My dream for ChatGPT
This is what I literally DREAM of chatGPT being able to do. It's so extensive it's not even funny, because IF this ever happened, it would be so profound. Here's a type of simulator I dream of chatGPT being able to build one day. WARNING: I get in depth here! I dream of being able to one day have chatGPT create something as extensive as an ICU Simulator. Where it Simulates what a real world ICU would be. Medication Administration, Proper Ventilator and patient physiology, meaning accurate lung and other physiological parameters. If I want to simulate a very sick patient with Acute Respiratory Distress Syndrome, I would be able to do that. The patient is on high ventilator settings, maxed out on the amount of oxygen the ventilator is administering. Let's say for example, a patient who's SpO2 is in the toilet, and it's only getting worse. They're on the ventilator on 100% Oxygen, the Positive End Expiratory Pressure is 22 cmH2o which is VERY high. The compliance of the patient's lungs is so bad, I cannot get good tidal volume into the patient's lungs. What does that mean? It means not only would oxygenation suffer, but Ventilation would be poor too, and that means the Carbon Dioxide levels would be high, and the Arterial PH would drop.
So in this simulator, I would simulate one of various options. I could put the patient into a specialized rotating bed that actually turns the patient upside down onto their stomach, and this would help recruit the air sacks in the lungs called Alveoli, and hopefully this could increase Oxygenation. If that did not work, I might want to bring in another therapy such as the Oscillator, or better known as High Frequency Oscillatory Ventilation, HFOV! This ventilator uses a unique method of ventilation, and what this does is it administers very tiny breaths very fast. So on a regular ventilator, you would see a rate that's 12 to 22 Breaths Per Minute, or in sicker patients, a patient might need a breath rate as high as 35 Breaths Per Minute.
The High Frequency Oscillatory Ventilator administers upwards of 300-420 Breaths Per Minute, and it does this in a way that won't hyperventilate the patient, because these breaths are very very small.
This ventilator can be used in Acute Respiratory Distress Syndrome. So in my simulator, I bring in this type of vent into the room, and I switch my simulated patient from the conventional ventilator to the oscillator. In my simulator, I would want accuracy PRECISELY! I would want to see accurate results like you would see in the Intensive Care Unit. Either the patient responds to this modality, or they continue to deteriorate. If they respond, I would see that both on my simulated patient monitor, as well as on the Arterial Blood Gases that I would obtain in the simulator. If the response to this mode of ventilation was good, the Arterial PH would come up according to how good I was ventilating the patient, and hopefully, Oxygenation would improve.
If It didn't, I would want to be able to bring in another therapy such as Extra-Corporeal membrane Oxygenation, or ECMO, which is a treatment where the lungs can be taken out of the picture while they're trying to heal. I would want accurate behavior according to how a real patient who is on ECMO might respond. As I increase the ECMO blood flow through the tubing connected to the patient via cannulas, I would expect to see accurate simulation. As I increased what is known as the Sweep Gas which would go through the Oxygenator, I would want to observe on the Arterial Blood Gases that I obtained from the patient, that the Arterial PH is coming up, and the Carbon Dioxide is coming down.
Now this is only touching the tip of the things I could imagine doing with chatGPT in the future. But I have other stuff I would want to simulate such as a whole accurate Operating Room environment, a whole Emergency Room environment, andeven simulated management of a patient in an ambulance or on an air ambulance. I'd want all that to be accurate and if this could actually happen, more Respiratory Therapists, Nurses, Surgeons, Nurse Practitioners, Paramedics, EMTs, and other Specialties could actually use this for educational purposes.
What this would mean is people for example Paramedics could simulate taking care of a patient in an ambulance. They could practice securing the airway in transport, securing IV Access, pushing Pain Medications, Securing the spine of a Possible Spinal Cord Injury patient. Or a physician could simulate assessment of a patient who has Guillain Barre Syndrome. In these cases, every second counts. In a patient with Guillain Barre Syndrome, getting them on either IVIG, or Plasmapheresis is critical, because otherwise you risk further progression, and possible Respiratory failure.
Another example of something that could be done is an Operating Room scenario, where an Anesthesiologist could practice accurately, the steps of General Anesthesia. They could practice the Premedication in the Holding area before they bring the patient to the Operating room, and then when they got the patient to the operating room, they could simulate getting the monitors on the patient, seeing accurate Heart Rate and rhythm, Oxygen Saturation levels AKA SpO2, Non-Invasive Blood Pressure Reading, simulate application of a Bispectral Index sensor to monitor the BIS during surgery, and as you administered medications throughout the case, you would be able to see accurate results on the monitor, and the other equipment.
An Anesthesiologist could administer medications such as 100 mg Lidocaine, and then the 200 mg of Propofol which will ultimately put the patient to sleep. Once you administer the 200 mg of Propofol, you would see the patient's breathing cease, and that's when that would be indicated on the ETCO2 Waveform, so the Anesthesiologist would take over, simulating squeezing the bag on the Anesthesia Machine, and this would put air into the patient's lungs while the next medications are being administered so that Endotracheal Intubation would be able to take place, followed by connection of the breathing tube to the Anesthesia machine.
At that time, in the simulator, the Anesthesiologist would simulate turning on the gases that would help keep the patient to sleep. The Anesthesiologist would be able to simulate verification of correct Endotracheal Tube placement by being able to hear accurate breath sounds in the simulator, and looking at the ETCO2 waveform to verify that YES, Carbon Dioxide is being detected. The breathing tube is in place. And then the anesthesiologist would be able to simulate maintaining anesthesia during the case at hand, and then once the case is over, the Anesthesiologist could turn off the gases and help reverse the anesthesia appropriately, and then transport the patient to the Post-Anesthesia Care Unit.
If we could get ChatGPT to create accurate simulations like that, good grief there's no limit to what it could do. Not only that, but other specialties could be simulated such as Law Enforcement, Factory Work, and so much more. THIS is what I dream of chatGPT being able to do! Yes, it is very invasive, would take a lot of work, and some people might just cringe at what I've just describe, and Like I said I'm only touching the surface of what I would like chatGPT to do.