Your profile contains your personal details and security settings.

From the main Portal dashboard, click on My Profile in the top navigation bar.

• Personal Information: Enter or update your full name in the provided text field and click Update Name.
• Account Security: * Change Email: Enter a new email address, provide your current password for verification, and click Change Email.
• Password Reset: Click Send Password Reset Email to receive a secure link to choose a new password.
• Danger Zone: If you wish to permanently delete your account and cancel your subscription, click Delete Account. Please note that this action is irreversible.

To view or change your subscription tier:

1. Navigate to the main Portal dashboard.
2. Locate the Subscription Plan section to view your current tier.
3. Click Manage Subscription.
4. You will be securely redirected to our payment provider, where you can upgrade, downgrade, update your payment details, or cancel your subscription.

If you are an administrator for an organisation, you can manage your team's access.

On the Portal dashboard, locate the My Organisation section and click Manage Organisation.

Inviting Members:

• By Email: Enter a colleague’s email address and click Send Invite.
• By Join Code: Click Generate Join Code on your portal dashboard and share this code. Users can enter this code in the "Join with Code" section.

Managing Roles:

In the "Current Members" list, you can search for users and change their roles (Make Admin / Make Member) or remove them entirely using the red Remove button.

The Portal dashboard is your central hub for controlling active simulations.

Starting a New Session

Locate the Start a New Session panel.

Choose your control type:

• Monitor Parameter Control: Opens the Basic Controller for direct, manual manipulation of patient vitals.
• Scenario Manager: Opens the Advanced Controller to build or run pre-programmed, phased scenarios.

Returning to an Active Session

If you accidentally close a control window, you do not need to start over.

1. Look at the Active Sessions list on your Portal dashboard.
2. Identify the session by its unique Connection Code.
3. Click the blue Rejoin button to resume control.
4. When finished with a simulation, click Close to terminate the session.

To display the simulated monitor on a secondary device (like a tablet or a separate monitor screen facing the students):

Method 1: Using the Portal

1. On the device you wish to use as the monitor, open the Vitals web address and click Connect a Remote Screen from the dashboard.
2. Enter the unique 7-character Session ID (e.g., S-XXXXXX) shown at the top of your instructor controller.
3. Click Connect Monitor.

Method 2: Using QR Codes

1. From your instructor control panel, click the Connect Screens button.
2. Use the remote device's camera to scan the Patient Monitor QR code to instantly link the screen.

The Basic Controller allows instructors to manipulate vitals on the fly. Navigation is handled via the left-hand sidebar.

Vitals Tab

Adjust parameters using the sliders or direct number inputs.

• Heart Rate (HR): Adjust the rate (bpm). You can select specific ECG rhythms (NSR, AFib, VTach, VFib, Asystole, etc.) and morphologies (e.g., STEMI). Toggle the Pulseless switch for PEA, and add ectopics.
• SpO2: Adjust oxygen saturation and alter the plethysmograph trace (Normal, Poor Perfusion, Artifact).
• Blood Pressure: Adjust Systolic and Diastolic values. Click Cycle NIBP to trigger a simulated blood pressure cuff reading on the student screen.
• Resp Rate & EtCO2: Adjust respiratory rate and End-Tidal CO2 values. EtCO2 waveforms can be changed to simulate obstructive patterns or stacking.
• CVP, PAP & Temperature: Adjust central venous pressure, pulmonary arterial pressure, and core/peripheral temperatures.

Interventions Tab

This tab handles physical interventions performed by the students.

• Defibrillator:
  • Selected Energy: Use the + and - buttons to select the joules (J).
  • Charge & Shock: Click Charge to simulate charging (a progress bar will appear). Once fully charged, click Shock to deliver energy.
  • Sync: Click the SYNC button to simulate synchronised cardioversion.
• Pacing: Adjust the Capture Threshold (mA). If the students' pacer is set above this threshold, the monitor will show electrical capture. Toggle Mechanical Capture to dictate whether the pacing produces a pulse.
• CPR & Ventilation: Toggle Show CPR Artifact to simulate chest compressions on the ECG, and adjust manual ventilation rates.

Fetal Tab

• Fetal Heart Rate (FHR): Set the baseline FHR and select the variability (Absent, Minimal, Moderate, Marked).
• Uterine Contractions (CTG): Set the frequency and strength of contractions.
• Events: Manually trigger Accelerations, Early Decelerations, Variable Decelerations, or Late Decelerations.

Settings Tab (Monitor Layouts & Alarms)

• Visible Modules: Use the checkboxes to show or hide specific waveforms on the student screen (e.g., hide the ECG, show the ART line).
• Alarm Limits: Set custom Critical Low, Warn Low, Warn High, and Critical High alarm thresholds.
• Advisory Messages: Trigger on-screen warnings for the students, such as "SPO2 PROBE OFF" or "NIBP CUFF LOOSE".

Vitals offers various screen layouts to mimic different clinical environments and devices. You can change these live from the Settings Tab > Display Layout dropdown. Changing the layout instantly updates the student-facing remote screen.

• Basic: A standard, high-visibility 3-waveform layout typically showing ECG, SpO2, and NIBP/Respiration. Ideal for general wards, PACU, or emergency departments.
• Values Only: Removes all waveforms, showing only large numerical data blocks. Excellent for quick glances, patient transport, or basic observations.
• ICU 1, ICU 2, ICU 3: Advanced, high-acuity setups. These layouts accommodate up to 6 overlapping or stacked waveforms. They are specifically designed to support invasive monitoring such as Arterial Lines (ART), Central Venous Pressure (CVP), Pulmonary Artery Pressure (PAP), and Waveform Capnography (EtCO2).
• Pre-Hospital (1, 2, and 3): Rugged, high-contrast layouts mimicking portable defibrillator/monitors used by prehospital providers.
  • Basic Variants: Show essential waveforms (ECG, SpO2) with large, bright numeric readouts.
  • Advanced Variants: Expand the display to include capnography or invasive lines while maintaining the rugged UI aesthetic.
• Fetal: A dedicated layout that splits the screen horizontally. The top half displays a continuous scrolling Fetal Heart Rate (FHR) tracing, whilst the bottom half shows Uterine Contractions (CTG/Toco).
• AED: A simplified, instructional screen that guides the user through basic life support and AED algorithms (Analyse, Stand Clear, Deliver Shock) based on the instructor's inputs from the AED Control tab.

The Vitals simulator engine automatically links certain physiological parameters to create a realistic clinical picture. Understanding how these interact will help you run more convincing scenarios.

ECG & Heart Rate (HR)

The ECG waveform is dynamically generated based on the selected rate and rhythm.

• Rhythms:
  • Normal Sinus Rhythm (NSR): Standard P-QRS-T complexes linked to the HR slider.
  • AFib (Atrial Fibrillation): Removes P-waves and generates an irregularly irregular R-R interval.
  • VTach & VFib: Generates wide-complex tachycardia or chaotic wavy lines. Note: Selecting these shockable rhythms automatically triggers the 'Pulseless' state (see below).
  • AV Blocks: Dynamically prolongs the PR interval (1st Degree) or drops QRS complexes (2nd and 3rd Degree).
  • Paced: Inserts distinct vertical pacer spikes before the P or QRS complexes.
• Morphology: You can overlay ST elevation or depression (e.g., Inferior, Anterior, Lateral STEMIs) onto the underlying rhythm.
• The 'Pulseless' Toggle (PEA): When toggled ON, the patient is in Pulseless Electrical Activity. The ECG rhythm will continue to display normally on the screen, but the engine will automatically flatline the mechanical waveforms (ART line and SpO2 plethysmograph) and drop NIBP readings to simulate a lack of cardiac output.

SpO2 (Pulse Oximetry)

• Value: Represents the peripheral oxygen saturation percentage.
• Waveform (Plethysmograph): The frequency of the waveform is perfectly synchronized with the patient's Heart Rate.
• Traces:
  • Normal: Standard pulsatile waveform.
  • Poor Perfusion: Dramatically flattens the amplitude of the waveform to simulate shock, cold peripheries, or low cardiac output, making the trace appear sluggish.
  • Artifact: Injects erratic, jagged noise into the waveform to simulate patient movement or shivering.

Blood Pressure: NIBP vs. ART

• NIBP (Non-Invasive): NIBP values are hidden or shown as "--/--" until the instructor explicitly clicks Cycle NIBP. This mimics the time it takes for a cuff to inflate and deflate.
• ART (Arterial Line): If enabled, the ART waveform provides a continuous, real-time arterial trace synced to the heart rate, complete with a dicrotic notch.
• ART Waveform Damping:
  • Normal: Crisp systolic peak and clear dicrotic notch.
  • Overdamped: Sluggish upstroke, rounded peak, and loss of the dicrotic notch (simulating air bubbles or kinks in the tubing).
  • Underdamped: Excessively sharp peaks and artifactual ringing/overshooting (simulating excessively stiff tubing).

Capnography (EtCO2) & Respiration

• Value: Represents End-Tidal CO2, toggleable between kPa and mmHg.
• Waveform: The frequency is dictated by the Respiratory Rate (RR) slider.
• Traces:
  • Normal: Standard square 'top-hat' waveform.
  • Obstructive: Slants the ascending phase of the waveform to create a 'shark-fin' appearance, perfectly simulating bronchospasm, asthma, or COPD.
  • Stacking: Simulates incomplete exhalation/breath-stacking by preventing the waveform baseline from returning to zero.

Invasive Pressures (CVP & PAP)

• CVP (Central Venous Pressure): Generates a characteristic low-pressure venous waveform (with a, c, and v waves) reflecting right atrial pressure.
• PAP (Pulmonary Artery Pressure): Generates a right-sided arterial waveform (lower pressure than systemic ART) representing pulmonary hemodynamics.

Fetal Monitoring (FHR & CTG)

Fetal physiology is simulated through two distinct interacting traces.

• Fetal Heart Rate (FHR): The baseline is set by the slider.
• Variability: Modulates the beat-to-beat fluctuation (Absent = flatline trace; Minimal = 1-5 bpm variation; Moderate = 6-25 bpm; Marked = >25 bpm erratic variation).
• Uterine Contractions (CTG): Governed by the Frequency (contractions per 10 minutes) and Strength sliders.
• Fetal Events:
  • Accelerations: Temporarily spikes the FHR above baseline (indicating a healthy, reactive fetus).
  • Early Decelerations: A drop in FHR that perfectly mirrors the peak of a uterine contraction (simulating benign fetal head compression).
  • Variable Decelerations: Sharp, unpredictable V or W shaped drops in FHR, unrelated to contractions (simulating umbilical cord compression).
  • Late Decelerations: A gradual drop in FHR that purposefully begins after the peak of a contraction, simulating placental insufficiency/hypoxia.

The Scenario Manager allows you to build, save, and run complex, phased clinical cases.

Creating a Scenario

• From the Scenario Manager welcome screen, click Create New Scenario.
• Phases & States: Scenarios are built using "Phases" (e.g., "Initial Assessment"). Inside each Phase, you add "States" (e.g., "Stable", "Deterioration").
• Editing a State: Click on a State card to open the Inspector Panel. Here, you can define exactly what the vitals should be during this specific point in time. Click Apply Changes when done.
• Transitions: Click the arrow between two States to edit how the scenario moves forward. You can set it to Manual (requires you to click 'Next') or Time Delay (automatically transitions after a set number of seconds).

Saving and Sharing Scenarios

• Save: Click Details in the top menu to name your scenario and add tags, then click Save.
• Load: Click Saved Scenarios to browse your "My Library" or "Organisation Library".
• Share: Click Share to generate a unique Share Code.

Importing a Shared Scenario

1. If a colleague gives you a Share Code (e.g., S-XXXXXX), go to your Portal dashboard.
2. Under Import Scenario, enter the code and click Import. It will now be saved to your personal library.

Running a Scenario

1. From the Scenario Manager, click the green Run Scenario button.
2. The Driver HUD (Heads-Up Display) will appear at the top of your screen, showing a live timer, current state, and miniature vitals.
3. Click Next State to progress the scenario linearly through your pre-programmed phases.

Live Overrides (During a Scenario)

If students perform an unexpected action, you can manually override the pre-programmed scenario.

1. Click on the Live Overrides or Rhythm & Events tabs in the sidebar while a scenario is running.
2. Adjust the sliders or trigger an event.
3. Click Apply Instantly for immediate changes, or adjust the transition timer and click Transition for a gradual shift.
4. To return to your structured scenario, click the Reset button in the Driver HUD and select the state you wish to resume from.

Because Vitals is a browser-based platform that relies on real-time cloud synchronisation, most issues are related to network connectivity or browser settings. Below are pragmatic solutions to the most common issues you may encounter.

The remote patient monitor screen is not updating or is out of sync

• The Cause: The platform relies on a continuous background connection to synchronise data. A momentary drop in Wi-Fi or high network latency can cause the remote screen to fall behind the instructor's controller.
• The Solution:
  1. On the instructor's control panel, locate and click the Update Monitor button (if available) or slightly adjust a slider to force a fresh data push to the cloud.
  2. If the monitor screen remains unresponsive, simply refresh the browser page on the display device. It will automatically reconnect to the active session without requiring a new code.

Unable to connect a remote screen using the Session ID

• The Cause: The 7-character code is incorrect, the session was closed, or corporate network firewalls are blocking the connection.
• The Solution:
  • Ensure the code is typed exactly as it appears on the instructor's screen, including the "S-" prefix and capital letters (e.g., S-AB12CD).
  • Verify that the instructor has not accidentally closed the session from their Portal dashboard.
  • Institutional Firewalls: If you are using the platform on a hospital or university network, strict firewalls sometimes block real-time database traffic. If the screen continuously shows a loading spinner, try connecting via a mobile hotspot to verify if the local network is the culprit.

The interface is unresponsive, or buttons are stuck on "Loading..."

• The Cause: Your browser is holding onto a "stale" cache of the application, or there is a temporary interruption to the cloud servers.
• The Solution: Perform a hard refresh of your browser to clear the cache and pull the latest version of the application.
  • Windows/Linux: Press Ctrl + F5.
  • Mac: Press Cmd + Shift + R.
  • Tablets/Mobiles: Clear your mobile browser cache in the settings menu, or close the browser tab completely and reopen it.

Sudden logout or "Session Expired"

• The Cause: For security purposes, your authentication token periodically expires, particularly if you have been inactive for a long period, logged in from a different device, or recently changed your password.
• The Solution: Simply log back in via the main Portal. Any simulations you were running will remain active in the background. Once logged in, look under Active Sessions on your dashboard and click Rejoin.

Scenarios or Profile changes are not saving

• The Cause: A momentary loss of internet connection. The system requires an active connection to write data to the cloud database.
• The Solution: Check your device's Wi-Fi or Ethernet connection. If you are building a complex scenario in the Scenario Manager, ensure your connection is stable before clicking Save. If an error message persists, copy any text you have written to a separate document to prevent data loss, then refresh the page.

Features are greyed out or showing "Subscription Required"

• The Cause: You are attempting to access a premium feature (such as the Scenario Manager, advanced layouts, or certain invasive parameters) whilst on the Free tier, or your subscription payment has recently failed.
• The Solution: Return to the Portal dashboard. Check your Subscription Plan status. If it reads "Free" or indicates a payment failure, click Manage Subscription to update your billing details. If you belong to an organisation, contact your Organisation Admin to ensure you have been assigned the correct role and that the organisation has available seats.