Nasco 101-7130 Lite AXEL Patient Simulator with Speech Recognition Ability User Manual

User Manual for Nasco models including: 101-7130 Lite AXEL Patient Simulator with Speech Recognition Ability, 101-7130, Lite AXEL Patient Simulator with Speech Recognition Ability, Speech Recognition Ability, Recognition Ability
Operation Manual

Simulaids AXEL Patient Simulator with Speech Recognition Ability
File Info : application/pdf, 36 Pages, 6.82MB
alex-axel-patient-simulator operation-manual-6april-2021
OPERATIONS MANUAL
Alex and Axel
101-7130 -- Lite, 101-7140 -- Plus,
101-7150 -- Pro, 101-7210 -- Axel
The following instructions are appropriate for both ALEX and AXEL. Some of the features will be dependent on your model that you have purchased. All information in this manual is the sole property of Nasco Healthcare. Any reproduction in part or as a whole without the written permission of Nasco Healthcare is prohibited.

ALEX/AXEL Instructions for Use
Contents
Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-7 About ALEX/AXEL. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Tiers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Specifications and Handling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 List of Components. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Minimum System Requirements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Getting Started. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-11 Setup and Power On . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Power Off . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Status Indicators . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Connect ALEX/AXEL to a Local Network . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Connecting ALEX/AXEL Via Wired Connection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Activation of ALEX/AXEL and Connecting ALEX/AXEL Via Wireless Connection -- Bundled Tablet 9 Connecting ALEX/AXEL Via Wireless Connection -- Other Wi-Fi® Devices. . . . . . . . . . . . . . . . . . . 9, 10 Open the Web App . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
General Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11-18 SmartScopeTM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11-13 Setting up SmartScopeTM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Using the SmartScopeTM : Sounds and Auscultation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12, 13 Blood Pressure Evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13 Installing and Switching Genitalia. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14 Performing Catheterization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14 Airway . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Breathing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

Pulses. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 CPR. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17 IrisCamTM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17 Speaking with ALEX . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 Text to Speech . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 Push to Talk. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Care and Maintenance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19-28 Cleaning Instructions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 Storage Instructions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 Preparing for Transportation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 Replacing the SmartCuffTM Battery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19, 20 Removing a Standard Arm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20, 21 Removing an IV Arm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 Installing a Standard Arm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .22, 23 Installing an IV Arm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23, 24 Replacing Lungs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24, 25 Replacing Leg "Skins" . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26, 27 Charging the SmartScopeTM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
Troubleshooting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28-32 Clothing Measurements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 Warnings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 Where to Find Additional Help . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 Additional Supplies/Replacement Parts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34

Introduction

About ALEX & AXEL
Thank you for purchasing a Nasco Healthcare simulator. Both ALEX and AXEL are completely assembled on-the-go patient simulators with built-in audio-visual solution. ALEX and AXEL will provide an interactive experience where learners can perform real-time assessments and clinical skills to meet educational requirements for current and future healthcare providers.
Time stamped log entries created for skills like · Obtain blood pressure, including two-step blood pressure · Feel pulses · Listening to heart, lung and bowel sounds · CPR compression rate/depth & ventilations
ALEX and AXEL are equipped with abilities for intubation and observation of programmable spontaneous chest rise and fall for your respiratory needs.
As the instructor, you will be able to control vitals, configure and run scenarios, create measurable objectives, communicate to learner remotely via internal microphone and speakers, and even view and record video from the patient's perspective through the IrisCamTM. All of this can be done in the cloud with a computer, tablet, or mobile phone. ALEX and AXEL must be connected to the Internet to be fully functional. They can be connected via a wired connection (Ethernet) or a wireless connection (Wi-Fi®)

Tiers
Depending on which version you purchased, it will have different capabilities. If at any time, you would like to upgrade to a higher tier, please contact customer service.

Lite

Plus

Pro

LITE

PLUS

PRO

Light Skin Tone
MAedlilumPShkyinsTioonelogical Features

101-7130 101-7130M

101-7140 101-7140M

101-7150 101-7150M

Adult/Adolescent Full Body Patient Simulator

$

$$

$$$

Cloud-Connected Control Speech Recognition (NLP)
Intubation  Oral, Nasal and Digital

Up to 250 questions per day Yes

Up to 1000 questions per day Yes

Unlimited Yes

Palpable Pulses  Bilateral

Yes

Yes

Yes

Advanced Carotid
Brachial

Speech

Features

(not Radial
Dorsalis

Paepdisplicable

for

Axel)

Yes

Up

to

250

questions

a

dayYes Yes

Yes

Yes

Yes

Up to 1,0YY0eess0 questions aYYeedss ay

Yes

Yes

Bilateral Blood Pressure (Manual & 2-step BP) with Smartscope & Smartcuff

Yes

Yes

Yes

IrisCamTM Anterior Heart and Bowel Sounds with Smartscope
Anterior/Posterior Lung Sounds with Smartscope

Yes

Yes

Yes

Yes

Yes

Yes

Spontaneous Breathing  Synchronized with Respiratory Rate BVM Ventilation
IrisCamTM Recording Patient Monitor with Vitals And Waveforms
HR, RR, ETCO2, SPO2, TEMP, BP, ECG & MAP

_

Yes Yes Yes Yes

Yes

Yes

Yes

Yes

1YY,ee0ss 00 hours

Yes Yes

Virtual AED/Pacing & 12 Lead ECG

Not Available

Yes

Yes

Simulation Log Archive CPR with Metrics Charting Depth, Rate & Ventilations
Real-Time Remote Simulation Control

60 days

LOG Yes

LIVE Yes

1

year

LIVE Yes

Scenarios Included with Customizable Patients

Yes

Yes

Yes

Measurable Objectives with Automated Assessment
API for AV/Center Patient Orders
Model-Driven Physiology
Management Integration Drug Treatments
Built-In Microphone and Speakers

_

Yes Yes Not Available Not Available Yes

Yes

Yes

Yes

Yes

Logs & Physio Events Not Available

Yes

Not Available

Yes

Yes

Yes

Events, Objectives & Orders Log Entry Record

Yes

Yes

Yes

Communication Transcription Log Entry Record

Yes

Yes

Yes

Warranty Included Iris Cam  Live Stream
Iris Cam  Recording

1 year

Yes Not Available

5 ye10a00rYsehso+urspre-shippUninlYimgesited

Simulation Log Archive

60 days

1 year

5 years

Teamspace

Not Available

Not Available

Yes

30-Day Free Returns Cloud Connected Control
Virtual Patient

Yes

Yes

Yes

Not Available

Not Available

Yes

Warranty

1 year

5 years

5 years

IV Arm  Optional

Optional

Optional

Optional

Female Conversion Kit  Optional

Optional

Optional

Optional

101-7210
101-7210M
$$
Manual microphone/speaker allows facilitor and student to speak to each other. Yes Yes Yes
UnliYYmeessited
Yes Yes Yes Yes Yes Yes
UnliYYmeessited
Yes
5 yLYeIVesEars Yes Yes
Logs & PhYYyeesss io Events, Live YYVeessideo
Yes Not Available
5 years 1+00p0Yerhseou-rsshipping 1 year Not Available Yes Not Available 5 years Optional Optional

Specifications and Handling

Do not operate or store ALEX/AXEL at temperatures less than 40° F (4° C) or exceeding 104° F (40° C).
Do not operate ALEX/AXEL in a humidified environment (greater than 80% relative humidity) or introduce humidified air to the airway via ventilations. Doing so may result in electrical failures and/or mold formation in the airway.

Shipping Weight Shipping Dimensions ALEX/AXEL Weight

67 lbs. (30 kg) 41" H x 19.5" W x 15" D 45 lbs. (20 kg)
5

List of Components
· ALEX/AXEL -- Fully Assembled Patient Communication Simulator (101-7130/101-7140/1017150)

· SmartScopeTM -- Auscultation Device (101-8031)

· Control Tablet

· SmartScopeTM Charging Cable

· Stethoscop

· SmartCuffTM Blood Pressure Cuff and Sensor (101-8032)

· Nasco Airway Lubricant (LF03644)

· External Power Supply

· Ethernet Cable

· Male Genitalia

6

Minimum System Requirements
Compatible Devices: · Any HTML5 Compatible Device  Computers: Mac®/Windows® PC  Tablets: AndroidTM/iPad®  Smartphones: AndroidTM/iPhone®
Software Requirements: · The current version of Google Chrome (Windows/macOS), or Microsoft Edge (Windows/macOS), or Mozilla Firefox (Windows) is recommended for optimal performance. Video capabilities are not currently supported with Apple® Safari. · Internet Explorer is NOT currently supported.
Connection Requirements: · Wired or wireless (including guest networks) · Simulator Control: 0.1 Mb/s upload and download speeds · Full Audio/Video: 2 Mb/s upload and download speeds
Getting Started Setup & Power On
1. Remove from the shipping container. · ALEX/AXEL is fully assembled prior to shipping. · Retain case and packaging materials to use for transportation.
2. Plug the AC adapter into the wall. · An AC Adapter is provided with a plug for U.S. outlets but is rated for 110V/220V and 50/60 Hz and may be used with international power outlets if the appropriate plug is used along with the provided AC adapter. Non-U.S. plugs are not included.
3. Lift T-shirt to expose the access panel on left side.
4. Plug the AC connector into the power jack on the left side of the simulator that is labeled 'Power In'. · ALEX/AXEL is capable of running off its internal battery for up to 8 hours when fully charged. · The battery comes partially charged. · When the battery is low, a high-pitched beeping sound will be heard from torso every 10 seconds.
5. Power on by briefly pressing the button on the left side of the simulator. Note: If connecting ALEX/AXEL to your network via a wired Ethernet connection, connect the cable prior to powering on. · The power button will turn blue to indicate that it is booting up. · After less than 5 minutes, the light will turn green. Note: Do not touch any of the pulse sites or have any conductive material such as metals close to any of the pulse sites during start up. Doing so may make the pulses non-reactive until reset.
7

Power Off
Shut down ALEX/AXEL when not in use for extended periods of time, even while connected to AC power. 1. To power off, briefly press the power button on the left side of the torso. · The power button will turn blue while shutting down. · The shutdown procedure may take up to 5 minutes. · When the shutdown procedure is complete, the power button will turn off or turn flashing purple if it is connected to a power source. 2. If the standard shutdown procedure fails and you need to power off, you can perform an emergency power off by pressing the power button for more than 5 seconds. WARNING: Emergency power off may corrupt computers! Only use emergency power off if absolutely necessary.
Status Indicators
The LED on the power button indicates simulator status. A solid light indicates that simulator is running off of battery. A flashing light indicates that simulator is currently connected to a power outlet.
Power Button LED Indicates ALEX/AXEL is
is off.
is off, but charging.
is booting up or shutting down.
is ready for use.
failed to start up.
Connect to a Local Network
ALEX/AXEL must be connected to a local network in order to operate properly. The connection can be made via a wired Ethernet connection or a Wi-Fi® connection. The preferred method is via a wired Ethernet connection to ensure reliability and obtain the highest quality AV (audio/video) streams. A pre-configured tablet has been provided in order to simplify the connection setup procedures. If any additional support is needed for connecting to a local network, email us at alexhelp@nascohealthcare.com or call 1-833-NASCOHC (627-2642). We are happy to help you!
Connecting ALEX/AXEL Via Wired Connection
Note: You may experience better results if you connect the Ethernet cable prior to powering ALEX/AXEL on. 1. Connect an Ethernet cable to an active network port. 2. Connect the opposite end of the Ethernet cable to the network port on the left side of ALEX/AXEL.
Note: Prior to first use, you must activate the simulator. To activate the simulator, follow the instructions in the "Activation of ALEX/AXEL and Connecting ALEX/AXEL Via Wireless Connection  Bundled Tablet" section on next page.
8

Activation of ALEX/AXEL and Connecting via Wireless Connection  Bundled Tablet
Every ALEX/AXEL comes with a customized tablet that can be used to activate, connect to your wireless network, and to control your simulator. To activate and/or connect to your wireless network using the tablet, follow the instructions below:
1. Follow the procedures in the "Setup & Power On" section on page 7. 2. Turn on the tablet by holding down the power button on the right side of the tablet. 3. After the tablet shows the home screen, tap the Chrome icon to open the app.
4. Follow the instructions that are shown on the tablet to complete the connection procedure.
Connecting ALEX/AXEL Via Wireless Connection -- Other Wi-Fi® Devices
1. Using any Wi-Fi® device, connect to simulator Wi-Fi® network just as you would to any other network. · The Wi-Fi® network will be named PCS-<SimID>- PCS-A0490 - SIM ID remains ANNNN where <SimID> is the Simulator ID located on the label on the right side of ALEX/AXEL or on the back of the "Getting Started with Your Simulator" guide. · You must unzip the zipper on the chest skin to be able to view the label.
· The Wi-Fi® password is printed on the label. Enter the password exactly as printed; it is case sensitive.
9

2. Using a web browser (Google ChromeTM or Mozilla Firefox is preferred), navigate to setup.pcs.ai. 3. Follow the prompts on the screen to finish connecting to the network.

Open the Web App

ALEX/AXEL can be controlled via the Web App which is hosted in the cloud.

The URL for the Web App is http://app.pcs.ai.

This site can be accessed by any network connected device (computers, tablets, or smartphones).

You can be provided with a guided tour of the Web App at any time by clicking the right corner of the screen and selecting "Guided Tour."

icon on the top

External Microphone and Speakers
ALEX/AXEL can output his sound through external speakers or a headset. He can also receive audio input through an external microphone. This can be useful in a noisy setting. There are two standard 3.5 mm audio connections on the simulators access panel on his left side. Speakers and headphones should be plugged in to the upper jack, marked with the symbol. Microphones may be connected to the lower jack, marked with the symbol. ALEX/AXEL will automatically detect that an external audio device is connected and will output audio and/or receive audio from the external device(s) automatically.

If using a headset that has audio input and output on the same device that uses a single 3.5 mm connection, a Y-Splitter adapter (not included) must be used to obtain simultaneous input and output. The type of connector should be female to 2 male.
10

General Use
SmartScopeTM
SmartScopeTM allows you to hear body sounds coming from ALEX/AXEL as though the simulator were a real patient. The SmartScopeTM is a white accessory with a red strap that can be attached to a stethoscope.

1

2 34

1 ) Audio/Output/Headphone Jack 2) Micro-USB Charging Port 3) LED Status Indicator 4) Power Button

Setting up SmartScopeTM
Note: When using a new SmartScopeTM, be sure to remove the tape that secures the activation flap.
The SmartScopeTM should be attached so that either the diaphragm or the bell of the stethoscope is in contact with the top of the SmartScopeTM (see picture at right).
You may use the included stethoscope or any other stethoscope that fits SmartScopeTM. The SmartScopeTM is compatible with all stethoscopes that have a chest piece front/back thickness of 0.5"- 1.4" (1.3-3.6 cm).
If sharing a stethoscope between users, clean the ear pieces using alcohol wipes between uses.

11

Using the SmartScopeTM: Sounds and Auscultation
You can hear body sounds coming from ALEX/AXEL using the SmartScopeTM.
ALEX/AXEL is capable of emitting heart, bowel, and lung sounds. The left and right lungs can be controlled independently.
The sounds can be changed using the Web App to simulate different conditions.

The following sound locations can be listened to on ALEX/AXEL:

Heart Sounds

Log Entries

Aortic (A)

Listened to heart sound at aortic area

Pulmonic (P)

Listened to heart sound at pulmonic area

Erb's point (E)

Listened to heart sound at Erb's point area

Tricuspid (T)

Listened to heart sound at tricuspid area

Mitral (M)

Listened to heart sound at mitral area

Additionally, both arms provide the Korotkoff sounds when checking blood pressure. Lung Sounds

Right Upper Lobe (RUL)

Listened to lung sound at front/back RUL area

Right Middle Lobe (RML)

Listened to lung sound at front RML area

Right Lower Lobe (RLL)

Listened to lung sound at front/back RLL area

Left Upper Lobe (LUL)

Listened to lung sound at front/back LUL area

Left Lower Lobe (LLL)

Listened to lung sound at front/back LLL area

Bowel Sounds

Aortic (B-A)

Listened to bowel sound at aortic area

Renal (B-R)

Listened to bowel sound at left/right renal area

Iliac (B-I)

Listened to bowel sound at left/right iliac area

To hear sounds, simply place the SmartScopeTM on the anatomically appropriate auscultation sites and listen through the stethoscope ear pieces. Each time a site is auscultated, it will display on the log on the Web App.

12

Blood Pressure Evaluation
ALEX/AXEL comes with SmartCuffTM, a blood pressure cuff with an integrated sensor to simulate blood pressure measurement. Place the blood pressure cuff on either arm and inflate as you would for a real patient. The appropriate Korotkoff sounds can be heard when using the SmartCuffTM to auscultate the antecubital sites on the appropriate arm as the pressure in the blood pressure cuff changes. The radial pulse strength will change as the pressure in the blood pressure cuff changes. The blood pressure can be altered from the Web App.
Note: The SmartCuffTM and SmartScope is not interchangeable between simulators. If you have multiple ALEX/AXEL simulators, it is recommended to label each SmartCuffTM with the Simulator ID that it was purchased with.
13

Installing and Switching Genitalia
Male genitalia are included with ALEX/AXEL and female genitalia may be purchased as an upgrade kit. The genitalia can be interchanged as needed. To change genitalia, simply pull off the genitalia and replace it with the genitalia you would like to use. When placing the genitalia, make sure that the tube coming off of the genitalia goes into the hole in the pelvis.
Performing Catheterization
ALEX/AXEL can be used to perform urinary catheterization on its male or optional female genitalia. When cleaning and "sterilizing" the genitalia, use distilled water. Do not use iodine or other sterilization solutions as they may stain the simulator. Lubricate the catheter with a water-based lubricant prior to inserting the catheter. You may use a size 14-18 Fr straight or Foley catheter. If using a Foley catheter, do not inflate the balloon with more than 15 cc of fluid. If more than 15 cc of fluid are used for inflation, the catheter will not move freely within the bladder. Realistic resistance will be felt as the catheter passes from the urethra to the bladder. An inflated Foley catheter will not be able to be retracted from the bladder while inflated. Forcefully trying to remove an inflated Foley catheter may result in damage to the simulator. Always remove the catheter immediately after training. Leaving the catheter in place for extended periods may permanently damage both the catheter and the trainer. When training is complete, remove the genitalia and allow the lubricant to air dry before storing.
14

Airway
ALEX/AXEL has an anatomically accurate airway that can be intubated and ventilated. When ventilated, ALEX/AXEL will demonstrate realistic chest and stomach rise to indicate ventilation performance.
The following procedures may be performed:
· Head Tilt/Chin Lift
· Jaw Thrust
· Bag-Valve-Mask Ventilation
· Orotracheal Intubation and Ventilation
· Nasopharyngeal Airway Insertion
ALEX/AXEL represents a 5 ft. 3" (160 cm) male patient weighing approximately 120 lbs. (54 kg). Airway adjunct size selection can be guided by these parameters, with some exceptions. See the chart below for recommended sizes and clinical recommendations for a patient of ALEX AND AXEL's size. Some recommended sizes differ from the guidelines for a typical patient of this body type to ensure adequate fit and to minimize damage to the simulator.

Device Endotracheal Tube Macintosh Blade Laryngoscope Miller Blade Laryngoscope King LTS-D LMA Combitube iGel® Bag-Valve-Mask Nasopharyngeal Airway

Recommended Size for Simulator 7.5 mm or 8.0 mm #3 #2 #4 #5 37 Fr or 41 Fr #4 Adult 6 mm

Guidelines for 5 ft. 3" (160 cm) adult male weighing 120 lbs. (54 kg) 8.5 mm #3 #2 #41 #41 37 Fr or 41 Fr1 #3  #42 Adult 6 mm3

1 Manual of Emergency Airway Management by Ron M. Walls and Michael F. Murphy, published by Lippincott Williams & Wilkins. 2012 2 iGel Information Sheet. Intersurgical© 2016. 3 Roberts K, Whalley H, Bleetman A The nasopharyngeal airway: dispelling myths and establishing the facts Emergency Medicine Journal 2005;22:394-396.
Notes
· Do not use any airway adjuncts aside from the types and sizes recommended above. Using other airway adjuncts or sizes may damage the airway.
· The guidelines for a patient of ALEX and AXEL's body type indicated in the chart above are provided only as a point of reference. Clinical recommendations may differ by region.
· Do not use ALEX/AXEL for rescue breathing involving human contaminants. · Prior to performing intubation, spray the airway device with Nasco Lubricant (included). Do not spray
lubricant directly into airway. · Do not introduce fluids into the airway. Doing so may damage the simulator.
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Breathing
ALEX and AXEL's respiratory rate and pattern can be altered from the Web App. Changing the respiratory rate will alter the chest rise frequency.
ALEX/AXEL is capable of breathing properly when lying flat on its back, sitting up at 90°, or anywhere in between.
Pulses
ALEX/AXEL has 8 pulse locations: · Left/Right Pedal · Left/Right Radial · Left/Right Brachial · Left/Right Carotid
Pulses are activated when they are touched and are synchronized with the ECG rhythm specified in the Web App. Pulse strength varies by palpated site (e.g., carotid pulse is stronger than pedal) and systolic blood pressure.
Each time the pulses are checked, it is logged on the Web App.
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CPR
You may perform chest compressions on ALEX/AXEL at any time to train on CPR. When you begin chest compressions, the chest movement will temporarily stop until chest compressions are no longer being performed. Once CPR is started, there will be a log entry that can be clicked to see data on chest compression rate and depth.
If ventilations are being performed during CPR, there will be a ventilation indicator shown on the same chart.
IrisCamTM
ALEX/AXEL can stream and record live high definition video from the IrisCamTM in the right eye. More information on viewing and recording the video can be found on the ALEX help website. For more information, email us at alexhelp@nascohealthcare.com or call 1-833-NASCOHC (627-2642). We are happy to help you!
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Speech and Audio Communication with ALEX and AXEL Push to Talk
The instructor can speak into a microphone or webcam connected to the instructor device and the audio will be relayed by ALEX/AXEL to facilitate patient learner communication. More information on "push to talk" can be found on the help website. For more information, email us at alexhelp@nascohealthcare.com or call 1-833-NASCOHC (627-2642). We are happy to help you!
Speaking with ALEX (only available on ALEX tiers)
1. Briefly touch your palm to ALEX's shoulder to activate his conversation abilities. · You will feel a vibration and a "be-beep" sound indicating that ALEX is now listening to you. · ALEX's conversation can be activated by touching either shoulder except the shoulder of the optional IV arm. · ALEX will continue listening to you until you touch your palm to the shoulder again or say "OK, thank you, ALEX." When the conversation is no longer active, you will hear a "be-boop" sound.
2. Ask ALEX questions as though you were communicating with a real patient. 3. ALEX will respond to you.
· ALEX's responses will differ based on what type of patient is being simulated. · The questions that ALEX hears and the responses are logged on the ALEX Web App.
For more information about speaking with ALEX, review the "Conversations with ALEX" document, included with ALEX.
Text to Speech (only available on ALEX tiers)
The instructor can type phrases into the web app and ALEX will speak them to the trainee. More information on "text to speech" can be found on the help website. For more information, email us at alexhelp@ nascohealthcare.com or call 1-833-NASCOHC (627-2642). We are happy to help you!
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Care and Maintenance
Cleaning Instructions
Most cleaning can be performed with a soft cloth, mild soap, and warm water. Avoid over-washing face as it may remove some of the coloring.
Stubborn stains can be treated using Nasco Cleaner (not supplied; LF09919U, see Additional Supplies/ Replacement Parts Section for ordering details) and a soft cloth.
Stains caused by makeup, ink, and newsprint are indelible and cannot be removed. Avoid contact with these substances and do not apply cosmetics or Betadine® solution to the manikin.
Avoid exposing ALEX/AXEL legs to any liquids.

Storage Instructions
When not in use, be sure that simulator is turned off and not plugged in after being fully charged.
Store in a cool, dry environment between 65° F to 85° F (15° C to 29° C). If storing below 65° F, place in a warmer environment for 15 minutes prior to use to ensure that the plastics do not get damaged.
Do not store with any fluids still in the optional IV arm. Flush the arm with water and drain the arm fully after each use and allow to air dry completely.
If storing for a long period of time (1 month or longer), remove the battery from the SmartCuffTM. Failure to remove the battery during long term storage may cause the battery to leak and damage the SmartCuffTM.
Preparing for Transportation
When transporting ALEX/AXEL, place the simulator in the included storage case. ALEX/AXEL fits into the storage case by placing the head at the top of the case with the supplied foam between the head and the case. The foam should be folded over the simulator's head and secured by folding the legs on top of the torso.

Replacing the SmartCuffTM Battery

The SmartCuffTM operates off of a replaceable CR2032 battery. With typical usage, the battery will last 3 to 6 months. To replace the battery:

1. Pry the top off of the SmartCuffTM sensor.

2. Remove the old battery from the SmartCuffTM sensor.

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3. Insert the new battery with the positive side facing up.

4. Replace the lid of the SmartCuffTM sensor. Line up the arrows at the corner of the lid with the arrows on the base of the sensor to ensure proper orientation.

Replacing and Changing Arms
Right arm may be replaced in order to change from the standard ALEX/AXEL arm to an optional IV arm or to replace a damaged arm.
Removing a Standard Arm 1. Rotate right arm upwards and past his head until you encounter resistance.

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2. Pull the arm out of the torso, being careful not to pull on the cables connecting the arm to the torso. Place the arm next to ALEX/AXEL.

3. Disconnect the white cable connector by pushing down on the tab at the top and pulling.

Removing an IV Arm 1. Rotate right arm upwards and past his head until you encounter resistance.

2. Pull the arm out of the torso.
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Installing a Standard Arm 1. If the arm connector is inside of the torso, pull it out of the torso.
2. Connect the arm connector to the new arm. Press the connector in until you hear a click.
3. Place the arm back into the arm socket, lining up the bump on the arm with the indent on the opening.
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4. Rotate the arm to lock it in to place.
Installing an IV Arm 1. If the arm connector is outside of the torso, push it inside of the torso. 2. Place the arm back into the arm socket, lining up the bump on the arm with the indent on the opening.
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3. Rotate the arm to lock it into place.
Replacing Lungs
Lungs may be replaced when necessary. 1. Remove overlay by unzipping the side and shoulder zippers.
2. Remove chest plate by flipping it over and leaving it on pelvis. The chest plate is secured in place by a snap on the lower stomach that can be removed by pulling straight up.
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3. Pull up on the lung bag connection points to remove the old lung bag.
4. Install the new lung bags by aligning the connection point to the holes on the yellow plate and pressing them in tightly.
5. Flip the chest piece plate over to return it to the proper position. Snap the lower stomach back in to place.
6. Zip up simulator's overlay.
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Replacing Leg "Skins"
Legs are wrapped in a spandex-like material that can be easily replaced if stained and/or torn. 1. Untuck the material from the pelvis.
2. Roll the material down the leg and pull it off of the foot.
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3. Pull the new material on to the leg over the foot. Pull the material up the leg. The material should end just above the ankle.
4. Tuck the material back underneath the pelvis.
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Charging the SmartScopeTM
The SmartScopeTM battery can be recharged using the included micro-USB cable. The cable can be charged via any USB port or an AC power adapter (used by most mobile phones).
· A light that is flashing green and amber on the SmartScopeTM indicates that the battery is low. · A slowly flashing green or orange light on the SmartScopeTM indicates that the battery is charging. · There is no indicator that the SmartscopeTM is fully charged. The SmartScopeTM battery lasts 5-8 hours of continuous use when fully charged.
Troubleshooting

Issue
Korotkoff sounds not heard when SmartCuffTM pressure
is increased.
No sounds heard from SmartScopeTM.
No sounds heard from SmartScopeTM on torso, but
sounds still heard on antecubital.

Cause
Using SmartCuffTM from another simulator.

Solution
Use the SmartCuffTM that came with the unit you are working with. Each SmartCuffTM is paired to a single ALEX/AXEL.

SmartCuffTM battery needs replacement.

Inflate the cuff to 150 mmHg and observe the LED indicator. If the LED does not turn on, replace the battery (refer to "Replacing the SmartCuffTM Battery").

Blood pressure being taken from IV arm.

Sounds are not supported using the IV arm. Use a standard arm to measure the blood pressure.

Volume set too low.

Press the blue button on the stethoscope to cycle through the volume settings.

SmartScopeTM not charged (in- Recharge the SmartScopeTM. dicated by no LED illumination on the side).

Using SmartScopeTM from another ALEX/AXEL.

Use the SmartScopeTM that came with the unit you are working with. Each SmartScopeTM is paired to a single ALEX/AXEL.

Using a chest skin from another ALEX/AXEL.
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Use the chest skin that came with the simulator you are working with. Each chest skin is paired to a single ALEX/ AXEL.

Issue
No sounds heard from SmartScopeTM from
antecubital site(s), but sounds heard on torso.

Cause Using an arm from another ALEX or AXEL.
Listening to sounds on an IV arm.

Solution
Use the arm that came with the ALEX you are working with. Each arm is paired to a single ALEX/AXEL.
Sounds are not supported on the IV arm. Use a standard arm to listen to the antecubital sounds.

Single pulse site not working.

Pulse site was being touched or in close contact with a conductive object during start up.

Verify that there are no conductive objects close to the pulse locations, and the pulses are not being touched, and then restart ALEX/AXEL.

Poor video quality.

Slow connection between Unit and the PCS server.

Use an Ethernet cable to connect to the network instead of Wi-Fi®.

Poor conversation responses  logs show inaccurate questions. (only available on ALEX tiers)

Ambient noise or questions are not loud enough.

Reduce ambient noise and/or speak louder and directed at ALEX's right leg.

No conversation responses.

ALEX is not in conversation mode.
ALEX's microphone is unplugged.

Touch ALEX's shoulder to activate conversation mode.
Remove ALEX's pants and verify that the microphone is plugged in.

No video displayed on Web App.

Slow connection between simulator and the server.

Use an Ethernet cable to connect to the network instead of Wi-Fi®.

Non-supported web-browser Use Firefox or ChromeTM to

used.

access the Web App.

Power LED does not flash Plug not fully plugged in. when plugged in.

Verify that the plug is fully plugged into the wall, the power adapter, and ALEX/ AXEL.

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Issue

Cause

Power LED stays blue or turns Simulator's main computer

red after powering on.

could not start up.

Network connection.

Restricted network access.

Simulator status is unavailable on Web App
when ALEX/AXEL is turned on.

Web server down.

Network firewall/blacklist.

Solution
Power simulator off and then back on.
Contact customer service.
Power simulator off and then back on.
Attempt to connect via a wired connection (if using Wi-Fi®).
Verify that the wired connection is fully plugged into the port and into ALEX/AXEL.
Connect to a different Wi-Fi® network (see "Connecting ALEX/AXEL Via Wireless Connection").
Verify that another device can connect to https://app.pcs.ai. If it can connect, then contact your local network/IT team and inform them that you are trying to connect ALEX/AXEL over a wired or wireless network connection and provide them with the appropriate MAC address that is located on the simulator ID sticker.
If no devices can access https://app.pcs.ai from your network, then contact help@pcs.ai and our team will determine if there is a server outage.
If there is no server outage, then there is likely a firewall/ blacklist blocking access to the Web server. Contact your local network/IT team for assistance.

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Issue
Blood cannot be aspirated from IV arm.
Unilateral chest rise when ventilating.
No chest rise when ventilating.

Cause

Solution

Clamp not opened.

Verify that the clamp is opened.

Kinks in the tubing of IV arm. Verify that there are no kinks in the tubing.

Tubing has been pinched shut by the constant pressure of pinch clamps.

Slide the pinch clamp to a new position and manipulate tubing with fingers to restore the lumen.
Replace the IV tubing.

Insufficient pressure generated by gravity. Clogged line. Improper airway adjunct positioning. Air leakage from one lung.
Improper airway adjunct positioning. Air leakage from both lungs.
Air leakage from silicone airway.

Raise the IV bag higher.
Use a large 50 cc syringe to force fluid through the tubing.
Verify correct intubation positioning and depth.
Verify the connection from the airway to the lung is secure.
Inspect the lung to see if any leaks can be seen or heard. If a leak can be identified, attempt to patch it and/or replace the lung. Refer to the Replacement Parts section on page 34 for ordering information.
Verify correct intubation positioning and depth.
Verify the connections from the airway to the lungs are secure.
Inspect the lungs to see if any leaks can be seen or heard. If leaks can be identified, attempt to patch it, and/or replace the lung(s). Refer to the Replacement Parts section on page 34 for ordering information.
Inspect the silicone airway for any holes or tears. If damage is observed, contact customer service.

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Issue
No stomach inflation when ventilating.
SmartCuffTM pressure won't hold.
ALEX/AXEL does not appear to be breathing.

Cause

Solution

Air leakage from stomach bag. Verify the connections from the airway to the stomach are secure.

Inspect the stomach bag to see if any leaks can be seen or heard. If leaks can be identified, attempt to patch it and/or replace the stomach bag. Refer to the Replacement Parts section on page 34 for ordering information.

Leak in the airline or cuff.

Contact customer service to obtain a replacement.

Not able to communicate with the PCS server.

Refer to "Simulator status is unavailable on Web App when simulator is turned on" troubleshooting section.

There is no active patient for Start an active patient from

this ALEX/AXEL.

the Web App.

Clothing Measurements
Measurement Torso Length Sleeve Length Chest Inseam Waist Head Circumference Neck Circumference Foot Length Shoe Size

Inch 19" 25.5" 39.5" 27.5" 39.5" 21.5" 14.5" 9.5" Men's 6.5

cm 48 65 100 70 100 55 37 24 Men's Euro 39/UK 6

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Warnings
Defibrillation and Pacing · Do not defibrillate ALEX/AXEL or connect the simulator to an external pacing device. Doing so will void any warranty.
Rescue Breathing · This manikin is not intended for rescue breathing techniques involving human contaminants. If contamination occurs, use CDC type protocols and agents to ensure that the airway is free from biological agents before use or storing. To accomplish this decontamination procedure, it is best to remove the head and airway from the manikin. Email our Customer Service Department at alexhelp@nascohealthcare.com to obtain instructions.
Ink Transfer/Indelible Marks · Do not place simulator in contact with any printed paper or plastic. The ink will transfer and cause an indelible stain. Similar inks, such as ballpoint pen, will also cause an indelible stain.
Electronics · Do not allow water or any other fluids to come into contact with any of the exposed electrical components of the simulator.
Power Supply · Only operate ALEX/AXEL using the power supply that was provided with the simulator.
Grabbing by the Limbs · Do not pick up or drag ALEX/AXEL by the limbs or head.
Dry Natural Rubber · The tubing used for the IV Arm contains latex. Caution should be exercised for users with latex sensitivity when touching these parts.

Where to Find Additional Help

Additional information about ALEX/AXEL can be found on the help website, help.pcs.ai. For assistance with ALEX/AXEL, you may reach our customer service team:

Technical Help Website: Help Email Address: Customer Service Number:

help.pcs.ai alexhelp@nascohealthcare.com 1-833-NASCOHC (627-2642)

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Additional Supplies/Replacement Parts

101-7110L 101-7110R 101-7110LM 101-7110LR 101-8029 101-8029M 101-8031 101-8032 101-8038 101-8038M 101-8039 101-8039M 101-7119 101-7119M 101-7115 101-7116 101-7117
101-7117M
101-7160 101-7160M 101-7161 101-7161M LF09919 101-7120 101-7162 101-7163 101-7164

ALEX/AXEL Replacement Arm Left ALEX/AXEL Replacement Arm Right ALEX/AXEL Replacement Arm Left Medium ALEX/AXEL Replacement Arm Right Medium ALEX/AXEL IV Arm ALEX/AXEL IV Arm Medium SmartScopeTM SmartCuffTM ALEX/AXEL Male Genitalia ALEX/AXEL Male Genitalia Medium ALEX/AXEL Female Genitalia ALEX/AXEL Female Genitalia Medium ALEX/AXEL Male Replacement Overlay ALEX/AXEL Male Replacement Overlay Medium ALEX/AXEL Lung Bag ALEX/AXEL Stomach Bag Universal ALEX/AXEL Replacement Skin/Tubing Universal ALEX/AXEL Replacement Skin/Tubing Medium ALEX/AXEL Female Accessory Kit ALEX/AXEL Female Accessory Kit Medium Replacement Female Overlay Replacement Female Overlay Medium Nasco Cleaner Replacement Tablet Blonde Wig Brunette Wig Black Wig

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COPYRIGHT © NASCO 2021 PRINTED IN U.S.A. NP065-17/RV4-21
References

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