Medical Monday; Paediatric Chest Drain

So here we go, with needing to modify another airway trainer for an A&E Insitu, so we can do a practise procedure that we'd normally do with meat. Chest Drain insertion training is something we'd generally do up in the lab, with animal ribcages covered in stretched skin. Not something we can do down in A&E (or ED as we're meant to be calling it now apparently- perhaps dropping the word 'Accident' will persuade people not to come in, and cut down on those waiting lists eh).

This is Kitty. She, like her plastic sister Frankie, was built from spare parts found in the A&E store. Specifically, she needed new lungs, repairs to her head, chest cavity, and a replacement hip joint. She has become a She permanently, partly to hide the head damage, and partly because the moulded, skin-toned plastic hair is bloody awful. Kitty- built as a Kit of parts. 

So, we needed to do a Chest Drain insertion. Poking a hole in the robot kids was out of the question, so Kitty drew the short straw. Anyway, an important part of the procedure is getting the insertion in the right place, with regards to the ribs, so I'd need to make her a rib cage. Broadly the same procedure as with the adult thoracotomy model, but made a litte trickier by her compact side. I drilled 4 holes and coping-sawed out a hole into her chest cavity.

As with the Thoracotomy model, I used airway kit to make the ribs, in this case, Paeds LMA's which we had on strength (and never use).

They were a bit too flexible, so I strengthened them with oxygen piping.

Making more right-angled bracing from cable troughs. As with the Thoracotomy model, this was to hold internal organs in place (though there was less room for them here with the gubbins for the CPR.

The 'lung'; this was a bit of a short-notice addition, and is just a balloon filled with teddybear stuffing. I'm working on a plan however, to fill this with fluid so a proper chest-drain prodedure can be carried out.

To make this model re-usable, the outer layer of skin needed to be removable, so I used some scavenged bolts, and a piece of the same flesh-coloured felt-backed material from the C-Section trainer.

Not, perhaps, the neatest solution, but it does the job. As this hopefully shows, there's a layer of thick foam (for the muscle wall), and the ribs are held with cable ties drilled through from the plastic chest wall, through the pipe robs, and back out again.

Detail of the cable-ties holding the ribs in.

Modifications were needed to the plate for the CPR compressions; the trouble was, Kitty needed to stay in use as an airway trainer, which meant cutting a slot out to clear the ribs. This also then needed a new central brace to support the plastic plate that sits under the stomach. Not a graceful solution perhaps, but it does the job.

Low-budget patient transfer; normally we move the kids in a wheelchair, but Kitty doesnt bend very well. Strapping her to the flatbed helped, though I ended up covering the whole shebang with a blanket so as to not spook the normal people in the main hospital (passing the canteen and shops) as I wheeled her back and forth.

As an aside, even though it has nothing to do with the scenario, the teddy is present as it's 'hers'. All the kid-robots and task trainers have a teddy of their own, which travels with them for insitus. It's a Human Factors prompt, how the treating medical staff interact with the child, and the toy, is one of those pointers for how well they treat the patient and display their bedside manner. 

So, the scenario. Poor dear was playing in the garden, punted her ball out into the road, ran out to get it, and was mashed by a prat in a Range Rover (the two terms often being synonymous here in Bradford) who did a runner.

A few additional wounds- but this time, not too many. We often have a 'distracting' wound (head injury, broken arm) on these, to distract from the 'real' one, but not this time as we wanted the focus on the chest drain requirement. That said, I felt the poor kid needed some road-rash, bruising, and grazing, just for reality.

Blocked and spinal-boarded, with a pelvic binder, which made her scream like a banshee.

On which note, that was something that had to be improvised. See, Kitty is no robot, so has no onboard electronics, and hence, no sounds. So I ended up taking Hallie's controller, and rigging up a set of speakers hidden under the head-end of the bed, so I could play the vast variety of screams, shrieks, cries, and such that me and one of the previous techs, Polly, recorded.

The procedure went very well; the staff recognised the problem, acted accordingly, and in went the chest drain. Once again, it was amusing to have Doctors worried about cutting into the mannequin; we've done too good a job training them not to go anywhere near the robots with a knife. In through her normal skin, the vinyl/felt, the foam, and into the chest.

Patient survived the procedure, ready to be stablised and blue-lighted to either Leeds or one of the specialist kids hospitals.

Pipe out, and you can hardly see the damage. A little glue on the skin layer, and a bit of repair on the vinyl and felt, and you'll never know it had been cut.

Another interesting little project, with room to develop it further, and to a higher level of fidelity. Plus, Kitty will be getting to have a bit of an adventure; by the time this is published, she'll have been to the National Sim Tech Conference in Maaadchester in order to demonstrate upcycling and low-fi construction techniques in Sim. 

Garden Railway Saturday; P.S Models Corris Vans

A recent project for the garden railway; with the line set nominally sometime in the late 1980's to early 1990's, in British Rail ownership, it made sense to paint the engineering stock in bright (but weathered) BR engineers colours.

A pair of Phil Sharples models Corris vans were purchased (they're lovely kits, and great value).

A bit of extra detailing - MDF sprues cut-down to make framing.

For a bit of variety, one van was modified with a bit of thin plasticard to represent a modernised/updated van, the original plaking plated over. Also note the floor from plastic strapping (both vans were modified to have part-open doors for interior details).

A base coat of black, over which the body colours were either sprayed or dry-brushed.

For the roofs, I used it as an experimented with the technique of moulding a curve into the material. Strapping/taping to an empty can, then filling the can with boiling water, then cooling the card to set the shape.

Chevron stripes added to the older van with Tamiya masking tape.

For the detail parts inside, a bumper box of old Playmobil tools were bought off eBay (a little out of scale for these wagons, but they look the part, and saved a fortune on 3D printed components).

Just enough on show to indicated the purpose of the wagons.

Quite a lot of weathering- these are meant to be engineers wagons in everyday use, cared for but getting a battering.

And here they are, in the mag.

 

Medical Monday; A Synthetic C-Section Trainer

It's been a wee while since the last Medical Monday, but that's more a reflection of the size of the projects I've been working on at the hospital over the Spring and early-summer.

One such project is this- a synthetic model for C-Section training...

So here's the brief; recently, we've had a need to do a few training sessions in the Big Hospital, around C-Sections. The staff have been re-drawing the Standard Operating Procedures, and that's meant some 'surprise' (i.e, surprise for the staff) simulations to test response times and techniques. 

This poses a problem; when we do C-Sections as part of courses, we use bought-in kits to make Meat Models. Essentially, a realistic baby doll in a balloon (we fill it with water), under a sheet of silicone, under some real bowel, then plastic apron, then a big sheet of pork belly. All of we cable-tie to a bespoke base. 

The problem? In the lab, on a tabletop, it works well. We got asked to do it on an insitu back in Jan in the ICU, which involved us taking our awesome Pregnancy Robot, Mama Anne, and a meat model, into one of the isolation rooms (which needed a deep clean afterwards). Feedback identified that it broke the scenario a bit, having to pause the scenario, wheel-in a meat model on a trolley, and cutting that instead of the mannequin.

We were asked, for the re-run of the Insitu, to make it 'a little more realistic' and have the meat model incorporated into the robot. Tricky, without sawing a £120k robot in half with a chain saw, so I improvised with the upper body of a Rescusi Anne, and legs made from towels shoved into PJ bottoms. Not bad, except for the the proportions... maybe she was a pregnant US Female Basketball champion, as she ended up about 7 and a bit feet tall.

We then got asked to do it again, this time in A&E. This was, indeed, a problem, as this time, we could have NO meat. Oh, and they needed to be able to still do CPR on the mannequin. Oh and there'd be a Doc playing the patient outside, who needed to look pregnant (beachball under her jumper being the stupidly low-tech solution). Oh, and the Yorkshire Ambulance Service would be involved. 

Raiding the scrap-pile. Thank goodness the NHS manages to both be piss-poor and incredibly wasteful at the same time eh?

 

Actually, these are at least a decade old, were written off as scrap as they are ker-nackered, but nobody threw them away in case they came in useful one day. And to be fair, they were right, all it needed was a weird Technician (me!) to come along.

Dismantling of one torso chassis underway; this is the crumbling foam stomach. I ended up chopping this to bits...

...because I needed to alter the proportions of the body. To stop her looking like the aforementioned basketball champ, the womb area would need to be placed a little higher up the body. That meant cutting down the size of the plastic plate for the CPR, and putting in a new bulkhead, to which could be attached a new lower half with a womb. Note the baseplate marked ready for cutting...

And using parts from a wiring cable trough to create L-section reinforced brakcets, part of the stomach moulding used to create a new bulkhead to seperate the CPR part from the womb area.

Two important bits; breasts made from another lot of Rescusi Annie skin (with breast examination pads inserted behind), and the womb from a scrap Adam Roully C-Section base and baby that could slide-in to the torso chassis, being seccured with velcro pads.

With the meat model, we use the baby in a balloon (specially put in, in a party shop), then silicone, then real bowel. For this one I used a pair of popped playballs that the Scouts had destroyed in games, and a section of punctured bicycle inner tube scrounged off a fellow technician.

For the skin, vinyl with felt backing, cable-tied on, over a layer of inch-thick foam sheet.

The Doc running the show then said the Babbie needed an umbilical and placenta; I used some transparent pink plastic from another popped inflatable (thank goodness my Scouts like destroying toys during games nights), with a windpipe upcycled from a broken robot skin.

Blood-soaked sponge inside, then two circles of vinyl put together with hot-glue (and more glue used to create veins and lumps).

Put into a vacuum-sealed bag.

And filled, laboriously, with water by puncturing the bag and piping in water. Remember when you used to be able to win goldfish in bags at the fair?

The legs next- blanking plates made from scrap MDF and ply, to attach to the stumps on the womb trainer.

Then flexible plastic tube scavenged from a broken ventilator.

Leg bones; the knee joints are foam, with leg bones made from the slats of a broken roller-shutter door from a cupboard.

This way, the legs would be vaguely flexible. These would be wrapped in towels to soak up the blood and water when the bag was cut- bearing in mind I didn't want to make too much mess in a live Resus bay. The towels would then be hidden inside a pair of PJ bottoms.

For the feet, the end of the pipes were curved around, inserted into bedsocks, then padded out with teddybear stuffing.

Here she is, on the table, ready for the op, with an electronic Sim Pad plugged in to do the obs (and the Doc hidden at the head of the bed to voice her, whilst I hid behind the console to run the obs).

So, the scenario- she's pregnant, has a collapse in the car park, bought in by the YAS crew, and she has a heart attack on the table. Quick, we need to get the baby out, whilst more of the team bang-away at the heart to try and keep it pumping.

Cut...

Baby out, cord clamped... Mom revived, babbie delivered safely. Scenario largely successful, and I can relax after a fairly high-stress build.

And here's the model back home in the education department. To re-use it, all it needs are new towel legs, a new umbilical cord, baby in a new bag, another playball to put the baby in, and the 'skin' re-suturing.

The only real damage? The velcro pads which attach the lower section to the airway chassis needs some work, and re-gluing.

Overall, very, very happy with how this turned out. Considering it was built on no budget from scrap parts, it all turned out as the docs specified, and didn't stuff-up the scenario.