Gen2 Patients

Last modified by Stephen Monette on 2024/03/01 21:40

Gen2 Patients are the equivalent of a digital high-fidelity manikin.

Every Gen2 Patient combines many requested features and interactions of Acadicus’s previous single-purpose patient characters into a single character. Nine Simulation Manager tabs provide a range of facilitator controls, and the more than 30 sockets plus optional learner control panel give learners many ways to interact with this patient.

The shared content library contains 11 Gen2 Patients, representing a range of patient appearances, and more patients are being added every few months.

Simulation Manager Settings

The Simulation Manager functionality is broken up into nine distinct tabs, which are detailed in the following subsections. The tabs are arranged at the top of the Simulation Manager panel as shown below.

Simulation Manager Tab - Vitals

The appearance of this tab as well as the vitals value ranges match those in existing patients (depicted below). Whenever a vital value is changed, the socketed (or linked) vitals monitor as well as any other socketed vitals monitoring equipment with an appropriate display all receive updated values. Additionally, the Respiratory Rate value controls the speed of the breathing animation.

Simulation Manager Tab - Animation

This tab is intended to be a quick access for controlling the patient’s animations while running a scenario.

Animation Status
Item	State	Description
Talking	Yes	Talking controls whether the mouth is moving. While conscious, Talking also influences their general idle animation (see General Idle Animation Combos table below)
Talking	No
Emotion	Neutral	The Emotion value controls the patient’s expression. While conscious, Emotion also influences their general idle animation (see General Idle Animation Combos table below)
	Happy
	Sad
	Angry
	Pained
	Nauseous
	Worried
	Confused
Head Gesture	Nod	Triggers a set of three quick nods
Head Gesture	Shake	Triggers a set of two quick head shakes
Arm Gesture	Shrug	Triggers a shrug of the shoulders
Arm Gesture	Push away	Triggers an animation of both arms pushing away in a motion expressing “No” or “Stop”
Head Pose	Left	The head generally faces this direction, but it may move around a little bit as part of the general idle animation.
	Center
	Right
Body Position	Fowler’s 30	The Body Position controls the patient's overall pose. When the bed is socketed to the patient, this will also control the pose of the bed. The “leaning forward” poses put the patient into a tripod pose.
	Fowler’s 45
	Fowler’s 90
	Fowler’s Leaning Forward
	Sitting (Bed Edge)
	Sitting (Chair)
	Sitting Leaning Forward (Chair)
	Supine
	Lateral Recumbent (Right)
	Lateral Recumbent (Left)
	Prone
	Sims’
	Standing
	Fallen

The following table details which general idle animation should be currently playing based on the combined values of Talking and Emotion. A description of each animation is provided below the table. Each animation will include the motions described in All in addition to its own specific movements.

General Idle Animation Combos
	Not Talking	Talking
Neutral	Basic	Basic Talking
Happy	Basic	Basic Talking
Sad	Basic	Basic Talking
Angry	Agitated	Agitated Talking
Nauseous	Unwell	Unwell
Worried	Agitated	Agitated Talking
Confused	Basic	Basic Talking

All: There is occasional blinking, eye movement, and head movement. The chest motion for breathing matches the rate of the RR vital value.
Basic: Hands rest at the patient’s sides. There is occasional fidgeting such as light hand tapping or scratching an arm or face.
Basic Talking: Hands and arms make occasional talking gestures.
Agitated: Hands are mostly resting at the patient’s sides. However, there is frequent impatient fidgeting, such as hand tapping or crossing the arms for a few seconds.
Agitated Talking: Arms are mostly kept crossed, but hands and arms make frequent talking gestures.
Unwell: Hands rest on the patient’s abdomen.
Drowsy: Same as Basic but with less extreme and less frequent idle movements

Simulation Manager Tab - General Apparel and Equipment

This tab controls a couple items relating to what the patient is currently wearing.

General Apparel and Equipment
Item	State	Notes
Clothing	Street Clothes	Several different clothing options that can work in any of the previously described animations and poses. The Dirtied Street Clothes state includes dirtied skin and disheveled hair, and the Unclothed state includes underwear.
	Dirtied Street Clothes
	Patient Gown
	Unclothed
Partial Gown	Top uncovered	While wearing the gown, the patient can be partially uncovered.
	Bottom uncovered
	Not Partial
Blanket	On	White blanket, covering feet to waist
	Off
Hospital Bed	On	The hospital bed can be optionally hidden
	Off

Simulation Manager Tab - Circulatory

Circulatory settings include heart sound options for auscultation as well as pulse strength options. There is a toggle for each section to control whether or not its interactions are currently active.

The Heart Sounds section controls what sound is heard by the user when the stethoscope diaphragm is placed within any of the heart auscultation sockets on the patient. The image below demonstrates how these controls appear in the Simulation Manager panel. Clicking on the button next to a socket location cycles through the possible sounds: Normal, Atrial Fibrillation, Murmur, S3, S4.

The Pulses section controls what information is displayed when the specified pulse locations are interacted with. To interact with a pulse location, a user places a hand at the location on the patient and clicks the front trigger of their controller. A small UI panel appears at that location to inform the user how strong the pulse is. It has the text “Pulse Strength: X”, where X is the value chosen in the Simulation Manager. After three seconds, the panel disappears. The image below demonstrates how these controls appear in the Simulation Manager panel. Clicking on the button next to a pulse location in the Simulation Manager cycles through the possible strength levels, which are as follows: 0, 1+, 2+, 3+, and 4+ (where the default is 2+).

The Capillary Refill section controls what information is displayed when the specified capillary refill locations are interacted with (thumbs and large toes). To interact with a capillary refill location, a user places a hand at the location on the patient and clicks the front trigger of their controller. A small UI panel appears at that location to inform the user how long the refill takes. It has the text “Capillary Refill Time: X”, where X is the value chosen in the Simulation Manager. After three seconds, the panel disappears. The image below demonstrates how these controls appear in the Simulation Manager panel. Clicking on the button next to a location in the Simulation Manager cycles through the possible times, which are as follows: 1, 3, and 5 (where the default is 1).

Simulation Manager Tab - Respiratory

The Respiratory tab includes options for setting nose discharge as well as continuous or one-time coughing. It also allows the selection of lung sound options for auscultation.

The table below details the patient appearance and animations that can be set or triggered.

Respiratory
Item	State	Notes
Cough (Single)	Nonproductive	Single coughing animation, with sound. The patient raises a partially closed hand to cover their mouth.
	Productive - Clear	Single coughing animation, with sound. The patient pulls out a tissue which they cough into before placing it on their lap. Afterwards, clearish fluid is visible on the tissue.
	Productive - Yellow	Single coughing animation, with sound. The patient pulls out a tissue which they cough into before placing it on their lap. Afterwards, yellowish fluid is visible on the tissue.
	Productive - Green	Single coughing animation, with sound. The patient pulls out a tissue which they cough into before placing it on their lap. Afterwards, greenish fluid is visible on the tissue.
Cough (Ongoing)	Off	While set to Occasionally, the patient will perform a single cough once every 120-360 seconds. While set to Frequently, the patient coughs every 60 seconds.
	Occasionally
	Frequently
Breathing	Unlabored	Controls the appearance of the breathing animation that goes along with the patient’s general idle animation. Shallow is a more subdued/subtle version of the normal breathing animation. Labored breathing includes extra shoulder motion and an opened mouth. Stridor adds a harsh vibrating noise during each breath.
	Shallow
	Labored
	Stridor
Nose	Default	Sets the appearance within and just below the nostrils. The drainage and discharge options are texture/decal changes and not continuous fluid animations.
	Bloody Drainage
	Clear Discharge
	Yellow/green Discharge

The Lung Sounds section controls what sound is heard by the user when the stethoscope diaphragm is placed within any of the lung sockets on the patient. The images below demonstrate how these controls appear in the Simulation Manager panel. Clicking on the button next to a socket location cycles through the possible sounds: Normal, Coarse Crackles, Fine Crackles, Wheezing, Diminished, Absent. There is a toggle at the top of this section to control whether the interactions are currently available or not.

Simulation Manager Tab - Digestive and Abdomen

The Digestive and Abdomen tab provides options for mouth and tongue appearance as well as vomit animation triggers. It also allows the selection of bowel sound options for auscultation.

The table below details the patient appearance and animations that can be set or triggered.

Digestive and Abdomen
Item	State	Notes
Tongue	Tongue Out - Center	Triggers an animation of the sticking out and then returning after about 2 seconds.
	Tongue Out - Left
	Tongue Out - Right
Vomit	Normal	All three options trigger a vomiting animation where the patient vomits into an emesis bag, presents the opening of the bag for a few seconds (holding the opening forward so that a student can assess the color), and places the bag at their side where it disappears. bucket. Normal - tan color with food debris Bloody - red/pinkish color, no food Black - dark brown color with coffee-ground-like debris Green - greenish bile
	Bloody
	Black
	Green
Mouth	Normal	Sets the appearance of the inside of the patient’s mouth
	White Patches
	Ulcers
Teeth	Good Teeth	Sets the appearance of the patient’s teeth
	No Teeth
	Decayed Teeth

The Bowel Sounds section controls what sound is heard by the user when the stethoscope diaphragm is placed within any of its sockets on the patient. The image below demonstrates how these controls appear in the Simulation Manager panel. Clicking on the button next to a socket location in the Simulation Manager cycles through the possible sounds: Absent, Hypoactive, Present (Normoactive), Hyperactive. There is a toggle at the top of this section to control whether or not its interactions are currently available.

Simulation Manager Tab - Skin and Subcutaneous Tissue

The Skin and Subcutaneous Tissue tab provides options for skin appearance. It also allows the selection of edema severity in several locations on each leg.

The table below details the patient appearance that can be selected.

Skin and Subcutaneous Tissue
Item	State	Notes
Skin Tone	Default	Any setting outside of default modifies the overall color tint of the skin
	Pale
	Cyanosis
	Flushed
Perspiration	Default	Equates to shininess of skin
	Sweaty
Pressure Injury (Sacral)	None	Sets the appearance of a sacral pressure wound Stage 1: Reddened or darkened skin Stage 2: Blistered appearance Stage 3: Small crater of an open wound Stage 4: Visible muscle and bone
	Stage 1
	Stage 2
	Stage 3
	Stage 4
Pressure Injury (Heel - Left)	None	Sets the appearance of a pressure wound on the patient’s heel Stage 1: Reddened or darkened skin Stage 2: Blistered appearance Stage 3: Small crater of an open wound Stage 4: Visible muscle and bone
	Stage 1
	Stage 2
	Stage 3
	Stage 4
Pressure Injury (Heel - Right)	None	Sets the appearance of a pressure wound on the patient’s heel Stage 1: Reddened or darkened skin Stage 2: Blistered appearance Stage 3: Small crater of an open wound Stage 4: Visible muscle and bone
	Stage 1
	Stage 2
	Stage 3
	Stage 4
Leg Swelling (Left)	None	While on, the left leg appears swollen.
	Swollen
Leg Swelling (Right)	None	While on, the right leg appears swollen.
	Swollen

The Edema section controls the appearance of the patient’s skin when any of the ”Check Edema” buttons (located near the patient’s legs) are pressed. The table below lists the rebound time and depth of the indent given the selected severity. The image farther below demonstrates how these controls appear in the Simulation Manager panel. Clicking on the button next to each location in the panel cycles through the severity levels, and there is a toggle at the top of this section to control whether the edema interactions are currently available or not.

Edema
Severity	Rebound Time	Indent Depth
Absent	Immediate	0 mm
1+	1 second	1 mm
2+	10 seconds	3 mm
3+	20 seconds	5 mm
4+	30+ seconds	8 mm

When a ”Check Edema” button is clicked, the skin surface indents at the corresponding location and stays that way for the time detailed in the table above before returning to normal. The button that was pressed disappears while the skin is indented. When the edema interactions are turned off, the legs are not swollen and all the edema buttons around the patient model are hidden from view.

Simulation Manager Tab - Nervous and Musculoskeletal

The Nervous and Musculoskeletal tab provides options for multiple patient animations and pupil appearance. It also allows the selection of displayed strength for several strength tests.

The table below details the patient animations that can be adjusted.

Nervous and Musculoskeletal
Item	State	Notes
Seizure	No	Tonic-clonic seizure, as exhibited in our existing Intubation Patient Jamal asset. There will be two versions of this animation: one for where the patient is in Fowler’s position and one for when they are supine. If the patient is set to any of the following Body Positions, the Fowler’s version of the seizing animation will play: Fowler’s Fowler’s Leaning Forward Sitting (Chair) Sitting Leaning Forward (Chair) If the patient is set to any of these Body Positions, the supine version will play: Supine Lateral Recumbent (Right) Lateral Recumbent (Left) Sitting (Ground) Standing Fallen
	Seizing
Shiver	No	General body shivers and subtle teeth chattering
	Shivering
Tremor	No	While Hand Tremor is active, both of the patient’s hands (with forearms) have a constant subtle shake animation with a rate of about 3 shakes per second.
	Hand Tremor
Eye	Open	The eyes are open to the extent chosen, but even half-open they will occasionally close for a blink.
	Half-open
	Left Closed
	Right Closed
	Both Closed
Face Droop	None	When a side of the face is drooping, that half ignores the current facial animation and has the following characteristics: reduced forehead creases, drooping eyelids, and sagging mouth corner. As an example, the patient’s right side (viewer’s left) is drooping in the following image:
	Left Droop
	Right Droop
Hemiplegia	None	While turned on, the arms and legs of the given side do not move in any general idle animations.
	Left Side
	Right Side

The Pupils section controls the appearance of the patient’s pupils and how they react to a pen light assessment. The table below details the available options for each setting. The image farther below demonstrates how these controls appear in the Simulation Manager panel. Clicking on a button next to each location in the panel cycles through the options for that particular setting.

Pupils
Item	Option	Notes
Dilation	Default	The pupil starts out at a normal level of dilation. It may react to the pen light as normal, with its response time depending on the Response Rate value.
	Constricted	The pupil starts out constricted and does not react to the pen light.
	Dilated	The pupil starts out dilated and may react to the pen light, its response time depending on the Response Rate value.
Response Rate	Briskly	The pupil constricts over about 2 seconds when the pen light is hovered in the socket.
	Sluggish	The pupil constricts over about 5 seconds when the pen light is hovered in the socket.
	No reaction	The pupil does not react to the pen light.

The Strength Tests section allows for triggering animations that relate to assessing the strength of the patient. The table below details the animations that can be triggered.

Strength Tests
Test Type	Option	Notes
Arm Raise (Forward)	Bilateral	Both arms lift forward and stay for 20 seconds before returning.
	Left only	Just the left arm lifts forward and stays for 20 seconds before returning.
	Right only	Just the right arm lifts forward and stays for 20 seconds before returning.
	Bilateral - left drift down	Both arms lift forward, the right stays up for 20 seconds while the left drifts down after about 4 seconds.
	Bilateral - right drift down	Both arms lift forward, the left stays up for 20 seconds while the right drifts down after about 4 seconds.
Hand Squeeze	Hand Squeeze Left: 0, 1+, 2+, 3+, 4+ Right: 0, 1+, 2+, 3+, 4+	Each hand can be independently set to one of 5 strength values. When the Hand Squeeze button is pressed, both hands are held in a fist for about 4 seconds. A UI popup appears above each fist with the text “Strength: X”, where X is the value that was selected for that hand.
Leg Raise	Left only	Just the left leg lifts upward about 3 inches and stays for 4 seconds before returning.
Leg Raise	Right only	Just the right leg lifts upward about 3 inches and stays for 4 seconds before returning.
Foot Press	Foot Press Left: 0, 1+, 2+, 3+, 4+ Right: 0, 1+, 2+, 3+, 4+	Each foot can be independently set to one of 5 strength values. When the Foot Press button is pressed, both feet make a brief animation of moving slightly flat before returning to their original positions. A UI popup appears above each foot with the text “Strength: X”, where X is the value that was selected for that foot.

Simulation Manager Tab - Cognition

The Cognition tab provides options for overriding the appearance of the patient’s general idle animation.

Cognition
Item	State	Notes
Alertness	Conscious	The patient performs their general idle animation as normal
	Sleepy	Eyes are half-closed, and the patient is set to the Drowsy general idle animation regardless of their emotion
	Nonresponsive (with pulse)	Eyes are closed, and the patient does not perform their general idle animation (apart from breathing)
	Nonresponsive (pulseless, non breathing)	Eyes are closed. The RR and HR are both set to zero, and the following interactions are set to Off: heart auscultation, lung auscultation, pulses.

Sockets

Socket Functionality

The table below describes the extra functionality associated with each type of socket, and the images farther below depict where the sockets are located on the patient.

Socket Functionality
Item	Notes
Forehead Thermometer	Once socketed or hovered, the display shows the patient’s temperature
Pen Light	When socketed or hovered, the pupils react based on the options selected in the Simulation Manager
Tympanic Thermometer	Once socketed or hovered, the display shows the patient’s temperature
Mouth/nose Sockets Non-rebreather Mask Venturi Mask Nasal Cannula CPAP Mask Surgical Mask Mouth Thermometer Nebulizer Mouthpiece ETT NG Tube Tongue Depressor Pen light	Only one node can be placed at this location at a time. While the ETT is socketed, an ETT holder appears, and while the NG Tube is socketed, an NG tube holder appears. When the tongue depressor or pen light are hovered at this location, the patient’s mouth is held open.
Tracheostomy Collar	Basic node
Shock Pad	Basic node
ECG Stickers and Electrodes (x10)	All the equipment necessary for a 12-lead ECG
IV (x6)	An IV can be placed on either arm, either wrist, on the neck, or subclavian
BP Cuff (x2)	While socketed, the BP cuff receives and displays the BP values of the patient. It can be placed on either arm.
PICC Line	Basic node
Chest Tube	Once placed, a bandage also appears around the entry point of the tube and a drain system appears on the floor connected to the tube.
Pulse Oximeter (x2)	One on either hand
Stethoscope (x17)	A specific sound is played on hover
Learner Interactions Panel	Once socketed, the learner can use this panel to change several settings on the patient and bed.
Vitals Monitor	The purpose of this socket is to make a node-socket bridge, such that from that point forward, all changes to the patient’s vitals are relayed and presented on the monitor.
Hospital Bed	While socketed, the hospital bed moves based on the Body Position setting in the Simulation Manager.