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.
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