Computer-Based Simulators simulators are described below. Most contain an interactive patient vital sign screen which responds to user interventions. Computer-based simulations generally are much less expensive than other types of simulators, and are easily portable. However, physical skills and tasks cannot be taught on them. Educational content is mainly focused on learning facts, using the information learned to make treatment decisions, and evaluating the effectiveness of that treatment.

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Below is an alphabetical list of computer based simulators with a brief description of the capabilities of each.



A-Ware (NEC SIM-series)

This program is designed to practice anesthetic patient cases. Standard drugs are modeled, including gaseous anesthetics, intravenous anesthetics, and resuscitation drugs. Preoperative and surgical anesthesia records are viewable, as well as physiologic and pharmacokinetic data. The ventilator and gases are controllable. Patient vital signs and display curves are emulated on a monitor image. If tests are desired (blood gas, TEE, etc) the results are displayed as ordered.

ACLS Simulator (AneSoft)

Anesoft's ACLS Simulator has two modules designed to give users practice with various aspects of ACLS skills. The first module, Rhythm, gives the user practice recognizing EKG dysrhythmia. The second module, Pulse, contains a series of scenarios based on ACLS codes. The Pulse screen contains an image of the patient, real time changes in vital signs and options for treatment. There is also a help function to recommend treatment pathways and drug dosages. The program is geared to ACLS-capable providers (mostly MD and RN, some prehospital providers). Physician CME and Nursing contact hour credits are available.

Anatomy Module (HeartWorks)

The Anatomy Module is a three dimensional model of a heart, viewable from from any angle, beating or still. The learner can slice the heart in any direction to view the internal structures at work. There is a list of over 100 anatomical features with educational material available which can be selected to view on the heart model. Structures, such as coronary vessels or one of the valves, can be removed or added back to the image of the heart in any combination to demonstrate spatial relationships. The Anatomy Module works in conjunction with the Ultrasound Module and the Mannequin Simulator Package to create a stepwise learning process, from basic information to clinical application.

Anesthesia Simulator (AneSoft)

The Anesthesia Simulator (previously known as Anesthesia Simulator Consultant, or ASC) contains cases in a wide variety of anesthetic specialty areas. Each case can (at the user's discretion) contain a known or unknown problem to be overcome, or can be run without complications to show a normal case to a novice trainer. The screen content includes a graphic of the patient, real time vital signs, and the ability to do interventions, such as change ventilation modes or values, induce the patient, or add invasive monitors. It is aimed mainly at Anesthesia residents, but can also be used for other specialties where induction is trained, such as Emergency Medicine or Internal Medicine. Physician CME and Nursing contact hour credits are available.

Bag Valve Mask Ventilation (University of Florida)

This is a simplistic but effective tool to visualize the air flow in functional and damaged ventilation bags, including stuck valves and leaks. The program also demonstrates what a bag check is verifying and why. Using a bag with oxygen is also demonstrated for variable flow and respiratory rates and reservoir tubing sizes.

Bioterrorism Simulator (AneSoft)

This program contains scenarios for diagnosis and treatment of patients exposed to Class A biological agents and chemical agents such as nerve gases. The trainee makes a diagnosis based on symptoms and diagnostic tests, then administer the correct treatment, including isolation and decontamination protocols. A help file is included, which contains the current recommendations on treatment The program is internet-based, to maintain currency for agents and treatments. The user base is wide, including emergency in-hospital personnel (MD and RN) and first responders. Physician CME and Nursing contact hour credits are available.

Blood Gases (Mad Scientist Software)

This program is general in nature and can be used by a wide audience. The program focuses on blood gas interpretation, by reviewing areas such as acid-base balances and A-a gradients. The program will also interpret blood gas values and give lung function information.

Body Simulation (Advanced Simulation Corporation)

The Body simulator is an anesthesia trainer, modeling the pulmonary and cardiovascular systems using a 45 compartment model. In many organs, the administered drug concentrations, organ pressures, resistances, and other factors are viewable in real time. Patient cases can be run in real time, slowed down, or fast forwarded. The program comes with a small number of preprogrammed patients, with the ability to create unlimited additional patients.

Cardiac Arrest (Mad Scientist Software)

The Emergency Department is the setting for this ACLS-based program. Patient history is available for review before beginning each patient (adult or pediatric). The patients' conditions go beyond basic codes, to include conditions such as hyperkalemia or hypothermia. During the code, real time vital signs and current lab results are presented as requested. The results are used for treatment decisions, which can be selected with the mouse, or typed in using basic English text. When rerunning patients, variables will change so that a trainee doesn't run exactly the same patient twice. CME credit is available through the program.

CardioSim (Cardionics)

CardioSim is an interactive heart sounds simulator. It provides the user or instructor with the ability to break apart normal and abnormal heart sounds into the component pieces for better understanding of the timing and underlying causes. The effects of respiration can also be shown, when used in conjunction with PneumoSim. As the heart sounds are playing, users can see a graph of the sounds in real time, to visualize the timing as well as hear it. Descriptions of the sound are also visible as they are playing. For a more in-depth understanding, over 125 images and videos are available to see. For example, a calcified mitral valve can be seen, then the resultant regurgitation played. The program interfaces with Windows, to allow additional information (PowerPoint slides, etc) to be incorporated.

Chest Pain (Mad Scientist Software)

The focus of Chest Pain is to provide both internists and emergency medical physicians with a variety of clinical presentations of chest pain, occurring for both cardiac and non-cardiac reasons. A basic chest pain workup is taught through the tutorials. Basic history-taking and physical exams are covered, as are more advanced topics, such as indications and contraindications of thrombolytic therapy. Users can see real time patient changes occur as their interventions are performed. Quizzes are provided to help the user evaluate their progress.

Clinical Simulator (TheraSim)

The Clinical Simulator (HIV module) is designed to allow trainees to practice initiating, evaluating, and adjusting therapies for HIV patients. Medical records are available for review, with the ability to ask the patient for additional information. Trainees can order drugs and tests, and make patient care decisions. Help is available through consults, but the level of help is controlled by the course instructor, so that only certain information is accessible from each consulting specialist, depending on trainee experience level and course goals. An evaluation is given at the end, and if desired, can also be viewed at each step. Several other modules are under development.

Code Team (Mad Scientist Software)

This program is comprised of three modules. The first module has quizzes which help prepare the trainee for the ACLS written test, including sections on drugs, the airway, and IVs. The second module is for EKG recognition (normal and abnormal), including teaching and quizzes. Interactive patient management using ACLS protocols is in the third module, which is designed to prepare a trainee for the megacode ACLS section. Treatment options can be entered directly through the keyboard with basic commands, or can be found on the mouse menus.

Coronary Circulation Model (Transparent Reality, University of Florida)

Both ventricles are represented in the animation of a beating heart, which responds to changes in variables, demonstrating the effect of pathophysiological states on the myocardium. Users can change basic variables such as heart rate and total blood volume, as well as advanced variables, including the elastance of each atrium and the partial pressure of oxygen in the coronary arteries. The system will display the results, including ejection fractions and perfusion of the left epicardium and endocardium.

Critical Care Simulator (AneSoft)

Both Emergency Medicine and Intensive Care Unit scenarios are included in this simulator. During management of the initial condition, critical events will occur which need to be managed concurrently. Help is available with treatment choices and drug dosages. The user manages the patient's ventilation, medication and fluid needs. This program is applicable to a wide list of users, including both MDs and RNs within several specialties. Physician CME and Nursing contact hour credits are available.

CritiControl (NEC SIM-series)

The focus of this program is emergency medicine and critical care, for cardiovascular patients. The user can order tests, perform procedures, and review the reports from physicians or prehospital providers. During the simulation, it is possible to view in real time changes to approximately 100 patient values, including interstitial and plasma volumes, stroke volume, renal blood flow, brain oxygen debt, and cellular potassium.

Dynamics Pipeline (MusculoGraphics)

This animation software ties into and uses models created in SIMM (see below) to create dynamic, adjustable models of various anatomic regions. The software works in both directions, allowing users to change individual muscle performance and watch the effect on the model, or to change the position of the joint and have the software calculate the forces required of the muscles to move the joint as indicated.

GasMan (Med Man Simulations)

GasMan is a pharmacologic modeling program. The simulation allows the user to enter gaseous anesthetic agents, calculate and graph effect doses, and see how the drug equilibrates through multiple compartments. It also takes into consideration the breathing circuit when calculating uptake. Pediatric values can be worked up by decreasing the patient weight. This program also monitors how much it would cost to give a particular anesthetic for a specified time. This program has a wide audience base. It can be used for upper level medical students through residents.

Generic Knee Model (MusculoGraphics)

This computer generated model of the knee shows a range of motion of the knee and how the bones, ligaments and menisci move relative to one another. The model incorporates two degrees of freedom for the joint. The movement is in three dimensions and has been calculated according to the literature cited on the manufacturer's web page.

GridSET (produced by a consortium of partners)

GridSET allows trainees to think through several invasive procedures demonstrating patient positioning, anatomical relationships, and equipment orientation and insertion. There are several modules available, including lumbar puncture, laparoscopic surgery prep, and ventricular catheterization. The patient image is either opaque or transparent to demonstrate relevant internal structures. Tools are selected, oriented and inserted to the correct depth using the mouse. Instructors can interact with multiple students in real time over a network to demonstrate and critique performance. The simulators include videos for additional content and questionnaires for testing.

Hemodynamics Simulator (AneSoft)

This simulation demonstrates the use of hemodynamic monitoring to diagnose a patient and to evaluate subsequent drug and fluid therapies. Vital signs are displayed as well as a list of intervention choices, including floating a pulmonary artery catheter and measuring cardiac output. Infusions can then be started to correct the underlying circulatory problem. Medical students and residents would benefit from this trainer. Physician CME and Nursing contact hour credits are available.

MicroEKG (Mad Scientist Software)

This program is for a general audience interested in learning about 12 lead EKG interpretation. Three levels of information cover topics from basic (cardiac anatomy and lead placement) to advanced (interpreting infarct location and age and hypertrophy). Tutorials guide the trainee through the various topics, with additional pop-up information available on request. The trainee can then take a quiz on EKG interpretation, by reviewing the strips and typing in the diagnosis. The program evaluates the answer and makes additional observations and comments.

Neonatal Simulator (AneSoft)

This program reviews neonatal resuscitation and crisis management protocols. Fetal crises, such as decelerations, and newborn crises, such as meconium aspiration, are covered.  AMA PRA Category 2 credits are available for completion of the program. 

Obstetric Simulator (AneSoft)

The cases include obstetric crises, such as postpartum hemorrhage and placental abruption.  There are also general crises involving pregnant patients, such as trauma to a pregnant patient or cardiac arrest in a pregnant patient.  A fetal heart rate monitor simulator is included to give more information about each situation.  CME credits are available in AMA PRA Category 2 upon completion of the course.

PAC Simulator (Manbit Technologies)

This is a screen-based program that allows users to insert a pulmonary artery catheter (PAC), advance the catheter, and inflate the balloon to obtain a wedge pressure. Changes are shown on screen to show various complications that may be encountered. Optionally, a manikin can be used to demonstrate an actual catheter insertion. This program is geared mainly for residents in several specialties.

PALS Simulator (AneSoft)

The 16 scenarios in this program include tachycardias and bradycardias, stable and unstable ventricular tachycardia, asystole and other dysrhythmias. In addition to the preprogrammed scenarios, instructors are able to write their own. AMA PRA Category 2 credits are available upon completion of the course. The program is also listed as SCORM/AICC compliant (for compatibility with learning management systems).

Pediatric Simulator (AneSoft)

The pediatric scenarios include emergent cases such as multiple traumas and near drowning. There are also cases such as septic shock and meningitis. There are AMA PRA Category 2 CME credits available for completing the course.

PhysioLogical (Mark Colson)

This is a freeware program that demonstrates lung dynamics, based on variables such as fresh gas flow, shunt, and dead space. The program demonstrates real time changes in acid base balances, hemoglobin dissociation curve, and partial pressures of various gases in the alveolus, artery and vein.

PneumoSim (Cardionics)

PneumoSim is an interactive program allowing users to select and adjust various simulated lung sounds. Once trainees understand the different abnormal sounds, they can listen to real patient recordings demonstrating the various conditions. Variables include breathing rate, I:E ratio, and inspiratory vs. expiratory sound. Examples of spoken and whispered words are also available for both normal and abnormal conditions.

Sedation Simulator (AneSoft)

Managing safe sedation is the goal of this software. It caters to the non-anesthesiologist (although anesthesiologists can benefit as well). Patients experience complications which must be managed by fluids, medication, or other treatments. Real time vital signs display changes based on trainee interventions. A help module is available to aid in treatment protocols and drug dosages. CME and CNE credits are available.

Software for Interactive Musculoskeletal Modeling - SIMM (MusculoGraphics)

The Software for Interactive Musculoskeletal Modeling (SIMM) is a program that enables users to create anatomically accurate models of joints or areas of the body. Muscle attachments, tendons, bone, and other components work together to create a replication of the desired anatomy. Normal and deformed structures of adjustable size can be modeled to replicate various patient presentations. This program can be tied into related modeling software, Dynamics Pipeline (see above), to increase functionality.

TCD Simulator (

This program models cerebral circulation and pathologies, and the ways to monitor them. The Doppler position is variable, as is the condition of the artery or vein, including several spasm and occlusion choices. Anatomic variations are also selectable. Educational content includes background, mathematical equations and derivations, monitor placement, and details on pathophysiologic and traumatic states. Hemodynamic variables such as baroreceptors and ventricular contractility are adjustable in real time, to demonstrate the effect on the doppler output.

Trauma One (Mad Scientist Software)

Trauma One allows the user to practice both diagnosis and treatment on a variety of trauma victims. After stabilization, the trainee can get a history on the patient, then request labs or monitoring. Based on these real-time values, the trainee can then perform therapeutic interventions, such as a pericardiocentesis or drug therapy. When the patient has been stabilized, a diagnosis is entered, and they are transferred to the ICU.

Ultrasound Module (HeartWorks)

The Ultrasound Module is an addition to the Anatomy Module which allows the user to view the heart and transesophageal echo probe from any angle, with a representation of the probe's plane of view transecting the heart. The heart and probe can be rotated, and the probe can be inserted, rotated or withdrawn interactively. The ultrasound image on the screen is adjusted in real time to match the probe's position. The heart can be sliced open along the probe's plane to see (from either side) the internal structures next to the corresponding ultrasound image. The Ultrasound Module works in conjunction with the Anatomy Module and the Mannequin Simulator Package to create a stepwise learning process, from basic information to clinical application.

Virtual Anesthesia Machine (University of Florida)

**Requires free membership** The program allows the user to change settings on the ventilator and observe the changes in the breathing circuit and anesthesia machine. Settings for variable gas mixtures of oxygen, nitrous oxide and volatile agents are alterable as well. There are several valves within the system that can be opened or closed. The user can try manual or machine ventilation. As the settings are changed, a computer model directs altered movement of individual gas molecules (visible to the user) around the circuit, into the lungs, into the reservoir bag, through the CO2 absorber, or out the scavenging system. CME credits are available.