VitalsSim Comprehensive Guide

The complete reference for instructors and simulation technicians.

Note: VitalsSim is a browser-based application. No installation is required, but a stable internet connection is recommended for real-time synchronisation.

Portal & Account

The Portal is your command centre. From here, you manage your organisation, subscription, and launch simulation sessions.

Organisation Management

VitalsSim uses a "Unified Tier" model. If you join an organisation, you inherit the organisation's subscription limits (e.g., higher session caps), even if your personal account is on the Free tier.

Create Org: Contact support to upgrade your account to an Organisation Owner.
Invite Members: Owners and Admins can invite members via email from the "Manage Organisation" panel.
Join Code: If you don't have an email invite, ask your admin for a "Join Code" and enter it in your dashboard.

Understanding Sessions

A "Session" is a live connection between a Controller (Instructor) and a Monitor (Student). There are two distinct ways to run a session:

1. Monitor Parameter Control (Basic)

Best for: Ad-hoc training, ALS courses

You get a mixing board of sliders. You manually change HR, BP, etc., and push updates to the screen. Ideal for dynamic scenarios where the instructor adapts on the fly.

2. Scenario Manager (Advanced)

Best for: Standardised exams, Complex sims

You pre-program states (e.g., "Baseline", "Sepsis", "Arrest"). During the sim, you just click "Next State". Ensures every student sees the exact same progression.

Basic Simulation: Quick Start

Follow these steps to get a basic monitor running in under a minute:

Log in to the Portal.
Click the blue Monitor Parameter Control button. This creates a new session ID (starting with U...).
The Basic Controller will open.
On the controller, look for the "Patient Monitor" card.
Scan the QR code with an iPad/Tablet OR click "Open Monitor in New Tab" if using a second screen on the same computer.
The monitor screen will appear (initially black/standby).
On the Controller, click the green Send to Monitor button to activate the display.

Using the Basic Controller

The controller is divided into tabs to organise the complexities of patient physiology.

Important: Staged vs. Instant Updates

To prevent accidental changes, the controller uses two different update methods:

Method	Examples	Behavior
Staged Updates	HR, BP, SpO2 Sliders	Adjust sliders freely. Changes are not sent until you click the green "Send to Monitor" button. This allows you to prepare complex vital signs changes (e.g., shock) and deploy them at once.
Instant Actions	ECG Toggle, Rhythm Select, Shock	Actions happen immediately. For example, selecting "VFib" instantly changes the rhythm on the monitor.

Controller Tabs

Vitals: Core hemodynamic parameters. Note that if you check "PEA" in the Rhythm tab, these sliders may be overridden by the simulation logic.
Rhythm & CPR:
- Rhythm Select: Choose the ECG waveform.
- PEA Toggle: Disconnects the electrical rhythm from the mechanical pulse. (See "Physiology Engine" for details).
- CPR Artifact: Adds compression noise to ECG, ART, and CVP waveforms.
Interventions:
- Defibrillator: Control the energy and shock status remotely (instructor overrides).
- Pacing: Set capture thresholds and mechanical capture simulation.
- ROSC: Configure the "Return of Spontaneous Circulation" values (target HR/BP after resuscitation).

Fetal Monitoring

VitalsSim includes a comprehensive CTG simulator. Access this via the "Fetal" tab.

Baseline FHR: Set the baseline fetal heart rate (110-160 bpm).
Variability: Choose from Absent, Minimal, Moderate, or Marked. The system uses procedural noise generation to simulate beat-to-beat variability.
Decelerations: Trigger specific events like Early, Late, or Variable decelerations. These will animate on the student monitor in real-time.
Contractions: Control the frequency and strength of uterine contractions (displayed on the bottom TOCO trace).

Advanced Simulation Concepts

The Advanced Controller allows you to build reproducible scenarios. It uses a Phase & State hierarchy.

Scenario: The entire file (e.g., "Anaphylaxis Case 1").
Phase: A logical chapter (e.g., "Phase 1: Induction", "Phase 2: Reaction"). Phases help organise long scenarios.
State: A snapshot of vitals (e.g., "Baseline", "Hypotension", "Arrest"). This is the atomic unit of the simulation.

You can transition between states manually (clicking "Activate") or automatically (time-based).

Scenario Builder

Access this via the "Scenario Manager" button on the portal.

Create: Click "Create New Scenario".
Add Phase/State: Use the buttons to build your timeline. Drag and drop states to reorder them.
Inspector Panel: Click on any State Card to open the Inspector on the right. Here you edit the specific heart rate, BP, and logic for that state.

Arrest Configuration

New Feature: States can now be designated as "Cardiac Arrest States".

In the Inspector, check "Designate as Cardiac Arrest State". This unlocks special logic:

Rhythm: Choose VFib, Pulseless VT, Asystole, or PEA.
Defib Logic: Define how many shocks are required to convert.
ROSC Target: Select which state the patient should transition to if a shock is successful.
Degradation: Automatically transition from VFib to Asystole after a set time if not treated (e.g., 120 seconds).

Running the Driver

When you click "Run Scenario", the interface transforms into the Driver HUD (Heads Up Display). This is optimised for running the simulation without distractions.

Timer: Click the "Start Timer" text to begin the simulation clock. This syncs with all connected monitors.
Mini Monitor: A text-based replica of what the student sees, allowing you to run the sim while standing away from the main screen.
Next State: The primary button you will use. It advances to the next programmed state in the sequence.

Manual Override

Simulations rarely go exactly to plan. Click "Manual Override" to open a modal that lets you seize control.

Live Vitals: Adjust sliders and click "Apply Vitals" to smoothly transition to new values immediately, bypassing the pre-programmed scenario.
Trigger Arrest/ROSC: Emergency buttons to instantly force the patient into cardiac arrest or recovery, regardless of the current scenario state.

Connecting Screens

You can connect multiple devices to a single session. All devices stay in sync via the cloud.

Patient Monitor: Displays waveforms. Run this on a large screen or TV.
Ventilator Monitor: Displays loops and mechanics. Run this on a separate screen if needed.
Mobile Controller: A remote control for the instructor.

Connection Method: Open the QR code panel in your controller. Scan with a device, or copy the URL to send to a remote learner.

Layouts & Settings

The monitor layout can be changed on the fly from the Controller (bottom of the page) or locally on the Monitor (Settings gear icon).

Basic

Large numbers, minimal waves. Ideal for EMS/BLS training.

ICU 1 / 2 / 3

Progressively complex. Adds ART line, CVP, and PAP waveforms.

Anaesthesia

Prioritises ETCO2 and Agent monitoring.

Fetal

Dedicated CTG layout with FHR and TOCO.

Values Only

Giant numbers, no waveforms. Best for low-fidelity mannequins.

Ventilator Module

VitalsSim includes a physics-based ventilator engine. It is not just an animation; it calculates pressure based on the Equation of Motion:

Pressure = (Flow × Resistance) + (Volume / Compliance) + PEEP

Modes Reference

Mode	Control Variable	Description
AC/VC	Volume	Delivers a set tidal volume. Pressure varies based on patient lung compliance.
AC/PC	Pressure	Delivers a set inspiratory pressure. Volume varies based on lung compliance.
APRV	Pressure	Airway Pressure Release Ventilation. Alternates between two CPAP levels (High/Low) to recruit alveoli.

Interactive Physics

Changes to lung parameters in the scenario are immediately reflected in the ventilator waves:

Compliance: Lower compliance ("stiff lungs") increases PIP in Volume Control and decreases Tidal Volume in Pressure Control.
Resistance: Higher resistance creates a larger gap between Peak Pressure (PIP) and Plateau Pressure (Pplat).

Physiology Engine Deep Dive

Understanding how VitalsSim handles transitions helps you run smoother sims.

Interpolation & Decay

When you change a vital sign (e.g., HR 60 → 100 over 10 seconds), the system linearly interpolates the value.

However, for Cardiac Arrest, we use specific decay curves to mimic physiological collapse:

Hemodynamics (BP/SpO2): Drop to zero rapidly (approx 30s).
Respiratory (RR/ETCO2): Decay slower (60s) to simulate agonal breathing, unless paralyzed or ventilated.

PEA Logic

When PEA (Pulseless Electrical Activity) is active:

The ECG continues to show the selected rhythm (e.g., Sinus).
The SpO2 waveform amplitude is scaled down based on the falling Blood Pressure.
Numeric BP values are hidden or show "---" once they drop below detectable thresholds.

ROSC Phase

When ROSC is triggered (either manually or via correct shock count), the system enters a two-stage recovery:

Instability Phase (10s): Vitals begin to recover, but the ECG throws frequent PVCs (Premature Ventricular Contractions) to simulate myocardial irritability.
Stabilisation Phase (10s): The rhythm regularises, and BP/SpO2 climb steadily to their target values.

Parameter Reference

Valid ranges for input fields:

Parameter	Range	Default
Heart Rate	0 - 300 bpm	80
SpO2	0 - 100 %	98
Systolic BP	0 - 300 mmHg	120
Diastolic BP	0 - 300 mmHg	80
Resp Rate	0 - 60 /min	14
ETCO2	0 - 15 kPa	4.5
CVP	0 - 40 mmHg	8
Fetal HR	50 - 220 bpm	140

Troubleshooting

Monitor Not Connecting

Ensure both devices are connected to the internet.
Check that the Session ID matches exactly.
If on a restricted network (hospital/university), try using a mobile hotspot to rule out firewall issues.

Audio Not Playing

Browsers block audio autoplay. You must interact with the monitor page (click anywhere on the screen) at least once to enable sound.
Check the system volume and the "Silence" button state.

Waveforms are Flat

Check if the simulation is paused or if vitals are set to 0.
Ensure you have clicked "Send to Monitor" if using the Basic Controller.
If the patient is in arrest (VFib/Asystole), pressure waveforms (ART/CVP) will naturally flatline.