Learning hemodynamics is hard. I created a simulator that let's you titrate vasopressors, inotropes, vasodilators, and fluids across different hemodynamic states. How can I make this even more realistic? Still some hemodynamics responses to optimize. Try it and let me know👇

As part of this simulator, you can also go in "mystery mode" where you get a random hemodynamic profile you need to determine based on response to different drugs... all without having your patient have a cardiac arrest! Really appreciate feedback on this hemodynamic gurus out there!

One step closer to the anaesthetic machine having a big red "optimise patient" button on it.

Can you put echo clips in there? Simulate changed in cavity size/wall thickness etc?

Interesting! I can certainly try... let me think about that a bit more. Are you imagining the actual echo image would change over time dynamically throughout the sim. E.g. EDV changes?

YEP...I always understand better when I can see it.

Is there a way you could add a pulmonary vascular resistance parameter to it? High dose phenylephrine worked decently well to treat RV failure, which I don’t think would happen in real life

Good call, will improve that logic. I have it built in for RV failure and inhaled NO but should have it penalize use of alpha in some circumstances

@slippish When I added milrinone to rv failure it didn’t help. I thought it was indicated in rv/PH?

@slippish It should help, but does depend on the SVR too. What dose and how long? The slow half-life may not be super well represented in this sim but am updating the hemodynamic engine so can optimize

I would add coupling parameters to calculate Ea and Ees

Capillary refill time Options for fluid removal And somehow an Andromeda Shock 2 protocol option to work through it Also Methylene blue & Hydroxycobalamin :)

Amazing job Ross!!! Would love a PCWP reading which would unlock PH crises, and LV Failure vs Biventricular failure as distinct etiologies to play around with. How about Lasix as well?

On it! I struggle with lasix because the diuretic response is so much slower than onset of most of the other infusions

Coolest thing I’ve seen today!

This is awesome! Did you build your own physiology engine or are you using a pre existing one (eg BioGears)?

Diuresis and a possible dialysis module? Not sure I’m not using it correctly though and may have missed it😂

This is amazing Ross. There’s definitely scope to add additional clinical info eg. assessments of fluid responsiveness, echo/POCUS findings. In time you could build this into a comprehensive ICU simulator to aid with exam prep and CPD.

Can it be used in low resources settings where we only have access to HR and BP values?

How does it compare to Harvi? . We have to remind Students that Simulators do not predict real patient responses, so cannot be called Educational tools. Just for fun.