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
This document is a modified version of the Body Simulation Users Manual. The introductory sections give an explanation of exactly what Body Simulation for Anesthesia is.
II. LIMITED WARRANTY
III. ABOUT SIMULATION
IV. HOW TO USE THIS MANUAL
V. GENERAL CONCEPTS
VI. QUICK START: HOW TO SET UP AND START A CASE - THE BASICS
VII. TEACHING WITH BODY SIMULATION FOR ANESTHESIA
Sample Scenarios
- Clinical scenario: Induction of anesthesia.
- Physiologic scenario: "How long do I have?"
- Pharmacologic scenario: Uptake and distribution of thiopental
- Anesthesia Machine scenario: Low-flow anesthesia
- A critical incident scenario: Rapid hemorrhage
- An inhaled gas scenario: The second-gas effect
VIII. BODY SIMULATION WINDOWS :: THE DETAILS
Clinical Windows
- General Concepts (Clinical, Scientific, Stay on top, Modal, Child Windows)
- Body Simulation for Anesthesia - Startup : The Opening Screen
- Body Simulation for Anesthesia : The Main Window, and Main Menu
- The Patient and Interaction Window : View Patient
- Physiologic Monitor : Patient Monitoring
- Case Transcript : A transcript of audio interaction
- Anesthesia Machine : Control of Inhaled Anesthetic Agents and Ventilator
- Select Drugs : Setup Drugs from the Drug Cart
- Automated Anesthetic Record : Record of the Case
- Setup Intravenous Lines : Setup the IV Lines for the Case
- Setup Fluids : Select Fluids and Connect to IV Lines
- Setup Monitors : Select Monitors to be Used During the Case
- Critical Incidents : Setup Critical Incidents to Occur During the Case
- Patient Condition : Setup or Modify Patient Pathophysiology
- Squeeze : Squeeze the Re-breathing Bag
Scientific Windows
- Dynamic Time Plots : Real Time Data Plots vs. Time
- Dynamic Gas Display : Graphical View of Gas Data in Airways
- Drug Bars : Representation of Drug Concentration and Mass in the Compartments
- Other Details : Miscellaneous Modeled Data
I. LEGAL INFORMATION
The software described in this document is furnished under a license agreement. The software may be used or copied only in accordance with the terms of the agreement. It is against the law to copy the software on any medium except as specifically allowed in the license agreement. The purchaser may make one copy of the software for backup purposes. No part of this manual may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or information storage and retrieval systems, for any purpose, without the express written permission of Advanced Simulation Corporation.
Copyright © 1999 Advanced Simulation Corporation. All rights reserved.
BODY Simulation , BODY Simulation for Anesthesia, BODY, Dial-a-Patient, Dynamic Bar Graphs, Dynamic Time Plots, Dynamic Tables, Dynamic Gas Display, Dynamic Drug Bars, and View Patient are trademarks of Advanced Simulation Corporation.
Patents are pending for Dynamic Drug Bars and Dynamic Gas Display.
IBM is a registered trademark of International Business Machines Corporation.
Macintosh is a registered trademark of Apple Computer, Inc.
Advanced Simulation Corporation P.O. Box #1010 Point Roberts, WA 98281 U.S.A. TEL: (360) 945-3090 FAX:(360) 945-3091 Email: bodysim@whidbey.com http://www.bodysim.comII. LIMITED WARRANTY
The software is a medical education tool and is not intended to be used for the diagnosis or treatment of any person. The results obtained from use of the software should not be construed as medical advice or relied upon as such. Accordingly, the software is furnished "as is" and Advanced Simulation Corporation makes no warranty, express or implied, regarding the performance, quality, accuracy of results or other characteristics of the software or its suitability for your intended use.
The warranties of Advanced Simulation Corporation and your remedies set forth in this warranty statement are exclusive and in substitution for and you hereby waive, release and disclaim all other warranties, obligations and liabilities of Advanced Simulation Corporation and its suppliers, express or implied, arising by law or otherwise, with respect to the software and other items furnished by Advanced Simulation Corporation including, but not limited to: (A) any implied warranty of merchantability or fitness for a particular purpose; (B) any implied warranty arising from course of performance, course of dealing or usage and trade; (C) any obligation, liability, remedy, right or claim for infringement; and (D) any obligation, liability, right, remedy, or claim in tort, notwithstanding any fault, negligence, strict liability or product liability of Advanced Simulation Corporation and its suppliers (whether active, passive or implied).
In no event will Advanced Simulation Corporation be liable to you for any damages, including any lost profits, lost savings or other incidental or consequential damages arising out of the use or inability to use this program, or for any claim by any other party. The entire risk as to the results and performance of the program and manual is assumed by you.
III. ABOUT SIMULATION
A simulator is a device that allows a user or users to practice, test, or evaluate "real-world" procedures in a simulated environment.
The simulator most familiar to the public is the flight simulator. It accurately replicates the look and feel of an airplane cockpit. In the flight simulator, a pilot may practice takeoffs, landings, navigation procedures, and critical incidents, without risk to passengers, crew members, or expensive hardware. New procedures may be evaluated, and new equipment may be tested or certified.
Other types of simulators include nuclear power station simulators, petroleum pumping station simulators, space shuttle simulators and automobile simulators. In general, simulators are designed for use in complex task areas. They reduce the financial cost of testing and training and reduce the risk to human life.
They have many advantages:
- The user can encounter and practice incidents that occur rarely.
- The same training scenario can be repeated over and over.
- The student can be trained without endangering lives or expensive equipment.
- The student can proceed at his or her own pace, in a non threatening environment.
- Testing students with a simulator provides a scenario that is far more realistic than written or oral examinations. It also allows standardized testing as the same scenario can be presented to all candidates.
2. Types of simulators
In its training programs, the aviation industry uses both the full flight simulator (FFS), as well as the computer-based trainer (CBT). Each has its advantages and disadvantages. The full flight simulator looks, feels, sounds and even smells like a real cockpit. These are analogous to the anesthesia simulators that simulate the operating room using a mannequin and a real anesthesia machine. This type of simulator is very expensive, both to purchase and maintain, and they require centers where the user must come to be trained or tested. Because of this, FTS are only used in 1% of all simulated flight training. The more frequently used simulator is the computer-based trainer. The realism attained with today's CBT's is very close to that seen with the FFS, and its low cost and general accessibility allow it to be widely used. BODY Simulation is essentially a CBT that has been implemented on a PC.
3. What is Body Simulation?
BODY Simulation for Anesthesia is a multi-media interactive anesthesia trainer that has been implemented on a PC. It simulates a patient, an anesthesia workstation, a ventilator and gas delivery circuit, parts of the operating room, and even some operating room personnel. It allows the user the experience of clinical anesthesia training and education outside of the operating room.
Body Simulation for Anesthesia is based on mathematical models of physiology and pharmacology. When affected by a stimulus (drugs, gases, pain, etc.), the patient's response is calculated to be as close as possible to that of an average person. This is done using a complex set of mathematical equations.
BODY Simulation exemplifies the exciting prospects that simulation holds for education and training in the areas of anesthesia, physiology, and pharmacology. BODY allows excellent realism, with its beating heart and breathing lungs, its real anesthesia machine and monitor, its detailed model and real compartments, and its ability to control every aspect of anesthetic administration. In addition, the analytical functions of the program give the user insight into the scientific aspects of anesthesia, physiology, and pharmacology. As the user interacts with BODY Simulation, it is apparent that two categories of interaction are available: clinical training and scientific education.
Clinical training
On the clinical side, the user may select monitors, including those for the cardiovascular, respiratory, and neuromuscular systems, select intravenous lines, syringes and infusion setups, select the type and doses of drugs to be administered, select the type and flow rate of fluids, and select gas flows and ventilation parameters. The user may perform actions like endotracheal intubation, testing neuromuscular response, injecting drugs, checking breath sounds, etc. He or she may then obtain information by observing the patient, the anesthesia workstation, the ventilator, the monitors, or by querying the state of the patient. The user may carry out routine clinical tasks, or face critical operating room incidents.
Several types of patients are provided with Body Simulation for Anesthesia. You may also build and save your own patients. Different aspects of a given case may be mixed and matched according to user preference. One may construct a virtually unlimited number of scenarios for teaching, training, evaluation and experimentation.
Scientific education
Body Simulation for Anesthesia has many scientific and analytical tools that can be explored for any given case. Real time data plots allows the user to see 150 different clinical and physiologic parameters graphically displayed. Graphics of drug concentrations and drug mass in 16 different body compartments may be viewed. Dynamic gas displays and X-Y plots of respiration are available. These tools allow the user to see the pressures, flows, resistance, and compliance in the heart, blood vessels, lungs and other organs, as well as drug concentrations and/or masses in the compartments. Scientific data may be viewed in real time as events are occurring during the case, or it may be recorded for subsequent viewing and printing. With the scientific tools available in Body, the user can explore the effect of different interventions on multiple physiologic parameters.
Body Simulation can be used for clinical training, basic physiology or pharmacology education, as well as student and resident evaluation. Since Body allows the user to study the mechanisms behind the clinical events, the user can learn and understand why an event or problem happened. One can learn physiology and pharmacology in ways never thought possible.
An unlimited number of teaching scenarios may be created and stored by the educator. An example of five such teaching scenarios are supplied with this software. Depending on the specific objectives of your curriculum, you may build an entire library of teaching scenarios specifically tailored to meet the needs of your students.
Body Simulation for Anesthesia is designed for use with Windows 95, Windows 98, Windows NT, or Windows 2000.
4. The Enhanced Fukui-Smith Model:
BODY is a digital implementation of an enhanced version of the original Zwart-Smith and Fukui-Smith physiologic-pharmacologic models.
BODY Simulation is based on two innovations in computer modeling that allow a high degree of realism in the areas of physiology, pharmacology, and the basics of administering an anesthetic. These two innovations are called multiple modeling and transport modeling . Multiple modeling allows one to combine complex models, each of which can stand by itself. When these models are combined, however, they can interact in complex ways. A transport model allows one to carry anything in blood or in nerve fibers. The former includes gases, vapors, injected drugs, hormones, endocrines, pH, and even temperature.
The multiple compartment transport architecture was suggested and developed by Rideout and Beneken; Zwart, Smith and Beneken; and Fukui and Smith. We have been working on this type of model for 25 years. The model represents physiological functions and pharmacological actions and interactions. The physiology model, as does the real body, centers around a cardiovascular model, which consists of a beating heart; blood to transport gases, ions, chemicals, drugs, etc.; and compartments, such as the brain, heart, and liver. The pulsatile function of the heart, although computationally very intensive, has at least two advantages over other types of models. 1) The outputs (blood pressures and flows, for example) resemble the real cardiovascular system, and add immeasurably to the realism of the simulation. 2) The model is more accurate. For example, the function of the heart as described by ventricular function curves is a natural result of implementing the model in this manner.
As presently constructed, the model is a 45-compartment (and growing fast) multiple transport model of the lungs, heart, and circulation. Within each compartment, as appropriate, is a series of "receptor compartments", each for a different agent. Each receptor compartment contains a concentration-effect relationship, for example, concentration vs. the strength of the heart. At this time the concentration-effect relationship is implemented as a sigmoid curve for basically all drugs and effects, with a few minor exceptions. See Appendix A for an explanation of the implementation some of these concepts.
The following describes the current and potential capabilities of the model. Since the model is a transport model, it can carry anything in the lungs and blood to the various compartments and thence into and out of these compartments. In particular, it can transport information, gases, inhaled agents (anesthetics or toxins), drugs and agents via any route (intravenous, intramuscular, subcutaneous, skin, and lungs), ions, hormones, dyes, tracers, markers, etc.
The substances transported can participate in cellular function, such as glucose or oxygen, or only carry information to control a specific action, such as do hormones. The transport can be more than merely in the blood; it can be on protein or hemoglobin, with the binding related to pH, protein species and concentration, presence of other drugs, etc. Since it is a multiple model, any number of models or transportable elements can be added. Currently, as well as models for the lungs and the heart and circulation, the main model contains the following models of gases and agents to be transported: oxygen, nitrogen, carbon dioxide, hemoglobin and 48 ancillary and anesthetic agents.
From this point onward in this manual, the above described mathematical implementations of physiology and pharmacology will be referred to as "the model".
IV. HOW TO USE THIS MANUAL
This manual is divided into several sections which have their own goals for assisting users with learning how to use BODY Simulation for Anesthesia.
Section I and Section II contain the license agreement, warranty information and information about contacting Advanced Simulation Corporation.
Section III provides some basic information about simulators, gives a brief overview of the types of things that can be done with Body Simulation, and briefly outlines the type of model used in Body. Although the information contained within this section is not essential for the operation of Body, the first time user may want to read the section titled "What is Body Simulation" prior to starting the program.
Section IV, "General Concepts", introduces a few important concepts that will assist the reader to use Body Simulation efficiently. It describes the required operating systems, it introduces the types of windows used in Body and gives some helpful suggestions to enhance performance. All users should read this section.
Section VI, "Quick Start", is designed to familiarizing the user with Body Simulation as quickly as possible. It contains the basic steps for performing a straightforward anesthetic case from start to finish. The user will be taken through the a case in a step by step and window by window fashion. A demonstration of a small number of the scientific capabilities of Body Simulation are also given in this section.
Section VII is a collection of 6 sample teaching scenarios- both clinical, and scientific. The scenarios demonstrate more detailed techniques for interaction with the software. It is recommended that the first time user go through these scenarios after they have completed the Quick Start section. The 6 cases are examples of an infinite number of cases that a user may build for teaching procedures, teaching principles of physiology and pharmacology, demonstrating equipment usage etc. Once you are familiar with the software you can start to build and save your own cases and scenarios. You can build an entire library of cases to keep on file.
PART III is a detailed summary of each of the windows of BODY Simulation. All interactions available within the software are referenced in this section.
V. GENERAL CONCEPTS
Body Simulation for Anesthesia is designed for use with Windows 95, Windows 98, Windows NT, or Windows 2000. Body Simulation for Anesthesia is a high performance software. It has been designed as a real-time application that utilizes as much computing power as it can get. Although it has been designed to run in parallel with other Windows applications, it should be the only application running on your computer. Failure to observe this suggestion will result in poor performance, and may cause your system to become unstable.
If the images on your screen are not clear, the settings on your computer need to be adjusted to accept more color. Adjust the screen size by right clicking on the Windows desktop, select properties , and then select settings . Increase the color setting until the image is clear. (you will most likely need to go to "high color.")
Adjusting the screen resolution can make a big difference. Both screen size, and number of colors should be adjusted to the users preference. The more video RAM the computer has, the more flexibility the user has in adjusting the system.
If the screen size is made very large (many pixels), it becomes possible to see several windows, unobscured, side-by-side on the screen. This setting will also make the text on each window appear much smaller, perhaps becoming difficult to read. In either case try to select the most colors possible for your particular screen resolution.
Throughout this manual, Body Simulation for Anesthesia may be referred to as "Body Simulation", or simply "Body". This manual assumes you have basic working knowledge of the Windows operating system. The term "select" is often used in this manual in the imperative sense. It is a general term for clicking, or double clicking on an object or area with the mouse cursor.
Body Simulation is divided into several interface windows. There are windows that represent different parts of the anesthesia environment as well as scientific windows that can display a wide range of parameters.
The window titled Body Simulation for Anesthesia is the main or "parent" window. It serves as the background and it contains all the other windows. The menu bar at the top of this window allows access to all interface windows.
The clinical windows titled Patient , Physiologic Monitor , and Anesthesia Machine are "child" windows that are always present in the parent window. The Audio Transcript window is also a "child" type window. They are either visible as a normal window within the "parent" window, or they are minimized and appear along the bottom of the parent window. These windows may be viewed simultaneously if desired. One may access the clinical windows in several ways: by clicking on the minimized icon, by clicking on "View" on the menu bar and selecting the desired window, or by clicking on the appropriate clinical window button found at the bottom of all the clinical windows.
The scientific windows may also be opened and viewed simultaneously with other windows. These include the windows titled Dynamic Time Plots , Dynamic Gas Display , Drug Bars , and Insight Into Model . When these windows are not open they are not visible on the parent screen. The scientific windows are accessed by clicking on "Scientific" on the menu bar and selecting the desired window. Although it is helpful to be able to view these windows at the same time as the clinical windows, it is important to remember that whenever an additional window is opened, more memory is required by your system. You may notice computer performance reduction if you have too many windows open - the more RAM you have, the better the performance will be. When the user is finished actively using the scientific window, you may want to close the window rather than leaving it open while using other windows.
There are several 'modal' windows that appear upon request. These include the windows titled Select Drug , Setup Monitors , Select IV Lines , Select Fluids , Anesthetic Record , Critical Incidence and Patient Condition. Modal windows are designed to direct the user's attention to make a required input or to momentarily view data. Modal windows must be closed before any other window can be accessed. If you click anywhere but on the modal window, your system will only beep at you. When the modal window is closed, the user can carry on with the case. The use of modal windows in this program reduces memory usage.
The Squeeze window is a small floating window called a "stay-on-top" window. It will always be present, but it will always appear on top of the other windows. Other windows are not aware of its presence - that is, other windows do not require the stay-on-top window to be closed in order to respond. There are a few program control items on the squeeze window: a fast-forward button, a freeze button (to pause the simulation), and mute buttons for muting the pulse oximeter tones, and other sounds. You will find the Squeeze window quite helpful, especially when working on scientific scenarios.
The buttons on the various windows may be color coded. Buttons with red text switch to a clinical window, buttons with blue script open a modal window, and buttons that perform a function within a window have black script.
When you first start Body, the software must initialize itself. This is a necessary step required to allow the simulation of the physiology to find equilibrium; This process is different for each patient. The speed with which it does this depends entirely on CPU speed and operating system. During the initialization process Body is essentially moving in fast forward. The fast forward mode under Windows NT is much faster than that of a Windows 95 or 98 machine.
The Main Menu:
The Main Menu along the top of the parent window is a navigation tool that allows access to the windows in Body. Virtually every window can be opened through the Main Menu. Clicking on any of the items on the Main Menu will bring down a submenu from which you can open the windows listed. It is rare that a window can only be accessed through the main menu. most of the windows in Body have several buttons that allow easy access to other windows. Experiment with the menu items to help become familiar with their operation.
A good thing to remember is that where ever you are allowed to click, or should click, the cursor will change to one that looks like a finger pointing, as opposed to the usual arrow. This will be your cue that clicking at this position will result in an action.If you are not familiar with Body, the above section may be somewhat confusing. We recommend that you return to the above section and read it through again after you have completed the Quick Start Section. The information contained within is very useful for the efficient use of Body Simulation.
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Following Sections:
- Chapter VI. Quick Start: How to set up and start a case : The Basics
- Chapter VII. Teaching with Body Simulation for Anesethesia
- Chapter VIII. Body Simulation Windows - The details
