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SimMan 3G: endtidal CO2 despite PEA

Last post 09-12-2013, 8:09 PM by ScottWilson. 4 replies.
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  •  07-13-2013, 2:04 PM 5026

    SimMan 3G: endtidal CO2 despite PEA

    Hi all,

    yesterday I noticed that SimMan 3G would show an endtidal CO2 trace when being ventilated despite  being in PEA cardiac arrest. A very annoying bug....

     Has anyone a solution for this (other than un-ticking the CO2 box - and re-ticking with ROSC)?

     http://www.youtube.com/watch?v=BQD1cNnIYKg

     

    Regards, Christian 


    Dr. Christian Karcher MD FCICM
    Intensive Care Specialist
    The Royal Melbourne Hospital
    Clinical Sub-Dean Simulation
    The University of Melbourne
    Australia
  •  07-17-2013, 11:03 PM 5033 in reply to 5026

    Re: SimMan 3G: endtidal CO2 despite PEA

    I checked the video and I'm assuming that the waveform coincided with ventilations. If so, this is accurate- you just need to adjust your values to reflect the low levels found during the code (12-14 with adequete CPR)  and the rapid elevation that occurs with ROSC (maybe increase it to 50 to have it relect the initial high levels and gradually return to normal). I'm wondering if you could create a handler that when you click Good CPR the CO2 goes to 12, if you click Poor CPR it goes to 6, if you click ROSC it goes to 50 and then trends down. I may have to try that at well!


    Barbara K. Ratliff RN, BSN, MBA, CHSE
    Baptist Health Montgomery, AL
    Institute for Patient Safety
    and Medical Simulation
    Simulation Specialist
  •  07-19-2013, 6:58 AM 5041 in reply to 5033

    Re: SimMan 3G: endtidal CO2 despite PEA

    Yes, the etCO2 was synchronised with the ventilation but at the time there was no CPR performed > Patient had no cardiac output > SimMan should have no endtidal.

    We noticed this in a scenario where a patient had initial ROSC and the went back into PEA. The participants were ventilating and didn't notice the re-arrest since there was still etCO2 which made them think that there was circulation.

     

    Will have a play with the handlers as well, thanks for that! 


    Dr. Christian Karcher MD FCICM
    Intensive Care Specialist
    The Royal Melbourne Hospital
    Clinical Sub-Dean Simulation
    The University of Melbourne
    Australia
  •  08-20-2013, 9:34 PM 5091 in reply to 5041

    Re: SimMan 3G: endtidal CO2 despite PEA

    When SimMan 3G goes into a non-perfusing rhythm there is a "behind the scenes" handler that is automatically activated called "PerfusionStopHandler.hne". I have found that it is also affected by the global  enable/disable handler settings. If you have several handlers running at the point that the patient re-arrested PerfusionStopHandler.hne may not have re-activated. 

    I can only assume that the presence of such a handler allows for easier on-the-fly simulations so that operators would not have to set all values to zero each time the patient goes into a non-perfusing rhythm.

    The handler is located here "C:\Program Files (x86)\Laerdal Medical\SimMan3G\ri\userdata\default\handlers"  if you wanted to take a look at it. 

     

  •  09-12-2013, 8:09 PM 5128 in reply to 5026

    Re: SimMan 3G: endtidal CO2 despite PEA

    Your program is working correctly. There is no flaw by the waveform being there. As Barbara said above, CO2 waveforms are supposed to be there anytime there are ventilations taking place and are universally accepted to have certain value ranges associated with poor CPR, good CPR, ROSC, etc. It is not dependent on there being a pulse or a blood pressure, only ventilations/respirations. Yes, the number and waveform will change if there is not a pulse, but there will still be one (with the exception of maybe someone who is asystolic and been dead for quite some time). If there was not a CO2 waveform present when I was ventilating a patient, I would think something is wrong with the airway.
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