Laerdal Als simulator Manual

ALS Simulator

Directions for Use

www.laerdal.com

E

Table of Contents

Introduction .........................................................1

Cautions and Warnings (Intended Use) .................................1

Items Included .......................................................2

Skills Taught..........................................................2

Simulation Software ..................................................2

Unpack..............................................................3

Attaching the Legs..................................................3

SimPad and LLEAP Connections .....................................4

Getting Started ......................................................4

Cricothyroid Membrane/Neck Skin Collar ............................4

Pupil Replacement..................................................4

In Use...............................................................4

Airway Management................................................4

Obstructed Airway.................................................4

Tension Pneumothorax Decompression ..............................4

IV Cannulation .....................................................5

Intramuscular Injections .............................................5

Urinary Catheterization.............................................5

Simulator Functionalities ..............................................6

Cardiac Related Skills ...............................................6

Blood Pressure (BP) Arm ...........................................6

Heart, Breath and Bowel Sounds and Speech..........................7

Spontaneous Breathing and Airway Closures ..........................7

Maintenance .........................................................7

Cricothyroid Membrane/Neck Skin Collar ............................7

IV Cannulation .....................................................7

Intramuscular Injections .............................................7

Urinary Catheterization.............................................7

Pneumothorax.....................................................7

A) Bilateral Mid Clavicular Sites ....................................7

B) Mid Axillary Site (RIGHT) ......................................8

Chest Drain .......................................................8

Attaching/Removing Arms...........................................8

IV Arm Skin and Vein Replacement...................................8

After Use ...........................................................9

Cleaning...........................................................9

Extend Cleanliness .................................................9

Technical Data .......................................................9

General ...........................................................9

ALS Simulator .....................................................9

Replacement Parts ...................................................9

Introduction

The Advanced Life Support (ALS) Simulator is a realistic interactive training

simulator for simulating a wide range of advanced life saving skills in pre-hospital

emergencies. The simulator responds to clinical intervention, instructor

control, and comprehensive pre-programmed scenarios for eective practice

of diagnosis and treatment of a patient. With spontaneous breathing, airway

control, voice, sounds, ECG, and many other clinical features, the ALS Simulator

is the fully functional pre-hospital simulator.

The manufacturing quality of this simulator should provide many sessions of

training when reasonable care and maintenance are practiced.

Laerdal Recommends

Endotracheal Tube – Size 7.5

Laryngeal Mask Airway – # 4

Combitube- Large Adult or Trainer

KING LT – # 4

Needle or Catheter – Size 21-gauge or smaller

Cautions and Warnings

This product contains Natural Rubber latex which may cause

allergic reactions when in contact with humans.

Cautions and Warnings (Intended use)

• There are electronic components mounted inside the airway head. The

following techniques should not be performed on this simulator due to the

inability to properly sanitize the airway if they are performed:

• Mouth-to-mouth/Mouth-to-mask ventilation

• Insertion of simulated vomit for suctioning

• Lubricate the oral and nasal airways liberally with the lubricant provided prior

to inserting any instrument, tube or airway device into the airway. Additionally,

instruments and tubes should also be lubricated prior to use.

• Do not allow the simulator’s skin to come in direct contact with ink or

photocopied paper, as this can permanently stain the skin. Avoid using

colored plastic gloves when handling the simulator, as they may also cause

discoloration.

• Care should be taken when palpating the pulses to not use excessive force as

this will result in no pulse being felt. Only two individual pulses can be felt at

the same time.

• If a training session involves the administration of ﬂuids and/or drugs into the

IV arm, empty the arm immediately following the training session.

• Deﬁbrillation

• Only apply the deﬁbrillator to a deﬁbrillation post or zap plate which is

properly mounted on the simulator’s chest.

• Do not provide more than 2 x 360J deﬁbrillator discharges per minute as

an average over a period of time to prevent overheating.

• The simulator chest must be kept dry. Special attention should be taken

when using IV Arm.

• Do not apply conductive gel or conductive deﬁbrillation pads intended for

patient use to prevent chest skin pitting.

• Do not use cables or connectors with visible damage.

• Observe all normal safety precautions for use of deﬁbrillators.

• Deﬁbrillation must be performed over the two deﬁbrillation connectors

only.

Air Tank Precautions: The right thigh of the ALS Simulator contains a com-

pressed air tank. Contents under pressure:

• Do not puncture

• Do not store in excessive heat

• Release pressure in air tank prior to shipment

Do not pressurize above 120 psi or remove any safety devices to increase

pressure. The tank is protected with safety devices not allowing the pressure

to exceed 150psi. Do not disassemble or attempt to repair the internal parts

of the right thigh. In the event of failure, contact the Laerdal Service Center

immediately for instructions.

This device generates, uses and possibly radiates radio-frequency energy. If it is

not installed and used in accordance with the instructions, it may cause harmful

interference to radio communications. In that case, the user is encouraged to

attempt correction of the interference by:

• Reorienting or relocating the receiving antenna

• Increasing the distance between the device and receiver

• Connecting the device to an outlet on a circuit dierent from that to which

the receiver is connected

• Consulting the dealer or an experienced radio/TV technician for help

Electromagnetic radiation from other radio transmitters or other electronic

equipment may cause noise in the head speaker. To eliminate this noise, move

simulator away from the radiation source or turn the head speaker volume to

zero.

E

Table of Contents

Items Included........................................................1

Skills Taught....................................................... . . . 1

Teeth ........................................................... . . . 2

Carotid Pulse ........................................................2

Tracheostomy Plug & Care.......................................... . . . 2

NG Tube Placement ............................................... . . . 2

Intubation ........................................................ . . . 2

Lungs ............................................................ . . . 2

Stomach Reservoir ................................................. . . . 2

Belly Plates........................................................ . . . 2

Injection Pads ..................................................... . . . 3

Waist, Knee and Ankle Joints ........................................ . . . 3

Arms ............................................................ . . . 3

Legs ............................................................. . . . 3

IV Arm ........................................................... . . . 3

Replacing Skin & Vein System........................................ . . . 3

Blood Pressure Arm ............................................... . . . 4

Auscultation of Heart, Breath, Bowel Sounds and Fetal Tones ........... . . . 4

Genitalia.......................................................... . . . 4

Colon Reservoir ................................................... . . . 5

Urinary Catheterization and Enema Simulation ............................5

Troubleshooting ................................................... . . . 5

Attaching Nursing Anne Modules to Manikin .......................... . . . 5

SimPad Connection. ..................................................4

Care and Maintenance.............................................. . . . 6

Replacement Parts ................................................. . . . 6

Items Included:

(1) Full-Body Female Manikin

(1) Articulating Blood Pressure Training Arm (Nursing Anne SimPad)

(1) Articulating Female Multi-Venous IV Training Arm

(1) Hospital Gown

(1) Male Genitalia

(1) Female Genitalia

(3) Urinary Valves

(3) Anal Valves

(1) Simulated Blood Concentrate

(1) 100 cc Syringe

(1) Manikin Lubricant

(1) Assembly Tool Kit

Wig pictured on front cover, not included

Optional Accessories

Nursing Anne Modules:

(1) Breast Exam Module, with interchangeable abnormalities

(1) Mastectomy Module with staples and drain

(1) Fundus Module with interchangeable uteri

Wound Care & Assessment Set:

(1) Abdominal Incision Module with Painted Sutures

(1) Abdominal Incision Module with Staples and Penrose Drain

(1) Abdominal Incision Module with Nylon Sutures

and Penrose Drain

(1) Abdominal Subcutaneous Heparin and Insulin Injection Module

(1) Abdominal Packing Module

(1) Infected Colostomy Stoma

(1) Ventro-Gluteal and Gluteal Decubitus Ulcer Modules

(1) Below Knee Amputation Stump

(1) Thigh Packing and Irrigation Module

(1) Thigh Suture Module

(1) Thigh Debridement Module

(1) Varicose Vein Leg with Stasis Ulcer

(1) Diabetic Foot Module

Skills Taught:

• Basic patient handling

• Denture care

• Oral hygiene

•

• Eye and ear irrigation(simulated)

• NG Tube insertion, care medication administration and removal

• Tracheostomy care and suctioning

• Blood pressure skills (When used with SimPad)

• IV care and

management

• Subcutaneous and intramuscular injection

• Oxygen deliveryprocedures

• Ostomy irrigation and care

• Catheterization skills

• Enema simulation

•Colonic irrigation

•Wound assessment and care

•Bandaging and dressing

•Post-surgical mastectomy-care procedures

•Recognition of breast disorders, their sizes and relative locations

•Practice of fundus massage skills

•Auscultation and recognition of normal and abnormal heart,

breath and bowel sounds and fetal tones

(When used with SimPad)

Caution: Latex

This product contains Natural Rubber latex which may cause

allergic reactions when in contact with humans.

Please contact Laerdal Customer Service

for more information on Replacement Parts in other skin tones.

ENGLISH

E NGLISH

Nursing Anne 1 Laerdal

The product, when carrying the CE-mark, is in

compliance with essential CE requirements and other

relevant provisions of council directive 1999/5/EC.

• Lavage/Gavage

Oral and nasal Intubation

Items Included:

ALS Simulator

(1) Adult, Full Body Simulator

(1) Articulating IV Training Arm

(1) Left Lower IO Leg

(1) IO Leg Skin

(1) Tibial IO Pad

(1) Tibial IO Bag Set

(1) Red Simulated Blood

(1) Blood Pressure Training Arm

(1) Simulator Lubricant

(1) Interchangeable Pupil Set

(6) Neck Skin Collars

(1) Cricothyroid Membrane Tape Roll

(1) Set of Replacement Pneumothorax Bladders

(2) Mid-Clavicular Bladders

(2) Mid Axillary Bladders

(6) Chest Drain Modules

(1) Blood Pressure Cu

(1) Air Pump

(1) Set of Deﬁbrillation Posts

(1) Carry Case

(1) Jacket

(1) Pants

(1) Directions for Use

(1) Laerdal Global Warranty Booklet

Skills Taught:

Airway Management Skills

• Assessment of respirations

• Obstructed airway

• Tongue Edema

• Right Lung Blockage

• Left Lung Blockage

• Both Lung Blockage

• Endotracheal intubation

• Nasotracheal intubation

• Digital intubation

• Oropharyngeal airway insertion

• Nasopharyngeal airway insertion

• Bag Valve Mask

• Retrograde intubation

• Lightwand intubation

• Laryngeal Mask Airway insertion

• Laryngeal Tube insertion

• Combitube insertion

• Trans-Tracheal Jet Ventilation

• Surgical cricothyrotomy

• Needle cricothyrotomy

• Suctioning techniques

• Stomach auscultation to verify proper airway positioning

• Head Tilt/Chin Lift

• Modiﬁed Jaw thrust

• Ventilations

Drug Administration

• IV insertion, infusion and bolus into peripheral veins of forearm, antecubital

fossa and dorsum of the hand

• Subcutaneous and intramuscular injections

Tibial I.O Capabilities

• Proximal tibial tuberosity (left)

Tension Pneumothorax Decompression

• Bilateral mid-clavicular sites

• Mid-axillary site (Right)

Chest Tube Insertion

• Mid-axillary site (Left)

Cardiac Related Skills

• 3 – 4 lead ECG with an extensive ECG library available for interpretation.

• Pacing with variable threshold, with or without capture

• Deﬁbrillation capabilities (25 -360 joules)

• Programmable scenario base algorithms for instructor control

• Closed chest compressions

Circulatory Skills

• Bilateral carotid pulse

• Measurement of non-invasive blood pressure

- Brachial and radial pulses

- Auscultation or palpation of non-invasive blood pressure measurement

- Values to be set for systolic and diastolic pressures, heart rate, auscultatory

gap and volume

Sounds and Speech

Refer to SimPad Directions for Use or LLEAP Help Files

Logging and Scenario Functions

Refer to SimPad Directions for Use or LLEAP Help Files

Simulation Software

If you have purchased relevant licenses, you will have access to a number of PC

applications that facilitate your simulation. To run a simulation, LLEAP (Laerdal

Learning Application) must be started from Laerdal Simulation Home on the

Instructor PC.

Laerdal Simulation Home

Laerdal Simulation Home is an application from where LLEAP and other Laerdal

programs related to patient simulation can be found and started. Also, the

help ﬁles can be opened from here. Laerdal Simulation Home is located in the

Laerdal Medical folder under the Windows start menu (Windows 7).

Software used in a simulation session can be divided in the following main

applications:

– LLEAP (Laerdal Learning Application)

– Voice Conference Application

– Patient Monitor

– SimView Server or Session Viewer

In addition SimDesigner and other applications are used for designing or

preparing a simulation.

LLEAP

LLEAP is the instructor’s application from where the simulation session is run,

controlled, and monitored. LLEAP can be operated in Automatic or Manual

mode. Automatic mode is used for pre-programmed scenarios while Manual

mode allows the instructor full manual control over the simulation session.

Running simulations in Manual mode generally requires some medical expertise

to create clinically sound simulations.

Voice Conference Application (VCA)

The VCA software is needed to transmit all vocal sounds used during simulation.

It allows the instructor to communicate through the simulator during the

session. VCA can also be used to communicate with other instructors on a

network, and create separate channels that only members can talk and listen to.

Patient Monitor

The Patient Monitor application emulates a typical hospital patient monitor. It is the

learner’s console and can be set up and controlled by the instructor, as well as by

the learner, through on- screen touch menus.

Session Viewer and SimView Server

Session Viewer and SimView Server are applications that record video and patient

monitor screen captures during simulation, in addition to providing an interface

to debrief your session. After a session is ended, log ﬁles generated in LLEAP are

transferred and merged with the video ﬁles in Session Viewer or SimView Server

for the debrief.

Session Viewer typically runs locally on the same computer used for LLEAP,

SimView Server runs on a dedicated server in the local network. During the ﬁrst

start-up of LLEAP you are prompted to select a debrieﬁng system available on

your computer or local network. This can be changed later.

Other Applications

There are also other programs that are used in conjunction with the simulation

sessions, for example License Manager for handling program licenses and Simulator

Firmware & Network Fixer for updating the ﬁrmware of the simulators or

troubleshooting network problems.

SimDesigner

SimDesigner is an application for conﬁguring your own pre-programmed scenarios.

It can also be used to analyze and print out a graphical representation of a scenario.

SimDesigner must be installed to allow conversion of legacy instructor application

ﬁles to LLEAP compatible ﬁle formats.

For a full overview of all applications and their help ﬁles, start LLEAP Home.

Web Downloads

Visit www.laerdal.com/downloads to download the latest User Guide and

Software.

Unpack

The ALS Simulator is packaged without the legs attached. Remove the upper body

and legs from the packaging and attach the legs to the torso.

Attaching the Legs:

To attach the Right Leg (with enclosed air tank):

1. Remove bladder reservoir from pelvis.

2. Remove blank genitalia module from pelvis.

3. Carefully slide the tubing and wiring exiting the ﬁxed bolt from the upper thigh

of the right leg through the connector hole and into internal cavity of pelvic

area. (Photo 1)

4. Continue to advance the bolt and wiring though the connector hole until the

thigh is ﬂush with the pelvis of the simulator.

5. From inside pelvic area, thread the longer air connection tube ﬁrst through the

provided washer, spring, and thumb nut in that order. Then, thread the shorter

electronic wire through the washer, spring, and thumb nut.

6. Connect the wire and cable inside the pelvis.

7. Tighten the thumb nut until desired articulation is achieved.

8. Replace bladder reservoir in torso.

9. Replace blank genitalia module in pelvic region of torso.

To attach the Left Leg:

1. Remove left thigh injection pad (A), genitalia module (B) and bladder

reservoir assembly (C)

B C

Photo 2 Photo 3

Photo 4 Photo 5

2. Select and prepare hardware (Photo 2), pass spring and small washer over

bolt (Photo 3)

3. To install pass bolt assembly through thigh, then pelvis opening from outside

inward (Photo 4), select large fender washer and pass over bolt from inside

simulator abdominal cavity. Screw wing nut onto bolt (Photo 5)

4. Replace bladder reservoir and genitalia module in pelvis and injection pad in

thigh. (See Step 1)

NOTE: Tighten wing nut as desired to simulate leg range of motion.

Photo 1

E

SimPad and LLEAP Connections

1. Connect ALS Simulator to Link Box (Photo 6), via cable located on lower right

side of simulator.

2. Connect the clear tubing exiting the simulators lower right side to the Link Box

3. Attach blood pressure cu to simulator’s left arm.

4. Attach clear pneumatic tubing from blood pressure cu (Photo 7) to

corresponding clear pneumatic tubing exiting the simulator’s left shoulder.

Getting Started

Cricothyroid Membrane/Neck Skin Collar:

1. Cut a 5 cm (2 inch) strip of Cricothyroid Membrane Tape.

2. Adhere tape to edges of cricoid opening, covering opening with tape, to create

actual membrane.

3. Lay a Neck Skin Collar into molded track around neck area of simulator.

(Figure 1)

4. Attach collar using Velcro®strips.

Laerdal Recommends

A tight seal will enhance actual feel and sound of penetrating cricothyroid

membrane, and facilitate full rise and fall of the chest during bag valve mask

ventilation.

Pupil Replacement

ALS Simulator is delivered with a set of normal pupils mounted in the head. A

separate case contains 3 sets of plastic pupil inserts (normal, constricted and

dilated pupils) for use in simulating other conditions.

To change the pupils in the airway head:

1. Open the eyelids wide, take care not to rip the face skin.

2. Using the suction cup provided or the edge of your ﬁngernail, remove the pupil

from the eye.

3. Replace with the pupil of choice, using the small suction cup tool provided or

press into place with ﬁnger.

Filling the Thigh Air Tank

1. Attach the provided air pump to the Schrader valve located laterally on the

posterior of the right thigh. (Photo 8)

2. Fill the air container using the air pump to120 psi. NOTE: An over pressure

release valve is included inside the thigh and will be activated at pressure above

10 Bar (150 psi). This valve has a built in reset mechanism.

3. Detach air pump from the Schrader valve.

NOTE: Most products designed for automobile/bike tire inﬂation will be

sucient to ﬁll the thigh tank. i.e. electric pumps, air compressors, air tanks,

etc. Pressure limitations vary with each unit and should be considered prior to

purchase.

In Use

Laerdal Recommends

• Endotracheal tube - size 7,5

• LMA # 4

• Combitube Large Adult or Trainer

• KING LT – # 4

Airway Management:

1. Spray inside of pharynx, nostrils and all intubation tubes with a liberal amount

of provided simulator lubricant or liquid soap. Sit the simulator upright to allow

lubricant to coat passages.

2. Perform further intubation procedures as per your local training protocol.

NOTE: Should incorrect ventilation be performed, air will pass through

esophagus, causing distention of the abdomen.

Obstructed Airway

Obstructed Airway (Manual Inﬂation of Tongue):

1. Locate inﬂation bulb at lower left side of torso labeled “tongue.”

2. Tighten air release knob.

3. Pump bulb several times to inﬂate tongue to desired size.

To deﬂate tongue, loosen air release knob.

Obstructed Airway (Right/Left/Both Lung Blockages):

See SimPad Directions for Use or LLEAP Help Files for complete

airway blockage functionality and operating information.

Tension Pneumothorax Decompression

(Manual Inﬂation of Pneumothorax):

1. Locate inﬂation bulb which exits lower left side of simulator, labeled “pneumo.”

2. Tighten air release knob so that as you pump the bulb, no air escapes.

3. Pump bulb several times to prepare three (3) sites for decompression.

4. Decompress the site, bilateral mid-clavicular or right side mid-axillary or per

your local training protocol.

When the site is “decompressed,” air can be heard/observed passing through

catheter.

Photo 6 Photo 7

Fig. 1

Photo 8

IV Cannulation:

Laerdal Recommends

Use a 21G or smaller catheter for IV cannulation to extend the life of your

simulator’s IV Arm. When using a catheter or other venipuncture device,

spray with lubricant spray for easier insertion.

NOTE: Do not use iodine as this will permanently stain the simulator.

1. Attach an IV bag with tubing. NOTE: Make sure the clamp is closed.

2. Use a syringe to inject blood concentrate and 500cc of water into an IV bag

with tubing. NOTE: Make sure the clamp is closed. This will serve as the

“blood source” bag. (Photo 9)

3. Attach the “blood source” bag with IV tubing to one of the latex tubes exiting

the simulator’s right IV Arm.

4. Attach an empty bag with IV tubing to the second latex tube exiting the

simulator’s IV Arm. This bag will serve as the collection reservoir. (Photo 10)

5. Control ﬂow of blood from arm, via clamp on collection reservoir tubing. Put

collection bag on ﬂoor to allow the now closed system to gravity feed.

6. Hang “blood source“ bag from IV pole and open clamp to allow concentrate

to ﬂow through arm.

NOTE: A blood pressure cu can be used as a pressure infuser. This will allow

the blood bag to be placed on the ﬂoor or between the mattress and frame.

(Photo 10)

7. When the “blood source” bag is empty, switch the “blood source“ bag and

reservoir. Hang the now full reservoir and place empty reservoir bag on ﬂoor

to reverse ﬂow of concentrate.

NOTE: Be sure to adjust the ﬂow regulator. The collection reservoir clamp

should always be used to control ﬂow rate.

The arm is now ready for cannulation. Train as per your local protocol.

Intramuscular Injections:

Medications can be administered via intramuscular injections bilaterally in the

deltoids and thighs and in the gluteal and ventro-gluteal locations.

Laerdal Recommends

Medications may be administered via local protocol. All precautions and safety

measures must be followed during training.

Urinary Catheterization (with genitalia upgrade kit):

1. Remove blank genitalia from the simulator.

2. Lift and rotate the pelvic pin to one side.

NOTE: Failure to replace the pelvic pin will result in pelvic spread.

3. Lift the urinary reservoir.

4. Using the urinary valves provided, attach threaded end of the connector valve

to the corresponding threaded urinary connector on the genitalia

(Photo 11-13).

5. Place the C Clamp over the valve, leaving loose.

6. Install the valve onto the black connector of the reservoir. Ensure that it sits

ﬂush to the reservoir.

7. Move the C Clamp over the connector and the valve.

8. Squeeze to tighten the C Clamp. This will lock the C Clamp in place.

9. Replace the genitalia assembly into the simulator torso.

10. Replace Pelvic Pin.

NOTE: Failure to replace the pelvic pin will result in pelvic spread.

11. Remove plug in urinary reservoir.

12. Using a 100cc syringe, ﬁll reservoir with colored water.

13. Perform urinary catheterization as per your local training protocol.

Photo 9

Photo 10

Photo 11 (Clamp not yet in place.)

Photo 13 (Apply clamp and squeeze to tighten.)

Photo 12 (Area where clamp is placed.)

E

Simulator Functionalities

Cardiac Related Skills:

ALS Simulator, when used with SimPad, features an extensive library of

ECG variations. External pacing with or without capture, deﬁbrillation and

synchronized cardioversion can also be performed. See SimPad Directions

for Use or LLEAP Help Files

NOTE: Prior to training, ensure the simulator cable exiting the simulator’s right

side is attached to the Link Box.

1. Compressions may be performed with one or two hands.

2. For monitoring purposes, lead placement snaps are located on simulator as

follows:

i. RA (Right Arm)

ii. LA (Left Arm)

iii. LL (Left Leg)

iv. RL (Right Leg)

NOTE: If the ECG snaps/deﬁbrillation connectors do not attach to the clinical

monitor/deﬁbrillator/external pacer used by your institution, additional ECG

snaps and or deﬁbrillation/pacing cables are available for purchase. Please

contact your representative for correct adaptor.

3. Two Zap Plates (discs) and two hands free adapters have been designed

for use with deﬁbrillators. Screw discs or hands free adaptors into post

sockets located on apex and sternum of simulator. Rhythm may be read from

simulator using a monitor by applying paddles to discs with ﬁrm pressure.

(Do not use gel or hands free self adhesive pads.)

4. For manual deﬁbrillation, place paddles on zap plates and press down ﬁrmly

for good contact. NOTE: Monophasic and Biphasic deﬁbrillators may be used.

Laerdal Recommends

Caution: Follow deﬁbrillation protocol by avoiding contact between the

paddle and any of the electrode sites while deﬁbrillating. A load of up to 360

joules can be delivered.

See SimPad Directions for Use or LLEAP Help Files for complete

cardiac functionality and operating information.

Safety Precautions used during Deﬁbrillation of a Patient/Trainer

1. Read and follow all safety and operating instructions provided with your

deﬁbrillator and associated equipment.

2. This trainer can be shocked with actual voltages and current used on a

live patient. All precautions and safety measures must be used during

the deﬁbrillation and pacing phases of training. Failure to follow safety

measures could result in injury or death to operators, students or

onlookers not heeding these warnings.

Blood Pressure (BP) Arm:

Left Arm Installation

The simulator is packaged with the left BP Arm attached. The BP Arm is

designed to rotate approximately 220º.

Caution: To prevent damage, do not over rotate the left BP Arm.

To detach the BP Arm:

1. Detach the chest skin, lift the chest plate and push it aside to remove the

stopper screw (photo 14) and release the BP Arm.

2. Take out the arm stopper, disconnect the BP cables and remove the BP

Arm. NOTE: Properly store the BP Arm and the attachment accessories

for future use.

To install the Left Arm (standard or wound model):

1. The simulator includes the necessary arm hardware (photo 15 ) Select the

replacement arm, remove the deltoid pad

2. Insert the arm adapter (photo 16) located inside the torso on the left side

3. Pass the small washer over the bolt, thread the bold and washer assembly

through the openings of the arm shoulder, torso and arm adapter (photo

17 & 18) NOTE: Tighten the wing nut as desired to simulate range of

motion

4. Replace the chest plate, the chest skin and the shoulder deltoid pad.

To re-attach the BP Arm, reverse the processes. Properly store the arm, the

adapter and the hardware set for future use.

Auscultating and palpating blood pressure:

1. Place the supplied Blood Pressure cu on the BP Arm (left).

2. Attach clear tubing on cu to matching clear pneumatic tubing exiting

underneath the simulator’s left arm. (Photo 19)

3. Ensure that the simulator cable and the clear pneumatic tubing, both exiting

the simulator’s right side are attached to the Link box.

Korotko sound volume can be controlled, an auscultatory gap heard and

pressure set in steps of 2 mmHg.

See SimPad Directions for Use or LLEAP Help Files for complete

Blood Pressure Arm functionality and operating information.

Photo 14 Photo 15

Photo 16 Photo 17 – Inside View

Torso Left Side

Photo 18 – Outside View Left

Shoulder Standard or Wound Arm

Photo 19

Laerdal Recommends

Do not insert needles into the BP Arm.

Heart, Breath and Bowel Sounds and Speech

The ALS Simulator has heart, breath and bowel sounds, both normal and

abnormal, with adjustable instructor controlled volume.

Ensure that the ALS Simulator is connected to the Link Box via the simulator

cable located on lower left side of simulator.

See SimPad Directions for Use or LLEAP Help Files for complete

Heart, Breath and Bowel Sound Auscultation and Speech

functionality and operating information.

Spontaneous Breathing and Airway Closures

The ALS Simulator has spontaneous breathing (visible chest rise and fall) with

variable breathing rate. The breathing is generated via an enclosed air tank in

the right thigh that is pressurized using a standard air pump. (See “Filling the

Thigh Air Tank” located in the “Getting Started” section of the DFU for

more information).

The left lung and right lung can be closed independently or together to create a

partial or complete airway obstruction.

See SimPad Directions for Use or LLEAP Help Files for complete

breathing and airway blockage functionality and operating

information.

Maintenance:

Cricothyroid Membrane/Neck Skin Collar:

1. Remove neck skin collar, by detaching Velcro®.

2. Remove used Cricothyroid Membrane Tape from cricoid opening.

3. Cut a 2 inch/ 5 cm strip of Cricothyroid Membrane Tape.

4. Adhere tape to edges of cricoid opening, covering the opening with tape, to

create the actual membrane.

5. Lay a Neck Skin Collar into molded track around neck area of the simulator.

(Figure 2) NOTE: If the used collar is still in good repair simply slide the

collar in either direction for a fresh site. If the collar is showing wear, discard

and replace with a new one.

6. Attach collar using Velcro®strips.

Laerdal Recommends

The neck skin collar is designed to provide multiple sites for needle and

surgical techniques. When a fresh site is needed, slide the collar in either

direction. If the neck skin collar is showing wear, discard and replace with a

new collar.

IV Cannulation

After IV training is complete:

1. Close both clamps on IV tubing and detach bag tubing from arm tubing. Fill a

100cc syringe with water. Flush IV Arm with syringe.

NOTE: This should be done over a basin to catch any ﬂuid.

2. Using the empty syringe, push air through venous system to remove excess

water.

Intramuscular Injections

After intramuscular injection training is complete:

1. Remove sponge from inside of injection pad skin.

NOTE: Do not store wet foam pads in skin. This will cause shrinkage of

injection pad skin.

2. Rinse sponge with water, allowing it to dry overnight.

3. Insert sponge back into injection pad skin. NOTE: A small amount of powder

applied to sponge will ease insertion.

4. Replace the pad in the simulator.

Urinary Catheterization (with genitalia upgrade kit):

After urinary catheterization is complete:

1. Remove complete genitalia assembly

2. Disassemble the genitalia assembly

3. Working over a basin empty the reservoir

4. Rinse parts and reservoirs thoroughly and allow to dry overnight

Pneumothorax:

(A) Bilateral Mid Clavicular Sites:

1. Detach the chest skin from torso from tabs at the shoulder and back and

remove.

2. Remove the hard chest plate from the torso.

3. Disconnect bladder hose from Y connector, located on the underside of the

chest plate. (Photo 20)

4. Remove the bladder by pulling it through the opening between the 2nd and

3rd intercostal spaces on the top side of the hard chest plate. (Photo 21)

5. Trim bladder tubing to match original tubing length to ﬁt this simulator style.

6. Insert the new pneumothorax bladder into the top side of the chest plate

though the 2nd and 3rd intercostal space opening with the bladder tubing

exiting though the back side of the chest plate. NOTE: The narrow edge of

the bladder should be inserted closest to the sternum. (Photo 22)

7. Reconnect hose to Y hose connector.

8. Return chest plate to proper position on torso.

9. Replace Chest Skin over torso, being sure to secure skin at shoulders and

back.

10. Fill puncture marks on the exterior of the Chest Skin with the wax included

in the Bladder Replacement Kit.

Fig. 2

Photo 20

Photo 21

Photo 22

E

(B) Mid Axillary Site (RIGHT):

1. Remove Chest Skin from tabs at the shoulder and back.

2. Remove pneumo bladder box from right side of torso. (Figure 3)

3. Disconnect bladder hose from inline hose connector, being sure hose does

not fall through hole and into torso.

4. Remove bladder from pneumo pad and discard.

5. Trim bladder tubing to match original tubing length to ﬁt this simulator style.

Connect new bladder hose to inline hose connector.

6. Fold and insert new pneumo bladder into pneumo box.

7. Replace Chest Skin over torso, being sure to secure skin at shoulder and back

tabs.

8. Fill puncture marks on exterior of Chest Skin with the modeling wax supplied

in the Bladder Replacement Kit.

NOTE: Bladders can be repaired using vulcanized or contact cement glue (not

provided). Cover punctured surface of pneumothorax bladders with glue. Allow

bladders to air dry completely overnight before replacing in the chest plate.

Chest Drain:

Mid Axillary Site (LEFT)

1. Remove Chest Skin from tabs at shoulders and back.

2. Remove the Chest Tube Insertion Module from the left mid-axillary site of

the simulator. (Photo 23)

3. Insert a new Chest Tube Insertion Module.

4. Replace Chest Skin over the torso being sure to secure the skin at the

shoulders and both sides.

Attaching/Removing Arms:

1. Remove Deltoid Injection Pad from upper arm.

2. Detach Chest Skin from tabs at shoulders and back.

3. Remove skin to reveal internal portion of upper chest.

4. Lift hard chest plate to reveal inside sockets for arm connections.

5. Place one washer on threaded 4 ½” bolt.

6. Insert threaded bolt through upper arm and through torso so that it is visible

in chest cavity. (Figure 4)

7. From inside of chest area, slip a washer, a spring and another washer on bolt.

8. Screw a wing nut on bolt and tighten until desired articulation is achieved.

9. Replace hard chest plate.

10. Pull Chest Skin back onto shoulder area.

11. Connect Chest Skin to torso at shoulder and back tabs.

12. Replace Deltoid Injection Pad on upper arm.

To remove arms(s), reverse procedure.

IV Arm Skin and Vein Replacement

Laerdal Recommends

When excessive leaking occurs at the puncture sites, a new vein system and

skin should be installed to reduce loss of ﬂuid.

We recommend working at a basin when replacing skin and veins.

Replacing Skin and Veins:

1. Cut o skin. This can be done with a sharp knife or scalpel. (Figure 5)

2. Discard skin.

3. Remove tubing from track in mandrel. Glue may need to be scraped away.

4. Rinse and dry vein grooves well and swab with alcohol. Be sure to remove

any excess glue.

5. Place new veins along grooves, (Figure 6) spot gluing as needed. (We

recommend a fast-drying glue applied sparingly every 2 to 3 inches.)

6. Generously lather arm mandrel with liquid soap.

7. Slide hand into skin. (Photo 24)

8. Work skin over ﬁngers, as with a glove. (Photo 25)

9. Work arm skin up, over mandrel. (Photos 26 &27.)

Fig. 3

Photo 23

Fig. 4

Fig. 5

Fig. 6

Photo 24

Photo 25

Photo 26

After Use:

Cleaning

1. Clean with mild soap and water; do not submerse the simulator or parts in

cleaning ﬂuids or water.

2. Use only on clean surface. Avoid felt tipped markers, ink pens, acetone, iodine

or other staining products and avoid placing the simulator on newsprint or

inked lines of any kind.

3. To ensure longevity, each simulator should be cleaned after each training

session and a general inspection should be conducted regularly.

4. Modules and all other parts should be drained and air-dried thoroughly

before storage and disinfected when needed. After use of injection pads

(use water only), accumulated water should be squeezed out. NOTE: Do

not store wet foam pads in the skin. To prevent mildew or mold, pads can

be soaked in a mild solution of disinfectant and water or bleach and water.

Squeeze excess solution from pads, allow them to dry, then store or reinsert

in simulator.

5. Articulating parts will beneﬁt from a light application of talcum powder prior

to training sessions.

Extend Cleanliness

To extend the cleanliness of your simulator:

1. Use a small towel and lightly dust the simulator head and chest with a small

amount of powder (provided). Wipe away any excess.

2. Use gloves when handling the simulator.

Laerdal Recommends

Use only on clean surface. Avoid felt tipped markers, ink pens, acetone,

iodine or other staining products and avoid placing the simulator on

newsprint or inked lines of any kind. These will stain the simulator.

Technical Data

General

Operating Temperature:

0°C – 40°C at 90% relative humidity, non-condensing

Storage Temperature:

-15°C – 50°C at 90% relative humidity, non-condensing

ALS Simulator

Deﬁbrillation: Average of 720 J /minute max

Emergency Cardiac Capabilities

• Synchronized variable heart rate, rhythm, abnormalities and duration

• Deﬁbrillation (25 -360 J)

IV Arm

Accessible veins include median, basilic and cephalic

Standards/Approvals

The product is in compliance with the essential

requirements of Council Directive 2004/108/EC on

electromagnetic compatibility (EMC).

The product is in compliance with Council Directive

2011/65/EU on restriction of the use of certain

hazardous substances (RoHS).

Minimum Computer Requirements

• Intel i-core generation 3 or newer

• Score over 3000 PassMark - CPU Mark

• 4 GB RAM

• 120GB hard disk space

• 1366x768 or better

• Headset w/microphone

• USB ports – 2

Minimum Software Requirements

• Windows 7 or Windows 8

• 100% DPI

Replacement Parts:

For latest version of Spare Parts and Accessories, visit www.laerdal.com

Photo 27