(c) 2017-2019 Ibi Keller (tanjera)

Licensed under GNU GPLv3

Infirmary Integrated is free and open-source software developed to advance healthcare education for medical and nursing professionals and students. Developed as in-depth, accurate, and accessible educational tools, Infirmary Integrated can meet the needs of clinical simulators in emergency, critical care, and many other medical and nursing specialties.

Infirmary Integrated is a free simulator for healthcare devices to aide in medical and nursing education. By simulating medical devices such as a defibrillator, students can practice reading tracings, interpreting waveforms, and starting interventions. Educators can use Infirmary Integrated to enhance simulations in a lifelike environment similar to patient care areas, allowing educators to simulate patient presentations and hemodynamic states ranging from simple simulations to extremely complex scenarios. Infirmary Integrated is developed to be clinically accurate and contain relevant content. Additionally, Infirmary Integrated is free and open source software in order to be accessible for healthcare professionals around the world.

Infirmary Integrated currently functions as a simulator for the following healthcare devices:

• Cardiac monitor
• Defibrillator
• 12-lead electrocardiograph (ECG)
• Intra-aortic balloon pump (IABP)

Main features in Infirmary Integrated include:

• Realistic waveforms draw according to multiple factors, accounting for:
  • Atrial and/or ventricular contractions
  • Aberrant/ectopic beats and resulting decreased pulsatility
  • Intrathoracic pressure, depending on mechanical or spontaneous ventilation
• Able to pause devices to better analyze waveforms or create screenshots
• Able to compile printouts including realistic 12 lead ECGs
• Able to create and play scenarios where the patient's condition changes and progresses
  • Students can react to changing patient conditions with pre-made scenario options
  • Instructors can guide students through simple or complex patient presentations and disease progressions
• Able to mirror patient data across multiple computers
  • A teacher can host a simulation via the internet, students can access the patient simulation remotely
• Able to save simulations to files (.ii extension) that can distributed or saved
  • Device information (e.g. cardiac monitor waveforms) are also saved in simulation files

And Infirmary Integrated can simulate hemodynamic and other readings including:

• Heart rate (HR)
• Temperature (T)
• Blood pressure (NIBP non-invasive and invasive ABP via arterial line)
• Respiratory rate (RR)
• Pulse oximetry (SpO2, pulse oximeter plethysmograph)
• End-tidal capnography (ETCO2)
• Central venous pressure (CVP)
• Pulmonary artery pressures and waveforms (Swan-Ganz catheter pressures)
  • Including all pressures and waveforms to simulate catheter placement and wedging
• Intracranial pressure (ICP) factoring compliance in the waveform
• Intra-abdominal pressure (IAP, bladder pressure)
• Intra-aortic balloon pump augmentation pressures
• Cardiac axis deviation, pulsus paradoxus, and pulsus alternans on waveforms
• ST-segment elevation/depression and T-wave elevation/depression on all 12 ECG leads
• Defibrillation, cardioversion, and transcutaneous pacing

Also, Infirmary Integrated simulates the following cardiac rhythms with waveforms and corresponding vital signs for scenario management:

• Asystole
• Atrial Fibrillation
• Atrial Flutter
• AV Block, 1st Degree
• AV Block, 3rd Degree
• AV Block, Mobitz II
• AV Block, Wenckebach
• Bundle Branch Block
• CPR Artifact
• Idioventricular
• Junctional
• Pulseless Electrical Activity
• Sick Sinus Syndrome
• Sinus Arrhythmia
• Sinus Rhythm
• Sinus Rhythm with Arrest (Sinoatrial Arrest)
• Sinus Rhythm with Bigeminy
• Sinus Rhythm with Trigeminy
• Sinus Rhythm with PACs
• Sinus Rhythm with PJCs
• Sinus Rhythm with PVCs Multifocal
• Sinus Rhythm with PVCs Unifocal
• Supraventricular Tachycardia
• Ventricular Fibrillation Coarse
• Ventricular Fibrillation Fine
• Ventricular Standstill
• Ventricular Tachycardia Monomorphic Pulsed
• Ventricular Tachycardia Monomorphic Pulseless
• Ventricular Tachycardia Polymorphic

Infirmary Integrated also simulates the following respiratory rhythms:

• Agonal
• Apnea
• Apneustic
• Ataxic
• Biot
• Cheyne-Stokes
• Regular

Infirmary Integrated also supports full localization (translation) for the following languages:

• አማርኛ (Amharic)
• عربى (Arabic)
• 中文 (Chinese)
• Deutsche (German)
• English
• Español (Spanish)
• فارسی (Farsi)
• Français (French)
• עברית (Hebrew)
• हिंदी (Hindi)
• Italiano (Italian)
• 한국어 (Korean)
• Português (Portuguese)
• Русский (Russian)
• Swahili (Kiswahili)

For more information, feel free to visit http://www.infirmary-integrated.com/

Install the following prerequisites (as of Ubuntu 18.04):

sudo apt install apt-transport-https gnupg ca-certificates
sudo apt-key adv --keyserver hkp://keyserver.ubuntu.com:80 --recv-keys 3FA7E0328081BFF6A14DA29AA6A19B38D3D831EF
echo "deb https://download.mono-project.com/repo/ubuntu stable-bionic main" | sudo tee /etc/apt/sources.list.d/mono-official-stable.list
wget -q https://packages.microsoft.com/config/ubuntu/19.04/packages-microsoft-prod.deb -O packages-microsoft-prod.deb
sudo dpkg -i packages-microsoft-prod.deb
sudo apt update
sudo apt install cmake libmono-microsoft-csharp4.0-cil mono-mcs mono-xbuild mono-devel mono-complete nuget dotnet-sdk-3.1

For MacOS Catalina 10.15:

brew install cmake
brew cask install mono-mdk

Build on Linux:

mkdir build
cd build
nuget install PdfSharp
find . -name "PdfSharp.dll" -exec cp {} . \;
cmake ..
make

Build on MacOS:

mkdir build
cd build
nuget install PdfSharp
find . -name "PdfSharp.dll" -exec cp {} . \;                                      
export PATH=/Library/Frameworks/Mono.framework/Versions/Current/Commands:$PATH 
cmake ..
make