VitalsSim User Manual

ECG & Rhythms

The simulator generates dynamic ECG waveforms based on Gaussian function modeling, allowing for realistic morphology changes.

Supported Rhythms

• Normal Sinus Rhythm (NSR): Includes sinus arrhythmia logic (P-P interval variation).
• Atrial Fibrillation (AFib): Irregularly irregular rhythm with simulated fibrillatory waves and variable R-R intervals.
• Blocks:
  • 1st Degree: Prolonged PR interval.
  • 2nd Degree Type 1 (Wenckebach): Progressive PR prolongation logic.
  • 2nd Degree Type 2: Fixed drop (2:1 or 3:1).
  • 3rd Degree (Complete Heart Block): Complete dissociation between P waves (atrial rate) and QRS complexes (ventricular escape rate).
• Tachycardias: SVT (Supraventricular Tachycardia), VTach (Ventricular Tachycardia - wide complex).
• Arrest Rhythms: VFib (Ventricular Fibrillation - chaotic waveform), Asystole (flatline with minor noise).
• ST Changes: ST Elevation and ST Depression morphology options.

Artifact & Ectopics

You can introduce artifacts and ectopic beats dynamically:

• PVCs (Premature Ventricular Contractions): Can be triggered manually or set to a frequency (ectopics/min). During a PVC, the arterial pulse pressure is automatically reduced to simulate pulse deficit.
• CPR Artifact: Simulates compression noise on ECG, ART, CVP, and PAP waveforms (~110 compressions/min).

Hemodynamics (BP/SpO2)

SpO2 (Pulse Oximetry)

The plethysmograph waveform is physiologically linked to perfusion status.

• Perfusion Scaling: The amplitude of the SpO2 wave scales dynamically with Systolic Blood Pressure. As BP drops (e.g., in shock), the waveform amplitude decreases.
• Waveform Issues:
  • Poor Perfusion: Reduces signal amplitude significantly.
  • Movement Artifact: Introduces random noise to the signal.

Blood Pressure

Supports both Non-Invasive (NIBP) and Invasive (ART) monitoring.

• NIBP: Simulates a cycling cuff. The value is "staged" and only updates after a cycle completes (approx. 5 seconds). Cycling sound effects are included.
• ART Line: Continuous beat-to-beat pressure waveform.
  • Damping: Choose from Normal (dicrotic notch visible), Overdamped (smoothed, no notch), or Underdamped (exaggerated ringing/overshoot).
  • Pulse Deficit: During PVCs, the arterial pulse is visibly smaller and earlier than a normal beat.

Respiratory & EtCO2

Respiratory Rate (RR) is derived from the EtCO2 waveform frequency.

EtCO2 Waveforms

Selectable capnography morphologies include:

• Normal: Standard square-wave appearance.
• Obstructive (Shark Fin): Slow expiratory upstroke, indicating bronchospasm (e.g., Asthma/COPD).
• Rebreathing: Elevated baseline, indicating CO2 re-inhalation.
• Curare Cleft: A dip in the alveolar plateau, indicating spontaneous respiratory effort during ventilation.
• Cardiogenic Oscillations: Small ripples on the waveform caused by the beating heart against the lungs.

Advanced Monitoring

For ICU and Critical Care scenarios.

• CVP (Central Venous Pressure): Values 0-40 mmHg. Waveform shows A, C, and V waves.
• PAP (Pulmonary Artery Pressure): Values 0-50 mmHg. Distinct systolic/diastolic waveform with dicrotic notch.
• Temperature: Dual-channel monitoring (T1, T2) with delta calculation. Supports Celsius and Fahrenheit.

Fetal Monitoring

Specialized logic for Obstetric scenarios (FHR & CTG).

• Variability: Control beat-to-beat variability (Absent, Minimal, Moderate, Marked).
• Decelerations: Trigger specific events:
  • Early: Mirrors contraction (head compression).
  • Late: Lags behind contraction (placental insufficiency).
  • Variable: "V" shaped drop (cord compression).
• Accelerations: Transient increases in FHR.
• Contractions (CTG): Set frequency (e.g., every 2-10 mins) and strength/duration.

Defibrillation & Pacing

Defibrillator

Fully simulated manual defibrillator interface.

• Charging: 3-second charge cycle with audio cues.
• Sync Mode: Synchronizes shock delivery to the R-wave (cardioversion).
• Shock Outcome: Advanced logic determines if a shock converts the rhythm based on energy delivered and number of shocks (configurable in scenarios).
• Post-Shock PEA: Option to have the electrical rhythm convert (e.g., to Sinus) but with no mechanical pulse (PEA).

Transcutaneous Pacing

Demand and Async pacing modes.

• Capture Threshold: You set the patient's capture threshold (mA). If the pacer output is below this, pacer spikes appear but no QRS follows. Above this, wide QRS complexes are generated.
• Mechanical Capture: The system simulates electrical capture. The instructor must verify mechanical capture by checking the SpO2/ART waveform.

Setting Up a Session

1. Start Controller: Log in and launch the "Monitor Controller".
2. Session ID: Note the unique Session ID (e.g., U12345) displayed at the top.
3. Connect Monitor: On the display screen (iPad/TV), navigate to the "Connect Monitor" page.
4. Enter Code: Input the Session ID. Alternatively, use the QR code feature in the controller (Settings > Session Recovery) to pair devices quickly.

Monitor Layouts

The system supports multiple layouts, switchable instantly from the Controller.

Alarms & Display Settings

• Alarm Limits: Fully customizable High/Low limits for HR, SpO2, BP, RR, and EtCO2.
• Silence: Global alarm silence toggle (2-minute timeout logic).
• Fullscreen: Toggle fullscreen mode for immersive simulation.
• Layout Switching: Change the monitor view remotely without touching the student's screen.

Scenario Builder

The Scenario Builder is the core of the Advanced Controller, allowing you to pre-program complex clinical progressions.

Creating a Scenario

1. Click Create New Scenario from the welcome screen or the "Saved Scenarios" modal.
2. Enter a Name for your scenario (e.g., "Anaphylaxis Case 1").
3. Use the Details button to assign tags or organize it into folders.

Phases & States

Scenarios are organized hierarchy:

• Phases: Broad chapters of the simulation (e.g., "Baseline", "Reaction", "Treatment").
• States: Specific snapshots of vital signs within a phase (e.g., "Initial Tachycardia", "Hypotension").

To build your flow:

1. Click + Add New Phase to create a new chapter.
2. Within a phase, click Add New State to define a set of vitals.
3. Drag and drop states or phases to reorder them.

Transitions

You can control how the simulator moves from one state to the next:

• Manual: The simulator waits for you to click "Next State".
• Time-Based: Automatically advances after a set duration (e.g., 60 seconds). Click the arrow between states to configure the timer.

Live Overrides

Even while a scenario is running, you can take manual control of any parameter using the "Live Overrides" tab.

Adjusting Vitals

1. Navigate to the Live Overrides tab in the sidebar.
2. Use the Sliders or Input Fields to change values (HR, SpO2, etc.).
3. Changes are staged (highlighted in orange) until you apply them.

Applying Changes

• Apply Instantly: The monitor updates immediately to the new values. useful for sudden events like cardiac arrest.
• Transition: The monitor gradually changes to the new values over a set duration (default 10s). Use this for physiological responses to drugs.

Interventions

The "Interventions" tab handles advanced cardiac life support (ACLS) features.

Defibrillation

Fully simulates a manual defibrillator:

• Energy: Select Joules (e.g., 150J, 200J).
• Charge: Click "Charge". You will hear the charging sound.
• Shock: Once charged, the "Shock" button becomes active. Clicking it delivers the shock.
• Sync: Toggle "Sync" for cardioversion. The shock will only be delivered on the R-wave.

Pacing

For bradyarrhythmias:

• Pacer On: Activate the pacer.
• Capture Threshold: Set the patient's capture threshold (mA). Below this, only pacer spikes are seen. Above this, the rhythm is captured (wide QRS).
• Mechanical Capture: Toggle whether the electrical capture produces a pulse (affects SpO2/ART waveform).

Manual ROSC

Quickly recover a patient from cardiac arrest:

1. Configure the target vitals (e.g., Sinus Rhythm, BP 120/80).
2. Set a transition time (e.g., 15 seconds).
3. Click Initiate Recovery. The system will smoothly transition the patient to the stable state.

Ventilator Control

Simulate a mechanical ventilator screen alongside the patient monitor.

Modes & Settings

• Mode: Select from standard modes like AC/VC, AC/PC, SIMV, and PSV.
• Parameters: Adjust Tidal Volume (TV), Respiratory Rate (RR), PEEP, and FiO2.
• Live Updates: Changes made here reflect instantly on the ventilator display.

Emergencies

Trigger ventilator-specific alarms and waveform changes:

• Occlusion: Simulates a blocked tube (High Peak Pressure).
• Disconnect: Simulates a circuit disconnect (Low Pressure, Low Minute Volume).
• Pneumothorax: Simulates lung collapse (High Pressure, Low SpO2 progression).

Inspector Panel

The Inspector Panel allows for granular editing of any state in your scenario.

Editing a State

1. Click on any State Card in the Scenario Builder.
2. The Inspector Panel will slide open (or appear in a modal).
3. Modify the specific parameters for that state.

Advanced Properties

• Cardiac Arrest: Toggle "Designate as Cardiac Arrest" to enable special logic (e.g., shockable vs. non-shockable rhythms).
• Temperature: Set T1/T2 temperatures and custom labels (e.g., "Nasopharyngeal").
• Fetal: Configure Fetal Heart Rate (FHR) and Uterine Contractions (CTG) for that specific state.