HeartStart MRx - Philips InCenter

HeartStart MRx - Philips InCenter
User Training Workbook
HeartStart MRx
M3535A/M3536A
Notice
About This Edition
Publication number 453564045051
Edition 6
Printed in the USA
To determine the product level version to which this
guide applies to, refer to the version level on the label of
the User Documentation CD-ROM that accompanied
the device. This information is subject to change without
notice.
Other trademarks and trade names are those of their
respective owners.
Use of supplies or accessories other than those
recommended by Philips may compromise product
performance.
THIS PRODUCT IS NOT INTENDED FOR HOME
USE.
IN THE U.S., FEDERAL LAW RESTRICTS THIS
DEVICE TO SALE ON OR BY THE ORDER
OF A PHYSICIAN.
Medical Device Directive
Philips shall not be liable for errors contained herein or
for incidental or consequential damages in connection
with the furnishing, performance, or use of this material.
The HeartStart MRx complies with the requirements of
the Medical Device Directive 93/42/EEC and carries the
0123 mark accordingly.
Edition History
Manufacturer:
Edition Print Date
Philips Healthcare
3000 Minuteman Road
Andover, MA 01810
1
September, 2006
2
February, 2007
3
August, 2007
4
May, 2009
5
December, 2011
6
August 2013
Copyright
Copyright © 2013
Koninklijke Philips N.V.
All rights are reserved. Permission is granted to copy and
distribute this document for your organization’s internal
educational use. Reproduction and/or distribution
outside your organization in whole or in part is
prohibited without the prior written consent of the
copyright holder.
SMART Biphasic is a registered
trademark of Philips.
Microstream® and FilterLine® are registered trademarks
of Oridion Medical Ltd. Smart CapnoLine™ is a
trademark of Oridion Medical Ltd.
Q-CPR® is a registered trademark of Laerdal Medical.
The HeartStart MRx contains an Ezurio PC Card with
Bluetooth® wireless technology. The Bluetooth
wordmark and logos are owned by the Bluetooth SIG,
Inc. and any use of such marks by Ezurio is under license.
Authorized EU-representative:
Philips Medizin Systeme Böblingen GmbH
Hewlett Packard Str. 2
71034 Böblingen
Germany
Canada EMC:ICES-001
U.S. FCC and Industry Canada Radio Compliance:
Contains FCC ID: PQC-WMTS-MODULE
When using the IntelliVue networking option, operation
of this equipment requires the prior coordination with a
frequency coordinator designated by the FCC for the
Wireless Medical Telemetry Service. This device
complies with Part 15 of the FCC rules and RSS-210 of
Industry Canada. Operation is subject to the following
conditions:
• This device may not cause harmful interference.
• This device must accept any interference received,
including interference that may cause undesired
operation.
Any changes or modifications to this equipment not
expressly approved by Philips Medical Systems may cause
harmful radio frequency interference and void your
authority to operate this equipment.
i
China:
After Sales Service: Beijing MEHECO-PHILIPS Medical
Equipment Service Center.
After Sales Service Address: No. 208, 2nd District, Wang
Jing Li Ze Zhong Yuan, Chao Yang District, Beijing.
Postal code: 100102.
Telephone: 010-64392415.
Registration number: SFDA(I)20043211207.
Product Standard number: YZB/USA 52-21.
For the Declaration of Conformity Statement, please see
the Philips Medical web site at http://
incenter.medical.philips.com/PMSPublic. Scroll over the
Quality and Regulatory Tab located in the upper left
corner of the window. Click to select Regulatory by
Modality. Then click to select Defibrillators and select
the entry for Declaration of Conformity (DoC).
Warning
Radio frequency (RF) interference from nearby
transmitting devices may degrade the performance of the
HeartStart MRx. Electromagnetic compatibility with
surrounding devices should be assessed prior to using the
monitor/defibrillator.
ii
This workbook should be used primarily for HeartStart MRx instructor-based end-user training, along
with the 453564045041 Instructor Guide. The workbook contains the following conventions:
iii
"Voice"
represents voice prompt messages
Text
represents messages that appear on the HeartStart MRx display
Text
represents options that appear on HeartStart MRx menus
[Soft key]
represents soft key labels that appear on the display above the
button to which they correspond
iv
Table of Content
1
Getting Acquainted
1
Lesson Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Objectives .
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Lesson Presentation . . . .
Basic Orientation . . .
Display View . . . .
Responding to Alarms .
Password Security . . .
Printing Waveforms . .
Continued Use . . .
Return to Owner . . .
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Carrying Case and Accessory Pouch Assembly .
Storing Accessories . . . . . . . .
Review . . . . . . . . . . . . . . . .
2
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ECG and Arrhythmia Monitoring
1
2
2
7
8
9
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10
11
12
14
15
Lesson Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Objectives .
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Lesson Presentation
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Monitor View .
Preparation. .
Heart Rate and Arrhythmia Alarms
Displaying an Annotated ECG .
Arrhythmia Learning/Relearning
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Review . . . . . . . . . . . . . .
3
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Semi-Automated External Defibrillation
. 15
. 16
. 16
. 17
. 19
. 22
. 23
. 24
25
Lesson Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
Objectives .
. .
Lesson Presentation . . .
AED View . . . .
Preparation. . . .
AED Mode . . .
Shock Advised . . .
No Shock Advised . .
Review . . . . . . . .
4
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Manual Defibrillation and Cardioversion
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. 25
. 26
. 26
. 27
. 28
. 29
. 30
. 31
33
Lesson Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
v
ii
Objectives
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Lesson Presentation
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Code View .
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Manual Defibrillation Preparation .
Manual Defibrillation . . . .
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Synchronized Cardioversion Preparation .
Synchronized Shock Delivery . . . .
Review . . . . . . . . . . . . . .
5
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33
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. 34
. 35
. 36
. 37
. 38
. . 39
Q-CPR® with CPR meter
41
Lesson Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
Objectives
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Lesson Presentation . . . . .
Overview . .
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Q-CPR Preparation . . . .
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Starting CPR with the CPR meter .
CPR meter Display . . . . .
Q-CPR in Manual Defib Mode .
Q-CPR in AED Mode . . . .
Review . . . . . . . . . . .
6
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41
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. 42
. 43
. 44
. 45
. 48
. 50
. . 52
Q-CPR® with Compression Sensor
53
Lesson Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
Objectives
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53
Lesson Presentation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54
Overview . . . . . . .
Q-CPR Preparation . . . .
Q-CPR in Manual Defib Mode
Q-CPR in AED Mode . . .
Review . . . . . . . . . .
7
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Noninvasive Pacing
54
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. 61
63
Lesson Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
Objectives
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Lesson Presentation . . . .
Pacer Mode .
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Pacing View .
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Demand vs. Fixed Mode .
Preparation . . . . .
Demand Mode Pacing . .
Fixed Mode Pacing . . .
Defibrillating During Pacing
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Review . . . . . . . . . .
8
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63
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. 64
. 64
. 65
. 66
. 67
. 68
. 69
. . 70
Pulse Oximetry Monitoring
71
Lesson Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71
Objectives
vi
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71
ii
Lesson Presentation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72
Monitoring SpO2 . . .
Setting SpO2 Alarms . .
Setting Pulse Rate Alarms.
Disabling SpO2 Monitoring
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Review . . . . . . . . . .
9
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Noninvasive Blood Pressure Monitoring
72
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. 76
77
Lesson Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77
Objectives .
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Lesson Presentation . . . . .
Preparing to Measure NBP .
Measuring NBP . . . .
Alarms . . . . . . .
Review . . . . . . . . . .
10
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. 77
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Carbon Dioxide Monitoring
83
Lesson Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83
Objectives .
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Lesson Presentation . . . . .
Measuring EtCO2 . . . .
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Setting Up the EtCO2 and AwRR Alarms . .
Disabling EtCO2 Monitoring . . . . .
Review . . . . . . . . . . . . . . . .
11
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. 83
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Invasive Pressures Monitoring
89
Lesson Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89
Objectives .
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Lesson Presentation
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Overview . .
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Pressure Measurement Set-up . . . .
Selecting a Pressure to Monitor . . . .
Pressure Waves . . . . . . . . .
Zeroing the Pressure Transducer . . . .
Alarms . . . . . . . . . . .
Pulse . . . . . . . . . . .
Review . . . . . . . . . . . . . . .
12
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Temperature Monitoring
. 89
. 90
. 90
. 90
. 91
. 91
. 93
. 94
. 95
. 97
99
Lesson Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99
Objectives .
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Lesson Presentation
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Overview . .
Selecting a Temperature Label
Monitoring Temperature . .
Setting Temperature Alarms .
Disabling Temperature Monitoring
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. 99
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. . . 101
vii
ii
Review . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103
13
12-Lead ECG Monitoring
105
Lesson Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105
Objectives
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Lesson Presentation .
Preview Screen .
Preparation . .
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Acquiring the 12-Lead ECG .
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Acquiring a 12-lead ECG with ACI-TIPI or ACI-TIPI/TPI Analysis .
12-Lead Report . . . . . . . . . . . . . . . .
Adjusting Wave Size . . . . . . . . . . . . . . .
Review . . . . . . . . . . . . . . . . . . . . . . .
14
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. 105
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Vital Signs Trending
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Lesson Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113
Objectives
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Lesson Presentation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114
Reviewing Trending Data . .
Trending Report Intervals . .
Scrolling in the Trending Report
Printing the Trending Report .
Exiting the Trending Report .
Review . . . . . . . . . .
15
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IntelliVue Networking
114
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Lesson Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117
Objectives
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. 117
Lesson Presentation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118
Overview . . . . . . . . .
IntelliVue Networking Display . . .
Connecting to the Network. . . .
Patient Admit, Discharge, and Transfer
Sharing Information on the Network .
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Review . . . . . . . . . . . . . . . .
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Working with Data
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129
Lesson Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129
Objectives
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Lesson Presentation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 130
Overview . . . . . . . . . .
Copying from Internal Memory . . .
Viewing and Erasing the External Data Card
Printing During a Patient Event . . .
Printing from Data Management Mode .
Marking Events . . . . . . . .
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Review . . . . . . . . . . . . . . . .
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. 134
ii
17
Data Transmission
135
Lesson Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135
Objectives .
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Lesson Presentation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136
Overview . . . . . . . . . . . . .
Preparing for Transmission . . . . . . . .
Setting Up Bluetooth Transmissions (Optional topic) .
Setting up Wireless Link Transmissions (Optional topic)
Transmitting in 12-Lead Mode . . . . . . .
Periodic Clinical Data Transmission (Optional topic) .
Transmitting Post Events . . . . . . . . .
Transmitting in Data Management Mode . . . .
Tracking Data Transmission . . . . . . . .
Cancelling a Transmission . . . . . . . .
Queuing Transmissions . . . . . . . . .
Finding Transmission Results . . . . . . .
Batch LAN Data Transfer (Optional topic) . . . .
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Review . . . . . . . . . . . . . . . . . . . .
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. . 151
Maintenance
153
Lesson Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153
Objectives .
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Lesson Presentation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 154
Automated Tests . .
Ready For Use Indicator
Shift Check . . .
Weekly Shock Test .
Operational Check .
Battery Maintenance .
Cleaning Instructions .
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Review . . . . . . . . . .
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ix
ii
x
User Training Workbook
1
Getting Acquainted
1
Lesson Introduction
This lesson provides an overview of the HeartStart MRx controls, indicators, operational modes, and
display views. It also provides general information on use of the device.
Objectives
Upon completion of this lesson, you should be able to:
1. Identify the physical features, controls, and indicators of the MRx.
2. Identify the purpose of various controls and indicators.
3. Identify the display view characteristics associated with MRx’s operating modes.
Notes:
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
1
1 Getting Acquainted
Lesson Presentation
Lesson Presentation
Basic Orientation
The MRx controls are organized to facilitate ease of use.
Front Panel
External Power Indicator
Location of Networking icon
(if device is network enabled)
Synchronized Cardioversion
(Sync) Button
Ready For Use (RFU)
Indicator
Mark Event
button
Therapy Knob
Charge button
nc
Sy
M anu
al
De
Lead Select
button
fib
100 120
Adult
Dose
150
70
170
50
30
200
Select
Energy
20
15
P acer O n Off O n
AED
M onitor
Shock button
2
1-10
Display
1
Charge
Shock
3
Printer (50mm)
Printer door
Printer door latch
Print button
Speaker
Microphone
Alarm Pause button
Summary
button
2
Soft keys (4 total)
Navigation buttons
Menu Select button
Lesson Presentation
1 Getting Acquainted
Notes:
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
3
1 Getting Acquainted
Lesson Presentation
Side Panels
CO2 Inlet Port
Invasive Pressure ports
CO2 Outlet Port
1
NBP Port
CO 2
2
M
ic
ro
st
re
a m™
ECG Port
E CG
Temperature Port
ECG Out (Sync)
Jack
SpO2 Port
ECG
Therapy Connector
Data Card
Notes:
________________________________________________________________
________________________________________________________________
________________________________________________________________
4
Lesson Presentation
1 Getting Acquainted
Top Panel
Notes:
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
5
1 Getting Acquainted
Lesson Presentation
Back Panel
Bed Rail Hook Mount
Battery/AC
Compartment B
Battery
Compartment A
LAN Connection
Battery
RS 232 Serial Port
AC Power Module
DC Power Input
Notes:
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
6
Lesson Presentation
1 Getting Acquainted
Display View
The MRx layout is as follows.
General Status
Area
10 Feb 2006 11:20
Mark Event
Inops Area
Patient name
Adult Non-Paced
ECG/HR alarms
HR
bpm
80
C Pulse bpm NBP
Temp
120
50
HH:MM:SS
39.0
36.9 36.0
80
mmHg q120
120/80
(95)
SYS
160 10:40
90
Parameter
Block 1
Primary ECG
Wave
Sector 1
150
Wave
Sector 2
ABP
75
0
ABP
118/77
(95)
Wave
Sector 3
30
mmHg
SYS
160
90
PAP
24/10
(15)
mmHg
DIA
16
0
SpO2 % EtCO2 mmHg AwRR
100
100
90
PAP
30
8
Parameter
Block 2
Printed Waves
Measurements/Alarms
CO2
Patient Info
30
Trends
Softkey
#1
Menu
Area
Other
0
Soft Keys
50
30
Volume
15
60
38
18
Main Menu
Displayed Waves
0
Wave
Sector 4
rpm
Softkey
#2
Softkey
#3
Softkey
#4
High Contrast On
Exit
Notes:
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
7
1 Getting Acquainted
Responding to Alarms
Follow the steps below to respond to an alarm condition.
1. Attend to the patient.
2. Identify the alarm(s) indicated.
3. Silence the alarm(s) using the Navigation and Menu Select buttons.
4. Address the alarm condition.
Notes:
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
8
Lesson Presentation
Lesson Presentation
1 Getting Acquainted
Password Security
Access to Manual Defib and Pacer Modes may be password protected if enabled in Configuration.
Failure to enter the correct Manual Therapy Security password prevents manual defibrillation/
synchronized cardioversion delivery or pacing therapy. AED Mode is always available without a
password.
Printing Waveforms
To change wave forms for the second wave printed with a 50mm printer:
1. Press the Menu Select button.
2. Using the Navigation buttons, select the Printed Waves option and press Menu Select.
3. Using the Navigation buttons, select the wave form you want to print in Wave 2 and press Menu
Select.
To change wave forms for the second or third wave printed with a 75mm printer:
1. Press the Menu Select button.
2. Using the Navigation buttons, select the Printed Waves option and press Menu Select.
3. Using the Navigation buttons, select Wave 2 or Wave 3 and press Menu Select.
4. Using the Navigation buttons, select the wave form you want printed and press Menu Select.
5. Repeat Steps 2 through 4 for the other printed wave.
Continued Use
MRx’s Continued Use feature facilitates continued treatment of the same patient by retaining current
settings and the patient record when the MRx is turned off for less than 10 seconds or switching
between modes (e.g., Monitor, AED, and Manual Defib).
9
1 Getting Acquainted
Return to Owner
To enable the Return to Owner feature:
1. Press the Menu Select button.
2. Select Other and press Menu Select.
3. Select Return To Owner and press Menu Select.
4. Press the [Activate] soft key.
5. Enter the number of days in the loan period and press Menu Select.
6. Press the [Exit Return-To] soft key.
To disable the Return to Owner feature:
1. Press the Menu Select button.
2. Select Other and press Menu Select.
3. Select Return To Owner and press Menu Select.
4. Press the [Deactivate] soft key.
5. Enter the password and press Menu Select.
6. Press the [Exit Return-To] soft key.
Notes:
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
10
Lesson Presentation
Lesson Presentation
1 Getting Acquainted
Carrying Case and Accessory Pouch Assembly
The following topics are for only customers who have carrying cases and accessory pouches, and require
assembly procedures and recommended accessory placement and storage. The following illustrations
show carrying case and accessory pouch assembly. Detailed directions can be found in the Setting Up
chapter of the MRx Instructions For Use.
11
1 Getting Acquainted
Lesson Presentation
Storing Accessories
(( (
((((
(( ((
(((((
( ( ( ( ( ( ((((
( ( ( ( ( ( ( (((((((((((((((((((((((((((((((((((
( ( ( ( ( ( ( ( ( ( ( ( ( ( ( ((
(( ( ( ( ( (((((
( ( ( ( ( ( ( (((((
((((((((((((((((((((
( ( ( ( ( ((((((
(((((((
( ( ( ( ( ( ( (((((
((
The following illustrations show parameter cabling and accessory storage in the left pouch.
( (((
((((
((((
(((((
(((((
(((((
( ( ( ((
(((((
(((((
Below is right pouch storage for the Therapy cable (on the left) and back pouch storage for ECG
electrodes (on the right).
((((((
((((
( ( ((
( ( ((
( (((
((((
( (((
((((
( (( (
((((
((((
((((
((((
((((
((((
((((
((((
((((
((((
((((
((((
((((
((((
((((
((((
((((
((((
( ( ((
( ((
((((
(((
(((
(((
(
(((
((((((((((((
( ( ( ( ( ( ( ((
( (((((
( ( ( ( ( ( ( ((
( ( ( ( ( ( ( ((
(((( (
(((((((
((((((( (((((
(
(((
(((
(((
( ( ( ( ( ( ( (( (( ( ( ( ( ( ( ( ( ( ( ( (
( ((
12
Lesson Presentation
1 Getting Acquainted
Here are recommended carry bag storage instructions for Q-CPR accessories.
Option 1
PHILIPS
Option 2
PHILIPS
Notes:
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
13
1 Getting Acquainted
Review
Review
Please answer the following questions related to MRx features, controls, and display view.
1. Identify at least three controls or buttons on the MRx involved with defibrillation.
a. ______________________________________
b. ______________________________________
c. ______________________________________
2. What does a solid red "X" and periodic audio chirp indicate on the RFU?
a. No battery is present
b. No power is available
c. A low battery condition
d. Defibrillation therapy may not be available
3. The arrhythmia algorithm uses the ECG in which Wave Sector for analysis?
a. 1
b. 2
c. 3
d. all of the above
4. You can select the ECG lead for Wave Sector 2 using either the Lead Select button or Displayed
Waves menu. T or F
5. You should respond to alarms primarily by pressing the Alarm Pause button. T or F
14
User Training Workbook
2
ECG and Arrhythmia
Monitoring
2
Lesson Introduction
This lesson describes the basic ECG and arrhythmia monitoring functions of the HeartStart MRx. It
briefly examines Monitor View, monitoring preparation, alarms, annotated ECGs, and arrhythmia
learning/relearning.
Objectives
Upon completion of this lesson, you should be able to:
1. Locate pertinent information in Monitor View.
2. Prepare a patient for ECG and arrhythmia monitoring.
3. Set heart rate and arrhythmia alarms.
4. Display an annotated ECG.
5. Initiate manual relearning.
Notes:
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
15
2 ECG and Arrhythmia Monitoring
Lesson Presentation
Lesson Presentation
Monitor View
Monitor View is displayed when you turn the Therapy Knob to Monitor.
INOPs
ECG/HR Alarms
Heart Rate and
Alarm Settings
10 Feb 2006 11:20
Mark Event
Inops Area
Patient Name
Adult
Non-Paced
ECG/HR alarms
HR
bpm
80
Temp
120
50
36.9
C Pulse
39.0
36.0
80
bpm
02:42
NBP
mmHg q120
120/80
(95)
SYS
160 10:40
90
II
Wave 1
150
ABP
Wave 2
75
0
ABP
118/77
(95)
30
mmHg
SYS
160
90
PAP
24/10
(15)
mmHg
DIA
16
0
SpO2 % EtCO2 mmHg AwRR
100
100
90
38
50
30
rpm
18
30
8
PAP
15
Wave 3
0
60
CO2
30
Wave 4
0
Start
NBP
12-Lead
Zero
Press
MENU
Notes:
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
16
Lesson Presentation
2 ECG and Arrhythmia Monitoring
Preparation
Follow the steps below to prepare for monitoring using multifunction electrode pads or electrodes.
Multifunction electrode pads
1. Prepare the patient’s chest (i.e., remove clothing, remove moisture from chest, and remove excessive
hair).
2. Apply multifunction electrode pads to the patient according to the pads package directions or your
organization’s protocol.
3. If not pre-connected, insert the pads cable into MRx’s green Therapy port.
4. Connect the pads to the pads cable.
Electrodes
1. Prepare the patient’s skin at appropriate electrode sites.
– If necessary, clip hair at the electrode sites (or shave sites if needed).
– Clean and abrade the skin at each electrode site.
– Dry the electrode sites briskly to increase capillary blood flow in the tissues and to remove oil
and skin cells.
2. Attach the snaps to the electrodes.
3. Apply the electrodes.
4. If not pre-connected, connect the ECG patient cable to the MRx.
Lead Selection
Use the Lead Select button to select the ECG lead for Wave Sector 1. To select a lead for Wave Sectors
2-4:
1. Press the Menu Select button.
2. Select Displayed Waves and press Menu Select.
3. Select the appropriate Wave Sector and press Menu Select.
4. Select the desired lead (with the clearest signal) and press Menu Select.
17
2 ECG and Arrhythmia Monitoring
Lesson Presentation
Practice Exercise 1
Attach a simulator and 3-, 5-, and 10-Lead ECG set to the MRx (5- or 10-Lead set preferred), set the
simulator to a normal sinus rhythm, and complete a variety of lead selections for Wave Sectors 2, 3,
and 4, as appropriate.
Questions
1. How do Wave 2, 3, and/or 4 menus differ from each other in terms of available leads? From the
Wave 1 menu?
2. What wave size(s) provide the clearest wave form?
3. What happens if you add a parameter?
Notes:
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
18
Lesson Presentation
2 ECG and Arrhythmia Monitoring
Heart Rate and Arrhythmia Alarms
Introduction
The ST/AR Basic Arrhythmia Algorithm generates heart rate and heart rate alarms, and can never be
disabled. Here are the various alerts MRx generates:
• Red alarms
• Yellow alarms
• INOP messages
HR/Arrhythmia Red Alarms
Alarm Message
Condition
Indicator
Latching/
Non-Latching
Asystole
No detectable beats for four Red alarm message,
seconds in the absence of
alarm tone
Vfib
Latching
VFIB/VTACH
A fibrillatory wave detected Red alarm message,
for four seconds
alarm tone
Latching
VTACH
Consecutive PVCs and HR Red alarm message,
exceed defined limits
alarm tone
Latching
Extreme Brady
10 bpm below HR Low
limit, capped at 30 bpm
Red alarm message,
alarm tone
Latching
Extreme Tachy
20 bpm above HR High
limit capped at 200 bpm
(adult) or 240 bpm (pedi)
Red alarm message,
alarm tone
Latching
HR/Arrhythmia Yellow Alarms
Alarm Message
Condition
Indication
Latching/
Non-Latching
HR High
The HR exceeds the configured
HR high limit
Yellow alarm
message, alarm tone
Non-Latching
HR Low
The HR is below the configured
HR low limit
Yellow alarm
message, alarm tone
Non-Latching
PVC/min. High
(value > limit)
The number of detected PVCs in Yellow alarm
a minute exceeds the limit of 15 message, alarm tone
(adult/pedi)
Non-Latching
Pacer Not Capture
No QRS following a pacer pulse
Yellow alarm
message, alarm tone
Latching
Pacer Not Pacing
No QRS or pacer pulse detected
Yellow alarm
message, alarm tone
Latching
19
2 ECG and Arrhythmia Monitoring
Lesson Presentation
Alarm Chain for Basic Arrhythmia Monitoring
(RED ALARMS)
Asystole
V-Fib/V-Tach
V-Tach
Extreme Tachy
Extreme Brady
(YELLOW ALARMS)
PVC Alarms
Frequent PVCs
Beat Detection Alarms
PNC*
PNP*
Rate Alarms
High HR Low HR
First level timeout period
Second level timeout period
PVCs>xx/Min.
* PNC = Pacer Not Capture
PNP = Pacer Not Pacing
Practice Exercise 2
Set the simulator and MRx to produce a variety of latching, non-latching, and INOP conditions, as
directed.
Questions
1. What do you see and hear when a red alarm goes off? A yellow alarm? An INOP message?
Notes:
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
20
Lesson Presentation
2 ECG and Arrhythmia Monitoring
Setting Alarms
• Alarms are automatically enabled in Monitor and Pacer Modes.
• In Manual Defib Mode, alarms are automatically enabled if the Sync function is enabled. If the Sync
function is not enabled, alarms are enabled using the Alarm Pause button.
• Alarms alert you when values exceed or fall below defined limits.
• Heart rate (HR) and VTACH alarm settings are as configured but may be changed during operation
for the current patient.
• The PVC rate limit setting may only be changed in response to a PVC rate alarm condition.
• Other HR and arrhythmia alarms may not be changed.
Changing Heart Rate or VTACH Alarm Limits
To change HR or VTACH limits:
1. Press the Menu Select button.
2. Select Measurements/Alarms and press Menu Select.
3. Select HR/Arrhythmia and press Menu Select.
4. Select HR Limits and press Menu Select.
5. Select new values and press Menu Select.
6. Select VTACH Limits and press Menu Select.
7. Select new values and press Menu Select.
Enabling/Disabling Heart Rate and Arrhythmia Alarms
To enable or disable HR and arrhythmia alarms:
1. Press Menu Select.
2. Select Measurements/Alarms and press Menu Select.
3. Select HR/Arrhythmia and press Menu Select.
4. Select Alarms On/Off and press Menu Select.
Note: Disabling alarms prevent all alarms associated with HR measurements from being annunciated.
If an alarm condition occurs, no alarm indication will be given.
Responding to HR and Arrhythmia Alarms
To respond to the Audio Pause label, press the Menu Select or Navigation buttons.
To respond to alarms:
1. Acknowledge the alarm condition.
2. Adjust the limits using the New Limits menu.
21
2 ECG and Arrhythmia Monitoring
Lesson Presentation
Practice Exercise 3
Change HR or VTACH limits, enable or disable alarms, and respond to HR and arrhythmia alarms.
Questions
1. What happens when you change a limit? Disable an alarm? Respond to the Audio Pause label or an
alarm?
Notes:
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
Displaying an Annotated ECG
An annotated wave displays how the ST/AR Algorithm labels beats. To display an annotated ECG:
1. Press Menu Select.
2. Select Displayed Waves and press Menu Select.
3. Select Wave 2 and press Menu Select.
4. Select Annotated ECG and press Menu Select.
Practice Exercise 4
Complete the steps to display an annotated ECG.
Question
Where does the annotation first appear?
Notes:
________________________________________________________________
________________________________________________________________
________________________________________________________________
22
Lesson Presentation
2 ECG and Arrhythmia Monitoring
Arrhythmia Learning/Relearning
MRx automatically performs arrhythmia learning/relearning when the lead or mode of operation is
changed so the ST/AR Algorithm can properly analyze the patient’s normal and/or paced complexes.
Initiate manual relearning if beat detection is not occurring or if beat classification is incorrect and
results in a false alarm. To initiate relearning manually:
1. Press Menu Select.
2. Select Measurements/Alarms and press Menu Select.
3. Select HR/Arrhythmia and press Menu Select.
4. Select Relearn Rhythm and press Menu Select.
Practice Exercise 5
Complete the steps to initiate manual relearning.
Notes:
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
23
2 ECG and Arrhythmia Monitoring
Review
Review
Please answer the following questions related to ECG and arrhythmia monitoring.
1. Identify the Monitoring View elements.
____________
____________
____________
10 Feb 2006 11:20
Mark Event
Inops Area
Patient Name
Adult
Non-Paced
ECG/HR alarms
HR
bpm
80
Temp
120
50
36.9
02:42
C Pulse bpm NBP
39.0
36.0
mmHg q120
120/80
(95)
80
SYS
160 10:40
90
II
150
__________
ABP
__________
75
0
ABP
118/77
(95)
30
mmHg
SYS
160
90
PAP
24/10
(15)
mmHg
DIA
16
0
SpO2 % EtCO2 mmHg AwRR
100
100
90
38
50
30
18
30
8
PAP
15
__________
0
60
rpm
CO2
30
__________
0
Start
NBP
12-Lead
Zero
Press
MENU
2. You can select the ECG lead for Wave Sectors 1-4 using the Lead Select button. T or F
3. Which of the following alarms can ONLY be changed while IN RESPONSE TO AN ALARM
CONDITION?
a. HR
b. PVC
c. VTACH
4. Which of the following statement(s) are TRUE?
a. All arrhythmia alarms are classified as "latching" alarms.
b. Yellow alarms can communicate equipment failures.
c. Alarms are enabled as soon as you enter Monitor Mode if the Sync function is enabled.
d. Menu Select AND Navigation buttons can acknowledge alarms.
5. The MRx automatically performs arrhythmia learning/relearning when there is a lead selection
change for Wave Sector 1 or 2. T or F
24
User Training Workbook
3
Semi-Automated External
Defibrillation
3
Lesson Introduction
This lesson describes how to use AED Mode. It highlights the AED display view and explains the steps
and associated prompts that guide users through the defibrillation process.
Objectives
Upon completion of this lesson, you should be able to:
1. Locate pertinent information in AED View.
2. Prepare a patient for AED defibrillation.
3. Defibrillate in AED Mode.
Notes:
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
25
3 Semi-Automated External Defibrillation
Lesson Presentation
Lesson Presentation
AED View
Turn the Therapy Knob to AED to display the AED View.
10 Feb 2006 11:20
Mark Event
Alarms Off
HR
154
Pads
02:42
Enlarged Event Timer
Enlarged ECG
Shocks: 0
Analyzing
Do Not Touch Patient
Pause
for CPR
Shock Counter
Message Window
MENU
Notes:
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
26
Lesson Presentation
3 Semi-Automated External Defibrillation
Preparation
To prepare for AED defibrillation:
1. Confirm the patient’s condition (i.e., unresponsive, not breathing, and/or pulseless).
2. Prepare the patient’s chest.
3. Apply multifunction electrode pads using the anterior-anterior electrode placement.
4. If not pre-connected, insert the pads cable into the green Therapy port.
5. Connect the pads to the pads cable.
Notes:
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
27
3 Semi-Automated External Defibrillation
Lesson Presentation
AED Mode
To defibrillate in AED Mode:
1. Turn the Therapy Knob to AED.
2. Follow the voice and screen prompts.
3. Press the orange Shock button, if prompted.
Practice Exercise 1
Turn the Therapy Knob to AED and to see what happens when your pads cable and/or pads are not
connected.
Notes:
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
28
Lesson Presentation
3 Semi-Automated External Defibrillation
Shock Advised
Practice Exercise 2
Attach an ECG simulator to the MRx via a hands-free (pads) cable, set the simulator to a shockable
rhythm (e.g., VF), and follow the steps to defibrillate. Complete one shock.
Questions
1. What screen prompts do you see and voice prompts do you hear initially?
2. How do you know the device is ready to deliver a charge?
3. What do you see and hear after delivering a shock?
4. What happens when you press the [Resume Analyzing] soft key?
Notes:
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
29
3 Semi-Automated External Defibrillation
No Shock Advised
Practice Exercise 3
Set the simulator to a normal sinus rhythm and see what happens.
Questions
1. What screen prompts do you see and voice prompts do you hear?
2. What happens when you press the [Pause for CPR] soft key?
Notes:
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
30
Lesson Presentation
Review
3 Semi-Automated External Defibrillation
Review
Please answer the following questions related to AED.
1. Identify the AED View elements.
10 Feb 2006 11:20
Mark Event
Alarms Off
HR
154
Pads
02:42
________________
________________
Shocks: 0
Analyzing
Do Not Touch Patient
Pause
for CPR
________________
________________
MENU
2. Apply multifunction electrode pads using anterior-posterior placement for AED. T or F
3. What are the three basic steps for AED using the MRx?
a. ____________________________________________
b. ____________________________________________
c. ____________________________________________
4. Which of the following statement(s) about AED Mode are TRUE?
a. The MRx automatically checks for proper pads cable and pads connection.
b. If artifact interferes with ECG analysis and persists, analysis will suspend but resume
automatically after 60 seconds.
c. The MRx automatically disarms if a shock becomes unnecessary.
d. The MRx automatically analyzes the patient’s heart rhythm after a shock is delivered.
31
User Training Workbook
4
Manual Defibrillation
and Cardioversion
4
Lesson Introduction
This lesson explains how to prepare for and perform manual asynchronous and synchronous
(cardioversion) defibrillation using multifunction electrode pads and external/internal paddles.
Objectives
Upon completion of this lesson, you should be able to:
1. Locate pertinent information in Code View.
2. Prepare a patient for asynchronous and synchronous defibrillation.
3. Perform asynchronous and synchronous defibrillation.
Notes:
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
33
4 Manual Defibrillation and Cardioversion
Lesson Presentation
Lesson Presentation
Code View
Turn the Therapy Knob to Manual Defib to display the Code View.
10 Feb 2006 11:20
Mark Event
Adult
Alarms Off
Heart Rate
HR
bpm
II
180
Temp
Non-Paced
C Pulse bpm
02:42
Enlarged
Event Timer
Selected Energy: 150 Joules Shocks: 0
SpO2 % EtCO2 mmHg AwRR rpm
Shock Status
Area
120
50
39.0
36.0
36.9 80
Enlarged
ECG
60
100
90
34
50
30
18
30
8
Pleth
60
CO2
30
0
Start
NBP
Disarm
MENU
Notes:
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
34
Lesson Presentation
4 Manual Defibrillation and Cardioversion
Manual Defibrillation Preparation
Follow the steps below to prepare for manual defibrillation using multifunction electrode pads or
external paddles.
Multifunction Electrode Pads
1. Confirm the patient’s condition (i.e., unresponsive, not breathing, and/or pulseless).
2. Prepare the patient’s chest.
3. Apply multifunction electrode pads to the patient according to pads package directions or your
organization’s protocol.
4. If not pre-connected, insert the pads cable into MRx’s green Therapy port.
5. Connect the pads to the pads cable.
External Paddles
1. Confirm the patient’s condition (i.e., unresponsive, not breathing, and/or pulseless).
2. If not pre-connected, insert the paddles cable into the green Therapy port.
3. Remove the paddles from paddle tray. Clean any debris or residue (including dried electrode gel)
off the surfaces of the paddles, if necessary.
4. Apply the paddles to patient’s bare chest, using the anterior-anterior placement or your
organization’s protocol.
Internal Paddles
1. Select the appropriate switched or switchless paddle electrode size.
2. If using switchless paddles, connect the paddles to the M4740A Paddle Adapter Cable.
3. Connect the paddles cable (or the paddle adapter cable) to the MRx.
Notes:
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
35
4 Manual Defibrillation and Cardioversion
Lesson Presentation
Manual Defibrillation
To defibrillate in Manual Mode:
1. Turn the Therapy Knob to Manual Defib and select an energy setting.
2. Press the Charge button on the MRx (or external paddle).
3. Make sure no one is touching the patient or anything connected to the patient before shock; call
out loudly and clearly “Stay Clear!”.
4. Press the orange Shock button on the MRx (or the shock buttons on the external or switched
internal paddles).
Practice Exercise 1
Attach a simulator and parameter accessories (if available and appropriate) to the MRx, set the
simulator to a shockable rhythm (e.g., VF), and complete the manual defibrillation steps (with three
shocks).
Questions
1. What do you see and hear during a charge?
2. How do you know the device is ready to deliver a charge?
3. What do you see and hear after delivering a shock?
4. What happens when you press the [Disarm] soft key?
Notes:
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
36
Lesson Presentation
4 Manual Defibrillation and Cardioversion
Synchronized Cardioversion Preparation
Follow the steps below to prepare for synchronized cardioversion.
1. Perform the steps as described in the previous Manual Defibrillation Preparation topic.
2. If monitoring through a 3-, 5-, or 10-Lead ECG cable, plug the cable into MRx’s ECG port and
apply monitoring electrodes to the patient.
3. Press the Lead Select button to select Pads, Paddles, or a lead from attached monitoring electrodes.
Notes:
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
37
4 Manual Defibrillation and Cardioversion
Lesson Presentation
Synchronized Shock Delivery
To deliver a synchronized shock:
1. Turn the Therapy Knob to Monitor position and press the Sync button.
2. Confirm that the Sync marker appears with each R-wave.
3. Turn the Therapy Knob to Manual Defib and select an energy setting.
4. Press the Charge button on the MRx (or external paddle).
5. Make sure no one is touching the patient or anything connected to the patient before shock; call
out loudly and clearly “Stay Clear!”.
6. Press and hold the orange Shock button on the MRx (or the orange shock buttons on both
paddles) until the shock is delivered.
Practice Exercise 2
Attach a simulator and pads to the MRx, set the simulator to a shockable rhythm (e.g., VF), and
complete synchronized cardioversion.
Questions
1. What do you see when you press the Sync button?
2. Once in Sync mode, what happens when you turn the Therapy Knob to a position other than
Manual Defib?
3. What happens when you press the Sync button again?
Notes:
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
38
Review
4 Manual Defibrillation and Cardioversion
Review
Please answer the following questions related to manual defibrillation and synchronized cardioversion.
1. Identify the Code View elements.
10 Feb 2006 11:20
Mark Event
Adult
Alarms Off
____________
HR
bpm
II
180
Temp
120
50
Non-Paced
C Pulse bpm
39.0
80
36.9 36.0
02:42
____________
____________
Selected Energy: 150 Joules Shocks: 0
SpO2 % EtCO2 mmHg AwRR rpm
60
100
90
34
50
30
18
____________
30
8
Pleth
60
CO2
30
0
Start
NBP
Disarm
MENU
2. What are the three basic steps for manual defibrillation using the MRx?
a. __________________________________________________
b. __________________________________________________
c. __________________________________________________
3. Which of the following indicate that the MRx is ready to deliver a shock via pads?
a. The device sounds a continuous high-pitched tone. Y or N
b. The Charged value on the display matches the Therapy Knob setting. Y or N
c. The disarm soft key is disabled. Y or N
d. The Shock button flashes. Y or N
4. What are the four basic steps for synchronized cardioversion using the MRx?
a. __________________________________________________
b. __________________________________________________
c. __________________________________________________
d. __________________________________________________
39
User Training Workbook
5
Q-CPR® with CPR meter
5
Lesson Introduction
This lesson describes how to set-up and use the Q-CPR® option (with CPR meter) available on the
HeartStart MRx.
Note: Q-CPR® is a trademark of Laerdal Medical AS.
Objectives
Upon completion of this lesson, you should be able to:
1. Identify intended use and preparation for use related to Q-CPR.
2. Identify characteristics related to the CPR meter.
3. Identify characteristics related to Q-CPR in Manual Defib and AED Modes.
Notes:
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
41
Lesson Presentation
5 Q-CPR® with CPR meter
Lesson Presentation
Overview
Q-CPR:
• Offers measurement and corrective feedback on:
– compression rate, depth, and complete release
– ventilation rate
– CPR inactivity
• Measures compressions through the CPR meter and acquires ventilation data through multifunction
defib electrode pads
• Is used with only the HeartStart MRx
• Is not active in 12-Lead Mode
• Is not intended for use:
– on patients under 8 years of age or weighing less than 25 kg (55 lbs.)
– in a moving environment
– with any other CPR compression devices (aside from the CPR meter)
• Events related to Q-CPR are logged to the patient incident record but not stored in the MRx Event
Summary.
Notes:
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
42
Lesson Presentation
5 Q-CPR® with CPR meter
Q-CPR Preparation
Follow the steps below to prepare for Q-CPR use.
1. Connect the Pads/CPR cable to the MRx, aligning the white pointer on the cable with the white
arrow on the green Therapy port, inserting the cable into the port, and pushing until you hear it
click into place.
2. Connect the CPR meter to the Pads/CPR cable, aligning the key on the CPR meter cable with the
key on the receptacle end of the Pads/CPR cable, and pushing until you feel it snap into place.
There should be no gap between the two connectors.
3. Attach the CPR meter Adhesive Pad to the meter, aligning the channel on the adhesive is directly
over the visible groove in the plastic and pressing the pad into place.
Note: Complete steps 1-3 before a rescue or resuscitation event to save time on set-up.
4. Prepare the patient’s chest and apply the multifunction electrode pads to the patient as directed on
the pads package, using the anterior-anterior placement.
5. Connect the pads to the Pads/CPR cable.
6. Peel off the green liner from the CPR meter Adhesive Pad and position the CPR meter‘s
compression area on the lower half of the sternum and on the centerline of the bare chest.
Notes:
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
43
Lesson Presentation
5 Q-CPR® with CPR meter
Starting CPR with the CPR meter
Use standard CPR technique and observe the CPR meter display area for feedback (See figure below).
Provide chest compressions according to your organization’s CPR protocol.
Figure 1 CPR and Positioning
The display changes to enlarged compression indicators when the meter first detects compressions (as
depicted blow).
Figure 2 Beginning Compressions on CPR meter
44
Lesson Presentation
5 Q-CPR® with CPR meter
CPR meter Display
The CPR meter provides real-time graphical feedback as a coaching tool once CPR compressions
begin. (See figure below)
Figure 3 CPR meter Indicators
Compression
Release Target
Compression
Depth Indicator
Compression Rate Target
Compression
Rate Indicator
Compression
Depth Target
Compression Depth
As you perform CPR on the patient, the CPR meter tells you your compression depth and if you are
not completely releasing pressure after a compression. (See figures below.)
Figure 4 Compression Depth Indicator
Top target lights up on complete pressure release
Compression is represented by a moving white
compression depth indicator bar
Bottom target lights up for the correct
compression depth
• Bottom target does not light up for shallow
compression depth
• Yellow arrow appears if four consecutive
compressions fail to meet the depth target
Depth indicator bar falls below the target area if
compression is too deep (for a meter connected to a
MRx with software version F.01/R.01) or reaches
70mm/2.75” (for a meter connected to a MRx with
software version F.02/R.02 or later)
Yellow arrow points up to the compression release
target zone if you do not fully release pressure
between four consecutive compressions
45
Lesson Presentation
5 Q-CPR® with CPR meter
Compression Rate
The CPR meter gives feedback on your compression rate and tells you to speed up or slow down. (See
figures below.)
Figure 5 Compression Rate Indicator
Speedometer needle points to the green target zone
(which lights up) if compression rate is within the
target area
Speedometer needle points to the right if
compression rate is too fast
Speedometer needle points to the left if compression
rate is too slow
46
Lesson Presentation
5 Q-CPR® with CPR meter
Table 1 Other icons appearing on the CPR meter display
Icon on Display
Definition
Do Not Touch The Patient - appears when the MRx:
• provides prompts to stop CPR for heart rhythm analysis
• is charging, or
• advises a shock is required.
CPR should be resumed - appears when compressions are stopped for 10
seconds
Customer service needed - appears only at shutdown when the number of
compressions performed on the CPR meter reaches the device’s limit. Take the
CPR meter out of service.
Practice Exercise 1
Make all cable attachments and then detach a cable to see what inop is produced. Loosen a
multifunction pad to see what inop is produced. Attach the CPR meter adhesive pad properly and
position the CPR meter correctly on the patient (or manikin). Practice using the CPR meter on a
manikin or compliant surface, attempting to achieve appropriate compression depth and rate.
Notes:
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
47
Lesson Presentation
5 Q-CPR® with CPR meter
Q-CPR in Manual Defib Mode
Turn the MRx Therapy Knob to Manual Defib and select the 150J energy setting to display the
Advanced CPR View, which can be configured in AED Mode. The screen below depicts an MRx with
software version F.01/R.01.
11 Feb 2006 22:32
Mark Event
Alarms Off
HR
bpm
145
Adult Non-Paced
120
50
14:02
II
CPR: 02:30
CPR timer
Comp
cpm
No Flow sec
107
Compressions:
EtC02 mmHg
37
Vent
rpm
Compression
counter
31
Comp
12
Comp
Compression
waveform
60
Compressionvtarget
zone
CO2
*Minimum depth: 40mm
*Maximum depth: 50mm
30
0
Start
NBP
Disarm
Stop
CPR
MENU
With MRx software version F.02/R.02 (and later) and AHA 2010 CPR guidelines configured, the target zone is:
Minimum
depth
(50mm/2”)
Soft surface minimum
depth
(70mm/2.75”)
48
Lesson Presentation
5 Q-CPR® with CPR meter
With MRx software version F.02/R.02 (and later) and ERC 2010 CPR guidelines configured, the target zone is:
Minimum
depth
Maximum
depth
(50mm/2”)
(60mm/2.4”)
Softvsurface
minimum
depth
(70mm/2.75”)
Practice Exercise 2
Turn to the 150J adult manual defibrillation setting and practice performing CPR alone and with a
another student on a manikin (to experience 1- and 2-rescue person situations) according to AHA or
ERC guidelines for compression-to-ventilation ratio. Also, press the Sync and/or Alarm Pause button
to see what happens to Q-CPR.
Questions
1. What voice prompts do you hear when performing CPR? What is the most frequently heard
prompt?
2. How long can you perform CPR without getting a voice prompt? How long could you perform
CPR before getting totally fatigued?
3. What range of compression rate do you achieve?
4. How often do you get ‘No Flow’ times and how long are those times?
5. What happens to Q-CPR when you press the Sync and/or Alarm Pause button?
Notes:
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
49
Q-CPR in AED Mode
Turn the Therapy Knob to AED and press the Pause for CPR soft key to display the Basic CPR View.
11 Feb 2006 22:25
Mark Event
Alarms Off
HR
bpm
180
02:09
Pads
Shocks: 0
CPR Timer
Status Bar
COMPRESS FASTER
Resume
Analyzing
MENU
Practice Exercise 3
Turn to AED, press the Pause for CPR soft key, and practice performing CPR alone and with a
another student on a manikin (to experience a 1- and 2-rescue person situation) according to AHA
guidelines for compression-to-ventilation ratio.
Questions
1. What voice and text prompts do you get when performing CPR? What is the most frequent voice
or text prompt produced?
2. How long can you perform CPR without getting a voice or text prompt? How long could you
perform CPR before getting totally fatigued?
Lesson Presentation
5 Q-CPR® with CPR meter
Notes:
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
CPR Feedback Volume Adjustment
To mute the CPR feedback voice prompts (once you start CPR):
1. Press Menu Select.
2. Select Mute CPR Voice and press Menu Select.
To resume voice prompts set at the previously selected volume:
1. Press Menu Select.
2. Select Resume CPR Voice and press Menu Select.
To adjust the volume of CPR feedback voice prompts:
1. Press the Menu Select button.
2. Select Volume and press Menu Select.
3. Select Voice and press Menu Select.
4. Select the desired volume level and press Menu Select.
51
Review
5 Q-CPR® with CPR meter
Review
Please answer the following questions related to Q-CPR.
1. Q-CPR can be used on patients 8 years and older. T or F
2. The multifunction pads should be placed in an anterior/posterior position to measure ventilation
activity. T or F
3. The CPR meter can indicate whether you are doing good compressions, what your compression
depth is, and what your compression rate is. T or F
4. In Manual Defib Mode, good compression depth is indicated by the downward “peak” of the
waveform appearing between the horizontal lines representing the target zone. T or F
5. The ventilation detection icon indicates ventilation has been detected but not the actual filling of
both lungs. T or F
6. Only AED Mode provides voice and text prompts associated with compression and ventilation
activity. T or F
52
User Training Workbook
6
Q-CPR® with Compression
Sensor
6
Lesson Introduction
This lesson describes how to set-up and use the Q-CPR® option (with Compression Sensor) available
on the HeartStart MRx.
Note: Q-CPR® is a trademark of Laerdal Medical.
Objectives
Upon completion of this lesson, you should be able to:
1. Identify intended use and preparation for use related to Q-CPR.
2. Identify characteristics related to Q-CPR in Manual Defib and AED Modes.
Notes:
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
53
Lesson Presentation
6 Q-CPR® with Compression Sensor
Lesson Presentation
Overview
Q-CPR:
• Offers measurement and corrective feedback on:
– compression rate, depth, and duration time,
– ventilation rate, volume, and flow rate (inflation time)
– CPR inactivity
• Measures compressions through a Compression Sensor and ventilations through multifunction defib
electrode pads
• Is used with only the HeartStart MRx
• Is contraindicated:
– on neonatal and pediatric patients (under 8 years of age or weighing less than 25 kg)
– when CPR is contraindicated
– in a moving environment
– with any other CPR compression devices (aside from the Q-CPR Compression Sensor)
• Events related to Q-CPR are not stored in the HeartStart MRx Event Summary.
Notes:
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
54
Lesson Presentation
6 Q-CPR® with Compression Sensor
Q-CPR Preparation
Follow the steps below to prepare for Q-CPR use.
1. Connect the Pads/CPR cable to the MRx, aligning the white pointer on the cable with the white
arrow on the green Therapy port, inserting the cable into the port, and pushing until you hear it
click into place. Compression Sensor to the Pads/CPR Cable
2. Connect the Compression Sensor to the Pads/CPR cable, aligning the key marker on the
Compression Sensor cable with the key marker on the receptacle end of the Pads/CPR cable, and
pushing until you hear it click into place.
3. Attach the Compression Sensor Adhesive Pad to the Compression Sensor, peeling the white liner
from the bottom of the Compression Sensor Adhesive Pad, aligning the Sensor Adhesive Pad with
the yellow area of the sensor, and pressing into place.
Note: Complete steps 1-3 before a rescue or resuscitation event to save time on set-up.
4. Prepare the patient’s chest and apply the multifunction electrode pads to the patient as directed on
the pads package, using the anterior-anterior placement.
5. Connect the pads to the Pads/CPR cable.
6. Place the Compression Sensor on the lower half of the patient’s sternum, which is at the normal
CPR hand location.
Notes:
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55
Lesson Presentation
6 Q-CPR® with Compression Sensor
Practice Exercise 1
Make all cable attachments and then detach a cable to see what inop is produced. Loosen a
multifunction pad to see what inop is produced.
Notes:
________________________________________________________________
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________________________________________________________________
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56
Lesson Presentation
6 Q-CPR® with Compression Sensor
Q-CPR in Manual Defib Mode
Turn the MRx Therapy Knob to Manual Defib and select the 150J energy setting.
11 Feb 2006 22:32
Mark Event
Alarms Off
HR
145
bpm
Adult Non-Paced
14:02
120
50
II
Shocks: 0
Selected Energy:150 Joules
Comp cpm
No Flow sec
107
EtC02 mmHg
37
Vent
rpm
Comp
12
Comp
60
Compression
Target Zone
CO2
30
0
Start
NBP
Disarm
Stop
CPR
Intubate
MENU
Practice Exercise 2
Turn to the 150J adult manual defibrillation setting and practice performing CPR alone and with a
another student on a manikin (to experience 1- and 2-rescue person situations) according to AHA
guidelines for compression-to-ventilation ratio. Also, press the Sync and/or Alarm Pause button to see
what happens to Q-CPR.
Questions
1. What voice prompts do you hear when performing CPR? What is the most frequently heard
prompt?
2. How long can you perform CPR without getting a voice prompt? How long could you perform
CPR before getting totally fatigued?
3. What range of compression and ventilation rates do you achieve?
4. How full does the ventilation (lungs) icon get when you do ventilations?
5. How often do you get ‘No Flow’ times and how long are those times?
6. What happens to Q-CPR when you press the Sync and/or Alarm Pause button?
57
Lesson Presentation
6 Q-CPR® with Compression Sensor
Notes:
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58
Lesson Presentation
6 Q-CPR® with Compression Sensor
Q-CPR in AED Mode
Turn the Therapy Knob to AED and press the Pause for CPR soft key.
11 Feb 2006 22:25
Mark Event
Alarms Off
HR
bpm
180
02:09
Pads
Shocks: 0
CPR Timer
Status Bar
COMPRESS FASTER
Resume
Analyzing
MENU
Practice Exercise 3
Turn to AED, press the Pause for CPR soft key, and practice performing CPR alone and with a
another student on a manikin (to experience a 1- and 2-rescue person situation) according to AHA
guidelines for compression-to-ventilation ratio.
Questions
1. What voice and text prompts do you get when performing CPR? What is the most frequent voice
or text prompt produced?
2. How long can you perform CPR without getting a voice or text prompt? How long could you
perform CPR before getting totally fatigued?
59
Lesson Presentation
6 Q-CPR® with Compression Sensor
Notes:
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________________________________________________________________
CPR Feedback Volume Adjustment
To mute the CPR feedback voice prompts (once you start CPR):
1. Press Menu Select.
2. Select Mute CPR Voice and press Menu Select.
To resume voice prompts set at the previously selected volume:
1. Press Menu Select.
2. Select Resume CPR Voice and press Menu Select.
To adjust the volume of CPR feedback voice prompts:
1. Press the Menu Select button.
2. Select Volume and press Menu Select.
3. Select Voice and press Menu Select.
4. Select the desired volume level and press Menu Select.
60
Review
6 Q-CPR® with Compression Sensor
Review
Please answer the following questions related to Q-CPR.
1. Q-CPR can be used on patients 8 years and older. T or F
2. The multifunction pads should be placed in an anterior/posterior position to ensure the ventilation
algorithm interprets ventilations properly. T or F
3. The compression sensor should be positioned on the upper half of the patient’s sternum to
perform compressions. T or F
4. In Manual Defib Mode, good compression depth is indicated by the downward “peak” of the
waveform appearing between the horizontal lines representing the target zone. T or F
5. The ventilation volume icon indicates ventilation has been detected but not the actual filling of
both lungs. T or F
6. Only AED Mode provides voice and text prompts associated with compression and ventilation
activity. T or F
61
User Training Workbook
7
Noninvasive Pacing
7
Lesson Introduction
This lesson describes the noninvasive transcutaneous pacing option available with the HeartStart MRx
and how to perform pacing.
Objectives
Upon completion of this lesson, you should be able to:
1. Identify pertinent information in Pacing View.
2. Prepare a patient for pacing.
3. Perform demand or fixed mode pacing.
Notes:
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63
7 Noninvasive Pacing
Lesson Presentation
Lesson Presentation
Pacer Mode
In this mode:
• Pace pulses are delivered through multifunction electrode pads.
• Waveforms, ECG monitoring, measurements, and most alarms* (from Monitor or Manual Defib
Mode) remain active if enabled and retain settings.
*Arrhythmia alarms for Pacer Not Pacing and Pacer Not Capture (associated with non-transcutaneous
pacing) are off. All other red and yellow alarms are active if enabled and their limits may be changed
while in Pacer Mode. ECG INOPs are also annunciated.
Pacing View
Turn the Therapy Knob to Pacer to display the Pacing View.
10 Feb 2006 11:20
Mark Event
Jones, Samuel
Adult
HR
70
Temp
120
50
36.9
02:02:42
C Pulse bpm NBP
39.0
36.0
70
mmHg q120
120/80
(95)
SYS
160 10:40
90
II
Pacing
Markers
SpO2 % EtCO2 mmHg AwRR
100
100
90
38
50
30
rpm
18
30
8
Pleth
Pacing
Status Area
PACING ON BATTERIES
Demand Mode
Start
NBP
Resume
Pacing
70 ppm
50 mA
Pacer
Rate
Pacer
Output
MENU
Notes:
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64
Lesson Presentation
7 Noninvasive Pacing
Demand vs. Fixed Mode
Demand mode
• Pace pulses are delivered when the patient’s heart rate is lower than the selected pacing rate.
• This mode uses monitoring electrodes AND pads for pacing.
• Demand mode is the suggested pacing mode.
Fixed mode
• Pace pulses are delivered at a selected rate.
• Use when motion artifact or ECG noise makes R-wave detection unreliable or when monitoring
electrodes are not available.
Notes:
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________________________________________________________________
________________________________________________________________
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65
7 Noninvasive Pacing
Lesson Presentation
Preparation
Follow the steps below to prepare for pacing.
1. Prepare the patient’s chest. Wipe moisture away and, if necessary, clip or shave excessive chest hair.
2. Apply multifunction electrode pads to the patient as directed on the pads packaging or according
to your organization’s protocol.
3. If not pre-connected, connect the pads cable to green Therapy port on the MRx.
4. Connect the pads connector to the pads cable.
5. If pacing in demand mode, apply monitoring electrodes and connect the ECG cable to the ECG
port on the MRx.
Notes:
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________________________________________________________________
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66
Lesson Presentation
7 Noninvasive Pacing
Demand Mode Pacing
To pace in demand mode:
1. Turn the Therapy Knob to the Pacer position.
2. Press the Lead Select button to select the best lead with an easily detectable R-wave.
3. Verify white R-wave markers appear above or on the ECG waveform, with a single marker for each
R-wave. If no R-wave markers appear or coincide with the R-wave, select another lead or increase
wave size.
4. Press the [Pacer Rate] soft key and use the Navigation and Menu Select buttons to select the
desired number of pace pulses per minute.
5. If needed, adjust the initial pacer output. Press [Pacer Output] and use the Navigation and
Menu Select buttons to select the desired output.
6. Press [Start Pacing].
7. Verify white pacing markers appear above or on the ECG waveform.
8. Press [Pacer Output]. Then use the Navigation and Menu Select buttons to adjust the output
to the lowest level that still maintains capture.
9. Verify the presence of a peripheral pulse.
10. Press [Pause Pacing] to stop pacing. Press [Resume Pacing] to resume delivery, as
appropriate.
Note: You may also stop pacing by turning the Therapy Knob from Pacer to another position.
Practice Exercise 1
Attach pads and electrodes to the MRx and a simulator, set the simulator to bradycardia, and complete
the demand mode pacing steps.
Questions
1. What display changes do you see when completing each step (i.e., turn on pacing, set pacing status,
adjust pacer rate and output, and stop pacing)?
2. How do you know when pace pulses are being delivered?
Notes:
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67
7 Noninvasive Pacing
Lesson Presentation
Fixed Mode Pacing
To pace in fixed mode:
1. Turn the Therapy Knob to Pacer.
2. Change the pacer mode to Fixed.
3. Press the Lead Select button to select the desired lead.
Note: The remaining steps are similar to demand mode pacing.
4. Press [Pacer Rate] and use the Navigation and Menu Select buttons to select the desired
number of pace pulses per minute.
5. If needed, adjust the initial pacer output by pressing [Pacer Output] and using the Navigation
and Menu Select buttons to select the desired output.
6. Press [Start Pacing].
7. Verify the presence of a peripheral pulse.
8. Press [Pacer Output] and use the Navigation and Menu Select buttons to adjust the output, as
needed.
9. Press [Pause Pacing] to stop pacing.
Practice Exercise 2
Attach pads and electrodes to the MRx and a simulator, set the simulator to bradycardia, and complete
the fixed mode pacing steps.
Questions
1. What display changes do you see when completing each step (i.e., turn on pacing, set pacing status,
adjust pacer rate and output, and stop pacing)?
2. How do you know when pace pulses are being delivered?
Notes:
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________________________________________________________________
________________________________________________________________
________________________________________________________________
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68
Lesson Presentation
7 Noninvasive Pacing
Defibrillating During Pacing
To defibrillate, turn the Therapy Knob to Manual Defib or AED. Note that:
• Pacing stops in either Manual Defib or AED Mode.
• Pacing settings selected prior to defibrillation are retained once pacing recommences.
Notes:
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
69
7 Noninvasive Pacing
Review
Review
Please answer the following questions related to pacing.
1. Which of the following statement(s) are TRUE related to pacing with the MRx?
a. The device requires a 3-, 5- or 10-Lead ECG cable and monitoring electrodes during demand
mode pacing.
b. The device always delivers pace pulses in demand mode.
c. The Pacing status area indicates pacing mode, status, rate, and output.
d. If you exit Pacing Mode to defibrillate and then return to pacing, the settings from the
previous pacing session must be re-entered.
2. Which ONE of the following steps should be performed before pacing is initiated in demand
mode?
a. Verify that a white pacing marker appears in front of each QRS complex.
b. Verify that white R-wave markers appear above or on the ECG waveform.
c. Increase pacer output until capture occurs.
d. Decrease pacer output to the lowest level that still maintains capture.
70
User Training Workbook
8
Pulse Oximetry Monitoring
8
Lesson Introduction
This lesson describes how to use the HeartStart MRx to monitor Pulse Oximetry (SpO2).
Objectives
Upon completion of this lesson, you should be able to:
1. Monitor SpO2.
2. Set SpO2 and pulse rate alarms.
Notes:
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
71
8 Pulse Oximetry Monitoring
Lesson Presentation
Lesson Presentation
Monitoring SpO2
To monitor SpO2:
1. Connect the appropriate sensor cable to the MRx.
2. Apply the sensor to the patient. If a finger sensor is used, the cable should come down the back of
the hand.
3. Turn the Therapy Knob to Monitor.
Notes:
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
72
Lesson Presentation
8 Pulse Oximetry Monitoring
Setting SpO2 Alarms
Changing Alarm Limits
To change the SpO2 alarm limits:
1. Press the Menu Select button.
2. Using the Navigation buttons, select Measurements/Alarms and press Menu Select.
3. Select SpO2 and press Menu Select.
4. Select SpO2 Limits and press Menu Select.
5. Using the Navigation buttons, select the new high limit value and press Menu Select.
6. Select the new low limit value and press Menu Select.
Enabling/Disabling Alarms
To enable the SpO2 alarms:
1. Press the Menu Select button.
2. Select Measurements/Alarms and press Menu Select.
3. Select SpO2 and press Menu Select.
4. Select Alarms On/Off and press Menu Select.
Practice Exercise 1
Change the SpO2 limits, and enable/disable and respond to related alarms.
Questions
What happens when you change a limit? Disable an alarm? Respond to an alarm?
Notes:
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
73
8 Pulse Oximetry Monitoring
Lesson Presentation
Setting Pulse Rate Alarms
Changing Pulse Rate Alarm Limits
To change pulse rate alarm limits:
1. Press the Menu Select button.
2. Using the Navigation buttons, select Measurements/Alarms and press Menu Select.
3. Select Pulse and press Menu Select.
4. Select Pulse Limits and press Menu Select.
5. Using the Navigation buttons, select the new high limit value and press Menu Select.
6. Select the new low limit value and press Menu Select.
Enabling/Disabling Pulse Rate Alarms
To enable pulse rate alarms:
1. Press the Menu Select button.
2. Select Measurements/Alarms and press Menu Select.
3. Select Pulse and press Menu Select.
4. Select Alarms On/Off and press Menu Select.
Practice Exercise 2
Change the pulse rate limits, and enable/disable and respond to related alarms.
Question
What happens when you change a limit? Disable an alarm? Respond to an alarm?
Notes:
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
74
Lesson Presentation
8 Pulse Oximetry Monitoring
Disabling SpO2 Monitoring
To disable SpO2 monitoring:
• Disconnect the sensor cable from the SpO2 port. The message SpO2 Unplugged. Turn off SpO2?
appears. Select Yes and press Menu Select.
• Should the sensor cable be disconnected accidentally, select No and press Menu Select. Then, secure
the connection to re-enable the function.
Notes:
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
75
8 Pulse Oximetry Monitoring
Review
Review
Answer the following questions related to SpO2 monitoring.
1. You can monitor SpO2 in all MRx modes (Monitor, Manual Defib, AED or Pacer). T or F
2. The pleth wave is auto scaled to grid lines when the signal quality is poor. T or F
3. SpO2 alarms are off unless turned on during use while pulse rate alarms are on unless turned off
during use. T or F
4. How many seconds are SpO2 INOP messages suppressed during an NBP measurement?
a. 15
b. 30
c. 45
d. 60
76
User Training Workbook
9
Noninvasive Blood Pressure
Monitoring
9
Lesson Introduction
This lesson describes how to monitor noninvasive blood pressure (NBP) with the HeartStart MRx.
Objectives
Upon completion of this lesson, you should be able to:
1. Monitor NBP.
2. Set NBP alarms.
Notes:
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
77
9 Noninvasive Blood Pressure Monitoring
Lesson Presentation
Lesson Presentation
Preparing to Measure NBP
To prepare to measure NBP:
1. Select the appropriately sized cuff.
2. Attach the cuff to the NBP tubing.
3. Insert the NBP tubing into the NBP port on the MRx.
4. Apply the blood pressure cuff to the patient’s arm.
5. Place the limb used for taking the measurement at the same level as the patient’s heart.
Notes:
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
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78
Lesson Presentation
9 Noninvasive Blood Pressure Monitoring
Measuring NBP
To measure NBP:
1. Press the [Start NBP] soft key.
2. Press the [Stop NBP] soft key to stop a reading.
Changing the NBP Schedule
To change the NBP schedule and/or the interval of automatic measurements:
1. Press the Menu Select button.
2. Using the Navigation buttons, select Measurements/Alarms and press Menu Select.
3. Select NBP and press Menu Select.
4. Select NBP Schedule and press Menu Select.
5. Using the Navigation buttons, select the desired interval and press Menu Select.
Practice Exercise 1
Complete manual and automatic NBP measurements, including changing the NBP schedule.
Questions
1. What displays when you start a measurement? Stop a measurement?
2. How does the display differ between a manual and automatic measurement?
Notes:
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________________________________________________________________
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79
9 Noninvasive Blood Pressure Monitoring
Lesson Presentation
Alarms
Changing NBP Alarms
To change the NBP alarm source and/or limits:
1. Press the Menu Select button.
2. Using the Navigation buttons, select Measurements/Alarms and press Menu Select.
3. Select NBP and press Menu Select.
4. Select NBP Limits and press Menu Select.
5. Select the desired source for the alarm and press Menu Select.
6. Using the Navigation buttons, increase or decrease the high limit value and press Menu Select.
7. Set the new low limit value and press Menu Select.
Enabling/Disabling NBP Alarms
To enable/disable NBP alarms:
1. Press the Menu Select button.
2. Using the Navigation buttons, select Measurements/Alarms and press Menu Select.
3. Select NBP and press Menu Select.
4. Select Alarms On/Off and press Menu Select.
Practice Exercise 2
Change the alarm limits, and enable/disable and respond to related alarms.
Questions
1. What happens when you change a limit? Disable an alarm? Respond to an alarm?
Notes:
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
80
Review
9 Noninvasive Blood Pressure Monitoring
Review
Answer the following questions related to monitoring NBP.
1. Which of the following items can display when monitoring NBP?
a. Systolic and diastolic pressure
b. Alarm limits
c. Automatic measurement schedule
d. Time stamp
2. You can take manual measurements during an automatic measurement schedule. T or F
3. NBP alarms are “on” unless disabled. T or F
81
User Training Workbook
10
Carbon Dioxide Monitoring
10
Lesson Introduction
This lesson describes how to monitor carbon dioxide (CO2) and measure end-tidal carbon dioxide
(EtCO2) and Airway Respiration Rate (AwRR) with the HeartStart MRx using the Microstream®
(sidestream) method.
Note: Microstream® is a trademark of Oridion Medical Ltd.
Objectives
Upon completion of this lesson, you should be able to:
1. Monitor CO2.
2. Set EtCO2 and AwRR alarms.
Notes:
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
83
10 Carbon Dioxide Monitoring
Lesson Presentation
Lesson Presentation
Measuring EtCO2
To prepare and measure EtCO2:
1. Select the appropriate Microstream accessories based on the type and airway status of the patient.
2. Set up the Microstream accessories.
Using the nasal FilterLine®
a. Attach the FilterLine tubing to the CO2 Inlet port.
b. Position the nasal FilterLine on the patient. If using dual purpose FilterLine tubing, connect the
green tubing to the oxygen source.
Note: FilterLine® is a trademark of Oridion Medical Ltd.
Using the FilterLine and airway adapter
a. Attach the FilterLine tubing to the CO2 Inlet port.
b. Connect the wide end of the airway adapter to the endotracheal tube.
c. Connect the narrow end of the airway adapter to the ventilator tubing or manual resuscitator.
3. A measurement is automatically turned on when the FilterLine is connected to the CO2 Inlet port.
Note: The Outlet port is used for removing anesthetic gases from MRx.
Notes:
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84
Lesson Presentation
10 Carbon Dioxide Monitoring
Setting Up the EtCO2 and AwRR Alarms
Changing EtCO2 Alarm Limits
To change the EtCO2 alarm limits:
1. Press the Menu Select button.
2. Using the Navigation buttons, select Measurements/Alarms and press Menu Select.
3. Select EtCO2 and press Menu Select.
4. Select EtCO2 Limits and press Menu Select.
5. Using the Navigation buttons, increase or decrease the high limit value and press Menu Select.
6. Set the new low limit value and press Menu Select.
Enabling/Disabling EtCO2 Alarms
To enable or disable the EtCO2 alarms:
1. Press Menu Select. Using the Navigation buttons, select Measurements/Alarms and press Menu
Select.
2. Select EtCO2 and press Menu Select.
3. Select Alarms On/Off and press Menu Select.
Changing AwRR Alarm Limits
To change the AwRR alarm limits:
1. Press Menu Select.
2. Using the Navigation buttons, select Measurements/Alarms and press Menu Select.
3. Select AwRR and press Menu Select.
4. Select AwRR Limits and press Menu Select.
5. Using the Navigation buttons, increase or decrease the high limit value and press Menu Select.
6. Set the new low limit value and press Menu Select.
Changing Apnea Time Alarm Limit
To change the Apnea Time alarm limit:
1. Press Menu Select.
2. Using the Navigation buttons, select Measurements/Alarms and press Menu Select.
3. Select AwRR and press Menu Select.
4. Select Apnea Time and press Menu Select.
5. Using the Navigation buttons, increase or decrease the limit and press Menu Select.
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10 Carbon Dioxide Monitoring
Lesson Presentation
Enabling/Disabling AwRR Alarms
To enable the AwRR alarms:
1. Press Menu Select.
2. Using the Navigation buttons, select Measurements/Alarms and press Menu Select.
3. Select AwRR and press Menu Select.
4. Select Alarms On/Off and press Menu Select.
Practice Exercise 1
Change EtCO2, AwRR, and Apnea Time limits, and enable/disable and respond to related alarms.
Questions
1. What happens when you change a limit? Disable an alarm? Respond to an alarm?
Notes:
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
86
Lesson Presentation
10 Carbon Dioxide Monitoring
Disabling EtCO2 Monitoring
To disable EtCO2 monitoring:
• Disconnect the FilterLine from the CO2 inlet port. The message CO2 Unplugged - Turn Off
EtCO2? appears. Select Yes and press Menu Select.
• Should the FilterLine be disconnected accidentally, select No in response to the message and press
Menu Select. Then, secure the connection to re-enable the function.
Notes:
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
87
10 Carbon Dioxide Monitoring
Review
Review
Answer the following questions related to monitoring CO2.
1. EtCO2 values may be significantly low if a patient is breathing through their mouth when using a
nasal FilterLine. T or F
2. The CO2 waveform only displays in Wave Sector 3. T or F
3. FilterLine or exhaust tubing blockage can generate an apnea alarm. T or F
4. AwRR alarms are disabled unless turned enabled during use. T or F
88
User Training Workbook
11
Invasive Pressures Monitoring
11
Lesson Introduction
This lesson describes how to monitor invasive pressures using the HeartStart MRx.
Objectives
Upon completion of this lesson, you should be able to:
1. Set up a pressure measurement.
2. Select a pressure to monitor.
3. Zero the pressure transducer.
4. Set pressure alarms and view related settings.
5. Identify how pulse works with the Invasive Pressures option.
89
11 Invasive Pressures Monitoring
Lesson Presentation
Lesson Presentation
Overview
• Two channels of real-time continuous invasive pressure measurements and waveforms are available
in Monitor, Manual Defib and Pacer Modes.
• Systolic, diastolic and mean pressure values display for pulsatile pressure signals and mean value for
non-pulsatile pressure signals.
Pressure Measurement Set-up
To set up medical equipment to display a pressure measurement on the MRx:
1. Turn the HeartStart MRx to Monitor.
2. Connect the pressure cable to the MRx.
3. Connect the pressure cable to the transducer.
4. Prepare the flush solution.
5. Flush the system to expel air from the tubing. Make sure the stopcocks and transducer are also free
of air bubbles.
6. Connect the pressure line to the patient catheter.
7. If you are using an infusion pressure cuff with the pressure line, attach the pressure cuff to the fluid
to be infused. Inflate it according to your hospital’s standard procedure and then begin the
infusion. Position the transducer so that it is level with the heart, approximately at the level of the
midaxillary line.
Notes:
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
90
Lesson Presentation
11 Invasive Pressures Monitoring
Selecting a Pressure to Monitor
To select a pressure label:
1. Press the Menu Select button.
2. Using the Navigation buttons, select Measurements/Alarms and press Menu Select.
3. Select Press 1 (or Press 2) and press Menu Select.
4. Select Label and press Menu Select.
5. Select the appropriate label from the list provided and press Menu Select.
Label
Description
Label
Description
ABP
Arterial Blood Pressure
LAP
Left Atrial Pressure
ART
Arterial Blood Pressure
PAP
Pulmonary Artery Pressure
Ao
Aortic Pressure
RAP
Right Atrial Pressure
CVP
Central Venous Pressure
P1
Non-specific pressure label
(Channel 1)
ICP
Intracranial Pressure
P2
Non-specific pressure label
(Channel 2)
6. Verify and change the size of your scale, as appropriate.
7. Verify and change the alarm source type, as appropriate.
8. Set the high and low alarm limits.
Pressure Waves
To select a pressure wave and the associated scale for the display or printed strip:
1. Press the Menu Select button.
2. Using the Navigation buttons, highlight Displayed Waves and press Menu Select.
3. Select Wave Position (Wave 1, Wave 2, Wave 3 or Wave 4) and press Menu Select.
4. Select the appropriate wave and press Menu Select.
5. Select the appropriate scale and press Menu Select.
Practice Exercise 1
Attach a simulator (e.g., Dale14 multiparameter simulator) and pressure cable(s) to the MRx, select
different pressure waves and associated scales, and display and print out the results, as appropriate.
Questions
1. How does the display (or printout) differ from one pressure wave to another? From Wave 1 menu?
2. What wave scale(s) provide the clearest wave form?
3. How would you assign a specific label to pressure channel 1 if it is already assigned to channel 2?
91
11 Invasive Pressures Monitoring
Notes:
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92
Lesson Presentation
Lesson Presentation
11 Invasive Pressures Monitoring
Zeroing the Pressure Transducer
Zeroing Using the Menu Select Button
To zero the transducer using the Menu Select button:
1. Place the transducer at the appropriate level for the measurement site.
2. Close the transducer stopcock to the patient and vent the transducer to atmospheric pressure.
3. Press the Menu Select button.
4. Using the Navigation buttons, select Measurements/Alarms and press Menu Select.
5. Select the pressure label you wish to zero.
6. Press Zero and press Menu Select. Zeroing begins.
Zeroing in Monitor Mode
To zero the transducer in Monitor Mode:
1. Place the transducer at the appropriate level for the measurement site.
2. Close the transducer stopcock to the patient and vent the transducer to atmospheric pressure.
3. Press the soft key under the [Zero Pressure] label.
4. Using the Navigation buttons, select the pressure(s) you wish to zero from the Zero menu and
press Menu Select. Zeroing begins.
Last Zero
To view dates and times for a channel’s last zero:
1. Press the Menu Select button.
2. Using the Navigation buttons, select Measurements/Alarms and press Menu Select.
3. Select the pressure label (channel: label) you want and press Menu Select.
4. The last zero dates and times are displayed.
Notes:
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________________________________________________________________
________________________________________________________________
________________________________________________________________
93
11 Invasive Pressures Monitoring
Lesson Presentation
Alarms
Enabling/Disabling Alarms
To enable/disable alarms:
1. Press the Menu Select button.
2. Using the Navigation buttons, select Measurements/Alarms and press Menu Select.
3. Select the pressure label (channel: label) you wish to modify alarm status on and press Menu
Select.
4. Select Alarms On (or Alarms Off ) and press Menu Select.
Viewing/Changing/Setting Source for Alarms
To view or change alarm settings for a given pressure label:
1. Press the Menu Select button.
2. Using the Navigation buttons, select Measurements/Alarms and press Menu Select.
3. Select the pressure label (channel: label) you wish to view/modify alarms on and press Menu
Select.
4. Select pressure label Limits and press Menu Select.
5. If the pressure label is pulsatile, select the desired source of the alarm (Systolic, Diastolic or Mean)
and press Menu Select.
6. Using the Navigation buttons, increase or decrease the high limit and press Menu Select.
7. Set the new low limit and press Menu Select.
Practice Exercise 2
Change invasive pressure alarm limits, and enable/disable and respond to related alarms.
Questions
1. What happens when you change a limit? Disable an alarm? Respond to an alarm?
Notes:
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94
Lesson Presentation
11 Invasive Pressures Monitoring
Pulse
Changing Pulse Source
To change pulse source for the current incident:
1. Press the Menu Select button.
2. Using the Navigation buttons, select Measurements/Alarms and press Menu Select.
3. Select Pulse and press Menu Select.
4. Select Pulse Source and press Menu Select. Pick a source with an arterial or pulmonary waveform.
5. Using the Navigation buttons, highlight the pulse source desired and press Menu Select.
Enabling/Disabling the Pulse Alarm
To enable/disable the pulse alarm:
1. Press the Menu Select button.
2. Using the Navigation buttons, select Measurements/Alarms and press Menu Select.
3. Select Pulse and press Menu Select.
4. Select Alarms On/Off and press Menu Select.
Changing Pulse Alarm Limits
To change pulse alarm limits:
1. Press the Menu Select button.
2. Using the Navigation buttons, select Measurements/Alarms and press Menu Select.
3. Select Pulse and press Menu Select.
4. Select Pulse Limits and press Menu Select.
5. Using the Navigation buttons, select the new high limit value and press Menu Select.
6. Select the new low limit and press Menu Select.
Practice Exercise 3
Change pulse alarm limits, and enable/disable and respond to related alarms.
Questions
1. What happens when you change a limit? Disable an alarm? Respond to an alarm?
95
11 Invasive Pressures Monitoring
Notes:
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96
Lesson Presentation
Review
11 Invasive Pressures Monitoring
Review
Answer the following questions related to monitoring invasive pressures.
1. You must flush the tubing system to remove air bubbles to prevent potential incorrect readings. T
or F
2. Which of the following statement(s) are TRUE regarding pressure selection and related wave scale
adjustment?
a. When selecting a label, you need to specify its color, alarm source and limits, and scale.
b. Controls for scale and alarm settings automatically appear after selecting a new label.
c. You can not select the same label for both pressure channels.
d. The available pressure wave scale spans from 300 to -20 in mmHg and from 38 to -2.5 in kPa.
3. Which of the following statement(s) are TRUE regarding zeroing a pressure?
a. You must zero a pressure every time you reconnect the transducer cable to the MRx.
b. Before zeroing a pressure, you must vent pressure transducers to atmospheric pressure and close
the stopcock to the patient.
c. Invasive pressure alarms are active while the transducer is zeroing.
d. The message Unable to zero message displays if the zeroing process fails.
4. Which of the following statement(s) are TRUE regarding pressure alarms?
a. All invasive pressure alarms cease when their alarm condition no longer exists.
b. The PAPd High message means the pulmonary artery diastolic pressure has exceeded the high
alarm limit.
c. If the pressure label is non-pulsatile, you select either Systolic, Diastolic or Mean as the desired
alarm source.
d. When CPP and ICP are displayed together, only one of them can have related alarms enabled.
5. If SpO2, as the default pulse source, is not active but the ABP source is, the pulse value displays but
it is invalid. T or F
97
User Training Workbook
12
Temperature Monitoring
12
Lesson Introduction
This lesson describes how to monitor temperature using the HeartStart MRx.
Objectives
Upon completion of this lesson, you should be able to:
1. Select a temperature to monitor.
2. Set temperature alarms and related limits.
Notes:
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99
12 Temperature Monitoring
Lesson Presentation
Lesson Presentation
Overview
• MRx offers one channel of real-time continuous temperature monitoring (in Fahrenheit or Celsius)
while in Monitor, Pacer or Manual Defib Modes.
• It can monitor nasopharyngeal, esophageal, rectal, skin, arterial, venous, core and urinary bladder
(vesic) temperatures.
Selecting a Temperature Label
Label
Type
Label
Type
Tesoph
esophageal temperature Tnaso
nasopharyngeal temperature
Trect
rectal temperature
Tvesic
urinary bladder
Tskin
skin temperature
Tart
arterial temperature
Temp
non-specific temp label Tven
Tcore
core temperature
venous temperature
To select a temperature label:
1. Press the Menu Select button.
2. Using the Navigation buttons, select Measurements/Alarms and press Menu Select.
3. Select the temperature label option currently assigned to your measurement and press Menu Select.
4. Select Label and press Menu Select.
5. Select the appropriate label from the list provided and press Menu Select.
Monitoring Temperature
To monitor a temperature:
1. Connect the temperature cable to the HeartStart MRx.
2. Select the correct temperature label for your measurement.
3. Check that the current device settings (including alarm settings) are appropriate for the patient.
4. Apply the temperature probe to the patient.
Notes:
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100
Lesson Presentation
12 Temperature Monitoring
Setting Temperature Alarms
Changing Alarm Limits
To change the temperature alarm limits for the current incident:
1. Press the Menu Select button.
2. Using the Navigation buttons, select Measurements/Alarms and press Menu Select.
3. Select the temperature label option currently assigned to your measurement and press Menu Select.
4. Select Temperature Limits and press Menu Select.
5. Using the Navigation buttons, change the high limit and press Menu Select.
6. Using the Navigation buttons, change the low limit and press Menu Select.
Disabling/Enabling Alarms
To disable/enable temperature alarms:
1. Press the Menu Select button.
2. Using the Navigation buttons, select the Measurements/Alarms menu and press Menu Select.
3. Select the temperature label option currently assigned to your measurement and press Menu Select.
4. Select Alarms Off/Alarms On and press Menu Select.
Disabling Temperature Monitoring
To disable the Temperature monitoring:
• Disconnect the temperature cable from the MRx Temperature port. The message Temp (or the label
currently activated) Unplugged. Turn Off Temp (or the label currently activated)? appears. Select
Yes and press the Menu Select button.
• Should the temperature cable get disconnected accidentally or if the probe and cable separate, and
you want to continue monitoring temperature, select No and press Menu Select. Reconnect the
temperature cable to restart the temperature monitoring function.
Practice Exercise 1
Change temperature alarm limits, and disable/enable and respond to related alarms.
Questions
1. What happens when you change a limit? Disable an alarm? Respond to an alarm?
101
12 Temperature Monitoring
Notes:
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102
Lesson Presentation
Review
12 Temperature Monitoring
Review
Answer the following questions related to monitoring temperature.
1. When you change a temperature label, you need to activate its related alarm limits. T or F
2. Which of the following statement(s) are TRUE regarding temperature alarms?
a. All temperature alarms cease when their alarm condition no longer exists.
b. The Tesoph Low message means the esophageal temperature has fallen below the low alarm
limit.
c. Temperature alarms default to off.
d. Changing the label may change the alarm limits.
103
User Training Workbook
13
12-Lead ECG Monitoring
13
Lesson Introduction
This lesson describes how to use the diagnostic 12-Lead ECG function of the HeartStart MRx.
Objectives
Upon completion of this lesson, you should be able to:
1. Identify pertinent information in the 12-Lead Preview screen.
2. Perform 12-Lead ECG acquisition.
3. Identify characteristics of the ACI-TIPI and TPI algorithms. (Optional objective)
4. Identify important characteristics of the 12-Lead Report.
Notes:
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105
13 12-Lead ECG Monitoring
Lesson Presentation
Lesson Presentation
Preview Screen
The 12-Lead Preview Screen is displayed when you turn the Therapy Knob to Monitor and press the
[12-Lead] soft key.
10 Feb 2009 11:20
Mark Event
Jones, Samuel
Adult Non-Paced
HR
bpm
80
120
50
36.0 80
36.9 39.0
mmHg q120
100
120/80
(95)
SYS
160 10:40
90
EtCO2 mmHg AwRR
SpO2 %
100
90
38
50
30
rpm
18
30
8
55 Years Male
ID: 12345
I
V1
II
V2
III
V3
aVR
V4
aVL
V5
aVF
V6
Display: .05-150 Hz
Start
NBP
02:42
C Pulse bpm NBP
Temp
Exit
12-Lead
Start
Acquire
Report: .05-150 Hz
.05-40 Hz
Filter
MENU
Notes:
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106
Lesson Presentation
13 12-Lead ECG Monitoring
Preparation
To prepare for ECG acquisition:
1. Connect the 10-Lead cable to the MRx.
2. Prepare the patient’s skin at appropriate electrode sites.
– If necessary, clip hair at the electrode sites (or shave sites if needed).
– Wash sites thoroughly with soap and water.
– Dry the electrode sites briskly to increase capillary blood flow in the tissues and to remove oil
and skin cells.
3. Attach the snaps to the electrodes.
4. Apply the electrodes to the patient. (Use the 10-Lead placement illustrated below.)
5. Turn the Therapy Knob to Monitor.
6. Enter the patient’s ID, name, age, and sex. Also, enter chest pain symptoms if the MRx is
configured to run the ACI-TIPI and TPI algorithms.
7. Confirm the patient’s pacing status is correct.
Note: With software version F.xx, the paced status is determined by the DXL ECG Algorithm.
107
13 12-Lead ECG Monitoring
Lesson Presentation
Notes:
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Acquiring the 12-Lead ECG
To acquire a 12-Lead ECG:
1. Press the [12-Lead] soft key.
2. Check the signal quality on each lead and, if necessary, make adjustments.
3. Press the [Start Acquire] soft key.
4. If the patient age and sex haven’t been entered, input this information using the Navigation and
Menu Select buttons. If connected to the IntelliVue Network, you enter the patient’s date of birth
(instead of age). Also, enter the patient’s chest pain symptoms if your MRx is configured to run the
ACI-TIPI and TPI algorithms.
5. Keep the patient still while the message Acquiring 12-Lead is displayed.
6. ECG analysis begins once acquisition is complete.
7. Following analysis, the 12-Lead Report is displayed, printed, and stored internally.
8. Press [New 12-Lead] to acquire another 12-Lead ECG.
9. Press [Exit 12-Lead] to exit the 12-Lead function.
Practice Exercise 1
Attach a 10-Lead set to the MRx and a simulator, set the simulator to a normal sinus rhythm (NSR),
and complete 12-Lead acquisition.
Questions
What display changes occur when you press the [Start Acquire] soft key? When acquisition is
completed? When analysis is completed?
108
Lesson Presentation
13 12-Lead ECG Monitoring
Notes:
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Acquiring a 12-lead ECG with ACI-TIPI or ACI-TIPI/TPI Analysis
To acquire a 12-lead ECG with ACI-TIPI or ACI-TIPI and TPI analysis:
1. Perform steps 1-5 from the previous “Acquiring the 12-Lead ECG” procedure.
2. If the MRx is not configured for TPI analysis, the 12-Lead Report (including the ACI-TIPI
predicted probability of acute ischemia percentage) is displayed, printed, and stored internally.
If the MRx is configured for TPI analysis, it performs a TPI screening test to see if the ECG is a
candidate for TPI analysis. (Press the [Skip TPI] softkey to bypass TPI analysis.)
– If the ECG is not a candidate, the 12-Lead Report is displayed, printed, and stored internally.
– If the ECG is a candidate, you’re prompted to input more patient information. Continue with
Step 3.
3. When required, the MRx displays a list of TPI patient data and related values that must be entered.
Press Menu Select to view possible values for the first highlighted topic.
4. Select and complete all inputs, and press the [Run TPI] softkey.
5. Select any thrombolytic therapy contraindications from a pre-configured list based on speaking
with and observing the patient.
To change a contraindication:
1. When the list of contraindications appears on the MRx display, use the navigation arrows to
highlight one of the contraindications and press the Menu Select button.
2. Use the Navigation arrows to select a new value for the contraindication and press Menu Select.
3. Use the Navigation arrows to select the next contraindication.
4. Complete steps 1-3 for the remaining contraindications in the list. Navigate to additional page(s)
as needed.
5. Press the [Done] softkey to exit contraindications to thrombolytic therapy. The 12-Lead analysis
is complete.
6. To acquire another 12-Lead ECG, press [New 12-Lead]. To exit the 12-lead function, press
[Exit 12-Lead].
109
13 12-Lead ECG Monitoring
Lesson Presentation
Practice Exercise 2
Complete a 12-Lead acquisition with ACI-TIPI or ACI-TIPI and TPI Analysis. Be sure your simulator
is set to AMI.
Question
What display changes do you see when completing each step?
Notes:
________________________________________________________________
________________________________________________________________
________________________________________________________________
12-Lead Report
The 12-Lead Report displays as follows.
12345
HR
60
PR 168
QRSD 74
QT 360
QTc 360
--Axis-P
52
QRS 45
T
41
Start
NBP
110
11-Apr-2009 11:19:00
Sinus rhythm
Consider right atrial abnormality
Inferior injury, probable early acute infarct
Ant-sept injurt, probable early acute infarct
Lateral leads are also involved
55 years Male
Unconfirmed diagnosis
-ABNORMAL ECGPhilips Predicted Probability of Acute Ischemia
>>> Acute MI <<<
Exit
12-Lead
New
12-Lead
Print
MENU
Lesson Presentation
13 12-Lead ECG Monitoring
Notes:
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
Accessing Stored Reports
To access stored reports to print additional copies, copy them to a data card, or delete them from
internal storage:
1. While in 12-Lead Mode, press the Menu Select button.
2. Use the Navigation buttons to select Reports.
3. Use the Navigation buttons to select a report and press Menu Select.
4. Select Print, Copy, or Delete and press Menu Select.
5. Press Exit to close the menu.
Adjusting Wave Size
To adjust the ECG wave size:
1. While in 12-Lead Mode, press the Menu Select button.
2. Using the Navigation buttons, select ECG Size and press Menu Select.
3. Using the Navigation buttons, select the desired size value and press Menu Select.
Notes:
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
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111
Review
Answer the following questions related to 12-Lead ECG.
1. Which of the following statement(s) are FALSE? The 12-Lead Preview screen displays:
a. Patient ID, age, and sex.
b. Waveforms presented at a rate of 15mm/sec. for approximately 2.5 seconds.
c. A dotted line which indicates a lead can’t be derived.
d. SpO2, CO2, and NBP measurements in Parameter Blocks 1 and 2, if configured.
2. Once ECG acquisition is complete, you press the Start Analysis soft key to start ECG analysis.
T or F
3. The MRx acquires how many seconds of ECG data?
a. 5
b. 10
c. 12
d. 15
4. Which one of the following inputs is required by the ACI-TIPI algorithm?
a. blood pressure
b. history of hypertension
c. history of diabetes
d. chest pain symptoms
5. Which of the following statement(s) are TRUE regarding the 12-Lead Report?
a. It displays standard interval and duration measurements, as well as interpretive statements on
waveform morphology.
b. It can be configured to include ALL 12 leads and related measurements.
c. Its printout can includes on-screen data and up to two rhythm strips.
d. An alarm strip is printed when an alarm condition occurs during printing.
User Training Workbook
14
Vital Signs Trending
14
Lesson Introduction
This lesson describes the HeartStart MRx Vital Signs Trending and related report data.
Objectives
Upon completion of this lesson, you should be able to:
1. Identify data and functionality of the Vital Signs Trending Report.
Notes:
________________________________________________________________
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113
14 Vital Signs Trending
Lesson Presentation
Lesson Presentation
Reviewing Trending Data
1. Turn the Therapy Knob to Monitor.
2. Press the Menu Select button.
3. Using the Navigation buttons, select Trends and press Menu Select.
26 Jul 2006 10:52
Mark E vent
Jones, S amuel
Adult
Non-Paced
HR
80
Pulse
120
50
Temp
80
02:42
NBP q30 10:40
101.0 120/80
96.0
(95)
SYS
160
90
100.9
II
ABP 150
75
0
ABP
118/72
(95)
Report
Date
Parameters
ICP
SYS
100
90
(9)
CPP (86)
10
0
SpO2 % EtCO2 mmHg AwRR
100
100
90
38
50
30
rpm
18
30
8
26 Apr 10:10 10:15 10:20 10:25 10:30 10:35 10:40 10:45 10:50
ABPd
72
72
72
72
72
72
72
72
72
ABPm
95
95
95
95
95
95
95
95
95
ICPm
9
9
9
9
9
8
8
9
9
CPPm
86
86
86
86
86
87
87
86
86
NBPs
120
117
120
120
NBPd
80
64
60
70
NBPm
95
81
80
82
10:06
10:23
10:38^
10:47
EtCO2
38
38
37
38
39
35
36
38
39
Close
Trends
Print
Trends
Time Interval
Trending Data
MENU
Trending Report Intervals
To adjust the report interval:
1. With Vital Signs Trending active on your display, press the Menu Select button.
2. Using the Navigation buttons, select Trend Interval and press Menu Select.
3. Using the Navigation buttons, select the trend interval you want and press Menu Select.
Scrolling in the Trending Report
• Use the [<<] or [>>] softkeys to scroll left and right (backward and forward) in the report.
• Use the Navigation buttons to scroll up and down with the vertical scroll bar on the display.
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Lesson Presentation
14 Vital Signs Trending
Printing the Trending Report
Print the Trending Report two ways:
1. Press the soft key under the Print Trends label. A report for the displayed period and interval is
printed.
2. Press the Summary button, select Trends, and then Trends Interval. A report for the entire
incident period is printed.
Exiting the Trending Report
To exit the Trending Report and return to a waveform display, simply press the [Close Trends]
soft key. You will be returned to Monitor Mode.
Practice Exercise 1
Change report time intervals, scroll through data, and print out sample reports.
Questions
1. Does the layout of a report change in any way when you increase or decrease the time interval?
2. Does the information on a printout differ from what you see on the display?
Notes:
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
115
14 Vital Signs Trending
Review
Review
Please answer the following questions related to the Vital Signs Trending Report.
1. Which of the following statement(s) are TRUE regarding data displayed on the Trending Report?
a. If you scroll left to view older data, the screen will not update to new data when available.
b. Questionable data is indicated by -?-.
c. Unavailable data is indicated by an empty space.
d. A ^ after the timestamp indicates multiple measurements taken during the interval.
2. For the one-minute time interval, data from continuous measurements is the average reading for
that one-minute period. T or F
116
User Training Workbook
15
IntelliVue Networking
15
Lesson Introduction
This lesson describes the HeartStart MRx’s IntelliVue Networking Option.
Objectives
Upon completion of this lesson, you should be able to:
1. Identify IntelliVue Networking display data.
2. Identify how to connect the MRx to the IntelliVue Network.
3. Admit, discharge, and transfer patients to or from the Philips IntelliVue Information Center.
4. Share information and data with the Information Center.
117
15 IntelliVue Networking
Lesson Presentation
Lesson Presentation
Overview
The MRx IntelliVue Networking Option:
• Allows the M3535A HeartStart MRx to connect and communicate with the Philips IntelliVue
M3185 Clinical Network (System L or later),
• Has an identifying icon placed on the device’s handle,
• Enables connection to the Philips IntelliVue Information Center or IntelliVue Information Center
iX System (PIIC iX) A.01 and later, which allows you to silence most alarms and send patient
demographic data to the MRx from a remote location, and
• Enables the MRx to perform like a bedside monitor and send patient electronic medical data
through the IntelliVue HL7 connection (if applicable).
IntelliVue Networking Display
Figure 6 HeartStart MRx with IntelliVue Networking Option Status Area
Network Connectivity Icon
Bed/equipment label
Mark Event
ECG Unplugged
Extreme Tachy
118
Bed5678901
Lesson Presentation
15 IntelliVue Networking
Table 2 Icon Definitions
Symbol
Definition
No symbol
No connection/association with the Information Center is established.
Connected. A wired connection is established. The MRx is assigned to
a sector and is being monitored by the Information Center.
Connected. A wireless connection is established. The MRx is assigned
to a sector and is being monitored by the Information Center.
Notes:
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
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15 IntelliVue Networking
Lesson Presentation
Connecting to the Network
To use the MRx on the IntelliVue Network:
1. Confirm the MRx and the Information Center are configured to “talk” with each other.
2. Physically connect the MRx to the network.
Figure 7 Wired Connection Physical Set-up
Figure 8 Wireless Connection Physical Set-Up
Figure 9 Simultaneous Wired and Wireless Physical Network Connections
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Lesson Presentation
15 IntelliVue Networking
Note:
– The radio/AC module must be fully connected before turning on the MRx.
– If you lose the wired connection, the MRx automatically attempts to connect to the network via
the wireless radio/AC module. If the radio/AC module is not connected to the MRx, plug the
module in and restart the MRx to obtain a wireless connection.
Using the Device Location Option (optional topic)
• Identifies the general location of the MRx by associating it with network access points installed in
the healthcare facility
• Not intended for use when attempting to locate a patient
Network Settings (optional topic)
To view current network settings in Monitor, Pacer, and Manual Defib modes:
1. Press the Menu Select button.
2. Using the Navigation buttons, select Other and press Menu Select.
3. Select Network Settings and press Menu Select.
Table 3 Network Settings Parameters
Field
Description
Connection
Displays current connection status: Wired, Wireless, or Inactive
MAC Address
HeartStart MRx MAC address
MAC Instr. Tele. Instrument Telemetry Radio Module MAC address
RF Access Code
Used to identify which RF channel the HeartStart MRx-Information Center
communications use (Set in Configuration Mode.)
IP Address
Current IP address - HeartStart MRx (wired) or Radio Module (wireless)
Server IP
Information Center IP address
Subnet Mask
Subnet mask of wired or wireless network
RSSI
Instrument Telemetry Radio’s Received Signal Strength Indicator (Value updates while
window is open)
Notes:
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15 IntelliVue Networking
Lesson Presentation
Patient Admit, Discharge, and Transfer
Admit
To admit a patient from the MRx:
1. Press the Menu Select button.
2. Using the Navigation buttons, select Patient Info and press Menu Select.
3. Select Name, ID, Date Of Birth or Sex and press Menu Select.
4. Enter the appropriate information and press Menu Select.
A Patient Admitted momentary message displays on the MRx when a patient is admitted.
Note: The above procedure is easier to accomplish at the Information Center.
Practice Exercise 1
Admit a patient on the MRx to the Information Center.
Questions
1. What is displayed on the MRx and Information Center once you complete the patient admittance?
Is there any difference in the format of the information displayed between the MRx and
Information Center?
Discharge
To discharge a patient:
1. Press the Menu Select button.
2. Using the Navigation buttons, select Patient Info and press Menu Select.
3. Select Discharge Patient and press Menu Select.
4. The MRx displays one of two Discharge Patient messages and prompts you with a Discharge
Patient? question.
5. Select Yes to discharge the patient or No to cancel the discharge.
Transfer
To access Transfer:
1. Confirm that the MRx is on the network, not already in Transfer Mode, and the patient has been
admitted. (The patient’s name or “---” is displayed.)
2. Press the Menu Select button.
3. Using the Navigation buttons, select Patient Info and press Menu Select.
4. Select Transfer and press Menu Select.
5. The Transfer Patient message prompts you with a Transfer Patient? question.
6. Select Yes to transfer the patient or No to cancel transfer.
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15 IntelliVue Networking
Transfer Mode
Transfer Mode allows hands off of patient data from one monitoring location to another.
Re-admit Patient
To re-admit a patient:
1. Press the Menu Select button.
2. Using the Navigation buttons, select Patient Info and press Menu Select.
3. Select Re-admit and press Menu Select.
4. When Re-admit is selected, a Re-admit Patient message displays, prompting with a Re-admit
Patient? question. Select Yes to re-admit the patient or No to cancel re-admission.
Clear Transfer
To exit Transfer Mode after losing network connectivity:
1. While in Transfer Mode, press the Menu Select button.
2. Using the Navigation buttons, select Patient Info and press Menu Select.
3. Select Clear Transfer and press Menu Select.
4. The message “Transfer mode will be exited.” displays when Clear Transfer is selected,
prompting with a Clear Transfer? question. Select Yes to clear transfer or No to remain in
Transfer Mode
Automatic Re-Admit
If a lost network connection between the MRx and Information Center is restored while in Transfer
Mode, the patient is automatically re-admitted from the transfer list.
Turning the MRx off
When the MRx is turned off or enters a non-clinical mode while in Transfer Mode, the current patient
incident is closed and the MRx exits Transfer Mode.
Notes:
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
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15 IntelliVue Networking
Lesson Presentation
Sharing Information on the Network
Patient Information
Updates
After the MRx makes a network connection with the Information Center, patient information entered
at one location is automatically reflected at the other.
Date Of Birth
To enter the date of birth:
1. Press the Menu Select button.
2. Using the Navigation buttons, select Patient Info and press Menu Select.
3. Select Date Of Birth and press Menu Select.
– If the patient type is adult, the default menu option is the current date, 50 years ago.
– If the patient type is pediatric, the default menu option is the current date, 7 years ago.
4. Using the Navigation buttons, enter the date of birth and press Menu Select.
Date and Time
Whenever the MRx’s date and time are not in agreement with the Information Center, the MRx
automatically synchronizes its date and time to match the Information Center’s.
Conflict Handling
• Conflicting patient information between the Information Center and the MRx is automatically
resolved when the MRx associates with the Information Center. If patient information on the MRx
has changed as a result of a resolution, you can confirm or edit the information via a menu.
– To confirm the information, press Menu Select.
– To edit patient info, highlight Edit Patient Info and press Menu Select to display the Edit
Patient Info menu. Any selection from this menu brings up a screen for modifying the
selection. After modifying the information, the Patient Information merged menu reappears
with the new patient information included. The Information Center is also updated with the
modified information.
• If the MRx is connected to the PIIC iX and the PIIC iX can determine the likely outcome of the
conflict, you answer a Smart Question to help resolve the conflict. If the PIIC iX cannot determine
the likely resolution or if you answer No to the Smart Question, you have as many as four options to
resolve the conflict via appropriate patient demographic changes.
Viewing Patient Incident Data
• While at the Information Center, you can view patient incident data sent from the MRx. Refer to
the IntelliVue M3150 Information Center Instructions for Use for details.
• Up to 30 single-valued and/or tripled-valued parameters, up to four waveforms (excluding Q-CPR
compression waveform), and up to seven alarms are viewable at the Information Center.
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Alarms
• If configured, you can silence/reset most MRx alarms and INOPs from the Information Center.
Alarms re-sound after two minutes if a condition is not cleared.
• Pacing Stopped (occurring when leads or pads off), Batteries Low, and Defib Shutdown alarms
result in Red INOPs that cannot be silenced at the Information Center. The Pacer Output Low
alarm results in a Yellow INOP that cannot be silenced at the Information Center. All four alarms
must be silenced at the MRx.
Printing
• The MRx prints to the installed 50mm or 75mm printer, not to a printer located on the institution’s
network.
• Alarm recordings are configured at the MRx and sent to the Information Center central recorder (if
present), where they can be recorded from the Record/Store tab under All Controls.
• Vital Signs Trending Reports generated by the MRx can only be printed at the MRx.
• Patient data on the Information Center can be printed from the Information Center.
Turning a Networked Device Off
• If a networked MRx is turned off, wave and alarm data may be displayed at the Information Center
for 10 more seconds. After 10 seconds, a No data from bed INOP statement appears on the
Information Center display. The current patient incident is closed at the MRx but the patient will
not be discharged from the Information Center.
If the MRx is turned back on, the ADT state is initially set to Not Admitted and patient type,
paced status and alarm limits are reset to their default settings. If the patient is still admitted at the
Information Center, the MRx is updated with patient information from the Information Center.
The ADT state is reset to “admitted.”
• In the event the MRx loses its network connection with the Information Center and both devices
are still powered on, the devices retain the patient’s status and other settings when a network
connection is restored.
Leaving a Clinical Mode
If a networked MRx is changed to a non-clinical mode*, the current patient incident is closed at the
MRx but the patient will not be discharged from the Information Center. If you re-enter a clinical
mode, the ADT state is initially set to Not Admitted and patient type (category), paced status and
alarm limits are reset to their default settings. If the patient is still admitted at the Information Center,
the MRx is updated with patient information from the Information Center. The ADT state is reset to
“admitted.”
*Note: Be sure the MRx is not connected to a patient while in a non-clinical mode (e.g., Data
Management or Operational Check).
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Events Logged
The MRx automatically creates an Event Summary for each patient incident.
INOPs, Alarms, and Messages at the Information Center
Most HeartStart MRx alarms, INOPs, and messages display at the Information Center in their entirety
or in an abbreviated form.
Notes:
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15 IntelliVue Networking
Review
Answer the following questions related to the IntelliVue Networking option.
1. The IntelliVue Information Center replaces the equipment label on the MRx display with a bed
label when the MRx connects to the network. T or F
2. Which of the following statement(s) are FALSE regarding MRx connectivity to the IntelliVue
Network?
a. If you connect the radio/AC power module to MRx after you turn it on, it takes 10 seconds for
the MRx to detect the module.
b. If a MRx leaves the healthcare facility, disconnect the radio module from the device.
c. If you lose the wired connection, the MRx automatically attempts to connect to the network via
the wireless radio/AC module.
d. The MRx provides the same level of network functionality for both wired or wireless
connections.
3. Which of the following statement(s) are FALSE regarding patient admittance, discharge, and
transfer?
a. The MRx admits patients via patient name, patient ID, patient type, date of birth, or sex.
b. Discharging a patient resets patient type, paced status, and other MRx settings to default values.
c. When a patient transfer is confirmed, the patient is discharged to the transfer list at the
Information Center.
d. When the MRx enters a non-clinical mode (e.g., Data Management) while in Transfer Mode,
the patient remains on the Information Center’s transfer list.
4. Which of the following statement(s) are TRUE regarding the type of information shared between
the MRx and Information Center?
a. A patient’s weight and height entered on the Information Center are automatically updated on
the MRx.
b. If the Information Center sends a neonatal patient type to the MRx, the MRx modifies the
setting to pediatric.
c. If patient information changes on the MRx due to a conflict resolution, you will see a ’patient
information merged’ message and a menu to confirm or edit patient info in all modes.
d. You can silence or reset most MRx alarms and INOPs from the Information Center.
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User Training Workbook
16
Working with Data
16
Lesson Introduction
This lesson describes the data management features of the HeartStart MRx.
Objectives
Upon completion of this lesson, you should be able to:
1. Identify MRx data management features.
2. Identify characteristics associated with printing Event Summaries.
3. Mark patient events.
Notes:
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Lesson Presentation
Overview
• MRx creates Event Summaries that:
– Have an event ID number and date/time stamp.
– Contain parameter measurements.
– Include trending and associated 12-Lead Reports.
– Are stored in internal memory.
– Can be copied to an external data card.
– Can be transmitted to a remote PC.
– Can be printed out.
• New Event Summaries are initiated:
– on the arrival of a valid ECG signal, SpO2 data, CO2 data, invasive pressure data, temperature
data, or CPR meter compression.
– when an NBP measurement is requested.
– when the Charge button is pressed.
– when the Mark Event button is pressed.
• Monitoring and defibrillation functions are disabled in Data Management Mode
Notes:
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16 Working with Data
Copying from Internal Memory
To copy Event Summaries and 12-Lead ECG Reports stored in internal memory to an external data
card:
1. Insert a data card into MRx.
2. Turn the Therapy Knob to Monitor.
3. Press the Menu Select button.
4. Using the Navigation buttons, select Other and press Menu Select.
Note: Using T.00 software on the MRx M3536A, you can access Data Management Mode by
pressing the Summary (i) button, thus eliminating steps 3 and 4 above.
5. Select Data Management and press Menu Select.
6. Press Menu Select to acknowledge the message Leaving Normal Operational Mode.
7. Use the [Prev Item] and [Next Item] soft keys to select an Event Summary.
8. Press Menu Select to display the Data Management menu.
9. Select Copy and press Menu Select.
Note: You can copy all event data or individual 12-Lead Reports at this point in the procedure if you
have software Version 9.xx or greater (including Version F.xx).
Viewing and Erasing the External Data Card
To display a list of Event Summary and 12-Lead ECG Reports located on the data card:
1. Turn the Therapy Knob to Monitor.
2. Press the Menu Select button.
3. Using the Navigation buttons, select the Other menu and press Menu Select.
Note: Using T.00 software on the MRx M3536A, you can access Data Management Mode by
pressing the Summary (i) button, thus eliminating steps 2 and 3 above.
4. Select Data Management and press Menu Select.
5. Press Menu Select to acknowledge the message Leaving Normal Operational Mode.
6. Press Menu Select to display the Data Management menu.
7. Select View Data Card and press Menu Select.
Use the [Prev Page] and [Next Page] soft keys to navigate to additional display pages. Use
the Erase Card menu option to delete the data card contents.
Notes:
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Printing During a Patient Event
Event Summaries
• Press the Summary button and select Event Summary from the Print menu to print the current or
most recent Event Summary.
Vital Signs Trending Reports
• To print the current or previous Vital Signs Trending Report:
– press the Summary button, select Trends and then Trends Interval from the menu,
– press the soft key under the [Print Trends] label while in Trends Mode, or
– select Trends from the Print menu in Data Management Mode.
12-Lead ECG Reports
• Print a current individual 12-Lead ECG Report by hitting the [Print] softkey in 12-Lead View.
• To print a recent 12-Lead ECG Report:
1. Press the Menu Select button and highlight Reports.
2. Use the Navigation buttons to highlight the report you want to print.
3. Press Menu Select and highlight Print.
4. Press Menu Select to print the report.
Notes:
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16 Working with Data
Printing from Data Management Mode
To print a historical Event Summary, Vital Sign Trends Report or 12-Lead Report:
1. Turn the Therapy Knob to Monitor.
2. Press the Menu Select button.
3. Using the Navigation buttons, select the Other menu and press Menu Select.
Note: Using T.00 software on the MRx M3536A, you can access Data Management Mode by
pressing the Summary (i) button, thus eliminating steps 2 and 3 above.
4. Select Data Management and press Menu Select.
5. Press Menu Select to acknowledge the message Leaving Normal Operational Mode.
6. Press Menu Select to display the Data Management menu.
7. Use the soft keys labeled [Prev Item] and [Next Item] to select the Event Summary you
want to print.
8. Press Menu Select to display the Data Management menu.
9. Highlight Print and press Menu Select.
10. Select the data option listed that you want to print (Event Summary, Trends, or specific 12-Lead
Report) and press Menu Select to print.
Note: If you are using a HeartStart MRx M3536A with software version R.03 and later, you can print
four different Event Summary report lengths (short, medium, long, or full) based on device
configuration.
Marking Events
To annotate the Event Summary and the ECG strip with an event:
1. Press the Mark Event button.
2. Using the Navigation buttons, select the desired event from the Events menu and press Menu
Select.
Notes:
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Review
Review
Please answer the following questions related to MRx data management.
1. Which of the following statement(s) are TRUE related to MRx’s data management?
a. Data management includes Event Summaries that have a unique event identification number
and are automatically stored in internal memory.
b. New Event Summaries are initiated by the arrival of valid SpO2, CO2, or invasive pressure data,
along with other activities.
c. The amount of patient data collected is determined by the amount of data card space available.
d. When using the Data Management function, monitoring and defibrillation modes are disabled.
2. If an alarm condition occurs while an Event Summary is printing, any associated ECG waveform is
not stored nor is an alarm strip printed. T or F
3. For a ‘Shock delivered’ or ‘Shock failed’ event, the MRx will print a 12-second string, if so
configured. T or F
4. The Mark Event button can be configured to print a 6-second ECG strip real time or prepended
with the previous 10 seconds of data leading up to the marked event. T or F
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17
17
Data Transmission
Lesson Introduction
This lesson describes how to transmit data from the HeartStart MRx to various external devices using a
suite of available data transmission options.
Objectives
Upon completion of this lesson, students should be able to:
1. Identify characteristics of the MRx data transmission.
2. Set up for Bluetooth transmission. (Optional objective)
3. Transmit a 12-Lead Report.
4. Identify characteristics of a Periodic Clinical Data Transmission. (Optional objective)
5. Identify characteristics of MRx’s Data Management Mode. (Optional objective)
6. Identify characteristics of a Batch LAN Data Transfer. (Optional objective)
Notes:
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Lesson Presentation
Overview
• Transmit MRx data during or after a critical care event.
• Data includes 12-Lead Reports, Event Summaries, and Periodic Clinical Data
Figure 10 Bluetooth Data Transmission Options for Periodic Clinical Data Transmission
Printer
12-lead / PCDT
12-lead / PCDT
Patient report
Cell Phone / PDA
Pocket PC
Fax
12-lead / PCDT
Mobile
Gateway
E-mail
address
12-lead / PCDT
Internet
LandLine / BT Modem
12-lead / PCDT
Firewall
12-lead / PCDT
Telemedicine
Server
Telemedicine
Server
12-lead
`
Laptop / Tablet
Data Messenger S/W
TraceMasterVue
12-lead / PCDT
12-lead
`
Datamed FT
GE MUSE
Figure 11 Wireless Link Option for Periodic Clinical Data Transmission
Printer
Fax
12-lead / PCDT
Patient report
E-mail
address
Cellular
transmission
12-lead /
PCDT
Internet
12-lead / PCDT
Firewall
WiFi
transmission
Telemedicine
Server
Telemedicine
Server
12-lead
`
TraceMasterVue
`
Datamed FT
GE MUSE
Gateway/hotspot
12-lead
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17 Data Transmission
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Preparing for Transmission
• Set up the MRx based on the type of transmission option selected (e.g., Bluetooth wireless, Wireless
Link, Batch LAN Data transfer).
• Test the transmission before using in a clinical situation.
• Waveforms for all monitored parameters can be viewed during the transmission process; however,
the waveform appearing in Wave Sector 4 is partially obscured when the transmission status bar is
displayed. Related alarms, measurements, and INOP messages remain active and are reported in
Parameter Blocks 1 and 2 and the general status area.
• The MRx transmits data from internal memory only.
Modifying Reference IDs
To change the Reference ID of an MRx during an event:
1. Press the Menu Select button.
2. Use the Navigation buttons to highlight Other and press Menu Select.
3. Highlight Reference IDs and press Menu Select.
4. Select the Reference ID you want to use or Other to add an additional Reference ID.
Notes:
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17 Data Transmission
Setting Up Bluetooth Transmissions (Optional topic)
Adding a Bluetooth Device
To add a Bluetooth device to the list of transmission devices:
1. Access 12-Lead Mode and press the Menu Select button.
2. From the 12-Lead Main Menu, select Bluetooth Devices and press Menu Select.
3. Select Add Device and press Menu Select. The message Searching for Bluetooth Devices
displays. The search lasts for 30 seconds.
4. From the Add Device menu, select the desired Bluetooth device and press Menu Select.
The selected Bluetooth device must now go through the “pairing” process described below.
Pairing a Bluetooth Device and Selecting a Profile
To pair a Bluetooth device with the MRx:
1. Use the Navigation buttons to enter the passkey on the MRx and select Done.
Note: The passkey is like a PIN number or password you create for a personal account.
2. Enter the same passkey on your Bluetooth device. See the documentation that came with your
Bluetooth device for instructions.
3. Select a Bluetooth Service.. Highlight File Transfer or Dial-Up Networking and press the
Menu Select button.
4. If you selected DUN, select the designated profile from the Phone/Modem Profiles menu. If you
selected FT, proceed to the next step.
5. Once the Bluetooth device is paired with the MRx and the profile selected, the MRx performs a
transmission test. After successfully connecting, the message Transmission Test Passed displays.
Press Menu Select to acknowledge the message. If the transmission test fails, the message
Transmission Test Failed displays, along with additional information about where the failure
occurred. See “Transmission Problems (Bluetooth)” in the Troubleshooting chapter of the MRx
Instructions for Use for support on failures.
Changing a Bluetooth Profile
To change a Bluetooth device profile:
1. In 12-Lead Mode, press Menu Select.
2. From the 12-Lead Main Menu, select Bluetooth Devices and press Menu Select. A list of
configured Bluetooth devices displays.
3. Use the Navigation buttons to select a device and press Menu Select.
4. Select Change Profile and press Menu Select. A menu of configured profiles for that device
displays, with the current associated profile highlighted.
5. Select the profile you want to associate with the device.
The MRx tests the profile to determine if the Bluetooth device can communicate with the 12-Lead
Transfer Station. If successful. press Menu Select to acknowledge the message. If unsuccessful, the
message Transmission Test Failed displays, along with additional information about where the
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failure occurred. See “Transmission Problems (Bluetooth)” in the Troubleshooting chapter of the MRx
Instructions for Use for support.
Practice Exercise 1
Complete a Bluetooth transmission setup.
Questions
1. What does it mean if you can’t find a Bluetooth device when trying to add it to the transmission
device list?
2. What other resources would you use to troubleshoot a problem?
Notes:
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Setting up Wireless Link Transmissions (Optional topic)
• An appropriate IT professional sets up the Wireless Link device and configures your HeartStart MRx
before you can send data.
• Data transmission using Wireless Link is easy by connecting the Wireless Link device to MRx’s RS232 serial and LAN ports respectively.
• Here are the various Wireless Link indicator lights located on the side of the device, which should be
checked if you need to troubleshoot any data transmission.
Figure 12 Wireless Link Indicators
Cell Signal Indicator
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WiFi Signal Indicator
Power Indicator
Run Indicator
Ethernet Indicator
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17 Data Transmission
Notes:
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Transmitting in 12-Lead Mode
To transmit a displayed 12-Lead Report:
1. From the 12-Lead Report screen, press the Menu Select button.
2. Select Send and press Menu Select.
3. Select the report destination from the Send To menu and press Menu Select.
4. Highlight the device you want to use and press Menu Select.
Transmitting to a Fax Number
To transmit a displayed 12-Lead Report to a manually entered fax number:
1. Press Menu Select.
2. Using the Navigation buttons if necessary, select Send from the 12-Lead Main Menu and press
Menu Select.
3. Select Fax Number from the Send To menu.
4. Enter the fax number from the numeric list using the Navigation buttons. Include any extra digits
necessary (e.g., 9 for an outside line or 1 plus the area code for long distance).
5. Select Done and press Menu Select.
Transmitting to a Personal Computer
• Using Bluetooth FTP, the MRx can send 12-leads and periodic data to a PC during an event and
send event summaries to a PC after an event.
• Transfer data is used by an ePCR or Event Review Pro on the receiving personal computer or
forwarded on to a remote destination using HeartStart Data Messenger software.
Practice Exercise 2
Complete a transmission in 12-Lead Mode to a configured site, fax number, and/or PC.
1. What display changes do you see when completing each transmission procedure?
2. What differences exist between each procedure?
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Periodic Clinical Data Transmission (Optional topic)
• Periodic Clinical Data Transmission (PCDT) uses Bluetooth or Wireless Link to automatically
transmit “live” periodic vitals, 12-leads, and waveform data to a remote data viewing server,
providing advance status and decision making assistance.
• Icons indicate connectivity status, as follows.
Bluetooth PCDT Icons
Symbol
Definition
No symbol
No connection/association with the data viewing server is established.
PCDT Values is not activated.
A PCDT session has been established and is working properly.
(Blue icon with white Bluetooth symbol)
A PCDT session is currently transmitting data.
(Blue icon with green Bluetooth symbol)
A PCDT session has been started but the connection to the data
viewing server has failed.
(Blue icon with white Bluetooth symbol crossed out)
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17 Data Transmission
Wireless Link PCDT Icons
Symbol
Definition
No symbol
A transmission has not been initiated.
A Wireless Link connection for PCDT has been made.
(White symbol)
Wireless Link is currently transmitting PCDT data.
(Green symbol)
Wireless Link started a PCDT transmission but the connection failed.
Starting a Periodic Clinical Data Transmission
To begin a PCDT if utilizing Bluetooth:
1. Confirm the MRx is in a clinical mode and has a properly configured data viewing software
destination and Bluetooth device.
2. Press the Menu Select button.
3. Using the Navigation buttons, select Start Data Transmit and press Menu Select.
4. From the Send To menu, select a pre-configured data viewing server location to send the data to
and press Menu Select.
5. From the Transmission Devices menu, select the transmission device option you want to use and
press Menu Select. The PCDT icon appears on the display and transmission begins. If your device
does not have a transmission device, the MRx prompts you to add a device.
To begin a PCDT if utilizing Wireless Link:
1. Confirm the MRx is in a clinical mode and press the Menu Select button.
2. Using the Navigation buttons, select Start Data Transmit and press Menu Select.
3. Using the Navigation buttons, highlight the pre-configured Telemedicine destination for the data
and press Menu Select. Transmission begins.
Ending a PCDT
To end an on-going PCDT:
1. Press the Menu Select button.
2. Select End Data Transmit and press Menu Select.
3. Confirm you want to end the transmission by highlighting Yes and press Menu Select. (Selecting
No continues the transmission.)
Practice Exercise 3
Complete a PCDT.
Question
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17 Data Transmission
What display changes do you see during the procedure?
Notes:
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17 Data Transmission
Transmitting Post Events
Transmit data after an event via Bluetooth or Batch LAN Data Transfer (wired, as illustrated below,
and wireless via Wireless Link), or save data to the data card for personal transport to another device.
Figure 13 Post Event Transmission
ePCR
ePCR database
Event Review Pro
HeartStart MRx
Data Messenger
PC locally
Event Review
Pro PC at central
location
Notes:
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Transmitting in Data Management Mode
To transmit an Event Summary or 12-Lead Report from internal memory to a receiving device via
Bluetooth FTP:
1. Press the Menu Select button.
2. Using the Navigation buttons, select Other and press Menu Select.
Note: Using T.00 software on the MRx M3536A, you can access Data Management Mode by pressing
the Summary (i) button.
3. Select Data Management and press Menu Select.
4. Press Menu Select to acknowledge the message Leaving Normal Operational Mode.
5. Using the [Prev Item] and [Next Item] softkeys, highlight the Event Summary you
want to transmit (or the Event Summary which contains the 12-Lead Report you want to transmit)
and press Menu Select.
6. Highlight Send and press Menu Select.
7. Highlight the type of data you want to transmit on the Send menu and press Menu Select.
8. Depending upon which option you selected in Step 7, you are presented with different menus.
– If you selected a 12-Lead Report:
a. Select a destination for the 12-Lead Report from the Send To menu and press Menu Select.
b. If your device has more than one configured transmission device, highlight the transmission
device you want to use and press Menu Select.
– If you selected an Event Summary:
If your device is configured with just one transmission device, transmission begins. If your device
has more than one configured transmission device, highlight the option you want to use and press
Menu Select.
Notes:
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Tracking Data Transmission
Data transmission progress is displayed on the MRx, as follows:
• For events - Event ID, date, and time
• For 12-Lead reports - date and time
• The phrases Connecting to Device and Sending
• A percentage complete when MRx is sending data
• Once transmission is complete - Confirming. Stand by... message, followed by a Disconnecting
message
Cancelling a Transmission
Cancel a transmission in progress.
1. From either 12-Lead Mode or Data Management Mode, press the Menu Select button.
2. Highlight Cancel Transmission and press Menu Select.
3. Select Yes and press Menu Select to cancel or No and press Menu Select to continue the
transmission.
Queuing Transmissions
• Queue more than one 12-Lead Report or Event Summary for a non-BLDT transmission using the
same transmission device.
• Queue 12-Lead Reports to the same or different locations.
• Queue another transmission while a transmission is in progress.
• Complete the first transmission before initiating the next one if transmitting using different
transmission devices,
• Queued transmissions are cancelled when a transmission fails or is cancelled.
Finding Transmission Results
• Data transmitted from the MRx to a receiving device is placed in a “philipsMRx” folder and,
depending on the data sent, a sub-folder: “12-Leads” or “events”.
Practice Exercise 4
Complete a transmission in Data Management Mode for a single Event Summary, all summaries, or a
single 12-Lead Report, as appropriate.
Question
What display changes do you see during any of the transmission procedures?
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17 Data Transmission
Batch LAN Data Transfer (Optional topic)
• Batch LAN Data Transfer (BLDT) enables you to download either a single Event Summary or all
Event Summaries from the internal data card to an external personal computer running Data
Messenger software for further review and archiving. When you download all summaries, they are
erased from the MRx automatically.
• Data Messenger software communicates with the MRx to download Event Summaries, storing them
in a folder locally or forwarding files to a remote Event Review Pro computer.
Setting Up for Batch LAN Data Transfer
• Connect a cable from the LAN port on the back of the MRx to either a router or Network Interface
Card (NIC) on a local personal computer. Ask your IT support how your setup has been configured.
• Alternatively, accomplish BLDT using Wireless Link. Make sure that a PC running Data Messenger
is connected to the same WiFi network as the MRx. Confirm with your IT support which wireless
network you've been configured for.
Transferring Files with BLDT
To transfer data using the BLDT option:
1. Confirm the MRx is in Data Management Mode, Data Messenger is running on the receiving
personal computer (as indicated by the Data Messenger icon in the task bar), and the LAN cable
(or Wireless Link device) is securely connected to the MRx. For wireless transmission, the PC is on
the same WiFi network as the MRx.
Note: When Wireless Link is used in access point mode (which is the standard configuration for
sending cases to ePCRs), it will only broadcast its SSID when in Data Management mode. So, you
need to ensure that they are connected to the same network as MRx when in Data Management
mode.
2. Once the LAN cable is connected, the HeartStart MRx automatically communicates with the Data
Messenger personal computer and prompts you to send data.For wireless transmission, once the
MRx is in Data Management mode, the MRx automatically displays the Send menu once it has
successfully communicated with the Data Messenger. This can take between 30-60 secs. During
this time, you will observe a connecting message on the MRx.
To transfer a single event:
To transfer all events:
3. Use the [Prev Item] and [Next item] 3. Select Send All and press Menu Select.
softkeys to highlight the correct Event
Summary to download.
4. Select Send Selected and press Menu Select.
5. Select the type of data you wish to download
and press Menu Select.
• Once the transfer begins, the MRx tracks progress indicating the number of files sent and the
percent complete.
• Press Menu Select to acknowledge the Transmission Complete message.
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Cancelling a BLDT
To cancel a BLDT:
1. Press the Menu Select button, select Cancel Transmission, and press Menu Select.
Practice Exercise 5
Complete a BLDT.
Question
What display changes do you see during the transfer?
Notes:
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17 Data Transmission
Review
Answer the following questions related to data transmission from the HeartStart MRx to various
external devices.
1. True or false? Excluding Wireless Link transmissions, MRx requires Bluetooth wireless technology
to transmit a 12-Lead ECG to a personal PC.
2. Which one of the following statements is TRUE? To establish communication between a
Bluetooth device and the MRx, a pass key is needed for:
a. only the Bluetooth device.
b. only the MRx
c. both the Bluetooth device and MRx.
3. Which one of the following statements is FALSE regarding 12-Lead Report transmission?
a. You can transmit reports to printers, fax machines, PDAs, and cell phones.
b. The MRx transmits reports from internal memory only.
c. If you are transmitting to a fax number, you may need to include a “9” for an outside line or “1”
before the area code.
d. You must wait for one transmission to complete before initiating another one.
4. Which of the following statements is FALSE regarding Periodic Clinical Data Transmission?
a. A blue icon with a green Bluetooth symbol indicates a PCDT session is currently transmitting
data.
b. All transmitted personal patient-identifiable data is encrypted to insure patient confidentiality.
c. For multiple transmissions, event summary transmissions are sent first, patient vital signs
transmissions second, and 12-Lead Report transmissions third.
d. If you start a PCDT within 10 seconds of turning the MRx on, the first transmission contains
no wave data.
5. True or false? The Send menu option transmits periodic clinical data if you are in clinical mode.
6. True or false? You can transmit all event data, a specific 12-Lead Report, audio data, and Q-CPR
data from Data Management Mode.
7. Which of the following statements is FALSE regarding BLDT?
a. Batch LAN Data Transfer is simply a LAN cable between the MRx and a router or personal
computer.
b. Data Messenger software serves as communication software between the MRx and PC.
c. You can queue a second BLDT while the first transfer is in progress.
d. After successfully sending all Event Summaries at once via BLDT, MRx’s internal memory card
is erased.
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User Training Workbook
18
Maintenance
18
Lesson Introduction
This lesson describes how to care for your HeartStart MRx and includes a brief look at battery
maintenance and cleaning.
Objectives
Upon completion of this lesson, you should be able to:
1. Identify the meaning of each Ready For Use status.
2. Identify the appropriate steps to complete a shift check.
3. Perform the necessary steps to complete an operational check on the MRx.
4. Identify the appropriate steps related to battery maintenance.
5. Identify the appropriate steps to clean the MRx and its associated accessories.
Notes:
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Lesson Presentation
Lesson Presentation
Automated Tests
Three automated tests assess MRx’s operational performance and notify you of any problems.
• Hourly: Tests batteries, internal power supplies, and internal memory.
• Daily: Tests batteries, internal power supplies, internal memory, internal clock battery, defibrillation,
pacing, monitoring parameters, Bluetooth, and printer.
• Weekly: Performs the Daily test and delivers a high energy internal discharge to further exercise the
defibrillation circuitry.
Test results include Pass, Fail/DX (device error that may affect therapy), Fail/BF (battery failure), and
Fail/D (device error that does not affect therapy).
Ready For Use Indicator
The Ready For Use (RFU) indicator provides four statuses:
– Blinking black hourglass: sufficient battery power and is ready for use.
– Blinking red “X” with or without a periodic chirp: low battery or no battery.
– Solid red “X” and a periodic chirp: device failure that may prevent shock delivery, pacing, or ECG
acquisition.
– Solid red “X” without a periodic chirp: no power or device failure.
Notes:
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Lesson Presentation
18 Maintenance
Shift Check
• The American Heart Association (AHA) recommends completion of a checklist (shift check) at the
beginning of each change in personnel to ensure that defibrillators are ready when needed.
• Checklist activities include:
– Device exterior
– Cables
– Connectors
– Paddles/Pads
– Monitoring electrodes
– Batteries
– AC/DC power
– Printer paper
– Data card
– SpO2 sensor
– NBP cuffs and tubing
– CO2 FilterLine
– Invasive pressure transducer
– Temperature sensor
– CPR meter (or Compression Sensor for MRxs running software version 9.xx or lower)
– CPR meter adhesive pads (or Compression Sensor adhesive pads for MRxs running software
version 9.xx or lower)
Weekly Shock Test
Perform either a weekly shock test or an Operational Check (Op Check) once a week to verify the
ability to deliver defibrillation therapy. To perform a weekly shock test:
1. If using:
– External paddles: Make sure the paddles and the paddle tray are thoroughly clean, there is no
debris or residue (including all conductive material) on the electrode surfaces of the paddles and
tray, the paddles are secure in their trays, and the Patient Contact Indicator (PCI) LEDs located
on the sternum paddle are not lit. If the LEDs light, adjust the paddles in their pockets. If the
LEDs continue to light, clean both the adult and pediatric paddle electrode surfaces.
Also, if the MRx has the Pacing option, test external paddles using the Weekly Shock test. You
must run Operational Check with a pads cable in order to pass the Pacer test.
– Multifunction electrode pads: attach a test load to the end of the patient Therapy cable.
2. Turn the Therapy knob to 150J.
3. Press the Charge button.
If it is necessary to disarm the defibrillator, press the [Disarm] soft key.
4. If using:
– External paddles: simultaneously press the shock buttons located on the paddles to deliver a shock
into the paddle tray.
– Pads: press the Shock button on the MRx to deliver a shock into the test load.
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18 Maintenance
Lesson Presentation
5. Confirm on the strip print that the energy delivered to the test load is 150J + 23J (127J to 173J). If
not, take the device out of use and call for service.
Note: Detach the test load from the patient Therapy cable after performing the shock test.
Operational Check
The Op Check verifies performance of a variety of device features, functions, and accessories.
To perform the Op Check:
1. Insert a charged battery (capacity of 20% or greater).
2. Turn the Therapy Knob to Monitor.
3. Press the Menu Select button.
4. Using the Navigation buttons, select Other and press Menu Select.
5. Select Operational Check and press Menu Select.
6. Select Run Op Check and press Menu Select.
7. Press Menu Select to acknowledge the Leaving Normal Operating Mode message.
8. Read and respond to setup instructions.
9. Read and respond to applicable test prompts.
Notes:
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Lesson Presentation
18 Maintenance
Operational Check Summary
To display and print an Operational Check Summary:
1. Turn the Therapy Knob to Monitor.
2. Press the Menu Select button.
3. Using the Navigation buttons, select Other and press Menu Select.
4. Select Operational Check and press Menu Select.
5. Using the Navigation buttons, select Op Check Summary and press Menu Select.
6. Press Menu Select to acknowledge the message Leaving Normal Operating Mode.
The Operational Check Summary screen is displayed.
7. Press the [Print] soft key to print the report.
Notes:
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18 Maintenance
Lesson Presentation
Battery Maintenance
Activity:
When to Perform:
Perform a visual inspection.
As part of the Operational Check
Charge the battery.
Upon receipt, after use, or if the message Batteries Low is
displayed
Perform a calibration.
When the Operational Check test results state
Calibration Recommended, or every 6 months,
whichever comes first
Store batteries in a state of charge in the When not in use for an extended period of time
range of 20% - 40%.
Discard the battery.
When there are visual signs of damage or calibration
reports less than 80% capacity
Notes:
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Lesson Presentation
18 Maintenance
Cleaning Instructions
• Use isopropyl alcohol, mild soap and water, chlorine bleach, or quaternary ammonium compounds
on the exterior surfaces of the HeartStart MRx, as well as the batteries and data card.
• Use a soft cloth on the display to prevent scratching.
• The MRx, along with its accessories and supplies, may not be autoclaved, ultrasonically cleaned, or
immersed unless otherwise indicated in the MRx Instructions for Use that accompany the accessories
and supplies.
• Do not use abrasive cleaners or strong solvents such as acetone or acetone-based cleaners.
• Do not mix disinfecting solutions (such as bleach and ammonia) as hazardous gases may result.
• Do not clean electrical contacts or connectors with bleach.
• Disinfect the device as determined by your organization’s policy to avoid long-term damage to the
device.
• To clean the printer printhead:
1. Push the printer door latch to open the door.
2. Remove the roll of paper.
3. Clean the printhead surface (above the brush) with a cotton swab dipped in isopropyl alcohol.
4. Replace the roll of paper.
• Refer to the Maintenance chapter of the MRx Instructions for Use for cleaning instructions on
paddles and therapy cable, ECG cable, NBP cuff, SpO2 sensor and cable, invasive pressure cable,
temperature probe and cable, CPR meter (or Compression Sensor), and carrying case.
Notes:
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18 Maintenance
Review
Review
Please answer the following questions related to MRx maintenance.
1. Which of the following RFU status indicates MRx may be unable to acquire ECG?
a. Blinking red X with a chirp
b. Blinking red X without a chirp
c. Solid red X with a chirp
d. Solid red X without a chirp
2. Which of the following statement(s) are TRUE related to the Operational Check?
a. It is automatic. You can start it, leave, and come back later when it’s done.
b. The Battery Compartment B test checks for BOTH capacity and calibration of battery B.
c. An ECG cable must be connected to the MRx to complete the Leads ECG test.
d. A pads cable must be connected to complete the Pads ECG test.
3. Which of the following statement(s) are TRUE related to battery maintenance?
a. Batteries should be inspected as part of the Operational Check.
b. Discard the battery when calibration reports less than 80% capacity.
c. Batteries charge automatically if they are in an MRx connected to AC or DC power.
d. Frequency and duration of use have a direct correlation on battery life.
4. Which of the following statement(s) are TRUE related to MRx and accessory cleaning?
a. You can clean the exterior of the MRx and the batteries with chlorine bleach.
b. You can clean the printer printhead surface with isopropyl alcohol.
c. You can ETO sterilize the external paddles.
d. You can clean the carrying case by hand or machine with mild soap and water.
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Review Answers
19
Getting Acquainted
1. Therapy Knob, Charge button, Shock button, Sync button
2. d. Defibrillation therapy may not be available.
3. a. 1
4. False - You can only use the Displayed Waves menu to select the ECG lead for Wave Sector 2.
5. False - You should respond to alarms by acknowledging them and changing limits, if needed vs.
pressing the Alarm Pause button.
ECG and Arrhythmia Monitoring
1. Four wave sectors, INOP area, ECG/HR alarms, HR values, alarm settings
2. False - The Lead Select button can only be used with Sector 1.
3. b. PVC
4. c. Alarms are enabled as soon as you enter Monitor Mode Menu Select if the Sync function is
enabled; d. Menu Select AND Navigation buttons can acknowledge alarms.
5. False - Automatic relearning takes places when there is a lead change for Wave Sector 1 only
Semi-Automated External Defibrillation
1. Event timer, enlarged ECG, shock counter, message window
2. False - Use anterior-anterior placement.
3. a. Turn the Therapy Knob to AED.; b. Follow the voice and screen prompts.; c. Press the orange
Shock button, if prompted.
4. a. The MRx automatically checks for proper pads cable and pads connection.; c. The MRx
automatically disarms if a shock becomes unnecessary.; d. The MRx automatically analyzes the
patient’s heart rhythm after a shock is delivered.
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19 Review Answers
Manual Defibrillation and Cardioversion
1. Event timer, heart rate, enlarged ECG, shock counter
2. a. Turn the Therapy Knob to Manual Defib on a desired energy level.; b. Press the Charge button.;
c. Press the Shock button.
3. a. The device sounds a continuous high-pitched tone.; b. The Charged value on the display
matches the Therapy Knob setting.; d. The Shock button flashes.
4. a. Turn the Therapy Knob to Monitor and press the Sync button.; b. Turn the Therapy Knob to
Manual Defib on a desired energy level.; c. Press the Charge button.; d. Press and hold the Shock
button.
Q-CPR with CPR meter
1. True
2. False - The pads need to be in an anterior/anterior position for interpretation.
3. True
4. True
5. True
6. True
Q-CPR
1. True
2. False - The pads need to be in an anterior/anterior position for interpretation.
3. False - The sensor should be placed on the lower half of the sternum, at the normal CPR hand
location.
4. True
5. True
6. True
Noninvasive Pacing
1. a. The device requires a 3-, 5- or 10-Lead ECG cable and monitoring electrodes during demand
mode pacing.; c. The Pacing status area indicates pacing mode, status, rate, and output.
2. b. Verify that white R-wave markers appear above or on the ECG waveform.
Pulse Oximetry Monitoring
1. False - You cannot monitor SpO2 in AED Mode.
2. False - The wave is auto scaled with a good signal.
3. False - SpO2 alarms are on unless turned off during use while pulse rate alarms are off unless turned
on.
4. d. 60
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19 Review Answers
Noninvasive Blood Pressure Monitoring
1. a. Systolic and diastolic pressure; b. Alarm limits; c. Automatic measurement schedule; d. Time
stamp
2. True
3. True
Carbon Dioxide Monitoring
1. True
2. False - The CO2 waveform displays where it is configured to display; it fills the first available
empty wave sector if the configured wave sector is full.
3. True
4. False - AwRR alarms are enabled unless disabled during use.
Invasive Pressures Monitoring
1. True
2. b. Controls for scale and alarm settings automatically appear after selecting a new label.; c. You can
not select the same label for both pressure channels.; d. The available pressure wave scale spans
from 300 to -20 in mmHg and from 38 to -2.5 in kPa.
3. a. You must zero a pressure every time you reconnect the transducer cable to the MRx.; b.Before
zeroing a pressure, you must vent pressure transducers to atmospheric pressure and close the
stopcock to the patient.; d. The message Unable to zero message displays if the zeroing process
fails.
4. a. All invasive pressure alarms cease when their alarm condition no longer exists.; b. The PAPd
High message means the pulmonary artery diastolic pressure has exceeded the high alarm limit.; d.
When CPP and ICP are displayed together, only one of them can have related alarms enabled.
5. True
Temperature Monitoring
1. False - All settings (including alarm limits) associated with a label become active as soon as you
change the label.
2. a. All temperature alarms cease when their alarm condition no longer exists. b. The Tesoph Low
message means the esophageal temperature has fallen below the low alarm limit. d. Changing the
label may change the alarm limits.
12-Lead ECG Monitoring
1. b. Waveforms are presented at a rate of 25mm/sec.; c. A dashed line which indicates a lead can’t be
derived.
2. False - Once ECG acquisition is complete, ECG analysis begins automatically.
3. b. 10
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19 Review Answers
4. d. chest pain symptoms
5. a. It displays standard interval and duration measurements and waveform morphology.; b. It can be
configured to include ALL 12 leads and related measurements.
Data Transmission
1. True
2. c. both the Bluetooth device and MRx.
3. d. You must wait for one transmission to complete before initiating another one.
4. c. For multiple transmissions, event summary transmissions are sent first, patient vital signs
transmissions second, and 12-Lead Report transmissions third.
5. False
6. True
7. c. You can queue a second BLDT while the first transfer is in progress.
IntelliVue Networking
1. True
2. a. The radio/AC power module must be fully connected before turning on the MRx; otherwise,
the MRx will not detect the module.
3. a. You can’t admit a patient by changing patient type.
4. b. If the Information Center sends a neonatal patient type to the MRx, the MRx modifies the
setting to pediatric.; d. You can silence or reset most MRx alarms and INOPs from the Information
Center.
Vital Signs Trending
1. a. If you scroll left to view older data, the screen will not update to new data when available. c.
Unavailable data is indicated by an empty space. d. A ^ after the timestamp indicates multiple
measurements taken during the interval.
2. True
Working with Data
1. a. Data management includes Event Summaries that have a unique event identification number
and are automatically stored in internal memory.; b. New Event Summaries are initiated by valid
SpO2, CO2, or invasive pressure data, along with other activities. d. When in Data Management
Mode, monitoring and defibrillation modes are disabled.
2. F - The corresponding ECG waveform is stored and available in the Event Summary.
3. True
4. True
Maintenance
1. c. Solid red X with a chirp
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19 Review Answers
2. b. The Battery Compartment B test checks for BOTH capacity and calibration of battery B.; d. A
pads cable must be connected to complete the Pads ECG test.
3. a. Batteries should be inspected as part of the Operational Check.; b. Discard the battery when
calibration reports less than 80% capacity.; c. Batteries charge automatically if they are in an MRx
connected to AC or DC power.; d. Frequency and duration of use have a direct correlation on
battery life.
4. a. You can clean the exterior of the MRx and the batteries with chlorine bleach.; b. You can clean
the printer printhead surface with isopropyl alcohol.
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19 Review Answers
166
453564045051
Edition 6
Koninklijke Philips N.V.
Printed in the U.S.A. Aug. 2013
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