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125

Using METIman

Once 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

126

Using METIman

Neurological

The 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 View

Neurological

parameters

Click the brain

to access the

Neurological view

127

Using METIman

Eyes

The 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.

Convulsions

METIman 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 Blockade

To 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 Temperature

To 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 Temperature

To 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.

128

Using METIman

Head 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

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.

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.

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 Shoulder

Open 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

129

Using METIman

Respiratory

METIman 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 View

Click the lung to access

the Respiratory view

Respiratory

parameters

130

Using METIman

Airway

Various 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.

131

Using METIman

Airway Features

Anatomy, Physiology

and Clinical Signs Clinical Interventions, Patient

Monitoring and Scenarios. Software Control Manual

Control

Realistic 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

Ventilation

Alveolar and arterial gas concentrations

appropriately reect the ecacy of

ventilation and oxygen administration.

Oxygen

administration input

by the instructor.

VIEW: Respiratory

None 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

Teeth

Tongue 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,

132

Using METIman

Swollen Tongue

The 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.

133

Using METIman

Realistic 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).

Intubation

The 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.

134

Using METIman

Laryngospasm (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.

135

Using METIman

Airway 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 Suction

To 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 Shoulder

The 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

136

Using METIman

Cricothyrotomy

Cricothyrotomy 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

session. To prevent damage to the simulator, always spray silicone lubricant into

the airway.

Locate the simulated cricothyroid membrane sealed with tape underneath the

neck skin.

Follow standard clinical techniques and palpate to nd the cricothyroid space.

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

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 Tape

Remove 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.

137

Using METIman

Resealing the Membrane After a Puncture

To 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.

138

Using METIman

Pulmonary

METIman 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 System

Anatomy,

Physiology and

Clinical Signs

Clinical Interventions, Patient Monitoring

and Scenarios.

Software Control

Manual Control

Spontaneous

Breathing

Normal tidal breathing and pathophysiological

conditions such as atelectasis, pneumothorax,

asthma and COPD.

None required, but

adjustable

VIEW: Respiratory

None required.

Exhaled CO2

(Prehospital only)

Measure the presence or absence of CO2 during

positive pressure ventilation.

None required. CO2 canister is

inserted

Pneumothorax or

Hemothorax

Increase in intrapleural volume, leading to

asymmetrical breathing.

None required, but

adjustable

VIEW: Respiratory

CONTROL: 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

adjustable

VIEW: Sounds

None required.

Bronchial

Occlusion

Completely 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

adjustable

SpO2 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

adjustable

None 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

adjustable

None required.

139

Using METIman

Pulmonary System

Needle

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: Respiratory

CONTROL: Needle

Decompression,

Intrapleural Vol: Left,

Intrapleural Vol: Right

See 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 Switch

Needle Decompression

When 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 Tube

When 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.

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Using METIman

Bronchial 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 Switch

Respiratory Rate

To 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 Parameter

Pulse Oximetry

To 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 Parameter

The 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.

141

Using METIman

Positive Pressure Ventilation

When 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 Prehospital

METIman 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.

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.

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 Shoulder

Open the clamp and allow uid to ow into the simulator until uid is seen in the METIman 7.

Priming Tube.

Chest Tube ports

142

Using METIman

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.

The chest tube must be fully inserted for the uid to ow.

Chest Tube Insertion

NOTE: 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.

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.

Inject the remaining contents of the syringe into the 4. CHEST TUBE port.

Remove the syringe.

Chest Tube and Needle Decompression

The 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.

143

Using METIman

Chest Tube: METIman Nursing

METIman 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.

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.

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 Shoulder

Open 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

Tube. The simulator is ready for chest tube insertion.

Keep the IV bag attached and adjust the ow rate manually using the roller clamp.

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

144

Using METIman

Cardiovascular

With METIman’s Cardiovascular system, users can replicate the clinical signs associated with

cardiac activity, including palpable pulses, heart sounds and electrical activity.

Cardiovascular System

Anatomy,

Physiology and

Clinical Signs

Clinical Interventions, Patient Monitoring

and Scenarios.

Software Control

Manual

Control

Heart 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:

Cardiovascular

None 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

Ischemia

Myocardial 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

screen

None required.

Non-Invasive

Blood Pressure

Measurement

Systemic 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.

145

Using METIman

To 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 view

Pulses

Cardiovascular

parameters

146

Using METIman

Pulses: METIman Prehospital

METIman 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 Inactive

Activated pulse

Deactivated

pulse

147

Using METIman

Pulses: 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 Inactive

Activated pulse

Deactivated

pulse

148

Using METIman

Blood Pressure

METIman supports non-invasive blood pressure measurements, and systolic and diastolic

readings can be obtained and manipulated through the software.

Systolic and Diastolic Blood Pressure

To manually adjust the systolic and/or diastolic blood pressure:

From the Cardiovascular view, click the parameter of desired blood pressure.

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

Override switch to Modeled.

Non-Invasive Blood Pressure Measurement

Blood 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.

Insert the barbed end tubing connectors into the cut ends of the blood pressure 2.

cu tubes.

149

Using METIman

Secure the tubing connectors with cable ties. 3.

An Attached Tubing Connector

Attach the blood pressure adapter to the connectors.4.

An Attached Blood Pressure Cu Adapter

150

Using METIman

To 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 Shoulder

METIman Nursing’s Left Shoulder

METIman’s Right Shoulder

NIBP RIGHT port

NIBP LEFT port

151

Using METIman

Connect 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.

152

Using METIman

Heart Rate

To 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 ECG

On 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 Sites

The 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

153

Using METIman

Cardiovascular Interventions/Therapy

METIman can simulate chest compressions and three types of electrical therapy: debrillation,

cardioversion and pacing.

Realistic Cardiovascular Interventions

Anatomy,

Physiology and

Clinical Signs

Clinical Interventions, Patient

Monitoring and Scenarios.

Software Control

Manual

Control

Chest

Compression

E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

Monitoring

The desired arrhythmia can be selected. The response to

clinical intervention

must be controlled by

the instructor.

VIEW:

Cardiovascular

None 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 palette

VIEW:

Cardiovascular

See 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.

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Using METIman

Chest Compressions

METIman 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 Cardioversion

Manual 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 Sites

However, 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

155

Using METIman

The 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.•

Pacing

Pacing 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).

156

Using METIman

Subclavian 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 Catheter

NOTE: Cleanup is very important when using simulated uids. Please refer to the Care and

Maintenance section for directions on uid removal.

Intramuscular Injection

METIman 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

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Using METIman

IV Cannulation

Veins 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 Cannulation

To 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 Shoulder

Fluids 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

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Using METIman

Fluids

METIman 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 View

Simulated 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 view

Bleeding

parameters

159

Using METIman

Hemorrhage Setup

The 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.

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 Shoulder

METIman’s Right Hip

Enable 3. Bleeding: Upper or Bleeding: Lower on the Fluids view of the Müse

software, as desired.

Hemorrhage Control

When bleeding is controlled (e.g., hemostat, tourniquet), the action is detected and logged,

and the physiology responds accordingly.

UPPER

MOULAGE port

LOWER

MOULAGE port

160

Using METIman

Tourniquet Application

A 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 Application

Fluid Loss Blood

To 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 Plasma

To 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.

161

Using METIman

Gastrointestinal

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 Lavage

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.

162

Using METIman

Gastric 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 Shoulder

Fluids 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

163

Using METIman

Genitourinary System

METIman 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 Catheterization

Catheterize the simulator using a standard 16-Fr urinary catheter lubricated with silicone spray.

Urinary Catheterization

The bladder for the simulated urine is accessed directly via the urethra.

164

Using METIman

Simulating Urine Output

METIman 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.

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.

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 Shoulder

METIman Nursing’s Left Shoulder

The GU port

165

Using METIman

Open 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.

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 Genitalia

METIman comes with male and female genitalia.

To switch genitalia:

Pull apart the Velcro holding the genitalia.

Loosen and remove the urethra connector. This connection may be tight when 2.

genitalia are removed the rst time.

Remove the genitalia.

Attach urethra tube to the urethra connector.4.

Attach the desired genitalia using the Velcro.5.

166

Using METIman

Sounds

A variety of simulated sounds are available to enhance realism. A patient must be running on

METIman for any sounds to be available.

Speech

Speech can be added to simulations using the Vocal Sounds and Speech Sounds features on

the software or by using an external microphone.

Vocal Sounds

A variety of programmable vocal sounds are available. Vocal sounds are male or female based

on the gender of the active patient.

Vocal Sounds

None

Audible Wheezing

Crying

Gagging

Gasping

Groaning

Long loud cough

Long soft cough

Mumbling

167

Using METIman

To select a sound from the Vocal Sounds drop-down menu, click the Sounds button on the

Run screen. The Sounds panel appears.

Vocal Sounds Menu

Click 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.

168

Using METIman

Speech Sounds

Speech 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 Sounds

Loud Cough

Soft Cough

Short Loud Cough

Short Soft Cough

Scream

Grunt

“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”

169

Using METIman

To play a Speech Sound, click the Speech balloon. A list of Speech Sounds appears.

The Speech Sounds Menu

Select 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

170

Using METIman

Wireless Voice Capability

In addition to the pre-programmed speech, any response can be transmitted through the

speakers using the wireless microphone.

Wireless Microphone

The microphone volume can be adjusted on the microphone itself using the volume control.

Wireless Voice Link

If a wireless voice link package was included with the METIman simulator, see Appendix B -

Wireless Voice Link on page B-1 for additional instructions.

171

Using METIman

Throat Sounds

Stridor 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 Menu

Click the Throat Sounds drop-down menu to change the type of sound. Click and drag the

slider to adjust the volume.

172

Using METIman

Breath Sounds

Breath 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 Sounds

Normal

Crackles

Diminished

Gurgling

Pleura Rub

Rhonchi

Wheezing

Click 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

173

Using METIman

Heart Sounds

Heart 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 Sounds

Normal S1-S2

S3 and S4

Early Systolic Murmur

Mid Systolic Murmur

Late Systolic Murmur

Pan Systolic Murmur

Late Diastolic Murmur

Heart sounds can be adjusted by clicking the Sounds button on the Run screen. When the

Sounds panel appears, select Heart Sounds.

The Heart Sounds Menu

Click the Heart Sounds drop-down menu to change the type of sound. Click and drag the

slider to adjust the volume.

174

Using METIman

Bowel Sounds

Learners 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 Menu

Bowel 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.

175

Care and Maintenance

Maintaining 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.

176

Care and Maintenance

METIman Warranty Programs

General Information

CAE 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 Agreement

For 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.

177

Care and Maintenance

How to Contact Customer Service

CAE 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.com

CAE 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.com

CAE 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.com

CAE 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.com

Principal hours of operation exclude holiday and non-business days.

178

Care and Maintenance

Contract Period

Warranty 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 Agreement

Your 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.

179

Care and Maintenance

System Software Upgrade Support

Customers with current warranty contracts are entitled to receive upgrades to applications

software previously purchased. Installation of the system software is the user’s responsibility.

The System Software Upgrades Support includes software upgrades for base software and

purchased optional software modules.

**This does not apply for major upgrades or technological enhancements.**

Pricing Structure

Time and Materials

For those systems not under agreement, service will be provided as required on a Time and

Material basis:

Description In-House On-Site

Technical Support As quoted at time of repair

CAE Healthcare’s prevailing

labor rate with a minimum of

four hours labor

Material As quoted at time of repair As quoted at time of repair

Travel N/A Priced at CAE Healthcare’s

fully burdened cost plus fee

Principal 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.

180

Care and Maintenance

Breakdown

After 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 Steps

Stop All Running SCEs

Clean the Simulator and the Fluid System

3Shut Down the Software

4Power o the Simulator

Step 1: Stop All Running SCEs

Stop 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 System

Refer to the Maintenance Advice on the following pages for detailed instructions.

Step 3: Shut Down the Software

To shut down the Müse software:

Click the Account Name in the lower, right-hand corner of the screen. The Logout/

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.

181

Care and Maintenance

Step 4: Power O the Simulator

Carefully 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.

Maintenance Advice

Simple 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 Care

Avoid 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.

Storage

When 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.•

182

Care and Maintenance

Care of Electronic Equipment

Install any CAE Healthcare software updates as soon as they become available.

Airway Inspection

METIman 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 Battery

After 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

183

Care and Maintenance

Lift the abdominal insert.2.

Lifting the Abdominal Insert

Remove the abdominal support.3.

Removing the Abdominal Support

Release the Velcro battery tie-down.4.

Releasing the Battery Tie-Down

Remove the

abdominal support

Release the Velcro

battery tie-down

184

Care and Maintenance

Disconnect the battery leads.5.

Disconnecting the Battery Leads

Remove the uncharged battery.

Removing the Battery

Insert a charged battery and ax the battery tie-down.

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.

Recharging the Battery

The 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 warnings

Remove the

uncharged battery

Disconnect the

battery leads

185

Care and Maintenance

Recharging should take approximately four hours.

IMPORTANT: Never recharge the battery while it is connected to METIman.

Draining Condensation from the Simulator

As 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.

Condensation Drain Hose

Bring 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.

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.

186

Care and Maintenance

Cleaning the Simulator and the On-Board Bleeding System

NOTE: 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.

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

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

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.

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

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 simulator

14. .

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.

187

Care and Maintenance

Cleaning 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.

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.

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

bucket.

Allow the tank to empty completely (the remaining air pressure will purge the

uid from the lines.

Reinstall the lid onto the Overow Bottle and place the bottle back onto the tank

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.

188

Care and Maintenance

Cleaning the In-Line Filter

To clean the in-line lter:

Grasp both ends of the in-line lter and twist counterclockwise.

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

lter cone to the inside, removing all debris.

Repeat process until all debris is removed.

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

189

Care and Maintenance

Troubleshooting the Trauma Fill Tank

Before making any repairs, ALWAYS depressurize the tank, remove all trauma solution and

clean the tank.

Problem Cause Solution

Tank 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.

190

Care and Maintenance

Emptying and Flushing the Chest Tube Reservoir

Removing 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 Lines

To 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.

Emptying the Genitourinary Reservoir

To 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 the

2. IV FILL port. The uid drains out of the IV

DRAIN port.

Continue to push air until empty.

Using the same syringe, push air through the Subclavian Catheter until empty. 4.

191

Care and Maintenance

Handling 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 Regulator

The 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 CO

1. 2 regulator assembly from the simulator.

While holding the regulator assembly rmly, slowly unscrew the CO

2. 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.

192

Care and Maintenance

Important Canister Information

The 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/WARNINGS

CO2 Canister

Store 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 Assembly

Care 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 Equipment

Canister 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.

193

Condition Guidelines for Programming METIman

This 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: Desaturation

Desaturation SpO2 Value

Reset 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%

194

Condition Guidelines for Programming METIman

Cardiovascular: Blood Pressure

Hypertension Hypotension

Reset 110s/70s Reset 110s/70s

Increased 120s/80s Decreased 100s/70s

Pre-Borderline 130s/80s Pre-Borderline 100s/60s

Borderline 140s/90s Borderline 90s/50s

Mild 150s/90s Mild 80s/40s

Moderate 160s/100s Moderate 70s/40s

Severe 170s/100s Severe 60s/30s

Profound 190s/110s Profound 50s/30s

Extreme 220s/120s Extreme 40s/30s

195

Condition Guidelines for Programming METIman

Cardiovascular: Heart Rate

Tachycardia Bradycardia

Reset 70s Reset 70s

Increased High 70s Decreased Mid 60s

Elevated 80s Pre-Borderline Low 60s

Pre-Borderline 90s Borderline Mid 50s

Borderline 100s Intermediate Low 50s

Intermediate 110s Mild High 40s

Mild 120s Moderate Mid 40s

Moderate 130s Severe Low 40s

Severe 140s Extreme Mid 30s

Supra 150s Acute Low 30s

Profound 160s

Extreme 170s

Acute High 170s

196

Condition Guidelines for Programming METIman

Respiratory: Respiratory Rate

Tachypnea Bradypnea

Reset 11 Reset 11

Increased 15 Increased 10

Elevated 18 Intermediate 9

Borderline 20 Mild 7

Intermediate 22 Moderate 6

Mild 25 Severe 5

Moderate 28 Profound 3

Severe 31 Extreme 2

Profound 33

Extreme 36

A-1

Appendix A – Parameter Descriptions

Appendix A – Müse Parameter Descriptions

The 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.

Neurological

METIman can simulate a variety of neurological clinical indicators, such reactive eyes and

convulsions.

Neurological Parameters

Eyes: Pupil Size

Ey es: Blink Speed

Convulsions

ICP

NMB

Te mperature: Body

Te mperature: Blood

Eyes

Each eye has reactive pupils and eyelids that blink and close.

A-2

Appendix A – Parameter Descriptions

Eyes: Pupil Diameter

These 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: Reactive

Eyes: Blinking

In 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: Auto

The 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: Normal

Convulsions

The Convulsions parameter is used to simulate the presence of convulsions. They are either

ON or OFF.

Default: O

A-3

Appendix A – Parameter Descriptions

Intracranial 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 mmHg

Neuromuscular 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: Body

The 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-4

Appendix A – Parameter Descriptions

Temperature: Blood

The 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° C

Respiratory Parameters

Swollen Tongue

Airway Occluder (Prehospital Only)

Laryngospasm (Prehospital Only)

Ne edle Decompression (Left and Right) (Prehospital Only)

Br onchial Occlusion

Respiratory Rate

A-5

Appendix A – Parameter Descriptions

Respiratory Parameters

SpO2

NMB

Tidal Volume

In trapleural Volume: Left

In trapleural Volume: Right

Chest Tube Flow: Left

Ch est Tube Flow: Right

Swollen Tongue

This 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-6

Appendix A – Parameter Descriptions

Airway 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 Occlusion

Turning 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-7

Appendix A – Parameter Descriptions

For 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 minute

SpO2

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 Volume

The 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-8

Appendix A – Parameter Descriptions

remains 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 mL

Intrapleural 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 mL

Chest 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 minute

Cardiovascular Parameters

Blood Pressure

Heart Rate

Cardiac Rhythm

A-9

Appendix A – Parameter Descriptions

Cardiovascular Parameters

Arterial Catheter

Ce ntral Venous Catheter

PA Catheter

PA Balloon

Deb

Pacing Current

Pacing Rate

Pa cing Capture Threshold

Cold Fluid Inject

Blood 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 mmHg

Heart Rate

The 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-10

Appendix A – Parameter Descriptions

Cardiac Rhythm

The 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-11

Appendix 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-12

Appendix A – Parameter Descriptions

Arterial Catheter

The 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 Ventricle

Central Venous Catheter

The 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 Vein

Pulmonary Artery (PA) Catheter

The 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-13

Appendix A – Parameter Descriptions

PA Balloon

In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ated

De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 Joules

Pacing Current

The 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 mA

Pacing Rate

The 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-14

Appendix A – Parameter Descriptions

Pacing Capture Threshold

The 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 mA

Cold 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-15

Appendix A – Parameter Descriptions

Pulses

The tables below show the defaults and ranges for the pulses and pulse decits for METIman

Prehospital and METIman Nursing.

METIman Prehospital

Pulse Default Range

Left Carotid On N/A

Right Carotid On N/A

Carotid Decit 60 0 - 300

Left Brachial On N/A

Right Brachial On N/A

Brachial Decit 80 0 - 300

Left Radial On N/A

Right Radial On N/A

Radial Decit 90 0 - 300

Left Femoral On N/A

Right Femoral On N/A

Femoral Decit 70 0 - 300

Left Popliteal On N/A

Right Popliteal On N/A

Popliteal Decit 80 0 - 300

Left Dorsalis Pedis/

Left Posterior Tibial

On N/A

Right Dorsalis Pedis/

Right Posterior Tibial

On N/A

Dorsalis Pedis/

Posterior Tibial Decit

80 0 - 300

A-16

Appendix A – Parameter Descriptions

METIman Nursing

Pulse Default Range

Left Carotid On N/A

Right Carotid On N/A

Carotid Decit 60 0 - 300

Left Brachial On N/A

Right Brachial On N/A

Brachial Decit 80 0 - 300

Left Radial On N/A

Right Radial On N/A

Radial Decit 90 0 - 300

Left Femoral On N/A

Right Femoral On N/A

Femoral Decit 70 0 - 300

Left Popliteal On N/A

Right Popliteal On N/A

Popliteal Decit 80 0 - 300

Left Dorsalis Pedis On N/A

Right Dorsalis Pedis On N/A

Dorsalis Pedis Decit 80 0 - 300

Left Posterior Tibial On N/A

Right Posterior Tibial On N/A

Posterior Tibial Decit 80 0-300

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. Click and hold a

pulse location to adjust the pulse decit.

A-17

Appendix A – Parameter Descriptions

Fluids

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 Parameters

Fluid Loss Blood

Fluid Loss Plasma

Colloid Infusion

Crystalloid Infusion

PRBC Infusion

Whole Blood Infusion

Bleeding: Upper

Bleeding: Lower

Fluid 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 mL

Fluid 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 mL

Colloid 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-18

Appendix A – Parameter Descriptions

Crystalloid 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 mL

PRBC 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 mL

Whole 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 mL

Bleeding: 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-19

Appendix A – Parameter Descriptions

Sounds

A variety of simulated sounds are available to enhance realism.

Bowel Sounds

Normal

Hypoactive

Hyperactive

None

Normal, 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 Locations

All Bowel Sounds

LUQ Bowel Sounds

RUQ Bowel Sounds

LLQ Bowel Sounds

RLQ Bowel Sounds

To 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-20

Appendix A – Parameter Descriptions

Breath Sounds

Normal 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 Locations

All Breath Sounds

Breath Left Upper Sounds

Breath Right Upper Sounds

Breath Left Lower Sounds

Breath Right Lower Sounds

Breath Sounds

Normal

Crackles

Diminished

Gurgling

Pleural Rub

Rhonchi

Wheezing

To aect the breath sounds simultaneously in all anatomical regions, select All Breath 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-21

Appendix A – Parameter Descriptions

Heart Sounds

Normal and abnormal heart sounds are selected using this parameter. Heart sounds are

synchronized with the cardiac cycle.

Heart Sounds

Normal

S3 and S4

Early Systolic Murmur

Mid Systolic Murmur

Late Systolic Murmur

Pan Systolic Murmur

Late Diastolic Murmur

Default: Normal

NOTE: The volume control slider may be used to adjust the amplitude of the sound.

A-22

Appendix A – Parameter Descriptions

Speech Sounds

Speech 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 Sounds

Loud cough

Soft cough

Short Loud Cough

Short Soft Cough

Scream

Grunt

“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-23

Appendix A – Parameter Descriptions

Throat Sounds

The Stridor throat sounds option from the simulator is selected using the Throat Sounds

parameter. The stridor is synchronized with ventilation of both lungs.

Default: None

NOTE: The volume control slider may be used to adjust the amplitude of the sound.

A-24

Appendix A – Parameter Descriptions

Vocal Sounds

To 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 Sounds

None

Crying

Gagging

Gasping

Groaning

Long Loud Cough

Long Soft Cough

Wheezing

Mumbling

To 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: None

NOTE: The volume control slider may be used to adjust the amplitude of the sound.

B-1

Appendix B – Wireless Voice Link

Appendix B - Wireless Voice Link

This information is intended to assist in preparing Wireless Voice Link (WVL) devices for use in

conjunction with METIman.

Cautions and Warnings

This 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.

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.

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-2

Appendix B – Wireless Voice Link

What’s Included

The 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 Works

The 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 Use

To 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-3

Appendix B – Wireless Voice Link

Wireless Voice Link Devices

There 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 Handset

The base station device antenna is almost fully exposed.

Figure 2: WVL Base Station

B-4

Appendix B – Wireless Voice Link

Physical Features

The following features are located on the top of the WVL devices:

Headphone jack: • Used to plug in headphones or an iPhone compatible headphone/

microphone combination

Microphone jack: • Used to plug in a standalone microphone

Red 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 View

The 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-9

Figure 4: WVL Side View

On 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

jack

Red power light

Headphone

jack

Green connection light

DC Power

Line out

Volume/mute dial (Handset)

Volume/mute dial (Base Station)

ON/OFF switch

Battery

compartment

B-5

Appendix B – Wireless Voice Link

Preparing the Base Station in the Simulator

When 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 Settings

The serial connector is located on the side of the base station (Figure 6: Serial Connector).

Figure 6: Serial Connector on base station

DIP Switch

Settings

Serial

Connector

B-6

Appendix B – Wireless Voice Link

The base station should come already connected and installed inside the METIman.

Figure 7: Base Station in METIman

To prepare the base station:

Set the base station DIP switch positions 6 and 7 to OFF, and 8 to ON.

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.

Figure 8: DIP Switch Settings for the Base Station

NOTE: 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-7

Appendix B – Wireless Voice Link

Preparing the Handset for Use

To prepare the handset for use:

Insert two AAA batteries into the battery compartment.

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 Handset

While 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 Channel

There 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-8

Appendix B – Wireless Voice Link

If 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 Methods

For a complete list of the initial frequencies associated with the RF Channels, see RF Channel

Initial Operating Frequencies on page B-12.

B-9

Appendix B – Wireless Voice Link

Powering Up the WVL Pair

To 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 Microphone

DIP 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 Microphone

To 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-10

Appendix B – Wireless Voice Link

Special Handset Settings

Advanced settings for the handset DIP switch are available.

Noise reduction enable (default)

Base station volume control enable

Microphone gain control enable (default)

Noise reduction disable

Standalone microphone enable (default)

iPhone microphone enable

Figure 12: Advanced DIP Switch Settings

DIP 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 Indicator

The 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-11

Appendix B – Wireless Voice Link

Troubleshooting

CAE 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 Problems

The 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 Problems

The 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 Problems

The 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-12

Appendix B – Wireless Voice Link

The 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-13

Appendix B – Wireless Voice Link

RF Channel Initial Operating Frequencies

RF Channel Frequency 1 (GHz) Frequency 2 (GHz)

0 2.402 2.480

1 2.405 2.477

2 2.408 2.474

3 2.411 2.471

4 2.414 2.468

5 2.417 2.465

6 2.420 2.462

7 2.423 2.459

8 2.426 2.456

9 2.429 2.453

10 2.432 2.450

11 2.435 2.447

12 2.402 2.480

13 2.404 2.478

14 2.406 2.476

15 2.408 2.474

16 2.410 2.472

17 2.412 2.470

18 2.414 2.468

19 2.416 2.466

20 2.418 2.464

21 2.420 2.462

22 2.422 2.460

23 2.424 2.458

24 2.426 2.456

25 2.428 2.454

26 2.430 2.452

27 2.432 2.450

28 2.434 2.448

29 2.436 2.446

30 2.438 2.444

31 2.440 2.442

B-14

Appendix B – Wireless Voice Link

Specications

Frequency of operation: 2.400 – 2.4835 GHz

Wireless range: 100 ft clear line of sight

RF power output: 0dBm

Batteries: 2 AAA Alkaline, NiCd, NiMH, Lithium

Handset battery life with base station on: 25 hours with alkaline batteries

Handset battery life with base station o: 100 hours with alkaline batteries

DC voltage input: 5 VDC, 0.2A

Line out jack: 3.5 mm

Headphone/iPhone jack: 3.5 mm

Standalone microphone jack: 3.5 mm

Mechanical 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 866-233-6384

For customer service, please contact CAE Healthcare.

Customer Service Headquarters - United States and Latin America

Monday - Friday from 7:00 a.m. to 6:00 p.m. ET

Phone 1-866-462-7920

Email: customerservice@caehealthcare.com

Customer Service - Canada

Monday - Friday from 8:00 a.m. to 5:00 p.m. ET

Phone 1-877-223-6273

Email: can.service@caehealthcare.com

Customer Service - Europe, Middle East, Africa, India, Asia and Australia

Monday - Friday from 8:00 a.m. to 5:00 p.m. CET

Phone +49 (0) 6131 4950354

Email: international.service@caehealthcare.com

Customer Service - United Kingdom and Ireland

Monday - Friday from 9:00 a.m. to 5:00 p.m. GMT

Phone +44 (0)800-917-1851

Email: uk.service@caehealthcare.com

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CAE Healthcare WVL WIRELESS VOICE LINK User Manual 2

CAE Healthcare, Inc. WIRELESS VOICE LINK 2

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User Manual 2

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