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3. Log-In Please select your name from the list Henry Gibbs Bill Clinton Hawkeye Perce BJ Honeycutt Mike Smith Steve Hawking Conrad Black Henry Gibbs Bill Clinton Hawkeye Perce BJ Honeycutt Mike Smith Steve Hawking Conrad Black Jane Smith Password: Students work independently but are Allowed to consult with each other. This same context as In the clinical area.

4. Screen Layout RR Set TV pH PCO 2 PO 2 HCO 3 SaO 2 Blood Gas Ventilator Settings Mode FiO 2 Patient Responses RRTV E MV E Help Activate Changes Timer PEEP 5 This is an example of one screen Layout that the students can choose This layout mimics layout of The Puritan Bennett 840. Students have the option of choosing Layouts for Seimens 300C and the Evita version 5 mechanical Ventilators. These are currently the most commonly Used ventilators in practice.

5. Description of screen elements pH PCO 2 PO 2 HCO 3 SaO 2 Blood Gas Ventilator Settings Mode Set RR Set TV FiO 2 Patient Responses RRTV E MV E Help Activate Changes Timer This Section of the screen has The results of a blood gas. The student will have to interpret the blood gas before making any changes on the mechanical ventilation settings

6. RR Set TV pH PCO 2 PO 2 HCO 3 SaO 2 Blood Gas Ventilator Settings Mode FiO 2 Patient Responses RRTV E MV E Help Activate Changes Timer This section has the changes the student Can make to the mechanical ventilator Settings. They are a simulation of the Buttons on a Puritan-Bennett 840A. PEEP 5

7. Set TV pH PCO 2 PO 2 HCO 3 SaO 2 Blood Gas Ventilator Settings Mode Set TV FiO 2 Patient Responses RRTV E MV E Help Activate Changes Timer Patients do respond to mechanical ventilation. In this box is how the patient is responding. For instance if the student sets the respiratory Rate at 10, it is conceivable the patient could Breathe above this set rate. The student will have to take into consideration The patient’s efforts to breathe when making Changes. PEEP 5

8. RR Set TV pH PCO 2 PO 2 HCO 3 SaO 2 Blood Gas Ventilator Settings Mode FiO 2 Patient Responses RRTV E MV E Help Activate Changes Timer Once the student has decided on what Changes to make, they click on This button to activate the changes they Have selected. This mimics closely What occurs in the clinical area. PEEP 5

9. pH PCO 2 PO 2 HCO 3 SaO 2 Blood Gas Ventilator Settings Mode Set RRSet TV FiO 2 Patient Responses RRTV E MV E Help Activate Changes Timer Once the student has activated their change A timer will count down from 20 seconds. Most health care facilities will check A blood gas result 20 minutes after a Ventilator change. For this simulation 1sec = 1 minute. The student will slowly see the blood gas Change as time ticks down. This way they will know they are on the Right track or not. PEEP 5

10. pH PCO 2 PO 2 HCO 3 SaO 2 Blood Gas Ventilator Settings Mode Set RR Set TV FiO 2 Patient Responses RRTV E MV E Help Activate Changes Timer At any time the student can push the Help button for assistance The help button will flash to indicate That it has something to contribute Concerning the changes to ventilation. PEEP 5

11. Example of setting changes using Rate change pH 7.12 PCO 2 75 PO 2 89 HCO 3 24 SaO 2 92% Blood Gas Ventilator Settings Mode A/C Set RR 10 Set TV 250cc FiO 2.45 Patient Responses RR 10TV E 240MV E 2.5 L/m Help Activate Changes Timer PEEP 5

12. Student resetting rate pH 7.12 PCO 2 75 PO 2 89 HCO 3 24 SaO 2 92% Blood Gas Ventilator Settings Mode A/C Set RR 10 FiO 2.45 Set TV 250cc Patient Responses RR 10TV E 240MV E 2.5 L/m Help Activate Changes Timer 16 15 14 13 12 11 10 Student is changing set respiratory rate PEEP 5

13. Timer activated after change pH 7.12 PCO 2 75 PO 2 89 HCO 3 24 SaO 2 92% Blood Gas Ventilator Settings Mode A/C Set RR 16 Set TV 250cc FiO 2.45 Patient Responses RR 16TV E 240MV E 4.0 L/m Help Activate Changes 19 sec Student has activated the changes And the timer has started the count down PEEP 5

14. 10 secs after changes. pH 7.32 PCO 2 50 PO 2 89 HCO 3 24 SaO 2 92% Blood Gas Ventilator Settings Mode A/C Set RR 16 Set TV 250cc FiO 2.45 Patient Responses RR 16TV E 340MV E 4.0 L/m Help Activate Changes 10 secs 10 secs have passed since change, some changes Are apparent on the blood gas PEEP 5

15. Congratulations; can you solve it another way pH 7.38 PCO 2 41 PO 2 89 HCO 3 24 SaO 2 92% Blood Gas Ventilator Settings Mode A/C Set RR 16 Set TV 250cc FiO 2.45 Patient Responses RR 16TV E 240MV E 4.0 L/m Help Activate Changes 00 secs Excellent. You have correctly Resolved the respiratory Acidosis by adjusting the Respiratory rate. Can you think of another way To solve the acidosis? Let’s go back to the start and See if you can solve it without Adjusting the rate. I am here if you need help. Just click on “Help”. PEEP 5

16. Re-setting TV pH 7.12 PCO 2 75 PO 2 89 HCO 3 24 SaO 2 92% Blood Gas Mode A/C Ventilator Settings Set RR 10 Set TV 250cc FiO 2.45 Patient Responses RR 10TV E 240MV E 2.5 L/m Help Activate Changes Timer Returned to the same situation 350 325 300 275 250 Student has determined they can change TV PEEP 5

17. Changes activated pH 7.12 PCO 2 75 PO 2 89 HCO 3 24 SaO 2 92% Blood Gas Ventilator Settings Mode A/C Set RR 10 Set TV 350cc FiO 2.45 Patient Responses RR 10TV E 340MV E 4.0 L/m Help Activate Changes 19 sec Student has activated the changes And the timer has started the count down PEEP 5

18. 10 secs after changes. pH 7.32 PCO 2 50 PO 2 89 HCO 3 24 SaO 2 92% Blood Gas Ventilator Settings Mode A/C Set RR 10 Set TV 350cc FiO 2.45 Patient Responses RR 10TV E 340MV E 4.0 L/m Help Activate Changes 10 secs 10 secs have passed since change, some changes Are apparent on the blood gas PEEP 5

19. Congratulations; solved both ways pH 7.38 PCO 2 41 PO 2 89 HCO 3 24 SaO 2 92% Blood Gas Ventilator Settings Mode A/C Set RR 16 Set TV 250cc FiO 2.45 Patient Responses RR 16TV E 240MV E 4.0 L/m Help Activate Changes 00 secs Excellent. You have correctly Resolved the respiratory Acidosis by adjusting the Respiratory rate and TV. By adjusting the rate and/ or TV you can blow Off CO2. Knowing this what settings would you manipulate For respiratory alkalosis?? PEEP 5

20. Example of setting changes using mode change(PC) pH 7.12 PCO 2 75 PO 2 89 HCO 3 24 SaO 2 92% Blood Gas Ventilator Settings Mode PC Set RR 10 Set Pressure 22 FiO 2.45 Patient Responses RR 10TV E 240MV E 2.5 L/m Help Activate Changes Timer Note same blood gas but different Ventilator settings PEEP 5

21. Student resetting rate pH 7.12 PCO 2 75 PO 2 89 HCO 3 24 SaO 2 92% Blood Gas Ventilator Settings Mode PC Set RR 10 FiO 2.45 Set Pressure 22 Patient Responses RR 10TV E 240MV E 2.5 L/m Help Activate Changes Timer 16 15 14 13 12 11 10 Student is changing set respiratory rate PEEP 5

22. Timer activated after change pH 7.12 PCO 2 75 PO 2 89 HCO 3 24 SaO 2 92% Blood Gas Ventilator Settings Mode PC Set RR 16 Set Pressure 22 FiO 2.45 Patient Responses RR 16TV E 240MV E 4.0 L/m Help Activate Changes 19 sec Student has activated the changes And the timer has started the count down PEEP 5

23. 10 seconds after changes pH 7.32 PCO 2 50 PO 2 89 HCO 3 24 SaO 2 92% Blood Gas Ventilator Settings Mode PC Set RR 16 Set Pressure 22 FiO 2.45 Patient Responses RR 16TV E 240MV E 4.0 L/m Help Activate Changes 10 secs 10 secs have passed since change, some changes Are apparent on the blood gas PEEP 5

24. Congratulations; can you solve it another way pH 7.38 PCO 2 41 PO 2 89 HCO 3 24 SaO 2 92% Blood Gas Ventilator Settings Mode A/C Set RR 16 Set TV 250cc FiO 2.45 Patient Responses RR 16TV E 240MV E 4.0 L/m Help Activate Changes 00 secs Excellent. You have correctly Resolved the respiratory Acidosis by adjusting the Respiratory rate. Can you think of another way To solve the acidosis? Let’s go back to the start and See if you can solve it without Adjusting the rate. I am here if you need help. Just click on “Help”. PEEP 5

25. Adjusting set pressure pH 7.12 PCO 2 75 PO 2 89 HCO 3 24 SaO 2 92% Blood Gas Mode PC Ventilator Settings Set RR 10 Set Pressure 22 FiO 2.45 Patient Responses RR 10TV E 240MV E 2.5 L/m Help Activate Changes Timer Returned to the same situation 28 26 24 22 20 18 Student has determined they can set pressure As this will change TV PEEP 5

26. Timer activated after change pH 7.12 PCO 2 75 PO 2 89 HCO 3 24 SaO 2 92% Blood Gas Ventilator Settings Mode PC Set RR 10 Set Pressure 28 FiO 2.45 Patient Responses RR 10TV E 405MV E 4.0 L/m Help Activate Changes 19 sec Student has activated the changes And the timer has started the count down PEEP 5

27. 10 seconds after changes pH 7.32 PCO 2 50 PO 2 89 HCO 3 24 SaO 2 92% Blood Gas Ventilator Settings Mode PC Set RR 10 Set Pressure 28 FiO 2.45 Patient Responses RR 10TV E 405MV E 4.0 L/m Help Activate Changes 10 secs 10 secs have passed since change, some changes Are apparent on the blood gas PEEP 5

28. Congratulations; can you solve it another way pH 7.38 PCO 2 41 PO 2 89 HCO 3 24 SaO 2 92% Blood Gas Ventilator Settings Mode A/C Set RR 10 Set Pressure 28 FiO 2.45 Patient Responses RR 16TV E 240MV E 4.0 L/m Help Activate Changes 00 secs Excellent. You have correctly Resolved the respiratory Acidosis by adjusting the Set pressure. To resolve respiratory acidosis in PC ventilation Adjusting either the rate or the set pressure Allows for more CO2 to be blown off. PEEP 5

29. Example of choosing the wrong settings 10.45 PC pH 7.12 PCO 2 75 PO 2 89 HCO 3 24 SaO 2 92% Blood Gas Ventilator Settings Mode Set RR Set Pressure 22 FiO 2 Patient Responses RRTV E MV E Help Activate Changes Timer PEEP 5

30. Student selecting PEEP- wrong choice pH 7.12 PCO 2 75 PO 2 89 HCO 3 24 SaO 2 92% Blood Gas Ventilator Settings Mode PC Set RR 10 Set Pressure 22 FiO 2.45 Patient Responses RR 10TV E 240MV E 2.5 L/m Help Activate Changes Timer PEEP 5 9876598765 Student is changing the PEEP in this case Which is not the correct choice

31. Timer activated after change pH 7.12 PCO 2 75 PO 2 89 HCO 3 24 SaO 2 92% Blood Gas Ventilator Settings Mode PC Set RR 10 Set Pressure 28 FiO 2.45 Patient Responses RR 10TV E 405MV E 4.0 L/m Help Activate Changes 19 sec Student has activated the changes And the timer has started the count down PEEP 10

32. No change after PEEP adjusted pH 7.12 PCO 2 75 PO 2 89 HCO 3 24 SaO 2 92% Blood Gas Ventilator Settings Mode PC Set RR 10 Set Pressure 28 FiO 2.45 Patient Responses RR 10TV E 405MV E 4.0 L/m Help Activate Changes 0 sec Student has activated the changes, time has Expired and no changes have occurred to Blood gas. Help button flashes indicating the tutor can help PEEP 10

33. Tutor gives first level of advice pH 7.12 PCO 2 75 PO 2 89 HCO 3 24 SaO 2 92% Blood Gas Ventilator Settings Mode PC Set RR 10 Set Pressure 28 FiO 2.45 Patient Responses RR 10TV E 405MV E 4.0 L/m Help Activate Changes 0 sec The change you have selected will not work. Look again at the blood gas and determine the correct interpretation PEEP 10

34. Tutor gives second level of advice pH 7.12 PCO 2 75 PO 2 89 HCO 3 24 SaO 2 92% Blood Gas Ventilator Settings Mode PC Set RR 10 Set Pressure 28 FiO 2.45 Patient Responses RR 10TV E 405MV E 4.0 L/m Help Activate Changes 0 sec The change you have selected will not work. The blood gas is a respiratory acidosis indicating Inadequate ventilation PEEP 10

35. Tutor gives Third level of advice pH 7.12 PCO 2 75 PO 2 89 HCO 3 24 SaO 2 92% Blood Gas Ventilator Settings Mode PC Set RR 10 Set Pressure 28 FiO 2.45 Patient Responses RR 10TV E 405MV E 4.0 L/m Help Activate Changes 0 sec The change you have selected will not work. The blood gas is a respiratory acidosis indicating Inadequate ventilation. You need to make changes To either the rate or the set pressure. PEEP 10