Auscultation Manikin

Submitted in partial fulfillment of the requirements for the degree of

Bachelor of Technology
in
Biomedical Technology
by

Tushar Gangadhar Tathe

15BMD0018

Under the guidance of

Dr. Bhaskar
Mohan Murari
Department of sensor and Biomedical Technology

SENSE
VIT, Vellore.

April,2019
 DECLARATION

I hereby declare that the thesis entitled “Auscultation Manikin” submitted by

me, for the award of the degree of Bachelor of Technology in Department of sensor and
Biomedical Technology to VIT is a record of bonafide work carried out by me under the
supervision of Dr. Bhaskar Mohan Murari .
I further declare that the work reported in this thesis has not been submitted and will not be
submitted, either in part or in full, for the award of any other degree or diploma in this
institute or any other institute or university

Place : Vellore
Date :
5/04/2019
Signature of the Candidate
 CERTIFICATE

This is to certify that the thesis entitled “Auscultation Manikin” submitted

by Tusahr Gangadhar Tathe & 15BMD0018, SENSE, VIT University, for the
award of the degree of Bachelor of Technology inDepartment of sensor and
Biomedical Technology, is a record of bonafide work carried out by him under my
supervision during the period, 01. 12. 2018 to 30.04.2019, as per the VIT code of
academic and research ethics.

The contents of this report have not been submitted and will not be submitted
either in part or in full, for the award of any other degree or diploma in this institute or
any other institute or university. The thesis fulfills the requirements and regulations of
the University and in my opinion meets the necessary standards for submission.

Place : Vellore

Date : 5/04/2019 Signature of the Guide

Internal Examiner External Examiner

Head of the department

(Biomedical Engineering)
 ACKNOWLEDGEMENTS

I would like to extend my sincere & heartfelt gratitude towards all those who have assisted
me in this endeavour. Without their active guidance, help, cooperation and encouragement I
would not have been able to achieve the goal of the project successfully.

I would like to take this opportunity to thank my project guide and coordinator, Dr.
Bhaskar Mohan Murari for his constant support, guidance, mentorship and for his critical
remarks at each and every step towards the betterment and realization of my goals, without
which it would have been really difficult to improve upon my original designs and complete
the project successfully.

Furthermore, I would also like to acknowledge with much appreciation, the important role
of Prof. R. Sivacoumar, Associate Professor & Head, Department of Sensor & Biomedical
Technology, SENSE, whose contribution in encouragement helped me plan better.

I would like to thank the Dr. Kittur Harish Mallikarjun, Professor and Dean, SENSE who
provided me with the facilities required for the project.

Finally, I would like to express my sincere gratitude to Vellore Institute of Technology,

which provided me with a platform to hone my skills over a period of four years.

Tushar Gangadhar Tath

Executive Summary
This study mainly focuses on to know the auscultation sites with the help of buzzer. The
main aim is to let medical student from private colleges to hear the heart sound with the help
of Manikin because they have less number of patients. User has to put stethoscope on
Manikin and after knowing the different auscultation positions with the help of different
buzzer sound. The buzzer sound will recognize the auscultation position or location based
on type of sound. User will have Digital stethoscope with AYUSYNK (Bluetooth module
of ayu devices) attached .After hearing sound user will get to know position of heart sound
and will play any specific heart sound through mobile which will go to stethoscope using
AyuSynk and user need to recognize the sound.This is how an individual can practices for
time as much as he want.
 CONTENTS Page

No.

Acknowledgement 4

Executive Summary 5

Table of Contents 6

List of Figures 9

List of Tables 10

1 INTRODUCTION 13

1.1 Aims and Objective 13

1.2 Thesis structure

1.3 Background and thesis motivation 13

1.3.1.Auscultation

1.32 .History of the development of auscultation manikin

a.Definations

b.Approach

1.3.3 .Emergence of auscultation manikin 14

a.Origin of the modern era of simulation

b.Harvey cardiology manikin

.Physiological Models of realistic simulations

2 PROJECT DESCRIPTION AND GOALS 19

2.1 Idea
2.2 Source
 2.3 Heart sounds

3 TECHNICAL SPECIFICATION 31

Tone libraries
Arduino UNO

4 DESIGN APPROACH AND DETAILS (as applicable) 27.

4.1 Simple cartboard wiith chest design on it .

4.2 Buzzer circuit code of arduino
.
4.3 Tone library
4.4 Buzzer circuit with different tones

5 SCHEDULE, TASKS AND MILESTONES 33.

Tasks performed

Schedule

Milestones

6 COST ANALYSIS / RESULT & DISCUSSION (as applicable) 34.

6.1 Fixing circuit

6.2 Importing Libraries
6.3 Creating Model
6.4 Fixing the circuit
6.5 Running the model
6.6 Fitting conditions
6.7Testing localities
 .

8 REFERENCES 36.

APPENDIX A .
 List of Figures

Figure No. Title Page No.

2.1 Origin of modern 15
era simulation
2.2 SimOne model 16

2.3 Harvey Model 17

2.4 SAM3D auscultation Manikin 20

2.5 PAT 22

2.6 Simshirt system 23

2.7 Bionic Man simulation 24

2.8 Piezoelectric sensor circuit 27

2.9 Design of Manikin with circuit 27

2.10 circuit of one position of heart 29

2.11 circuit of all four positions of heart 30

 List of Tables

Table No. Title Page No.

3.1 Task performed and scheduled 33

3.2 Results 34
1.INTRODUCTION
1.1.OBJECTIVE
We all know that Auscultation is the very basic and important parameter to diagnose any
disease.But there is lack of knowledge student have to diagnose the disease or any heart
murmur because of lack of availability of patients Therefore he main objective of this
project was to make auscultation manikin too cost effective so that Medical students can
buy it at cheaper process and can practice it to get better in auscultation.

1.2 History of the development of auscultation manikin

Simulation for medical and healthcare applications, although still in a relatively nascent
stage of development, already has a history that can inform the process of further research
and dissemination. The development of mannequin simulators used for education, training,
and research is reviewed, tracing the motivations, evolution to commercial availability, and
efforts toward assessment of efficacy of those for teaching cardiopulmonary resuscitation,
cardiology skills, anaesthesia clinical skills, and crisis management. A brief overview of
procedural simulators and part-task trainers is also presented, contrasting the two domains
and suggesting that a thorough history of the 20+ types of simulator technologies would
provide a useful overview and perspective. There has been relatively little cross fertilisation
of ideas and methods between the two simulator domains. Enhanced interaction between
investigators and integration of simulation technologies would be beneficial for the
dissemination of the concepts and their applications. While still in a relatively nascent stage
of development, simulation for healthcare applications has already evolved through its
initial historical phases. Recounting stories of some key simulation technologies could be
useful for informing future simulation advocates. In this brief history of medical simulation
we focus primarily on the origin of mannequin simulators, especially those employing
computer control, and we examine some of the pedagogy and evaluations of effectiveness
that aided dissemination. A listing of part-task trainers for surgical and medical procedures
(which we refer to as “procedural” simulators) and more limited discussion of their origins
are also given to indicate the extent of activity in that area.

1.3 Definitions
Some definitions are needed for this discussion. As there is no accepted convention, those
used here are arbitrary, although drawn from suggestions by others. “Simulator” refers to a
physical object or representation of the full or part task to be replicated. “Simulation” refers
to applications of simulators for education or training. The term simulator is used by some
specifically to refer to technologies that recreate the full environment in which one or more
targeted tasks are carried out. This can also be called fully immersive simulation. The term
“part-task trainer” should be applied to technologies that replicate only a portion of a
complete process or system. However, simulator is commonly used in a generic sense to
apply to all technologies that are used to imitate tasks. Gaba defines 11 spectra of simulation
characteristics.4 One spectrum uses the following terms:

 verbal (role playing)

 standardised patients (actors)

 part-task trainers (physical; virtual reality)

 computer patient (computer screen; screen based “virtual world”)

 electronic patient (replica of clinical site; mannequin based; full virtual reality)

While most of these types of simulations and simulators are not examined in this history, all
will probably be integrated into the restructuring of the education and training processes for
clinicians in all domains. That most simulation technologies and techniques for medical and
healthcare applications are not examined here is a reflection of how broad the field is
already. Even for the areas that are covered, the discussions are relatively brief summaries,
describing only key events that can be uncovered.

1.4 Approach
We have found PubMed for the keywords “simulation” and “simulator” for the years 1965
to 2004. Several summary publications were used as primary sources to other references.
Because a substantial body of work was conducted by private corporations, we used several
non-referenced sources, including hand searches of many volumes of the proceedings
of Medicine Meets Virtual Reality. Many other sources of abstracts—for example, other
medical and nursing meetings—were not searched because of time and resource constraints.
Interviews were conducted with several pioneering investigators and developers of
technology for procedural simulators.

1.5. Emergence of Auscultation Manikin

We begin with the earliest published accounts of some part task trainers that are precursors
to computer based simulators. naba has produced history of the development of manikins
and some screen simulators, particularly as they were first used in anaesthesia, and he and
his colleagues also reported on a 10 year experience in using simulation for crisis resource
management training.6 presented an overview of simulators and trainers in several domains
Origin to the modern era simulations
At the point when not PC driven and having generally constrained usefulness, Resusci-Anne
denotes a start for discussion.It is utilized for restorative preparing and is an ancestor of one
of the two current business mannequin test systems., this puppet for preparing in mouth to
mouth ventilation was planned by Asmund Laerdal, a Norwegian producer of plastic toys
He was urged to do as such by Dr Bjorn Lind and other Norwegian anaesthesiologists,
following Dr Peter Safar's disclosures about the prevalence of mouth over mouth revival.
The aviation route could have been impeded, and it was important to utilize hyperextension
of the neck and forward push of the jaw to open the aviation route before starting
insufflation of air into the puppet by the mouth to mouth system that Safar had depicted. In
light of confirmation of the viability of close chest rub, later prompted laderal to incorporate
an inside spring joined to the chest divider, which has given authorization reenactment of
heart pressure. The likelihood of preparing to the ABC (aviation route, breathing, flow) of
cardiopulmonary revival (CPR) on the test system was conceived. This early test system of
a withering unfortunate casualty, not breathing and without a heartbeat, wound up known as
resysci-Anne and has been generally utilized for CPR preparing.
 Figure 1: Emergence of auscultation manikin

The Laerdal organization did not build up a higher constancy mannequin until the mid-
1990s when urged to do as such by many, including Dr Ake Grenvik, a Safar partner at the
University of Pittsburgh. Drs Rene Gonzales and John Schaefer, additionally of the
University of Pittsburgh, built up an all the more anatomically right aviation route and test
system, which was made By MPL of Texas. Laerdal gained MPL and built up the test
system, at that point called SimMan, which was less expensive than other accessible higher
constancy mannequin simulators,altering the market in a manner depicted by the
troublesome advancement model of Christensen.

1.6. SimOne model

SimOne is a starting point of true computer controlled, mannequin simulators, particularly
to simulation of the entire patient.formed by Dr Stephen Abrahamson, an engineer, and Dr
Judson Denson, a physician at the University of Southern California in the mid-1960s, it
was built in collaboration with Sierra Engineering and Aerojet General Corporation.
Abrahamson, in a video acceptance of an award from the Society for Technology in
Anesthesia, described the idea from Aerojet’s need to develop peacetime applications of its
capabilities in the face of diminishing military funding, before the escalation of the Vietnam
quarrel. The starting concept of copying anaesthesia machine functions quickly evolved to
the objective of recreating more of the entire patient. After meeting with rejection from the
National Institutes of Health and military funding sources, the project to build a prototype
was supported by a three year, $272 000 grant from the USOffice of Education.

Figure 2: SomOne model

SimOne did not achieve any acceptance. Only single was constructed; sadly, nothing
remains of it. The computer technology was expensive for commercialisation. But equally
importantly, the market for training in other than an apprenticeship model was non-existent.
naba speculates that the vision for the use of SimOne was narrow to create sufficient
demand.19 These pioneers were far ahead of the technology & the demand for its
application.

1.7 Harvey Cardioogy Manikin

This manikin is a full sized mannequin that simulates 27 cardiac conditions. It is among the
very first example of the modern concept of a part-task trainer for medical skills training. It
was firstly demonstrated in 1968 at the American Heart Association Scientific Sessions by
Dr. Michael Gordon of the University of Miami Medical School under the title of a
Cardiology Patient Simulator The motivation behind Harvey can be linked to Gordon’s days
as a cardiac fellow under his mentor, Dr. W Proctor Harvey of George town University,
after whom the mannequin was named. Inspired by Dr. Harvey’s use of audiovisuals in his
teaching, Gordon built a comprehensive cardiology patient simulator in partnership with the
CRME

Figure 3: Harvey cardiology manikin

The simulator displays various physical findings, including blood pressure by auscultation,
bilateral jugular venous pulse wave forms and arterial pulses, precordial impulses, and
auscultatory events in the four classic areas; these are synchronised with the pulse and vary
with respiration. Harvey is capable of simulating a spectrum of cardiac disease by varying
blood pressure, breathing, pulses, normal heart sounds, and murmurs.

Harvey has went genuinely thorough testing for instructive viability, maybe more than some
other preparing innovation. Pilot thinks about archiving Harvey's adequacy in showing
bedside cardiological examination abilities were first detailed in 1980.22 In 1987, the
investigation of the utilization of Harvey among 208 senior therapeutic understudies in five
restorative schools was supported by the National Heart, Lung, and Blood Institute.24
Fourth year medicinal understudies who prepared with Harvey amid their cardiology
elective performed fundamentally superior to their friends who interfaced just with patients.
This was evaluated through abilities post-tests utilizing the test system just as patients.
There were no revealed contrasts in the manner patients saw the expert conduct of Harvey
prepared versus non-Harvey prepared understudies. Or maybe, understudies who were
better ready to decipher discoveries on Harvey indicated upgraded certainty and capacity to
translate those equivalent discoveries on patients at the bedside.

Harvey has been utilized for preparing restorative and nursing understudies, assistants, and
inhabitants, and for proceeding with instruction of family physicians. It has likewise been
connected to testing bedside cardiovascular examination abilities of therapeutic
understudies, occupants, and going to doctors in inward prescription, pediatrics, and crisis
settings. By giving a stage to government sanctioned testing, Harvey was ahead of schedule
in taking into account increasingly far reaching inspecting of various aptitudes.

As it developed, Harvey was outfitted with an educational programs of cardiovascular

conditions, with related learning objectives and information rich slide programs created by a
national consortium of doctors and educators. It is much of the time utilized related to the
UMedic sight and sound PC educational programs, involving 10 tolerant focused, cased
based projects, which gives an exhaustive generalist educational programs in cardiology.

Around the time in which testing with Harvey was picking up force, a different heart sound
test system was appeared to improve cardiovascular auscultation aptitudes of nurses. Harvey
additionally roused the advancement of littler, progressively versatile cardiology persistent
test systems, for instance, Simulator K.

1.8 Physiological model of simulator

An imperative commitment to the historical backdrop of practical mannequin test systems
was the advancement of scientific models of the physiology and pharmacology of
medications in anesthesia. Thes
e served a double capacity: they developed into screen based test systems for various
applications and furthermore gave the basic ideas in displaying physiology that were
expected to help hands-on test systems with programmed control. A few PC based
reenactments of different parts of anesthesia have been created. Philip made a program for
showing take-up and circulation of sedative specialists, which he called GasMan®. Sikorski
et al portrayed a PC based recreation for training anesthesia occupants in overseeing
intraoperative events.

Progressively total models of human physiology have empowered higher devotion,

increasingly practical reenactments. Expanding on crafted by others in physiological
demonstrating, Dr N T Smith and associates at the University of California San Diego
(UCSD) considered a multicompartment model of human physiology and pharmacology
that framed the reason for SLEEPER, a screen based simulator. Intended fundamentally to
show physiology and pharmacology, it was a genuinely perplexing framework requiring
more registering force than was then accessible in PCs. SLEEPER developed into a more
extensive application, BODY™, which was showcased first by Marquette Medical Systems
and at present by Advanced Simulation Corporation.

Dr Howard Schwid, a previous individual in the UCSD labs, further built up the idea of
screen based reenactment by rearranging the models to keep running on a personal computer
and subsequently come to a more extensive audience. Schwid and O'Donnell additionally
extended the application to incorporate basic occasion the executives, for which there was a
more prominent market this was popularized in an item called the Anesthesia Simulator
Recorder, promoted in 1989. These specialists assembled a specialist framework around the
anesthesia test system to give learning goals, the executives counsel, and a computerized
debriefer. The new program was named Anesthesia Simulator Consultant (ASC). The
essential item has additionally advanced into a group of screen based test systems advertised
by Anesoft Corporation. Schwid and others directed various tests to survey the utility of
ASC, including investigations of viability of learning progressed heart life bolster abilities,
and examination of screen based and mannequin reproduction learning.

2. Project Description and goals

2.1. Idea:
The Idea came into mind while I was working in Ayu devices. For our device we visited
every week we do need to take review from Doctors from each Govt. and Private hospitals
as well as medical students from Govt. and private colleges in Mumbai. During that visits I
observe that private college students have lack of patients to practice as compared to govt.
colleges. Therefore they had very less knowledge about auscultation. After thinking a lot
about it I have decided to make this manikin. But already there were lot of manikin
available in market(US).For example SAM(student auscultation manikin)3D have an
auscultation manikin whose manikin cost around ,geri auscultation manikin,KERI
auscultation manikin whose cost lies around 5550$ to 6000$ which is equal to 3.5lacs to 4
lacs in INR.
Students cannot afford this costly manikin in India. So we have decided to make this cost
effectively with the help of AyuSynk which is an Bluetooth module of Ayu devices. With
the help of AyuSynk the cost goes around 20,000 -25000 which can be affordable for
students.

3. Project demonstration

Figure 4: SAM (STUDENT AUSCULTATION MANIKIN) SAM3D

Specifications:
 It is lightweight & portable
 It has the largest library of sounds (24 sounds) & videos (36 videos altogether)
 It has the complete Lesson Guide
  It can be used with any stethoscope
 It has a palpable carotid pulse
 Users can setup password protected lectures for student assessment
 It is available in light and dark skin version

Working:
The SAM II trainer can be used with any stethoscope. All sounds and videos are recorded
from live patients for students to experience a life-like simulation. Users can also create and
save their own case videos.
SAM II Student Auscultation Manikin is used in teaching and learning heart, lung and
bowel sounds. When connected to the laptop (included) with the pre-installed software, a
variety of sounds, videos and lessons recorded can be accessed.

Additionally, when connected to speakers (1021753) SAM II Student Auscultation Manikin

can be easily moved into a classroom or an auditorium for group instruction, where a larger
audience of students can benefit from a co-learning experience and share their thoughts at
the same time as high quality heart, lung and bowel sounds are emitted. The programmable
and password protected lectures allow teaching institutions to have numerous instructors
utilize the SAM II trainer. Included with the product is SAM’s Lesson Guide: a complete
guide of lessons for each auscultation sound that SAM II offers.

PAT(Pediatric auscultation trainer)

 Figure 5: PAT model

Working
Pediatric size auscultation trainer with listening points at the correct anatomical locations.
Heart sounds at different rates for comparison, (e.g. Example: Atrial Septal Defect at 75 bm
and 90 bm).
PAT's computer software interface is easily projected into any smart classroom. The
software includes phonocardiograms, correct anatomical locations, and written lessons for
each sound.
With programmable and password-protected lectures, many institutions find value in having
numerous instructors utilize PAT.

Sim shirt system

 Figure 6: Simshirt system

Working:

When worn by the standardized patient, the shirt simulates physiological conditions to test
diagnostic and procedural skills. It is controlled wirelessly with easy to use software and
responds in real time to diagnosis and treatment with direct feedback.

Instructors can easily adjust and adapt the suit scenarios to fit many conditions wirelessly by
using the SimScope Wifi.
The Shirt offers a basic version with all features of the Bionic Hybrid Simulator, except
EKG and blood pressure. Includes SimScop Wifi and tablet. Reusable and washable
(30°C), available in different sizes.

BIONIC HYBRID SIMULATOR

Figure 7: Bionic hybrid simulatior

Working:
When worn by the standardized patient, the suit simulates physiological conditions to test
diagnostic and procedural skills. It is controlled wirelessly with easy to use software and
responds in real time to diagnosis and treatment with direct feedback.

Features 5-wire EKG connections, pulse points, optional blood pressure cuff accessory, as
well as auscultation capabilities. Instructors can easily adjust and adapt the suit scenarios to
fit many conditions wirelessly by using the SimScope™ Wifi.

SimScope™ Wi-fi and tablet included with system reusable and washable (30°C), available
in different sizes.

Source
We have took the reference from previous Model, their structure,how they have made it.
First of all we went with Specifications and Brainstorming
Specifications: We have thought a lot about specifications.follwoing are the specifications:
1. Portability
2. Skin versions – (Normal)
3. Collection of different heart sound(Breath sound areas,cardiac diseases sound)
4. Auscultation sites(4)
5. Bluetooth since we are working with ayusync (sound,modifiable amplitude)
6. Computer connectivity –
7. Phonocardiographic display(if necessary)
8. Weight and size(Max. 9kg)

3.2 Brainstorming
Brainstorming about how to simplify it,How to make circuit as easy as possible.How to
make it lightweight,How to make it usable to use any stethoscope.

3.3 Heart sounds

Heart sounds is the main requirement for this project.We have collected about 96 different
heart sounds for four different heart locations.We have collected normal as well as abnormal
heart sounds for different locations. Names of collected heart sounds are as follows:
 S1
 S2
 S3
 S4
 Mitral regurgitation
 Mitral stenosis(Slow and normal)
 Aortic stenosis(Slow and normal)
 Aortic regurgitation(Slow and normal)
 Atrial septal defect(Slow and normal)
 Ventrical septal defec(Slow and normal)t
 TOF
 S1 split
 S2 split

4. Design approach and details

4.1 Design:
As of now we are doing it on cartboard just to check whether it is working or not.Location
and all others things are inspired from previous manikins. In this project We have tried
many circuit design for buzzer alarming like using Piezoelectric sensor

Piezoelectric sensor
As we know that piezoelectric sensor is a pressure sensor. With the help of piezoelectric
sensor buzzer will start alarming after putting pressure on it.Pressure will be given by
stethoscope itself. 9v I of supply would be required to on buzzer with the help of Voltage
amplifier(OP-AMP 602) .

In this circuit we have used

a) Inductor (10Mh)
b) Resistor(10kohm and 100Kohm)
c) Jumping wires(9)
d) Buzzer
e) Voltage amplifierOP-AMP 602)

Figure 8: Piezoelectric circuit

Since sometimes pressure sensor were giving just noise and needed a lot of force which an
normal doctors or medical student don’t use we have changed this circuit to button buzzer
circuit where buzzer alarms with very less pressure.

4.2 Design of button buzzer

1. Circuit is connected from backside of the cartboard
2. Arduino connection is given from back side also
3. Heart design is made on cartboard itself

Figure 9: Auscultation body

Circuit for one position of heart

4.3 Circuit for all four positions of heart

Figure 10: cIRCUIT

 Figure 11: final circuit

Components required
 -Dot PCB
 -Buzzer
 -Jumping wires
 -220ohm circuit
 -Blades and springs
 -Arduino UNO

5. Technical Part
5.1 Arduino coding

1.Tone Library

Tone library function is used to provide the sound of different frequencies to get to know
the different location of heart.Tone library will provide the different ringtones for different
heart positions.The code for arduino is as follows

Tone library code:

// Pin connected to buzzer

int buzzer = 5;

void setup()
{
// Defines the Buzzer pin as output
pinMode(buzzer,OUTPUT);
}

void loop()
{
// Sounds the buzzer at the frequency relative to the note C in Hz
tone(buzzer,261);
// Waits some time to turn off
delay(200);
//Turns the buzzer off
noTone(buzzer);
// Sounds the buzzer at the frequency relative to the note D in Hz
tone(buzzer,293);
delay(200);
noTone(buzzer);
// Sounds the buzzer at the frequency relative to the note E in Hz
tone(buzzer,329);
delay(200);
noTone(buzzer);
 // Sounds the buzzer at the frequency relative to the note F in Hz
tone(buzzer,349);
delay(200);
noTone(buzzer);
// Sounds the buzzer at the frequency relative to the note G in Hz
tone(buzzer,392);
delay(200);
noTone(buzzer);
}

Code used for project

// Pin connected to buzzer

int buzzer1 = 4;
int buzzer = 5;
int buzzer2 = 6;
int buzzer3 = 7;
void setup()
{
// Defines the Buzzer pin as output
pinMode(buzzer,OUTPUT);
pinMode(buzzer1,OUTPUT);
pinMode(buzzer2,OUTPUT);
pinMode(buzzer3,OUTPUT);
}

void loop()
{
// Sounds the buzzer at the frequency relative to the note C in Hz
tone(buzzer,100);
// Waits some time to turn off
delay(20);
//Turns the buzzer off
noTone(buzzer);
// Sounds the buzzer at the frequency relative to the note D in Hz
tone(buzzer1,400);
 delay(20);
noTone(buzzer1);
// Sounds the buzzer at the frequency relative to the note E in Hz
tone(buzzer2,20);
delay(20);
noTone(buzzer2);
tone(buzzer3,1000);
delay(20);
noTone(buzzer3);
}

6. Task performed and Schedule

S. Task Time taken Estimated

No. deadline

1. Collecting information about auscultation 1 week 5th feb

manikin

2. Fixing the specification 3 days 15th feb

3. Brainstorming 1 week 22th feb

4. Designing of Model 1 weeks 28th feb

5. Devloping Model 2 weeks 15th march

6. Testing Model 2 weeks March ending

6.3 Result:

After testing the model many times the model wa giving exact sound at respective area.As
the aim was to sound should be low so that it can listen to user only who is handling the
device and it was coming out as we wanted model was working neatly and we have used it
with different stethoscope and it was working. Sthethoscope is used in at every part or area
and gave the expected sound

s. no. Area Result

1. Aortic Sounding buzzer at 100Hz

2. Pulmonary Sounding buzzer at 400Hz

3. Tricuspid Sounding buzzer at 700Hz

4. Mitral Sounding buzzer at 1000Hz

7. Conclusion and Discussion

The proposed custom model is very cost effective according to other manikins.The model is
made in very cheap budget so that anyone can buy it for thir practice.We are thinking to add
another 5th position to this model which is nothing but ‘Erbs point’ after settling this model.
Next progression will be adding few more sounds o model of particular disease.This model
would be converted into proper auscultation manikin for selling to medical
studetns.Estimated cost of model would be around 20000Rs because medical students have
to buy Ayusynk which is Bluetooth module which converts and conventional stethoscope
into digital
On the basis of this experiment,w conclude that it would be an sufficient and efficient
product for medical student after comparing with other manikin products.Its price is reduced
1700% than other products

8. References
[1] https://www.3bscientific.com/bionischer-hybrid-simulator-1021981-718-
3800,p_148_31118.html
[2] Vukanovic-Criley JM, Criley S, Warde CM, Boker JR, Guevara-Matheus L,
 Churchill WH, Nelson WP, Criley JM. Competency in cardiac examination skills in
medical students, trainees, physicians, and faculty: a multicenter study. Arch Intern
Med. 2006;166:610–616. doi: 10.1001/archinte.166.6.610.

[3] Mangione S. Cardiac auscultatory skills of physicians-in-training: a comparison of

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