laerdal SimMan Articulated+LiveShock User Manual
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laerdal SimMan Articulated+LiveShock User Manual

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SimMan
/ Articulated + LiveShock
User Guide
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Summary of Contents for laerdal SimMan Articulated+LiveShock

  • Page 1 SimMan / Articulated + LiveShock User Guide laerdal.com...

  • Page 2: Table Of Contents

    TABLE OF CONTENTS Intended use ................. . . 4 Items included .
  • Page 3 Head, Neck and Airway ..............82 Leg .

  • Page 4: Intended Use

    Do not mix articulated and drug recognition arms. NOTES • Read the Important Product Information booklet before use. • Read the SimMan 3G PLUS Quick Setup Guide (QSG) for more information on usage. • See Laerdal's global guarantee for terms and conditions. For more information visit www.laerdal.com.

  • Page 5: Items Included

    ITEMS INCLUDED...
  • Page 6 24. Arm IO bone (x3) lubricant 25. Absorbent sheet (x10) 12. Fill and drain bottles 26. Arm IM pad (x3) 13. Wounds kit 27. Tool 14. Chest drain pleura (x6) 28. External power supply NOTE Visit www.laerdal.com for accessories overview.

  • Page 7: Features And Skills

    FEATURES AND SKILLS The following features are available on SimMan. Features overview Assessment capabilities • Automatic Non-Invasive Blood Pressure (NIBP) • Bilateral carotid, brachial, radial, femoral, popliteal and pedal pulses...

  • Page 8: Immersive Simulation

    • SpO monitoring • Configurable eye, eyelid and pupil settings • Heart, lung, bowel and vocal sounds Immersive simulation • More diverse patient representation • Fully articulating arms and legs • Palpable skin and anatomical landmarks • Anatomically correct male and female genitalia •...
  • Page 9 • Detection of proper head position • Jaw thrust • Pneumothorax decompression • Ventilations • Stomach distension Nasal Cannulation Nasal cannulation is possible with standard equipment. WARNING Do not supply oxygen. Artificial respiration Artificial respiration of SimMan can be achieved by the following methods: •...

  • Page 10: Clinical Interventions

    • Do not put biological or other materials in the simulator’s airways. • Only use Manikin Airway Lubricant. Use of silicone or any other lubricant not approved by Laerdal may cause damage to the airways. • Refer to the Important Product Information booklet for further cautions related to the Patient Simulator airway.

  • Page 11: Cardiac And Resuscitation

    Cardiac and resuscitation • LiveShock skin for defibrillation options • Cardioversion • ECG rhythm monitoring • External pacing • CPR capable...
  • Page 12 NOTES • SimMan provides CPR measurement and feedback compliant with AHA 2020 guidelines. • LLEAP provides real-time feedback on the quality of depth, release and frequency of CPR. CPR compressions generate palpable pulses, blood pressure wave form, and ECG artefacts. •...
  • Page 13 NOTES • Always follow the safety instructions from the defibrillator manufacturer when using the defibrillator on the Patient Simulator. • To prevent overheating during defibrillation, do not exceed a defibrillation sequence of 3 shocks in 45 seconds followed by 1 minute of CPR. •...
  • Page 14 Cardioversion and external pacing Synchronised cardioversion and external pacing with or without capture SimMan enables the attachment of real electrodes for ECG rhythm monitoring at 4 sites with 3-lead ECG. 12-lead ECG display. LLEAP features an extensive ECG library and records cardiac rhythms. Refer to LLEAP Help Files for further information.

  • Page 15: Injection Sites

    Injection sites Tension pneumothorax with needle decompression can be performed at the bilateral mid clavicle line, second intercostal space. Intraosseous (IO) simulation with needle insertion is possible through the left tibia and humeral in both arms. Intramuscular (IM) injections can be simulated in both deltoid arm areas and upper hip.
  • Page 16 Intrasmuscular (IM) injection Intramuscular injections can be simulated in both the arms and upper hip areas as shown. NOTES • The Pelvis IM pad absorbs up to 15 ml of fluid. • The Arm IM pads absorbs up to 10 ml of fluid. To dry or replace the pad(s) refer to Maintaining IM Pads &...
  • Page 17 Pneumothorax needle decompression Tension pneumothorax with needle decompression can be performed at the bilateral mid clavicle line, 2nd intercostal space. The bladders can be punctured approximately 10 times before needing to be replaced. Refer to Replacing the Pneumothorax Bladders (p. 62) How-to video: Setting Breating Status...
  • Page 18 Chest tube insertion Bilateral chest tube insertion can be simulated at the mid-axillary line in the 4th and 5th intercostal spaces. It is recommended to use chest tubes in the range of 14-28 Fr. Refer to section. Replacing the Chest Drain Pleura (p. 66)

  • Page 19: Articulations

    Articulations The Patient Simulator has a range of limb and joint articulation providing immersive patient handling. Joint Range of Mobility Neck 3-axis movement of the head Shoulder At least: 160° flexion of arm 30° extension of arm 70° abduction of arm 90° medial rotation Elbow At least 90°...
  • Page 20 Joint Range of Mobility Thumbs Free mobility Wrist Radial flexion and ulnar flexion Lumbar 1-axis rotation Hip Joints 3-axis rotation Knees 1-axis rotation Ankles 1-axis rotation...

  • Page 21: Panels Overview

    Panels overview Power panel 1. Power status 2. Battery status 3. Charge status No Light - Power Off Red - 0 - 20% Red - Not charging (check batteries) Green - Power On Orange - 20-70% Orange - Charging in Progress Orange - Start-up Green - 70-100%...
  • Page 22 Fluid panel Air out Blood inlet Fluid inlet Activate filling...
  • Page 23 An external supply of compressed air can be connected when the Patient Simulator is stationary over extended periods. Connect a suitable CO /external air source to a Laerdal external compressor or regulator panel. Connect a Laerdal double-lumen Air/CO tube from the external compressor or regulator panel to the Air/CO inlet on the panel.

  • Page 24: Recommended Sizes For Clinical Devices

    16 Fr IM Needle 21 G (maximum) Mask (for ventilation) Laerdal Adult Mask 4 to 5+ Intraosseous (IO) Access Tibial: BIG Automatic Intraosseous Device, 15 G EZ-IO, 15 G x 1”, 1.8mm x 25mm Jamshidi ® Illinois Bone Marrow Aspiration/Intraosseous Infusion Needle.

  • Page 25: Software

    SOFTWARE Operating software The Patient Simulator is operated and controlled by LLEAP - Laerdal Learning Application. LLEAP LLEAP is the instructor’s application from where the simulation session is run, controlled, and monitored. Installed on a laptop, PC or tablet, LLEAP can be operated in Automatic or Manual mode.

  • Page 26: Network Connectivity

    • Network Selector in Laerdal Simulation Home helps users connect LLEAP and Patient monitor to a wireless network and even host a network (Windows Hosted Network). For a full overview of all applications and their help files, start Laerdal Simulation Home. NOTE Refer to the Opening Laerdal Simulation Home video.
  • Page 27 Option 2 Router If a local or ad-hoc network is required, a router (Laerdal or user’s own) can be used. Option 3 Mobile router A portable, battery-operated router can be used for outside simulation sessions where an enterprise network may not be available.

  • Page 30: Power

    POWER Turning on the simulator Press the power button. • The power status indicator turns orange. • The Patient Simulator says “Simulator started”. • The eyes blink and there is visible chest rise. Charging the Simulator • Battery charging time is approximately 3 hours. Once fully charged, the batteries can last for up to 4 hours.
  • Page 31 CAUTIONS • Do not run the Patient Simulator for more than 1 minute on a single battery. • After the Patient Simulator is turned off, wait 20 seconds before restarting or the Patient Simulator may not function properly. • Never store fully charged batteries for longer than a month. •...

  • Page 32: Setup Batteries

    Setup batteries SimMan is powered by 2 Laerdal Lithium Ion (Li-Ion) batteries. Always use 2 batteries together to power the Simulator and ensure that they are connected properly. Ensure the Patient Simulator is switched off. Before starting, follow the procedure.
  • Page 33 Disconnect the battery cable from the torso cable as shown. Charge battery...
  • Page 34 Insert battery and connect battery to the torso cable as shown. Replace cover once battery/batteries are connected and in place. WARNING Inserting and connecting batteries incorrectly, short circuiting or exposure to fluids pose an explosion hazard. CAUTIONS • Ensure the LiveShock cable has been disconnected. •...

  • Page 35: Charging The Batteries

    Charging the batteries The Patient Simulator battery charger comes with 5 interchangeable international plugs which can be used to externally charge batteries outside of the Patient Simulator. NOTE The charger should only be used with Laerdal Li-ion batteries.

  • Page 36: Prepare For Simulation

    PREPARE FOR SIMULATION Intravenous (IV) setup IV cannulation can be performed. NOTE Only use purified water (distilled) to simulate IV drugs. This prevents clogging of the system.
  • Page 37 Connecting a drain bag The IV fluid system is an open system. IV fluids are drained as they are administered. NOTE The smaller drain port is for the IV drain bag and the larger drain port is for the IO drain bag.
  • Page 38 Connect an IV overflow tube and reservoir bag to the IV fluid drain port under the Patient Simulator’s arm. Excess fluid will drain into the reservoir bag during the simulation. Prepare IV with silicone dressing base For better adhesion of the IV dressings, position the silicone dressing base onto the arm skin.
  • Page 39 Place the dressing. Insert the IV cannula. Connect the tubes (luer lock) to the cannula and drain bag. Secure the IV area with tape. NOTES • The silicone dressing base can be used multiple times, and does not need to be replaced after each use.
  • Page 40 Automatic NIBP monitoring SimMan enables bilateral, automatic NIBP monitoring with a clinical monitor. NOTE Only use the Blood Pressure cuff supplied with SimMan Locate correct connector (supplied) to connect BP cuff to Patient Monitor. Attach connector to BP cuff (use a Y-connector if the patient monitor uses a dual tube).
  • Page 41 The NIBP system delivers simulated blood pressures with an accuracy of ≤ 10 mmHg (at 15-25 °C, 15-85% RH). NIBP system range Diastolic blood pressure 40-130 mmHg Systolic blood pressure 60-200 mmHg Refer to LLEAP Help Files for complete blood pressure measurements and operating information.
  • Page 42 Ensure that the index finger skin is correctly aligned with the (translucent) window area. Clip the probe on to the finger ensuring that it is firmly positioned over the window area. If positioned incorrectly a reading may not be recorded on the monitor. System values range (minimum) 70-100% SpO...
  • Page 43 System values accuracy of ≤ 2% 90-100% SpO Intraosseous (Arms IO) IO simulation with needle insertion is possible through the humeral bone. Ensure that the IO bone has not already been pierced or used. To repair and replace the IO bone refer to Maintaining Arm IO Bone (p.

  • Page 44: Torso

    Recommended Device Sizes EZ-IO, 15 G x 1” 1.8 x 25 or 45 mm CAUTIONS • Incorrect use of larger devices can damage the IO bone and/or internal components. The smaller size is recommended. • Do not inject fluids into the pads unless approved IO modules with fluid outlets are in place.
  • Page 45 Connect a suitable CO /external air source to a Laerdal external compressor or regulator panel. Connect a Laerdal double-lumen Air/CO tube from the external compressor or regulator panel to the Air/CO inlet on the panel. NOTES • Exhaled CO can be detected with a CO detection device.
  • Page 46 Emptying the Blood System (p. 97) wounds still attached. Remove wounds kit once cleaning is complete. Clean any tape residue left on the Patient Simulator skin with Laerdal Manikin Wipes. NOTE When removing wound tubing from the blood ports, cover the Patient Simulator skin with a cloth to prevent staining.
  • Page 47 Remove the Patient Simulator’s genitalia pad by gripping the pad pulling forward and down. Select new genitalia module. Connect the new genitalia module’s urine tube and the catheterization sensor cable from inside the Patient Simulator pelvis to the urine bladder module.
  • Page 48 NOTES • The Patient Simulator legs do not need to be removed before the genitalia pad can be replaced. • Common skin preparations such as chlorhexidine and povidone iodine-based products may be used safely without staining the genitalia. • Always use a water-based lubricant liberally when inserting a urine catheter. Use the following catheter sizes Female genitalia Foley 14Fr and Lofric 16Fr...

  • Page 49: Head, Neck And Airway

    Head, Neck and Airway Insert the head skin Position the head skin over the head module Align the eye sockets over the eyes. Align the airway tube with the right nostril, and secure into place.
  • Page 50 Insert the microphone carefully and connect the red, blue and green tube connectors. Turn the head to the other side and insert the microphone. Connect the red and blue tube connectors.
  • Page 51 Close the zipper. Place the neck skin. Prepare teeth Soft upper teeth may be replaced with a hard set for enhanced realism while practicing intubations. Grip soft teeth with two fingers. Remove soft upper teeth.
  • Page 52 Select new teeth. Align new teeth with the gums and push back until the teeth engage and lock onto the gums. Airway intubation Lubricate airway device. Insert lubricated device into the airway. CAUTION Do not spray lubricant directly into the airway.

  • Page 53: Prepare Simulated Blood & Fluids

    The use of smaller tube-type devices reduces wear of the Patient Simulator’s airways. Prepare simulated blood & fluids Preparing simulated blood Fill blood fill bottle with approximately 500 ml distilled water. Add approximately 10 drops of Laerdal Blood colored concentrate. Tighten the cap and mix.
  • Page 54 Preparing clear fluids and secretions Fill fluid fill bottle with approximately 500 ml distilled water. Tighten the cap. Blood and fluid systems The Patient Simulator has two internal tanks, one for simulated blood and one for fluids.The fluid fill panel is located at the top of the right leg. How-to video: in LLEAP.
  • Page 55 Roll the right leg skin down to expose the fill panel. Lift the panel cover. Connect the blood fill bottle tubes to the relevant inlet and the air outlet in the right leg panel. Turn on the Activate Filling. The button will light up and blood will flow into the Patient Simulator.
  • Page 56 Roll the right leg skin down to expose the fill panel. Lift the panel cover. Connect the fluid fill bottle tubes to the relevant inlet and the air outlet in the right leg panel. Turn on the Activate Filling. The button will light up and fluid will flow into the Patient Simulator.
  • Page 57 NOTES • Disconnect tubes from the Patient Simulator before turning off the Activate Fill button. Turning the fill button off before disconnecting the tubes will initiate draining of the tank. • Only one tank can be filled at a time. Secretions, sweat and urine Sweat, tears, cerebrospinal fluid (CSF) and urine functions can be set and adjusted in the LLEAP Fluids tab.

  • Page 58: Leg

    Prepare tibial IO with blood...
  • Page 59 Attach an IV bag to the tibial tube. Close off the pinch clamp. Roll down leg skin to access the tibial IO module. Remove the IO tape. Lift out the module from the leg. Remove the tube from the module. Fill the module with 30-35 ml of simulated blood.
  • Page 60 Recommended device sizes EZ-IO, 15 G x 1” 1.8 x 25 mm Jamshidi ® Illinois Bone Marrow Aspiration/Intraosseous 18 G Infusion Needle 9/16” (14 mm) - 1 ½” (38 mm) CAUTION Do not inject fluids into these pads unless approved IO modules with fluid outlets are in place.

  • Page 61: Maintenance

    MAINTENANCE Torso Open the torso skin Some maintenance tasks can only be carried out by opening the torso skin. Unzip the skin at shoulders and torso. Remove the genitalia pad. Release the skin flap. Move the torso skin to the side.
  • Page 62 NOTE Ensure that the tubes and cables are connected to the stomach foam. Replace the pneumothorax bladders Replace the pneumothorax bladders after multiple decompressions. Before starting, follow the procedure. Open the torso skin (p. 61) Lift the chest plate to expose pneumothorax bladders. Slide the bladder(s) out.
  • Page 63 Discard used bladder(s). Select new bladder.
  • Page 64 Slide bladder into place. Reconnect tube to the bladder. Replace chest plate.
  • Page 65 Replace the chest rise bladders Replace the chest rise bladders if they leak or are damaged. Before starting, follow the procedure. Open the torso skin (p. 61) Lift the chest plate to expose the chest rise bladders (one on each side). Disconnect the tube(s).
  • Page 66 Replace the chest drain pleura Before starting, follow the procedure. Open the torso skin (p. 61) Remove the used chest drain pleura module. Remove and discard the pleura skin from the module. Replace the used pleura skin with a new one. Insert the module into the torso.
  • Page 67 Replace the lung bladders Replace the lung bladders if they leak or are damaged. Before starting, follow the procedure. Open the torso skin (p. 61) Lift the chest and chest rise plates. Unhook the green lung compliance bands on each side of the lung assembly.
  • Page 68 Lift the hinged lung plate. Remove the used lung from the socket. Discard the used lung. Select the new lung bladder. Insert the new lung bladder into the socket. Ensure that the string is placed in the lung bladder fold. Close the hinged lung plate.
  • Page 69 Ensure the Patient Simulator is turned off. Open the torso skin (p. 61) Disconnect the filter from the leg and pelvis blood tubes by unscrewing the black connectors at each end. Remove filter from the Patient Simulator. Discard clogged filter. Select a new filter.

  • Page 70: Arm

    Remove the back torso skin section. Close the torso skin Put the torso skin over the torso. Push down the skin flap over the genitalia area. Attach the genitalia pad. Zip the torso at the shoulders and torso. Remove the arm skin Some arm maintenance tasks can only be carried out by opening the arm skin.
  • Page 72 Position the arm to expose underside and detach the skin at each plug. Detach the skin at inner elbow point. Remove the skin from the shoulder area. Remove the skin from the hand. Arm IM pads & absorbent sheets The arm IM pad can be punctured numerous times before being replaced or dried.
  • Page 73 Lift out the IO arm bone. Remove absorbent sheet, if wet. Discard used sheet. Select new sheet. Insert sheet into place. 10. Replace arm IO bone. 11. Ensure that base of IO bone slots into place. 12. Replace arm IM pad. How-to video: How to Replace Consumables Arm...
  • Page 74 Arm IO bone Unzip the arm skin from shoulder to wrist. Remove the arm IM pad. Lift and slide out the used arm IO bone.
  • Page 75 Puncture holes in the used IO bone can be repaired with Loctite 454 or similar superglue OR replace the IO bone completely when it has been significantly punctured. Replace repaired or new arm IO bone. Ensure that base of IO bone slots into place. Replace the arm IM pad.
  • Page 76 Remove the used seal from the inside IV port. Discard the used seal. Insert a new seal into the IV port. Align and attach the IV port to the tube. Rotate the IV port to secure in place. 10. Click back into the chassis. 11.
  • Page 77 Lift the chest plate to expose the arm bolt. a. Unscrew the arm bolt. Do not unscrew fully b. Lift up the arm bolt.
  • Page 78 Disconnect the cables as shown and feed them out of the arm socket. Remove the arm. Replace the arm • Take the new arm. How-to video: How to Replace Arms...
  • Page 79 Attaching the left arm Insert the arm in its socket Connect the cables as shown and feed them in the arm socket.
  • Page 80 a. Screw the arm bolt. b. Push down on the arm bolt. Close the chest plate This procedure is the same for the right arm.
  • Page 81 Replace the arm skin...

  • Page 82: Head, Neck And Airway

    Select new arm skin. Insert arm into new skin, ensuring that the SpO finger window is positioned correctly over the sensor area. Place arm skin over shoulder area and tubing. Closing the arm skin Attach the skin at the elbow point. Attach the skin at each plug.
  • Page 83 Remove the neck skin. Remove damaged or perforated tape. Select a new section of cricothyroid tape. Replace with new tape, ensuring it completely covers and seals the opening to prevent leakage during ventilation. Replace the neck skin. NOTE If the used neck skin is in good condition, move the skin along to position a new section over the cricothyroid tapeIf the used neck skin is in good condition, move the skin along to position a new section over the cricothyroid tape.
  • Page 84 Remove Head Skin...
  • Page 85 Remove the neck skin. Unzip the head skin. Lift the head skin to expose tubing. Disconnect the blue and red tube connectors. Carefully remove the microphone cable from inside the head skin. Turn the head. Disconnect the red, blue and green tube connectors. Carefully remove the microphone cable from inside the head skin.
  • Page 86 Replace the head skin Select the new head skin. Unzip the head skin. Turn the head skin inside out.
  • Page 87 Insert the head skin Position the head skin over the head module Align the eye sockets over the eyes. Align the airway tube with the right nostril, and secure into place.
  • Page 88 Insert the microphone carefully and connect the red, blue and green tube connectors. Turn the head to the other side and insert the microphone. Connect the red and blue tube connectors.
  • Page 89 Close the zipper. Place the neck skin.

  • Page 90: Leg

    Removing the left leg Before starting, follow the procedure. Open the torso skin (p. 61) Move stomach foam to one side. Disconnect the cables to the left leg. Pull out the thumb lock pin. Carefully remove the leg.
  • Page 91 Replacing tibial IO...
  • Page 92 Attach the tibial IO drain bag to the tibial tube. Close off the pinch clamp. Roll down leg skin to access the tibial IO module. Remove the IO tape. Lift out the tibial IO unit from the leg. Remove the tube from the tibial IO module. Remove the tibial IO pad from the tibial IO chassis.
  • Page 93 11. Connect the tibial tube to the tibial IO unit. 12. Insert the tibial IO module into the leg. 13. Secure the module with tape. 14. Roll the leg skin over the tibial module.

  • Page 94: General Care And Cleaning

    GENERAL CARE AND CLEANING Regular care, cleaning and maintenance are required to ensure longevity of the Patient Simulator. General patient simulator care • Wash hands before use and place the Patient Simulator on a clean surface to maintain Patient Simulator skins. •...

  • Page 95: Cleaning Monthly

    NOTE All servicing must be performed by qualified service personnel. Preventative maintenance Laerdal strongly recommends the Preventative Maintenance (PM) Service. This service will help to maintain the product in optimal operating condition. Contact your local Laerdal representative for more information.

  • Page 96: Cleaning The Blood System

    Cleaning the blood system Once all sessions are complete, flush the Blood System with distilled water, with the wounds connected.This will remove remains of Laerdal blood in the Blood System, and prevent clogging of valves and tubing. Emptying internal blood tank Connect an empty fill bottle to the bood inlet.
  • Page 97 WARNING Connecting a full Blood Unit to a Patient Simulator with an already full internal tank will result in system overflow. Blood will drain out of the right leg. Repeatedly overflowing the system may damage the product. NOTE Place the fill bottle on the floor or below the Patient Simulator to facilitate emptying the fluids.

  • Page 98: Cleaning The Fluid System

    From LLEAP, again check the boxes for Upper and Lower port (making sure Venous bleeding and maximum blood rates are still selected). Allow the blood system to flush until clear fluid runs out of all outlets. When finished, press Activate Filling to deactivate the filling procedure.The LED indicator on the Activate Fill will turn off.
  • Page 99 NOTE During the cleaning procedure – Tank empty warning - may occur in LLEAP Software. This message can be disregarded during the cleaning procedure. How-to video: Clean the fluid system NOTE The video shows the fluid inlets. Use the fluid inlet here.

  • Page 100: Accessories

    ACCESSORIES Trauma modules Trauma modules can be fitted to the Patient Simulator to simulate bleeding patient cases. After the simulation is complete, leave the trauma modules connected, and clean according to the instructions in Cleaning the Blood System (p. 96)
  • Page 101 NOTES • The SimMan arm adaptor kit is required to connect the trauma arm modules. • There will be no automatic non-invasive blood pressure functionality on the right arm when it is used with one of the left trauma arms. How-to video: in LLEAP.
  • Page 103 Select either the SimMan Amputation or Gunshot Arm with Arm Adapter and Adapter Screw. Unscrew the Adapter Screw. Insert the arm into the shoulder bracket. a. Tighten the arm bolt to secure. b. Push down the arm bolt. Attach the tube to the desired blood port.
  • Page 104 Tighten the screw to adjust the range of the arm motion with a screwdriver. CAUTION Do not over rotate arm. Over rotating the arm may cause the red vinyl tubing to disconnect. Attaching the trauma left leg Insert the trauma leg into the leg socket.

  • Page 105: Transport And Storage

    Insert the thumb lock pin, ensuring the leg is properly fixed into place. Connect the cables and tube. Transport and storage The Simulation System is supplied with two cases for easy transport and storage; one for the Patient Simulator legs and one for the torso. Before storage or shipping •...
  • Page 106 CAUTIONS • Do not store this product outside the storage conditions specified in the Important Product Information. • Store simulator in a clean, dry area. Storage in a damp area will cause corrosion of electronic parts. • Remove stomas prior to storage. Stomas should be stored in a plastic bag when not in use.
  • Page 108 © 2023 Laerdal Medical AS. All rights reserved. Laerdal Medical AS P.O. Box 377 Tanke Svilandsgate 30, 4002 Stavanger, Norway T: (+47) 51 51 17 00 20-21549 Rev A laerdal.com...

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