Arterial hypoxemia and hypercarbia automatically provoke hemodynamic abnormalities and cardiac dysrhythmias. The mannequin has a speaker allowing a confederate to be the patient's voice. Trainees unfamiliar with care of AAA patients often respond with excessive medication and soon after induction find the patient severely hypotensive, requiring heroic resuscitation with fluids and drugs. The trainee eventually learns from the simulated surgeon that the AAA has ruptured. The trainee is given opportunities to repeat this case.
Most residents handle the preinduction pain much differently on later attempts.
Today's simulators provide sophisticated models of the cardiovascular system. If the ECG lead disconnects or the blood pressure tubing kinks, no data or artifactual data are reported on the physiologic monitor. Normal and abnormal heart sounds are auscultated with a stethoscope in appropriate precordial locations, and peripheral arterial pulses can be palpated as long as the simulated patient is not hypotensive. A few years ago, patient simulators were demonstrated at the annual meeting of the Colorado Society of Anesthesiologists in Vail, Colorado. Just prior to opening of the exhibition area, anxious technicians summoned an anesthesiologist.