe Convulsions parameter is used to simulate the presence of convulsions. They are either ON or OFF. Default: O
A-3Appendix A – Parameter DescriptionsIntracranial Pressure (ICP) The ICP parameter is used to set the ICP displayed as a numeric value on the TouchPro monitor. The base value is set at 8 mmHg. This parameter is uninuenced by physiological models. Default: 8 mmHg Range: 0.0 mmHg - 65.0 mmHgNeuromuscular Blockade (NMB)The pharmacokinetic and pharmacodynamic models based on the neuromuscular blocking agents administered and the time course of their injection automatically determines the degree of NMB. For some educational applications, however, the instructor may wish to set a xed degree of neuromuscular blockade that remains stable for an indenite period. This can be accomplished using the NMB parameter. The default setting instructs the pharmacologic models to determine the degree of neuromuscular blockade based upon the drugs injected and their pharmacologic properties.When a positive numeric value is assigned to this parameter, the degree of NMB is set to that level. For example, 80% NMB causes the simulator to set the degree of NMB to 80%, regardless of the presence (or absence) of neuromuscular blocking drugs. Clinically, the spontaneous tidal volume is markedly reduced. Default: Modeled Range: 0% - 100%Temperature: BodyThe temperature measured at the body surface can be set using this parameter and can be displayed on the Patient Status Display and TouchPro software. The body temperature is not linked to the physiologic models. However, changes can be made “on the y” or scripted using the Scenario Designer. Default: 36.5° C Range: 32.0° C - 42.0° C
A-4Appendix A – Parameter DescriptionsTemperature: BloodThe arterial blood temperature can be set using the Temperature: Blood parameter. The arterial blood temperature can then be displayed on the Patient Status Display and TouchPro software. Note that changes in arterial temperature may alter the shape of the standard oxyhemoglobin dissociation curve. As temperature increases or pH decreases, more oxygen is released from hemoglobin and thus the patient’s saturation decreases. The inverse is also true. Default: 37° C Range: 32.0° C - 42.0° CRespiratory ParametersRespiratory Parameters Swollen TongueAirway Occluder (Prehospital Only)Laryngospasm (Prehospital Only)Ne edle Decompression (Left and Right) (Prehospital Only)Br onchial OcclusionRespiratory Rate
A-5Appendix A – Parameter DescriptionsRespiratory Parameters SpO2NMBTidal VolumeIn trapleural Volume: LeftIn trapleural Volume: RightChest Tube Flow: Left Ch est Tube Flow: Right Swollen TongueThis parameter is used to create tongue swelling. The tongue is either Swollen or Not Swollen. The Not Swollen setting returns the tongue to its normal anatomic state. Default: Not Swollen Options: Not Swollen, Swollen
A-6Appendix A – Parameter DescriptionsAirway Occluder (Prehospital Only) Using the Airway Occluder parameter, swelling of the posterior oropharynx can be activated to obstruct the view of the larynx and prevent intubation but allow mask ventilation of the patient’s lungs, thereby creating a “cannot intubate, can ventilate” scenario. Default: OLaryngospasm (Prehospital Only)Use the Laryngospasm parameter to simulate a laryngospasm. A laryngospasm actuator closes the patient’s vocal cords and prevents both ventilation and intubation. When activated with the Airway Occluder parameter, a “cannot ventilate, cannot intubate” crisis scenario is achieved. Default: ONeedle Decompression (Left and Right) (Prehospital Only)The Needle Decompression parameter is used to activate the Needle Decompression hardware in the simulator to relieve a pneumothorax in the simulator. This causes a rush of air to be heard on successful decompression. The amount of decompression is automatically subtracted from the Intrapleural Volume set. Default: O Bronchial OcclusionTurning on the Bronchial Occlusion parameter completely obstructs the right or left bronchi, simulating a lower airway obstruction (e.g., mucus plug). Improper intubation creates a main-stem occlusion, yielding an inability to ventilate the lungs. However, the right and left bronchi are not occluded individually. Default: ORespiratory Rate The Respiratory Rate parameter is used to set the respiratory rate to a given number of breaths per minute. Once set, arterial oxygen and carbon dioxide values have no eect on the resulting respiratory rate, but continue to inuence other components of the physiological models. The patient continues to breathe at the set number of breaths per minute, regardless of the arterial oxygen or carbon dioxide levels.
A-7Appendix A – Parameter DescriptionsFor example, when the respiratory rate is set to 10 breaths per minute, the respiratory rate remains at 10 breaths per minute, regardless of arterial oxygen or carbon dioxide levels. In such situations, the patient can only respond to arterial oxygen or carbon dioxide levels by adjusting the Tidal Volume parameter. Default: Modeled Range: 4 breaths per minute - 40 breaths per minuteSpO2 The SpO2 parameter is used to override the normal pulmonary circulation and set the SpO2 at a xed numeric value, regardless of the oxygen applied. Resetting to Modeled returns control of the underlying SpO2 to the physiological models. Default: Modeled Range: 0% - 100%Neuromuscular Blockade (NMB)The degree of NMB is automatically determined by pharmacokinetic and pharmacodynamic models, which are based on the neuromuscular blocking agents administered and the time course of their injection. For some educational applications, however, the instructor may wish to set a xed degree of neuromuscular blockade that remains stable for an indenite period. This can be accomplished using the NMB parameter. The default value instructs the pharmacologic models to determine the degree of neuromuscular blockade based on the drugs injected and their pharmacologic properties.When a positive numeric any other positive value is assigned to this parameter, the degree of NMB is set to that level. For example, 80% NMB causes the simulator to set the degree of NMB to 80%, regardless of the presence (or absence) of neuromuscular blocking drugs. Clinically, the spontaneous tidal volume is markedly reduced. Default: Modeled Range: 0% - 100%Tidal VolumeThe Tidal Volume parameter is used to set the tidal volume to a given volume per breath. Once Tidal Volume is set to a numeric value, arterial oxygen and carbon dioxide values have no eect on the tidal volume, but continue to inuence other components of the physiological models.For example, with the tidal volume set to 600 mL in the adult simulator, the tidal volume
A-8Appendix A – Parameter Descriptionsremains a constant (set) 600 mL even in the event of falling arterial oxygen levels. In such situations, the patient can only respond to arterial oxygen or carbon dioxide levels when the respiratory rate is adjusted. Default: Modeled Range: 0 mL- 2500 mLIntrapleural Volume (Vol): (Left and Right)The Intrapleural Vol parameters allow intrapleural volume to accumulate, for example, as happens during pneumothorax, hydrothorax or hemothorax. To simulate a pneumothorax, set the corresponding Intrapleural Vol to a value greater than 0 mL. Values more than 1500 mL reduce the corresponding lung volume signicantly. The breath sounds are automatically diminished on the appropriate side due to decreased ventilation of the aected lung. Default: 0 Range: 0 mL - 2500 mLChest Tube Flow: (Left and Right) The Chest Tube Flow parameter is used with the chest tube feature of the simulator. The Chest Tube Flow species the rate at which uid can be removed from the simulated pleural space via a chest tube drainage system. As the chest tube drains, the volume is automatically subtracted from the set amount of Intrapleural Volume. Default: 50 mL per minute Range: 0 mL per minute - 50 mL per minuteCardiovascular ParametersCardiovascular Parameters Blood PressureHeart RateCardiac Rhythm
A-9Appendix A – Parameter DescriptionsCardiovascular Parameters Arterial CatheterCe ntral Venous CatheterPA CatheterPA BalloonDebPacing CurrentPacing RatePa cing Capture ThresholdCold Fluid InjectBlood Pressure The Blood Pressure parameter is used to override the physiological modeling for blood pres-sure. The systolic and diastolic blood pressures can both be set to xed numeric values, regard-less of interventions performed. Resetting the parameter to Modeled returns control of the underlying Blood Pressure to the physiological models. Default: Modeled Range: Systolic 20 mmHg - 200 mmHg Diastolic 10 mmHg - 200 mmHgHeart RateThe Heart Rate parameter is used to set the heart rate to a given (xed) number of beats per minute. Once the heart rate is set to a numeric value, administered drugs or intravascular volume changes have no eect on the heart rate, but continue to inuence other components of the physiological models. Use this parameter to “x” or set the heart rate to a specic number. Default: Modeled Range: 30 beats per minute - 220 beats per minute
A-10Appendix A – Parameter DescriptionsCardiac RhythmThe Cardiac Rhythm parameter is used to change the patient’s underlying cardiac rhythm displayed on the Patient Status Display, TouchPro software or physiological monitor. To change the cardiac rhythm, click the Cardiac Rhythm parameter and select the desired rhythm from the available list. If a number appears following the cardiac rhythm on the list, this overrides the heart rate to the rate indicated. Default: Modeled Options: Modeled Asystole Atrial Enlargement, Left Atrial Enlargement, Right Atrial Fibrillation Atrial Fibrillation: HR 120 Atrial Fibrillation: HR 80 Atrial Flutter with 2:1 AV Conduction Atrial Flutter: HR 150 Atrial Tachycardia AV Block, First-Degree AV Block, Second-Degree - Mobitz I AV Block, Second-Degree - Mobitz II AV Block, Third-Degree Bundle Branch Block, Incomplete Right Bundle Branch Block: Left Bundle Branch Block, Left with PVC 25% Bundle Branch Block: Right Hypercalcemia Hyperkalemia Hypertrophy, Biventricular Hypertrophy, Left Ventricular Hypertrophy, Right Ventricular Hypocalcemia Hypokalemia Hypothermia Junctional Junctional: HR 50 Long QT Syndrome Myocardial Infarction with LBBB Myocardial Infarction, Anterior
A-11Appendix A – Parameter Descriptions Myocardial Infarction, Anterolateral Myocardial Infarction, Inferior Myocardial Infarction, Lateral Myocardial Infarction, Posterior Myocardial Infarction, Septal Myocardial Ischemia: Mild Myocardial Ischemia: Moderate Myocardial Ischemia: Moderate with PVC 10% Myocardial Ischemia: Severe Paroxysmal Junctional Tachycardia Paroxysmal Junctional Tachycardia: HR 130 Pericarditis Premature Atrial Contraction Premature Ventricular Contraction 10% Premature Ventricular Contraction 25% Pulseless Electrical Activity Sinus Sinus Bradycardia Sinus Bradycardia: HR 40 Sinus Tachycardia Sinus Tachycardia: HR 120 ST Elevation with Chest Pain Torsade de Pointes Trifascicular Block Ventricular Fibrillation: Coarse Ventricular Fibrillation: Fine Ventricular Tachycardia Ventricular Tachycardia: Pulseless Ventricular Tachycardia: HR 151 Ventricular Tachycardia: Pulseless HR 151 Wellen’s Syndrome WPW Syndrome, Left Lateral Pathway
A-12Appendix A – Parameter DescriptionsArterial CatheterThe arterial pressure displayed on the Patient Status Display or TouchPro software is set using this parameter. A non-pulsatile, “zero” pressure signal is emitted when the Atmosphere position is selected and can be used to simulate zeroing a pressure transducer. This may also be used to remove the arterial pressure waveform, if desired. The Left Ventricle position is useful for simulating cardiac catheterization procedures, or for demonstrating left ventricular end-diastolic pressure and its relationship to pulmonary artery occlusion (“wedge”) and central venous pressure. Default: Peripheral Artery Options: Atmosphere Peripheral Artery Left VentricleCentral Venous CatheterThe venous pressure displayed on the Patient Status Display or TouchPro software is set using this parameter. A non-pulsatile, “zero” pressure signal is emitted when the Atmosphere position is selected and can be used to simulate zeroing a pressure transducer. This may also be used to remove the central venous pressure waveform, if desired (i.e., beginning of an SCE with an “unmonitored” patient). Default: Intrathoracic Vein Options: Atmosphere Extrathoracic Vein Intrathoracic VeinPulmonary Artery (PA) CatheterThe pulmonary artery pressure displayed on the Patient Status Display or TouchPro software is set using this parameter. A non-pulsatile, “zero” pressure signal is emitted when the Atmosphere position is selected and can be used to simulate zeroing a pressure transducer. This may also be used to remove the pulmonary artery pressure waveform, if desired (i.e., beginning of an SCE with an “unmonitored” patient). The pulmonary artery catheter can be “oated” into position by sequencing through the right heart positions. This may also be scripted into a scenario using the Scenario Designer. Default: Pulmonary Artery Options: Atmosphere Intrathoracic Vein Right Atrium Right Ventricle Pulmonary Artery
A-13Appendix A – Parameter DescriptionsPA BalloonInation of the pulmonary artery catheter balloon is simulated by switching to the Inated option of the PA Balloon parameter. The appropriate pulmonary artery occlusion or “wedge” waveform is then displayed on the Patient Status Display or TouchPro software. Default: Deated Options: Deated InatedDebrillation (Deb)The Deb parameter is used to simulate a specied amount of energy discharged via an external cardiac debrillator. Setting this parameter results in the characteristic spike in the ECG, followed by a return to the pre-debrillation rhythm. Deb has no direct eect on the electrical conduction system of the heart. Thus, synchronized cardioversion may be done “on the y” or scripted using the Scenario Designer. Default: 0 Joules Range: 0 Joules- 360 JoulesPacing CurrentThe Pacing Current parameter is used to simulate a specied amount of current discharged via an external cardiac pacer. Setting this parameter results in the characteristic pacing signal on the ECG waveform when the pacing current is at or above the capture threshold. Also, see Pacing Capture Threshold. Default: 0 mA Range: 0 mA- 200 mAPacing RateThe Pacing Rate parameter determines the cardiac rate (in beats/minute) when the pacing current is at or above the pacing capture threshold. Also, see Pacing Current and Pacing Capture Threshold. Default: 80 beats per minute Range: 0 beats per minute - 119 beats per minute
A-14Appendix A – Parameter DescriptionsPacing Capture ThresholdThe Pacing Capture Threshold parameter determines the minimum pacing current necessary to pace the heart via an external cardiac pacer. Also see Pacing Current. Pacing current values below the pacing capture threshold have no eect on the patient’s heart rate. Default: 50 mA Range: 0 mA - 119 mACold Fluid Inject The Cold Fluid Inject parameter is used to simulate the injection of 10 mL iced saline into the pulmonary artery catheter. The appropriate Thermodilution waveform and cardiac output measurement are then displayed on the Patient Status Display or TouchPro software.
A-15Appendix A – Parameter DescriptionsPulsesThe tables below show the defaults and ranges for the pulses and pulse decits for METIman Prehospital and METIman Nursing.METIman PrehospitalPulse Default RangeLeft Carotid On N/ARight Carotid On N/ACarotid Decit 60 0 - 300Left Brachial On N/ARight Brachial On N/ABrachial Decit 80 0 - 300Left Radial On N/ARight Radial On N/ARadial Decit 90 0 - 300Left Femoral On N/ARight Femoral On N/AFemoral Decit 70 0 - 300Left Popliteal On N/ARight Popliteal On N/APopliteal Decit 80 0 - 300Left Dorsalis Pedis/Left Posterior TibialOn N/ARight Dorsalis Pedis/Right Posterior TibialOn N/ADorsalis Pedis/Posterior Tibial Decit 80 0 - 300
A-16Appendix A – Parameter DescriptionsMETIman NursingPulse Default RangeLeft Carotid On N/ARight Carotid On N/ACarotid Decit 60 0 - 300Left Brachial On N/ARight Brachial On N/ABrachial Decit 80 0 - 300Left Radial On N/ARight Radial On N/ARadial Decit 90 0 - 300Left Femoral On N/ARight Femoral On N/AFemoral Decit 70 0 - 300Left Popliteal On N/ARight Popliteal On N/APopliteal Decit 80 0 - 300Left Dorsalis Pedis On N/ARight Dorsalis Pedis On N/ADorsalis Pedis Decit 80 0 - 300Left Posterior Tibial On N/ARight Posterior Tibial On N/APosterior Tibial Decit 80 0-300All pulses, unless altered by an SCE, are enabled by default. To disable a pulse, click the pulse location on the human form. To enable a pulse, click the pulse location again. Click and hold a pulse location to adjust the pulse decit.
A-17Appendix A – Parameter DescriptionsFluids The blood droplet provides a means of controlling the amount of uid lost by or infused into the patient. The amount of uid to be lost or infused and the time frame during which the uid loss or infusion takes place can be entered.Fluid ParametersFluid Loss BloodFluid Loss PlasmaColloid InfusionCrystalloid InfusionPRBC InfusionWhole Blood InfusionBleeding: UpperBleeding: LowerFluid Loss Blood When used, the Fluid Loss Blood parameter reects a decrease in total blood volume. Blood loss proportionally decreases both the red blood cell volume and the plasma volume according to the current hematocrit. Range: 0 mL - 4000 mLFluid Loss Plasma When used, the Fluid Loss Plasma parameter reects a decrease in plasma volume. Plasma loss decreases the plasma volume without changing the red blood cell volume. It refers collectively and generically to all uid losses, including evaporative, transcellular, bowel and third space uid losses. Range: 0 mL - 4000 mLColloid Infusion When used, the Colloid Infusion parameter reects an addition to the plasma volume without changing the red blood cell volume. Colloids include modied uid gelatin starch solutions, dextran and human albumin. Range: 0 mL - 4000 mL
A-18Appendix A – Parameter DescriptionsCrystalloid Infusion When used, the Crystalloid Infusion parameter reects an addition to the plasma volume without changing the red blood cell volume. The term crystalloid is used to describe salt solutions for infusion (i.e., normal saline, dextrose in water and Ringer’s Lactate). Range: 0 mL - 4000 mLPRBC Infusion Packed red blood cells are a preparation of 70% red blood cells and 30% liquid plasma, often administered in severe anemia to restore adequate levels of hemoglobin and red cells without overloading the vascular system with excess uids. Range: 0 mL - 4000 mLWhole Blood Infusion The term whole blood is used to refer to blood that has not been separated into its various components. It represents a preparation of 40% red blood cells and 60% liquid plasma. Range: 0 mL - 4000 mLBleeding: Upper The Bleeding: Upper parameter is used to activate the site of bleeding. Default: OBleeding: Lower The Bleeding: Lower parameter is used to activate the site of bleeding. Default: O
A-19Appendix A – Parameter DescriptionsSoundsA variety of simulated sounds are available to enhance realism.Bowel SoundsBowel SoundsNormalHypoactiveHyperactiveNoneNormal, Hypoactive, Hyperactive and absent bowel sounds (None) are selected using this parameter. Independent control of the type and volume of bowel sounds may be selected in each anatomical region. Bowel Sounds LocationsAll Bowel SoundsLUQ Bowel SoundsRUQ Bowel SoundsLLQ Bowel SoundsRLQ Bowel SoundsTo aect the bowel sounds simultaneously in all anatomical regions, select All Bowel Sounds and the desired sound. Default: Normal NOTE: The volume control slider underneath each area may be used to adjust the amplitude of the sound.
A-20Appendix A – Parameter DescriptionsBreath SoundsNormal and abnormal breath sounds are selected using this parameter. Breath sounds are independently synchronized with ventilation of the left and right lungs. Independent control of the type and volume of breath sounds may be selected in each anatomical region. Breath Sounds LocationsAll Breath SoundsBreath Left Upper SoundsBreath Right Upper SoundsBreath Left Lower SoundsBreath Right Lower SoundsBreath SoundsNormalCracklesDiminishedGurglingPleural RubRhonchiWheezingTo aect the breath sounds simultaneously in all anatomical regions, select All Breath Sounds and the desired sound. Default: NormalNOTE: The volume control slider underneath each area may be used to adjust the amplitude of the sound.
A-21Appendix A – Parameter DescriptionsHeart SoundsNormal and abnormal heart sounds are selected using this parameter. Heart sounds are synchronized with the cardiac cycle. Heart SoundsNormalS3S4S3 and S4Early Systolic MurmurMid Systolic MurmurLate Systolic MurmurPan Systolic MurmurLate Diastolic Murmur Default: NormalNOTE: The volume control slider may be used to adjust the amplitude of the sound.
A-22Appendix A – Parameter DescriptionsSpeech SoundsSpeech Sounds include a male or female voice, based on the gender of the active patient, that can utter pain rating indicators from 0 to 10, various phrases and a series of other utterances. Unlike Vocal Sounds, Speech Sounds only play once. Speech SoundsLoud coughSoft coughShort Loud CoughShort Soft CoughScreamGrunt“Yes”“No”“Sometimes”“Ouch”“10, 9, 8, 7, 6...”“My leg hurts”“My belly hurts”“My chest is tight”“I can’t breathe”“Ow, that hurts”“0” through “10” - Pain Ratings“Sharp”“Pressure”“Aching”“Dull”“Stabbing”To play a Speech Sound, click the Speech balloon. A list of Speech Sounds appears.Select the desired sound. The sound plays once, and the list disappears. To replay the last sound, click the Play button in the Speech balloon.
A-23Appendix A – Parameter DescriptionsThroat SoundsThe Stridor throat sounds option from the simulator is selected using the Throat Sounds parameter. The stridor is synchronized with ventilation of both lungs. Default: NoneNOTE: The volume control slider may be used to adjust the amplitude of the sound.
A-24Appendix A – Parameter DescriptionsVocal SoundsTo have the simulator emit the various vocal sounds, select the one desired. It immediately begins to play in a continuous loop until None is selected.A variety of programmable Vocal Sounds are available. Vocal Sounds are male or female based on the gender of the active patient. Vocal SoundsNoneCryingGaggingGaspingGroaningLong Loud CoughLong Soft CoughWheezingMumblingTo select a sound from the Vocal Sounds drop-down menu, click the Sounds button on the Run screen. The Sounds panel appears. Click Vocal Sounds and select the type of sound desired from the Vocal Sounds drop-down menu. Default: NoneNOTE: The volume control slider may be used to adjust the amplitude of the sound.
B-1Appendix B – Wireless Voice LinkAppendix B - Wireless Voice LinkThis information is intended to assist in preparing Wireless Voice Link (WVL) devices for use in conjunction with METIman.Cautions and WarningsThis device complies with part 15 of the FCC Rules and with Industry Canada licence-exempt RSS standard(s). Operation is subject to the following two conditions: This device may not cause interference.1. This device must accept any interference, including interference that may cause 2. undesired operation of the device.Cet appareil est conforme aux normes d’Industrie Canada exempts de licence RSS (s). Son fonctionnement est soumis aux deux conditions suivantes: Cet appareil ne doit pas provoquer d’interférences.1. Cet appareil doit accepter toute interférence, y compris les interférences pouvant 2. provoquer un fonctionnement indésirable de l’appareil.Any modications made to this device without the express approval of CAE could void the user’s authority to operate this equipment.
B-2Appendix B – Wireless Voice LinkWhat’s IncludedThe WVL package includes the following items:Wireless Voice Link Handset (1)•Olympus ME52W Standalone Microphone (1)•AAA Alkaline Batteries (2)•Quick Start Guide (1)•How It WorksThe WVL is a radio pair that operates in the 2.4 GHz unlicensed radio band. The handset communicates wirelessly with the base station located inside the simulator. The base station converts the digitized microphone stream from the handset and outputs it via the base station to the headphone and line out jacks. The output projects through the head speakers inside the simulator.To accommodate multiple WVL pairs in close proximity, each WVL is assigned two RF channels on which to operate. The RF channels divide up the 2.400 – 2.4835 GHz spectrum in 80 single frequencies to prevent the WVLs from interfering with each other.Due to the nature of the unlicensed 2.4 GHz band, there may be other devices such as Wi-Fi, microwave ovens or Bluetooth® radios operating in the 2.4 GHz band as well. Therefore, two channels are used to transmit the audio stream redundantly to avoid interference. In case there is an interference in one channel, the other can be used to extract the audio stream.To operate correctly, both the handset and base station should be set to the same frequency using the DIP switches located in the devices. If the interference is too high, the WVL rmware has the ability to change channels automatically to avoid interruption. This process occurs simultaneously in both the handset and the base station without the need for user intervention. The units revert back to the original frequency set on the DIP switches when both devices are restarted using the power switch.Recommendations for UseTo receive the best sound quality from the WVL, please note the following recommendations:Do not separate the WVL pair with more than two walls. •Use channels 0 through 11 for the best sound quality.•Use channels 12 through 31 if more than 12 simulators are present in one area.•
B-3Appendix B – Wireless Voice LinkWireless Voice Link DevicesThere are two unique devices that make up a WVL pair: the handset device and the base station device. The base station device is located inside the simulator, while the handset device is battery powered and carried by the user. The handset transmits voice input through a microphone to the base station receiver, where it is transmitted to the speakers in the simulator’s head. The two dierent devices can be identied by their cases. The handset device has a cover that extends over the length of the antenna.Figure 1: WVL HandsetThe base station device antenna is almost fully exposed.Figure 2: WVL Base Station
B-4Appendix B – Wireless Voice LinkPhysical FeaturesThe following features are located on the top of the WVL devices:Headphone jack: • Used to plug in headphones or an iPhone compatible headphone/microphone combinationMicrophone jack: • Used to plug in a standalone microphoneRed power light: • Indicates when the unit is powered on by blinking. Also indicates when the Mute button is activated by solidly staying on.Green connection light: • Indicates an RF link connection between the handset and base station by blinking.• Figure 3: WVL Front ViewThe following features are located on the side of the WVL devices:Battery compartment: • Houses two AAA batteries and the DIP switch.DC power jack:• Accommodates a 5VDC/0.2A power source.ON/OFF switch: • Turns WVL handset power on or o.Line out jack: • Connects the WVL to the simulator’s audio amplier.Volume/mute dial: • Controls microphone gain and microphone mute on the handset. See Special Handset Settings on page B-9Figure 4: WVL Side ViewOn the WVL handset, the volume/mute dial controls the microphone volume or mutes the microphone. See Special Handset Settings on page B-9.On the WVL base station, the dial serves as the volume control for the speakers inside the simulator. Moving the dial toward the plus sign increases the volume. Moving the dial toward the minus sign decreases the volume and setting. On the handset, pressing straight down on the volume dial in the center mutes the microphone.Microphone jackRed power lightHeadphone jackGreen connection lightDC PowerLine outVolume/mute dial (Handset) Volume/mute dial (Base Station)ON/OFF switchBattery compartment
B-5Appendix B – Wireless Voice LinkPreparing the Base Station in the SimulatorWhen using the base station in the simulator, ensure the batteries are removed and the following items are attached: Power cable•Line out cable•Serial Connector•The DIP switch is located in the battery compartment of the base station (Figure 5: DIP Switch Settings).Figure 5: Dip Switch SettingsThe serial connector is located on the side of the base station (Figure 6: Serial Connector).Figure 6: Serial Connector on base station DIP Switch SettingsSerial Connector
B-6Appendix B – Wireless Voice LinkThe base station should come already connected and installed inside the METIman.Figure 7: Base Station in METImanTo prepare the base station:Set the base station DIP switch positions 6 and 7 to OFF, and 8 to ON. 3. Turn the power o and on using the power switch on the outside of the base 4. station to ensure the DIP switch changes take eect.Leave the power switch on the outside of the base station in the on position.5. Figure 8: DIP Switch Settings for the Base StationNOTE: Since the base station receives power from the simulator, the power switch on the outside of the base station must remain in the ON position. Use this power switch to refresh DIP switch settings. Do not turn the simulator o and on to refresh the DIP switch settings.Base Station Connected and Installed in METIman
B-7Appendix B – Wireless Voice LinkPreparing the Handset for UseTo prepare the handset for use:Insert two AAA batteries into the battery compartment.1. Set the handset DIP switch positions 6 and 7 to OFF and position 8 to ON. 2. Turn the power switch o and back on to ensure the DIP switch changes take 3. eect.Figure 9: DIP Switch Settings for the HandsetWhile DIP switch positions 6 through 8 aect the handset and base station settings, DIP switch positions 1 through 5 are used to set the radio frequency channel used for communication between the handset and the base station.Selecting the Radio Frequency ChannelThere are two ways to congure the radio frequency (RF) channel spacing. The rst method reduces channel-to-channel interference, but allows only 12 channels to operate simultaneously in the same vicinity. The second method increases the number of channels that can be used simultaneously to 20 channels. However, this method diminishes the channel-to-channel noise immunity. All of the WVL pairs in the same vicinity must use channels from RF Channel Group 1 or RF Channel Group 2, and channels must belong to the same group. The DIP switch determines the initial communication frequencies that the WVL pair use to communicate when the power of the base station and handset is rst turned on. If there is too much interference at the initial channel, the WVL pair changes frequency automatically and continues operating. The WVL pair repeats this process automatically as needed and changes frequencies when interference is too high.Multiple WVL pairs can be set to the same initial frequency. However, setting dierent initial frequencies helps the WVL pairs quickly nd a stable operating frequency.For example, if there are 12 or fewer simulators in the same vicinity, set all of the WVL pairs to use channel 0 of RF Channel Group 1. To give unique initial RF frequencies, assign each WVL pair to its own RF channel with the settings found in CH 0 through CH 11.
B-8Appendix B – Wireless Voice LinkIf you have 13 to 20 simulators in the same vicinity, set all of the WVL pairs to use channel 12 or RF Channel Group 2. To give unique initial RF frequencies, assign each WVL pair to its own RF channel with the settings found in CH 12 through CH 31.Figure 10: RF Channel Selection MethodsFor a complete list of the initial frequencies associated with the RF Channels, see RF Channel Initial Operating Frequencies on page B-12.
B-9Appendix B – Wireless Voice LinkPowering Up the WVL PairTo power up the WVL pair:Power on the base station by turning on the simulator. The base station power switch is in the on position by default.Power on the handset by setting the power switch to the on position. The red power light on each unit blinks when the unit is on. Once both units are powered on and communicating with each other, the green connection light ashes once every second. If the green connection light fails to blink, ensure both units are set to the same RF channel. See Selecting the Radio Frequency Channel on page B-6. If you make changes to the DIP switch settings, toggle the power switches of the handset and base station o and back on to ensure the changes takes eect.Using the iPhone/Standalone MicrophoneDIP switch position 6 on the handset determines if the iPhone microphone input or the standalone microphone input is enabled. When DIP switch position 6 is set to the OFF position, the standalone microphone jack is enabled for the standalone microphone, provided by CAE Healthcare.Figure 11: Handset and CAE Healthcare-provided MicrophoneTo use a microphone compatible with an iPhone (three-pole jack), set DIP switch position 6 to ON. Please note that an iPhone-compatible microphone is not provided as part of the product package. Any microphone with a common 3.5 mm input jack can be used with the handset when DIP switch position 6 is set to ON.
B-10Appendix B – Wireless Voice LinkSpecial Handset Settings Advanced settings for the handset DIP switch are available.Noise reduction enable (default)Base station volume control enableMicrophone gain control enable (default)Noise reduction disableStandalone microphone enable (default)iPhone microphone enableFigure 12: Advanced DIP Switch SettingsDIP switch settings are only refreshed when the handset is powered on. To ensure the DIP switch changes take eect, turn the power o and back on after making changes.To enable noise reduction and minimize background noise in high ambient noise environments, place the position 8 DIP switch in the ON position.Battery Capacity IndicatorThe red power light ashes one time every second when the battery capacity is good. When the battery capacity is nearly depleted, the red power LED ashes twice in quick succession every second. This indicates the batteries need to be replaced.To get the most battery life out of the handset, the handset should be powered down when it is not in use.
B-11Appendix B – Wireless Voice LinkTroubleshootingCAE Healthcare Customer Service is available to help with iStan problems, should they arise. However, sometimes you can speed up the customer service process by performing diagnostics before calling, and eliminating some problems on your own with the help of the following instructions.Power ProblemsThe red power light on the handset does not ash when power switch is turned on.Check that the batteries are inserted correctly. Install a fresh set of batteries, if needed.•The red power light on my base station is not ashing when the simulator is powered on.Check that the cables from the simulator are installed in the base station correctly.•Communication ProblemsThe simulator and handset are turned on, but the green connection light is not blinking.Verify that DIP switch positions 1 through 5 are all set to OFF, which is the default position •set in the simulator base station and handset at the factory. If you have modied this setting, verify positions 1 through 5 on the handset and the simulator base station are the same. Be sure to turn the power o and back on for the changes to take eect on both the •handset and the base station. Check if the green connection light is ashing after turning the power o and back on each time to see if communication has been established between the base station and the handset.I’m experiencing static or dropouts in the simulator audio output.Reduce the range between the base station and the handset. Most likely, the handset •is out of range of the base station, or there may be too many obstacles (walls, windows, doors) between the handset and the simulator.Audio ProblemsThe sound output from the simulator is low when using a microphone on my lapel.Increase the microphone gain on the handset by moving the dial towards the plus sign. •DIP switch 7 must be in the OFF position for this to work.I’m hearing feedback from the microphone when I am close to the simulator.Decrease the microphone gain on the handset by moving the dial towards the minus •sign. DIP switch 7 must be in the OFF position for this to work.
B-12Appendix B – Wireless Voice LinkThe sound output from the simulator is too high or too low.The volume level is congured at the factory for optimal performance. However, if you •want to adjust the volume level of the base station (located inside the simulator), set the handset DIP switch 7 to ON. Remember to turn the handset power o and on after each DIP-switch change. After this step is complete, you will be able to adjust the volume level of the base station by adjusting the handset volume dial.The sound output from the simulator is noisy when the speaker is not speaking.You can use the noise reduction feature by setting the handset DIP switch position 8 to •ON.The simulator voice output is cut o when the speaker is speaking quietly.In this case, there are three possible options: •- Attempt to talk louder- Increase the microphone gain- Disable the noise reduction feature by setting the handset DIP switch 8 to OFF.
B-13Appendix B – Wireless Voice LinkRF Channel Initial Operating FrequenciesRF Channel Frequency 1 (GHz) Frequency 2 (GHz)0 2.402 2.4801 2.405 2.4772 2.408 2.4743 2.411 2.4714 2.414 2.4685 2.417 2.4656 2.420 2.4627 2.423 2.4598 2.426 2.4569 2.429 2.45310 2.432 2.45011 2.435 2.44712 2.402 2.48013 2.404 2.47814 2.406 2.47615 2.408 2.47416 2.410 2.47217 2.412 2.47018 2.414 2.46819 2.416 2.46620 2.418 2.46421 2.420 2.46222 2.422 2.46023 2.424 2.45824 2.426 2.45625 2.428 2.45426 2.430 2.45227 2.432 2.45028 2.434 2.44829 2.436 2.44630 2.438 2.44431 2.440 2.442
B-14Appendix B – Wireless Voice LinkSpecicationsFrequency of operation: 2.400 – 2.4835 GHzWireless range: 100 ft clear line of sightRF power output: 0dBmBatteries: 2 AAA Alkaline, NiCd, NiMH, LithiumHandset battery life with base station on: 25 hours with alkaline batteriesHandset battery life with base station o: 100 hours with alkaline batteriesDC voltage input: 5 VDC, 0.2ALine out jack: 3.5 mmHeadphone/iPhone jack: 3.5 mmStandalone microphone jack: 3.5 mmMechanical dimensions with antenna: 6.17” x 2.52” x 0.65”Mechanical dimensions without antenna: 4.2” x 2.52” x 0.65”
For more information about CAE Healthcare products, contact your regional sales manager or the CAE Healthcare distributor in your country, or visit caehealthcare.com. Tel +1 941-377-5562 or 866-233-6384For customer service, please contact CAE Healthcare. Customer Service Headquarters - United States and Latin AmericaMonday - Friday from 7:00 a.m. to 6:00 p.m. ETPhone 1-866-462-7920Email: customerservice@caehealthcare.comCustomer Service - CanadaMonday - Friday from 8:00 a.m. to 5:00 p.m. ETPhone 1-877-223-6273Email: can.service@caehealthcare.comCustomer Service - Europe, Middle East, Africa, India, Asia and AustraliaMonday - Friday from 8:00 a.m. to 5:00 p.m. CETPhone +49 (0) 6131 4950354Email: international.service@caehealthcare.comCustomer Service - United Kingdom and IrelandMonday - Friday from 9:00 a.m. to 5:00 p.m. GMTPhone +44 (0)800-917-1851Email: uk.service@caehealthcare.com©2012 CAE Healthcare165k360110 v.4.1caehealthcare.com

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