RU2693446C1 - Method of training practical skills in providing first aid and auscultation by means of a medical simulator - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine and can be used to develop practical skills in providing first aid and diagnosing disorders of internal organs by listening to sound phenomena of the lungs, heart, stomach, intestine and vessels. Method is implemented by means of a medical simulator containing a module of the patient's simulator in the form of a human mannequin, consisting in using a defibrillator-monitor including at least two outputs to metal electrodes of the defibrillator and one input for electric signals of electrocardiography. Auscultation modulus is used, including a stethoscope, a permanent magnet and voice coils, and simulating sound signals of internal organs. Human mannequin is used, including a cardiopulmonary resuscitation system, a defibrillation simulation system, an electrocardiography imaging system, a thoracic decompression imaging system, a system for simulating the drainage of the pleural cavity, a system for simulating the trachea intubation and conicotomy, a system for simulating the administration of drugs, a system for simulating bleeding and a system for simulating catheterization of the bladder. Preliminary into the mannequin embedded sound coils interacting with a permanent magnet, mounted on the membrane of the acoustic head of the stethoscope, and contactless devices providing identification of location of two metal electrodes of defibrillator with installed straps and four modules for electrocardiography electrodes imaging. Depending on used training scenario, sound and video signals of internal organs functioning are simulated, physical effects on mannequin for resuscitation or medical procedures are performed by means of exposure on the above systems. Physical effects on the simulating systems mentioned above, or their absence are detected. Pulse energy is measured to measure the electric discharge effect on the defibrillator electrodes through the load adapter unit. Data on exposures are transmitted to a computer for processing and simulating audio and video signals, and their transmission, respectively, to a system of voice coils for reproduction through the acoustic head of the stethoscope and to the control unit of the electrocardiography imaging system for reproduction through the defibrillator monitor depending on the physical actions on the said mannequin.

EFFECT: technical result consists in training skills in first aid and diagnosing disorders of internal organs.

1 cl, 5 dwg

Description

The invention relates to the field of medicine and can be used in simulators of the patient, as well as in medical simulators for practicing practical skills in first aid and diagnosis of disorders of internal organs by listening to the sound phenomena of the lungs, heart, stomach, intestines and blood vessels (blood flow to arteries and veins).

The analogue is a surgical operating simulator, which includes a patient simulator module, which allows you to simulate the reaction (condition) of the operated patient depending on the chosen scenario, medical history, actions taken by the medical team. The patient simulator module is made in the form of a human dummy equipped with systems for simulating signs of human life, systems for resuscitation, such as cardiopulmonary resuscitation (CPR), intubation, artificial respiration (ALV), medicine entry system, defibrillation, and systems that imitate urination, hemorrhage, tears, sweat, hyperemia, convulsions (RU patent No. 2546404, IPC G09B 23/28 (2006.01)). However, this simulator does not present the learning process for practicing auscultation practical skills. There is no technical implementation of the method of operation of the system simulation module for electrocardiography, defibrillation and auscultation.

The prototype is a device for training auscultation and related methods, which is a system of auscultation, which includes a dummy having at least one built-in speaker, a contactless device built into the dummy and capable of detecting the proximity of the auscultation device, a controller capable of interacting with a contactless device and receive a signal, the second controller, designed to override the first controller and a database that stores many sound files (patent U S 9064428 (B2), CPC G09B 23/28 (2013.01)). However, this device does not allow to simulate the reaction (state) of the dummy (patient simulator) depending on the actions taken by the doctor, that is, the feedback is not implemented. “The doctor's action is the response of the patient simulator module — simulation of audio and video signals of the functioning of internal organs, respectively into the auscultation device and the standard defibrillator monitor device. "

The objective of the claimed invention is to develop ways to work modules imitation systems for defibrillation, electrocardiography and auscultation as part of a medical simulator for the comprehensive training of doctors to diagnose disorders of human internal organs and first aid in various clinical situations. In addition, an important task posed in the development of the claimed method of operation is to combine the methods of operation of modules for simulating systems for defibrillation, electrocardiography and auscultation with standard medical devices.

The technical result is the creation of a medical simulator that provides modeling of sound and video signals of the functioning of the internal organs of a human dummy, depending on the physical effects exerted on this dummy during resuscitation or medical procedures.

The technical result is achieved by the method of practicing practical skills in first aid and auscultation using a medical simulator, including a patient simulator module in the form of a human dummy, which consists in using a standard defibrillator monitor that includes at least two outputs on standard metal defibrillator electrodes and one input for electric electrocardiography signals, as well as using the auscultation simulation module, including a standard stethoscope, a permanent magnet and voice coils, and simulate sound signals for the functioning of internal organs, according to the present invention, use a human dummy, including a cardiopulmonary imitation system, a defibrillation imitation system, an electrocardiography imitation system, a chest decompression imitation system, a pleural cavity drainage system , imitation system for tracheal intubation and conicotomy, imitation system for drug injection, imitation system for bleeding and their system Bladder catheterization, previously inserted into the dummy, are embedded voice coils interacting with a permanent magnet mounted on the membrane of the acoustic head of the stethoscope and contactless devices that identify the location of two metal defibrillator electrodes with installed pads and four electrocardiography imitation electrodes, depending on the scenario training simulate sound and video signals of the functioning of internal organs, os There are physical effects on a human dummy for resuscitation or medical procedures by affecting these systems, recording physical effects or their absence on the above-mentioned imitation systems, measuring the pulse energy of an electrical discharge at the defibrillator electrodes through the load adapter; in a computer for processing, and carry out modeling of audio and video signals, and transmit them, respectively, in the system at the voice coils for playback through the acoustic stethoscope head and electrocardiography simulation control unit for playback through a standard defibrillator monitor depending on physical influences rendered to said dummy.

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

The invention is illustrated by drawings (Fig. 1 and 2), which presents a medical simulator for practicing practical skills in first aid and auscultation, having a patient simulator module (respectively, front and back view), auscultation simulation module, defibrillation imitation system and electrocardiography.

FIG. 3 shows a general view of a patient simulator module with specifically defined areas of physical exposure over a man's dummy.

FIG. 4 shows a general scheme for implementing a system for simulating defibrillation and electrocardiography on a patient simulator module.

FIG. 5 is a block diagram of the auscultation simulation module.

FIG. 1-5 digits are indicated:

1 - medical simulator,

2 - patient simulator module,

3 - module simulate auscultation,

4 - defibrillation imitation system,

5 - electrocardiography imitation system,

6 - computer (server)

7 - standard (traditional) stethoscope,

8 - voice coil (electromagnet),

9 - mannequin of the patient simulator module,

10 - the subject (doctor) of the interaction,

11 - system for simulating cardiopulmonary resuscitation,

12 - system for simulating chest decompression,

13 is a system for simulating the procedure for drainage of the pleural cavity,

14 - system for simulating tracheal intubation and conicotomy,

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

16 - system imitation bleeding,

17 is a system for simulating bladder catheterization,

18 - contactless device system imitation of defibrillation,

19 - contactless device system imitation of electrocardiography,

20 - standard defibrillator monitor,

21 - standard metal electrodes of a defibrillator,

22 - pads (pads) on the metal electrodes of the defibrillator,

23 - block adapter load system imitation defibrillation,

24 is a module for imitation of electrocardiography electrodes,

25 - splitter

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

27 - pulse oximetry simulation module,

28 - acoustic head of a stethoscope,

29 - the case of the acoustic head of the stethoscope,

30 - membrane acoustic head of a stethoscope,

31 - permanent magnet (neodymium magnet),

32 - cover the acoustic head of the stethoscope,

33 — Silicone skin of a human dummy

34 - contact leads winding of the voice coil (electromagnet).

Medical simulator 1 contains: patient simulator module 2, defibrillation imitation system 4 and electrocardiography 5 connected to computer 6, and auscultation imitation module 3. Auscultation simulation module 3 includes a standard stethoscope 7, a permanent magnet 31 mounted on an acoustic head membrane 30 28 stethoscope 7 and voice coils 8 mounted on the body of the dummy 9 of the patient simulator module 2 with which the subject 10 interacts. The voice coils 8 are located on the front and back of the body of the module dummy 9 and 2 itatora patient.

The patient simulator module 2 contains: a system for simulating cardiopulmonary resuscitation 11, a system for simulating chest decompression 12, a system for simulating the drainage procedure of the pleural cavity 13, a system for simulating tracheal intubation and conicotomy 14, a system for simulating drug injection (intravenous, intramuscular, intrasternal) 15 , a bleeding imitation system 16, a bladder catheter imitation system 17, and a positioning system of contactless devices 18 and 19, respectively, for interacting with imitation systems of defibril 4 and electrocardiography 5.

The systems of imitation of defibrillation 4 and electrocardiography 5 are connected to a standard defibrillator-monitor 20, which is characterized by the presence of at least two outputs to standard metal electrodes 21 of the defibrillator and one input for electrical signals of electrocardiography. The imitation system of defibrillation 4 is characterized by the presence of two pads (pads) 22, which are connected (attached) to standard electrodes 21 for discharge of electrical discharges to the load adapter unit 23. The imitation system of electrocardiography 5 is characterized by the presence of four modules of imitation electrodes 24, which by means of a splitter 25 are connected to the control unit 26, and one pulse oximetry simulation module 27, which is also connected to the control unit 26.

A standard stethoscope 7 contains: an acoustic head 28 made of a housing 29, a membrane 30 and a fixing cap 32.

Practicing practical skills in first aid and auscultation using a medical simulator is as follows.

A method of practicing practical skills in first aid and auscultation using a medical simulator 1, including a patient simulator module 2 in the form of a human dummy 9, which consists in using a standard defibrillator monitor 20 that includes at least two outputs on standard metal electrodes 21 a defibrillator and one input for electrical signals of electrocardiography, as well as use the auscultation simulation module 3, which includes a standard stethoscope 7, a permanent magnet 31 and sound catu ki 8 and sound signals simulate the functioning of internal organs.

The difference of the proposed method of practicing practical skills in first aid and auscultation is that they use a human dummy 9, including a system for simulating cardiopulmonary resuscitation 11, a system for simulating defibrillation 4, a system for simulating electrocardiography 5, a system for simulating chest decompression 12, a system for simulating procedures for the drainage of the pleural cavity 13, a system for simulating tracheal intubation and conicotomy 14, a system for simulating the administration of drugs 15, a system for simulating bleeding 16 and the system The subject of imitation of bladder catheterization 17, previously inserted into the aforementioned dummy 9, are embedded voice coils 8 interacting with a permanent magnet 31 mounted on the membrane 30 of the acoustic head 28 of the stethoscope 7, and contactless devices 18, and 19, which identify the location of two metal electrodes 21 of the defibrillator 20 with installed plates 22 and four electrocardiography electrode imitation modules 5, depending on the learning scenario used, simulate audio and video signals of the function internal organs, carry out physical effects on the human dummy 9 for resuscitation or medical procedures by affecting the above systems, record the physical effects or their absence on the above-mentioned imitation systems, measure the pulse energy of the electrical discharge at the electrodes 21 of the defibrillator 20 through the unit adapter 23, the impact data is transmitted to the computer 6 for processing, and carry out modeling of audio and video signals, and transmitting them, respectively, to the system of voice coils 8 for reproduction through the acoustic head 28 of the stethoscope 7 and to the control unit 26 of the electrocardiography simulation system 5 for reproduction through a standard defibrillator monitor 20, depending on the physical effects on the said dummy.

An example of a specific implementation.

Practicing practical skills in first aid and auscultation is carried out on the patient simulator module 2, which is made in the form of a human dummy of 9 people with an anatomically correct musculoskeletal structure (height - 183 cm, weight 70 kg, age 40-50 years). The patient simulator module 2 is primarily intended for simulating the widest possible range of clinical situations and practicing skills in performing cardiopulmonary resuscitation, conducting intensive therapy and a set of measures aimed at maintaining vital activity.

The work of the patient simulator module 2 is carried out using the computer program algorithm 6, which ensures the operation of all systems of imitation of vital signs on the dummy 9, depending on the scenario used. For example, when simulating cardiac complications on a dummy 9, an imitation of the corresponding clinical picture takes place — a change in blood pressure, heart rate, and pulsation power. When simulating respiratory complications, there is a change in the frequency of respiratory movements, the appearance of cyanosis, loss of consciousness, voice, and various rales. Also, when simulating injuries to the head, torso and extremities, various physiological reactions take place: no pupillary reaction, an auscultatory picture on the left or on the right, a drop in pressure during blood loss, and convulsions.

Infrared LEDs 18 and 19 are installed on the patient simulator module 2 to perform wireless interaction and determine the correct positioning of the two metal electrodes 21 of the defibrillator, respectively, with the pads 22 installed and the four electrocardiography electrode imitation modules 24. At the same time, 36 kHz infrared receivers (the frequency of the pulses of infrared radiation that the internal demodulator filters out) of the TSOP 2136 type for receiving infrared signals are installed on the pads 22 themselves and on the electrode simulators 24. Moreover, contactless devices such as infrared LEDs 18 and 19 are located at a certain depth of the body of the dummy 9, which is covered with a layer of silicone 33 (thickness 4 mm), a material that simulates human skin.

The systems of imitation of defibrillation 4 and electrocardiography 5 consist of two separately taken blocks 23 and 26, respectively, connected to a standard DKI-N-11 “AXION” type defibrillator-monitor 20 with the function of automatic defibrillation, intended for acute and chronic resuscitation and electropulse therapy of acute and chronic heart rhythm disorders, determination of hemoglobin blood oxygenation and blood pressure, as well as for external, transesophageal, endocardial pacing. The defibrillator monitor like DKI-N-11 "AKSION" is used in medical hospitals, cardiological clinics, for equipment of teams of emergency and emergency medical care.

Blocks 23 and 26 are supplied with Wi-Fi modules of the ESP8266 type for receiving and transmitting information through the server 6. For example, the load adapter unit 23 measures the impulse impact energy of the discharge in J and transmits this information to the server 6. At the same time, the discharge of electrical discharges from metal defibrillator electrodes 21 and measurement of pulse discharge energy by means of an electronic board (not shown in FIG.) of unit 23, where an electrical discharge flows through a block of resistors with a nominal power dissipation heat from 0.25 W to 50 W and is measured by means of an integrated circuit of a current collector with a Hall effect type ACS711 (measures bi-directional current up to 25A) controlled by a microcontroller type STM32F405RGT6 (ARM Cortex-M4 core, 32-bit, FLASH 1 MB, RAM 192 Kbytes). For example, the control unit 26 receives information from the server 6 about the simulated video signal, which is converted into several electrical signals with constantly changing voltage, which are subsequently reproduced on the screens of the standard DKI-11 AXION 11 AXION monitor in the form of curves that represent the current heart rate, respiratory rate, systolic and diastolic blood pressure, and saturation (SpO ₂ ). Moreover, to obtain an electrical signal with a constantly changing voltage on the electronic board (not shown in Fig.), The control unit 26 has several blocks of resistors through which electrical signals flow under the control of an STM32F405RGT6 microcontroller (ARM Cortex-M4 core, 32-bit, FLASH 1) MB, RAM 192 KB). In this case, the pulse oximetry simulation module 27 performs the function of recognizing (identifying) the presence or absence of fixation on one of the fingers of a human dummy 9. In the absence of fixation of the pulse oximetry simulation module 27 on one of the fingers of a human dummy 9, the saturation line curve does not reproduce blood oxygen) on the screens of a standard defibrillator monitor 20.

The method of operation of the module simulate auscultation 3 is as follows. Depending on the practical skills development scenarios on the patient simulator 2 module on a computer (server) 6, certain sound signals are simulated for each voice coil 8 that functions as an electromagnet. Voice coils 8 (diameter 38 mm) are rigidly (stationary) mounted on the body of the dummy 9 under a layer of silicone 33. The sound signal supplied to the contact pins 34 of the winding of the voice coil 8 is an alternating electric current where In the coil 8, a change in the magnetic flux in magnitude and direction occurs. To reproduce sound signals through the acoustic head 28 of a standard stethoscope 7, a permanent magnet 31 of a neodymium magnet type 31 is used, which is fixed (fixedly) centrally on the membrane 30 of the acoustic head 28 from the outer or inner side. At the same time, the overall dimensions of the neodymium magnet (diameter 6 mm, height 3 mm) are several times smaller than the dimensions of the membrane 30 itself (diameter 42 mm), which is made of a flexible material. Thus, the interaction of the electromagnetic field of the voice coil 8 with the magnetic field of the neodymium magnet 31 causes the mechanical oscillation of the magnet 31 to the beat with the frequency of the alternating current, which is transmitted to the flexible membrane 30, creating acoustic waves (sounds) that can be heard by the doctor 10 through the stethoscope 7. A similar principle of reproduction of sound signals is used in traditional sound loudspeakers (loudspeakers), except for the fact that in them the sound itself is subjected to mechanical oscillation. lug rigidly connected to the flexible diffuser. The main difference of the proposed solution is that the voice coil 8 and the permanent magnet 31 are separated from each other at a certain distance and their magnetic fields can interact with each other at a distance of up to 100 mm (experimental data), which allows you to install voice coils 8 on the dummy’s body 9 at a certain depth.

Further modeling (change) of sound signals occurs depending on the actions or omissions of the subject (doctor) 10 over the dummy 9, that is, any medical procedures are carried out on the dummy 9 by the subject (doctor) 10.

The actions or omissions of the subject (doctor) 10 are as follows. Any manipulations on a dummy 9: performing cardiopulmonary resuscitation on an imitation system 11, exerting an electric discharge using a real defibrillator 21 on an imitation system 4, administering drugs using special syringes on an imitation system 15, performing intubation, artificial respiration and conicotomy using endotracheal tubes, LMA, Combitube and other devices on the imitation system 14, carrying out decompression of the chest with intense pneumothorax on the imitation system 12, conducting pr procedures for the drainage of the pleural cavity on the imitation system 13, applying a tourniquet for bleeding on the imitation system 16 and performing catheterization of the bladder on the imitation system 17 are fixed by sensors of the position of the mechanisms of the patient simulator module 2, the data of which is transmitted and processed by the computer 6 and reflected on the state of the simulator patient 2, while simulating audio and video signals about the state of patient 2, which are sent, respectively, to the system of voice coils 8 and the control unit 26 of the system imitation electrocardiography 5. For example, the result of feedback when properly performing cardiopulmonary resuscitation on the simulation system 11 is the stabilization of the patient simulator module 2, namely the restoration of breathing (respiratory rate) and heart rate (heart rate), heart rate palpation, automatic the blinking and reaction of pupils to light, which can be visually observed on the module itself of the patient simulator 2 and on the standard defibrillator-monitor 20, as well as hearing the sound phenomena of internal organs using a standard stethoscope 7. However, improper actions or inaction of the subject (physician) 10 can lead to abnormal situations and simulate various audio and video signals, respectively, for the voice coil system 8 and the electrocardiography simulation system 5 depending on the scenario used .

The wrong actions of the subject (doctor) 10 may be as follows. When you enter the drug on the imitation system 15, which causes an allergic reaction, an algorithm for simulating anaphylactic shock is launched. Signs of anaphylaxis: tachycardia, tachypnea, low blood pressure. Breaks in the heart massage on the imitation system 11 or the total absence of resuscitation between the discharges of the defibrillator 21, the application of a low or too high voltage discharge on the imitation system 4, the discharge on the background of small-wave fibrillation without carrying out measures that increase myocardial energy resources can lead to imitation of death on the module patient simulator 2.

In this way, the subject (doctor) 10 is fully immersed in the learning process due to visual, auditory and tactile perception, where changes in sound and video signals occur in real time and are directly dependent on the physical influences exerted on the dummy 9 by the subject (doctor) 10 during resuscitation or medical procedures.

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

The use of the proposed medical simulator 1 allows, in comparison with the prototype, to conduct joint work of doctors both in providing first aid and in conducting auscultation, as well as to increase the practical skills of doctors in diagnosing a person’s condition in various clinical situations by working out practical skills in auscultation during reanimation measures or medical procedures on the patient simulator module 2. At the same time, realistic training of doctors iju first aid and diagnosis of the human condition by combining the methods of the modules for simulation of defibrillation systems 4, 5 and electrocardiography auscultation 3 with standard medical devices, such as a standard defibrillator and monitor 20 standard stethoscope 7.

Claims (1)

A method of practicing practical skills in first aid and auscultation using a medical simulator that includes a patient simulator module in the form of a human dummy, consisting in using a defibrillator monitor that includes at least two outputs to metal electrodes of the defibrillator and one input for electrical signals electrocardiography, as well as using the auscultation imitation module, which includes a stethoscope, permanent magnet and voice coils, and simulate the sound signals of internal organs, characterized in that they use a human dummy, including a system for simulating cardiopulmonary resuscitation, a system for simulating defibrillation, a system for simulating electrocardiography, a system for simulating chest decompression, a system for simulating the drainage of the pleural cavity, a system for simulating tracheal intubation and conicotomy, and a system for simulating drug injection, bleeding imitation system and bladder catheterization imitation system, sounds are pre-inserted into the mentioned dummy e coils interacting with a permanent magnet mounted on the membrane of the acoustic head of a stethoscope and contactless devices that identify the location of two metal defibrillator electrodes with pads installed and four electrocardiography imitation electrodes, simulate audio and video signals of the functioning of internal organs, depending on the learning scenario used , carry out physical effects on the man's dummy for resuscitation measures They influence the physical effects or their absence on the above-mentioned imitation systems, measure the pulse energy of the electrical discharge on the defibrillator electrodes through the load adapter block, transfer the data on the effects to the computer for processing, and perform sound simulations. and video signals, and transmitting them, respectively, to the voice coil system for playback through the acoustic head of the stethoscope and to the control unit detecting ECG simulation system for playback via a defibrillator-monitor, depending on the material impact on the mentioned dummy.

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