Pathologies - SIMLabHAW/SIMLab-Emergency-Simulator GitHub Wiki
On this page the simulated pathologies are introduced individually by giving a brief overview of the pathologies. The related changes in the ECG, SPO2, and etCO2 are described accordingly. For further information, references are linked.
The ES provides different pathologies which can be simulated when selected by the trainer. This includes asystole, junctional rhythm, ventricular tachycardia, atrial fibrillation, atrioventricular block (AV block 3), and elevation of the ST segment of the ECG (ST elevation). In order to select and apply one of these simulations, the trainer must open the pathology dropdown menu by clicking the currently displayed signal (default: sinus rhythm) in the upper right and select the regarding pathology. As always, the selection must be confirmed by pressing the blue "OK" button. In addition, COPD can be simulated. Regarding the ES training, the immediate treatment of the given pathologies involve high quality CPR and air way management.
Asystole is the most serious form of cardiac arrest. Due to the absence of ventricular contractions both electrically and mechanically, the ECG displays no activity. Therefore, Asystole is also referred to as "flat line". This pathology is a lethal heart arrhythmia which requires immediate actions.
For more information on asystole, follow the links below:
When asystole is selected in the trainer view, the heart rate, SPO2, etCO2, and respiration rate are automatically set to zero as to be seen in the image below. However, even when selecting one of the provided pathologies, the values can still be adjusted manually by using the input fields if necessary.
Junctional rhythm occurs whenever the sinoatrial node does no longer pace the rhythm of the heart and instead the atrioventricular node takes control. This pathology arises if there is a blockage somewhere along the regular pacemaking pathway or the atrioventricular junctional pacemaker exceeds that of the sinus node.
For more information on junctional rhythm, follow the links below:
When junctional rhythm is selected in the trainer view of the ES, the heart rate is automatically set to 40 bpm, the SPO2 value remains at 97 % while etCO2 is decreased to 30 mmHg, and the respiration rate is increased to 18. The non-invasive blood pressure (NIBP) is set to 70/30 mmHg. The diagnose involves a missing P wave in the ECG signal.
Ventricular tachycardia is caused by abnormal electrical signals in the ventricles and results in a heart rhythm disorder. In addition, the ventricles are not in sync with the upper chambers. The heart beats faster than normal and in this case usually exceeds 100 bpm. The symptoms of ventricular tachycardia range from brief elevated heart beat to dizziness, and even loss of consciousness.
For more information on ventricular tachycardia, follow the links below:
When ventricular tachycardia is selected in the trainer view of the ES, the heart rate is automatically increased to 180 bpm, the SPO2 remains constant at 97%, etCO2 is set to 35 mmHg together with an elevated respiration rate of 18. NIBP remains at a healthy value of 120/80 mmHg. The ECG waveform is reduced to broad QRS complexes.
Ventricular fibrillation is a pathology in which the heart quivers instead of pumping. It is caused by irregular and disorganised electrical activity in the ventricles and is a type of cardiac arrhythmia. It results in an accelerated heart beat up to 500bpm followed by cardiac arrest together with loss of consciousness and pulse. When it comes to ventricular fibrillation, the ECG indicates rapid unformed QRS complexes without clear P waves.
For more information on ventricular fibrillation, follow the links below:
When ventricular fibrillation is selected in the trainer view of the ES, the heart rate is automatically set to 250 bpm while the values for SPO2, etCO2, and respiration rate are decreased to zero. However, as the algorithm for peak detection is not fully developed at this point, the simulator detects a heart rate in the demonstrated trainee view every here and there. The ECG wave solely consists of hardly identifiable rapid sequential QRS complexes. NIBP indicates no activity and is therefore set to 0/0 mmHg.
Atrial fibrillation is the most common serious abnormal heart rhythm and is characterized by irregular and often rapid heart beat between 100 -175 bpm. It is caused by an irregular and chaotic activity of the atria. The symptoms are not always obvious and may only occur during short periods of time. The associated ECG waveform indicates no P waves and an abnormal ventricular activity rate.
For more information on atrial fibrillation, follow the links below:
When atrial fibrillation is selected in the trainer view of the ES, the heart rate is automatically increased to 110 bpm while the SPO2 value is decreased to 96%. EtCo2 and respiration rate remain at 36 mmHg and 12 respectively. The associated ECG shows no distinguishable P or T waves. The SPO2 waveform indicates irregular accelerated cycles. NIBP is adjusted to an abnormal value of 100/60 mmHg.
The third degree atrioventricular block (AV block 3), complete heart block, or AV dissociation is a type of heart block where no conduction between atria and ventricles takes place. This causes a complete blockage of the ventricles and may result in a cardiac arrest. The related ECG shows no association between the P waves and the QRS complexes.
For more information on the AV block 3, follow the links below:
When AV block 3 is selected in the trainer view of the ES, the values of the heart beat, SPO2, etCO2, and NIBP remain at the same numbers as for the healthy sinus rhythm. Only the respiration rate is increased to 15. Nevertheless, the ECG shows randomly and independently occurring P waves and QRS complexes as cased by a realistic model. The SPO2 waveform displays slower clocked cycles.
ST elevation is a pathology whereby the ST segment of an ECG is abnormally high above the baseline. The causes vary from myocardial infarction to ventricle paced rhythm.
For more information on ST elevation, follow the links below:
When ST elevation is selected in the trainer view of the ES, all input values remain the same as in a healthy sinus rhythm. Solely the ECG signal changes to a signal with an elevated ST signal.
Chronic pulmonary disease or COPD which complicates the breathing activity. It is a long-term disease which often gets worse over time and is characterised by inflammation and severe limitation of airflow passing through the lungs.
For more information on COPD, follow the links below:
In order to activate the modification of the etCO2 wave according to how it would appear when affected by a COPD, the trainer must switch on the button on the right of the etCO2 input field as demonstrated below. The signal is adapted immediately.
Related pages:
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