Thoracic TraumaTrainer
LM-093
Instruction Manual
Thank you for purchasing the LM-093 Thoracic Trauma Trainer.
Please read this instruction manual carefully to ensure correct use of the product,and store it in a safe place for easy access.

Manufacturer:

KOKEN CO., LTD.
1-4-14 Koraku, Bunkyo-ku, Tokyo 112-0004 JAPANwww.kokenmpc.co.jp

EU Authorized Representative for KOKEN CO., LTD.:EC REPMDSS GmbH
Schiffgraben 4130175 Hannover, Germany
www.mdssar.com©2019-2022 KOKEN CO., LTD. C-1-977-1-02-00

Handling and Safety Precautions
These precautions should be strictly observed in order to ensure safe,long-term use of the product.
The following precautions should be observed particularly strictly:
1. The model has a realistic feel. Careless handling may cause damage.
2. When handling the model (preparation, replacing puncture sites, cleaning, etc.), the simulated
blood may soil operators or the nearby area. When preparing the model, replacing the puncturesites, cleaning, or carrying out other tasks, prepare tissues or similar supplies ahead of time, andfrequently wipe up simulated blood on connectors and injection syringes.
3. Please do not place objects on the model. This may cause deformation of the skin.
4. To clean the model, wipe with gauze that has been soaked with water or a neutral detergent
diluted with water. Do not use solvents such as thinner or benzene, as these will cause damage.
5. Do not use oil-based inks or paints. They can soak into the model and may be impossible toremove.
6. In the event that pericardiocentesis site or skin fails to cause leakage of fluid, but fluid does leakgradually after multiple punctures in the same site, replace with a new part.
7. Use of wider needles shortens the life of pericardiocentesis sites, thoracentesis sites, and various
types of skin.
8. Choose a storage location where the model will not be exposed to direct sunlight. Hightemperatures may cause deformation, discoloration, and malfunction.
9. Remove the head model from the main body when storing unused for over one month.
10. This product is intended for use in standard operating environments. Do not use it in heavy
industrial settings.
11. This model uses urethane foam for some of its parts, and may be susceptible to damage frompests that are attracted to urethane foam (such as insects in the ant family).
When storing this model, ensure that thorough measures are taken to prevent pest damage
before storing. The company will not be involved with or held liable for pest damage that occurs
during storage.
12. Attached batteries are for the usage of operation check. There is a possibility that battery life isshort.

Caring for the simulator after use
Because the simulated blood may solidify when the model is stored for long periods, remove bloodfrom the pericardiocentesis site, the simulated blood pathway, and the simulated blood tank.
1. The contents of this instruction manual are subject to change without notice.
2. This operation manual cannot be reproduced in whole or in part without permission.
3. Please notify us in the event that you find any errors or omissions in the contents of this operation manual.
4. Please use the product according to the instructions in this operation manual. In particular, refrain from use
contrary to the methods given in the precautions.

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Table of Contents

1. Outline and Features

2. Configuration

3. Handling the model
3-1. Preparation for use
3-2. Puncture and Incision of the Cricothyroid Ligament
3-3. Thoracentesis
3-4. Thoracic Drainage
3-5. Pericardiocentesis

4. Specifications

5. Supplies (Sold Separately)21. Outline and Features
OutlineHigh-energy trauma often consists of multiple injuries, and thoracic trauma can be considered
key when determining priority in treatment. This thoracic trauma trainer is a model that combines
practice in surgically securing the airway with practice in the treatment of obstructive shock.
Additionally, this single model can be used to practice five different techniques: Puncture of theCricothyroid Ligament, Cricothyroid Ligament Incision, Thoracentesis (Left and Right), Thoracic
drainage (Left and Right), and Pericardiocentesis.

Featuresa. Puncture and Incision of the Cricothyroid Ligament
・ The puncture/incision site includes the airway, cricoid cartilage, and thyroid cartilage.
・ Attach your own surgical tape (paper) to simulate the cricothyroid ligament.
・ The cricoid cartilage and thyroid cartilage are structured so that they can be opened as aprocedure for widening the incision.
・ The skin is made with silicone, giving it an appearance and texture similar to real skin,making training more realistic.
b. Thoracentesis (Left and Right)
・ Air can be injected to create swelling of the left or right side of the chest (tension
pneumothorax, subcutaneous emphysema).
・ Distension of the jugular vein can be simulated in conjunction with swelling of the chest.
・ The sternal angle and second intercostal space are present for use as landmarks for thepuncture site.
・ Upon puncture, the air flows out, and the swelling of the chest and distension of the jugularvein subside.
・ When there is a syringe attached to the puncture needle, air pressure will lift the plunger.
・ The skin is made with silicone, giving it an appearance and texture similar to real skin,making training more realistic.
*Use a needle smaller than 18G.

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c. Thoracic Drainage (Left and Right)
・ Two types of sites are available (one that is uncut, so that an actual incision can be made,and one that is precut for repeated use), and procedures can be carried out on both the leftand right sides.
・ Actual insertion of drainage tubes (trocar catheters, etc.) is possible.
・ The fifth and sixth intercostal spaces are present for use as landmarks for the insertion site.
・ Attach your own surgical tape (paper) to simulate the pleura.
・ The skin is made with silicone, giving it an appearance and texture similar to real skin,making training more realistic.
d. Pericardiocentesis
・ A framework (xiphisternum and costal arch) for identifying the pericardiocentesis site ispresent.
・ Simulated blood can be drawn when a puncture with the correct angle and depth has been
made.
・ An error alarm will sound when the angle is incorrect or the puncture is too deep.
・ Distention of the jugular vein can be simulated. (Manual type)・ The skin is made with silicone, giving it an appearance and texture similar to real skin,making training more realistic.
*Use a needle smaller than 18G.

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2. Configuration

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Product nameMain Body of the Thoracic
Trauma Trainer (IncludingHead)
Cricothyroid Cartilage Skin
(No Cut)
Cricothyroid Cartilage Skin
(With Cut)Cricothyroid Cartilage PartThoracentesis Skin
Simulated SubcutaneousEmphysema Part
Thoracentesis Site (Right)

8

Thoracentesis Site (Left)

122

9

Thoracentesis Framework(Right)Thoracentesis Framework(Left)
Thoracic Drainage Site
(Right): With CutThoracic Drainage Site(Right): No Cut
Thoracic Drainage Site(Left): With CutThoracic Drainage Site(Left): No Cut

123

Pericardiocentesis Site for Thoracic
TraumaMount for Pericardioicentesis Site forThoracic Trauma
Main Body Skin for Thoracic Trauma

124

Simulated Blood (Dark Type) 500 mL

1125

1

126

1

Pericardiocentesis Simulated Blood
Tank for Thoracic Trauma
Pericardiocentesis Sponge Stand forThoracic Trauma
Stand1AA Batteries

4Soft Case

11234561011121314Quantity
115

Product nameThoracic Drainage Base (Right)

1

116

Thoracic Drainage Framework (Right)

1

117

Thoracic Drainage Base (Left)

112
2181920Thoracic Drainage Framework (Left)
Pericardiocentesis Site Sponge Sheet
Pericardiocentesis Site Skin

1
1
1

121

1

5

1
111

3. Handling the model
3-1 Preparation for use
The main body and the head model are stored separately in the storage bag.

Before using, insert the head model into the neck of the main body.

63-2 Puncture and Incision of the Cricothyroid Ligament
Configuration and Names(1) Cricothyroid Cartilage Skin (With Cut)

(2) Cricothyroid Cartilage Skin (No Cut)

(3) Cricothyroid Cartilage Part

(4) Housing for Cricothyroid Cartilage Part

Instructions for Use
Remove the cricothyroid cartilage skin (1) or (2) and take out the cricothyroid cartilage part.

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The space between the cricoid cartilage and thyroid cartilage parts of the cricothyroid cartilage
part can be expanded from 6 mm to 15 mm.
Do not expand beyond 15 mm. Excessive expansion may cause breakage.

To simulate the ligament in the cricothyroid cartilage part, attach surgical tape to the space
between the cricoid and thyroid cartilage parts while it is closed.
Please use your own surgical tape. Because the resistance and feeling when puncturing
or making an incision in the cricothyroid ligament will differ based on the tape, adjust it
by changing the number of pieces used.

8

Place the cricothyroid cartilage part in its housing in the main body of the model.
Attach the cricothyroid cartilage skin (with or without a cut).

9Preparations for puncture or incision of the cricothyroid ligament are complete.

103-3 Thoracentesis
Configuration and Names(1) Thoracentesis Site

(2) Thoracentesis Framework(3) Simulated Subcutaneous Emphysema Part (4) Thoracentesis Site Skin
(5) Thoracentesis Part Housing* There is one set of parts for each side (left and right)

Instructions for Use
Release the clip on the side on which you would like to simulate pneumothorax. Using therubber bulb to inject air will swell the side of the chest on which you wish to simulate thepneumothorax, recreating distension of the jugular vein.
Example: When you wish to simulate pneumothorax on the right side, release the clip on theright side and close the clip on the left side. The chest will swell on the right side, simulating
distension of the jugular vein.

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Injecting too much air may cause the balloon that simulates distension of the jugularvein to burst. Please do not squeeze the bulb once you begin to feel resistance.

Distension of the jugular vein is simulated on both sides, regardless of whether pneumothorax issimulated on the left or right side.
As more punctures are made, the amount of air leaking from the thoracentesis site
increases, and the plunger of the injection syringe may not rise at the time of puncture.
When this is the case, repeat the injection of air with the rubber bulb immediately
before puncture.

After injection of Air

Before injection of Air

Preparations for thoracentesis are complete.
When there is no swelling of the chest even when air is injected to the thoracentesis siteusing the rubber bulb, replace the thoracentesis site with a new one according to page 13,"Replacement of the Thoracentesis Site".

12Replacement of the Thoracentesis Site
Remove the tube from the connector on the back of the neck.

Remove the thoracentesis site skin and the simulated subcutaneous emphysema part fromthe main body of the model.

13Remove the tube and connector of the thoracentesis site, passing them behind the skin of themain body. Lightly pull the skin back, and remove the thoracentesis framework and thoracentesissite from the main body.

Remove the thoracentesis site from its framework.

Fit the surface of the new thoracentesis site and the gap in the thoracentesis framework together
and insert.

14

The left and right thoracentesis sites differ
in shape.
Pay attention to the shape when attaching.

Pass the tube and connector of the thoracentesis site behind the skin of the main body
towards the neck. Lightly pull the skin back and insert the thoracentesis framework and thethoracentesis site into the main body.

Insert the simulated subcutaneous emphysema part between the skin of the main bodyand the thoracentesis framework.

15

Insert the thoracentesis site skin between the skin of the main body and the simulated
subcutaneous emphysema part.

Connect the tube of the thoracentesis site to the connector in the back of the neck.

16

Replacement of the thoracentesis site is complete.

173-4 Thoracic Drainage
Configuration and Names(1) Thoracic Drainage Site

(2) Thoracic Drainage Framework(3) Thoracic Drainage Base

(4) Thoracic Drainage Site Housing* There is one set of parts for each side (left and right)
Thoracic drainage sites consist of those without cuts (which are actually cut during use) andthose with cuts (which can be used repeatedly).

Without CutWith Cut

The type without cuts is useful in identifying the site where the incision is actually made.
The type with cuts is useful when training will be repeated by multiple trainees.

When training will be carried out repeatedly, we recommend that powder be applied
to the thoracic drainage site beforehand.

18Instructions for Use
Insert a finger into the thoracic drainage site from the head side, and remove the thoracic
drainage site, framework, and base from the main body.

Slide the thoracic drainage site and framework off their base. After removing them, remove thethoracic drainage site.

19

Attach surgical tape to the thoracic drainage framework in order to simulate the pleura.
Please use your own surgical tape. Because the resistance and feeling whenpuncturing or making an incision in the pleura will differ based on the tape,adjust it by changing the number of pieces used.

Line up the directions of the letters that are stamped on the side of each part (R for right and L
for left), place the thoracic drainage site on the thoracic drainage framework, and then slide onto
the thoracic drainage base to insert.

20

Insert into the main body from the abdominal side, and push in the side that is in thedirection of the head.

21

Preparation for thoracic drainage is complete.

223-5 Pericardiocentesis
Configuration and Names(1) Main body of the Thoracic Trauma Trainer(2) Pericardiocentesis Site

(3) Mount for Pericardiocentesis Site		(4) Sponge Sheet for Pericardiocentesis Site

(5) Pericardiocentesis Site Skin			(6) Simulated Blood Tank

Instructions for Use
In its open position, connect the three-way stopcock of the simulated blood tank to theconnector in the back of the main body's neck.

Three-way stopcock

Pour the simulated blood into the tank and open the stopcock.

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The parts in the figure below are set up in the main body of the model.

pericardium partTube

Two-way stopcock

Use an injection syringe to remove the air in the pericardium part of the pericardiocentesissite and the tube through the two-way stopcock.

Two-way stopcock

Close Once Removal of Air is Completed.

Place the main body of the model on top of the sponge stand for pericardiocentesis. Hang
the simulated blood tank on the stand and loosen the cap.

24

When the cap of the simulated blood tank has not been loosened, there will be
negative pressure in the simulated blood pathway, making it impossible to withdraw
the simulated blood, even when pericardiocentesis has been carried out correctly.
The panel that is located on the abdominal side of the main body of the model will emit an error
alarm when the puncture needle has gone too deep during pericardiocentesis.
Place 4 batteries (AA) in the battery box, paying attention to the directions of their positive andnegative terminals.

Turn the switch of the panel on. The green light will come on. The red lamp will light if thebatteries have insufficient power.

25

In order to simulate distension of the jugular vein during pericardiocentesis, close the clips on
both sides and inject air using the rubber bulb.

Preparations for pericardiocentesis are complete.
If too much simulated blood leaks from the pericardiocentesis site for the sponge sheet
to absorb, replace with a new pericardiocentesis site, referring to "Replacement of thePericardiocentesis Site" on Page28.

26

Simplified Diagram of the Model Interior

The effective range of the pericardial area is as shown above. In the event of pericardiocentesis
outside of this area, the puncture needle will reach the error area, and the error alarm will sound.
However, when the angle of pericardiocentesis causes the needle to enter the gap in the error
area through which the simulated blood pathway passes, the error alarm may not sound,because the error area will not be contacted. When the error area is not contacted, the injectionsyringe will draw air.

27

Replacement of the Pericardiocentesis Site
Remove the pericardiocentesis site skin and the pericardiocentesis site sponge sheet.

Close the stopcock on the simulated blood tank. Close the clamp of the simulated blood
pathway tube.

After closing the three-way stopcock of the simulated blood tank, remove the connector.

Simulated blood may leak when the connector is removed. In order to avoid dirtying
the surrounding area, we recommend that you work above a tissue. Moreover, thesimulated blood that is on the connector and three-way stopcock should be frequently
wiped.

28

Remove the skin from the middle part of the back.

Squeeze the tab on the connector of the error part (located on the hip) and remove theconnector.

Rotate the locks on the puncture site mount holder so that their flat sides are facing inwards.

29

Remove the pericardiocentesis site mount from its holder.

Attach the new pericardiocentesis site to the mount.

Rotate the locks on the pericardiocentesis site mount so that their flat sides are facing inwardsand insert the aforementioned parts into the pericardiocentesis site mount holder.

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Simulated Blood Pathway Tubes are on the top

After confirming that the pericardiocentesis site is housed in its place in the chest area of themain body of the model, lock the locks of the pericardiocentesis site mount holder.

Hook up the error part connector and replace the skin of the main body while fastening theVelcro.

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Place the pericardiocentesis site sponge sheet on top of the pericardiocentesis site.

Insert the pericardiocentesis site skin between the main body and its skin.

Replacement of the pericardiocentesis site is complete.
Connect the simulated blood tank and prepare for pericardiocentsis, referring to page 23,"Instructions for Use".

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4. Specifications
Main bodySponge Stand

LengthApprox. 73 cm
Approx. 45 cm

Width
HeightApprox. 40 cm Approx. 20 cm
Approx. 30 cm Approx. 9cm

WeightApprox. 8 kg
Approx. 560g

* The angle of the sponge stand is Approx.10°

5. Consumable items (Sold separately)
For Puncture of the Cricothyroid Ligament / Cricothyroid Ligament IncisionLM -093B1
LM -093B2

Cricothyroid Cartilage Skin (No Cut/10pcs)Cricothyroid Cartilage Skin (With Cut/5pcs)

For Thoracentesis
LM -093CR
LM -093CL
LM -093D

Thoracentesis Puncture Site (Right)
Thoracentesis Puncture Site (Left)
Thoracentesis Puncture Skin (2 Pcs)

For Thoracic Drainage
LM -093ER
LM -093EL
LM -093FR
LM -093FL

Right Thoracic Drainage Site (With Cut)
Left Thoracic Drainage Site (With Cut)
Right Thoracic Drainage Site (No Cut/5pcs)
Left Thoracic Drainage Site (No Cut/5pcs)

For Pericardiocentesis
LM -093G
LM -093H
LM -090E

Pericardiocentesis Site for Thoracic Trauma
Skin Set for Pericardiocentesis Site for Thoracic Trauma(Pericardiocentesis Site Sponge Sheet and Pericardiocentesis
Site Skin)
Simulated Blood (Dark Type) 500mL33