Nasco Crisis lf03616u User manual

ONLINE: NascoHealthcare.com

EMAIL: [email protected]

PHONE: 1.800.431.4310

ADDRESS: 901 Janesville Ave.

Fort Atkinson, WI 53538

HEALTHCARE

Child

CRiSis™

Manikin

Simulator

LF03616U

INSTRUCTION MANUAL

WARNING: Products may contain dry natural rubber.

5-Year Warranty

Other Available Simulators

LF03617U Deluxe Child CRiSis™Manikin with Arrhythmia Tutor

LF03709U Infant CRiSis™Manikin

LF03953U CRiSis™Manikin, Complete

LF03955U Deluxe CRiSis™Manikin

LF03956U Deluxe “Plus” CRiSis™Manikin

LF03965U Adult CRiSis™Auscultation Manikin

LF03966U Adult CRiSis™Auscultation Manikin with ECG Simulator

LF03709U

LF03965U

Actual product may vary slightly from photo. Nasco reserves the right to change product color, materials,

supplies, or function as needed.

HC190001INM14.indd 1-2 2/20/19 11:23 AM

TABLE OF CONTENTS

Introduction ....................................................................3

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

IV Arm ............................................................................5

Blood Pressure Arm..........................................................9

Defibrillation Chest Skin ..................................................14

Intraosseous Infusion/Femoral Access Leg .........................16

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18 3

The Child CRiSis™Manikin is a completely modular system that lets you create a manikin to suit your

needs. It is ideal for ACLS, nursing, paramedic, and EMT training. This system features a completely

functional CPR manikin of a five-year-old child with Life/form®Airway Management Trainer, IV Arm,

Blood Pressure Arm, Defibrillation Chest Skin, and Intraosseous Infusion/Femoral Access Leg.

The Child CRiSis™Manikin allows you to simulate resuscitation; start IVs; check and evaluate blood

pressure; practice airway management skills including intubation and suction; and perform defibrillation,

CPR, and intraosseous infusion and femoral access.

ASSEMBLY OF YOUR CHILD CRiSis™MANIKIN

To facilitate packing, your manikin comes with the arms and legs unattached.

To connect the arms to the torso, place each in a position such that the hand is above the head.

(See figure 1.)

Align the arm fitting with the torso socket and plug the arm into place. Finish by rotating the arm forward

so it lies along the side of the body.

To connect the legs to the torso, simply slide the waist pin (supplied) through the torso and legs, pinning

the legs in their correct position. (See figure 2.)

USING THE MANIKIN

Each part of the manikin is covered under a different section of the instructions. Go to the table of con-

tents to locate the area of the manikin you choose to set up and use. You can set up as many components

as necessary to fit your training situation.

CLEAN UP PROCEDURES

1. Remove and discard any bones that have been charged with blood mixture.

2. Remove leg skins and use paper towels to completely wipe the simulator and remove any “blood” or

lubricating agent.

3. Drain the syringe and discard any of the unused blood mixture.

4. Use clean tap water to flush and clean the syringe and tubing. Allow to dry.

GENERAL INSTRUCTIONS FOR

FEMORAL ACCESS USE

1. Prepare the blood mix by filling one of the pint

bottles with water and shaking until mixed.

(Do not add K-Y Jelly to the femoral blood mix.)

2. Be sure the clamp on the IV bag tubing is

closed, and hang the bag no more than 18"

above the leg. Pour the blood mix from the

bottle into the IV bag.

3. Attach the fitting end of tubing to the access site

tubing. (See figure 7.)

4. Open the clamp on the IV bag.

5. To charge the vein, make your first needle inser-

tion in the vein, and pull back on the syringe to

remove air from the vein. Repeat until “blood” is

withdrawn. The vein is now charged, and subse-

quent insertions will produce an immediate flow

of “blood.”

CLEAN UP PROCEDURES

1. Close the clamp on the IV bag, pull the fitting from the femoral access tubing, and let the access

tubing drain.

2. Drain the bag into the pint bottle by placing the IV bag tubing end into the bottle and opening the

clamp.

3. When the bag is empty, close the bottle and flush out the IV bag with clean tap water. Let dry.

SUPPLIES/REPLACEMENT PARTS FOR THE INTRAOSSEOUS INFUSION/FEMORAL ACCESS LEG

LF03618U Intraosseous Infusion Bone Replacement Kit

LF03619U Intraosseous Infusion Left and Right Leg Skin Replacements

LF01111U Intraosseous Infusion Simulated Blood Mixture

LF03626U Femoral Injection Pad Replacement

LF00845U Life/form®Venous Blood, 1 quart (Femoral Access)

LF00846U Life/form®Venous Blood, 1 gallon (Femoral Access)

Figure 1 Figure 2

Figure 7

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ABOUT THE SIMULATOR

The Life/form®Child Airway Management Trainer Head is the most realistic simulator available for

the training of intubation and resuscitation skills. Nasco has taken great care to create a trainer that is

anatomically correct in respect to both size and detail.

Landmarks include nostrils, teeth, tongue, oral and nasal pharynx, larynx, epiglottis, arytenoids, false

and true vocal cords, cricoid ring, tracheal rings, trachea, esophagus, lungs, and stomach.

The Life/form®Child Airway Management Trainer Head allows you to practice oral, digital, and nasal

intubation, as well as CPR. Suction techniques can also be performed and evaluated. The simulator was

designed to use an uncuffed endotracheal tube measuring up to 5.0 mm I.D.

LIST OF COMPONENTS

• Child Airway Management Trainer Head

• Right and Left Lung Simulators

• Stomach Simulator

• 8-oz. Pump Spray Lubricant

• 3 Nylon Hose Clamps

LUBRICATION

Before using the Life/form®Child Airway Management Trainer, lubricate both the oral cavity and the

endotracheal tube with the pump spray lubricant provided. (See figure 1.)

Note: Nasco recommends the use of the provided lubricant or a similar vegetable-based lubricant for the

Child Trainer. The use of a silicone-based or similar lubricant may seriously damage the simulator, thus

voiding Nasco’s warranty on the trainer.

CLEANING THE FACE

Normal soil can be removed from the face with mild soapy water. Nasco Cleaner (LF09919U) will

remove stubborn stains. Simply apply Nasco Cleaner to soiled area and wipe clean with a soft cloth or

paper towel. Note: Avoid using cleaner around mouth area if students will be applying direct mouth-to-

mouth resuscitation techniques, as the cleaner may be toxic if ingested. NEVER place the trainer on any

kind of printed paper or plastic. These materials, as well as ballpoint pens, will transfer indelible stains.

Do not use any cosmetics.

AVAILABLE SUPPLIES

LF03631U Replacement Headskin with Airway

LF03627U Replacement Lungs

LF03628U Replacement Stomach

LF03644U 8-oz. Pump Spray Lubricant

LF09919U Nasco Cleaner

THE AIRWAY MANAGEMENT TRAINER

6. The bones have been designed so all four sides can be punctured. To change sides, carefully remove

the bone from the leg and wipe clean. Remove a small piece of wax (provided) and work with your

fingers until soft. Rub the wax piece back and forth across the bone holes until they are sealed. (See

figure 4.) A thin layer of wax left on the bone surface over the holes will help in sealing. Finish by

applying a thin film of Nasco lubricant over the whole bone. Turn the bone 90° and reinsert into the

leg. (See figure 5.) Do this until all four sides of the bone structure have been punctured, at which

time the bone can be discarded.

Special Note: The Intraosseous Infusion Leg duplicates a procedure that requires a great deal of pres-

sure to be placed on both the simulator and the needle being used. Extreme caution should be taken to

avoid pushing the needle completely through the simulator, injuring the person performing the proce-

dure. Nasco cannot be responsible for injuries resulting from improper use of the simulator.

Figure 1

4. Connect the end of the tubing to the bone piece. Apply

liquid lubricant to the entire bone, and slide into posi-

tion in the leg. (See figure 3.)

IMPORTANT

5. Make your first needle insertion into the bone and

remove the needle stylus. Proper insertion and pressure

applied to the syringe will allow “blood” to flow through

the tubing and fill the bone. When you observe “blood”

flowing up through the needle, the bone is completely

charged. Each new bone will need to be charged in

this same manner. Correct subsequent insertions will

produce an immediate flow of fluid through the needle.

To reduce the pressure being placed on the bone, pull

the plunger on the syringe back once verification of

the placement has been made. This will decrease the

amount of “blood” that may leak from the bone.

Figure 3

Figure 4 Figure 5

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16 5

ABOUT THE SIMULATOR

The Life/form®Child Injectable Training Arm duplicates the human condition as closely as modern

plastics technology allows – it is almost the real thing. Its care and treatment should be the same as with

a patient; abuse or rough handling will damage the simulator – just as it would cause pain to a patient.

Although this arm will provide you long, trouble-free usage, the skin and veins can be readily replaced

when needed. The outer skin is easily peeled off, revealing the “core” and veins, providing, literally, a

brand new arm. The life of the replaceable skin and veins will be prolonged by utilizing smaller needle

sizes (22-gauge or smaller). However, if instruction with larger needle sizes is required, this can be done;

the skin and veins will merely need replacing sooner. The Skin and Vein Replacement Kits are available

through Nasco (see list of supplies).

LIST OF COMPONENTS

• 3 cc Syringe with Needle

• 12 cc Syringe with Needle

• 2 IV Bags

• Needle (Butterfly)

• 1 Pinch Clamp

• Small Towel

• Arm

INTERNAL STRUCTURE

Internally, the vascular structure (rubber tubing) begins at the shoulder and continues under the arm,

crosses the antecubital fossa forearm, makes a loop in the back of the hand, and then returns to the under-

arm. (See figure 1.) This venous system is constructed of special self-sealing plastic tubing, with the lumen

being the approximate size of a human vein. This vascular structure has inlet tubing and outlet tubing at

the shoulder. It is via these tubes that synthetic blood is injected and removed. Thus, the techniques of

“blood” drawing and starting intravenous infusions may be practiced on the Injectable Training Arm.

THE IV ARM

Synthetic Blood

Posterior

Venous System

Outlet Tubing

Inlet Tubing

Posterior

12"

Needle

Adapter

Pinch

Clamp

Pinch

Clamp

ABOUT THE SIMULATOR

The Life/form®Child Intraosseous Infusion/Femoral Access Leg is a dramatic and exciting training aid

designed to demonstrate and simulate intraosseous infusion and femoral access procedures. It enables

students to learn and practice, with incredible accuracy and realism, a procedure that in the past has

been very difficult to simulate.

LIST OF COMPONENTS

• Leg

• Femoral Access Site

• 10 Bone Inserts

• 2 Small White Towelettes

• 1 60 cc Syringe

• K-Y Jelly

• Wax

• ½-oz. Liquid Lubricant

• 2 Leg Skins

• 2 Mixing Bottles w/Blood Mix

• IV Bag

THE INTRAOSSEOUS INFUSION/FEMORAL ACCESS LEG

Figure 1

GENERAL INSTRUCTIONS FOR INTRAOSSEOUS INFUSION USE

1. Place the simulator on a flat surface such as a tabletop. Lay towels under the knees for support and

to absorb any overflow.

2. To prepare the blood mixture, combine the red coloring, 1 full tube of K-Y Jelly, and 1¼ cups of tap

water in the pint bottle provided. (See figure 1.) Shake vigorously for 30 seconds, until contents

are mixed completely. After “blood” is mixed, fill the 60 cc syringe by placing the tubing end of the

syringe into the bottle and drawing the “blood” up into the syringe.

3. Wrap the leg skin over the lower leg and fasten it on the back side. (See figure 2.)

Figure 1 Figure 2

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GENERAL INSTRUCTIONS FOR USE

The Injectable Training Arm comes with all of the supplies necessary to perform most procedures.

A. Preparing and Drawing “Blood” from the Arm

1. Fill pint bottle containing synthetic blood concentrate with distilled water.

2. Pour the synthetic blood into one of the bags.

3. Be sure clamp on the IV tubing is closed, and hang the bag no more than 18" above the level of

the arm.

4. Attach the end of the IV tubing to one of the shoulder tubings.

5. With the other shoulder tubing in a basin or sink, gradually “flush” the vascular system with syn-

thetic blood by slowly opening the clamp. Allow some “blood” to pass through the system until the

air bubbles have been eliminated.

6. Once the system is filled, use the extra pinch clamp to close off the blood outlet tubing. The venous

system is now full of “blood” and pressurized. Be sure to leave the clamp on the IV tubing opened.

7. After filling the venous system according to instructions, the arm is now ready to practice drawing

“blood.” “Blood” can be drawn anywhere along the pathway of the vein. (See figure 1.) Distilled

water should be used to prepare the sites. Synthetic blood will actually be aspirated once the vein is

properly punctured.

8. Small diameter needles, 22-gauge or smaller, should be used.

B. Preparing the Arm for Intravenous Infusions

1. Close clamp at end of Bag A IV tube, then fill with water (distilled water is recommended), and

hang not more than 18" above the arm. (See figure 2.)

2. Appropriate intravenous infusion needles (or butterflies) should be used, and distilled water is

recommended as an infusion.

3. The self-sealing simulated veins lend themselves very well to the practice of starting IV infusions,

and IVs can be started anywhere along the pathway of the simulated vein. Cleanse the sites with

distilled water only.

Figure 2

Once your manikin is connected to your patient simulator, you will be able to pick up the ECG waves

either through the monitor hook-ups on the skin or through the two disks attached to the skin on the

defibrillation sites.

These disks will enable you to pick up the ECG waves using either the “Quick Look” paddle option or

directly through gel pads, just like on a real patient.

It is possible to use AED gel pads with the cable connectors built into the gel — the same ones you use on

patients. In an effort to help you save money, Nasco offers a set of training buttons that will correspond to

your particular AED unit. These buttons are sold separately, and can be used over and over again. They

come as a set with the patient simulator adapters. (See accessories at the end of this section.)

TROUBLESHOOTING

Problem ECG wave is not being picked up from the manikin.

Solution

1. Check your connections on the patient simulator; one or more may be disconnected.

2. Check to make sure your patient simulator is plugged in and working properly.

Problem ECG wave is inverted.

Solution

Recheck the position of the red and black lead snaps on the patient simulator.

Note: If the defibrillation chest skin is not functioning or wiring comes undone, please contact us to

repair or replace the unit. Failure to do so, or unauthorized repair, may void the warranty or cause

further harm or damage to you or your equipment.

ACCESSORIES FOR DEFIBRILLATION CHEST SKIN

LF03656U Physio Control Training Pad Adapters and Patient Simulator Adapters for

LifePak 10 and LifePak 20

LF03657U Marquette Electronics Training Pad Adapters and Patient Simulator Adapters

LF03658U Space Labs/Laerdal/Heartstart/First Medic Training Pad Adapters and

Patient Simulator Adapters

LF03961U Zoll Training Cables with Adapters

LF03962U Physio Control Training Cables with Adapters for LifePak 12

Note: If you need help selecting the training pad adapters that correspond to your AED unit, please feel

free to call us at 1.800.431.4310 for assistance.

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14 7

4. Attach fitting end of tubing from bag A to the shoulder tubing that has the pinch clamp. Attach the

fitting end of bag B to the remaining shoulder tube.

5. With bag A hanging and bag B laying on the surface, open clamps on both bags and the arm tube

clamp. Allow fluid to flow until air bubbles are gone. The venous system is now pressurized. Close

the clamp on bag B.

6. Insert IV needle (or butterfly) in vein. “Flashback” will indicate proper insertion.

7. Close the clamp on bag A and the clamp on the arm tube. Disconnect bag A from the shoulder

tubing. You may now use bag A as the infusion supply.

8. Attach the needle or butterfly to bag A using the latex adapter. (See figure 3.)

9. To start the IV flow, open the clamps on both bags A and B.

Proof of proper procedure will be evidenced by the flow of fluid from bag A. Control flow rate with the

clamp on bag A. This fluid can be reused. A user-supplied IV bag may also be used for the infusion fluid.

This will enable bags A and B to remain attached to the arm. If a more realistic experience is desired with

“blood flashback” instead of water when inserting butterfly into lumen of vein, use procedure C.

C. Recommended Procedure for Simultaneous IV Infusions and Drawing “Blood”

Use two IV Bag Kits. Hook up and install with IV bag A and IV bag B. (See figure 2.)

1. Begin with synthetic blood in IV bag A. Open the clamps on both A and B to pressurize the system.

“Flush” system by allowing “blood” to flow into container B until bubbles in tubing disappear, then

regulate blood flow from bag A (using the clamp). System is now full of “blood” and pressurized.

“Blood” can now be drawn anywhere along the pathway of the vein.

2. Intravenous infusion — Insert the butterfly needle into the lumen of the vein: A flashback of “blood”

is proof the needle was inserted correctly. Close the clamp on the bag A tubing and disconnect it at

the shoulder. Use the extra pinch clamp supplied to clamp off the loose shoulder tubing. Connect

the IV tubing from bag A to the butterfly needle using the special connector supplied. Open the

clamp on the bag A tubing and adjust it as desired. To keep the process going, when bag B fills,

simply switch the positions of bags A and B and their IV lines.

Note: Always regulate the flow of “blood” from the bag on the stand, and be sure the clamp on the

other bag is open.

Causes for Failure in Function

A. Forgetting to open a clamp.

B. Kinks in tubing of IV sets.

C. Is the supply hung at the appropriate height according to the instruction manual? Hanging the

supply bags “slightly” higher for the bags that are not producing enough pressure can create just

enough gravity on the fluid to facilitate flow.

D. Tubing pinched shut by constant pressure of clamps. Lumen remains pinched occasionally, even if

clamp is loosened. Slide clamp to new position and manipulate tubing with fingers at pinched site

to restore lumen. In heavy use, slide clamp to new position on tubing from time to time to prevent

the “permanent pinch” caused by constant clamp pressure. Replace IV kit.

ABOUT THE SIMULATOR

The Life/form®Child Defibrillation Chest Skin has been designed for the Child CRiSis™manikin to

enable you, the customer, to safely practice defibrillation. The Child Defibrillation Chest Skin has been

designed to absorb a maximum of 360 joules of energy*. Although capable of absorbing 360 joules, we

recommend that the smallest energy level possible be used while training with the skin.

The Child Defibrillation Chest Skin will enable you to practice defibrillation using manual, semiautomatic,

and automatic external defibrillators (AEDs). When using any one of these types of defibrillators in train-

ing, always follow the recommended operating procedures for that particular defibrillator.

LIST OF COMPONENTS

• Defibrillation Chest Skin with Load Box and Four Lead Snap Cable Connector. (See figure 1.)

*Note: 360 joules is the maximum energy level that Nasco recommends administering to the defibril-

lation chest skin. Energy levels in excess of 360 joules may cause irreparable damage to the chest skin,

circuitry, and patient simulator being used — thus voiding Nasco’s warranty and endangering your

equipment. Nasco assumes no liability for damage or injury that may be caused by the use and/or misuse

of this equipment. All normal safety precautions for defibrillation training should be followed, and energy

levels should be minimized. Nasco did not design nor intend this defibrillation chest skin to be used as

anything other than a training apparatus for defibrillation.

CONNECTING YOUR PATIENT SIMULATOR

Connect the four lead snap cable to your patient simulator.

Nasco has designed the Child CRiSis™System to be compatible with a variety of patient simulators.

This is possible via the standard four lead snap cable. (See figure 2.) If your patient simulator has only two

output posts, the red and black leads must be connected to the patient simulator.

If you want to connect the manikin to the simulator that came with your defibrillator, it is necessary to

purchase the corresponding adapters from Nasco separately, if the patient simulator doesn’t have the

standard snap connectors. (Please see accessories at the end of this section).

THE DEFIBRILLATION CHEST SKIN

Figure 1

Figure 3

Figure 2

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8 13

E. If these measures do not unclog the venous system, try using a large (50 cc) syringe to force fluid

through the tubing.

F. If none of these measures work, peel back the skin (soap up arm and skin generously with Ivory®

liquid detergent) of the arm to the knuckles (do not remove from fingers), and examine all tubing

for possible kinks. Soap up arm and skin generously with Ivory® liquid detergent, and return skin

over arm.

CARE OF SIMULATOR

After each class use, disconnect “blood” and flush the venous system. Return synthetic blood to the

storage bottle. Remove pinch clamp and IV sets from arm. Use tap water to flush venous system and

wash outside of arm with Ivory® liquid detergent and water. Excess water may be removed from the arm

by raising the hand, lowering the shoulder, and draining it into a sink or basin. Always remove the pinch

clamp from shoulder tubing and drain excess water from veins before storing.

Ordinary stains can be removed by washing with soap and warm water. Newsprint, similar printed paper,

plastic, and ballpoint pen will permanently stain the simulator if prolonged contact occurs. Stubborn

stains may be removed with Nasco Cleaner (LF09919U) simply by dispensing it on the area and wiping

with a soft cloth or paper towel.

CAUTIONS

1. This synthetic blood is specially formulated to be compatible with the self-sealing veins and plastics

used in manufacturing the arm.

2. DO NOT use dull or burred needles, as these will cause leaks in the system. Burred needles will

cause permanent damage. Use smaller needles (22-gauge or smaller).

3. DO NOT allow “blood” to dry on simulator — it may stain the arm.

4. Use only 500 cc of infusion fluid, as a larger amount will also increase the pressure of the venous

system, resulting in leaks.

5. DO NOT clean the simulator with solvents or corrosive material, as they will damage it.

6. DO NOT use for subcutaneous injection. Nasco’s Intradermal Injection Simulator (LF01008U) is

specially designed for intradermal injection training and practice.

7. Nasco Vein Tubing Sealant Kit (LF01099U) will extend the useful life of the tubing.

SUPPLIES/REPLACEMENT PARTS FOR CHILD INJECTABLE TRAINING ARM

LF00845U Life/form®Venous Blood, 1 quart

LF00846U Life/form®Venous Blood, 1 gallon

LF01099U Vein Tubing Sealant Kit

LF03629U Skin and Vein Replacement Kit

LF09919U Nasco Cleaner

Lastly, take the loose end of the tubing and push the

male luer fitting into it. (See figure 17.) Attach the

male luer fitting to the fitting marked CUFF at the

top of the unit. Once all of the necessary connec-

tions have been properly made, go to the section

titled “Calibration Procedures” and calibrate the

unit. When the calibration procedures have been

completed, the simulator is ready for use.

Figure 15

Figure 16

Figure 17

Figure 14

PREPARING YOUR EQUIPMENT FOR USE WITH THE

NASCO Life/form®CHILD BLOOD PRESSURE SIMULATOR

To adapt your sphygmomanometer for use with the simulator, it is first necessary to obtain the luer fitting

and the T-fitting included with the simulator, which is also available through your Nasco catalog sales

office. Using a scissors, carefully cut the pressure line of the sphygmomanometer about 2" from the

gauge. (See figure 14.)

Take the T-fitting and insert it between the two ends of tubing that were previously cut. (See figure 15.)

Assemble the portion of pressure line tubing over the remaining barbed end on the T-fitting.

(See figure 16.)

SUPPLIES/REPLACEMENT PARTS FOR CHILD BLOOD PRESSURE SIMULATOR

LF01096U Electronic Control Unit with Sphygmomanometer

LF01189U Amplifier/Speaker System

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12 9

THE BLOOD PRESSURE ARM

GENERAL INSTRUCTIONS FOR USE INSTALLING THE BATTERIES

Take the Blood Pressure Electronic Control Unit from the box and turn it over, placing it face down onto a

padded work surface. Locate the “Open” compartment on the back of the panel where the batteries are

to be installed. (See figure 1.) Place your thumb or index finger on the “Open” compartment and push up.

This will open the battery compartment. The compartment is marked as to the “+” and “–” positions of

the batteries. The battery bracket is now accessible to the user.

Install six “AA” batteries as indicated by the orientation diagram embossed in the bottom of the bracket.

It is recommended that alkaline batteries be used for increased battery life. After the batteries have

been properly installed, reassemble the Blood Pressure Simulator by simply reversing the disassembly

procedures. Place the unit face up on the work surface and turn it on by pressing the on/off switch on

the top right of the unit. (See figure 2.) Observe the display and verify that a readable display is present,

indicating proper battery installation. Note: The control box has a battery saving feature which will turn

the unit off after about 8-10 minutes if no keys are used within that period of time.

Figure 1

Compare the results of reading the systolic and diastolic blood pressures on the gauge with the respective

settings on the simulator. If the readings were accurate, they should compare favorably with the preset

values. If the auscultatory gap had been selected, then an absence of an audible pulse would have been

noticed during what would have been the phase 2 Korotkoff sound. It is this lack of an audible pulse that

is considered an auscultatory gap. Note that in reality the auscultatory gap can be present in either the

phase 1 or phase 2 Korotkoff sounds. If it is desired to demonstrate the sounds heard while measuring

a subject’s blood pressure to the trainee or group of trainees, an auxiliary amplifier/speaker system is

available (LF01189U). If the auxiliary speaker is used, the speaker is plugged into the EXT AUDIO AMP

jack located next to the ARM output jack at the top of the unit. Adjust the volume control to increase the

output of the auxiliary speaker amplifier, and proceed with the blood pressure measurement sequence

as it would normally be performed, except that the stethoscope need not be used. Instead, listen to the

sounds as they emanate from the speaker amplifier, noting the differences in the Korotkoff phases being

presented.

The Nasco Life/form®Child Blood Pressure Simulator is programmed to demonstrate the five Korot-

koff phases, including an auscultatory gap, which can be heard during auscultation of a subject while

measuring the subject’s blood pressure. Each is distinctly different and present for only a portion of the

measurement sequence.

LOW BATTERY INDICATOR

When the battery supply diminishes to a level near the point that the unit will no longer function properly,

the “low batt” segment of the systolic pressure display will activate when the pressure in the sphygmoma-

nometer cuff reaches above 20 mmHg. At this point, the batteries should be replaced as soon as possible

in order to insure proper operation of the unit. Refer to the section titled “Installing the Batteries.”

CALIBRATION PROCEDURES

To calibrate the simulator, set the unit up as described in the section titled “Using The Nasco Life/form®

Child Blood Pressure Simulator.” Apply the cuff to the simulated arm. Set the control box systolic pressure

to 150 mmHg and set the diastolic pressure to 70 mmHg. Proceed with a simulated blood pressure

measurement. Note the discrepancy in the readings between the gauge and the control box. Set the

systolic “offset.” Example: If the blood pressure reading was taken and the sounds started at 148 mmHg,

then the offset is +2. If the sounds started at 152 mmHg, the offset is –2. For this example, assume that

the sounds started at 148 mmHg. Press and hold the Calibration key until the systolic correction window

appears. (See figure 12.) Using the arrow up key, set the correction to +2. Set the diastolic offset.

Example: If the blood pressure reading was taken and the sounds stopped at 72 mmHg, the offset is –2;

if the sounds stopped at 68 mmHg, the offset is +2. For this example, assume that the sounds stopped at

72 mmHg. From the systolic window, press the Menu key to change the diastolic window. (See figure 13.)

With the arrow down key, set the correction to –2. Press the Menu key again and the message “CALIBRA-

TION COMPLETE” will appear. The main menu window will be displayed.

Figure 12

Figure 2

On/Off Switch

The next step is to connect the simulated arm and speaker assembly along with the sphygmomanometer

cuff and gauge assembly included with the unit. First, locate the end of the pressure line attached to the

sphygmomanometer that has the male luer fitting attached to it. Attach this to the female luer fitting at

the top of the unit marked CUFF. (See figure 3.) After the pressure line fitting has been properly installed,

locate the plug that is at the end of the wire which extends from the simulated arm assembly. Insert the

plug from the arm into the jack at the top of the unit marked ARM. (See figure 4.) At this point the Blood

Pressure Simulator is ready for use. The unit has been factory calibrated for use with the accessories

included in the kit. No further calibration adjustments should be necessary at this time. If the unit is to be

used with a sphygmomanometer other than that supplied with the unit, or if recalibration is necessary at

a later date, then see the section titled “Calibration Procedures.”

Figure 3 Figure 4

Figure 13

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10 11

Familiarizing Yourself with the Nasco Life/form

Child Blood Pressure Simulator Control Panel

Under the display window are three buttons: Menu,

Gap, and Calibrate. (See figure 5.) The systolic

pressure is set by pressing the Menu key once.

The pressure is adjusted up or down using the up

and down arrow keys. (See figure 6.) The diastolic

pressure is set by pressing the Menu key a second

time. Adjust the setting up and down with the arrow

up and down keys. (See figure 7.) The heart rate

is set by pressing the Menu key a third time and

adjusting the rate with the arrow up and down keys.

The pulse rate can be set from 0 beats per minute

to 300 beats per minute. (See figure 8.) The palpa-

tion can be set to either on or pulseless. When the

pulseless setting is used, the diastolic and systolic

pressures will automatically be set to 0.

Figure 5

Figure 6

Figure 7

Figure 8

PALPABLE PULSE FEATURE

The Nasco Life/form

Child Blood Pressure

Simulator also incorporates a palpable pulse at the

radial location. (See figure 9.) Palpations can be

felt upon start-up of the unit or after blood pressure

settings have been made. Press the Menu key

repeatedly until “Set PALPATION” menu appears.

“Pulse ON” is defaulted and enables the palpation

feature. The pulse in the wrist will begin when the

electronic box is turned on. During the actual blood

pressure reading, the palpable pulse will turn off

when the cuff is inflated and surpasses the systolic

set point. It will turn on again when the cuff is

deflated 20 mmHg BELOW the diastolic set point.

Pulse Location

Figure 10 Figure 11

Note: The pulse feature is turned off during this time to allow students to clearly hear the Korotkoff

sounds through the stethoscope without interference from the background noise of the pulse feature in

the wrist. The palpable pulse is delicate and should be palpated lightly, as you would with a real

patient. Pressing too hard can damage the pulse feature.

Make sure the cable from the blood pressure arm is properly connected to the electronic box and the

palpation feature is in the “PULSE ON” mode.

A pulseless condition can be simulated by switching your unit to the “pulseless” mode. Press the Menu

key repeatedly until “Set PALPATION” menu appears. By pressing the down arrow at this point, palpa-

tions can be disabled, causing the simulator to be pulseless. When in the “pulseless” mode, all settings

are automatically reset to 0 and all blood pressure sounds are disabled.

The pulseless setting will also turn off the sounds in the arm. The pulse will always be on unless the

pulseless feature is activated or if the systolic or heart rate levels are set to zero. To do this, press the

Menu key four times. The down arrow key will set the pulse to pulseless. Press the arrow up key to turn

the pulse back on. (See figure 10.) Located to the right of the Menu key is the auscultatory Gap key. (See

figure 11.) This key is included to simulate the auscultatory gap that is sometimes present between phase

1 and phase 2 sounds in which no audible sound is noted during this portion of auscultation. This control

function is included so that the trainee can become familiar with this phenomenon. Pressing the Gap

key simply turns the gap function off or on. When the key is pressed, a message will briefly appear that

the auscultatory gap is enabled or disabled. Also the main display will show (at the bottom right of the

display) either AGap:Y (for on) or AGap:N (for off).

The arrow up and down keys also control the volume of the sounds that are present in the arm. From the

main menu, press the up arrow key to increase the volume, press the down arrow key to decrease the vol-

ume. The volume levels can be adjusted from level 1 (the lowest volume) to level 7 (the highest volume).

USING THE NASCO

Life/form®

CHILD BLOOD PRESSURE SIMULATOR

First, verify that the pressure line tubing from the sphygmomanometer and the audio line coming from

the simulated arm assembly are properly connected to the blood pressure simulator unit, as previously

described in the setup procedures. Apply the sphygmomanometer cuff and gauge to the simulated arm

assembly in the usual manner. Apply the stethoscope to the simulated arm, also in the usual manner.

Set the systolic and diastolic controls to the desired levels. Select the auscultatory gap if desired. Finally,

adjust the pulse rate control to the desired setting.

To proceed with the simulated blood pressure measurement, first close the valve on the sphygmoma-

nometer bulb tightly and begin pumping air into the cuff until the gauge reads higher than the preset

systolic level chosen. Once this point is reached, loosen the valve on the bulb slightly to allow the gauge

pressure reading to decrease slowly. While monitoring the arm assembly with the stethoscope, note the

point on the sphygmomanometer gauge when the first Korotkoff sound is heard. This will be the systolic

blood pressure. Allow the pressure in the cuff to continue to decrease until the point at which the last

pulse is heard, noting the reading on the gauge. This is the diastolic blood pressure.

CRiSis™

Figure 9

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