medication/treatment/parameters

[haime]

i have scenario which i want to give muscle relaxan drugs,why no effect with the respiratory rate pamameters.when we give this drugs the RR does not change.any one here can give their experience and pls share it here.what is the reason the rr not chaging.

[Pete Dickens]

Hallo Haime

The community I'm sure would be happy to help you out, but we need a bit more detail.

Which muscle relaxant drugs where you using, and what amount?

Thanks

PETE

[wwilkinson]

Haime
Yes, we would need to know which drug you are giving. All the drugs in the HPS6 software are those drugs which have an immediate impact on the cardiovascular and respiratory status. So if the drug is in the profile, you should see the results of that drug when you administer.

Also, are you using the HPS or ECS platform, and if using the HPS, are you using the drug recognition system?

Thanks
Wendy Jo
Clinical Educator, METI

[haime]

thanks for the reply we are using istan not hps and ecs but i tried also with ecs and hps, i use cisatracurium 50mg just want to know if will effect for the rr but nothing change.the maniqine or the machine died when we give that drug.spont vt is 0 also. aside from that we found new problem after we give this drugs.when you open the instructor workstation with the simulation tab is completely ok but when you connected to istan297 or the machine the heart rate continous going up untill died without manipulating any tabs.and also the scenario doesnt work anymore.

[haime]

more drugs is not incuded in the drug tab.like diuretic which is indicated in most scenario.

[Pete Dickens]

HI Haime,

I *think* I understand some of your issues.

When you apply a neuromuscular block through the software (either by a drug or by fixed neuromuscular blockade) the spontaneous tidal volume will decrease as the intercostal muscles become flaccidly paralysed.

The Respiratory Rate displayed is the one from the physiological model and is linked to hypoxia and hypercapnia. It is not a measure of what the respiratory system is actually doing in this instance, but can be understood to be what the respiratory system would like to be doing

So it's natural that your patients HR climbs as the cardiovascular system works harder to perfuse the organs and tissues with the decrease in oxygen from gaseous exchange, ultimately it is unable to compensate and the patient enters the death spiral

I'm not an expert on iStan but as I understand it, the respiratory system only works "properly" when the patient is attached to the mannikin, which would explain why it appears to be okay when not connected, but dies when it is

Any drugs that are "missing" can be modeled using the Pharmacology Drug Editor

Hope this is some help, I'm only a member of the community so this isn't expert advice, maybe someone from METI can tell me how wrong I am ;)

Good luck

PETE

[haime]

thank you i got your point.i just solved our problem regarding istan parameters its a matter of resetting.anyway the RR problem is still,in any muscle relaxan given should be the RR stop just like the real patient.but my problem we are connected to the maniquine its iether hps,ecs and istan when we give that drugs the px will die and spont vt is 0 but the RR parameters is ramain working which is not normal.

[wwilkinson]

Haime,
The respiratory rate displayed on the Heads up Display (HUD) is determined by the underlying physiological models controlling the patient. For a spontaneously breathing patient, this value should match the observed respiratory rate of the mannequin. A patient with a depressed neuromuscular activity (due to neuromuscular blockers or the Fixed Neuromuscular Blockage) may exhibit a disparity between the observed respiratory rate and the spontanteous respiratory rate displayed on the HUD. For example, a paralyzed patient who begins to desaturate will show an increase in the spontaneous respiratory rate shown on the HUD even though the patient remains apneic. The underlying models recognize the fall in 0oxygen levels and attempt to compensate by "increasing" the patient's respiratory rate. However, the paralyzing agents will block the mannequin's ability to spontaneously breathe.
As the respiratory rate is not displayed on the waveform monitor, the learners would not be seeing the respiratory rate as displayed on the HUD.

[haime]

thanks for the reply,so as matter of fact the the correct RR will not displayed in the HUD.as i check also the tab for respiratory rate factor.the minimum value is 0.10. please comment on this.

[jmcbride]

very interesting topic..our problem is almost related to mr. haime.RR is not given the correct result because it just a programmed. then there is no RR in our waveform display.

i want to ask if it is possible to another panel for RR in the wavefor?or if we can use other cardiac monitor where RR is available. thank you

[haime]

well i dont think if there is a possibilities to add panel in the waveform unless meti will make a program on it.we try also to use other monitor just to check the RR but unfortunately not working.hope we can find good answer to our problem im sure meti will help us.:)

[haime]

most costumer asking me why meti didnt make a program for RR in the waveform,most of the student need to observe the monitor.any meti here can explain what is the reason?

[wwilkinson]

At this time, the software has not been programmed to display the respiratory rate waveform. Even if you connect to another cardiac/respiratory monitor, you will not get the respiratory rate waveform.
This feature is currently being worked on and will be available in the future.

[haime]

thanks at least we can explain to every university and hospital.

[haime]

i have new question hope you can reply on it, regarding the drugs administer we try to administer epinephrine of 1000mcg which 1mg it give too much effec to HR and oher parameters till the become assystole this is not normal for real px.i just want to know how they make the drugs conversion like mcg to mg?