Body Simulation

Body Simulation is built around the excellent physiologic and pharmacologic models of N. Ty Smith, M.D. The software is integrated with many aspects of relevant physiology to present users with the most life-like PC based flat screen anesthesia simulation available.

 











About the Body Simulation System

VI. QUICK START: HOW TO SET UP AND START A CASE: THE BASICS

Back to Body Manual Index | Next Chapter ( VII. Teaching with Body Simulation for Anesethesia)

Welcome to Quick Start. You will be taken through a straightforward anesthetic case in a step by step and window by window fashion. To get the most from 'Quick Start', read the paragraph or section describing the action, then perform the action yourself. The action to be performed appears in italicized text . When you encounter italicized text you should stop and perform the task. The example used in this section requires a particular setup, so it is important that you follow all of the italicized commands .

Starting Body

Start Body by double clicking on the Body Simulation icon on your desktop:

or

Body Simulation for Anesthesia will be launched. The first screen will allow you to register your copy of Body. You need only register once. The registration number that you were given is derived from the name that you supplied when you purchased Body. The registration number will only work with that name. If you choose not to register right away, you will only be allowed to run the program for seven minutes before it shuts down. For the Quick Start Scenario, we will assume that you have already registered.

Double click on the Body Simulation Icon Now

How to Select a Patient

When Body is opened, the first screen offers the following choices:

Select Patient Now

Quick Setup Now

Close This Window

Select Patient Now :

This option is chosen when you want to select a patient for a case. Clicking on the Select Patient Now button will open another window prompting the user to select a patient. There are 6 patient choices supplied with the software. :

  • Pat01 - 44 y/o healthy male.
  • Pat02 - 44 y/o hypovolemic male with bleeding a ulcer.
  • Pat03 - 84 y/o frail female.
  • Pat04 - 39 y/o male, heavy smoker with liver disease.
  • Pat05 - 51 y/o obese male with renal dysfunction.
  • Pat06 - 72 y/o female with COPD.

With a single click on a patient filename, a brief description of the patient will appear in the Description Window. To select a patient, double click on one of the patient filenames, OR single click on a patient filename and then click on the Open button.

When you are more familiar with Body, you will be able to add your own patients to the Select Patient folder.

Quick Setup Now:

This option is chosen when you would like to select a file from the Quick Setup Folder. Choosing the Quick Setup Now option will open another window prompting the user to select a Quick Setup file. There are two Quick Setup files provided with Body Simulation:

  • BasicInductionHealthyPatient - for the "Induction of Anesthesia" scenario.
  • HowLongDoIHave - for the "How Long Do I Have" scenario from this manual.

With a single click on a Quick Setup filename, a brief description of the file will appear in the Description Window. To select a Quick Setup file, double click on a Quick Setup filename, OR single click on a Quick Setup filename and then click the Open button.

When you are more familiar with Body, you will be able to add your own files to the Quick Setup Folder. You can build a file that will preset any of the following parameters:

  • Patient
  • Intravenous lines
  • Fluids
  • Monitors
  • Drugs setup
  • Critical incidents

How to build and save Quick Setup Files is described at the end of Quick Start . By choosing a case from the Quick Setup, you bypass having to set up the items that have been pre-specified for that file. This option will save time for users whose goal is to get to a specific part of the case. It also permits setting scenarios for many different individuals to use.

Close This Window

If this option is chosen, the window will close. Once the window is closed, you must click on Case on the Main Menu and chose either Select Patient or Open Quick Setup to start a case.

Click on Select Patient Now

Single Click on Pat 01 to show the patient description.

Click on open item

The Patient window is now open. On top of the Patient window is a small message window titled Body Simulation Initializing.

Body Simulation Initializing

Each time a case is opened, the model must initialize the patient. Body will do this automatically every time a case is opened. The speed with which it does this depends entirely on your operating system. The process of initialization takes five minutes of SIMULATED TIME, but since the model is operating in fast forward during this process, the actual time to initialize the patient depends on how quickly your operating system can run the fast forward. If you have Windows NT it may take as little as 30seconds whereas Windows 95 may take as long as 3 to 4 minutes. While the model is initializing, you may set up a case but it is not recommended that you start the case until initialization is complete.

While the model is initializing, all clocks will be counting backwards from 5 minutes. When the process is complete, the clocks will read zero. They will then start counting forwards in real time. The Body Simulation Initializing message window opens when the case is opened and closes when the initialization process is complete. This window gives you 4 options:

  1. Freeze when initialization is complete: The model and time will be frozen when initialization is complete. When you are ready to proceed with your case, simply click on the Freeze button on the Squeeze window to start the model again.
  2. Beep when initialization is complete: The model will beep letting the user know that initialization is complete.
  3. Do not show this message again: This window will not appear again. The initialization process will still occur each time you select a case but you will not see this message window. You will know that initialization is complete when the clocks start to move forwards in real time.
  4. Close: The window will close, the initialization process will proceed, and you will know that it is complete when the clocks start to move forwards in real time.

If you choose none of the options, the message window will disappear when initialization is completed, and the clocks and the model will start operating in real time.

Do not choose any of the items on the Body Simulation Initializing window

The Patient Window

The PATIENT DISPLAY area is in the left upper quadrant of the Patient window. Below this area are two buttons labeled Info and View Patient . Click on the Info button to change the display to a written description of the patient. Click on the View Patient button to display the patient.

  • Click on the View Patient button
  • Click on the Info button
  • Click on the View Patient button

Setup the Monitors :

Clicking on the Setup Monitor button at the bottom of the Patient window will open the Monitor Setup window. To select your monitors for a case, click on the desired monitors. You will notice that if the cursor rests over a monitor, written text will appear in the area titled "Potential Errors and Complications ". This area describes potential sources of errors and potential complications from the monitor that you have highlighted. This area is presented only as a reminder that all forms of monitoring are subject to error and that many carry the risk of serious complications. Once you have selected the desired monitors, click on Done and you will be back in the Patient window.

After the monitors have been setup at the start of each case, the Setup Monitor button at the bottom of the Patient window changes to the Monitor button. Clicking on this button will bring up the Monitor window. To access the Monitor Setup window subsequently, open the Monitor window and select the Monitor Setup button at the bottom of this window. Alternately, you can click on Setup on the main menu and select Monitors .

  • Click on Setup Monitors
  • Move your cursor over the monitors without selecting anything
  • Select ECG
  • Select Pulse Oximeter
  • Select NIBP at 1 reading every 1 minute
  • Select Capnogram (CO 2 )
  • Select inspired O2
  • Click Done
  • You should be back at the Patient window
  • Click on the Monitor button at the bottom of the Patient window to view the Monitor window

To get back to the Patient window, you can click on the Patient button at the bottom of the Monitor window. This will simply change windows but will leave the monitor window open. Alternatively, you may also minimize the monitor window by clicking on the X in the upper right hand corner of your screen. This will minimize the Monitor window and you will be back in the Patient window.

  • Click on the Patient Button at the bottom of the Monitor window.

You should be back at the Patient window

If you wish to mute the oxygen saturation monitor click on Mute SpO2 Button on the Squeeze window

Setup Intravenous Lines:

The Setup IV Lines button appears in the upper center of the Patient screen. Clicking on this button opens the Setup IV Lines window. When the cursor is moved over the patient outline in this window, it changes to a pointing hand when it passes over sites where an IV may be inserted. A text description will appear briefly indicating the name of the insertion site. To insert an IV, click over an insertion site when the pointing hand is present. When the site is selected, a popup menu will appear, prompting selection of the cannula size. The desired size is selected by clicking on it. The IV will appear on the patient, and the name of the selected IV will appear on the right hand side of the window. You may insert several lines by repeating the same steps.

The anatomy buttons showing vascular structure are for educational purposes only, and do not have a specific function in the software. If the detail anatomy button is high lighted , you must click on the button a second time to return to the basic outline prior to IV insertion.

  • Click on the Setup IV Lines button
  • Move the cursor around the patient to see where IV lines may be inserted
  • Click on the Rt antecubital site
  • Select a 16g cannula
  • Click on the Lt wrist site
  • Select a 18g cannula

Setup Fluids:

The Setup Fluid window is accessed by clicking on the Setup Fluid button at the bottom of the Setup IV Lines window. If the Setup IV Lines window is closed because the user selected the Done button after choosing the IV lines, a Setup Fluid button will appear on the Patient window.

The Setup Fluids window allows you to choose which fluids to connect to an IV line. You do not set the rate of the infusion in this window; that function is performed in the Patient window. In this window, you simply select the fluid(s) that you may want to infuse through a particular line during the case.

Click on the Setup Fluids button to open the Setup Fluids window

To setup fluids:

  1. Click on the IV line that you wish to setup
  2. Click on the button that reads Add a New Fluid to this IV Line
  3. Select the fluid by clicking on the desired fluid
  4. Select the bag by clicking on the desired size
  5. Click on the ACCEPT button

Repeat steps 1 to 5 to setup fluids on all of the lines. Click Done when finished. This will close the window and bring you back to the Patient window. After this point, if you want to return to the Setup Fluids or Setup IV Lines windows again, click on Setup on the main menu.

  • Click on the Rt Antecubital (16g)
  • Click on Add a New Fluid to this IV Line
  • Click on Normal Saline
  • Click on 1000ml
  • Click on Accept
  • Click on the Lt Wrist (18g) IV
  • Click on Add a New Fluid to this IV Line
  • Click on Lactated Ringers
  • Click on 500ml
  • Click on Accept
  • Click on Done

The IV rate is set in the Patient window. If you do not set the rate, no fluid will run through the line.

The IV solutions that you have chosen now appear in the IV BAG area in the lower central portion of the Patient window. To set the rate for a fluid, click on the desired fluid in the IV BAG area. Your selection will now appear under the IV INFUSION image. Move the slide bar on the IV INFUSION image to set the rate. For finer rate control click above or below the slide bar. To run the fluid under pressure, open the slide bar and click on P . To stop pressure click on P again. The rate chosen at any one time is displayed under the IV INFUSION image.

To set the rate for another fluid, click on the desired fluid in the IV BAG area, and repeat the same procedure.

You can change the rate of any fluid at any time during the case. You can also return to the Setup Fluids window from the Setup Menu at any time to add or remove more fluids.

  • Click on Normal Saline
  • Move the slide bar up and down and observe rate
  • Click above and below slide bar and observe rate
  • Open slide bar fully, Click on P and observe rate
  • Click on P again
  • Set rate to 150 cc/hr
  • Click on Lactated Ringers
  • Set rate to 75 cc/hr

Choose Drugs for the Case:

This part of the setup is analogous to setting up drugs at the anesthetic workstation. The drugs are drawn up in this window, but not administered. To set up drugs for a case, click on the Drugs button at the bottom of the Patient window or the Setup Drugs button in the middle of the Patient window. This will open the Setup Drugs window.

  • Click on the Drugs button at the bottom of the Patient window to open the Setup Drugs window

Drugs are grouped into categories. Click on the desired tab to display the drugs available in that category. To select a drug, click on the desired drug. A new window will appear that will allow you to choose a syringe or a bag, to choose the IV line into which the drug will be delivered, and to set the concentration of the drug. This is accomplished with the following steps:

  1. Click on the desired drug category tab
  2. Click on the desired drug label
  3. Click on either the syringe or bag tab
  4. Click on the desired size
  5. Click on the desired IV site
  6. A default drug concentration will be displayed. To change the default, delete the number that is displayed, enter the desired drug concentration, and select mg or mcg.
  7. Click on Accept

This will bring you back to the main Setup Drugs window

To setup more drugs, repeat the above steps for each selection. Up to 12 syringes and bags may be selected for a single case. If a drug infusion is to be used in the case, the drugs are drawn up in the appropriate sized syringe or bag in this window, but the actual infusion pump is setup later in the Patient window

From the Setup Drugs window we will setup the following:

  1. Pentothal 25 mg/cc in a 20 cc syringe
  2. Succinylcholine 20 mg/cc in a 10 cc syringe
  3. Fentanyl 25 mcg/cc in a 10 cc syringe
  • Click on the Inductio n tab
  • Click on pentothal
  • Click on the 20cc syringe
  • Select the Lt wrist IV
  • Click on Accept
  • Click on the Neuromuscular Blocking tab
  • Click on succinylcholine
  • Click on 10cc syringe
  • Select the Lt wrist line
  • Click on Accept
  • Click on the Narcotic tab
  • Click on fentanyl
  • Click on the 10cc syringe
  • Select the Rt antecubital IV
  • Move the cursor to the CONCENTRATION dialogue box, hit delete and type in 25
  • Click on mcg
  • Click on Accept
  • Click on Close and you will be back at the Patient window

Your drugs appear in the DRUG area on the Patient window

Setup Critical Incidents:

Critical Incidents may be added to your case during the setup process. To set up a critical incident, click on Problems on the Main Menu and select Critical Incidents. The Critical Incidents window will appear. Critical incidents are organized into a tab-box system. Click on the tabs to display the critical incidents. The area at the top of the window is different for each tab. Generally, it will outline choices for selecting the desired incident. Selecting the desired incident is straight forward.

The area at the bottom of the window is identical for each tab. This is the area where you set the time for the critical incident to occur. There are three choices.

  1. The Start Incident Now button will start the critical incident immediately.
  2. The Manual Trigger will list the selected critical incidents on the Squeeze window. You can then initiate the event at any time.
  3. The Select Trigger Events section allows the user to specify a trigger for the critical incident. Click on a 'time' and an 'event' to complete the blanks:

Incidence Occurs at _______ after _________ Triggering Event. Click on Accept

Trigger Event.

  • Click on Problems on the main menu
  • Click on Critical Incidents
  • Click on the different tabs to look through the incidents that may be chosen
  • Click on the bleeding tab
  • Set the rate of bleeding to 350 ml/min
  • Set the duration of bleeding to 3 minutes
  • In the Select Trigger Events area, set the bleeding to occur at 1 minute after the start of surgery
  • Click on Accept Trigger Event
  • Click on the Done button to close the window

The Anesthesia Machine:

Before applying the mask to the patient, gas flow must be set on the Anesthesia Machine . To open the Anesthesia Machine window, click on the Anesthesia Machine button at the bottom of the Patient window.

  • Click on the Anesthesia Machine button at the bottom of the Patient window to open the Anesthesia Machine

A brief description of this window will be provided here even though you will not be performing all of the functions at the present time. The left side of the window contains the controls for the inhaled agents and gases whereas the right side of the window is the ventilator.

On the left side of the window the buttons along the bottom select the gas and the slider bars along the top set the flows. The first button allows you to select the inhaled agent. To select an agent, click on the Select button, click on the desired agent and click Accept . The selected agent will appear on the machine. Skip this step if you wish to use the default agent (isofluorane) which appears on this window when it opens. When you are ready to deliver the agent, move the slide bar to the desired concentration.

The next button selects the gas mode. To select the desired gas mode click beside one of the two choices provided. To deliver the gas, move the slide bars. For experimental purposes, it is possible to deliver less than 21% O 2 .

The ventilator settings are controlled by buttons along the bottom of the window and slide bars along the top. To turn the ventilator on and off, click on the Ventilator button. To set the I:E ratio, click on the I:E Ratio button until the desired ratio is displayed. To select the pop off pressure, the PEEP, the tidal volume and the respiratory rate, adjust the slide bars. Notice that the default tidal volume and respiratory rate are 600 and 12 respectively.

At this point in the process, you can setup the entire anesthesia machine without turning on the ventilator and without turning on the inhaled agent. After the patient has been intubated and you return to the anesthesia machine, you will only need to perform these two functions.

  • Click on the Select button in the AGENT area
  • Click on the inhaled agent that you would like to use in this case
  • Click on Accept
  • Do not move the slide bar for the agent at this time
  • Select AIR+O2 under GAS MODE
  • Use the slide bar to turn up the oxygen to pre-oxygenate the patient
  • Click on the I:E Ratio button and cycle through the choices, set it at 1:3
  • Set the pop-off valve to 15
  • Set the tidal volume to 0.7
  • Set the respiratory rate to 14
  • Return to the Patient window by clicking on the Patient button

Pre-Oxygenate the Patient:

The patient must have the mask in place before it is possible to deliver gases. To place or remove the mask, click on the MASK icon in the lower left quadrant of the Patient window. Mask placement will be visibleo in the PATIENT DISPLAY area.

  • If the patient is not displayed in the patient display area, click on the View Patient button
  • Click on the Mask Icon

The gases that you set up on the anesthesia machine are now being delivered to the patient

Administer Drugs:

Drugs are administered from the Patient window. Drugs set up in syringes are delivered from the DRUG area on the right hand side of the window. To inject these drugs, use the three buttons beside the drug that you wish to inject. Drugs set up in IV bags are delivered from the IV INFUSION area in the center of the window.

There are three ways to inject drugs that have been setup in syringes:

1. Click on the Inject button. The plunger on the syringe will start to move. The Start button will now read Stop . When the desired amount has been injected, click on the Stop button.

2. To pre-select the dose to be injected, click on the Dose button. A pop-up window will open. Select the number of cc's to be injected by moving the slide bar along the syringe to the point on the syringe where you would like the plunger to stop. As the slide bar is moved, the dose and volume to be delivered will appear below the syringe. Click Inject to deliver the chosen dose. Click Cancel to close the pop-up window without delivering the drug. In this window, the body compartment where the drug is to be injected may also be selected. This is for scientific purposes only and should not be used for routine anesthetic cases. Most users will want to leave this set on the venous compartment, which is the default compartment.

Click on the Pump button to setup a syringe pump. A pop up window will open. Record the patients weight and the dose in mcg/Kg/min. Click on Accept Start Later or Accept Start Now . This will close the window. To control the pump, click on Pump again and use the Start or Stop buttons.

There is only one way to deliver drugs that have been set up in an IV bag:

  1. Click on the drug in the IV BAG area. A pop up window will open. Record the

Patient's weight and the dose in mcg/Kg/min. Click on Accept Start Later or Accept Start Now . This will close the window. To control the pump, click on Pump again and use the Start or Stop buttons.

You will now give the following drugs:

  1. 350mg (14 cc) of pentothal
  2. 120mg (6cc) of succinylcholine
  • Click on the Dose button on the pentothal syringe
  • Move the cursor on the syringe to the 6cc mark
  • Observe the dose/volume written below the syringe
  • Click on the Inject button
  • Click on the Inject button below the succinylcholine syringe
  • Click on the Stop button after 6cc has been injected (remember this is a 10cc syringe)
  • If you click on the dose button you can see how much you actually injected

Test Neuromuscular Response:

To assess neuromuscular blockade, click on the Nerve Stimulator Icon . The patient's train of 4 response will be shown in the PATIENT DISPLAY area.

  • Click on the Nerve Stimulator Icon
  • Watch the patient view area

Intubate the Patient:

Click on the Mask Icon to remove the mask. Click on the Laryngoscope Icon to initiate endotracheal intubation. Laryngoscopy and tube insertion will be shown in the PATIENT DISPLAY area. A pop-up window will open. If you wish to stop the intubation click on Abort, if you wish to speed up the demonstration click on Quick. The pop-up window will disappear if neither buttons are selected. To complete the intubation procedure set the tube depth.

  • Click on the Mask Icon
  • Click on the Laryngoscope Icon
  • Ignore the pop up window
  • Observe the patient display area
  • Click on Out until the arrow is at 21
  • Click on Set Tube Now

Check Breath Sounds:

To perform this function the user must communicate with the other OR personnel. The Dialog button on the lower right side of the Patient window allows communication with the patient, the surgeon, the assistant, and the circulating nurse. Click on the Dialog button to display these people in the dialog box. Click on the person you wish to communicate with to display a pop-up menu with questions you may ask or comments that you may make. To ask a question, click on the desired question. If you have audio capability on your computer you will hear the answer to your question. The answer will also be displayed in the PATIENT DISPLAY area. The person answering the question will appear in this area with a written response. Click on the Dialog button again to make the dialog box disappear.

The dialog box is crucial to diagnosing many critical incidences.

  • Click on the Dialog button
  • Click on each person to show the types of comments and questions you may ask
  • Click on the Assistant
  • Click on "Check Breath Sounds"
  • Wait ten seconds and watch the PATIENT DISPLAY area
  • Click on the Dialog button again when you are finished

Start Agent Flow and Turn on the Ventilator:

Click on the Anesthesia Machine button at the bottom of the Patient window to access the Anesthesia Machine. Turn on the ventilator, start the inhalation agent, change the gas flows and adjust the ventilator settings as desired.

  • Click on the Anesthesia Machine button
  • Click on the Ventilator button turn the ventilator on
  • Set the inhaled agent concentration
  • Set the N2O flow
  • Click on the Patient button

You can also turn the ventilator on and off by clicking on the the Bellows Icon on the Patient window

Let the Surgeon Start the Procedure:

To start the case you must communicate with the surgeon through the dialog box.

  • Click on the Dialog button
  • Click on the surgeon
  • Click on 'You may start now'
  • Click on the Dialog button

Maintain Anesthesia:

The clinical windows are used to maintain anesthesia.

1. From the Anesthesia Machine window, the user may adjust gas flows and the ventilator settings as described previously

2. From the Monitor window, observe the monitors you have set up for the case

3. From the Patient window:

  • Administer drugs as described previously.
  • Administer fluids as described previously.
  • Click on the Scan Room button to assess blood loss, urine output, status of the surgery, pressures in the supplemental gas tanks, and patient temperature.
  • Click on the Dialog button to ask the Assistant or the Nurse to perform procedures such as checking the breathing circuit, turning on the O2 tank or taking a blood sample.
  • Click on the Dialog button to communicate with the surgeon.
  • Click on the Transcript button to obtain a transcript of the dialogue.
  • Click on Record to view the Automated Anesthetic Record .
  • Click on drugs to draw-up more drugs from the Setup Drugs window
  • Click on the Ner ve Stimulator Icon to assess neuromuscular blockade.
  • Click on the Bellows Icon to turn off the ventilator.
  • Click on the Bag Icon to bag the patient
  • Explore the features described above

Initiate Emergence and Extubation:

The Surgeon will tell you when he is finished. To initiate emergence, click on the Anesthesia Machine button. Reduce agent flow, and adjust gases as required. Return to the Patient window and administer antagonists as required. When ready to extubate, click on the Extubate Icon to remove the endotracheal tube.

  • Click on the Anesthesia Machine button
  • Turn down the agent
  • Turn down the N2O
  • Click on the Patient button
  • Click on the Extubate icon

Finish the case:

Click on the Record button at the bottom of the Patient window to open the Automated Anesthesia Record . Click on the Anes End button to record your completion time.

  • Click on the Print button to print a copy of your record. Click on the Close button to close the window.
  • Click on the Record button
  • Click on the Anes End button
  • Click on the Close button

Save the Setup for this Case

The Setup of any case can be saved as a Quick Setup file. This is useful if you want to repeat a case in the future using the same set up, or if you want to set up cases for others to use. Once saved, you can open the setup that you have saved through the Open Quick Start Now button on the opening screen, or by selecting Case on the Main Menu.

To save the setup of a case to a Quick Setup file, select Case on the Main Menu and click on Save Quick Setup . This will open the Save Quick Setup window. In this window, you chose the items of the case setup that you would like to save into a Quick Setup file. You can select any of the following to save:

  • Selected patient
  • IV lines setup
  • Fluid selections
  • Monitor setup
  • Drug setup
  • Critical incidents selections
  • Plotted variables

The current setup for the items you choose will be stored in a file. In the future, when you open that file, the case will be setup using these settings. For example, if the first four items are selected, you will be given the same patient with the same IV lines, fluids and monitors when you open that file, but you will have to set up your own drugs.

To save a Quick Setup file from the Quick Setup Window , check the items you wish to save, make annotations in the Notes box to describe your Quick Setup file, enter a file name, and click on Save Now .

You will be able to select this new file the next time you start Body.

Starting a New Case or Closing Body

When you are finished with the current case you can either close Body or start a new case. To close Body either click on the X on the right upper corner of the parent window or select Quit under Case on the Main Menu.

To start a new case, select Restart-New Patient under Case on the Main Menu.

You have completed the Quick Start Section

Back to Body Manual Index | Next Chapter VII. Teaching with Body Simulation for Anesethesia