CodeCritical Walkthrough

Copyright Femtosim Clinical Inc.  2011

Last edited: July 2, 2011

This walkthrough explains how to beat each mission.

"Prologue: Medical Pavilion"

This sets the stage for the game.

"Introduction:  Meet Your Big Boss"

                Just read this.  This is just some more setting of the stage.

"Mission 1:  Need Some Help Over Here"

                Ok we have to do a couple of things here.  Click on the “connect ecg electrodes and cable” button on the Patient to equipment connections window.  This will give us the ECG.  Next, click on the “Admit/Discharge” tab on the monitor.  Enter the patients name in the top field and then click on the “Admit Patient/Update Data button.

"Mission 2:  One Dozen Please"

                To view 12 a lead display, click on the “Display Tab” on the monitor.   On the “Wave Order” tab, check the “Display all 12 ECG leads” tab.  Then click the apply button.  Click on the “Waveforms” tab to see the result.

"Mission 3:  Microchip Medicine"

                Ok you have 1 minute to hook up the AED and apply a first shock.   If you don’t make it in time, you can retry the mission.  You will see Vfib on the monitor with the alarm sounding.  First, turn on the AED.   Follow the instructions on the AED, next click on the “Attach defibrillator/pacing pads” button on the Patient to Equipment Connections window.  Wait for the AED to tell you to push the Shock button in the center of the AED.  Once this is clicked before the timer runs out you will have completed the mission. 

"Coffee Break 1"

"Mission 4:  The Pressure is On"

                OK we have to set up intracranial pressure monitoring.  There’s a bit of work with this mission.  On the Patient to Equipment Connections window, connect Inv. Pressure 1 as intracranial, and Inv. Pressure 2 as Arterial.  Click on the monitors Zero tab and then click on Zero P1 and Zero P2.  Then click on the monitors Display tab.  Click on the IBP sub-tab.  Select Intracranial for the P1 label and Arterial for the P2 label.  Select the “Activate Common Scale” checkbox.  Click on the tabs’ Apply button.   You’ll see the CPP pressure on the monitor.  We need to view the pressures with different colors to finish the mission:  Click on the monitors display tab and then click on the “Appear.” sub tab.  Click on P1 and select a different color than P2 then click on the Apply button. 

"Mission 5:  Blow Hard"  

                This one is easy.  We just need to zero the End-tidal CO2 monitoring:  Click on the monitors’ Zero tab, and then click on the Zero ETCO2 Sensor button. 

"Mission 6:  Set Me Up"

OK we have some work to do.  On the Patient to Equipment Connections window, connect Inv. Pressure 1 as Arterial, and Inv. Pressure 2 as Femoral,  click the “connect ECG electrodes and cable” button and the “Attach SpO2 sensor” button.  Click on the monitors Zero tab and then click on Zero P1 and Zero P2.  Then click on the monitors Display tab.  Click on the IBP sub-tab.  Select Arterial for the P1 label and Femoral for the P2 label. Click on the Apply button.  Click on the SpO2 sub-tab and check the “activate Non-waveform display” checkbox.  Click on the Apply button.  Select the Wave Order sub-tab.   Select the required waveforms: P1, P2, resp, ECG II, ECG V5, and ECG aVR.  Click on the Apply button.

"Coffee Break 2"

"Mission 7:  You’re Too Demanding"

                This mission is slightly advanced in that we have to set up the pacing function on the defibrillator.  Click on the “Attach defibrillator/pacing pads” button on the Patient to Equipment Connections window.   Turn the defibrillator on.  You should see the ECG.   If you observe the ECG, you will see a skipped beat every 7 or so beats.  The pacemaker will fill in for the skipped beats.  Select the Pacemaker tab on the defibrillator.  Set the rate to 65 ppm.   Make sure “Demand” is selected.  Now move the output slider to the right until capture is achieved resulting in mission success.  

"Mission 8:  Nice Curve"

                Here we must do a cardiac output measurement.  Click on the “Insert Swan-Ganz Catheter” button on the Patient to Equipment Connections window.   Select the Cardiac Output tab on the Patient Monitor.   Select the Model Y-7.5 catheter, the 0-5 water bath, and the 5 ml injectate volume on this tab.  Note the Computation constant automatically adjusts to 0.256.  Click the Inject button and wait for the measurement to finish resulting in mission success. 

"Mission 9:  Watch your P's and Q's"

                Ok watch the patient monitor for a while and note the sudden onset of atrial fibrillation.  Click the “Attach defibrillator/pacing pads” button on the Patient to Equipment Connections window.   Turn the defibrillator on.  You should see the ECG on the defib now.  Check the synchronized cardioversion box on the Defibrillator tab of the defibrillator.  Move the energy selection slider to more than 200 J and click the charge button.   Once the defib is charged and ready, click the shock button.  You should see a normal ECG resulting in mission success.  

"Coffee Break 3"

"Mission 10:  Tiny Sparks"

This mission is slightly advanced in that we have to set up the pacing function on the dual chamber pacemaker.  If you observe the ECG, you will see a skipped beat every 7 or so beats.   The p wave is present but the QRS complex and T wave are missing.  This implies that we need to apply ventricular pacing only.  Click on the “Insert Pacing Leads” button on the Patient to Equipment Connections window.   Turn the pacemaker on.  Click on the Display tab of the patient monitor.  Select the ECG/Pace sub-tab.  Check the “Pace Detect Activated” checkbox.  Click the Apply button.  Select the Waveforms tab again to see the ECG.  You will see the pacing spikes overlaid on the ECG.  Click on the Atrial Output label on the pacemaker.  Move the slider to the left to deactivate atrial output.  Click on the base rate.  Move the slider to 65 so that inserted beats will only fall in the missing beat area.   Select Vent. Sensitivity on the pacemaker.  Increase the sensitivity by moving the slider to the right until pacing spikes only occur in the missed beat area.  Now select the Vent. Output on the pacemaker and move the output slider to the right until capture is achieved resulting in mission success.  

"Mission 11:  Fine Tuning"

Ok we just have to do some setup.  On the Patient to Equipment Connections window,  click on the connect ECG electrodes and cable button and the Apply NIBP Cuff button.  Click on the NIBP tab of the patient monitor.  Click on the Activate Periodic NIBP checkbox.  Insure that the repetition interval is set to 5.  Click on the Alarms tab of the Patient monitor.  Click on the initiate learning or re-learning button.  Note the top right of the monitor will show Arrh. Detect. Ready after a few seconds.  Click on the ST sub-tab.  Click on the Establish or Re-establish an ST reference.  This will activate the ST analysis and complete the mission. 

"Mission 12:  Depression Watch"

Ok we just have to do some setup again.  On the Patient to Equipment Connections window,  click on the connect ECG electrodes and cable.  Click on the Alarms tab of the Patient monitor.  Click on the initiate learning or re-learning button.  Note the top right of the monitor will show Arrh. Detect. Ready after a few seconds.  Click on the ST sub-tab.  Click on the Establish or Re-establish an ST reference.  This will activate the ST analysis.  Click on the Monitors Trend tab.  In the trace selection area, select leads II, avr and v5 in that order from top to bottom to complete the mission. 

"Coffee Break 4"

"Mission 13:  The Runs"

Ok we have to set up alarms appropriately.  On the Patient to Equipment Connections window,  click on the connect ECG electrodes and cable.  Click on the Alarms tab of the Patient monitor.  Click on the initiate learning or re-learning button.  Note the top right of the monitor will show Arrh. Detect. Ready after a few seconds.  Observe the ECG for about a minute.  Note there is a recurring run of about 5 vpcs.  Note also the VPCs/Min display on the right by the heart rate indicator.    Eventually it will settle to be around 41 or 43.  Select the alarms tab and the VPC sub-tab.  Set the VPCs/Min alarm limit to 45.  Set the VPCs in a Row (Run) to 7.  Click on the apply button to complete the mission.

"Mission 14:  Oops Flatline"

Ok this mission is a bit far-fetched.  This mission is slightly advanced in that we have to set up the pacing function on the dual chamber pacemaker.  Click on the “Insert Pacing Leads” button on the Patient to Equipment Connections window.   Turn the pacemaker on.  Click on the Display tab of the patient monitor.  Select the ECG/Pace sub-tab.  Check the “Pace Detect Activated” checkbox.  Click the Apply button.  Select the Waveforms tab again to see the ECG.  You will see the pacing spikes overlaid on the flat line.  Click on the Atrial Output label on the pacemaker.  Move the slider to the right until p waves appear.  Now select the Vent. Output on the pacemaker and move the output slider to the right until ventricular capture is achieved resulting in mission success.  

"Mission 15:  Back From the Abyss"

Ok another far-fetched mission involving flatline.  This time we will use the crash cart defib.  Click on the “Attach defibrillator/pacing pads” button on the Patient to Equipment Connections window.   Turn the defibrillator on.  You should see the flatline  ECG.  Select 300 J and charge the defib.  Press the shock button once charging is finished.  A more normal ECG should appear.  If you observe the ECG, you will see a skipped beat every 7 or so beats.  The pacemaker will fill in for the skipped beats.  Select the Pacemaker tab on the pacemaker.  Set the rate to 65 ppm.   Make sure “Demand” is selected.  Now move the output slider until capture is achieved resulting in mission success.  

"Endlude:  Thank You"