Instructor guide

Solo learning — what a learner does

1. Open Practice cases → Virtual ICU bed in the app menu (or the tile on Home).
2. Pick a patient from the list — filter by category or level, search, or press 🎲 Random patient. The count on each chip is how many cases it holds.
3. Read the brief, then Begin. Each decision has a clock (60 s, or 40 s in consultant pace). Every answer is graded best / acceptable / harmful with feedback, and the patient's physiology moves accordingly — a harmful choice creates a complication the learner must then rescue.
4. At the end: an outcome, a percentage, a debrief of every decision, consultant pearls and the evidence. Pass = 75% or more with no harmful decision. Best scores stay on the device; every attempt is also logged to the account (section 7).

Running a class — the 5-minute setup

1. On your laptop or tablet, open the Virtual ICU bed and either Open the simulator (free play) or start a case.
2. In the 📡 Live session panel press Start live session. A 6-character code, a link and a QR code appear.
3. Learners open the link or type the code at https://icu.emtupo.com/icu-bed/live on any phone — no account needed. Put the same link on the projector and press Fullscreen there.
4. Leave Broadcasting ticked. From now on, everything on your bedside — rhythm, vitals, lines, ventilator, labs, the 12-lead, images, and the case you are running — appears on every learner screen within a second or two.
5. End session when you finish; learner screens show "Session ended".

The remote control — what you can push to every screen

• Instructor controls (in the simulator): any of 25 rhythms, every vital, perfusion, an arterial line, intubation (adds capnography and the ventilator), an obstructive capnogram, lung presets (ARDS, asthma, COPD, pneumothorax, disconnect), and the ventilator mode.
• Investigations shown to learners: add any test from the list (or type your own), edit a value and it changes on every screen; results are flagged high/low against adult ranges.
• Show 12-lead ECG on every screen: ticks the box and a 12-lead prints on every learner's monitor (with the infarct territory you pick when the rhythm is ST elevation). Untick to close it everywhere.
• Message banner: a line of text across the top of every screen — "What is the rhythm? Decide in 30 seconds."
• Show an image: paste a URL or upload a photo (a real X-ray, a report, a drug chart) — it pops up on every screen; Hide image removes it.

The monitor

• Traces: ECG lead II and V5, pleth, invasive ABP (only with an arterial line), CO₂ (only when intubated). The traces are generated from the rhythm in real time — AF is irregular, VF is chaos, the pleth disappears in PEA.
• Numerics show their alarm limits; a tile flashes when out of range and the alarm bar names it. NIBP is a real cuff: it cycles every minute, re-measures when the pressure changes, and reads "no pulse" in arrest; with an arterial line the tile becomes continuous ABP.
• Softkeys: Silence / Sound on (alarm tones and the pulse beep — off by default), NBP start, Freeze (stop the sweep to read a complex), 12-Lead (prints a 12-lead from the current rhythm; Re-acquire repeats it), Trends (HR, SpO₂, BP and RR over the session), Alarm limits (edit them; learners can edit their own).

The ventilator

• Appears when the patient is intubated. Modes: VC-CMV, PC-CMV, PSV. Settings are the round dials (Vt, rate, PEEP, FiO₂, I:E, Pinsp) — ± on your screen, read-only on learner screens.
• Scalars (pressure, flow, volume) and the P–V and F–V loops come from a single-compartment lung model with the compliance and resistance you set — so a stiff lung raises the plateau, a tight airway leaves flow unfinished at end-expiration and builds auto-PEEP, and a disconnection drops everything.
• Measured values: Ppeak, Pplat, Pmean, PEEP (+ auto-PEEP), Vte, MVe, Cstat, Raw, EtCO₂, rate. Alarms: high pressure, low volume, auto-PEEP, disconnection.

The cases

124 cases in 9 categories, each built from real ICU practice in this region with the evidence cited at the end. Registrar-level cases teach the standard; consultant-level cases add the judgement calls, the transfers, the family conversations and the system lessons.

Every case: a brief, 3–6 timed decisions with 2–4 options, physiology that responds to each choice, a debrief, pearls and references. Wrong turns are survivable but costly — the design is "rescue the complication you caused", not "game over".

Scores and export

• Learners see My attempts on the case picker: every finished case with score, grade counts and time.
• Admins also see the Score log: every attempt by every learner, with Download CSV for the course file, and Hardest decisions — the decision points learners most often get wrong, with the most common wrong answer, drawn from the saved logs. That table is your next teaching session.
• Passing standard: 75% or more and no harmful decision. Scores are recorded against the signed-in account, so ask learners to sign in before they practise if you want their results.

Tips from the first sessions

• Put the learner link on the projector with Fullscreen — the monitor and ventilator scale to fill it — and keep your own screen for the controls.
• Turn Sound on on the projector screen only; the room needs one set of alarms, not thirty.
• Freeze the sweep to teach a complex; open the 12-lead on every screen for the territory; clear it before the next decision.
• Change one thing at a time — a rhythm, then a pressure, then a lab — and ask the room what it means before you tell them.
• Physiology is simplified for learning. For real patients follow LRRH protocols and senior advice; the cases say so on every page.