iElastance vs SimShockPad

iElastance is an application designed for calculate Ventricular Elastance, Arterial Elastance and Ventricular-Arterial Coupling using Echocardiographic derived values in a single beat determination. This application is extremely useful to a variety of health care givers such as Cardiologists, Intensivists, Anesthesiologist and more who want to calculate ventricular arterial coupling even in the Critical Care setting and, above all, bedside. The variables needed for the calculator to work are: Systolic Blood Pressure (mmHg) Diastolic Blood Pressure (mmHg) Stroke Volume (ml) Ejection Fraction (%) Pre Ejection Time (msec) Total Ejection Time (msec) Formulas are validated and extracted from the article by Chen CH et Al J Am Coll Cardiol. 2001 Dec;38(7):2028-34. DISCLAIMER: The calculator provided is not meant to be a substitute for professional advice and is not to be used for medical diagnosis. Extensive effort has been exerted to make this software as accurate as possible; however the accuracy of information provided by this software cannot be guaranteed. Health care professionals should use clinical judjement and individualize therapy to each patient care situation. All rights reserved - 2024 Pietro Bertini

SimShock is a hemodynamic simulation game. It is not a teaching or instructional tool, nor is it a clinical simulator. Think of it as a home flight simulator: true to the spirit, carefully made, but still a game. One critically ill patient, vital signs changing in real time, and very little room for error. The patient may arrive with heart failure, massive hemorrhage, septic shock or an arrhythmia. Each condition behaves differently, and what saves one patient can sink another. NEW HEMODYNAMIC ENGINE A new model links heart rate, stroke volume, cardiac output and vascular resistance to filling pressures. The baroreflex has two arms and can become exhausted, each patient has an individual sensitivity to each drug, and infusions have a therapeutic window: inside it they do their job; outside it, they do something else. No drug has a hard ceiling — if you overdo it, you will see the consequences. Real physiology is far more complicated. Many rules have been deliberately simplified to make the game playable. THE THREE SCREENS · Monitor — real-time ECG and pulse waveform, with systolic pressure, heart rate and venous pressure shown in traffic-light colors. Ventricular and supraventricular arrhythmias may develop spontaneously during a case. · Hemodynamics — cardiac output, cardiac index, vascular resistance, capillary and pulmonary pressures, stroke volume, blood volume and ventricular work, displayed as either values or a profile. · Trends — 1-, 5- and 10-minute evolution with an event log: this is where you can see exactly where the game went wrong. ACTION BUTTONS · Norepinephrine — at high doses, increased resistance chokes the ventricle: capillary pressure rises and cardiac output falls. · Dobutamine — increases cardiac output without increasing blood pressure. At high doses: tachycardia and hypotension. · Dopamine — above 20 µg/kg/min it irritates the ventricle: ectopic beats after ten seconds, ventricular tachycardia after twenty-five. · Nitroglycerin — unloads the lungs quickly, and can take the blood pressure down with it if the patient has little to spare. · Furosemide — makes a difference in the fluid-overloaded patient, not in the dry one, no matter how high you turn it up. · Saline and transfusion — finite bags: every milliliter counts. · Antibiotics — three regimens and one source of infection. Only the regimen that covers it works, and the infection itself must be controlled (Infection Control button). · Antiarrhythmics — adenosine, diltiazem, esmolol, propranolol, procainamide and amiodarone. · Defibrillator, non-invasive ventilation and transfer to intensive care. · Transfusion — transfusing alone is not enough: the bleeding must also be controlled (Bleeding Control button). THE CONTROLS · Notes — the assistant tells you what the patient still needs to become stable. · The doctor — tap to switch between a male and female doctor. If things go wrong, the expression changes. · Events — a log of what you did and when. · Pause — freezes time. Speed makes it run faster or slower. · Difficulty — changes how the patient evolves, not the reference ranges. · Arrhythmias — from off to a randomized 30% probability, or automatic according to difficulty. · Patient — variable or standard. Switch it off if you want reproducible games. · Random — hides the condition name and switches off the traffic lights: you have to read the numbers. · Exam — ten consecutive cases with scoring. · Cockpit — switches between the classic interface and the command-station view without losing the current game. · Language, Instructions and volume from 0 to 100 next to the clock, with a separate mute control. NOTICE SimShock is a game that represents pathophysiological situations in a simplified way. It is not an educational tool or a clinical guide, and it does not provide medical advice or recommendations. Always consult healthcare professionals.