Manikin-based simulators, sometimes called high fidelity simulators or mannequins, are those that use a manikin body or torso to physically represent the patient. Many manikins have the option of choosing physiologic modeling, instructor input, or a combination of the two to change the manikin’s vital signs and symptoms. The pharmacological models direct real time autonomous reactions to interventions and therapies. For example, using a needle to decompress a tension pneumothorax could automatically allow chest rise and breath sounds on the affected side. Using instructor input to change the vital signs allows control in situations where the standard response may not be desirable, such as an unusual disease presentation or an unstable patient with novice learners.
These types of simulators can integrate signs and symptoms from multiple systems, such as pulmonary (breath sounds, chest rise), cardiac (heart sounds, pulses) and neurological (pupil reflex, seizures), to produce a realistic patient response. Suspension of disbelief is not only possible, but easy for many users due to the life-like reactions.
These systems can be used to teach normal and abnormal physiology and pharmacology, equipment usage, patient and provider safety, resource management, crisis management, and many other areas. They can teach at many different educational levels, depending on the complexity of the case.
The simulator is usually sold by itself or with a simulated patient monitor, so ancillary equipment must often be purchased separately to create a realistic setting. The more time and creativity that are put into outfitting the simulation area, the more realistic the experience. Each individual must decide how important interaction and realism are to the educational goals of the session.
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Below is an alphabetical list of manikin-based simulators with a brief description of the capabilities of each.
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Apollo is similar to MetiMan, but has additional features and a more realistic appearance. Apollo also comes with either a Nursing package or a Prehospital package, each of which has features which are relevant to the respective specialties.
Athena is a wireless, tetherless female simulator that can be used with physiological modeling (Muse software) or as an instructor-driven manikin (Vivo software). Several different mechanical ventilation modes can be demonstrated using real ventilators, which influence pulmonary function and gas exchange. Cardiac features include pacing and a dynamic 12-lead EKG. Measurable CPR metrics include depth and rate of compression and ventilation rate.
BabySim represents an automatically reactive 3-6 month old infant. Vital signs such as EKG tracings (normal and abnormal) and pulmonary arterial pressures (multiple positions as catheter is floated) are viewed on standard patient monitors. Cardiac output, urine output, end tidal carbon dioxide, manual blood pressure, and other measurements can also be performed. The fontanelles are palpable and can indicate intracranial pressure abnormalities. The manikin is capable of additional patient signs, such as crying, pulses in multiple locations, heart / lung / bowel sounds, and secretions are also present. The manikin responds automatically to treatments such as oxygen administration, drug bolus or infusion.
The Hal Adult series of manikins come with a variety of feature packages for Prehospital, Nursing, Critical Care and Trauma cases. The entry-level model has features such as pupil reaction, intubation detection and cyanosis. Additional features on other models include user-edited EKGs, trauma extremities with bleeding, variable lung compliance, and bilateral chest tubes. Some models can also interact with real noninvasive patient monitors, ventilators, and 12-lead EKG machines.
The Human Patient Simulator (HPS) is a full body manikin with accompanying integrated physiologic models for the cardiac and pulmonary systems. It also includes a pharmacological model for approximately 50 intravenous drugs (bolus and infusion) and 5 inhalational agents (anesthetics). Standard patient monitors can be used to monitor and, in some cases, treat the patient. Over 100 physiologic parameters can be adjusted to simulate a disease state’s signs and symptoms.
I-Stan is CAE’s adult wireless portable manikin. The model has an internal skeleton which allows for more lifelike motion. The cardiac system includes a 5 lead EKG and defibrillation / pacing with real equipment, pulses at seven different locations bilaterally, jugular venous distention and Korotkoff sounds (5 phases). The pulmonary system includes features such as multiple difficult airway settings, flail chest segment, and real-time carbon dioxide monitoring. Arterial and venous hemorrhage and secretions at multiple locations are available as well and are integrated into the physiological modeling system.
Lucina is a wireless childbirth simulator that can demonstrate normal and complicated birth conditions. The manikin comes with both a birthing fetus and a Leopold fetus. Both Trendelenberg and left lateral tilt positioning are sensed and recorded, as well as maneuvers such as McRoberts, Zavanelli, Woods’ Screw and superpubic pressure support. Post-partum complications, such as boggy uterus, post-partum hemorrhage and uterine massage, can also be demonstrated.
There are two versions of MetiMan, one for nursing education and one for prehospital education. Each version has slightly different skills that can be practiced on the manikin, but they use the same basic operating system. The manikin is wireless and uses either a physiologically-based or an instructor-driven control program. Both are compatible with Mac and PC. Muse allows the person controlling the manikin to use the model-driven physiological features. Vivo is the instructor-driven control program. Quality CPR feedback (hand position, rate and depth) is reflected in the physiological modeling. Signs and symptoms are displayed on the manikin (loss of pulses, pupil reaction, etc) or the simulated patient monitor (vital sign changes).
Newborn Hal is a wireless neonatal manikin that can be used independently or in conjunction with the Noelle birthing simulator. Cardiac rhythms and blood pressures can be detected by real monitors and defibrillators. Features such as cyanosis, decreased body movement, umbilical pulses, vocal sounds, and chest rise enable training of both perinatal and pediatric crises. Events or actions specific to any team member can be noted by the instructor in real time or bookmarked and annotated later. The manikin uses Gaumard’s standard control software.
Noelle is an obstetric and neonatal simulator package designed to demonstrate routine births as well as known and unexpected perinatal complications such as shoulder dystocia and breach position. Included in the system is a birthing infant with stress monitors in the neck to detect excessive force during delivery. Noelle can also be used in combination with either Newborn Hal or Preemie Hal for post-partum cases. Monitoring with real patient equipment is available for the mother. An ultrasound library is also available through the software. Possible interventions include airway and ventilation (mother and baby), fetal positional changes (Leopold maneuvers, etc., with interchangeable abdominal insert) and adjunct equipment usage (forceps, vacuum). CPR can be performed and measured. The delivery is simulated and programmable through a wide range of timeframes and patterns. Pause and fast forward are available during the delivery to enhance in-the-moment teaching points. The control software is Gaumard’s standard interface.
Orpheus Perfusion Simulator (Manbit Technologies)
The Orpheus Perfusion Simulator is designed to introduce trainees to cardiopulmonary bypass procedures. It also has the capability to show abnormal states and critical events. The program which runs the simulator includes physiological, pharmacological and thermal models. There is a hydraulic system included, a modified cardiac anatomy (one half of a heart), valves and vessels. Real monitors read electricity from the ventricle as it is connected to an actual bypass machine. Resistance and compliance of the aortic valve and contractility changes in the ventricle add to the realism.
PediaSim is a wireless pediatric full body manikin, based on the Human Patient Simulator. The model physically appears as a medium sized child, and contains the appropriate integrated physiologic modeling of a pediatric patient. Pharmacological models support over 50 intravenous and inhalational drugs. Standard patient monitors are used to demonstrate invasive and non-invasive vital signs and gas mixtures being exhaled. The patient exhibits disease-specific signs from the cardiovascular and pulmonary systems, as well as neurologic and genitourinary signs. There are two feature packages available on this platform. The PediaSim HPS model is geared for providers such as anesthesia and respiratory care. The features included in PediaSim ECS are designed more for medicine and nursing applications.
The 5 year old tetherless manikin has variable pulse strength, cyanosis and can adjust the rate and depth of respirations. Pediatric Advanced Life Support (PALS) and basic CPR statistics are sensed and logged. Various lung sounds (unliateral or bilateral) and heart sounds are available and are synchronized to chest rise and pulse / EKG, respectively. The manikin can be run fully by the instructor or have automatic responses active. Test results such as radiographs and CAT scans can be displayed on the simulated patient monitor on request.
The 1 year old Gaumard tetherless manikin can be used with real defibrillators for defibrillation, cardioversion or pacing. Pediatric cases can be run for a number of specialties, as well as Pediatric Advanced Life Support (PALS) and Basic Life Support (BLS) cases. Procedures can be performed, such as intraosseous (IO) placement, foley catheterization with urine output, tracheotomy, and enemas. Invasive hemodynamic pressures can be controlled and displayed on a simulated patient monitor. The manikin can be controlled by the instructor with or without automatic responses.
This wireless / tetherless manikin represents a premie baby weighing less than 1400g. For PALS training, ventilation and compressions are measured and recorded, and the vitals and patient color can be set up to respond automatically to effective ventilation. The program controls parameters such as pulse strength at multiple locations, left and right chest wall movement, heart / lung / crying sounds, and others. Venous access sites include umbilical veins, dorsal hand veins and an intraosseous site. Educational content includes x-rays, lab results, and more.
Airway complications can be demonstrated using swelling in the pharynx and tongue, laryngospasm, increased lung resistance and see-saw or retraction breathing patterns. Vascular access is possible through an intravenous arm and intravenous / intraosseous legs. Procedures can also be practiced, including needle decomression and chest tube insertion as well as defibrillation, pacing and cardioversion. The manikin can have seizures. Blood pressure can be taken manually or displayed with other vital signs on a simulated patient monitor.
Sim Junior represents a 6 year old manikin and was designed to demonstrate basic and critical patient conditions. Both the arm and hand have veins for catheterization, and the leg has an intraosseous site. The manikin can be defibrillated, paced or cardioverted as well as display an optional 12 lead EKG on a simulated patient monitor. Chest compressions and ventilations are measured and logged during resuscitations.
SimMan ALS and SimMan Essential are two versions of the SimMan model. SimMan Essential has features that include tibial and sternal intraosseous access, carbon dioxide exhalation, decreased cervical motion, and laryngospasm. SimMan ALS has obstructed airway features, cyanosis, and sensors to detect correct defibrillation pad placement. Both manikins can have multiple airway complications and pathophysiologies, can be defibrillated, cardioverted or paced, and has flashback on IV catheterization.
This manikin comes with two option packages. The first is SimMan 3G Trauma. The trauma package adds features such as light-sensitive pupils, multiple amputation options, and hemorrhage control. SimMan 3G, the non-trauma option, has features such as bilateral clavicular needle decompression sites, real carbon dioxide exhalation and seizures. Both models can demonstrate multiple airway complications, measure and log CPR statistics, and have programmed cases or change vital signs in real time.
SimMom is a tetherless simulator that can be used to demonstrate a number of routine and emergent conditions surrounding a pregnant woman, using instructor-controlled manual birth or an automated birthing module. Complications such as an inverted or ruptured uterus or a retained placenta can be treated, with improvement in patient vitals following correct treatment. Maternal positioning can be used to facilitate delivery, as can suction and forceps. Non-natal emergencies, such as a pregnant trauma victim, can also be taught using the programmable vital signs.
Surgical Chloe is a combination of full body manikin and skills trainer. The manikin can demonstrate surgical and non-surgical cases, with a simulated or real patient monitor reflecting vital signs consistent with the manikin’s condition. Real flashback occurs during peripheral IV insertion and ovarian arteries and veins bleed. Stats can be recorded and logged during CPR. Surgical skills can be taught for a number of procedures from skin incision or trocar placement to tumor removal or hemorrhage control.
Susie is a tetherless full body manikin with various option packages that allows training of patient care and basic crises in many hospital settings. The manikin has measurable CPR statistics, senses the depth of intubation, has automatic pupillary response, and varies the pulse strengths dependent on blood pressure. Real noninvasive patient equipment can be used, in addition to defibrillators. Blood can be drawn from the fingertip. Add-on modules include an Ob/Gyn package, bowel sounds, urinary catheterization, and others.
Tory simulates a 6 pound newborn with seamless, articulated joints. Access sites include umbilical vein and artery as well as arm and leg veins and an intraosseous tibia. The manikin’s arms can move or stay limp or the whole body can seize. Neck hyperextension will cause an airway obstruction. Tory can be used with the Noelle birthing manikin series to create post-partum cases. On intubation, real carbon dioxide is detectable.
Victoria is constructed with an internal skeleton and seamless skin, allowing for a variety of delivery positions. Real patient monitoring can be used for noninvasive vital signs and fetal monitoring. Fetal position and uterine contractions are palpable, with Leopold’s and other maneuvers possible. Episiotomy and c-section repair can be demonstrated using a multi-layer tissue wall, with bleeding on incision in the abdomen. A variety of complications and conditions can be simulated, such as shoulder dystocia, breech presentation, retained placental fragments, and post-partum hemorrhage.