Quantitive physiology with the Human Patient Simulator

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Quantitive physiology with the Human Patient
Simulator

• Hans van Oostrom, PhD.
• University of Florida, Anesthesiology
  Biomedical Engineering
• Benno Lansdorp, MSc.
• University of Twente, The Netherlands
• Technical Medicine

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Overview

• Introduction
• The essence of teaching physiology
• Demonstration of teaching physiology using
  METI-HPS
• Starling Curve
• Discussion of using METI-HPS in teaching
  physiology, other possible scenarios, your
  experience

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Aims workshop

• Identify and describe the relevance of teaching
  physiology to gain insight in the human system
• Identify and describe the advantages of using
  simulation as a tool for teaching physiology
• Develop learning modules based on simulation by
  themselves

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Essence of teaching Physiology

• Knowledge of physiology is essential to
  understand the functioning of the human system in
  interaction with the supportive technology and
  thereby come to innovative solutions
• This quantification and modeling help to gain
  insight in the complex interrelationships of the
  human system

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Homeostasis (equilibrium nonlinear system)
equilibrium pointanalysis
Two dynamic systems in a loop
Proces 2
Proces 1
equilibriumpoint
Control of equilibrium is essential in many body
processes, e.g. involved in homeostasis
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Cardiac output is determined by the intersection
of return function and cardiac function
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Cardiac Output Curve
Sympathetic ?
Heart rate ?
Sympathetic ?
Heart rate ? Myocardial damage
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Mathematics Cardiac Output
C capacitance, Ddiastole, Ssystole, Praright
atrial pressure, Pplpleural pressure,
PAarterial pressure
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Venous return curve
Q
Venous cap. ?
Resistance ?
Pra
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Mathematics of venous return
Pmsmean circulatory pressure, Praright atrial
pressure, Rresistance,C capicitance,
Aarterial, Vveneus
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Steady-state closed-loop Cardiac output regulation
Contractility ?
normal
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1
3
Blood volume ?
2
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Simulation exercise 1

• Design three scenarios to derive the starling
  curve from 3 different patients
• Normal but hypovolemic patient
• Sick (low CO) patient
• Treated patient (with an Inotrope)

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Possible solutionTreat by adding volume, record
CVP, HR, CO
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Simulation exercise 2

• In one graph plot 3 Starling curves from the
  obtained data and answer the following questions
• Explain the shape of the Normal and Sick curves
• To treat the patient an Inotrope was given. Look
  up what inotropic drugs do and explain how it
  caused a difference in the Starling curve

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Other possible simulation topics

• Barorelex
• Respiratory control
• ....
• ..

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Discussion

• Comments?
• Suggestions?
• Your experience?