CRITICAL CARE WORKSTATION Bedside Telemetry v2.4 v2.4 Live

SYSTEM ONLINE • GUARDRAILS ACTIVE

ICU Infusion & Smart Drip Simulator

Master critical care pharmacokinetics, titrate vasoactive drips on a virtual smart pump, observe patient hemodynamic response, and tackle realistic OSCE emergency simulations.

Drug Formulation & Protocol Selection

VASOPRESSOR / INOTROPE

Select Critical Care Drug Protocol 16 High-Alert Monographs

Standard ICU Hospital Formulations (Click to auto-populate bag):

Infusion Parameters

Step 1 & 2

Patient Body Weight 70 kg

30 kg (Pediatric) 70 kg (Standard Adult) 200 kg (Bariatric)

Total Drug in Infusion Bag Concentration Source

Diluent Volume (D5W / 0.9% NS) IV Bag Size

Prescribed Infusion Dose Rate Target Rate

IV Administration Tubing Drop Factor Gravity Backup Set

QUESTO CAREPUMP 5000™

STOPPED

NOREPINEPHRINE PERIPHERAL LINE

0.0

MILLILITERS PER HOUR (mL/hr)

Bedside Rate Titration Step Adjust

Reverse Titration Solver (mL/hr → Patient Dose)

Bedside Double-Check

Pump Speed (mL/hr):

Resulting Dose:

Flow Rate

0.0 mL/hr

Mechanical volumetric speed

Final Concentration

0 mcg/mL

In 250 mL diluent

Gravity Drip Rate

0 gtts/min

Tubing calibration: 60 gtts/mL

Drop Frequency

Stopped

1 drop every X seconds

Mechanical Syringe Driver Plunger Motion

IV Drip Chamber Fluid Dynamics

Critical Dose Limit Warning

Current dosage parameter exceeds safe hospital clinical guidelines. Monitor patient ECG and telemetry continuously.

1. Final Bag Concentration Formulation

Concentration = (Dose Amount / Bag Volume) = ...

Converts the drug mass in the diluent bag (mg to mcg if needed) and divides by total solution volume (mL).

2. Mechanical Infusion Flow Rate (mL/hr)

Flow Rate (mL/hr) = (Target Dose * Weight * 60) / Concentration = ...

For weight-based drugs, multiplies prescribed dose by patient weight (kg) × 60 min, divided by the concentration.

3. Gravity Drip Rate (gtts/min)

Drip Rate (gtts/min) = (Flow Rate in mL/hr × Drop Factor) / 60 min

Essential during emergency transport or power failure when electrical smart pumps are unavailable.

CASE 01

Septic Shock Resuscitation

Norepinephrine • Target MAP 65-75

CASE 02

Acute Cardiogenic Shock

Dobutamine • Inotropic Support

CASE 03

Severe DKA Crisis

Regular Insulin • K+ Repletion Guardrail

CASE 04

Hypertensive Emergency

Nitroprusside • Controlled MAP Drop

TELEMETRY LIVE • BED 4 • ICU TRAUMA

Scenario Active: Monitoring Hemodynamics

LEAD II ECG • 25mm/s

ART LINE (MAP WAVEFORM)

HEART RATE

75 BPM

BP (MAP)

120/80 (93)

TEMP / LAB

36.8 °C

CRITICAL ALERT: Patient K+ is below 3.3 mEq/L! Hold insulin until potassium replacement is initiated.

Scenario 1: Septic Shock Resuscitation

Clinical Brief

Manage a 70 kg patient in severe septic shock refractory to 30 mL/kg crystalloids. Goal: Maintain Mean Arterial Pressure (MAP) between 65 - 75 mmHg using Norepinephrine. Note: Vasoactive catecholamines require central line access to prevent peripheral extravasation necrosis.

Protocol Verification Steps:

1. Launch 60-second OSCE challenge session
2. Switch vascular access to Central Venous Catheter
3. Configure bag and initiate Smart Pump infusion
4. Titrate dose until target MAP is maintained for 15s

OSCE CHALLENGE MODE

Stabilize Hemodynamic Targets

01:00

You have 60 seconds to evaluate the patient, verify vascular access, configure the smart infusion pump, and stabilize vital signs within the target therapeutic window.

High-Alert ICU Infusion Reference Compendium

Standardized concentrations, therapeutic dosing windows, vascular access rules, and extravasation safety protocols.

ICU Standard 2026

Medication & Brand	Clinical Indication	Standard Concentration	Therapeutic Titration Range	Access Route	Critical Clinical Pearls & Antidotes
Norepinephrine Levophed	1st-line in Septic & Distributive Shock	4 mg / 250 mL D5W (16 mcg/mL)	0.02 - 1.0 mcg/kg/min Target MAP ≥ 65	Central Line	Extravasation causes severe ischemic necrosis. Antidote: Phentolamine 5-10 mg intradermal.
Epinephrine Adrenaline	Anaphylactic Shock, ACLS, Severe Bradycardia	4 mg / 250 mL D5W/NS (16 mcg/mL)	0.01 - 0.5 mcg/kg/min 1 - 10 mcg/min non-weight	Central Preferred	Potent inotrope + vasopressor. Monitor for transient hyperlactatemia and tachyarrhythmias.
Vasopressin Pitressin	Refractory Vasodilatory Shock (Sepsis)	20 units / 100 mL NS (0.2 units/mL)	Fixed 0.03 - 0.04 units/min Do NOT titrate rapidly	Central Line	Pure V1 vasoconstrictor without beta-1 chronotropy. Sparing effect on norepinephrine.
Dopamine Inotropin	Cardiogenic Shock with Bradycardia	400 mg / 250 mL D5W (1600 mcg/mL)	Low: 1-3 • Med: 5-10 • High: 10-20 mcg/kg/min	Central Line	Dose-dependent receptors (DA → Beta-1 → Alpha-1). High tachyarrhythmia risk vs norepinephrine.
Dobutamine Dobutrex	Cardiogenic Shock & Severe Acute Decompensated HF	250 mg / 250 mL D5W (1000 mcg/mL)	2.5 - 20 mcg/kg/min Inotropic titration	Peripheral / Central	Beta-1 inotrope with mild beta-2 vasodilation. Can provoke hypotension if patient is hypovolemic.
Nitroglycerin Tridil	Acute Coronary Syndrome & Flash Pulmonary Edema	50 mg / 250 mL D5W (200 mcg/mL)	5 - 200 mcg/min Titrate q5min by 5-10 mcg	Non-PVC Glass/Poly	Venodilator reducing preload. Contraindicated if PDE-5 inhibitors (Sildenafil) taken in past 24-48h.
Sodium Nitroprusside Nitropress	Severe Hypertensive Crisis & Aortic Dissection	50 mg / 250 mL D5W (200 mcg/mL)	0.3 - 10 mcg/kg/min Max <2 mcg/kg/min prolonged	Arterial Line Req.	Arterial + venous dilator. Cyanide / Thiocyanate toxicity risk. Bag must be light-shielded.
Esmolol Brevibloc	Aortic Dissection, SVT, Post-Op Hypertension	2500 mg / 250 mL NS (10 mg/mL)	50 - 300 mcg/kg/min Ultra-short t1/2: 9 min	Central Preferred	Cardioselective beta-1 blocker. Rapid onset/offset. First-line for rate control in acute type A/B dissection.
Amiodarone Cordarone	Refractory VT / VF & Atrial Fibrillation	150 mg bolus, then 900 mg / 500 mL D5W	1 mg/min × 6h, then 0.5 mg/min × 18h Total 1000 mg/24h	In-line Filter Req.	Peripheral line can cause severe phlebitis if >2 mg/mL. Monitor for QTc prolongation and bradycardia.
Propofol Diprivan	Mechanical Ventilation Sedation	1000 mg / 100 mL (1% emulsion) (10 mg/mL)	5 - 50 mcg/kg/min RASS target -1 to -2	Dedicated Lumen	Monitor triglycerides and serum lactate for Propofol Infusion Syndrome (PRIS). 1.1 kcal/mL lipid calories.
Dexmedetomidine Precedex	Light ICU Sedation without Respiratory Depression	200 mcg / 50 mL NS (4 mcg/mL)	0.2 - 1.4 mcg/kg/hr No loading bolus in ICU	Peripheral / Central	Selective alpha-2 adrenergic agonist. Patient remains easily arousable. Watch for sinus bradycardia.
Regular Insulin Humulin R	Diabetic Ketoacidosis (DKA) & HHS	100 units / 100 mL NS (1 unit/mL)	0.1 units/kg/hr Target glucose fall 50-75 mg/dL/hr	Priming required	NEVER initiate insulin if serum K+ < 3.3 mEq/L! Add dextrose (D5W) when BG reaches 200-250 mg/dL.
Heparin Sodium	PE, DVT, Acute Coronary Syndrome (NSTEMI/STEMI)	25,000 units / 250 mL D5W/NS (100 units/mL)	12 - 18 units/kg/hr aPTT protocol titration (1.5-2.5x)	Dedicated Line	Monitor platelet count for HIT (Heparin-Induced Thrombocytopenia). Antidote: Protamine Sulfate.
Fentanyl Sublimaze	Continuous ICU Analgesia & Sedation Adjunct	1000 mcg / 100 mL NS (10 mcg/mL)	25 - 200 mcg/hr (0.5 - 2.0 mcg/kg/hr)	Dedicated Line	Lipophilic opioid, accumulates in adipose tissue over prolonged infusions prolonging emergence.