Assisted systole (decreased pressure prior to native systolic waveform)
Mean arterial pressure (MAP) accurately calculated on IABP
Diastolic pressures adjusted for realism
Control sizes and colors adjusted for ease of use
Realism improvements made to all devices and waveforms
Mean arterial pressure (MAP) realistically miscalculated on other devices when IABP active (since these devices don’t factor IABP functionality into their calculations)
Tracing timing adjusted between electrical vs. pressure tracings (electrical activity precedes mechanical activity by approx. 100-200 ms)
Full support for 15 languages
Amharic
Arabic
Chinese
Farsi
Hebrew
Hindi
Development and release improvements
Defibrillator device actively under development, possibly for next release
Development portions of program removed from release build
Release is fully functional- no clutter from development
See the screenshots and captions below for more information, and check out the Downloads page to get the new version!
Monitor advanced hemodynamics in the cardiac monitor- identify the anomalous parameters to determine the cause, such as this picture of right heart failure!A side-by-side comparison of the cardiac monitor and intra-aortic balloon pump functioning simultaneously. Note the inaccurate MAP calculation of the bedside cardiac monitor, and the balloon pump factoring augmentation pressures into hemodynamic values.Infirmary Integrated is localized into 15 languages that can easily be selected from the Settings menu, and can be changed on the fly!
Introducing new features added to Infirmary Integrated in version 0.91:
Intra-Aortic Balloon Pump (IABP) simulator is complete
Arterial waveforms accurately modeled with and without IABP inflation and/or pulsed cardiac rhythm.
Augmentation time on waveform scales with heart rate.
Full support for 9 languages (recently added Korean and Swahili)
Miscellaneous improvements to realism
Transduced lines now must be zeroed prior to use.
See the screenshots and captions below for more information, and check out the Downloads page to get the new version!
A realistic experience setting up a balloon pump! You must zero the arterial blood pressure transducer for the balloon pump to function if it is set to pressure trigger. Also, don’t forget to prime the balloon pump with helium! And keep an eye on the helium tank to make sure it’s not empty…
Currently, frequency and triggers work properly! You can toggle 1:1, 1:2, or 1:3. And if set to pressure trigger, the pump will only operate if there is an arterial waveform (zeroed the transducer with a pulsed rhythm); similarly, ECG trigger will only operate if there is a QRS complex.
Major improvements done to Infirmary Integrated over the past few weeks are finally unveiled today with the release of version 0.9!
Major highlights include:
– 12 lead ECG simulator is fully functional.
– Full support for 7 languages has been implemented.
– Complete user interface re-write for a faster, cleaner look and experience.
– Groundwork for cross-platform compatibility is complete.
See the screenshots and captions below for more information, and check out the Downloads page to get the new version!
A screenshot of the 12-lead ECG simulator running. Can you tell the location of this simulated patient’s myocardial infarct based on the electrocardiogram?
A screenshot of Infirmerie Integree (Infirmary Integrated in French). Full support was added for 7 languages: German, English, Spanish, French, Italian, Portuguese, and Russian. Though some spelling mistakes are still being ironed out, plans are for Infirmary Integrated to be usable around the world! Language options can be changed in the “Settings” menu.
While the entire user interface of Infirmary Integrated was re-written in order to run faster on all computers, the Cardiac Monitor also got a little bit of a new look!
The main screen for Infirmary Integrated got a new look with the user interface re-write. Future plans include implementing more devices including simulators for a defibrillator, a ventilator, a fetal heart monitor, and others! In the meantime, the buttons for these devices that aren’t yet implemented will remain grayed out.
Now on Youtube, you can watch the short 5-part guide on Infirmary Integrated version 0.8, showing what Infirmary Integrated is, how to use it, and what it can do.
In addition, you can also watch and see all of the different cardiac rhythms modeled in the video below!
It’s a definite milestone for Infirmary Integrated now that the cardiac monitor simulator is complete. Completely functional, complete with all the features I initially envisioned it to have, completely usable in the classroom.
So what’s new? For starters, a lot of polishing was done to the user interface, more cardiac rhythms were added (pulsed vs pulseless ventricular tachycardia, coarse vs fine ventricular fibrillation, monomorphic vs polymorphic ventricular tachycardia), more waveforms were added (central venous pressure, pulmonary artery catheter), and the ability to save and load simulation files.
So what’s the next step? Porting Infirmary Integrated to Mac OS X so that all future versions will simultaneously be released for Windows and Mac!!
Central venous pressure waveform only populates on beats with atrial contractions, similarly pulmonary artery and arterial blood pressure waveforms only populate on ventricular contractions.
With this new website, I would like to introduce Infirmary Integrated, an advanced cardiac monitor simulator that I have been developing for use as a teaching tool in medical and nursing education. Monitoring a patient’s vital signs and hemodynamic status is key in emergency and critical care medicine, so it is important for clinicians to be practiced at reading echocardiograms and interpreting vital signs. For this, Infirmary Integrated can be a priceless tool for teaching and practicing reading waveforms and interpreting a patient’s status based on monitoring.
22+ cardiac rhythms can already be selected, and more can be modeled with additional options (e.g. STEMI, T-wave inversions, coarse vs. fine ventricular fibrillation).
Infirmary Integrated is free and open source software. As a critical care nurse, I wanted to create a teaching tool that I would have found useful when I was a student- and to make sure it is accessible to students and teachers without being limited by price or accessibility. My goal was to create a piece of software that could be utilized across the world in simulation labs or on personal computers for practice and learning, to better prepare nurses to care for critically ill patients with advanced techniques and equipment.
Infirmary Integrated simulates patient monitoring realistically, digitally simulating 22+ cardiac rhythms and additional waveforms, showing tracings from all 12 ECG leads and various hemodynamic monitoring devices, and realistically displaying the data as a real cardiac monitor would in any monitored hospital unit.
Although development continues on Infirmary Integrated, at its current version, it is still a usable teaching tool. Future plans are to include simulated devices including a 12 lead ECG, defibrillator, intra-aortic balloon pump (IABP), and ventilator- hopefully within the coming months. If you are interested in using Infirmary Integrated, you can download an installation package from the Github repository. Note that Infirmary Integrated is only available on Windows- I do have distant future plans to port it to other operating systems and devices, but those plans are very distant.
12 ECG leads and many devices can be drawn as tracings in Infirmary Integrated.
If you have any questions about Infirmary Integrated regarding its use, development, or any bugs you may encounter with it, please feel free to contact me at ibi.keller [at] gmail [dot] com
Thank you,
Ibi Keller, MSN, RN, CCRN, CEN
Electrical and mechanical capture is differentiated, for realistic blood pressure and oximetry waveforms generated from ectopic beats. Respiratory rhythms are modeled, in addition to cardiac rhythms.
