HPS
From WickedSim
Solving HPS problems
A recurring theme is the problem of mask ventilating the METI HPS. Here's a typical note from a recent SSH mailing list discussion[1]
Our problem is that we have to use a freshgas flow of 20 l/min to adequately mask ventilate our "chip head". This seems to be far too much, but we are unable to find any major leakage/tear/hole which could explain for this problem. Did anyone have similar experiences? How did you cope with the problem? (Michael St. Pierre)
The response from Richard Kyle is worth quoting in full:
Received first HPS about 6 years ago, when METI had just ceased using a head/body supplied by MPL. Problem: That new head and mouth was bigger (always leaked) than any known face mask in any clinical inventory that my clinical colleagues had access to. Solution: Returned entire body in exchange for smaller, MPL-sourced "C" body. Problem: this mouth/face was too pointy (always leaked) for any known face mask in any clinical inventory that my clinical colleagues had access to. Solution: Extend sides of mouth, thus flattening the overall front of the face by inserting inside the mouth, just under the lips, a flexible, clear torus composed of two thick tube sections (to push the lips out from the two sides of the mouth) and two thin tube sections (to add zero addition protrusion across the front of the upper and lower teeth) while holding the thick side pieces in their correct locations. The torus is held in place against the gums by the added stretch placed on the elastic material of the face. This modification is known as the Don Corleone appliance after Marlon Brando who stuffed the gap on the outer sides of his mouth to make is face fuller, and his speech thicker. Inside the HPS mouth, this appliance is rarely noticed as it is hidden from casual view into the mouth, and adds no distraction or disruption during insertion of any airway device. On the occasion that a student does remark on the appliance, we applaud them for their complete oral assessment of their patient. Then we tell them what it is in there for, and life goes on. We have had no problems with mask ventilation ever since, provided that the operator does a fully attentive job of holding the mask to the face in a clinically correct way. Otherwise, it leaks. This is the silver lining in this story: the sim is harder to mask ventilate than most humans (or so I'm told) unless all the actions are performed correctly. This makes the final result the ideal teaching tool: i.e. ideally, our students' real life clinical adventures will always easier than what they had to overcome with their sim patients.
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