Code Blue Monitor – User Guide
For version 2.2 (September 2026). How to use an iPad as a simulated patient monitor and defibrillator, with an iPhone as the instructor's remote. Sold as "NCLS Monitor" in Japan.
1. Overview
The instructor operates the iPhone; the iPad in front of the learners changes. Learners look at the monitor, notice the abnormality themselves, assess and act.
| What it does | 35 ECG rhythms, changing vital signs, 23 scenario presets, defibrillation, synchronised cardioversion and transcutaneous pacing, 12-lead ECG, 47 blood gases (with progression), 5 chest X-rays, 3 echo clips and your own images, breath and heart sounds, pupil examination, patient chart (28 SIM-Chart cases), ambient sounds, patients from adult to neonate, selectable units, a debriefing record (PDF), Japanese / English / Spanish |
|---|---|
| What it does not do | Measure compression depth or rate, or ventilation volume; play video. For skills measurement use a sensor-equipped simulator |
| Requirements | iPad (iPadOS 15 or later). For two devices, an iPhone (iOS 15 or later). No Wi-Fi router or internet needed |
2. Setup and connecting two devices
- Turn on Wi-Fi and Bluetooth on both devices. Wi-Fi only needs to be on; it does not need to be connected to a network.
- Open the app on the iPad and note the 4-digit room code on screen.
- Open the app on the iPhone and enter the same 4 digits.
- Choose Monitor on the iPad and Remote on the iPhone.
- The first time, iOS asks for "Local Network" permission. Allow it (you can change it later in Settings → Code Blue Monitor).
Connecting can take up to a minute; the remote shows "Connecting" meanwhile. Once connected, the remote shows HR, BP and SpO₂ at the top. If the link drops afterwards (screen off, devices moved apart), it reconnects automatically within seconds once they are back.
Single device: choose Monitor on the iPad and use Show control panel at the bottom to operate directly.
Session set-up screen
After you choose a role and before the monitor is powered on, Session set-up opens. It gathers everything you decide before a session on one screen, and remembers your choices for next time. You can reopen it later from Display & settings → Open session set-up.
| Age and weight | Adult, child (10 y, 6 y), toddler, infant, neonate. Normal ranges and alarm limits follow the age, and the recommended energy (2 J/kg, then 4 J/kg) is marked on the dial for the instructor only |
|---|---|
| Defibrillator | Hide the defibrillator (larger monitor) for sessions that do not need it. The dial stays visible until the monitor is powered on |
| Appearance | Dark or light housing |
| Units | mmHg or kPa, mg/dL or mmol/L, °C or °F |
| Language | Japanese, English, Spanish. The app reloads when you switch; set the remote to the same language |
| Chart case and phase | What learners see when they open the chart (section 8) |
| Blood gas | Choose a progression and step through early → worsening → pre-arrest → arrest → ROSC → recovery with Next during the session, or pick a single case |
| Imaging and pupils | What is shown when learners open them |
| Sound and pulse sound | Check the room volume here, and choose which device plays the palpation sound |
| Room code | Same number as the remote |
Your first scenario (5 minutes)
Once the devices are connected, run through this once. It works in the free version too.
- Power on: turn the defibrillator dial on the iPad from OFF to Mon. After the self-test, normal sinus rhythm appears
- Attach sensors: tap "Attached" on the iPhone for SpO₂, and Measure on the iPad for blood pressure. The values fill in
- Switch to learner view: Learner view at the bottom of the iPad screen. From here on, this is what learners see
- Make the patient worse: raise the heart rate and lower the blood pressure with the iPhone sliders. Watch whether learners notice
- Go to VF: choose VF in the rhythm list on the iPhone. The alarm sounds
- Learners defibrillate: select the energy on the iPad dial, Charge → Shock. Learners press the shock button themselves
- Restore a rhythm: the waveform does not change by itself after a shock. The instructor sets Sinus rhythm (or another) on the iPhone
- Debrief: Create record (PDF) in the Events tab puts the vital sign trends and the event log on one page (full version)
3. The monitor screen
Power dial and sensors
Turn the defibrillator dial from OFF to Mon to power on (it clicks as you turn it). As on a real device, a short self-test runs before the waveform appears; while powered off the screen shows only the date, time and battery. Nothing else is displayed at first: values appear only after a sensor is attached.
| ECG / heart rate | Shown once powered on |
|---|---|
| SpO₂ | After the probe is attached ("Sensors" in the control panel or the "Attached" buttons on the remote) |
| NIBP | Tap Measure on the monitor; the cuff inflates and the reading appears. It does not measure automatically unless you choose an interval (2.5, 5 or 15 min) in the alarm settings |
| Respiration / temperature | After the sensor is attached |
| Arterial line | When attached, the ART waveform and ABP value appear |
| EtCO₂ | Enable the capnogram in Display & settings |
Alarm limits: tap a value tile (HR, NIBP, SpO₂, RESP) to open the alarm settings, as on a real monitor. Adjust high and low limits with + / −, turn either OFF, or restore Defaults. VF, VT and asystole alarms are always on. Silence alarm at the top mutes alarms for two minutes.
Pause freezes the waveforms, Reset returns to the initial state, Full hides the browser frame.
Learner view
The learner view is the screen with the control panel hidden. Switch with Hide control panel (learner view) in Display & settings or the Learner view tab. Always use this view when learners are watching. With a keyboard, H toggles it.
4. Instructor control panel
Rhythm
35 rhythms in six groups: sinus, supraventricular, ventricular, arrest, AV block, ischaemia and electrolytes. The waveform changes the moment you tap.
- The rhythm name is not shown on the monitor. Learners read the waveform.
- Heart rate is measured from the R–R interval, so Wenckebach and bigeminy show a rate that differs from the palpable pulse, as in reality.
- In VF, asystole, pulseless VT and PEA there is no pulse; SpO₂ and BP cannot be measured and EtCO₂ falls to 6 (during CPR, or if you set a value, that value is shown).
Pacing
Set the capture threshold (the mA at which pacing captures) under Set threshold…. Learners cannot see it. Operation is in section 6.
Vitals
Heart rate, systolic / diastolic BP, SpO₂, respiratory rate, EtCO₂ and temperature are sliders, so you can build a seamless course from gradual deterioration to arrest. Scenario presets set the rhythm and vitals together with matching breath sounds, heart sounds, pupils and blood gas in one tap (anything not specified returns to normal).
| Circulation (9) | Symptomatic bradycardia, unstable tachycardia, haemorrhagic shock, septic shock, inferior MI with bradycardia, anaphylactic shock, tension pneumothorax, long QT (before TdP), cardiac tamponade |
|---|---|
| Respiratory (9) | Pulmonary embolism, postoperative respiratory failure, hypoxia with sinus tachycardia, severe asthma, COPD exacerbation, acute heart failure with pulmonary oedema, opioid-induced respiratory depression, airway obstruction, respiratory arrest |
| Consciousness and metabolic (5) | Intracerebral haemorrhage with raised ICP, hyperkalaemia, hypoglycaemia, diabetic ketoacidosis, post-seizure |
A preset is a starting point: use the sliders afterwards to make the patient deteriorate or improve.
Display & settings
| Sensors | Attach or remove SpO₂, respiration, temperature and the arterial line |
|---|---|
| Hide values | Hide HR, BP, SpO₂, RR, temperature and the rhythm name individually. You can keep the waveform and hide only the number. For physical assessment practice and OSCEs |
| EtCO₂ (capnogram) | Show or hide |
| Pulse sound output | Monitor, remote or both |
| Test charge sound | Check the speaker |
| Back to home | Change role or room code |
Exams
Decide here what learners will see when they open an exam.
| Breath sounds | Normal, wheeze, asthma exacerbation, stridor, snoring, coarse crackles. When the respiratory rate is 0, breath sounds are silent whichever is selected. In the control panel, tap to play and tap again to stop; on the remote they play only while the button is held, like holding a stethoscope Full |
|---|---|
| Heart sounds | Normal, S3, aortic stenosis, mitral regurgitation, pericardial rub, muffled. Timed to the ECG on screen; silent when there is no pulse Full |
| Ambient sounds | Siren, in-hospital emergency call, Code Blue announcement Full |
| Blood gas | 47 cases. Asthma, sepsis, haemorrhage, MI, airway obstruction, DKA and seizure can be stepped through as a progression (session set-up) Full |
| Imaging | 5 chest X-rays, 3 echo clips, plus your own images (stored on the device only; do not add images that could identify a patient) Full |
| Pupils | Normal, miosis, mydriasis, anisocoria (right / left), sluggish reflex Full |
| Chart case | The built-in COPD case or one of 28 SIM-Chart cases. Advance the phase and learners see the records and results up to that point (section 8). SIM-Chart cases are in Japanese Full |
Events
Every action — rhythm changes, shocks, CPR start and stop, exams opened, alarm changes — is logged with a timestamp. Save log (.txt) exports it. Create record (PDF) builds a one-page debriefing record with the vital sign trends and the event log, which you can share by AirDrop, Mail or Files. During CPR the chest compression fraction (CCF) is calculated automatically.
5. iPhone remote
From the top: device controls (power, pause, reset), rhythm, scenario presets, vital sliders, breath / heart / ambient sounds, exam cases, and "show on monitor". Everything in the control panel is available here.
The bottom bar has three large buttons: CPR, pulse on/off, and palpate pulse.
The HR, BP and SpO₂ at the top mirror the monitor. If the connection drops, "Not connected" is shown; "Reconnect" restores it.
6. Defibrillation and pacing
Defibrillation
- Turn the dial to the energy (2–270 J; 120–200 J is typical for adult defibrillation).
- Press Charge. The charge tone sounds and "Charged" appears after a few seconds.
- Press Shock. Learners do this themselves.
- After the shock, the instructor changes the rhythm (it does not change by itself).
If charged but not used, Internal discharge disarms safely. With a keyboard: C charge, S shock, ←→ energy.
Synchronised cardioversion
Press SYNC and markers appear on the R waves. Shock now waits for an R wave; in VF, where there is none, no shock is delivered — as on a real device.
Transcutaneous pacing
- Turn the dial to Pace Demand (or Fixed).
- Set the rate and press Start pacing.
- Output starts at 0 mA. Raise it with +5 until a wide QRS follows each pacing spike (electrical capture).
- Then palpate the pulse to confirm mechanical capture.
The capture threshold is set by the instructor and hidden from learners.
7. CPR and pulse check
CPR: press CPR on the remote or panel. Compression artefact appears on the ECG, arterial line and pleth, and EtCO₂ rises. Press again to pause. Interruptions are logged and CCF is calculated. Keyboard: P.
Palpate pulse: while holding Palpate pulse, a pulse sound plays if a pulse is present. In PEA there is a waveform but no sound; the same in VF and asystole, and a notice appears. During chest compressions a weaker, duller compression pulse is felt at the compression rate — it is not a native heartbeat, so check the pulse during a pause. Output (monitor / remote) is set in Display & settings.
8. Exams learners can open
Opened from "Labs" on the left of the learner view. The content is whatever the instructor set under Exams; the instructor can also open them from the remote.
| Blood gas | The selected case |
|---|---|
| 12-lead | Reconstructed from the current rhythm. Choose the infarct location (inferior, anterior, lateral), press "Automated analysis" for an interpretation, "Save image" for a PNG |
| Imaging | Chest X-ray or echo with findings |
| Pupils | Diagram of both eyes. Hold a penlight button to shine the light; the light reflex and the consensual reflex on the other side respond. No numbers — compare with the pupil gauge |
| Chart | Five tabs: progress notes, patient, vitals, labs, orders. For SIM-Chart cases, only the information up to the phase the instructor has reached is visible |
Chart phases
SIM-Chart cases progress "Phase 1 stable → Phase 2 event → course → full disclosure". Let learners gather information in Phase 1, then advance to Phase 2 after they enter the room: the event-time vitals and results arrive. "Full disclosure" is for debriefing. If the chart is open, the change appears immediately.
9. Sounds
| QRS beep | Every QRS. Quieter while breath or heart sounds play |
|---|---|
| Alarms | When HR, SpO₂, BP or RR leave the set limits. "Silence alarm" mutes for two minutes |
| Charge / shock | With the defibrillator |
| NIBP | Cuff inflation and deflation on "Measure" |
| Breath / heart / ambient | Whatever the instructor selected. Breath sounds are recordings; heart sounds are synthesised in time with the ECG |
No sound? Check the iPad's silent switch and the volume in Control Centre. "Test charge sound" in the app confirms the speaker.
10. Free and full versions
| Free | 4 rhythms (sinus, VF, pulseless VT, asystole), defibrillation (2 shocks per scenario), vital control, iPhone remote, learner view, built-in chart case. Enough to run a BLS session |
|---|---|
| Full | 35 rhythms, unlimited shocks, pacing, 12-lead with interpretation, 47 blood gases with progression, 5 chest X-rays, 3 echo clips and your own images, breath and heart sounds, pupils, ambient sounds, 28 SIM-Chart cases, arterial line and EtCO₂, 23 scenario presets, patients from child to neonate, units, debriefing record (PDF), log export |
| One-time purchase | In-app purchase: buy once, use it for good. Works on every device signed in with the same Apple ID; on another device, tap any lock icon and choose "Restore purchase" |
| Monthly plan | For people who teach only a few times a year. Every feature of the full version, one month at a time (auto-renewing). New subscribers get the first month at an introductory price. Available on the purchase screen from version 2.2 |
| Cancelling the monthly plan | It renews until cancelled. Cancel any time in Settings → your name → Subscriptions → Code Blue Monitor; you are not charged after that and can keep using it until the end of the period. The app shows a Manage or cancel reminder right after purchase and when you power off after using it for 5 minutes or more (at most once a day), which opens the subscription screen directly |
| Institutions | "Code Blue Monitor Pro" is a separate paid app with everything included, for volume purchase through Apple School Manager / Apple Business Manager and deployment by MDM. The free app's in-app purchase cannot be bought in volume. If a device already has the full version unlocked, you do not need Pro for it as well |
Full-version features show a lock icon; tapping one shows the purchase screen.
11. Troubleshooting
| The two devices do not connect | Check in order: (1) Wi-Fi and Bluetooth are on on both devices (Wi-Fi does not need to be joined to a network); (2) the room code matches; (3) Local Network is allowed (Settings → Code Blue Monitor); (4) both devices run the same app version. If they still will not connect, fully quit the app on both devices, open it again and re-enter the same room code. The first connection can take up to a minute |
|---|---|
| The link keeps dropping | Set the iPhone's Auto-Lock to Never (the link can stop when the screen turns off). Turn off Low Power Mode. Joining both devices to the same Wi-Fi network is more stable than a direct link; on a crowded hospital network, a mobile hotspot for both devices helps |
| No values shown | Sensors are not attached. Attach them in Display & settings or with "Attached" on the remote. BP appears only after "Measure" |
| No sound | Silent switch and volume. Right after launch, tap the screen once before expecting sound |
| Shock does not fire | SYNC waits for an R wave — turn it off in VF. It also does not fire before "Charged" |
| EtCO₂ stuck at 6 | Pulseless rhythm. Start CPR or set a value with the slider |
| No heart sounds | They are silent when there is no pulse (VF, asystole, PEA) |
| Waveforms stutter | On older iPads the app automatically switches to lighter rendering when frames keep dropping (the event log shows "Switched to low-power rendering"). Turn off Low Power Mode and close other apps |
| Locks still shown after purchase | Tap a lock icon and choose "Restore purchase"; make sure you are signed in with the Apple ID used for the purchase |
| Cancelling the monthly plan | Settings → your name → Subscriptions → Code Blue Monitor → Cancel Subscription. "Manage or cancel" inside the app opens the same screen |
| The monthly plan is not shown on the purchase screen | It appears once the price has been received from the App Store. Open the purchase screen again where you have a connection. Version 2.2 or later is required |
| On an external display, the start screen appears but nothing moves | A second copy of the app has opened on the external display (Stage Manager's extended-display behaviour on M-series iPads), separate from the one running on the iPad. Go to Settings → Home Screen & Multitasking → Stage Manager and turn External Display off; the iPad screen is then mirrored. If you keep Stage Manager on, close the second copy and drag the running window to the external display instead. Non M-series iPads mirror by default |
| The edge of the dial seems to shimmer | A rendering effect on some iPads, only on the instructor's screen. It does not affect operation and does not occur in learner view |
| Learners can see the control panel | Tap "Hide control panel (learner view)" |
12. Design principles
Everything a real monitor shows, and nothing it does not. Information is presented as on the real device, not deliberately hidden or added.
- No rhythm name on screen. The pacing threshold is hidden. No values until a sensor is attached. All of this is so that learners have to think.
- The QRS beep follows the ECG, not the pulse. In PEA it keeps beeping while the waveform is present.
- Heart rate is measured from the R–R interval.
- Paced beats have discordant ST–T changes; they are not infarction.
Feedback and bug reports: see the contact page.