RU2693444C1 - Method of practicing practical skills in providing first aid and diagnosing various types of cardiac pathologies using a medical simulator - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine and can be used to develop practical skills in providing first aid and diagnosing various types of cardiac pathologies by electrocardiography using a standard defibrillator-monitor. Method is realized by means of a device comprising a module of a patient simulator in the form of a dummy man. Defibrillator-monitor is used, including at least two outputs to metal electrodes of defibrillator and one input for electrical signals of electrocardiography. Dummy man is used, including a cardiopulmonary resuscitation system, a defibrillation simulation system, an electrocardiography imaging system, a thoracic decompression simulation system, a pleural cavity drainage simulation system, a tracheal intubation and conicotomy imitation system, a drug loading imitation system, a bleeding simulation system and a urinary bladder catheter system. First, non-contact devices are built in said dummy man to identify location of two metal electrodes of defibrillator with installed straps and four modules for electrocardiography electrodes imaging. Depending on the used training scenario, video signals of the cardiovascular system functioning are simulated, physical effects on the dummy man for resuscitation or medical procedures by exposing said systems. Physical effects on the simulating systems mentioned above, or their absence are detected. Impulse energy of the electric discharge is measured on the defibrillation electrodes through the load adapter unit, data on exposures are transmitted to a computer for processing and simulating video signals and transmitting them to a control unit of the electrocardiography imaging system for reproduction through a defibrillator monitor depending on physical effects on said dummy man.

EFFECT: technical result consists in providing practical skills training for first aid.

1 cl, 3 dwg

Description

The invention relates to the field of medicine and can be used in simulators of the patient, as well as in medical simulators for practicing practical skills in first aid and diagnosis of various types of heart disease by performing electrocardiography using a standard defibrillator monitor.

The analogue is a surgical operating simulator, which includes a patient simulator module, which allows you to simulate the reaction (condition) of the operated patient depending on the chosen scenario, medical history, actions taken by the medical team. The patient simulator module is made in the form of a human dummy equipped with systems for simulating signs of human life, systems for resuscitation, for example, cardiopulmonary resuscitation (CPR), intubation, artificial respiration (ALV), medicine entry system, defibrillation, and systems that imitate urination, hemorrhage, tears, sweat, hyperemia, convulsions (RU patent No. 2546404, IPC G09B 23/28 (2006.01)). However, in this simulator there is no technical implementation of the method of operation of the system simulation module for electrocardiography and defibrillation using a standard defibrillator monitor. Therefore, this simulator does not allow to simulate the reaction (state) of the dummy (patient simulator) depending on the actions taken by the doctor, that is, the feedback is not implemented “the doctor’s action is the response of the patient’s simulator module to simulate the video signals of the body’s cardiovascular system functioning standard defibrillator monitor ".

The prototype is a simulator for teaching emergency trauma and resuscitation care. The simulator contains a model of a person that includes: a head unit with a student's protection device against cross-infection, a trunk block made hollow, inside which is installed a simulator of respiratory movements of the chest, a shock sensor to the heart, a video simulator of external bleeding in pneumothorax and sensors of the plaster on laterally and vertically, upper limb simulators with pulse simulators and with pressure sensors and external bleeding simulator, lower limb simulators with pulse simulators, with simulator ohm external bleeding, pressure sensors and magnetically contacts; anatomical display, external hemorrhage and bone fracture video simulators and simulator control system, simulator control panel, training remote electrodes and electrical defibrillation circuit (RU Patent No. 21274762, IPC G09B 23/28 (1995.01)). However, in this simulator there are no imitation systems for carrying out medical procedures (for example, a system for injecting medical preparations). It is also not possible to connect (adapt) the simulator to a standard (not educational) defibrillator-monitor with automatic defibrillation function, which leads to low informativeness of the actions performed by students on this simulator, which is implemented on the simulator in a primitive way, by highlighting the desired image on the anatomical display performed in the form of relief panels, on which images of the human bone skeleton and the outline of the person are applied. Thus, this simulator does not allow to simulate the reaction (state) of the dummy (patient simulator) depending on the actions taken by the doctor, that is, the feedback is not implemented. “The doctor's action is the reaction of the patient simulator module — simulation of the video signals of the cardiovascular system functioning into a standard defibrillator monitor device. "

The objective of the claimed invention is to develop ways of working modules imitation systems for defibrillation and electrocardiography as part of a medical simulator for training doctors in first aid and diagnosis of various types of heart pathologies in various clinical situations. In addition, an important task posed in the development of the claimed method of operation is to combine the methods of operation of modules for simulating systems for defibrillation and electrocardiography with a standard medical device.

The technical result is the creation of a medical simulator that provides simulation of video signals of the functioning of the cardiovascular system of the body (the work of the heart) of a human dummy depending on the physical impacts on this dummy during resuscitation or medical procedures.

The technical result is achieved in that the method of practicing practical skills in first aid and diagnosis of various types of heart pathologies using a medical simulator, including a patient simulator module in the form of a human dummy, which consists in using a standard defibrillator monitor that includes at least two output to standard metal electrodes of a defibrillator and one input for electric signals of electrocardiography, according to the present invention, use a dummy including a cardiopulmonary resuscitation imitation system, a defibrillation imitation system, an electrocardiography imitation system, a chest decompression imitation system, a pleural cavity drainage imitation system, a tracheal intubation and conicotomy imitation system, a drug imitation imitation system, a bleeding imitation system and a imitation system catheterization of the bladder, previously in the above-mentioned dummy embed contactless devices that provide identification of the location two metal defibrillator electrodes with installed pads and four electrocardiography electrode imitation modules, depending on the training scenario used, simulate the video signals of the body’s cardiovascular system, perform physical effects on a human dummy for resuscitation or medical procedures by acting on these systems, fix physical effects, or the lack thereof, of the imitation systems mentioned t measuring the pulse energy of the electric discharge on the defibrillator electrodes through the load adapter block, the exposure data is transmitted to the computer for processing, and the video signals are modeled and transmitted to the control unit of the electrocardiography simulation system for playback through a standard defibrillator monitor effects on the mentioned dummy.

Thus, the technical result is achieved due to the full implementation of real-time feedback “the action of the subject (physician) - the response of the patient simulator module - the simulation of video signals into an electrocardiography simulation system to which a standard defibrillator monitor is connected”.

The invention is illustrated in the drawing (Fig. 1), which presents a medical simulator for practicing practical skills in first aid and diagnosis of various types of heart disease, having a patient simulator module, a system for simulating defibrillation and electrocardiography.

FIG. 2 shows a general view of a patient simulator module with specifically defined areas of physical exposure over a human dummy.

FIG. 3 shows a general scheme for implementing a system for simulating defibrillation and electrocardiography on a patient simulator module.

FIG. 1-3 digits are indicated:

1 - medical simulator,

2 - patient simulator module,

3 - system for simulating defibrillation

4 - electrocardiography imitation system,

5 - computer (server),

6 - mannequin of the patient simulator module,

7 - the subject (doctor) of the interaction,

8 - system for simulating cardiopulmonary resuscitation,

9 - system for simulating chest decompression,

10 - system for simulating the procedure for drainage of the pleural cavity,

11 - system for simulating tracheal intubation and conicotomy,

12 - system of imitation of drug administration (intravenous, intramuscular, intraosseous),

13 - system imitation of bleeding,

14 is a system for simulating bladder catheterization,

15 - contactless device system imitation defibrillation,

16 - contactless device system imitation of electrocardiography,

17 - standard defibrillator monitor,

18 - standard metal electrodes of a defibrillator,

19 - lining (pads) on the metal electrodes of the defibrillator,

20 is a block adapter load system imitation defibrillation,

21 is an electrocardiography electrode imitation module,

22 - splitter

23 is a control unit of the system for simulating electrocardiography,

24 - pulse oximetry simulation module.

Medical simulator 1 contains: patient simulator module 2, defibrillation imitation system 3 and electrocardiography 4, connected wirelessly to a computer 5, and a standard defibrillator monitor 17, connected via a wired channel to simulation systems 3 and 4.

The patient simulator module 2 contains: a system for simulating cardiopulmonary resuscitation 8, a system for simulating chest decompression 9, a system for simulating the procedure for drainage of the pleural cavity 10, a system for simulating tracheal intubation and conicotomy 11, a system for simulating drug injection (intravenous, intramuscular, intrasternal) 12 , a bleeding imitation system 13, a bladder catheterization imitation system 14, and a positioning system of contactless devices 15 and 16, respectively, for interacting with defibrill imitation systems 3 and electrocardiography 4.

The systems of imitation of defibrillation 3 and electrocardiography 4 are connected to a standard defibrillator-monitor 17, which is characterized by having at least two outputs to standard metal electrodes 18 of the defibrillator and one input for electrical signals of electrocardiography. The imitation system of defibrillation 3 is characterized by the presence of two plates (contact pads) 19, which are connected (attached) to standard electrodes 18 for diverting electrical discharges to the load adapter unit 20. The imitation system of electrocardiography 4 is characterized by the presence of four modules of imitation electrodes 21, which with a splitter 22 are connected to the control unit 23, and one pulse oximetry simulation module 24, which is also connected to the control unit 23.

Practicing practical skills in first aid and the diagnosis of various types of heart disease using a medical simulator is as follows.

The method of practicing practical skills in first aid and diagnosis of various types of heart pathologies using a medical simulator 1, including a patient simulator module 2 in the form of a human dummy 6, which consists in using a standard defibrillator monitor 17, including at least two outputs standard metal electrodes 18 defibrillator and one input for electrical signals electrocardiography.

The difference of the proposed method of practicing practical skills in first aid and diagnostics of various types of heart pathologies is that a human dummy 6 is used, including a system for simulating cardiopulmonary resuscitation 8, a system for simulating defibrillation 3, a system for simulating electrocardiography 4, and a system for simulating chest decompression 9, a system for simulating the procedure for drainage of the pleural cavity 10, a system for simulating intubation of the trachea and conicotomy 11, a system for simulating the administration of drugs 12, the system in the imitation of bleeding 13 and the system of imitation of catheterization of the bladder 14, contactless devices 15 and 16 are inserted into the said mannequin 6, providing identification of the location of two metal electrodes 18 of the defibrillator with installed pads 19 and four electrocardiography imitation electrodes 21 modules 4, depending on the used script learning simulate the video signals of the functioning of the cardiovascular system of the body, carry out physical effects on the human dummy 6 for conducting resuscitation measures or medical procedures by affecting the said systems, fixing physical effects or their absence on the above-mentioned imitation systems, measuring the pulse energy of the electrical discharge on the electrodes 18 of the defibrillator 17 through the load adapter unit 20, the data on the effects are transmitted to the computer 5 for processing, and carry out the simulation of video signals and transfer them to the control unit 23 of the system for simulating electrocardiography 4 for playback via andartny defibrillator-monitor 17 depending on a material impact on said dummy.

An example of a specific implementation.

Practical skills in first aid and auscultation are performed on the patient simulator module 2, which is made in the form of a dummy of 6 people with an anatomically correct musculoskeletal structure (height - 183 cm, weight 70 kg, age 40-50 years). The patient simulator module 2 is primarily intended for simulating the widest possible range of clinical situations and practicing skills in performing cardiopulmonary resuscitation, conducting intensive therapy and a set of measures aimed at maintaining vital activity.

The work of the patient simulator module 2 is carried out using the computer program algorithm 5, which ensures the operation of all systems of imitation of vital signs on the dummy 6, depending on the scenario used. For example, when simulating cardiac complications on a dummy 6, an imitation of the corresponding clinical picture takes place - a change in blood pressure, heart rate, pulsation power value. When simulating respiratory complications, there is a change in the frequency of respiratory movements, the appearance of cyanosis, loss of consciousness, voice, and various rales. Also, when simulating injuries to the head, torso and extremities, various physiological reactions take place: no pupillary reaction, an auscultatory picture on the left or on the right, a drop in pressure during blood loss, and convulsions.

Infrared LEDs 15 and 16 are installed on the patient simulator module 2 to perform wireless interaction and determine the correct positioning of two metal electrodes 18 of the defibrillator, respectively, with lining 19 and four imitation electrocardiography electrodes 21 modules 4. At the same time, on the plates 19 and simulators of the electrodes 21 36 kHz infrared receivers are installed (the frequency of the infrared radiation pulses that the internal demodulator filters out) of the TSOP 2136 type for receiving frared signals. Moreover, contactless devices such as infrared LEDs 15 and 16 are located at a certain depth of the body of the dummy 6, which is covered with a layer of silicone (thickness 4 mm), a material simulating human skin.

The systems of imitation of defibrillation 3 and electrocardiography 4 consist of two separate blocks, respectively, 20 and 23, connected to a standard defibrillator-monitor 17 of the type DKI-N-11 “AKSION” with the function of automatic defibrillation, intended for resuscitation and electropulse therapy of acute and chronic heart rhythm disorders, determination of hemoglobin blood oxygenation and blood pressure, as well as for external, transesophageal, endocardial pacing. The defibrillator monitor like DKI-N-11 "AKSION" is used in medical hospitals, cardiological clinics, for equipment of teams of emergency and emergency medical care.

Blocks 20 and 23 are supplied with Wi-Fi modules of the ESP8266 type for receiving and transmitting information through the server 5. For example, the load adapter unit 20 measures the pulse energy of the discharge impact in J and transmits this information to the server 5. At the same time, the discharge of electrical discharges from metal defibrillator electrodes 18 and measurement of the pulse impact energy by a discharge is carried out using an electronic board (not shown in FIG.) of unit 20, where an electrical discharge flows through a block of resistors with a nominal power dissipation heat from 0.25 W to 50 W and is measured by means of an integrated circuit of a current collector with a Hall effect type ACS711 (measures bi-directional current up to 25 A) under the control of an STM32F405RGT6 microcontroller (ARM Cortex-M4 core, 32-bit, FLASH 1 MB, RAM 192 kb). For example, the control unit 23 receives information from the server 5 about the simulated video signal, which is converted into several electrical signals with constantly changing voltage, which are subsequently reproduced on the screens of the standard DKI-11 AXION 11 AXION monitor in the form of curves that represent the current heart rate, respiratory rate, systolic and diastolic blood pressure, and saturation (SpO ₂ ). Moreover, to obtain an electrical signal with a constantly changing voltage on the electronic board (not shown in Fig.), The control unit 23 has several blocks of resistors through which electrical signals flow under the control of an STM32F405RGT6 microcontroller (ARM Cortex-M4 core, 32-bit, FLASH 1) MB, RAM 192 KB). In this case, the pulse oximetry imitation module 24 performs the function of recognizing (identifying) the presence or absence of fixation on one of the fingers of a human dummy 6. In the absence of fixation of the pulse oximetry imitation module 24 on one of the fingers of a human dummy 6, the saturation line curve does not reproduce blood oxygen) on the screens of a standard defibrillator monitor 17.

Further modeling (change) of video signals occurs depending on the actions or omissions of the subject (doctor) 7 over the dummy 6, that is, any medical procedures on the dummy 6 are performed or not carried out by the subject (doctor) 7.

The actions or omissions of the subject (doctor) 7 are as follows. Any manipulations on the dummy 6: performing cardiopulmonary resuscitation on the imitation system 8, exerting an electrical discharge using the real defibrillator 18 on the imitation system 3, administering drugs using special syringes on the imitation system 12, performing intubation, artificial lung ventilation and conicotomy with using endotracheal tubes, LMA, Combitube and other devices on the imitation system 11, carrying out chest decompression during an intense pneumothorax on the imitation system 9, carrying out The drainage of the pleural cavity on the imitation system 10, the strand overlay on the imitation system 13 and the bladder catheterization on the imitation system 14 are fixed by sensors of the position of the mechanisms of the patient simulator module 2, the data of which is transmitted and processed by the computer 5 and affect the state of the simulator patient 2, while simulating video signals of the functioning of the cardiovascular system of the body (heart work) of patient 2, which are sent to the control unit 23 of the system and Electrocardiography 4. For example, the result of feedback when properly performing cardiopulmonary resuscitation on the simulation system 8 is the stabilization of the patient simulator module 2 state, namely the restoration of respiration (frequency of respiratory movements) and heart rate (heart rate), heart palpation, automatic blinking and reaction of pupils to light, which can be visually observed on the module itself of the patient simulator 2 and on the standard defibrillator-monitor 17. However, the wrong actions or without it The effects of the subject (physician) 7 can lead to an emergency situation and the simulation of various video signals for the electrocardiography simulation system 4, depending on the scenario used.

Wrong actions of the subject (doctor) 7 may be as follows. When you enter the drug on the imitation system 12, which causes an allergic reaction, an algorithm for simulating anaphylactic shock is launched. Signs of anaphylaxis: tachycardia, tachypnea, low blood pressure. Breaks in the heart massage on the imitation system 8 or the total absence of resuscitation between the discharges of the defibrillator 18, applying the discharge of low or too high voltage on the imitation system 3, applying the discharge against the background of small-wave fibrillation without carrying out activities that increase myocardial energy resources can lead to imitation of death on the module patient simulator 2.

Thus, the subject (doctor) 7 is fully immersed in the learning process due to visual and tactile perception, where changes in video signals occur in real time and are directly dependent on the physical effects on the dummy 6 by the subject (doctor) 7 during resuscitation events or medical procedures.

As the position sensors of the mechanisms in the patient simulator module 2, standard limit switches can be used, as well as contactless position sensors of the following types: capacitive, inductive, oscillating, magnetic-magnetic and photoelectronic.

The use of the proposed medical simulator 1 allows in comparison with the prototype to improve the practical skills of doctors in providing first aid and diagnosing the condition of a person in various clinical situations. At the same time, realistic training of doctors in providing first aid and diagnosing a person’s condition is ensured by combining the methods of operation of imitation systems modules for defibrillation 3 and electrocardiography 4 with a standard medical device such as a standard defibrillator monitor 17.

Claims (1)

A method of practicing practical skills in first aid and the diagnosis of various types of heart pathologies using a medical simulator, including a patient simulator module in the form of a human dummy, consisting in using a defibrillator monitor that includes at least two outputs to metal defibrillator electrodes and one input for electrical signals of electrocardiography, characterized in that they use a human dummy, including a system for simulating cardiopulmonary resuscitation, a system defibrillation, electrocardiography imitation system, chest decompression imitation system, pleural cavity drainage imitation system, tracheal intubation and conicotomy imitation system, drug injection imitation system, bleeding imitation system and bladder catheter imitation system, previously contactless devices are inserted into the mentioned dummy identifying the location of two metal electrodes of a defibrillator with pads installed and Depending on the training scenario used, the modules for simulating electrocardiography electrodes simulate the video signals of the cardiovascular system functioning, perform physical effects on the human dummy for resuscitation or medical procedures by affecting the said systems, fix physical effects or their absence, measure the pulse energy of the electric discharge at the electrodes efibrillyatora unit through load adapter exposure data is transmitted to a computer for processing video signals and perform simulation and transfer them on electrocardiography simulation control unit for playback via defibrillator monitor depending on physical influences rendered to said dummy.

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